Smith, Bucklin & Associates QUANTITATIVE SURVEY RESULTS For the BOARD FOR CERTIFICATION IN PEDORTHICS March 5 - 6, 1998.

Smith, Bucklin & Associates

QUANTITATIVE SURVEY RESULTS

For the

BOARD FOR CERTIFICATION INPEDORTHICS

March 5 - 6, 1998


QUANTITATIVE SURVEY RESULTS

These are the answers!

The findings of the Smith, Bucklin quantitative survey used a sample of 1,400 pedorthists.

535 responses were received (38 %).


RESEARCH OBJECTIVES

• Assess the needs of pedorthists.

• Understand the attitude of certificants towards BCP.

• Level of satisfaction with the benefits and services provided by BCP.

• Understand the benefits and services pedorthists value.

• Assist in identifying the strategic priorities of BCP.


PROFILE OF RESPONDENTSAge of BCP Members

2%

20%

37%

29%

9%3% 1%

0%5%

10%15%20%25%30%35%40%

<26 26-35

36-45

46-55

56-65

66+ n/ a

Age

A verage age = 43.7 years


PROFILE OF RESPONDENTSGender of BCP Members

Male85%

Female15%


PROFILE OF RESPONDENTSOwners vs. Non-owners/Employee

Owners51%

Non-owners49%


Q1. NUMBER OF YEARS SPENT FILLING PEDORTHIC PRESCRIPTIONS

<217%

3-417%

5-817%

9-1518%

16-209%

20+22%


Q1. NUMBER OF YEARS SPENT FILLING PEDORTHIC PRESCRIPTIONSBy Credentials/Certifications Currently Held

CO/ BOCO/ C.Ped CPO/ BOCP/ C.Ped

Total Only CP ROF DPM (C)

% % % % % %< 2 years 17 18 2 6 68 18-4 years 17 19 15 12 11 -5-8 years 17 14 32 14 11 18

9-15 years 18 16 18 33 - 916-20 years 9 9 12 15 - 1920+ years 21 23 18 20 11 36No Response - 2 - - -

Average # of Years 11.15 11.17 11.68 13.02 4.37 14.82(Base) (535) (345) (40) (66) (19) (11)


Q2. YEARS OF EXPERIENCE AS A CERTIFIED PEDORTHIST

<229%

3-427%

5-818%

9-1513%

16-205%

20+8%


Q2. YEARS OF EXPERIENCE AS A CERTIFIED PEDORTHISTBy Owner vs. Non-owner

25% 24%

16% 16%

8%11%

32% 30%

20%

11%

2%5%

0%5%

10%15%20%25%30%35%

<2 3-4 5-8 9-15 16-20 >20

Years

Owner Non-Owner


Q2. NUMBER OF YEARS EXPERIENCE AS A CERTIFIED PEDORTHISTBy Primary Practice Setting

Ped. O&P Hosp./ Phys. Shoe Shoe Total Facility Facility Clinic Office Store Repair

% % % % % % %< 2 years 28 18 30 38 41 20 51-4 years 27 25 34 22 29 21 95-8 years 18 22 18 22 21 15 239-15 years 13 19 10 10 6 14 616-20 years 5 6 2 2 - 14 320+ years 8 10 4 6 3 15 9No Response 1 - 2 - - - -

Average # of Years 6.87 8.31 5.22 5.64 4.22 9.92 5.64 (Base) (535) (132) (163) (50) (34) (118) (35)


Q3. CREDENTIALS/CERTIFICATIONS CURRENTLY HELD (By Primary Practice Setting)

Ped. O&P Hosp./ Phys. Shoe Shoe Total Facility Facility Clinic Office Store Repair

% % % % % % %C.Ped 94 95 92 90 91 97 94BOCO 11 4 28 4 6 - 3C.Ped(C) 7 8 9 10 3 5 6DPM 5 2 - 14 47 1 -CPO 4 1 13 - - - -CO 4 2 10 6 - - -ROF 4 5 7 6 - - -CP 3 1 8 - - 1 3BOCP 2 - 7 2 - - -PT 2 - 1 12 3 - -All Others 20 16 20 22 29 14 40


