O&P Professionals Deserve Fair Reimbursement
August 2016 Issue
Do you know what gets my blood boiling? When the reimbursement world treats me as a vendor rather than as a trained medical professional who treats patients with difficult pathologies and helps them manage and restore their health and mobility and improve their quality of life. It is important to remember that the business of O&P is clearly a profession and not an industry.
What is the difference and why should it matter? A profession requires the mastery of knowledge and skills through formal education and practical experience. An industry, on the other hand, is a group of manufacturers or businesses that produce a particular kind of goods and services. While we may fabricate custom products in our patient care facilities, we are definitely not acting as an industry. Our primary focus is on patient care-rebuilding lives and restoring hope, as my business slogan states.
Because we have specialized education and training, physicians consult with us about their patients' prosthetic and orthotic needs. They may prescribe an orthosis or prosthesis, in general, but they do not expect to have to define the type of device that will best treat a patient's unique condition. They trust that we will evaluate the patient's needs and determine the best device, from the many options available, to help him or her stay mobile and enjoy a better quality of life. My referral sources understand my expertise and can be confident that I will develop the best treatment plan for their patients; they depend on my professionalism to provide the appropriate care to achieve the desired outcomes.
However, third-party payers, including the Centers for Medicare and Medicaid Services, reimburse O&P practitioners as though we are vendors and that the extent of our patient care is to simply pull a product out of a box and hand it to the patient. They refuse to acknowledge the value of our expertise or understand how important the service component is in providing and maintaining an orthosis or prosthesis.
Because they don't want to pay for or recognize the patient care we provide, at times the claim reimbursement barely exceeds the manufacturer's invoice for the device we provide, and other times it is even less than the manufacturer's invoice. Also, with regard to labor and repairs, some insurance companies pay as little as $60 per hour. We are compensated less than an IT person or copier repairman. When I have to pay a manufacturer $149 an hour to repair a myoelectric prosthesis and we are reimbursed much less than that, something is wrong with the system.
The time has come to reach out to our members of Congress and the insurance industry to convince them that O&P professionals deserve fair compensation for the complex care we provide that will protect our patients.
Rick Stapleton, CPO, is the president of Tidewater Prosthetic Center, Portsmouth, Virginia. He can be reached at .