Business Issues in O&P

John French, M.S.Ed., C.O., L.O.P&O Program

University of Texas Southwestern Medical CenterDallas, Texas

Questions

• Why worry about business issues?

• Where will P&O students get this information? Whose job is it?

• What are the P&O schools currently doing?

• What is UTSW doing?

Why Worry About Business Issues?

• CAAHEP recommendation: “Advanced and/or specialized courses in the core subjects in communication & interpersonal skills, business (financial, billing, marketing, reimbursement, etc.), quality improvement, legal and insurance requirements (loss control, malpractice, etc.), occupational considerations, production and scheduling, and referral documents are recommended.”

Standards and Guidelines Sec.II (Curriculum) B.2.c., adopted 2001.

• CAAHEP recommendation: “Health Economics. Goal: To develop Knowledge of the basic economic forces affecting orthotics and prosthetics.”

Standards and Guidelines Sec.II (Curriculum) C.23., adopted 2001.

Why Worry About Business Issues?

Where will P&O students get this information? Whose job is it?

• School Programs

• Residency Experience

• Employer – On the job

What are the P&O schools currently doing?

• Current practice ranges from fragmentary integration into other curriculum to comprehensive and discreet curricula

• Practices continue to develop + evolve

What is UTSW Doing?

• Moving from fragmentary to coherent• Identifying the issues• Initial development of materials

– AOPA Billing & Coding Seminar– Columns from Almanac, O&P Business News– HHS/CMS

• Trial presentations of key topics in Seminar classes + Professional Issues debates

• Evolving to separate class for credit?

Identifying Issues

• Introduction

• Billing & Coding

• Health economics system

• Business economics

• Employment issues

• Practice improvement

• Roles and responsibilities

Introduction

• Rationale

• Terminology

• Integrity + Ethics

• Patient relations

• Documentation

Billing & Coding

• Overview (Senior project)Terminology

L-codes

Modifiers

New code process

HHS, HCFA (CMS), OIG, DMERCs, SADMERC, NCH

Compliance guidelines

• Clinical Rotation and class doc notes must include proper coding

Billing & Coding

– Fraud & abuse – guest expertsHHS OIG Special AgentAsst US AttorneyEvidence room itemsLocal case study – Fed Grand Jury charged

practitioner with 170 Counts• Total potential fines: $42,500,000• Total potential imprisonment: 850 years

– Ethics and avoiding the “slippery slope”

Billing & Coding

– Fraud & Abuse• Federal prosecution success rate: 99%

• Return on investment: >$30 per $1 spent

• “Good” news: most F&A occurs in DME, not O&P

• Bad news: it still happens in O&P

Health economics system

• Intro to the “playing field”• Guest speaker - VP BCBSTX• Payment strategies

– Fee for service– Contracts– Capitation– Rationale and consequences

• Managed care systems– PPO – HMO – POS – etc– Rationale and consequences

Business economics

• Practitioners will work for a business

• Practitioners will operate a business

• Practitioners will interact with other businesses– Suppliers– Competitors– Referral sources

Business economics(What is the employer thinking about?)

• Personnel – salaries, benefits, training, recruiting• Overhead• Equipment• Supplies• Inventory• Revenue vs. expense• Receivables, write-offs, pro bono• Practice expansion, acquisition, sale

Business economics(What are employees thinking about?)

• Employees think/act like owners

move decision making closer to patients

improve operational efficiency

employees become responsible participants

• Knowledgeable and responsible employees are more valuable to employers

Employment issues(What should prospective employees think about?)

• Overview for new practitioners entering workforce

• Job seeking• More realistic career plans and expectations• Employee rights and responsibilities• Certifications, licenses, privileges, etc• Practice settings, scope of practice• Marketing

Employment issues

• Practice options– Practitioner / management– Private office / branch office– Hospital based– Institution based / rehab team– Consultant– Central fabrication– Education– Mission– Sales rep

Practice improvement

• Professional organizations

• Licensure

• Continuing education

• QA vs. QI

• Cross-discipline issues

teams, collaboration, infringement,

scope of practice

Roles and responsibilities

• O&P practitioners• PT / OT• Rehab counselors• Physicians / fellows / residents / med students /

PAs / NPs• Nurses / aides• Parents – natural, custodial, foster• Third party payers

Conclusion

• Business issues are important for future practitioners

• Business issues are important for future of P&O profession

• This information can be acquired from several sources

• Too much information will be better than too little

Questions?