Q4B. WHERE PRESENT OWNERS AND NON-OWNERS SEE THEMSELVES IN 5 YEARS

89%

27%

6%

70%

4% 2%0%

20%

40%

60%

80%

100%

Owner's prediction Non-owner's prediction

As an ownerAs a non-ownerNo response


Q5A-B. PRIMARY PRACTICE SETTING NOW VS. WHERE SEE MOST C.PEDS IN FIVE YEARS

5%

6%

7%

9%

22%

25%

2%

3%

3%

9%

14%

46%30%28%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Other

Physician's office

Shoe repair

Hospital/ clinic

Shoe store

Pedorthic facility

O&P facility

Now Where see most C.Peds in 5 years


Q5B. FIVE YEARS FROM NOW, IN WHAT PRACTICE SETTING DO YOU SEE MOST C.PEDS? OTHER:

Medical health care/enhancement facility Nursing homes Combination shoe store and ped facility


Q6. CREDENTIALS PLANNING TO ADD DURING NEXT FIVE YEARSBy Age of Member

Total < 35 36-45 > 46% % % %

CO 13 20 14 7BOCO 11 14 15 7

C.Ped(C) 7 4 7 8BOCP 6 7 5 6CP 4 6 4 4CPO 4 5 4 3ROF 1 3 1 1DPM 1 2 1 -PT 1 2 1 -

Other(s) 6 9 6 5No Response 55 44 52 64

(Base) (535) (118) (196) (218)


Q9. LOCATION OF PRACTICE

Northeast26%

Midwest29%

West14%

Canada4%

South/Southeast

27%


Q10. AMOUNT OF IMPACT THE FOLLOWING FACTORS ARE HAVING ON THE PEDORTHIC PROFESSION

a) Managed care and the change in referral sources 83 %

b) State Provincial Licensure 36 %

c) The O&P profession 65 %

d) The podiatric profession 66 %

e) Other health care professions dispensing

orthoses, footwear, and modifications 65 %

f) Comfort footwear retailers 52 %


Q11. HOW DISPENSING OF PRESCRIPTION PEDORTHIC DEVICES IS DIVIDED BY THE AVERAGE BCP MEMBER

Shoes36%

Shoe Modifications

15%

Foot orthoses49%


Q12. SOURCE OF PRESCRIPTION-BASED PEDORTHIC REVENUE(Response by facility owners/managers only)

1 %

6 %

7 %

1 2 %

1 8 %

5 6 %

0 % 5 % 1 0 % 1 5 % 2 0 % 2 5 % 3 0 % 3 5 % 4 0 % 4 5 % 5 0 % 5 5 % 6 0 %

O t h e r

W o r k e r ' s C o m p .

H M O / M a n a g e d C a r e

3 r d P a r t y / P r i v a t eI n s u r a n c e

M e d i c a r e / M e d i c a i d

S e l f - p a y


Q13. PREDICTION FOR AMOUNT OF GROWTH OPPORTUNITIES FOR PEDORTHIC PROFESSION IN NEXT 5 YEARS

Increasing77%

Decreasing8%

Stay the same14%

n/a1%


Q14. OPINION OF STRATEGIC POSITION FOR PEDORTHIC PROFESSION REGARDING THIRD-PARTY REIMBURSEMENTSBy Member Opinion of How Third-Party Reimbursements Affect Business

Positively Negatively Affect Affect Their Their No

Total Business Business Effect% % % %

a) Take a position that actively seeks greater third-party reimbursement for pedorthics 65 73 66 55b) Take a position that moves the profession toward more self-pay reimbursement 18 11 21 26c) Remain at about the same level of third-party reimbursement as it is today 7 10 4 8d) Take a position that moves the profession away from third-party reimbursement 5 3 6 7No Response 5 3 3 4


Q15. AMONG MEMBERS WHO FEEL PEDORTHICS SHOULD SEEK GREATER THIRD-PARTY REIMBURSEMENT, RANKING OF OPTIONS

Ranked 1st or 2nd Ranked Ranked Ranked Ranked No (Net) 1st 2nd 3rd 4th Response

% % % % % %1. Educate referral sources about pedorthics 59 38 21 19 14 82. Attempt to convince regulators to add more pedorthic devices as covered items 49 22 27 25 18 83. For quality assurance purposes, request that providers of pedorthic devices meet minimum standards (via certification, education experience and/or inventory) 41 18 23 20 32 74. Attempt to convince regulators to increase reimbursement for pedorthic devices 35 15 20 28 28 8


