This is my 40th year working in the O&P industry. 30 of those years as a
certified practitioner. I have observed the items we provide dwindle until
there is not much left. The painful part of this is because non-certified
non-accredited people and companies are providing these services. I quit
doing many services because we didn’t do much of it and the requirements to
provide these services kept becoming more and more difficult to meet. Lets
look at some of the services we used to provide that because of self-imposed
professional standards we no longer do.
We used to provide mastectomy services. One of our secretaries said that
she wanted to provide breast forms and bras. We sent her to a class, she
became very good, developed a large following of women that trusted her and
all was well. ABC decided that it was needed to make sure we were not doing
a poor job and that we could not possibly provide a quality service without
them. Even though the place was already an ABC accredited facility, loaded
with ABC practitioners. Those women that trusted our fitter did not realize
how much danger they were in. Across town was another woman that had never
heard of ABC and she was providing this service in her dress shop. It
really wasn’t a big part of what we did, so we dropped that service.
We used to provide 5 to 10 Lenox Hill ACL braces per week. When the Lenox
Hill patent expired, non-accredited knee brace manufactures dropped out of
the trees and began providing their products direct to our referral sources
using non-certified sales reps. I remember thinking, they can’t do that,
those guys aren’t certified. That one did hurt. It really cut into our
business.
We used to provide wheelchairs, crutches, walkers, custom seating systems,
all types of custom wheelchair modifications, anti-decubitus cushions and
much more. This was a natural. The patients we serviced for their braces
and limbs needed mobility devices of all types and we were experts at
providing those services. Services like those moved to a DME provider. We
lost the ability to provide those services unless we obtained the proper DME
certification. Once again, it really wasn’t the main focus of our business,
so we let it go.
We used to provide a complete shoe service. I know that the development of
the poly orthosis cut deeply into that business, but there were still a lot
of people out there with leg length discrepancies needing shoe
modifications. If the patient you have been servicing since she was a little
girl comes in for her usual 1″ heel and sole elevation, you risk loosing
your accreditation if you provide the service without an Rx written by the
physician within the last 6 months, (the doc can’t just fax you one) a DWO,
physicians notes and medical records, your initial evaluation SOAP notes,
signed delivery slip, patient satisfaction survey, ABN, signed HIPPA form.
I know I left something out, and because of that I’ll have to refund the
money in a year or two. Meanwhile, John’s Shoe Shop is down the street has
work more than he can do. (without a Rx) He’s providing the people I used to
see with this service. He takes cash, check, and a credit card, but he’s
going to add 3% to swipe your card. He’s charging $180.00, getting paid, and
it takes a staff at my office to fight for $50.00. Because of the
reimbursement we decided to stop losing money and let this service go.
We used to do a lot of upper extremity work. The reimbursement killed
those.
We used to do a lot of diabetic insoles and shoes. The current process can
take 3 months for approval and the paperwork is unbelievable. Many people
say, I’ll just pay for the insoles and shoes. They can do that, but the
process doesn’t change. The process isn’t as much about getting paid as it
is about not losing our facility accreditation Think about that. The only
real reason for doing this dance is to maintain our ABC accreditation. In
the mean time the good feet store across town is providing this service and
getting paid. The physicians send the patient there because all that’s
needed is an Rx. No idiotic correspondence with your staff constantly
calling the nurse back letting them know that the paper work is still not
correct. We stopped providing this service because it was too much trouble
and it was just making our referrals angry. Besides it wasn’t a big part of
our business.
We do a lot of AFO’s. I’m not sure how much longer this will last. We now
have to prove that a custom brace is needed. This requires a lot of
documentation on our part and the physicians part. If there is not a good
reason for custom, then off the shelf it is. How long before the common
carbon AFO that’s made in China starts showing up in the physicians office.
Afterall, If the doctor’s cast tech can fit the brace then they don’t have
to deal with the CPO who is shackled to a nightmare of regulations. The
doctor can always have a non-certified sales rep provide the service. Off
the shelf AFO’s are not that great. We can let those go.
We are known for our spine bracing. We fabricate all types of LSO’s and
TLSO’s But it seems that a big part of our work has become adjusting or
occasionally switching out off the shelf LSO’s and TLSO’s fit in the
referral sources office. Did I mention that these devices are provided by
non-accredited companies delivered by sales reps and fit by the
non-certified nurses aide. By the way, It didn’t take the nurses aide
almost 10 years meet the requirements of ABC to fit that brace. If we fit a
brace we have to prove that custom is necessary. Generally, that’s not a
problem because all that’s left are 90 year old hyper kyphotic grandmothers,
5’5″ 400 lb. guys and patients with insurance that the physician can’t
bill. The people that provide all these braces direct to our referral
source are the same people that show up at our meetings, pee on our leg and
tell us it’s raining.
My subject is “wondering.” I’m wondering if our professional organizations
will ever back off, even if only a little. We just had 5 more hours added
to our recertification requirements. Why? I’m sure 1 additional hour per
year is not that big a deal. But I have to pay for every hour. If I go to
a national meeting where my supplier/competitors are, the cost of those
hours are between $100.00 and $200.00 each. I have 5 practitioners at our
facility. 80 hours X 5 practitioners X $100.00 = $40,000.00. Just
something to wonder about. It’s not that big a deal. It’s only 5 more
hours. I should just let it go.
I’m wondering why it was necessary to make it so difficult to provide
unbelievably simple services. Especially, when there are easy alternative
paths for the public to obtain these same products. We have become the
greatest path of resistance to obtaining services that we should easily
provide. John’s Shoe Service is successful because his process is not a PIA,
and I pretty much left a void that he is filling.
I’m wondering, how much is left that’s OK for me to let go because, it’s
not really a big part of what I do.
