2006 Trends: Deja Vu All Over Again?

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By John Michael, MEd, CPO, FISPO, FAAOP

In preparation for this article, I reread my December 2002 retrospective for The EDGE and was struck by how apropos the summary statement from that era still remained:

"Most P&O observers would agree that although there were no tremendous disasters for the field, a number of negative trends continue unabated. Managed care organizations still exclude, contest, and deny appropriate P&O rehabilitation regardless of the patient's medical and functional needs."

Prosthetic Parity Grows

One of the more heartening changes in the past four years is the Amputee Coalition of America's (ACA's) decision to make prosthetic parity, defined as "Insurance Companies Covering Appropriate Prosthetic Care," a major goal ( www.amputee-coalition.org/advocacy/factsheet-prosthetic_parity.html). Colorado passed the first parity law in 2001 and, contrary to naysayers' assertions, insurance premiums have not significantly increased despite better treatment for amputees. Maine's law followed in 2003 with New Hampshire's in 2004, and parity legislation now is being pursued in 26 additional states as of press time.

Education Advances

In 2002, many of our professional training programs were struggling financially, but the picture in 2006 looks better, in part because of the success of the Academy's Project Quantum Leap. The National Commission on Prosthetic-Orthotic Education (NCOPE) recently published a position paper recommending transition to an entry-level masters degree that incorporates the now-separate residency experience as part of the academic program ( www.ncope.org/summit/).

The fledgling University of Iowa masters program folded in 2002 before taking in the first class but, like a phoenix rising from the ashes, much of that effort was incorporated into the burgeoning Masters of Science in Prosthetics & Orthotics program at the Georgia Institute of Technology ( www.ap.gatech.edu/mspo/).

P&O Still on Medicare Radar Screen

The year 2002 was frustrating due to Medicare's practice of abruptly canceling useful L-Codes. Regretfully, the SADMERC still is making incorrect rulings about roll-on liners, reversing the changes, and then issuing additional decisions that further confuse the issues--so these problems will undoubtedly continue into 2006 and beyond.

In 2002, Medicare unilaterally slashed the allowable amounts for a number of common spinal orthoses, but suddenly reversed course when federal litigation was filed. In 2006, we are entering the third year of an across-the-board price freeze. All the P&O associations have joined ranks and are working hard to persuade Congress not to extend the freeze. More about these and similar "hot issues" is highlighted at www.aopanet.org/hot_op_issues/

Provider Standards Move Forward

By the end of 2002, the ill-fated Negotiated Rulemaking meetings were underway but ultimately failed to reach unanimous consensus. As 2006 is dawning, the Government Accountability Office (GAO) again has sternly recommended strengthening Medicare supplier standards, noting that it remains extremely easy to obtain payment for bogus claims. (The egregious fraud in which Region C paid unlicensed charlatans in Florida millions for nonexistent prostheses is just the most recent example.) Medicare recently has published plans to restrict payment for prostheses and "certain custom orthoses" to licensed prosthetists-orthotists in those states with CPO licensure laws currently in effect. More details are at www.oandp.com/resources/organizations/naaop/

Consolidation Continues

Supplier consolidation was a major trend in 2002 and the big news was the Seattle Limb Systems-United States Manufacturing merger. The combined company was recently purchased by CAMP, so this trend continues as does Otto Bock's and OSSUR's expansion by acquisition of competitors.

2006: Good News, Bad News

The good news for 2006 is that no radically new problems seem to be on the horizon. The bad news is that, because most of these difficulties are deep-seated issues, there are no quick fixes, and it will take a concentrated and sustained collaborative effort to overcome them.

But I am encouraged overall as we enter this new year: More than at any other time in memory, CPOs are acutely aware of the challenges we face, the opportunities that change inevitably presents, and the importance of speaking nationally with a common voice to achieve positive long-term results.

John Michael, MEd, CPO, FISPO, FAAOP, has had a noted career as a clinician, lecturer, and educator, and is currently president of CPO Services, a consulting firm. He may be contacted at JWM.CPO@verizon.net