Q16-17. HOW THIRD-PARTY REIMBURSEMENTS AFFECT BUSINESSNow vs. Prediction for five (5) years from now

34%

41%

23%

13%

40% 42%

3% 4%

0%5%

10%15%20%25%30%35%40%45%

Affect business now Will affect business in 5years

PositivelyNo effectNegativelyn/ a


Q18-19. IN REGARD TO 3RD PARTY REIMBURSEMENT ISSUES AND MEDICARE/ MEDICAID REGULATIONS AND POLICIES, SHOULD ADDITIONAL PEDORTHIC DEVICES BE ADDED IF CURRENT PRICING STRUCTURE...

8 7 %

6 1 %

w o u l d b eI N C R E A S E D ?

w o u l d b e T H ES A M E ?

% YES


Q20. LEVEL OF CONCERN REGARDING STATE/PROVINCIAL LICENSURE’S AFFECT ON THE PEDORTHIC PROFESSION

6 0 %

2 3 %

3 7 %3 0 %

7 %

0 %

1 0 %

2 0 %

3 0 %

4 0 %

5 0 %

6 0 %

7 0 %

V e r yc o n e r n e d /c o n c e r n e d

( n e t )

V e r yc o n c e r n e d

C o n c e r n e d N o t v e r yc o n c e r n e d

N o t a t a l lc o n c e r n e d


Q21. RANKING OF ACTIONS THE PEDORTHIC FIELD SHOULD TAKE REGARDING STATE/PROVINCIAL LICENSING LAWS/REGULATIONS

Ranked 1st or 2nd (Net) 1st 2nd 3rd 4th Resp. % % % % % %

1. Add pedorthics to state/provincial licensure, creating OP&P licensure (C.Peds would be licensed under separate standards as part of an O&P law) 59 32 27 21 9 12 2. Promote separate pedorthic state/ provincial licensure not in conjunction with O&P licensure 46 25 21 26 17 11 3. Add pedorthic definitions to O&P state/ provincial licensure (C.Peds would be licensed as part of O&P industry) 45 15 30 26 17 12 4. Exempt C.Peds from need to be licensed for foot orthoses(if shoes are not regulated) 30 19 11 15 43 12


Q22. WITH RESPECT TO PEDORTHIC PRESCRIPTIONS FILLED, AVERAGE PERCENTAGE OF PATIENTS REFERRED BY...

8 %

4 %

9 %

8 0 %

O t h e r

A n O & P f a c i l i t y

M a n a g e dc a r e / H M O

T h e p r e s c r i b i n gp h y s i c i a n


Q23. AT CURRENT REIMBURSEMENT LEVELS, LEVEL OF CONFIDENCE IN BEING ABLE TO PROVIDE ADEQUATE AND PROFESSIONAL SERVICE

63%

20%

43%

29%

5%

0%

10%

20%

30%

40%

50%

60%

70%

V eryconfident/confident

(net)

V eryconfident

Confident N ot veryconfident

N ot at allconfident


Q24. AS A C.PED, VALUE OF VARIOUS ASPECTS OF THE PROFESSION

Very Very Satisfied/ Very Dissatis- Dissatis- Satisfied Satisfied Satisfied fied fied (Net) (+4) (+3) (+2) (+1) (Base)

% % % % %a. State/provincial licensure 63 24 39 26 10 (535)b. Recognition by referral sources 96 76 21 2 1 (535)c. Standing within allied health community 96 65 30 3 1 (535)d. Recognition by patient 95 70 25 3 1 (535)


Q25. DOES CURRENT PRE-CERTIFICATION EDUCATION PROCESS PREPARE C.PED FOR ENTRY-LEVEL PEDORTHIC CARE

Yes52%

No46%

n/a2%


Q26. IF FEEL PRE-CERTIFICATION EDUCATION PROCESS DOES NOT ADEQUATELY PREPARE C.PEDS, AREAS THAT SHOULD BE IMPROVED

24%

32%

37%

42%

62%

76%

Other(s)

Pedorthic professionalresponsibility

Practice management

Patient management

Pedorthic assessment

Pedorthic techniques &applications


Q27. WOULD BE WILLING TO GO THROUGH ADDITIONAL EDUCATION/EXAMINATION TO EXPAND C.PED’S STANDARD OF PRACTICE

Yes70%

No29%

n/a1%


Q28. IN THE PRACTICE OF PEDORTHICS, WHAT TYPES OF ADDITIONAL SERVICES WOULD YOU LIKE TO BE ABLE TO PROVIDE FOR YOUR PATIENTS AS A C.PED?

