O&P stakeholders press case on DTC model

WASHINGTON – The O&P Alliance has issued a statement opposing direct-to-consumer delivery of custom orthotics and prosthetics. 

The alliance, which includes the American Orthotic & Prosthetic Association, American Academy of Orthotists and Prosthetists, ABC, BOC and National Association for the Advancement of Orthotic and Prosthetic Patient Care, says such devices should be fitted by a licensed O&P professional as part of the overall plan of care. The direct-to-consumer model, they say, puts the patient at risk and exposes the health care system to inefficiency and waste.  

“When direct-to-consumer models fail, patients must seek qualified practitioners to obtain proper clinical care and restart the care process, which is wasteful and time-consuming,” the letter states. “Technology alone cannot make nuanced assessments that factor-in myriad complications, circumstances, and real-life demands of patients with limb loss and limb difference.” 

A bill in the House of Representatives, H.R. 1990, would among other things, restore the term “minimal self-adjustment” to more clearly define off-the-shelf orthoses; and prohibit the practice of “drop shipping” custom orthoses and prostheses, as well as off-the-shelf orthoses. 

The alliance says it: 

• Supports the delivery model that preserves the meaningful person-to-person relationship between the patient and an appropriately credentialed O&P clinician to ensure that the custom orthosis or prosthesis is appropriate, safe, and effective.  
• Rejects any direct-to-consumer delivery model for the provision of custom orthoses or prostheses that bypasses the critically important, direct relationship between the patient and an appropriately credentialed clinician. 
• Supports the use of technology to enhance the ability of qualified healthcare providers to deliver high-quality, clinically appropriate care, but does not believe that technological advances should replace the clinical expertise of the orthotist and/or prosthetist.  
• Recommends that third-party payers reject claims for orthotic and prosthetic care that do not meet current standards of clinical engagement in order to disincentivize the absence of safe and effective clinical care associated with direct-to-consumer models. 
• Encourages the enforcement of state O&P licensure laws requiring a licensed O&P practitioner to provide O&P care.