Balancing Efficiency and Quality

During the seven years he spent working for the federal government, Zach Harvey, CPO , says he didn't truly appreciate the freedom he had to do his job. At Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland, costs didn't matter as much as the ability to keep up with the workload, says Harvey, now co-regional manager for Creative Technology Orthotic Prosthetic Solutions, headquartered in Denver. For example, working at WRNMMC meant he could immediately get a patient fitted once he got the prescription. "We could just get started on the project right away," he says. He also had advanced materials and technologies at his fingertips. "It was like Candyland," he says. "I was able to do whatever was best for the patient, and I didn't give much thought to the cost." Before he worked at WRNMMC, Harvey had been in private practice for six years. The transition from private practice to the public sector wasn't as challenging as the transition back to private practice from WRNMMC. When he went back, his old way of doing business had changed. "I had to learn a whole new skillset," he says. In this new healthcare landscape, Harvey learned that he might not get reimbursed for the care and device he provided if he didn't wait and make sure all of the paperwork was filled out correctly after receiving a prescription. He couldn't just jump in and start fitting a patient as quickly as he would like. Suddenly, the costs of devices he was putting on patients had a direct impact on the practice's bottom line, and he had to consider options that worked well but were less costly. "It used to be you could do anything and be profitable," Harvey says. "Now you have to be a lot more careful about who you are hiring, what you are spending, and what documentation you need to get together." In short, Harvey had to learn what many private O&P practitioners have struggled to figure out: how to provide high-quality care while still running an efficient and profitable business. Striking that balance is especially tough in today's landscape of lower reimbursements and increased costs of doing business, says Joyce Perrone , a consultant-partner with Promise Consulting and director of business development for De La Torre Orthotics & Prosthetics, both headquartered in Pittsburgh. Most practices have already made big cuts just to stay afloat, she says. In order to keep up, they also need to look at smaller ways to save time and money that can add up in the long run without negatively affecting their patients. "If a clinician can shave off 15 minutes here and there, then suddenly they may have the time to see another patient in the day," Perrone says. Once a practice is already efficient and profitable, it becomes even harder to find ways to improve, she warns. "It's like heating water where it gets up to a certain level pretty quickly, but once you get to the boiling point, it takes a lot more energy to get beyond that point," she says. "At a certain level it's harder to make another dollar. It's really looking for all of those little cracks that we can keep patching up." The experts recommend practices take the following steps to find efficiencies without sacrificing patient care: Track processes Save on fabrication costs Obtain technology and use it well Hire the right staff Do a good job all the time Track Processes In her work as a consultant, Perrone says she constantly sees practices that are putting too much time into business processes that yield too few benefits. For example, one practice would print e-mails and then scan them to file them electronically. "They are already digitized in the e-mail; there's no need for that type of redundancy," she says. "It can be simple things like that, or by working off of two computer screens instead of one. There will be a learning curve, but in the long run, it will save time and money." Perrone encourages all of the practices she consults for to look at their processes and figure out what things are taking the most time. "Are you spending 80 percent of your time on something that gives you just 20 percent of your return?" she asks. "You really need to start understanding your business with a magnifying glass to look at what you are doing and why." Harvey says that by looking at his time and practice, he figured out how he could save money and see more patients. When he first started out, he was doing a lot of the laminations himself, which meant that he didn't have the time to see additional patients. Once he looked carefully at what he was doing and what it would cost to hire a technician, he realized it would be less expensive to hire a part-time technician than to do that work himself. "Running the numbers is a healthy business practice," he says. Save on Fabrication Costs One of the most obvious ways that practices can save money is to keep fabrication costs as low as possible. However, that doesn't mean they should be using low-quality materials, says Bruce "Mac" McClellan, CPO/L, FISPO, FAAOP , president of Prosthetic-Orthotic Associates, headquartered in Tyler, Texas. "We are always seeking the lowest-cost quality materials and components," he says. "The key word there is 'quality.' I'm not interested in low-cost things that are not appropriate for my patients or something that could potentially fail." To find these materials and components, he says his technical staff is constantly on the hunt for new, quality, components or materials that can replace other, more expensive ones. The person who runs his lab is especially diligent, McClellan says. "He's always looking for new components that we aren't currently using and, when appropriate, we will make a change from what we have been using," he says. At Harvey's practice, the financial manager provides a component analysis to all of the practitioners so they know what the different options are and how much each one costs. "It's nice because it's in front of you, and you can make an informed decision," Harvey says. "If there's something equivalent that will give you the same outcome but is $500 less, then it may make sense to do it." Another way to save is to pay less for the materials that are being used, McClellan and Harvey say. McClellan suggests that practices talk with the manufacturers and try to see if they can get a better price. "We'll talk directly to manufactures or distributors and ask 'Hey, what can you do for us?'" McClellan says. "They are probably more willing