Almost universally, credentialed orthotists and prosthetists acknowledge physical therapists as clinical colleagues on the rehabilitation team and agree that the two professions are complementary and integral to best patient care. However, that's as individuals and fellow clinicians. From an organizational and legislative perspective, it's another story.
"The 'problem' is with the organization [the American Physical Therapy Association], not with the therapists in the trenches," Terry Supan, CPO, FAAOP, FISPO, says succinctly. And Supan should know. He and colleague Mike Brncick, CPO, who also was interviewed for this article, are battle-scarred veterans of the failed Negotiated Rulemaking Committee Meetings (NRM, or "NegReg") in 2003. The committee was formed to assist then Health & Human Services (HHS) Secretary Tommy Thompson in implementing the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), which includes provisions aimed at protecting Medicare patients from receiving orthotic and prosthetic care from unqualified providers.
Since, as Shakespeare noted, "the past is prologue," the present-day legislative battlefront between physical therapists and orthotists/prosthetists regarding Medicare physical therapy direct access legislation and increased physical therapy scope-of-practice provisions at the state level grew from BIPA and the NRM. The controversy centers around the educational and experience requirements for fitting prosthetic patients and the more complex orthotic cases which require highly trained patient evaluation, custom orthotic design for the specific patient, along with skilled follow-up care and adjustments.
Most certified prosthetists and orthotists acknowledge that physical therapists, as well as athletic trainers, physician assistants, and other allied health professionals, have the skills to fit many prefabricated orthoses, especially since many of these have improved in quality. But caring for amputees and orthotic patients with more complex conditions requires much more intense education and training--and continuing education to keep up with rapidly changing new technology and clinical research in O&P, most credentialed O&P practitioners believe.......
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