Vol.11, No.5

October 2006

NEW - Prosthetic Foot/Ankle Mechanisms Course Available The latest in the series of online professional continuing education (PCE) courses based on findings from the Academy's State-of-the-Science conferences is now available at the Paul E. Leimkuehler Online Learning Center. The course on Prosthetic Foot/Ankle Mechanisms stems from the Academy's fifth SSC chaired by Don Cummings, CP with Texas Scottish Rite Hospital and Co-Chaired by Susan Kapp, MEd, CPO, of the University of Texas Southwestern Medical Center. The conference was convened to examine the body of scientific evidence that supports the clinical prescription and use of prosthetic foot and ankle mechanisms. A formal literature search and ranking was conducted prior to the conference forming a basis for the presentations and discussion. The course, accessible at your convenience, offers practitioners 12 PCE credits and includes a 100-question assessment quiz. The conference on which this latest PCE course was based, the subsequent printing and distribution of findings, and the course development were funded by a grant from the U.S. Department of Education (H235J040017). Visit the OLC for this and many other available PCE courses:

Report to Members on CMS Accreditation and Quality Standards

As many of you are aware, the Center for Medicare and Medicaid Services (CMS) has recently come out with Accreditation Standards and Quality Standards that will be required for all Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) suppliers providing services to CMS beneficiaries. While there are many unanswered questions regarding implementation of both of these, we wanted to keep you abreast of the proceedings and our understanding of how they will effect you, the O&P professional.

The Accreditation Standards were designed to decrease fraud and abuse by those claiming to provide care. The Academy, in conjunction with ABC, AOPA, and NAAOP within the O&P Alliance, has tried to educate CMS that our profession's current accreditation standard, the ABC facility Accreditation, is far more comprehensive than that which CMS has proposed. CMS has indicated that it will most likely accept ABC accredited facilities as sufficient to meet the CMS standards with no additional accreditation necessary. While the standards do not go as far as we had hoped that they would, they are a big step forward from what is currently required—none. Furthermore, while these standards are at a much lower level than that which we propose, they are comprehensive enough to be onerous to suppliers who provide only occasional or limited care. This may lead to a decrease in the number of what the Academy views as non-traditional O&P providers. However, CMS has left the question of who is actually competent to provide our services unanswered. The chosen accrediting bodies will be responsible for determining qualifications necessary for accreditation. Therefore, if there are four organizations chosen to accredit suppliers, there could conceivably be four disparate sets of qualifications.

The Quality Standards are also a very mixed bag for us. Again, they are far better than nothing, but not as high a standard as we had lobbied for. On the positive side, CMS is requiring that "the supplier shall be trained in a broad range of treatment options to ensure that the items prescribed are optimal for a beneficiary's condition." The Alliance interprets this to mean that a single manufacturer's course would be insufficient. In addition, the Quality Standards "...requires access to a facility with the equipment necessary to fulfill the supplier's responsibility to provide follow-up treatment and fabrication/modification of the specific device". There needs to be some clarification regarding exactly what CMS intends for this. Issues such as: does the location of the facility and the provision of care need to be within a certain distance of each other, thus preventing a single supplier from having a location in one state and billing for services provided in distant states, need to be addressed.

Although the information provided above is far from definitive, the Academy wants to keep you updated regarding what is transpiring with changing regulations affecting the provision of orthotic and prosthetic care. We will continue to inform you as more information becomes available.

Academy Teams with AOPA in Push Towards Evidence-Based Practice

Representatives of the Academy's Board of directors recently met with representatives of AOPA's Board of Directors in Hollywood, FL and agreed that the two organizations would work together on a clinical outcomes research project intended to assist the profession in the transition to evidence-based practice (EBP). The goal is to move forward on some immediate data collection and then to look for funding for a larger project. Each organization will name a number of individuals to a project steering committee and then this committee will invite additional researchers to a first face to face meeting to move the project forward. The general concept of the project calls for individual practitioners and facilities to participate in the collection of data. This data would be what the team of research experts would work with to begin further in-depth studies if funding can be found. This basic data will be incorporated into larger findings to create a comprehensive view of the clinical results of the care provided by O&P professionals. Academy President Gary Berke, MS, CP, FAAOP is excited about the prospect of collaborating with AOPA because of the far-reaching implications. Berke commented, "This is clearly a case where each organization brings certain strengths that collectively will exceed the sum of their parts." Walter Racette, CPO, Berke's presidential counterpart at AOPA states, "We feel strongly about the need for outcomes research and AOPA is prepared to dedicate significant resources to this joint project."

Evidence-based practice is currently being utilized in other healthcare disciplines to help medical professionals make clinical decisions that impact quality of care. In the process, the value of individual procedures is established, which further enhances the ability to make proper medical choices. Academy Research Council Chair Scott Cummings, PT, CPO, FAAOP feels that the outcomes project will be a significant step in improving the manner in which O&P care is provided. Cummings added, "The information generated through a study of O&P treatments that are currently being delivered will tell us a lot about how to provide optimal care in the future." The shift to EBP is a long-term initiative that will continue for years but the expectation is that the outcomes project will have some immediate benefits for the O&P profession. The Academy and AOPA are in the process of selecting a steering committee so that work can begin.

GRANT UPDATE - Academy Awarded Fourth Year of Funding from the U.S. Department of Education

The Academy is pleased to announce that is has formally been awarded its fourth year of grant funding from the U.S. Department of Education (#H235J060001). Academy Executive Director, Peter Rosenstein explained, "This year will focus on creating future sustainability for the grant programs to help further O&P awareness, education and research."

The programs funded by the $1M grants from the U.S. Department of Education have focused on key project areas:

Project One (Awareness): A national O&P awareness and recruitment campaign to attract qualified students to the field of O&P to include a public awareness campaign and the development of a targeted and relevant O&P-related science curriculum;
Project Two (Geographic Map): This project has been successfully completed in previous grant years and has no effort proposed for Grant Year IV. However, the outcomes from this project continue to provide considerable benefit to the other six projects and will be used to determine the direction of the projects.
Project Three (Strategic Planning): A series of meetings will be held with institutions with rehabilitation PhD programs to encourage inclusion of an O&P emphasis in the degrees they award;
Project Four (Master Agenda): Development of a methodology course that will result in a comprehensive curriculum for performing literature reviews and critical evaluation of published literature. Additional efforts will focus on the development of an online professional education course outlining clinical research processes to enhance a practitioner's ability to conduct and use research.
Project Five (State-of-the-Science Conferences [SSCs]): One additional conference in a series of State-of-the-Science topics in O&P will be held and certificate programs predicated upon two previous SSCs will be developed;
Project Six (Professional Continuing Education [PCE] Courses): One additional offering in a series of online PCE courses will be produced based on the findings of a multidisciplinary group of acknowledged experts who define State-of-the-Science on critical clinical issues.
Project Seven (Entry-Level Education): Identify the necessary fundamentals and unique challenges of conducting research to help update the O&P residency program to keep pace with the changing demands of O&P care and allow new practitioners to provide better care to their patients.

To keep informed on the Academy's grant work, please visit www.oandp.org/grants.