Dear List,
Here is an excerpt from the Federal Register’s 20 page posting in August from CMS. From Page 14
“Moreover, we believe that physicians can furnish DMEPOS to their own patients as part of professional services. In addition, in many cases, a physician furnishing DMEPOS to their own patients can benefit those patients in terms of convenience and continuity of care”
Here is CMS telling all Americans that DMEPOS (read bracing) is better dispensed in the doc’s office. I agree. But the problem is that the person who fits the brace should be qualified to do so. I agree that it is more convenient for the patient to receive the brace at the Docs office. But just as the orthopedic surgeon had to hire a qualified xray technologist to take radiographs, they should also have to hire qualified O&P personnel. If they just want to do non-custom braces then they should hire an Orthotic Fitter. If they want to do custom they need to hire an Orthotist and so on. Licensure states and Medicare now exempt Docs from having to do this. They can have their receptionist fit a brace. The Doc’s will do more bracing in the future as they see this as profit center…just like physical therapy or nutricuticals.
But now is a new day. I feel that both ABC & BOC should open their certifications to experienced allied professionals from other professions that have bracing as part of their scope of practice. Certified Athletic Trainers (licensed in most states and 35,000+ strong) and Orthopedic Technologists working in 10,000+ orthopedic offices should have a special pathway to fitter certification. Then all O&P professional organizations should demand that Medicare only reimburse bracing applied by “qualified” people. If the O&P certifying organizations just represent a small minority (under 3%) of all allied professionals fitting all levels of braces, they might limited impact on O&P policy in the future. There is strength in numbers.
Even state licensure boards should consider these other professions for inclusion in their state O&P laws. A good start would be to offer licensure for Orthopedic Technologists. Most Orthotechs now apply more braces than casts in a typical working day. I tried to have orthotechs included in the Florida O&P Law over 15 years ago. The “powers that be” back then thought it was not a good idea. But like I said, it is now a new day.
Thank you,
Charles Barocas, CO
