As We Look Back on 2002—and Ahead to 2003
By John W. Michael, MEd, CPO, FISPO, FAAOP  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.
Education Struggles
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. 
Table Of Contents - January 2003
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