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Where Should Our Focus Really Be?
By Tom DiBello, CO, LPO, FAAOP 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). 
Table Of Contents - May 2004
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