O&#038;P Goes to Washington

In Frank Capra's 1939 blockbuster hit Mr. Smith Goes to Washington, Jefferson Smith, played by Jimmy Stewart, is sent to Washington, DC, to fill out the term of a deceased senator. Idealistic and naïvely sure of the honesty of his fellow congressmen, he discovers himself caught in a web of political misdeeds. He receives an education in American politics he didn't expect, and finds enemies and allies in surprising places.

For this idealistic managing editor from the Midwest, who during the Reagan administration considered the career path of a lobbyist on Capitol Hill, the chance to attend the 2005 O&P Policy Forum and actually see American politics in action was an exciting one. Absent any political misdeeds, at least those that could be observed from Room 106 of the Dirksen Senate Building, the experience fell short of, or perhaps rose above, Mr. Smith's personal experience. And according to follow-up interviews with several state delegates, the 2005 O&P Policy Forum left most attendees with a sense of satisfaction that the industry's concerns were heard loud and clear by some sympathetic congressional leaders.

Four Key Concerns

The American Orthotic & Prosthetic Association (AOPA), based in Alexandria, Virginia, organizer of the event, reports a record breaking participation in the largest-ever three-day O&P Policy Forum. Over 120 O&P professionals from across the country gathered in DC to address these four key concerns of the O&P profession:

Defend a full Medicare O&P fee schedule payment update in 2007; Reduce Medicare fraud and abuse by implementing "Qualified Provider" regulations; Orthotic care in skilled nursing facilities (SNFs); and Oppose direct access to physical therapist services under the Medicare program Three Productive Days

Day one presented all the state delegates with an opportunity to participate in a State Issues Roundtable, which was moderated by Kathy Dodson, AOPA senior director of governmental affairs; Walter Gorski, AOPA director of legislative and regulatory affairs; and Peter Thomas, NAAOP general counsel. For more information about the State Issues Roundtable, see sidebar Roundtable Discusses Licensure, Parity, Direct Access.

Commented Glenn Crumpton, CPO, LPO, CPed, Alabama Artificial Limb Co. Inc., Montgomery, "I felt as though we in Alabama got a good return on our investment of time and money in attending the Policy Forum, especially when we arrived to find that AOPA had combined with NAAOP for this meeting and had invited Peter Thomas to be on the panel of speakers throughout the meeting. To my knowledge, there has not been this level of cooperation prior to this. However, at this point it was a perfect fit because the AOPA issues to be discussed on Capitol Hill were issues also important to the NAAOP. In my opinion, the NAAOP is very well-versed on the issues such as 'Direct Access for Physical Therapists' and has been lobbying legislators, and for once, we combined resources."

Attendees spent much of the morning on day two of the 2005 O&P Policy Forum receiving opening commentary from AOPA President Michael Hamontree and Judge John J. Farley III (ret.), who is on the US Army Amputee Patient Care program Board of Visitors and is an amputee peer visitor and an Amputee Coalition of America (ACA)-certified trainer of peer visitors at Walter Reed Army Medical Center, Washington, DC.

Senate Finance Committee Chairman Charles Grassley (RIA), presented the keynote address. While the remarks of all three speakers were well-received, two specific comments elicited a round of hearty applause from the attendees. When commenting on direct access, Farley, who himself is an amputee, commented that prosthetics requires a fine art more than science, and in his best impression of the late Johnny Cochran, former attorney for O.J. Simpson, "If the socket doesn't fit, the amputee will sit." The other comment that resulted in a round of applause was when Grassley vehemently expressed that he "opposed competitive bidding."

The remainder of the morning was spent taking an inside look at the key O&P issues at the Centers for Medicare & Medicaid Services (CMS) with Herb Kuhn, director of the Center for Medicare Management. Following a brief recess, attendees reconvened and listened intently to an O&P policy update presented by Don Muse, PhD, president of Muse & Associates, Washington, DC, a firm that studied and gathered statistical evidence on "What Is Driving O&P Spending" from a 1999-2002 study of the overall costs of O&P within the Medicare system. This session was moderated by Keith Cornell, CP, BOCO, FAAOP, AOPA immediate past president and 2005 AOPA government relations chairman.

Surprising Statistics

The stats shared in this portion of the meeting certainly raised some eyebrows. While it is not a surprise that the number of O&P patients is increasing, it was reported by Muse that the greatest number of those patients are female. And while many would tend to believe that the factors driving costs are billable fees, service, and/or the cost of devices, Muse surprisingly stated, "The bottom line is that the increasing number of persons receiving O&P services is truly what is driving the costs of O&P."