- AFOs (57) - Currently provide - Compression stockings (12) all I need to provide. (17)- Ankle braces (8) - Above ankle bracing (6)- Knee braces (6) - Wound care (6)- Cam walkers (4) - Lower extremity - Nail care (4) physical therapy. (4)- Braces (4) - Gait analysis. (4)- KOs (3) - SMOs (3)- Below knee orthotics. (3) - Build orthoses without - Air casts. (2) prescription. (3)- Additional gait systems for lower extremity. (2)


Q29. SHOULD THERE BE A LEVEL OF CREDENTIALING FOR PEDORTHISTS WHO DO NOT PROVIDE PATIENT CARE, BUT INVOLVED IN FABRICATION/ TECHNICIAN WORK?

Yes59%

No40%

n/a1%


Q30. RATING OF THE VALUE OF FACULTY ACCREDITATION

Very Not Not at Valuable/ Very Very all Valuable Valuable Valuable Valuable Valuable (Net) (+4) (+3) (+2) (+1)

% % % % %1. Increase credibility to referral sources 70 35 35 20 82. Increase credibility of patients 66 31 35 24 83. Use as a marketing tool to managed care 73 35 38 17 8


Q31. SATISFACTION WITH VARIOUS ASPECTS OF BCP

Very Very Satisfied/ Very Dissatis- Dissatis- Satisfied Satisfied Satisfied fied fied (Net) (+4) (+3) (+2) (+1)

% % % % %a. BCP Board Structure 96 30 65 1 1b. BCP Administrative Staff 95 34 61 3 1c. Continuing Education Requirements 79 17 62 15 4d. Precertification Standards 72 13 59 21 4e. Faculty Accreditation Standards 79 11 68 14 3f. BCP Marketing of Profession 72 11 60 21 4


Q32. FEELINGS ABOUT THE COST OF MAINTAINING CERTIFICATION

54%

4%

50%

38%

7%

0%

10%

20%

30%

40%

50%

60%

70%

Veryreasonable/reasonable

(net)

Veryreasonable

Reason-able

Expensive Too expensive

Note: Owner and Non-Owneranswers were virtually the same


Q34. IF YOU WOULD LIKE TO SEE ADDITIONAL PROFESSIONAL ASSISSTANCE, WOULD YOU SUPPORT INCREASED FEES?

Yes18%

No41%

Maybe41%


Q35. RATING OF METHODS FOR MARKETING PEDORTHICS AND THE C.PED

(+4) Extremely important Extremely (+3) Important Important/(+2) Not very important Important No (+1) Not at all important (Net) (+4) (+3) (+2) (+1) Response

% % % % % %1. Exhibiting at medical and allied health conferences 96 54 42 3 * 12. Providing and placing articles on pedorthics in trade journals, public magazines and newspapers 93 53 40 6 * 13. Answering requests/inquiries from the public 93 38 55 6 - 14. Distributing free directories of C.Peds to medical communities and referral sources 88 43 44 10 1 15. Distributing free information on getting certified 49 12 37 45 6 1


Q36. RANKING OF AREAS OF PEDORTHICS IN WHICH BCP CAN HAVE THE GREATEST IMPACT AND SHOULD EXPAND EFFORTS

%1. Educating physicians to have C.Ped as part of the health care team 702. Informing managed care organizations about pedorthics 423. Seeking allied health referrals for C.Peds 264. Changing reimbursement levels for Medicare services 205. Educating the consumer regarding pedorthics and the C.Ped 186. Educating and providing materials to assist the C.Ped in marketing his/her practice 97. State/Provincial licensure 9


Q37. DO YOU BELIEVE C.PEDS WOULD BE BETTER SERVED IF ...

