2006 Trends: Deja Vu All Over Again?
By John Michael, MEd, CPO, FISPO, FAAOP  In preparation for this article, I reread my
December 2002 retrospective for The EDGE and was struck by
how apropos the summary statement from that era still remained:
"Most P&O observers would agree that although there were
no tremendous disasters for the field, a number of negative trends
continue unabated. Managed care organizations still exclude,
contest, and deny appropriate P&O rehabilitation regardless of
the patient's medical and functional needs."
Prosthetic Parity Grows
One of the more heartening changes in the past four years is the
Amputee Coalition of America's (ACA's) decision to make prosthetic
parity, defined as "Insurance Companies Covering Appropriate
Prosthetic Care," a major goal ( www.amputee-coalition.org/advocacy/factsheet-prosthetic_parity.html).
Colorado passed the first parity law in 2001 and, contrary to
naysayers' assertions, insurance premiums have not significantly
increased despite better treatment for amputees. Maine's law
followed in 2003 with New Hampshire's in 2004, and parity
legislation now is being pursued in 26 additional states as of
press time.
Education Advances
In 2002, many of our professional training programs were
struggling financially, but the picture in 2006 looks better, in
part because of the success of the Academy's Project Quantum Leap.
The National Commission on Prosthetic-Orthotic Education (NCOPE)
recently published a position paper recommending transition to an
entry-level masters degree that incorporates the now-separate
residency experience as part of the academic program ( www.ncope.org/summit/).
The fledgling University of Iowa masters program folded in 2002
before taking in the first class but, like a phoenix rising from
the ashes, much of that effort was incorporated into the burgeoning
Masters of Science in Prosthetics & Orthotics program at the
Georgia Institute of Technology ( www.ap.gatech.edu/mspo/).
P&O Still on Medicare Radar Screen
The year 2002 was frustrating due to Medicare's practice of
abruptly canceling useful L-Codes. Regretfully, the SADMERC still
is making incorrect rulings about roll-on liners, reversing the
changes, and then issuing additional decisions that further confuse
the issues--so these problems will undoubtedly continue into 2006
and beyond.
In 2002, Medicare unilaterally slashed the allowable amounts for
a number of common spinal orthoses, but suddenly reversed course
when federal litigation was filed. In 2006, we are entering the
third year of an across-the-board price freeze. All the P&O
associations have joined ranks and are working hard to persuade
Congress not to extend the freeze. More about these and similar
"hot issues" is highlighted at www.aopanet.org/hot_op_issues/
Provider Standards Move Forward
By the end of 2002, the ill-fated Negotiated Rulemaking meetings
were underway but ultimately failed to reach unanimous consensus.
As 2006 is dawning, the Government Accountability Office (GAO)
again has sternly recommended strengthening Medicare supplier
standards, noting that it remains extremely easy to obtain payment
for bogus claims. (The egregious fraud in which Region C paid
unlicensed charlatans in Florida millions for nonexistent
prostheses is just the most recent example.) Medicare recently has
published plans to restrict payment for prostheses and "certain
custom orthoses" to licensed prosthetists-orthotists in those
states with CPO licensure laws currently in effect. More details
are at www.oandp.com/resources/organizations/naaop/
Consolidation Continues
Supplier consolidation was a major trend in 2002 and the big
news was the Seattle Limb Systems-United States Manufacturing
merger. The combined company was recently purchased by CAMP, so
this trend continues as does Otto Bock's and OSSUR's expansion by
acquisition of competitors.
2006: Good News, Bad News
The good news for 2006 is that no radically new problems seem to
be on the horizon. The bad news is that, because most of these
difficulties are deep-seated issues, there are no quick fixes, and
it will take a concentrated and sustained collaborative effort to
overcome them.
But I am encouraged overall as we enter this new year: More than
at any other time in memory, CPOs are acutely aware of the
challenges we face, the opportunities that change inevitably
presents, and the importance of speaking nationally with a common
voice to achieve positive long-term results.
John Michael, MEd, CPO, FISPO, FAAOP, has had a noted career
as a clinician, lecturer, and educator, and is currently president
of CPO Services, a consulting firm. He may be contacted at JWM.CPO@verizon.net 
Table Of Contents - January 2006
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