I had an administrative role in a hospital system early in my career that leveraged my first responder background and my knowledge of Life Safety and Building Officials and Code Administrators codes. I spent a lot of time in direct patient care as a firefighter/EMT in the emergency response realm. In my role at the hospital, I was a part of the ER mass casualty triage team, and I was tasked with safety and security compliance for the system. I was also tasked with our system-wide compliance with the applicable aspects of the Joint Commission on Accreditation of Healthcare Organizations hospital accreditation standards. Later, when I went to work for the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC), I fell in love with the professional provision of O&P care.
In my career, I had never really seen the immediate impact that appropriate O&P care has on the life and psyche of people in need of intervention. I was honored to work on the ABC Facility Accreditation program and to rewrite many of the old standards of care. I recognized very early that O&P care was underappreciated and misunderstood in both the healthcare and payer communities. For several years I was a member of the National Quality Forum, participating as a member of the Quality Measures Research Council. In that body, I was able to take part in discussions and decisions around the delivery of quality healthcare. We discussed how that is defined and how we can measure it.
As a result of my experiences, I think I have a pretty good grasp on the macro challenges we have in healthcare delivery. And as a result of my two decades in O&P, I think I understand how our micro struggles play into the macro world of healthcare provision.
In my role at OPIE, I talk to people all day and have the opportunity to discuss business trends and frustrations, ranging from the difficulty in recruiting good staff to poor payment for services. I absolutely understand the struggle. I also know that many of the struggles we have are shared with others in the healthcare world, and many of our struggles are unique to us. I know that most traditional O&P patient care is still provided by private clinics, and I recognize that there is a great deal of pressure on that model right now. The struggles we face are real, and the fight to keep the doors open is hard enough without adding the burden of solving tomorrow’s problems.
We talk about the evolution of O&P and to me that is an interesting topic. On the one hand, the physical science, education, materials science, and technology available today is vastly superior to that which we had only 20 years ago. Compared to 40 years ago, it’s almost unfathomable. Yet here we are: Neural implants, osseointegration, robotics, and artificial intelligence are making the Six Million Dollar Man a real possibility.
On the other hand, business practices, our reimbursement processes, and our direct clinical involvement as members of the professional physical medicine intervention team are largely unchanged. I still see clinicians providing in-service education that is really just an elementary school show and tell. We still tend to talk about the device we made and applied. How does that jibe with the advances being made? What is the role of the orthotist/prosthetist in that future? How does this profession maintain its relevance?
There is no one else in the habilitative care space that has the breadth of knowledge a good O&P practitioner brings to the table. You know the importance of the metatarsal arch and how a deformation or weakness there can adversely impact the knee, hip, or back. By creating a supportive foot orthotic and a heel wedge, you can alleviate crippling knee pain and straighten people’s shoulders. But who, outside of O&P, knows that? And why are you not considered competent by CMS to conduct a clinical assessment of a person’s musculoskeletal condition and recommend a course of treatment? You do it every day.
We have to change the dialogue. While that custom device is the tool you use to change someone’s life, it is not the thing you should show off. What you did was identify the meaning behind the complaint of knee pain. By focusing on the anatomy of the foot, you recognized the relatively simple solution to the underlying problem. You could have provided an offloading knee orthosis; that is probably what most physicians would start with. But your skill set is in knowing that temporary solution will not resolve the underlying problem.
This is but one example, and I am sure you have many of your own. The stories we have to tell with our experience and with our data, is how the application of clinical and materials science knowledge come together to create solutions to real problems and how those solutions contribute to lower healthcare costs and an improved quality of life.
What is the value of that? Why shouldn’t O&P practitioners be paid for that contribution? How much money do they save the system in unneeded pain medication alone? The only way to help people understand your contribution and to get paid for your contribution is to explain it. The cost of the stent does not dictate a surgeon’s pay. The cost of your raw materials should not dictate the value of your intervention either.
But when you are struggling to keep the doors open, how do you even begin to have these conversations? What can your one voice do to make a difference? For the professional care side of the O&P equation to evolve and keep pace with the technological side, we need to embrace that evolution and demonstrate that the knowledge, skills, and aptitude clinicians bring to the table are unmatched in the care team and O&P expertise is critical to long-term patient success. And no, you are not going to get paid for that right away.
You have to build your story. You build that story with data, with collaboration, by sharing knowledge, by being right (mostly), by being willing to listen, and by being successful. You build a reputation as a clinical partner, not a brace salesperson or a prosthesis salesperson. No organization can do that for you. But once you are successful at this, then you can start to secure better pay. You can shift your business from a frenetic, volume-based model to a respected, clinical care model.
There will always be pressure on reimbursement, and no payer is going to voluntarily give you more money—they are chasing profit too. But you can give yourself the tools to make an economic argument for the value of the services you provide. Good, reliable, and verifiable data is key, as is your reputation in the local community. And your willingness to stand up for yourself is probably the most important component. That ability starts when you change the words you use to describe what you do.
If you are out in public and you are asked what you do for a living, is your first response that you make legs? Or you make braces? If so, I implore you to change that.
When you do an in-service, do you bring a bag of devices? Or do you bring case studies? Don’t be afraid to share your knowledge. And don’t be afraid to talk through your decision-making processes. You don’t always get things right the first time. Talk about what you observed. How often does the patient describe something that is only a symptom of the underlying problem? You are a specialist, and the value you bring comes from your depth of knowledge. Other healthcare providers will not take that from you; they are too busy with their own specialty. But they will respect you and your ability and begin to engage you more frequently.
The professional evolution of O&P care must be intentional, and individuals cannot wait for the tide to roll in. In this case, the rolling tide is not here to lift all boats—it is here to inundate the fields. The rolling tide is the tide of entropy and devolution. It is the return of the widget makers and metal benders in the basement. The profession of O&P patient care requires the professionals to step up and represent themselves as the true clinical professionals they are.
Scott Williamson, CAE, MBA, is the president of Quality Outcomes and the executive director of education and events for OPIE Software. He can be contacted at scott.williamson@opiesoftware.com.
