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Licensure: Learning from Mistakes
By Judith Philipps Otto Sadly, the biggest mistake made in the pursuit of
licensure to date is the delay in starting sooner--a mistake that
has already cost the profession dearly, believes John N. Billock,
CPO/L, FAAOP, Orthotics & Prosthetics Rehabilitation
Engineering Centre, Warren, Ohio.
Billock, along with Mike Allen, CPO, LPO, FAAOP, Allen Orthotics
& Prosthetics Inc., Midland, Texas; Lou Haberman, CPO, Garden
State Orthopaedic Center Inc., Oakland, New Jersey; and other
colleagues, formed a group called the National Prosthetic-Orthotic
Licensure Fund (NPOLF) in 1995. NPOLF existed to promote the need
for licensure and provide support on a national level that was not
available through existing national O&P organizations.
Although Billock had little direct involvement in the final
drafting or push for legislation that led to licensure in Ohio, he
and his colleagues were directly involved behind the scenes with
several of the early movements towards O&P licensure in the
states of New Jersey, Texas, Florida, and Washington.
"Having been involved in the initial movements toward licensure,
the key thing I feel that could have been and should have been done
differently was that all of these efforts should have been
initiated 15 to 20 years sooner," says Billock. "Although it is not
well known today, there were several individuals interested in
pursuing O&P licensure in the early to mid 1980s; however, the
support needed amongst our national leadership in the profession
was nonexistent and not felt to be necessary. This lack of interest
and support was further fueled by what was perceived to be a
national moratorium on state licensure programs, which were felt to
be too costly to administer, and concerns they would place
excessive financial burdens on O&P facility owners, who
typically covered such costs.
"Unfortunately," Billock continues, "in hindsight we see that
licensure would have been much easier to achieve then, and would
have been better accepted for its real purpose, which is to protect
the consumers of O&P services and assure that care was being
provided by truly qualified practitioners, i.e. practitioners who
met standards consistent among allied healthcare providers and
standards that ensured appropriate training and educating in the
provision of O&P care--not the confusing situation consumers
find in today's practice of orthotics and prosthetics."
Are Others Defining O&P Scope of Practice?
Jim Rogers, CPO, FAAOP, Orthotic & Prosthetic Associates,
Chattanooga, Tennessee, and head of the Licensure Task Force of the
American Academy of Orthotists and Prosthetists (the Academy)
agrees. "Occupational therapists and physical therapists made state
licensure a priority years ago," Rogers says. "They embarked upon
that beginning in the 70s and established their allied health
profession with providers requiring licenses from each state.
Gaining licensure has very effectively defined their scope of
practice."
Rogers continues, "One of the problems I have, however, is that
it has effectively defined our scope of practice in some states as
well. When other professions who have some overlap with O&P
provider services, embark on licensure without the voice
of O&P providers, that vacuum creates an opportunity for our
professional scope of practice either to be constrained, or, in an
extreme sense, defined by another profession's state licensure
practice act."
Licensure: Preventing Fraud
Billock concurs, and adds, "Aside from being less complicated to
pursue 15 to 20 years ago, I firmly believe that licensure could
have prevented much of the fraudulent O&P care that has been
provided over the past 20 years by unqualified providers. Licensure
would have given O&P consumers and practitioners greater legal
stature in their efforts to see the development of meaningful
regulatory standards by state and federal healthcare agencies, as
well as private healthcare organizations, to better ensure quality
care was being provided by qualified providers. Also, there is no
doubt in my mind O&P licensure would have saved state and
federal agencies, such as Medicaid and Medicare, millions, if not
billions, of dollars in fraudulent O&P health care claims from
non-qualified providers."
Changing Times, More Problems
And with the changed times have come additional problems, even a
different perception of the purpose of licensure. Billock reminds
us, "Although licensure is truly about protecting the consumers of
O&P care and not about protecting one's turf, unfortunately,
due to the mix of individuals now seeking to provide O&P care
and the organizations that support them, the focus of licensure has
become more about protecting one's turf or expanding one's scope of
practice."
Allen also notes that when Texas introduced its licensure
initiative in 1995, there was no National Orthotic Manufacturers
Association (NOMA) and no opposition from physical therapy groups.
"Physical therapists were not opponents in Texas; they were allies.
They fully supported licensure in O&P--but that was then--ten
years ago. In today's environment, that might not be the case. I
believe those are currently licensure's two biggest opponents and
challenges." 
Table Of Contents - January 2006
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