<i><b>A.J. Filippis, CPO, Wright & Filippis, Rochester\r\nHills, Michigan, still has serious concerns about embracing\r\nlicensure:<\/b><\/i>\r\n\r\n"Because of the relatively small size of our industry, we are\r\nprobably not going to have our own licensing board in most cases,"\r\nhe worries. "In some states, I believe they combine O&P with\r\nthe chiropractic board; in others, I understand they're looking at\r\npodiatry. Thus I'm concerned that we're going to lose our\r\nvoice--get a licensure bill and be swept along with those other\r\ngroups with whom, in some ways, we are still competing.\r\n\r\n"From what I've seen," he adds, "almost all licensure bills are\r\ntagalong bills--but not being in that environment very often, I\r\nhaven't really seen the full effect of it."\r\n\r\nAnother problem he identifies is the cost of licensure. Although\r\nthat cost will vary from state to state, based on circumstances, he\r\nreminds us that "whatever size the board is, it has to be paid for\r\nby somebody--and that's we practitioners and facility owners."\r\n\r\nMontana or Wyoming, each with perhaps ten O&P facilities,\r\nmay not be able to fund a licensing board, as opposed to Florida or\r\nCalifornia which each have hundreds of facilities, he points out.\r\nThe cost tied to a licensing bill can be a formidable obstacle, and\r\nthe cost doesn't go away after the initial investment, he adds. The\r\ncost of maintaining a licensure board is ongoing.\r\n\r\nAnother concern Filippis cites is the implementation of yet\r\nanother set of rules O&P practitioners and facilities must\r\nobserve. "There are already many regulations that we have to\r\nfollow; now we're going to be governed by a state licensing board\r\nthat we must work with and maintain, making sure that inappropriate\r\nrules don't get slipped in Let's face it," he reminds us, "the\r\nphysical therapists have far more votes out there than we do. In\r\nMichigan, there could be as many as 20 PTs to every one O&P\r\npractitioner. My concern is that we may risk that high level of\r\ncare for the patients by opening that up to some degree."\r\n\r\nConcern for maintaining certification standards is another issue\r\nFilippis defines.\r\n\r\n"I think that what people are looking at is the possibility that\r\nwith state licensing, ABC [American Board for Certification in\r\nOrthotics and Prosthetics] facility certification may not be\r\nrequired. The licensing is going to take the place of a facility\r\naccreditation because you can't afford both. As reimbursement\r\ncontinues to get ratcheted down, here's still another cost that\r\nwe're taking on.\r\n\r\n"To be able to afford that cost, something has to go, and\r\nfacility accreditation may just be that something,'" he\r\nspeculates.\r\n\r\nFilippis feels that as a profession, O&P made a mistake by\r\nnot informing payers that the ABC should be the credentialing body\r\nused to define their standard of care. As early as 1976, he and his\r\nbrother approached payers such as Blue Cross and Medicaid to\r\nrecommend that ABC certification be identified in provider\r\ncontracts as the minimum standard for O&P care.\r\n\r\nThat standard was adopted and is still in place today, Filippis\r\nsays. "That's why we didn't have as much difficulty competing with\r\nstock-and-bill programs in Michigan--because PTs and physicians\r\ncouldn't provide services because they couldn't get paid for it.\r\nThat's the way we handled it here in Michigan, and it's been very\r\neffective up to this point."\r\n\r\nBecause of the direction that a handful of states have taken at\r\nthis point, prompting changes in some of the suppliers' standards,\r\nsaid Filippis, the situation is changing: The Department of\r\nVeterans Affairs (VA) is reportedly considering accepting state\r\nlicensure as its required credentials for O&P. "That may force\r\nour hand here in Michigan. If Medicare and the suppliers' standards\r\ncome through that way, and the VA accepts the criterion, I think\r\nit's going to be just a matter of time before we need to follow\r\nsuit. Otherwise we're going to be fighting that battle through ABC\r\nas well."\r\n<h4>Another Perspective<\/h4>\r\nOn the other hand, Jeff Fredrick, CPO, Hanger Prosthetics &\r\nOrthotics Inc., Tallahassee, Florida, is now frustrated by those\r\nwho promote a double standard by opposing licensure: "First of all,\r\nit's irrational because licensure is here to stay, and once\r\nMedicare or some of these higher payers really start dialing into\r\nit, you're going to have to be licensed in a state to provide\r\nservices, and that means further regulation. That's coming."\r\n\r\nFredrick continues, "But what offends me most about the guys on\r\nthe other side of the fence is that these are people who claim we\r\ndon't need the high qualifications that licensure demands, but let\r\ntheir three-year-old child get sick, and offer them the choice\r\nbetween two doctors--one licensed, with a lot more education; and\r\nthe other one isn't licensed. Close to 100 percent of them would\r\nopt for their family to be treated by the higher-educated and\r\nlicensed physician. Yet when they are being held to higher\r\nrequisites, they suddenly change their philosophy. That's\r\nhypocrisy."