xxx 1999


Accrediting Rehab Programs Through CARF

By Terry Supan, CPO

Last year was my first year as the Academy trustee on the Commission for Accreditation of Rehabilitation Facilities (CARF). And this is the 10th year that the Academy has been a sponsoring organization of CARF.

CARF is a multidisciplinary group that accredits programs internationally in medical rehabilitation, behavioral health, employment and community services, and adult day services.

The programs in medical rehabilitation are the ones that affect orthotists and prosthetists. Unlike the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the ABC facility accreditation committee, both of which accredit organizations, CARF accredits specific programs within an organization.

Thus, a rehab hospital can choose which of its programs achieve CARF accreditation. The loss of CARF accreditation can mean the closing of a program or business, because some states require it before they will pay for services.

Early this year, CARF and JCAHO reached an agreement to proceed with a joint accreditation process for the next couple of years. What impact this will have on O&P practices is unknown.

It should lessen the burden of multiple site visits. And, since they have set this precedent, it may mean that either or both will be more willing to work with ABC and recognize its facility accreditation program.

CARF has begun the process of receiving deemed status from HCFA for its Comprehensive Outpatient Rehabilitation Facility (CORF). Current HCFA regulations require ABC accreditation for both prosthetics and orthotics within a CORF. Because of the turmoil surrounding the prospective payment system within skilled nursing facilities and the subsequent reduction of CORFs, this project is now on hold.

The changes in the 1999 Medical Rehabilitation Standards that were passed by the CARF board in August 1998 would not have any major impact on orthotists and prosthetists.

The national advisory councils in spinal cord and brain injury programs allowed our profession to have some input in the process this year. Darrell Clark, CO, attended the Spinal Cord Injury National Advisory Council meeting this winter, and I have been monitoring both programs.

Until the 1995 Medical Rehabilitation Standards were published, only ABC credentials were recognized by CARF. That year, the glossary of terms changed to include BOC-accredited orthotists. However, the 1999 standards still only recognize ABC credentials for prosthetists.

Last fall, BOC requested that its accredited prosthetists receive the same status with CARF as CPs and CPOs, and that the glossary of terms be modified to match the current definition for orthotists. The matter was referred to the standard committee’s medical rehabilitation subcommittee.

Because BOC presented its case to the CARF board, I was given an opportunity to respond to its claims before the subcommittee. Most of what I said would not be new to any of you. The material presented included the international standards for Category I O&P personnel as defined by the International Society of Prosthetists and Orthotists and the World Health Organization. Also presented was the fact that five states in the U.S. require licensure for orthotists and prosthetists, but none of those states uses the BOC test for any state licensure examination.

The subcommittee appointed an ad hoc fact-finding committee that subsequently reported to the board at last April’s meeting. It was decided not to recognize BOC-accredited prosthetists.

Further, CARF has decided to take a neutral position on all national professional accreditation boards and, instead, cite national, state and provincial statutes and national educational standards. Besides our profession, 14 others will be affected by this decision.

The revision of the glossary at the board meeting last month coincided with the approval of new standards for spinal cord injury and traumatic brain injury.

The Academy’s goals within CARF for the remainder of the year are to:

  • educate more of the members of the board and staff on what the role of O&P is in the overall rehabilitation process;

  • create coalitions to better position O&P for any future votes within CARF; and

  • establish working relationships between CARF and ABC on facility accreditation and outcome studies.

Through our activities with CARF, we hope to further enhance our status with other health professions.

Terry Supan, CPO, is the director of orthotic and prosthetic services at the Southern Illinois University School of Medicine in Springfield, Ill. He also serves on the board of directors of ABC.