The Case for Customer Service

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By Karen Henry

The first step to healing, as the saying goes, is admitting you have a problem. Three years ago, Joe Sansone, president of TMC Orthopedic in Houston, Texas, found out he had a big problem.

With six locations throughout the city, TMC Orthopedic provides bracing, prosthetics, CPM/cryotherapy, allograft tissue, and electrotherapy products and services to patients in the greater Houston area. A businessman by trade, Sansone says he has always allowed the healthcare market to dictate the types of products and services his company offers, so TMC has run the gamut from providing durable medical equipment (DME), spinal instrumentation, and total joints to complete O&P products and services. Realizing the potential profit in the provision of prosthetic services, Sansone decided to conduct a focus group of ten prosthetic patients to determine how to meet their needs and boost prosthetic sales.

Peer visitor Jody Wallace explains The Amputee and Prosthetic Center's programs to patient Richard Lockley.
Peer visitor Jody Wallace explains The Amputee and Prosthetic Center's programs to patient Richard Lockley.

One of his sales representatives spent an hour and a half with the focus group and came out with an unexpected verdict.

"They hate us," Sansone recalls his sales representative saying. "Nobody in there is happy with us. Nobody in there is happy with anybody. It's just a room full of dissatisfied patients."

Sansone couldn't bring himself to address his company's patients. He stepped back, tail between his legs, and thought long and hard at what it was he was really trying to accomplish with the prosthetic side of his business. "I had gotten involved in prosthetics years ago just as an added side business," he says. "I hired a prosthetist, he fit patients, and I never bothered to look into it further. Life just went on."

Sansone was at a crossroads. He could take the easy road and continue with business as usual-after all, his profit per patient was high and the level of care his company was providing wasn't worse than anyone else out there-or he could invest time and resources to find ways to address his patients' needs. Self-described as "a guy who goes against the grain," Sansone decided to take the road less traveled.

He began by conducting telephone interviews with prosthetic patients. The results from the focus group were roundly confirmed-patients' needs just weren't being met.

"For the first time ever, I was able to look at prosthetic services from a patient's perspective," Sansone says. "What would it be like if I found out today that I was losing a limb tomorrow and had to deal with a company like mine? When I did that, it really opened my eyes."

A component of the Amputee and Prosthetic Center's program involves a close relationship between patient advocates and their patients. Here patient advocate Holly Urban reviews financial information with patient Robert Mayo.
A component of the Amputee and Prosthetic Center's program involves a close relationship between patient advocates and their patients. Here patient advocate Holly Urban reviews financial information with patient Robert Mayo.

What he had uncovered wasn't so much an indictment on O&P patient care alone as it was an indictment on the entire continuum of care-from the primary care physician and the orthopedic surgeon to the physical medicine and rehabilitation (PM&R) physician and the O&P professional. Each physician was performing his separate role, but amputees were often bounced from one to another. Patients had two main complaints. First, they felt that nobody was listening to their needs, and second, they felt like they had no continuity of care. "Nobody in the entire assembly line of care has time to deal with patients and their emotional needs," Sansone says. "It was the prosthetist's job to fit the patient with a limb and go on to the next one. That mindset would just not work. So we worked on developing a program that would enable us to meet all of our patients' needs in addition to the provision of a prosthetic device."

Starting Over

The first step in the transition process was to open a new division of TMC Orthopedic-The Amputee and Prosthetic Center. Sansone rebuilt TMC's prosthetic division from the ground up, with each building block designed to provide its customers-patients and referral sources alike-with the best service possible. Among the first steps he took was to create two new positions: patient advocate and peer visitor. The patient advocate's job is to listen to the patient, help educate the patient, and act as a liaison between the patient and the practitioner.

"A practitioner might say, 'But it's my job to listen to the patients', while a business man might say, 'These practitioners are busy. They need to move on to the next patient. I can have someone else to do that," Sansone says.

Sansone's program allows for the prosthetist to do his job efficiently, while ensuring that the patient's needs are met. Every new patient at The Amputee and Prosthetic Center is assigned a patient advocate, and in most cases, the patient advocate is the first person a patient sees. Once the advocate has determined the patient's concerns, needs, and expectations, the prosthetist can then sit down with the patient and develop a treatment plan that is tailored to meet his or her needs and expectations.

When a patient first learns that he or she has or will be losing a limb, the patient's anxiety level is understandably high. As early as possible, each patient will be seen by a peer visitor, someone who has also had an amputation and can help the patient cope and see that life is not over after an amputation. "Our goal as a company is to fast-forward our patients' anxiety levels to however many months down the road when they see that everything is going to be okay," Sansone says.

New People, New Protocols

A chain is only as strong as its weakest link, and Sansone knew he needed to strengthen The Amputee and Prosthetic Center chain. So in addition to creating new positions, he brought in several new prosthetists as well as a new fabrication staff. He instituted a rigorous hiring process to ensure that each new employee-regardless of position-is a good fit for The Amputee and Prosthetic Center and vice versa.

Qualified applicants must pass a problem-solving and a written test before continuing with the interview process. Potential employees are brought in for a minimum of two personal interviews, and once a finalist has been selected, he or she is invited to spend at least one day working at TMC to make certain the match is a good one.

"Its not uncommon for us to take 30 to 60 days to hire an hourly employee," Sansone says. "But when we do hire someone, we know we have the best of the best. As for practitioners, I'll wait as long as it takes until I find the best one."

Ben Falls, CP, evaluates microprocessor knee patient Richard Lockley.
Ben Falls, CP, evaluates microprocessor knee patient Richard Lockley.

All Amputee and Prosthetic Center employees follow an established set of protocols that are designed to make sure that patients' needs are met and that there is a consistent level of care and communication. For example, Sansone says The Amputee and Prosthetic Center has protocols for what to do for a patient at specific milestones after his or her amputation "to make sure our patients are never forgotten." There are protocols to address every situation as well as every problem the company has encountered over the years.

"What do you do when a patient loses funding?" Sansone asks. "What do you do when you can't get a letter of medical necessity?" For every problem, there are procedures to follow as well as guidance on how to prevent the problem from recurring. "So now if I lose an employee, I don't have to reinvent the wheel," Sansone says.

New Services

An integral part of The Amputee and Prosthetic Center's program is the education and resources that patients are given. "When you buy a car, you get a one-inch thick manual about the vehicle. But three years ago, we would give a patient a limb, and that patient would receive no printed materials on the care of that limb," Sansone says. "Unfortunately, this seems to be the norm for our industry." Today, The Amputee and Prosthetic Center boasts an impressive library with more than 100 books and resources devoted to educating patients about becoming an amputee. Staff members are required to provide certain educational materials to patients at various milestones in the patients treatment plan. In addition, TMC pays for each new patient to become a member of the Amputee Coalition of America (ACA).


Given the wide array of new employees and patient services that The Amputee and Prosthetic Center offers, Sansone says his profit per patient has been dramatically reduced. However, he adds that his total revenue and billing have increased.

"I struggled early on with balancing the 'greed for profit' and our standard level of service, but truly what caused my revelation was seeing the result of insufficient patient care," he says. "I felt somewhat hypocritical balancing the desire for profits with the needs of the patients. What made me at peace with this scenario was deciding that I needed to put the patient first. I have to know that if and when I put the patient first, the dividend will be an increase in referrals. I have to know that profits will always be there because were taking care of our patients. Thats the most important component of our recent successes." 

Karen Henry can be reached at