Here are the responses that I’ve received so far regarding the request
below.
> —–Original Message—–
> From: Anderson Harold R.
> Sent: Tuesday, January 26, 1999 2:56 PM
> To: ‘O&P-L’
> Subject: What we can provide
>
> We(the orthotics and rehab department) are currently having a dispute with
> an insurance provider that has it’s own, on staff, PT department. The
> PT’s write a prescription for “simple” devices such as custom or OTC FO’s
> or corsets and send the patients to us to provide the device. We’ve been
> asking them for prescriptions signed by a physician. They are telling us
> that, 1. They are the insurance company and are willing to pay for the
> device(s) without the physicians’ signatures, therefore we should provide
> them and 2. Most of what they are sending to us can be purchased over the
> counter at a pharmacy, therefore a physician’s signature is not needed.
>
> It is my understanding that our code of ethics requires that we have a
> physician signed prescription in order to provide any orthotic device
> whether it can be purchased OTC at a pharmacy or not. Our last
> communications from them lists the following products as examples of what
> they want us to provide without a physician signature:
> “Daytimer splint (for carpal tunnel)
> Spica thumb splint
> Cockup splints
> lumbosacral support
> genutrain(sp?) and other patellar femoral supports
> AOL for the ankle”
>
> It’s interesting to note that FOs are not on the list, though they are
> what initially started this discussion. I don’t know if that means they
> are dropping them from the dispute.
>
> Am I incorrect in my understanding? What, if any, are the limits of what
> we can do without a physician signature? I, personally, don’t like to do
> anything without the signature. It seems that I would be opening myself
> up for liability problems by doing so.
>
> Comments?
>
> Harold Anderson, CO
>
**********************
>Am I incorrect in my understanding? What, if any, are the limits of what
we
>can do without a physician signature? I, personally, don’t like to do
>anything without the signature. It seems that I would be opening myself up
>for liability problems by doing so.
>
>Comments?
>
>Harold Anderson, CO
>
My understanding is exactly as you describe.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
*******************
Contact Lance Hoxie, Exec Director ABC at [email protected] for a
definitive ruling on this matter and the ABC canons. We created language
last year that applies.
C. Pritham
Immed Past Pres, ABC
*******************
Our clinic goes by the policy that we do not fit anything without a Rx
from the M.D.
While it is tempting to dispense certain items that are easily obtained
elsewhere, we feel that we only are allowed to fit by Rx only.
Steve Fletcher, CPO
Shands Hospital at the University of Florida
*******************
Unless your state has licensure you have no legal exposure in providing O&P
devices or services, anyone can. Your only threat is from ABC if they want
to
enforce the canons, but this might not hold up in court given the
circumstances.
Al Pike, CP
*******************
Harold, sometime in 1998 (possibly 97) the ABC board made a change that
would allow OTC non prescription devices to be provided without being in
violation of the Canon of Ethics. E-mail Patty Spitnale
are in WI. What are the state laws about PT prescribing? I know that some
states allow it. Terry
Terry Supan, CPO
Associate Professor
Director, Orthotic Prosthetic Services
SIU School of Medicine
Orthotic Prosthetic Services, LL0300
PO Box 19652
Springfield, IL., USA, 62794-9652
phone: (217) 782-5682
fax: (217) 782-7323
E-mail:
*****************
This is a question of definitions. The Canons of Ethical Conduct state
“It is unethical to provide an orthotic or prosthetic devise without a
duly issued prescription.” There are no definitions included in the
Canons about what is an “orthotic or prosthetic devise” nor is there a
definition of “duly issued.”
The Licensure law in the State of Texas states that “The term [orthosis]
does not include a fabric or elastic support, corset, arch support,
low-temperature plastic splint, truss, elastic hose, cane, crutch, soft
cervical collar, orthosis for diagnostic or evaluation purposes, dental
appliance, or any other similar device carried in stock and sold by a
drugstore, department store, or corset shop.”
I’m not sure what the Canons mean, but the State of Texas has defined it
for practitioners in our State.
John D. Hatch, CPO
Clinical Manager
Rehab Designs of America
*****************
If the insurance company can purchase the same goods over the counter at the
drug store, then why are they even asking you? Is it not cheaper for them
to do just that? If they’re asking, then they clearly recognize a
difference. If there is a difference, then there should be a signature, in
my humble opinion.
Bryan .
*****************
Harold-
A couple of thoughts for you in chronological order. My office
manager,
who tries to stay abreast of the recent Medicare changes related this to me
a
couple of years ago: The only items we do without a prescription are
orthopedic shoes. We will do foot orthotics without a rx if we are
duplicating and replacing an existing pair.
Secondly, One of the original tenets of our liscensure law here in
Florida was to be able to do work without a rx (replacement work, etc.).
This
was one of the first items deleted from the bill as it was felt thatit could
open the way to large amounts of faud and abuse. Next, if you’re billing
Medicare, what do you put in the physician’s ID space.
In closing, if a malpractice case was ever filed, what are the limits
of your liability with or without a prescription.
Joshua C. Ryder, CO
President, FAOP
*****************
Over the years the ABC canons have been softened or loop holes opened. I
believe it has lost the strength to enforce some of the rules it has
established and is backing off. It would be unable to handle a major
contest.
******************
Thank you very much for your message – you raise a very important issue and
I’m happy to see you referencing the Canons for an answer.
The complete list of Canons can be found at our website
www.opoffice.org/abc under “Professional Discipline”. The canons you are
referring to reads as follows:
2.1 Diagnosis and Prescription
It is the sole responsibility of the physician or appropriately
licensed
health care provider, and not the orthotist or prosthetist, to determine
the medical appropriateness of the orthosis or prosthesis. Therefore, the
orthotist or prosthetist must receive a prescription from a physician or
appropriately licensed healthcare provider before providing any orthosis or
prosthesis to a patient.
Notwithstanding the above, the orthotist and/or prosthetist may,
without
prescription, provide an orthosis, component parts thereof or certain
component parts of a prosthesis to a patient if (i) the orthotist or
prosthetist does not expend his or her professional skills in the custom
fabrication and/or fitting of the orthosis, the component parts thereof, or
the certain component parts of a prosthesis to the patient, and (ii) the
cost of the orthosis, component parts thereof or certain component parts of
a prosthesis is billed directly to and/or paid by the patient or are billed
in accordance with third-party payer regulations.
2.2 Orthosis and Prosthesis Evaluation and Recommendation
It is the responsibility of the orthotist or prosthetist to
recommend
specific orthotics and/or prosthetics design. The orthotist and/or
prosthetist shall recognize that each individual patient is different and
deserves specific and responsive guidance from the orthotist or
prosthetist. After evaluating a patient, the orthotist or prosthetist
shall recommend to the physician or other prescribing healthcare provider
specific orthotic or prosthetic designs along with the reasoning for such
recommendations. The orthotist and/or prosthetist shall be guided at all
times by concern for the physical, emotional, social and economic welfare
of the patient. All decisions by the orthotist and/or prosthetist must be
made with the understanding and intent that the patient’s best interests
are the primary concern.
In summary, if the individual signing the script is an appropriately
licensed health care provider, then fulfilling that order would be in
compliance with the canons, OR if the order follows the specifications of
(1) or (2) of 2.1, then you would also be in compliance.
Not being a clinician myself, it is dificult for me to say definitively
that the services you listed qualify for service without prescription, but
I think the general intent of the canon is that if it is truly an OTC
service or device that does not require your specific education and
experience in custom fitting devices, then I think you’re ok without a
script.
I hope this answers your questions. Feel free to contact me again if you
need futher assistance.
*****************
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