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Business Issues in O&P

Business Issues in O&P. John French, M.S.Ed., C.O., L.O. P&O Program University of Texas Southwestern Medical Center Dallas, 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?

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Business Issues in O&P

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  1. Business Issues in O&P John French, M.S.Ed., C.O., L.O. P&O Program University of Texas Southwestern Medical Center Dallas, Texas

  2. 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?

  3. 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.

  4. Why Worry About Business Issues? • 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.

  5. Where will P&O students get this information? Whose job is it? • School Programs • Residency Experience • Employer – On the job

  6. 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

  7. 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?

  8. Identifying Issues • Introduction • Billing & Coding • Health economics system • Business economics • Employment issues • Practice improvement • Roles and responsibilities

  9. Introduction • Rationale • Terminology • Integrity + Ethics • Patient relations • Documentation

  10. 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

  11. Billing & Coding • Fraud & abuse – guest experts HHS OIG Special Agent Asst US Attorney Evidence room items Local 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”

  12. 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

  13. 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

  14. Business economics • Practitioners will work for a business • Practitioners will operate a business • Practitioners will interact with other businesses • Suppliers • Competitors • Referral sources

  15. 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

  16. 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

  17. 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

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

  19. Practice improvement • Professional organizations • Licensure • Continuing education • QA vs. QI • Cross-discipline issues teams, collaboration, infringement, scope of practice

  20. 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

  21. 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

  22. Questions?

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