Tuesday, March 21, 2023

Some thoughts on protecting our hard earned credentials

Michael Arnette

It’s a question we have all been asking for years:

How can we in O&P feel confident that our certification will have a competitive
place in provision of prosthetics when exemptions for other medical
providers that allow them to provide prosthetic care without the hard
earned education we have worked for?

Try this familiar scenario:

I recently treated a patient who came in to the office after a local
physical therapist had fit a custom AFO and had phoned the office to
request that I put a build up on the patient’s brace…

I instantly went from orthotist to shoe repair man/woman!

This and many other daily encounters with other healthcare providers have me
thinking about the future of our field of prosthetics. We in O&P have long
ago given up the fight on certain orthotic markets such as most off the
shelf products, custom knee bracing, cervical and spinal bracing, and
pediatric custom bracing. How can we keep from losing more?

We know that we cannot legislate other healthcare professionals out of
provision. However, we can allow them to police themselves. What if ABC and
or BOC created a temporary pathway for PT’s, OT’s, Podiatrists in practices
that are currently billing prosthetic codes (and only those practices
which are already billing CMS Lcodes), to become O&P certified through our
credentialing bodies? They can already practice and are billing for a
growing number of custom items that we provide so we wouldn’t have anything
to lose. We would have a lot more to gain by allowing this pathway because
the same physicans and therapists who were given certification would then
have an incentive to police the provision of custom prosthetics in the

Consider for a moment that CMS has exemptions for therapists and physicians
in provision of O&P and that most states have therapists and physicians
exempted from O&P licensure law as well. Times are changing, Osseo-integration,
3D printing, and other technologies will allow providers such as physicians
and therapists who may or may not be certified and or qualified to begin to
provide prosthetics to patients in much the same way as pediatric central
fab facilities and bracing manufacturers have with custom knee bracing and
pediatric custom bracing.

Here are some thoughts for those calling the shots for our credentialing
boards to consider:

With BOC closing the additional pathway for O&P certification, ABC and BOC
have the opportunity to partner and once and for all divide clinical
custom prosthetics
and orthotics from off the shelf DME. Here is what is could look like:

ABC and BOC could change specialization. ABC could become the certifying
agency for clinical care (Prosthetist, Orthotists, Pedorthics, Assistants,
and technicians). ABC would handle accreditation for all clinical
providers who had these professionals on staff.

BOC in turn could take on all certified fitters, mastectomy fitters, shoe
fitters, certified orthotic fitters, and DME certified facilities.

ABC could maintain a five-year window of alternative pathway to any
physician therapist or clinician to be able to sit for the BOC or ABC
in order to demonstrate clinical competence in orthotics and prosthetics.
While it is debatable how many would take advantage of this alternative
pathway it is a sure thing that these “newly credentialed” O&P providers
would out of self preservation help protect our field from non-certified
providers in the future.

To help start the ball rolling for the mammoth task of removing customized
orthotic and prosthetic care from DME I believe it would be in our
industry’s best interest to request that Medicare establish a core group of O&P
practitioners to determine who would be qualified to provide pre-fabricated
and clinically digitized and or manufactured custom fabricated devices.

This would then allow us the opportunity to demonstrate to Medicare who is
a qualified clinical provider of custom orthotics and prosthetics.


Jeff Arnette CPO,BOCP, LPO

Michael Arnette BOCPO, LPO
Progressive Orthotic and Prosthetic Services
9511 E. 46th St.
Tulsa OK, 74145
(918) 663 7077
(918) 724 6256

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