As I sit down to write this editorial, the field is enveloped in yet another controversy. It will be interesting to see how this ABC/BOC battle plays out. In the 25 years that I have been in the profession, there seems to have been one controversy after another. This ABC/BOC conflict goes back at least 20 years. There was also the consolidation of the national office, the combining of the two meetings, state licensure, etc., etc., etc. As I examine each of these events, I can say that the primary position held by each side in each controversy had some merit. It is remarkable to me, that in those 25 years, the field has never put aside personal agendas and come together to move forward for the advancement of the field. The relative cost in terms of money and time wasted on these controversies is staggering. Where would we be today if these resources had been directed more effectively?
Catastrophe Waiting?
What the field should be focused on today is a situation that will ultimately affect every one of us--whether we are ABC or BOC, corporate employee, small independent practitioner, university practitioner, educator, large manufacturing company, or small component manufacturer. What might this waiting catastrophe be? Nothing less than the fields' relevance in the rehabilitation community.
If you question this assertion, then simply look at one parameter that is very easy to measure: our level of reimbursement. Our importance is diminishing within the reimbursement community, and we lack the data and coordinated effort to dispute it. Recently, we have seen insurance companies choose not to pay for myoelectric componentry. They used a spurious argument and a distortion of facts to validate their decision. As an industry, we are unprepared to answer them. Another example is the large national insurance company that is limiting prosthetic care to a maximum of $2,500 per year. What this tells me is that orthotics and yes, even prosthetics, is becoming irrelevant to employers and insurance companies. This is a travesty.
If this continues, it will affect every aspect of our profession.
Einstein said that "a question defined is a question half answered." So, how did we get here? We have ignored the model used throughout medicine today--the model recognized by our pay sources--by failing to develop the educational and research model needed to validate what we do.
O&P's Value, Cost-Effectiveness to Rehabilitation
I am convinced that what we do represents some of the most cost-effective modalities used in rehabilitation today. The average custom-molded AFO costs the equivalent of several hours of physical therapy, yet it lasts for three to five years. Whether it is used for simple transfers or active ambulation, it has a positive impact on the client's life. The transfemoral myoelectric prosthesis costs the equivalent of a few weeks stay in the hospital, yet can enable its wearer to return to a demanding daily schedule and be an active member of society.
I don't mean to imply that orthotics and prosthetics is more important than physical therapy or an inpatient hospital stay. However, in the overall rehabilitation of the patient, O&P plays important roles, yet represents a small percentage of the total cost of that client's rehabilitation. That makes orthotics and prosthetics relevant; it makes what we do important. But it also means we are a good value to the patient who gets better care, to the employer who gets a productive employee back, and to the insurance company which allocates dollars toward the most effective and appropriate care.
Validating What We Do
We must begin the task of embracing the education and research models that will help us to validate what we do. Our leaders must join hands and move forward together. Our associations, trade groups, certifying organizations, educators, and practitioners must allocate resources and energy to this cause. Let us stop wasting time and resources on controversy and begin the task of demonstrating our importance to the rehabilitation community. Some of this can be done quickly to meet immediate needs, some will take years to accomplish, but we must begin now. Although it is getting late, it is not too late to focus.
Tom DiBello, CO, LO, FAAOP, is owner of Dynamics Orthotics and Prosthetics, Houston, Texas, and a past president of the American Academy of Orthotists & Prosthetists (AAOP).
