Licensure: Learning from Mistakes

Sadly, the biggest mistake made in the pursuit of licensure to date is the delay in starting sooner--a mistake that has already cost the profession dearly, believes John N. Billock, CPO/L, FAAOP, Orthotics & Prosthetics Rehabilitation Engineering Centre, Warren, Ohio. Billock, along with Mike Allen, CPO, LPO, FAAOP, Allen Orthotics & Prosthetics Inc., Midland, Texas; Lou Haberman, CPO, Garden State Orthopaedic Center Inc., Oakland, New Jersey; and other colleagues, formed a group called the National Prosthetic-Orthotic Licensure Fund (NPOLF) in 1995. NPOLF existed to promote the need for licensure and provide support on a national level that was not available through existing national O&P organizations. Although Billock had little direct involvement in the final drafting or push for legislation that led to licensure in Ohio, he and his colleagues were directly involved behind the scenes with several of the early movements towards O&P licensure in the states of New Jersey, Texas, Florida, and Washington. "Having been involved in the initial movements toward licensure, the key thing I feel that could have been and should have been done differently was that all of these efforts should have been initiated 15 to 20 years sooner," says Billock. "Although it is not well known today, there were several individuals interested in pursuing O&P licensure in the early to mid 1980s; however, the support needed amongst our national leadership in the profession was nonexistent and not felt to be necessary. This lack of interest and support was further fueled by what was perceived to be a national moratorium on state licensure programs, which were felt to be too costly to administer, and concerns they would place excessive financial burdens on O&P facility owners, who typically covered such costs. "Unfortunately," Billock continues, "in hindsight we see that licensure would have been much easier to achieve then, and would have been better accepted for its real purpose, which is to protect the consumers of O&P services and assure that care was being provided by truly qualified practitioners, i.e. practitioners who met standards consistent among allied healthcare providers and standards that ensured appropriate training and educating in the provision of O&P care--not the confusing situation consumers find in today's practice of orthotics and prosthetics." Are Others Defining O&P Scope of Practice? Jim Rogers, CPO, FAAOP, Orthotic & Prosthetic Associates, Chattanooga, Tennessee, and head of the Licensure Task Force of the American Academy of Orthotists and Prosthetists (the Academy) agrees. "Occupational therapists and physical therapists made state licensure a priority years ago," Rogers says. "They embarked upon that beginning in the 70s and established their allied health profession with providers requiring licenses from each state. Gaining licensure has very effectively defined their scope of practice." Rogers continues, "One of the problems I have, however, is that it has effectively defined our scope of practice in some states as well. When other professions who have some overlap with O&P provider services, embark on licensure without the voice of O&P providers, that vacuum creates an opportunity for our professional scope of practice either to be constrained, or, in an extreme sense, defined by another profession's state licensure practice act." Licensure: Preventing Fraud Billock concurs, and adds, "Aside from being less complicated to pursue 15 to 20 years ago, I firmly believe that licensure could have prevented much of the fraudulent O&P care that has been provided over the past 20 years by unqualified providers. Licensure would have given O&P consumers and practitioners greater legal stature in their efforts to see the development of meaningful regulatory standards by state and federal healthcare agencies, as well as private healthcare organizations, to better ensure quality care was being provided by qualified providers. Also, there is no doubt in my mind O&P licensure would have saved state and federal agencies, such as Medicaid and Medicare, millions, if not billions, of dollars in fraudulent O&P health care claims from non-qualified providers." Changing Times, More Problems And with the changed times have come additional problems, even a different perception of the purpose of licensure. Billock reminds us, "Although licensure is truly about protecting the consumers of O&P care and not about protecting one's turf, unfortunately, due to the mix of individuals now seeking to provide O&P care and the organizations that support them, the focus of licensure has become more about protecting one's turf or expanding one's scope of practice." Allen also notes that when Texas introduced its licensure initiative in 1995, there was no National Orthotic Manufacturers Association (NOMA) and no opposition from physical therapy groups. "Physical therapists were not opponents in Texas; they were allies. They fully supported licensure in O&P--but that was then--ten years ago. In today's environment, that might not be the case. I believe those are currently licensure's two biggest opponents and challenges."

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