Navigating the Uncertainties of Healthcare Policy

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By Andrea Spridgen

As we begin the new year, many are closely watching federal healthcare policy, which seems to shift daily, as well as adjusting to changes in our own insurance coverage that may have come with a new plan year. As we watch and anticipate how these changes may affect us on a personal level, we also look at how trends in the broader healthcare conversation will impact the O&P profession, such as those that affect essential health benefits that had been a key driver in ensuring O&P coverage within the private health insurance market. Although the shifting landscape understandably is causing some anxiety, in this issue we look at ways in which O&P practitioners and business owners can navigate the uncertainties by controlling documentation, informing themselves about changes that are impacting other healthcare professions to understand possible implications for O&P, and finding ways to influence future policy developments.

Third-party reimbursement policies, whether from the Centers for Medicare & Medicaid Services (CMS) or private insurance companies, are out of practitioners' control. However, as our experts point out in "Hitting the Mark With Documentation When Healthcare Policy Is a Moving Target," O&P practitioners can ensure that they provide thorough, evidence-based documentation that gives them the best chance of getting claims paid, despite tighter guidelines for O&P care. In addition, the experts encourage practitioners to work with and educate physicians about the notes they need to have in patients' records to ensure optimal O&P outcomes for their patients.

As policymakers search for methods to control costs and measure treatment efficacy against expenditure, CMS continues to roll out new payment models. Although the transition to value-based reimbursement has not yet extended to therapists and O&P practitioners, understanding the models being implemented within the physician, nurse practitioner, and related disciplines can provide insight into possible implications in O&P reimbursement and position the profession to be prepared to respond. "MIPS: Medicare's Strategy to Reimburse for Value Over Volume" looks at one such reimbursement program and its potential expansion.

Amidst changes and uncertainty in policy, we often think of the changes in regulations and philosophies behind policymaking as something that happens to us, rather than something in which we participate. In "Healthcare Policy: Where It Comes From and How to Change It," John T. Brinkmann, MA, CPO/L, FAAOP(D), explores how understanding the source of policy origination can help us be active participants in shaping policy in the future.

The future may be uncertain, but as the O&P profession continues to unite to provide quality care for patients, I think the outlook is bright. Happy New Year to you, our valued readers.