FEATURE: The State of O&P
Even if the regulatory activity is relatively quiet in your backyard, keeping an eye on other states is imperative for industry professionals. Regulators and legislators pay close attention to how other states are cutting back, and look to borrow those ideas to implement their own state budget cuts. What’s happening in a neighboring state today could determine your fate tomorrow.
Overcoming Capitation in Alabama
In Alabama, a state that has not opted into the Affordable Care Act, the health-care model has changed to feature five Medicaid regional care organizations (RCOs). Once the RCO model was announced last fall, representatives of the Alabama Prosthetic and Orthotic Association began meeting with Medicaid representatives to determine how O&P would be viewed in the new system. “We were told in March 2014 that O&P would be handled within the RCO system, which means it would be in a capitated system,” says Glenn Crumpton, CPO, of Alabama Artificial Limb & Orthopedic Services Inc., and an active member of the state association. The state hired Scott Williamson, MBA, president of Quality Outcomes, to help maneuver the red tape to ensure O&P did not become a capitated benefit. If it did, that would mean a contracted rate for each individual, or “per-member-per-month” rate, regardless of the number or nature of services provided. In this system, O&P patients might not have enough coverage—even for one device. “Capitated arrangements typically have not fared well for people who need O&P care,” says Thomas. “They may exclude many newer technologies and components that are actually pretty standard.” Alabama successfully argued that the proposed capitated system would catastrophically endanger and potentially disable beneficiaries who have traditionally benefited from appropriate O&P intervention. They also
Licensure: The Industry Debate Continues
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o far, about 20 states have enacted licensure laws. Several others are
pushing initiatives to do so. But practitioners in some states remain unconvinced that licensure is the best way to ensure quality O&P care. Licensure can be positive when it’s used as a tool to help recognize qualified providers, and when it has teeth to ensure any unlicensed professionals do not treat patients. But if it’s viewed as just another credential and regulators are not given enforcement powers, then it’s simply not worth it, some argue. In Georgia, James Young Jr., LP, CP, FAAOP, of Amputee Prosthetic Clinic headquartered in Macon, can see both sides of the argument. “As someone in a licensure state, I have mixed emotions about licensure,” says Young. The added costs associated with licensure fees and the associated regulatory burdens can be challenging for business owners. “But I’m an amputee and an O&P patient, too, so I like to know that only individuals who have met a miniJames Young, LP, CP, FAAOP mum benchmark will be treating patients.” Young also adds that licensure can be a challenge for practitioners who want to move across state lines: Established practitioners who were licensed in their home states because of grandfather clauses may not meet licensure requirements in other states because their education level does not meet new requirements. And sometimes this doesn’t seem fair: “A prosthetist who started as an apprentice and worked his way up may be much more competent than a new master’s level practitioner—but he may not be able to get licensed,” explains Young. Practitioners in North Carolina have conflicting opinions about licensure. “We don’t have licensure here, and there’s a 50/50 split about whether we should pursue it,” says Ashlie White, an employee at Beacon P&O in Raleigh and a board member for NAAOP. Some fear the additional regulations would add financial and administrative burdens. Others worry that their current staffing structures would be scrutinized. “You need to have a lot of money for a licensure fight, and you need more than 50 percent of the state to be onboard.” But White notes the many advantages of licensure as well: It increases professionalism, provides a forum for patient complaints, and legitimizes the profession. “Licensure is something states should do, but it should be more uniform,” says Ashlie White Carey Glass, CPO, of Allied O&P in New Jersey, a licensure state. “If we all have the same rules, then we could have reciprocity, and one high standard level of care.”
O&P Almanac | July 2014
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