In Support of a Temporary Prosthesis
January 2016 Issue
I posted on the OANDP-L listserv several months ago expressing my frustration about a business practice that I perceive to be doing long-term damage to our profession and abusing any goodwill that third-party payers may hold for prosthetists.
I believe we have misapplied prosthetic technology to patients who will never reach that technology's potential, which has deteriorated our relationships with referral sources and insurers. The Centers for Medicare & Medicaid Services and policymakers have no reason to believe we should have control over which prosthesis a patient receives when we are providing vacuum suspension and feet with adjustable heel height to people who reside in skilled nursing facilities. Why do practitioners fit individuals who have never ambulated with the most advanced prosthetic components available when they don't even know how an individual is going to perform?
I am not perfect; we have all worked in a grey area to benefit a patient, or misgauged someone's desire to ambulate. That's why it's best to fit a first-time prosthetics patient with a temporary prosthesis, have him or her develop an activity level, and then document the activity level as justification for higher-activity components. I am in the minority of prosthetists who fit temporary prostheses, and even though some colleagues tell me, "You can't make any money on a temporary," I still think it should be a requirement.
Those same colleagues will talk about being unable to obtain proper documentation to justify the devices they are trying to fit, and blame the physicians and insurance companies for delays, denials, and recoupments.
If I believe a patient with a transfemoral or transtibial amputation has the potential to benefit from K2, K3, or K4 components, I first fit him or her with basic components and, typically, a SACH foot. Following the fitting, I wait three to six months to allow the patient to reach his or her potential. The patient then has an appointment with a physician to document the level at which he or she is performing, leading me to fit him or her with a definitive prosthesis with higher functioning components, if the documentation supports it. In the case of someone who may never go beyond a K1 activity level, we should be able to place him or her directly into a definitive prosthesis as there is obviously no need to justify high-end components.
Commonsense, patient-first thinking allows me to truthfully evaluate a patient and pick the componentry that best suits that individual. Most importantly, it allows me to communicate with, and indirectly train, the physician about the importance of qualifying patients for the specific prosthetic components they actually need. This might not be the most profitable decision right away, but it does create a level of trust that can produce a stream of clients to your doorstep.
Christopher Wells, CPO/L, a second-generation practitioner, practices at Williams Orthotics & Prosthetics, Tallahassee, Florida. He can be reached at .