Dan Gottry - Blog

Dan Gottry's Blog

Friday, December 01, 2006

CIGNA Responds to Questions about David Sharma

Thanks to CIGNA for researching the situation with David Sharma by contacting a Linkia representative.

They were informed that "there are 4 certified prosthetists supporting that location." These include Jack Uellendahl, Randy West, Lori Pipinich and Todd Sheridan, who are each certified with ABC.

While there is no indication at David Sharma's site that they have an involvement (since he is listed as the only "clinician", CIGNA states that Jack Uellendahl, Randy West and Lori Pipinich "also" work at another location.

They confirm that "David Sharma is not certified at this time; however, he is currently in the certification process. In accordance with the American Board for the Certification of Orthotics and Prosthetics guidelines, a practitioner that is not certified can provide care under the direction of a certified practitioner. This requires a sign-off of clinical notes."

The fact does remain that his facility is not listed as an accredited site, something that appears to be in opposition to Linkia's stated requirements.

The ABC requirements, as per the written intent of the standard, go a little further than a simple sign-off. They state:

PC.3: Orthotic and prosthetic care is the responsibility and is provided by or under the direction and appropriate level of supervision of an ABC credentialed, and where appropriate, licensed practitioner staff member.

StdIntent: The underlying foundation of quality orthotic and/or prosthetic care is the provision of care by qualified practitioners. Thus, PC.3 requires that all such care be the responsibility of a certified practitioner. While aspects of patient care may be directly provided by another individual, it must only be delivered under the explicit direction of a certified practitioner.

As used in the ABC Scope of Practice and incorporated herein, the term "indirect supervision" denotes that the care giver is qualified to provide patient care independent (indicating that the individual so supervised, is competent to work with a patient without the immediate presence of the clinical supervisor in the room) of the designated clinical supervisor; however, the supervisor must review and countersign all entries in the patient's clinical record within 15 working days following the delivery of care.

The supervisor must be physically available for consultation within 60 minutes during the delivery of care.

PC.3.1: Non-credentialed or licensed staff may be privileged by the ABC credentialed practitioner to provide patient care according to written objective criteria based on the ABC Orthotics and Prosthetics Scope of Practice.

StdIntent: The underlying foundation of quality orthotic and/or prosthetic care is the provision of care by qualified practitioners. Thus, PC.3 requires that all such care be the responsibility of a certified practitioner. While aspects of patient care may be directly provided by another individual, it must only be delivered under the explicit direction of a certified practitioner.

As used in the ABC Scope of Practice and incorporated herein, the term "indirect supervision" denotes that the care giver is qualified to provide patient care independent (indicating that the individual so supervised, is competent to work with a patient without the immediate presence of the clinical supervisor in the room) of the designated clinical supervisor; however, the supervisor must review and countersign all entries in the patient's clinical record within 15 working days following the delivery of care.

The supervisor must be physically available for consultation within 60 minutes during the delivery of care.

Because the locations are within a couple of miles, it is possible that a supervisor would be physically available within 60 minutes but I question whether care in this situation is delivered "under the explicit direction of a certified practioner." This, I believe, would require a greater presence than appears to be the case.

Questions that remain, from my communication with CIGNA include:

1. Is Linkia firmly abiding by its own standards?

2. While the situation with David Sharma may be explainable, in all other cases where they have chosen to make exceptions to the accreditation standards, such as Jackson, Tennessee, do all of their non-certified practitioners operate "under direct supervision" and have a supervisor available for consultation within 60 minutes?

3. Is their agreement with Linkia truly non-exclusive, as indicated by Hanger's CEO in the O&P Edge?

4. Why is McCleve O&P is still under contract with CIGNA in this area while others have had their contracts terminated?

I have requested from CIGNA the name and contact information on the individual ultimately responsible for the O/P contract decisions but await their response to this request.

posted by Daniel Gottry at 6:41 AM