Raising Awareness of the Value of Orthotic and Prosthetic Care.

Abstract

It is no secret that government-funded health care programs face deficits. Dealing with these deficits has created a zeal for reformation of the payment system. Within the midst of this unprecedented revolution in health care, payers, health insurers, and government agencies are in the driver’s seat. The changes they are unleashing are disrupting the business and clinical service delivery models that have been the norm. All payers are driving toward outcomes-focused metrics. Although this emphasis in outcomes is positive, their heightened, and often misguided scrutiny of coverage decisions and their lack of appreciation of the value and cost of prosthetic and orthotic interventions have negative consequences. This unwarranted oversight impacts not only what care orthotists and prosthetists provide, but also what they are reimbursed for their services. This pressure is negatively impacting the quality of life for the people who receive orthotic and prosthetic care. The ongoing development, establishment, and dissemination of our evidence base is of critical importance if the orthotic and prosthetic profession is to stand any chance of defending itself and our patients from those who attack and undermine the value of our services. There is clearly increasing pressure in both the military and civilian medical sectors to identify and produce objective evidence about treatment protocols and practices that work. I hear people continually say that orthotics and prosthetics has a low, or at best, an immature scientific base; however, this is neither unique nor entirely negative, but rather an exciting opportunity. The development of a scientific or evidence base within orthotics and prosthetics is a process not an event, and we are making progress. Although the manuscripts in this supplement deal primarily with Medicare and the private sector, the concerns expressed and the guidelines suggested in these efforts should also apply to military medicine. Team management, documentation, provision of care by qualified providers and cost-effective services are as important in military medicine as they are in the civilian sector.