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Licensure: Is Anybody Still Opposed?
By Judith Philipps Otto A.J. Filippis, CPO, Wright & Filippis, Rochester
Hills, Michigan, still has serious concerns about embracing
licensure:
"Because of the relatively small size of our industry, we are
probably not going to have our own licensing board in most cases,"
he worries. "In some states, I believe they combine O&P with
the chiropractic board; in others, I understand they're looking at
podiatry. Thus I'm concerned that we're going to lose our
voice--get a licensure bill and be swept along with those other
groups with whom, in some ways, we are still competing.
"From what I've seen," he adds, "almost all licensure bills are
tagalong bills--but not being in that environment very often, I
haven't really seen the full effect of it."
Another problem he identifies is the cost of licensure. Although
that cost will vary from state to state, based on circumstances, he
reminds us that "whatever size the board is, it has to be paid for
by somebody--and that's we practitioners and facility owners."
Montana or Wyoming, each with perhaps ten O&P facilities,
may not be able to fund a licensing board, as opposed to Florida or
California which each have hundreds of facilities, he points out.
The cost tied to a licensing bill can be a formidable obstacle, and
the cost doesn't go away after the initial investment, he adds. The
cost of maintaining a licensure board is ongoing.
Another concern Filippis cites is the implementation of yet
another set of rules O&P practitioners and facilities must
observe. "There are already many regulations that we have to
follow; now we're going to be governed by a state licensing board
that we must work with and maintain, making sure that inappropriate
rules don't get slipped in Let's face it," he reminds us, "the
physical therapists have far more votes out there than we do. In
Michigan, there could be as many as 20 PTs to every one O&P
practitioner. My concern is that we may risk that high level of
care for the patients by opening that up to some degree."
Concern for maintaining certification standards is another issue
Filippis defines.
"I think that what people are looking at is the possibility that
with state licensing, ABC [American Board for Certification in
Orthotics and Prosthetics] facility certification may not be
required. The licensing is going to take the place of a facility
accreditation because you can't afford both. As reimbursement
continues to get ratcheted down, here's still another cost that
we're taking on.
"To be able to afford that cost, something has to go, and
facility accreditation may just be that something,'" he
speculates.
Filippis feels that as a profession, O&P made a mistake by
not informing payers that the ABC should be the credentialing body
used to define their standard of care. As early as 1976, he and his
brother approached payers such as Blue Cross and Medicaid to
recommend that ABC certification be identified in provider
contracts as the minimum standard for O&P care.
That standard was adopted and is still in place today, Filippis
says. "That's why we didn't have as much difficulty competing with
stock-and-bill programs in Michigan--because PTs and physicians
couldn't provide services because they couldn't get paid for it.
That's the way we handled it here in Michigan, and it's been very
effective up to this point."
Because of the direction that a handful of states have taken at
this point, prompting changes in some of the suppliers' standards,
said Filippis, the situation is changing: The Department of
Veterans Affairs (VA) is reportedly considering accepting state
licensure as its required credentials for O&P. "That may force
our hand here in Michigan. If Medicare and the suppliers' standards
come through that way, and the VA accepts the criterion, I think
it's going to be just a matter of time before we need to follow
suit. Otherwise we're going to be fighting that battle through ABC
as well."
Another Perspective
On the other hand, Jeff Fredrick, CPO, Hanger Prosthetics &
Orthotics Inc., Tallahassee, Florida, is now frustrated by those
who promote a double standard by opposing licensure: "First of all,
it's irrational because licensure is here to stay, and once
Medicare or some of these higher payers really start dialing into
it, you're going to have to be licensed in a state to provide
services, and that means further regulation. That's coming."
Fredrick continues, "But what offends me most about the guys on
the other side of the fence is that these are people who claim we
don't need the high qualifications that licensure demands, but let
their three-year-old child get sick, and offer them the choice
between two doctors--one licensed, with a lot more education; and
the other one isn't licensed. Close to 100 percent of them would
opt for their family to be treated by the higher-educated and
licensed physician. Yet when they are being held to higher
requisites, they suddenly change their philosophy. That's
hypocrisy." 
Table Of Contents - January 2006
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