Following those statistics shared by Muse, Tom Watson, CP, O&P PAC co-chairman, presented some equally surprising facts regarding "The Role of Your O&P PAC." In 2004 the O&P PAC received only slightly over $65,000 in contributions, from three percent of the practitioners in the O&P community (see graph).

Hitting 'the Hill'

Following Watson's appeal to attendees, urging them to get their peers involved, the crowd was treated to a luncheon address by Representative J. D. Hayworth (R-AZ). Hayworth, who was once a television sports anchor, delivered a lively and humorous speech making light of being voted in a Washington survey of Hill staffers as number one in Congress in the "no rocket scientist" category and number two in the "biggest windbag." He used this analogy to encourage attendees to be persistent in maintaining open communications with their congressional leaders regarding their concerns for their industry and livelihood, as it has been his persistence that has earned him reelection a number of times, despite what Hill staffers thought of him.

The remainder of the afternoon was spent reviewing the handouts that had been so efficiently prepared and organized by AOPA staffers for delegates to deliver to their respective congressional leaders the next day. In a sort of "Capitol Hill 101," attendees were given pointers on how to approach their congressional visits, and even had the opportunity to practice when given an open mike forum that afternoon with visiting congressional representatives.

On day three, the actual day of congressional visits, the morning included much of the same in an abbreviated "Capitol Hill 101" review. Capitol Hill visits began at 9:30 AM, lasting until around 2:30 PM. Upon their returns, delegates appeared to be enthusiastic and hopeful following their first meetings.

Terry Supan, CPO, O&P Associates of Central Illinois, Springfield, said, "This was my first O&P Policy Forum and it has been over 15 year since I was 'on the Hill.' I was very impressed with all the work that the AOPA staffand NAAOP General Counsel Peter Thomas did to prepare us for the meetings with the congressional staff.

"For the Illinois/Indiana delegation, they had scheduled meeting in four representatives' and three senators' offices," Supan continued. "We had very good meetings with my congressman, Rep. John Shimkus [R-IL], and Tim Costello's congressman, Rep. Chris Chicola [R-IN]. We also made a 'cold call' at the office of Senator [Barack] Obama [D-IL] and were able to meet with his heath and education policy advisor who is an internal medicine physician."

Supan commented, "We were able to put a personal face on the needs of our profession and to make those all important contact with our senators and representatives. Depending on the member of Congress' philosophy, we were able to discuss 'qualified provider' to stop fraud and abuse, APTA push for 'Direct Access' (self - referral), the SNFs' orthotic billing, and the possible extension of the Medicare reimbursement freeze.

"But we cannot stop with the Forum," Supan declared. "Now is a great time for the profession to e-mail or call the members of Congress. Getting back to our orthotic blacksmith roots, 'We need to strike when the iron is hot!'

"If you have never talked to a staff member at a congressional office before, I would recommend you contact Walt Gorski at AOPA. They have the four 'talking points' laid out really well so you can use the ones that are most important to you and your practice."

AOPA expressed how grateful it was for the sponsors of the 2005 O&P Policy Forum as the sponsorship dollars helped defray the costs of many of the meals and refreshments for attendees during the three-day event.

The sponsors were: gold sponsor, Ossur; silver sponsors, Ohio Willow Wood and Otto Bock HealthCare; bronze sponsors, Amputee Coalition of America (ACA), JLT Services Corporation, Orthomerica Products Inc., PMT Corporation, and Alabama Prosthetic & Orthotic Association.

"Overall I thought the O&P Policy Forum was well-organized," said Lisa DiGiacomo, marketing manager at Ohio Willow Wood. "I found it very helpful that AOPA made all the arrangements with members of Congress for our meetings. I am also appreciative of the follow-up thank-you notes AOPA provided." When asked how well DiGiacomo felt the Ohio delegation was received, she offered this comment, "I thought we were well-received and had quite a few beneficial meetings...A good and positive experience."

To the ordinary layperson, who did not plan a life of political activism, the opportunity to take part in these congressional visits on Capitol Hill may well have represented one of those rare opportunities of a lifetime. But when the opportunity arises within an industry plagued by skepticism due to potential outside threats coming down on the livelihood and quality of care of literally thousands, and particularly one that is shadowed by a cloudy economic future due to cuts in reimbursements by government agencies, an atmosphere of unity can result in a professionally orchestrated presentation of one loud and united voice. This can be a beautiful sound? that it was in the 2005 O&P Policy Forum.

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