Dan Gottry - Blog

Dan Gottry's Blog

Friday, December 29, 2006

Hanger/Linkia ... "Does Not Play Well With Others"

A new year is upon us ... but some of the old battles remain.

I am grateful to CIGNA for allowing me to continue to receive quality of care through December 31st with my prosthetist. I had my last appointment today, having been fitted with a new socket. Current contracts not withstanding, I fully anticipate that they will allow me to continue to receive that care, in the new year, as needed.

For Hanger/Linkia, I offer my contribution to their annual report card ... "does not play well with others" ... but I guess they figure when they are the only game in town, that will matter very little.

The battle for quality options for O/P patients continues on this front although you might say it has entered a "quiet phase". The O/P list serve has become very resistant to communications on this critical issue. I'm sure the pressure has been overwhelming such that even posts that are much less than combative are censored.

A bad idea, however, is always a bad idea and time does not make it better ... time just makes it more evident. I am looking forward to a meeting with CIGNA personnel in a few days. We all know what the topic of discussion will be. I strongly believe that they are beginning to understand the error of their decisions.

A consequence of the limitations of the list serve is that it is more difficult to hear what others are experiencing. It is very helpful to hear what others are experiencing. If you have a story to share, send it to dan@gottrys.com. And, thanks to all of you who have already send your stories!

Happy New Year to each of you!

posted by Daniel Gottry at 1:53 PM | 0 comments

Tuesday, December 05, 2006

Consistent Quality of Care Through Hanger/Linkia

After Karen's * second surgery, her knee was placed in a cast by her doctor, to stabilize her knee. When the cast was removed, she was sent to a Hanger facility in Phoenix where she was under the care of a clinician in the process of meeting certification requirements. Her experience was a self-described "nightmare".

She was to receive a type of full leg brace and subsequently and AFO.

When she was fitted with the initial brace, she wasn't even able to wear it for the full ride home as it was too painful. She just assumed she just would need to "get used to it". It continued to get worse.

When she want back to be fitted with an AFO, she was told she did not need to have a new mold/cast made as it could be done off the old brace. Because the brace never fit, she requested a new mold/cast but that request was refused.

When she received the AFO, it fit so poorly that she was in fairly constant pain, had swelling in her ankle and could not support her own weight.

Karen had physical therapy for two months with no success and was fighting depression. She wrongly believed that it was her issue ... she just wasn't trying hard enough. The therapist suggested that perhaps the brace wasn't right but who was Karen to question the professional who fitted her?

Finally she returned to her doctor and saw the doctor's assistant. The assistant indicated that Karen's ankle appeared to have shifted.

The assistant sent to another professional immediately. She learned that the brace was actually the wrong type of brace for her needs. Months of therapy could not relieve her pain.

She was fitted with a new correct brace and, after walking for months with crutches or a walker, she was walking with one cane within less than a week and she continues to improve.

At this point, Karen continues to battle her insurance company (United Healthcare) as they will only cover one brace every three years. Her reasonable question is ... what if it is the wrong brace?

I guess that's a question that no one should have to ask.

* Patient's name has been changed for confidentiality

posted by Daniel Gottry at 8:35 AM | 1 comments

Independent Providers CAN Work Together!

My experience is that independent business men and women are generally just that ... independent! It was encouraging to last Friday to see 20 O/P independent business professionals from throughout Arizona in one room, addressing a common concern with mutual respect and incredible openness.

These 20 men and women came together, many driving for hours, to consider how they could strengthen their industry and their businesses by working together toward a common goal. They heard a very informative presentation by Jim Andreassen of OPGA/Point about the benefits, in changing times, of working in collaboration with those with common interests. He addressed the benefit of creating a cooperative network within the state of independent providers as well as the benefits of partnering with a national network to help them compete in a changing market. Both of these possibilities were met with a positive response!

The survival of independent O/P professionals is critical to the quality of care that patients will receive and I applaud the foresight of their thinking and their efforts.

For more information, visit www.gottrys.com/resources/

Daniel Gottry
Amputee

posted by Daniel Gottry at 7:38 AM | 0 comments

Friday, December 01, 2006

Is CIGNA Really Getting What it Pays For?

FYI ... I asked a friend (CPO) who had responded to me about David Sharma about the requirements and the actual situation and he responded with the following:

"David Sharma works at that office independently as the sign on the front door states. More so his name on the sign does not have credentials. It is my understanding this has been the case since their previous Certified Orthotist David Garcia has left Phoenix and was transferred to Yuma."

"We have a patient who was serviced by David Sharma, she was evaluated by him, casted by him, delivered by him, and was back for numerous adjustments by him. I have specifically asked her about this and she said she was never seen by anyone else in that office."

"Per Linkia's own words and per ABC requirements, a resident can only work directly under an ABC certified practitioner. Per my understanding and how I run a business, that does not mean someone in the building or down the road, that means directly under, or side by side, or shadowing, or assisting... in no way do I see independently as appropriate."

"The bold message states "David Sharma is not certified", that means he is a board eligible resident which per law mandates him to residency requirements. Maybe a call to ABC and NCOPE (National Commission of Orthotic Prosthetic Education) to verify this structure is needed. NCOPE's job is to monitor O&P residents and set their formal guidelines. Davis Sharma is not following the residency guidelines."

I agree that there is certainly "intent" in the requirements that is being skirted by Hanger.

I know a little more about this individual's situation. She was sent to my contact by her physical therapist who found that the device that Mr. Sharma created was so poorly fit it was hurting rather than helping her. She did not tell him anything the therapist said to see if they were in agreement ... when he gave her the same information, she then shared what the therapist has told her. Certainly appropriate supervision would have prevented that issue.

posted by Daniel Gottry at 7:22 AM | 0 comments

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 | 0 comments