Licensure: Is Anybody Still Opposed?

A.J. Filippis, CPO, Wright & Filippis, Rochester Hills, Michigan, still has serious concerns about embracing licensure: "Because of the relatively small size of our industry, we are probably not going to have our own licensing board in most cases," he worries. "In some states, I believe they combine O&P with the chiropractic board; in others, I understand they're looking at podiatry. Thus I'm concerned that we're going to lose our voice--get a licensure bill and be swept along with those other groups with whom, in some ways, we are still competing. "From what I've seen," he adds, "almost all licensure bills are tagalong bills--but not being in that environment very often, I haven't really seen the full effect of it." Another problem he identifies is the cost of licensure. Although that cost will vary from state to state, based on circumstances, he reminds us that "whatever size the board is, it has to be paid for by somebody--and that's we practitioners and facility owners." Montana or Wyoming, each with perhaps ten O&P facilities, may not be able to fund a licensing board, as opposed to Florida or California which each have hundreds of facilities, he points out. The cost tied to a licensing bill can be a formidable obstacle, and the cost doesn't go away after the initial investment, he adds. The cost of maintaining a licensure board is ongoing. Another concern Filippis cites is the implementation of yet another set of rules O&P practitioners and facilities must observe. "There are already many regulations that we have to follow; now we're going to be governed by a state licensing board that we must work with and maintain, making sure that inappropriate rules don't get slipped in Let's face it," he reminds us, "the physical therapists have far more votes out there than we do. In Michigan, there could be as many as 20 PTs to every one O&P practitioner. My concern is that we may risk that high level of care for the patients by opening that up to some degree." Concern for maintaining certification standards is another issue Filippis defines. "I think that what people are looking at is the possibility that with state licensing, ABC [American Board for Certification in Orthotics and Prosthetics] facility certification may not be required. The licensing is going to take the place of a facility accreditation because you can't afford both. As reimbursement continues to get ratcheted down, here's still another cost that we're taking on. "To be able to afford that cost, something has to go, and facility accreditation may just be that something,'" he speculates. Filippis feels that as a profession, O&P made a mistake by not informing payers that the ABC should be the credentialing body used to define their standard of care. As early as 1976, he and his brother approached payers such as Blue Cross and Medicaid to recommend that ABC certification be identified in provider contracts as the minimum standard for O&P care. That standard was adopted and is still in place today, Filippis says. "That's why we didn't have as much difficulty competing with stock-and-bill programs in Michigan--because PTs and physicians couldn't provide services because they couldn't get paid for it. That's the way we handled it here in Michigan, and it's been very effective up to this point." Because of the direction that a handful of states have taken at this point, prompting changes in some of the suppliers' standards, said Filippis, the situation is changing: The Department of Veterans Affairs (VA) is reportedly considering accepting state licensure as its required credentials for O&P. "That may force our hand here in Michigan. If Medicare and the suppliers' standards come through that way, and the VA accepts the criterion, I think it's going to be just a matter of time before we need to follow suit. Otherwise we're going to be fighting that battle through ABC as well." Another Perspective On the other hand, Jeff Fredrick, CPO, Hanger Prosthetics & Orthotics Inc., Tallahassee, Florida, is now frustrated by those who promote a double standard by opposing licensure: "First of all, it's irrational because licensure is here to stay, and once Medicare or some of these higher payers really start dialing into it, you're going to have to be licensed in a state to provide services, and that means further regulation. That's coming." Fredrick continues, "But what offends me most about the guys on the other side of the fence is that these are people who claim we don't need the high qualifications that licensure demands, but let their three-year-old child get sick, and offer them the choice between two doctors--one licensed, with a lot more education; and the other one isn't licensed. Close to 100 percent of them would opt for their family to be treated by the higher-educated and licensed physician. Yet when they are being held to higher requisites, they suddenly change their philosophy. That's hypocrisy."

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Licensure: Is Anybody Still Opposed?

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Licensure: If There’s a Small Population

Bienniel Pacific Rim Meeting Set for Hawaii

Bienniel Pacific Rim Meeting Set for Hawaii

O&P JOBS

Orthotics and Prosthetics Assistant

Certified Orthotist — Full-Time or Part-Time, Pediatric Practice

Certified Prosthetist / Orthotist (CPO/CP/CO)

Get unlimited access!

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