1. BCP remained the same. 54 %

2. BCP formed a collaborative alliance with another certifying agency. 29 %

3. BCP merged with another certifying agency. 13 %

4. BCP was managed by another administrative agency. 1 %

No Responses 5 %(multiple responses allowed)


Q38. WHAT DO YOU SEE AS THE PROS AND CONS OF AN ALLIANCE OR MERGER BETWEEN BCP AND ANOTHER CERTIFYING AGENCY?

PROS:

- Credibility (27) - Greater recognition. (26)- Cost savings. (16) - Stronger legislative practices. (14)- Strength in numbers. (10) - Increased visibility. (10)- More clout with bigger - More income. (7) organization. (8) - Sharing knowledge and cost - More cooperation for HMO would benefit everyone. (7) coverage as C. Peds are - More qualified referrals (5) accepted with group - Better service to patient. (4) (i.e. company’s & C. Peds). (6)- More credibility with Medicare reimbursement and physicians. (4)


Q38. WHAT DO YOU SEE AS THE PROS AND CONS OF AN ALLIANCE OR MERGER BETWEEN BCP AND ANOTHER CERTIFYING AGENCY?

CONS:

- Loss of identity (41) - Loss of control (28)- Loss of autonomy (11) - May dilute the field of C. Peds. (8)- Loss of focus (7) - Cost increases (5)- Higher dues (5) - Increased certification fees. (4)- Other agencies, such as ABC, placing greater priority on their members. (3)- Dependency on others who do not understand our needs. (2)


Q39. WHAT OTHER GROUPS AND/OR CERTIFYING AGENCIES SHOULD BCP CONSIDER FOR AN ALLIANCE OR MERGER

1. American Board for Certification in Orthotics and Prosthetics 49 %

2. American Orthopaedic Foot and Ankle Society 43 %

3. American Podiatric Medical Association 26 %

4. American Orthotic and Prosthetic Association 26 %

5. Pedorthic Association of Canada 22 %

6. Board for Orthotist Certification 21 %

7. National Commission on Orthotic and Prosthetic

Education 12 %

Others 4 %

No Response 14 %(multiple responses allowed)


MAIN FINDINGSThe Demand for Government Relations

At present, 34 percent of BCP certificants feel third-party reimbursements positively affect business, 23 percent feel third-party reimbursements have no effect on business, and 40 percent feel third-party reimbursements negatively affect business. In five years, 41 percent of BCP certificants feel third-party reimbursements will positively affect business, 13 percent feel third-party reimbursements will have no effect on business, and 42 percent feel third-party reimbursements will negatively affect business.


MAIN FINDINGS

• The industry is growing.

• The practitioners are “young”.

• The certificants are satisfied - no major changes or mergers are desired.

• There is a demand for - Government Relations - Education

- Marketing

• Members are ready to pay more for additional substantive member services.


MAIN FINDINGSGeneral

The average BCP certificant is 44 years old, and the range of ages is normally distributed.

Eighty-five percent of BCP certificants are male.

More than three-quarters of BCP certificants feel there will be an increasing amount of opportunities for growth in the pedorthic profession in the next five years. This opinion was relatively consistent across various segments and demographics of BCP certificants.


MAIN FINDINGSThe Demand for Changes or Mergers

Fifty-four percent of BCP certificants feel BCP would be better served by remaining the same, versus 29 percent who feel BCP should form a collaborative alliance with another certifying agency and 12 percent who feel BCP should merge with another certifying agency.


MAIN FINDINGSBCP - Administration Level of Satisfaction & Costs

BCP certificants are very satisfied with BCP Board structure and BCP administrative staff.

Only four percent of BCP certificants feel the cost of maintaining certification is ‘Very Reasonable’, though 50 percent feel the cost is ‘Reasonable’. Forty-five percent feel the cost is ‘Expensive’ or ‘Too Expensive’.


MAIN FINDINGSBCP - Administration Level of Satisfaction & Costs

Among those BCP certificants who would like to see BCP provide administrative assistance that is not already provided, 18 percent would definitely support increased fees for the assistance, while 41 percent said maybe.