in today's, versus yesterday's, environment to talk about that. They realize that if we aren't using their components or materials, they aren't making a profit either." Harvey and McClellan both say that buying in bulk can help as well. If a practice isn't large enough to buy in bulk by itself, it can join a buying club to help keep the costs down. Obtain Technology and Use It Well Perrone says she constantly sees practices that aren't controlling their inventory well-and technology could be a simple solution for that issue. "We see it over and over again," Perrone says. "There are problems with controlling inventory; there is inventory loss, inventory cost, and ordering inefficiencies. Most of the systems out there can help on the inventory end and some can also be fully integrated into billing. On top of inventory control, technology can help make sure that bills are paid on time and that invoices are digitized and easily available. "In a time management system, if you can't find something in 60 seconds, you are considered to be disorganized," Perrone says. "Technology can help you keep organized." Technology can also help a practice stay compliant, the experts say. Harvey says his computer system has easy-to-fill-out letter templates to ensure that the practice has all of the physician documentation it needs for reimbursement. "It auto populates, so that it's not too much work on the office staff," he says. "We've had good results because of it." However, technology is only as effective as the manner in which it is utilized, the experts warn. Perrone has seen several practices that aren't using all of the capabilities of the software systems they have purchased. "Some of the practices aren't using their software to its full capability because of the learning curve and the capacity of the staff using the system," she says. Many times, employees aren't given the time or training to figure it out, and some staff are just unable to take on the greater complexity of newer technology, she says. "We don't have the luxury of any fluff time to our days anymore. When you convert to new technology, there has to be overtime and weekends to accommodate that learning curve," she says. However, if practices aren't using the technology to the fullest, then it's just a waste, McClellan says. "If you buy something that has a lot of capabilities and you only use two to three of them, then you've paid for the capabilities but you are not fully utilizing your investment," he says. He is always looking for additional training or webinars that he can provide to his staff to keep them up-to-date, he says. Harvey says that his practice has a couple of "super users" of the practice's software package. They are users who have been well trained and know almost everything there is to know. The super users are then a resource if the rest of the staff has questions or needs to learn something new. "I don't spend a lot of money on direct training, but fortunately we have some people who are really well trained to do the training." Hire the Right Staff Staffing will always be one of the highest costs of running a practice, but by choosing the right employees, a practice can be more efficient and also create a better experience for the patient at the same time. "In my practice, everybody is on board, and they understand what we are trying to do here," McClellan says. "If my scheduler is not friendly, accommodating, and helpful, I could be the greatest prosthetist in the world, but potential patients won't come to me because they didn't like the person who answered my phone." He says that his staff has weekly meetings so they can review current or new patients, get more training, and talk about any issues that may arise. "Our practice is a closely knit fabric that we are all a part of, and working together toward a singular purpose is critical," McClellan says. Harvey says that the right employees can save the practice money by freeing up practitioners to focus on the patients-especially the difficult cases. For instance, he has a well-trained assistant who is great at working with patients and educating them on how to use their prostheses. "He can help out with the patient education and other smaller duties that were tying me up," he says. In today's tight-budget world, Harvey says he's always looking for hardworking employees who have the ability to do different types of jobs. Having an employee with that ability, he says, is often more important than someone who might have more credentials. "I'd rather have really good people and train them well and keep them on board," he says. He also recommends hiring employees on a probationary period of at least three months to simplify the separation process if it doesn't work out. Do a Good Job, All the Time One of the best ways to be efficient is to do a good job, the experts say. McClellan says that excellent patient care is at the center of his business, and he's never been conflicted about choosing between what's best for a patient and what's best for the bottom line. "If you are in this profession and are dedicated to patient care, you should strive for excellence no matter what the financial climate is," he says. "Our belief has always been, 'If we take good care of patients, the money will take care of itself.' This has proven to be a successful formula for us." Practitioners who use inferior materials or don't dedicate the necessary time to do a good job have a worse business model than the ones who do the job right the first time, McClellan says. "If you aren't doing it right the first time, you are paying for it later," he says. "If patients have to return for multiple modifications or adjustments, then you aren't saving anything." Even if the practice does have to ensure the paperwork is in before a patient can be fitted, it can still do a good job at communicating well with the patient, Harvey says. His practice employs a patient care coordinator whose job it is to help patients navigate their way through the system. "It's their job to give them the timeframes and updates and follow-ups," Harvey says. No matter what, McClellan says, running the business well should never come at the expense of quality patient care. "There's a big difference between being efficient and cutting corners," he says. "In my mind, it's an ethical and moral decision." Maria St. Louis-Sanchez can be reached at msantray@yahoo.com .

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