title: Suggested Guidelines for the Prescription of Orthotic Services, Device Delivery, Education, and Follow-up Care: A Multidisciplinary White Paper.
abstract: OBJECTIVE
  This article establishes needed guidelines for determining orthotic prescriber authority, documenting medical necessity, and ensuring continuity of care for patients needing orthoses. It also identifies "off-the-shelf" (OTS) devices that can safely and appropriately be delivered to patients without professional adjustment as well as those that cannot.
  
  
  METHODS
  A multidisciplinary task force made up of experts in orthopedics and physical medicine physicians, along with therapists and certified orthotists, applied a consensus approach to answer key questions: (i) When can a device be safely, effectively delivered to the patient OTS without professional guidance or education, and which caregivers have a role in that decision? (ii) What documentation is appropriate for physicians and other caregivers to determine medical necessity? (iii) What documentation/communication ensures continuity of care among physicians, therapists, and orthotists?
  
  
  RESULTS
  Guidelines developed for consideration of OTS orthoses include accepting documentation from collaborating caregivers, including therapists and orthotists; keeping that documentation as part of the patient's total medical record for clinical, medical necessity determinations and reimbursement purposes; and using the physician's prescription for the device as the key determinant of whether a device is delivered OTS or as a custom-fitted device.
  
  
  CONCLUSIONS
  This review provides expert guidance for patient safety, minimizing wasted expenditures, maximizing clinical outcomes, and providing efficient delivery of care for Medicare and other patients. Centers for Medicare and Medicaid Services guidelines should be directed toward recognizing the level of expertise of the orthotist, the value of their patient encounters, and their role in facilitating the timely, safe, and effective use of orthotic devices.
authors.affiliation: Southern Illinois University School of Medicine, 4 Key West Drive, Saint Helena Island, SC 29920.
authors.forename: John R
authors.initials: JR
authors.lastname: Fisk
authors.affiliation: University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA 90089.
authors.forename: Sharon
authors.initials: S
authors.lastname: DeMuth
authors.affiliation: Becker Orthopedic, 635 Executive Drive, Troy, MI 48083.
authors.forename: James
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Hanger Clinic, 11155 South Main Street, Houston, TX 77025.
authors.forename: Thomas
authors.initials: T
authors.lastname: DiBello
authors.affiliation: MossRehab, 60 Township Line Road, Elkins Park, PA 19027.
authors.forename: Alberto
authors.initials: A
authors.lastname: Esquenazi
authors.affiliation: Hanger Clinic, 10 County Line Drive, Cromwell, CT 06416.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lin
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, 2300 North Childrens Plaza No. 46, Chicago, IL 60614-3363.
authors.forename: Bryan
authors.initials: B
authors.lastname: Malas
authors.affiliation: MedStar Georgetown University Hospital, 3800 Reservoir Road, Northwest, Washington, DC 20007.
authors.forename: Francis X
authors.initials: FX
authors.lastname: McGuigan
authors.affiliation: American Orthotic and Prosthetic Association, 330 John Carlyle Street, Suite 200, Alexandria, VA 22314.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Fise
mesh_terms: D000359:Aftercare / Q000592:standards*; D059019:Clinical Coding; D003266:Continuity of Patient Care / Q000592:standards*; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards*; D006801:Humans; D006278:Medicare; D009985:Orthopedics; D009989:Orthotic Devices / Q000191:economics / Q000592:standards*; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014481:United States