MAIN FINDINGSThe Demand for Marketing

While not necessarily rated poorly, satisfaction with BCP’s marketing of the profession was rated lower than other aspects of BCP.

As a C.Ped, approximately 95 percent of BCP certificants feel recognition by referral sources, their standing within the allied health community, and recognition by patients are ‘Very Valuable’ or ‘Valuable’.



When asked about various factors impacting the pedorthic profession, the following percentages of BCP certificants indicated these factors are having ‘Great Deal’ or ‘Fair Amount’ of impact: %

a. Managed care and the change in the referral system 83b. The Podiatric profession 66c. The O&P profession 65d. Other healthcare professions dispensing orthoses, footwear, and modifications 65e. Comfort footwear retailers 52f. State provincial licensure 36



Based on responses from facility owners/managers only, on average, 56 percent of prescription-based pedorthic revenue is from self-pay, 18 percent is from Medicare/Medicaid, and 12 percent is from third-party insurance.

Sixty-five percent of BCP certificants feel the pedorthic profession should take a strategic position that actively seeks greater third-party reimbursement for pedorthics, while 18 percent feel the profession should move toward more self-pay reimbursement.



Today, BCP certificants feel that 3rd party reimbursement effect the business.....

Positively34%

No Effect23%

Negatively40%



In five years, BCP certificants feel that 3rd party reimbursement will effect the business.....

No Effect13%

Positively42%

Negatively41%



Sixty percent of BCP certificants are ‘Very Concerned’ or ‘Concerned’ about the effect of state/provincial licensure on the pedorthic profession.

Among options for actions which the pedorthic profession should take regarding state/provincial licensing laws and regulations, the highest ranked option was to add pedorthics to O&P state/provincial licensure, creating O&P licensure (C.Peds would be licensed under separate standards as part of OP&P law).



With respect to pedorthic prescriptions filled by BCP certificants, on average, 80 percent are referred by the prescribing physician.

Sixty-three percent of BCP certificants feel they are ‘Very Confident’ or ‘Confident’ they can provide adequate and professional service at current reimbursement levels.



Among the 65 percent of BCP certificants who feel the pedorthic profession should take a strategic position that actively seeks greater third-party reimbursement for pedorthics, most feel the most important role is to educate referral sources/HCFA about pedorthics, followed by attempting to convince regulators to add more pedorthic devices as covered items.


MAIN FINDINGSThe Demand for Education

Only half of BCP certificants feel the pre-certification education process prepares the C.Ped for entry-level pedorthic care. Among those who do not feel the pre-certification education process prepares the C.Ped for entry-level pedorthic care, the areas cited for most improvement are pedorthic techniques/applications, followed by pedorthic assessment.

Seventy percent of BCP certificants would be willing to go through additional education/examination to expand the C.Ped’s standards of practice.


MAIN FINDINGSThe Demand for Education

Fifty-nine percent of BCP certificants feel there should be a level of credentialing for pedorthists who do not provide patient care, but are involved in fabrication/technician work.

In general, BCP certificants all find a high level of value of facility accreditation for increasing credibility of referral sources, increasing credibility to patients, and using the accreditation as a marketing tool.


MAIN FINDINGSThe Demand for Education / Marketing

When asked to rank the areas of pedorthics in which BCP can have the greatest impact and should expand efforts, the highest ranked area was educating physicians to have C.Ped as part of the health care team, followed by informing managed care organizations about pedorthics.


MAIN FINDINGSThe Demand for Marketing

When asked the importance of various methods for marketing pedorthics and the C.Ped, the following percentages of BCP certificants indicated these methods were ‘Extremely Important’ or ‘Important’: %

a. Exhibiting at medical and allied health conferences 96b. Providing and placing articles on pedorthics in trade journals, public magazines and newspapers 93c. Answering requests/inquiries from the public 93d. Distributing free directories of C.Peds to medical communities and referral sources 88e. Distributing free information on getting certified 49

Smith, Bucklin & Associates QUANTITATIVE SURVEY RESULTS For the BOARD FOR CERTIFICATION IN PEDORTHICS March 5 - 6, 1998.

Documents

bucklin associates q2

bucklin associates q5a

bucklin associates q3

bucklin associates q4b

bucklin associates q6

bucklin associates q9

bucklin associates q10

bucklin associates q5b