Controlling Foot Care Benefit Costs in Canada
The Pedorthic Association of Canada values its relationship with insurers, and shares their frustration with respect to unethical and fraudulent practices within the industry. In addition to increasing costs, there are medical risks associated with incompetent, unqualified, and unaccountable providers dispensing orthopaedic medical products simply for financial gain.
PAC will continue to work closely with the insurance industry to assist insurers in making informed decisions when establishing policy and criteria relating to orthoses, footwear, modifications, and related appliances. PAC will continue to help the insurance industry to expose unethical and fraudulent behaviour.
Limiting Provision to Qualified Foot Care Professionals
PAC strongly feels that provision of orthopaedic products should be limited to those who:
- are thoroughly educated in postural analysis, movement patterns, and musculoskeletal examination with a focus on the assessment of the lower limb anatomy, muscle and joint function, the interaction of the foot and lower limb with the rest of the body, as well as diseases and disorders that affect the foot;
- are thoroughly educated in the fabrication of custom-made foot orthoses, footwear modification, custom-made footwear, and the provision of orthopaedic footwear;
- have a professional designation from a Canadian certifying body (i.e., College) demonstrating that they have completed extensive competencies and passed a certification exam testing the competencies in the first two provisions;
- have a Canadian governing body (i.e., College) that has Standards of Practice and a Code of Ethics written specifically to govern their professional practice in the competencies outlined in the first two provisions; and
- have a professional association whose mandate is to develop and promote the study, practice, knowledge, and education in the competencies outlined in the first two provisions.
Limiting access to those professions that satisfy the five provisions listed above would not limit accessibility to plan members, but would direct them to qualified, accountable professionals.
Advances in Technology
As technology advances it becomes even more important to limit provision to qualified professionals. New technologies such as laser/optical scanners and 3D printing continue to change the way products are fabricated. It is important to understand that these technologies are simply tools utilized to design and fabricate these products but they play no role in the clinical assessment, biomechanical examination, and gait analysis that must be performed and interpreted by the qualified provider. An unqualified provider does not have the education, knowledge, or training to understand or differentiate among the various technologies, or recognize whether the orthopaedic product produced by them is appropriate.
Direct to Public Sales
With the advancement of technology and 3D printing specifically, fabrication companies are going directly to the consumer and bypassing the experienced healthcare provider. This raises a number of significant concerns such as:
- Who provides the clinical impression or medical diagnosis?
- Who performs the clinical assessment, biomechanical examination, and gait analysis to determine need?
- Who recognizes conditions that might be more sinister and require further investigation or other treatment?
- Who identifies, advises, and ensures appropriate treatment and compensations for joint, soft tissue, muscular, or neurological deficiencies or anomalies?
- Who ensures ideal casting posture?
- Who determines and provides the design, material, necessary components of the device (the orthosis prescription)?
- Who ensures the quality of the device?
- Who determines the appropriateness of the device?
- What happens if the device is uncomfortable, ineffective, or even detrimental?
- Who provides the footwear advice that is imperative to facilitate orthosis function?
- Who determines when the device needs modification or replacement?
Furthermore, advances in technology have enabled unqualified, unethical, and fraudulent providers to mislead plan members. Technology is impressive, but also confusing and overwhelming at times. Unqualified, unethical, and fraudulent providers can use technology to impress the public, enticing them into products and purchases that are unnecessary or even harmful. As technology plays an increasing role in the provision of these orthopaedic products, the importance of limiting provision to qualified providers becomes much more pronounced.
- offers clarity and helps to eliminate the current confusion by plan members as to who is qualified;
- prevents those providers who are unqualified and unethical from preying on unwitting plan members;
- raises the level of accountability of the qualified providers who risk losing their licence to practice and provide these orthopaedic products if they do not adhere to the Standards of Practice and Code of Ethics outlined by their Colleges; and
- enables the insurance industry to more effectively police, identify, and censure unethical or fraudulent providers within qualified professions.
Limiting provision to qualified providers who share a common understanding would take us a step closer to standardizing the information provided to insurers to validate claims for orthopaedic products. This will be imperative as automation increases and data mining software is used to analyze claims in the future.