Expanding on an O&P Business Model

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By Angela La Voie


When Jeff Brandt, CPO, opened Ability Prosthetics & Orthotics, Gettysburg, Pennsylvania, in 2004, he did not expect his business to expand at the rate it has, but he always had much more than a single-facility practice in mind. This year, he opened his 11th patient care facility and employs 17 practitioners among all of them. Today, Brandt is positioning the company for the future.

Ability's business model focuses on customer care while outsourcing or streamlining other services. For example, Ability outsources 100 percent of its fabrication.

Brandt points out that when outsourcing device fabrication, the practitioner must front-load all variables within the design, rather than rely on the convenience of tweaking the device in the lab.

Employees at the Mechanicsburg, Pennsylvania, office in 2012. Photographs courtesy of Ability Prosthetics & Orthotics.

Since most of Ability's vendors are connected to OPIE Software, Gainesville, Florida, the system used by all locations, orders are submitted electronically. Two days later, the patient is back in the office for an alignment.

"At Ability, the practitioners design the brace-they are not making it," says Brandt, who is also Ability's CEO and president. "We primarily assemble [rather than fabricate from raw materials] on-site," Brandt says. "We have small labs with everything in them except for an oven."

Even if the tradition of O&P is rooted in the practitioner as a craftsman and family-based businesses, patients don't share that expectation, he explains.

An Ability Practioner meets with a patient.

Paraphrasing the responses Brandt receives when he asks patients about this, he says, "I wouldn't expect my eyeglasses or my dentures to be made on-site, so why should I expect my prosthetic limb to be made here?"

Manufacturing devices off-site is better for patients, Brandt contends. Ability's approach emphasizes repeatability and consistency so that the patient can get the same device again in five years, if needed. He says that the devices are made from specifications that are logged and can be replicated within the brand for a single device, regardless of employee turnover; they are not made based on verbal orders. "We're not telling the patient, 'your technician is no longer here so your device may be a little different,'" Brandt says. "It elevates us as professionals."

Communication is another aspect of the Ability model. Each office is staffed by a managing practitioner and a patient care coordinator (PCC), who coordinate administrative functions with Ability's corporate office in Gettysburg. The staff at each facility handles all patient communications for its own location.

"We never tell patients to call corporate. We tell them that if they have a question to please call the office at which they are seen," Brandt says.

The day a patient is seen in an Ability office, the practitioner reviews a preliminary, ballpark estimate of the device charges in addition to discussing clinical information with the patient. While practitioners are not trained in the details of insurance billing, they have a general understanding of the charges for a particular device based on the patient's insurance and what they've seen in the past. This gives the patient the opportunity to begin a dialogue with the practitioner if he or she has any questions.

At the conclusion of the visit, the practitioner reviews the preliminary estimate with the PCC. The PCC coordinates billing and authorization with the corporate office, where these functions are centralized with one employee dedicated to each area for all locations using central computer systems-OPIE for patient data and Quickbooks Enterprises for accounting. In roughly two days, the PCC is able to call back the patient to discuss the actual charges.

Practitioners practice answering patient questions through role-play scenarios to give them more confidence when addressing specific patient concerns.

"If you balk at a patient question, it plants a seed of doubt about the practitioner," Brandt says.

Similarly, communication skills are a key feature Brandt looks for when interviewing potential practitioners.

"Interview candidates ask me whether I want to see them buff an AFO," Brandt says. "I want to see them communicate with a patient. I want to know [how] they communicate with a physician who calls with a question about a patient," he explains.

Even though Ability practitioners are separated geographically, from Pennsylvania to South Carolina, they often communicate with each other.

"I may speak with a practitioner who tells me he spoke with four or five other practitioners that day, kibitzing on a design, for example," Brandt says.

The company also brings employees together in person several times a year. Four times a year, the northern offices all get together and the southern offices all get together. Once a year, the employees at all of the locations convene.

Despite the company's rapid growth, Brandt takes a cautious tone about too much growth. "If we get outside our mission, then it's time not to grow."

For right now, Brandt says that he wants the 36 people employed at Ability to be "as happy as can be and as satisfied in their jobs as they can be."

Becoming an Outcomes-Based Practice

While future growth is always a possibility at Ability, Brandt is currently focused on implementing an outcomes-based model across all Ability offices. The goal is to make the assessment more objective and ensure that the patient receives the right device. Beginning in May 2012, all patients who have recently had an amputation are being evaluated using the amputee mobility predictor (AMP). The AMP has a strong correlation to Medicare's K levels, which dictate the level of technology that will be prescribed for the patient.

"It takes an additional 15 minutes with the patient, but the time is well-spent," says Brian Kaluf, CP, managing practitioner in Ability's Greenville, South Carolina, office.

Ability has also standardized the use of the prosthesis evaluation questionnaire across all relevant patients and is looking to add other widely accepted outcome measures.

"Patients get the most appropriate device and are not underprescribed or over-prescribed through an evaluation process that becomes more objective," he says. It also improves Ability's quality of documentation and readiness for an audit by Medicare or another party.

Anecdotally, this evaluation methodology has resulted in improved care for patients. Kaluf points to the example of a patient he saw earlier in the year. Kaluf forwarded the patient's AMP score and specific problem areas to the patient's home health therapist. This information gave the therapist a roadmap for areas to focus on in the patient's therapy.

"It's changed the way we interact with our referral sources as we can share the scores on standard measures," Kaluf says. This takes the subjectivity about how a patient is faring with a device out of the equation.

With data on nearly 35,000 patients, Brandt says he also hopes that Ability can begin to extrapolate that data and use it for research. "We are currently rolling out strategies to utilize the information on our patients to write standards of care and to further justify treatment options, as well as match functional levels with component selection," Brandt says.

Moving toward an outcomes-based model also puts us in a better position to deal with any curveballs that may come out of healthcare reform, Brandt says.

"With healthcare reform, there are $700 billion to be 'found,' and that certainly puts our devices and delivery of care at risk. If Ability can use its outcome measures to substantiate that what we are doing for our patients is in fact beneficial to them, then I believe we'll do a better job weathering the current storm," Brandt says.

Angela La Voie is a freelance writer in the Denver, Colorado, area who covers health and technology.