CONTEMPLATING HEALTH ECONOMICS, CODING AND REIMBURSEMENT IN ORTHOTICS, PROSTHETICS AND PEDORTHICS

M. Jason Highsmith; Christopher M. Fantini; Douglas G. Smith

doi:10.33137/cpoj.v4i2.36125

Authors

M. Jason Highsmith School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida. Tampa, Florida, USA. https://orcid.org/0000-0001-8361-7345
Christopher M. Fantini U.S. Department of Veterans Affairs, Rehabilitation & Prosthetics Services, Washington, USA. https://orcid.org/0000-0003-4859-0831
Douglas G. Smith Department of Physical Medicine and Rehabilitation, Uniformed University of the Health Sciences, Bethesda, Maryland, USA. https://orcid.org/0000-0002-6207-7711

DOI:

https://doi.org/10.33137/cpoj.v4i2.36125

Keywords:

Coding, Economics, Fee for Service, Orthotics, Prosthetics, Reimbursement

Abstract

Reimbursement to U.S. healthcare service providers is largely transitioning from fee for service to fee for value for those clinicians who code using current procedural terminology and through their coding, describe their professional services. The Orthotic, Prosthetic and Pedorthic profession (O&P), currently codes using a system that describes the devices they evaluate for, fabricate, fit and maintain and their professional services are incorporated into their codes. These O&P codes, in contrast to those for other healthcare disciplines, are predominantly product based rather than service based, focusing on product features and function more than clinical service. This editorial manuscript provides a brief overview of the system the US O&P profession uses currently, particularly in the context of other healthcare professions transitioning to value based coding and reimbursement and culminates in a call to action for the profession to academically consider the strengths and weaknesses of the current system relative to alternative systems.

Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36125/28316

How To Cite: Highsmith MJ, Fantini CM, Smith DG. Contemplating health economics, coding and reimbursement in orthotics, prosthetics and pedorthics. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.5. https://doi.org/10.33137/cpoj.v4i2.36125

Corresponding Author: M. Jason Highsmith, PhD, DPT, CP, FAAOP
School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida. Florida, USA.
E-Mail: mhighsmi@usf.edu
ORCID ID: https://orcid.org/0000-0001-8361-7345

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Author Biographies

M. Jason Highsmith, School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida. Tampa, Florida, USA.

M. Jason Highsmith, PT, DPT, PhD, CP, FAAOP, attended Northwestern University’s prosthetics program in 2004 and was certified following residency in 2006. He is dual licensed in physical therapy and prosthetics. He currently serves as the VA’s National Director of Orthotic, Prosthetic & Pedorthic Clinical Services Program Office. He is joint appointed as a Professor at the University of South Florida (USF), is a Past-President of the American Academy of Orthotists & Prosthetists and is a Captain (Physical Therapist) in the US Army Reserves. Dr. Highsmith manages a considerable research portfolio and has published numerous peer-reviewed scientific manuscripts. The views expressed in this article are his alone, and do not represent the US Departments of Defense, Veterans Affairs, any university or any other organization.

Christopher M. Fantini, U.S. Department of Veterans Affairs, Rehabilitation & Prosthetics Services, Washington, USA.

Christopher Fantini, MSPT, CP, BOCO, is a board-certified Prosthetist/Orthotist with over 25 years of physical rehabilitation experience. Mr. Fantini received a Master of Science in Physical Therapy from Columbia University in New York City and earned post graduate Certification in Prosthetics from Northwestern University in Chicago. Mr. Fantini has participated in notable work on advanced prosthetic devices to help facilitate the progression of emerging concepts & technologies to their clinical application. He has authored numerous peer reviewed articles as well as several chapters in texts relating to prosthetic care. He participates in the education/mentoring of Residents in the disciplines of Physical Medicine & Rehabilitation and Orthotics/Prosthetics. He has and continues to work on several projects relating to both direct patient care as well as strategic planning to advance the field of O&P. The views expressed in this article are his alone, and do not represent the US Department of Veterans Affairs or any other organization.

Douglas G. Smith, Department of Physical Medicine and Rehabilitation, Uniformed University of the Health Sciences, Bethesda, Maryland, USA.

Douglas G. Smith, MD is a board-certified Orthopaedic Surgeon with over 30 years of experience in amputation surgery, the rehabilitation of individuals with limb loss, prosthetic prescription and prosthetic evaluation. He is Professor Emeritus in the Department of Orthopaedics and Sports Medicine at the University of Washington in Seattle. He is also a Professor in the Department of Physical Medicine and Rehabilitation at the Uniform Services University of the Health Sciences in Bethesda, Maryland. He works for the Henry M. Jackson Foundation for the Advancement of Military Medicine, and in his role as the Chief Orthopaedic Advisor for The Center for Rehabilitation Sciences Research in the department of Physical Medicine and Rehabilitation at The Uniform Services University he provides clinical education, consultation to the multi-disciplinary amputee care team and he supervises clinical research in limb salvage, amputation surgery and rehabilitation. He also serves on the American Orthotic and Prosthetic Association (AOPA) medical advisory board. The views expressed in this article are his alone, and do not represent the US Department of Defense, any university or any other organization.

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