As we look back on 2002, most P&O observers would agree that although there were no tremendous disasters for the field, a number of negative trends continued unabated. Managed care organizations still exclude, contest, and deny appropriate P&O rehabilitation regardless of the patient's medical and functional needs.
Manybut not allof these decisions can be overturned on appeal if the patient is assertive. But, because many people are unwilling or unable to stand up for themselves, such policies are generally successful in avoiding reimbursement for care, which increases the bottom line for the insurance companies. Due to the continued decline in the stock market, insurers are expected to continue doing whatever they can to protect their profit margins, including double-digit premium increases.
Not surprisingly, student applications in all healthcare fields, including P&O, continue to decline. The fledgling masters degree program in orthotics at the University of Iowa folded this year due to looming funding problems, although two masters programs at other universities are still on track. Existing schools continue to struggle with federal funding cutbacks from the Rehabilitation Services Administration (RSA). However, efforts to restore funding by the American Academy of Orthotists and Prosthetists (AAOP) may help reduce the impact of this loss of financial support for those schools who survive these tough times.
P&O on Federal Radar Screen
The Centers for Medicare and Medicaid Services (CMS) surprised the field one year ago by unilaterally eliminating the L-Codes that applied to roll-on socket liners, and then steadfastly stood its ground despite widespread concern and protests. Late in the year, CMS finally relented and created new temporary codes to replace the deleted codes. As the year drew to a close, Medicare announced substantial changes to many spinal orthosis codes. The clarity and effect of those changes is still being determined.
The Negotiated Rulemaking meetings are now underway, so it is very clear that P&O will be on the radar screen for some time to come and can anticipate continued changes in business regulations and requirements.
Innovative New Products
On a more positive note, 2002 brought a plethora of new options for orthotists to offer their patients. Horton's started a stampede when the company unveiled its stance control orthotic knee joints in January, and by October's end, Otto Bock, Becker, and Fillauer had all followed with their own SCO designs. Becker also released several other innovative knee joints this year, including a unique gas strut-assisted design.
Prosthetic progress was less noteworthy, although there were a number of technical advances, such as the Motion Control electronic hand with integral wrist flexion.
Hanger has been successful in reducing its debt load, and its stock is stable at about $15 as a result. RDA is also slowly rebuilding the remnants of its group of practices. However, the most successful businesses in 2002 were those well-run mom-n-pops which reduced costs while maintaining quality of care and finding a successful niche in their local communities.
Consolidation of the major manufacturers continued at a brisk pace in 2002, with the Seattle-USMC merger as the most noteworthy conglomeration. OSSUR began centralizing control and manufacturing in Reykjavik, while Otto Bock expanded its presence in orthotics with selective acquisitions of competitor products and companies.
2003: More Challenges Ahead
The new year will undoubtedly bring another round of familiar challenges, as well as some surprises. Changes in the field always present new opportunities, and if history is any indication, P&O folks will be flexible enough and tenacious enough to find some way through the maze of opportunities and challenges we will all face in 2003.
John Michael, MEd, CPO, FISPO, FAAOP, has had a noted career as a clinician, lecturer and educator in both the US and international P&O markets. He is a past president of the American Academy of Orthotists and Prosthetists. Currently he is president of CPO Services, a consulting firm.