From COVID Chaos, Change Is Afoot

[caption id="attachment_234656" align="aligncenter" width="1024"] Image: Crustoff/stock.adobe.com[/caption] Although it may be too soon to identify the forms they will ultimately take, O&P professionals agree that the pandemic experience has wrought lasting changes—changes that will continue to evolve as our business culture is reborn. We asked O&P business leaders to share their experience and advice on navigating this undiscovered country beyond COVID and got some interesting and surprising answers. Company Culture Scott Williamson, executive director, Opie Choice Network, Gainesville, Florida, points out that business culture should be intentional. “Great companies have cultures that encourage everybody engaged in that company to contribute, to offer opportunities for improvement, to identify and recognize change, and help the company to deal with it,” he says. “When you have a very strong company culture that is guided absolutely empirically by your vision and mission, it’s easy for staff to make significant operational decisions within the guardrails that are set up. And if we have a good culture, then we can deal with things—even a pandemic—much more effectively than if we are just blown about like a leaf on a tree.” Many companies that had a good culture were able to adjust to the changing dynamics, while those who did not, consequently closed their doors or were sold, he points out. When elective surgeries stopped, new patients did not arrive, and existing patients and staff worried about coming to the office, thus creating what Williamson recognized as a perfect opportunity to foster the collaborative culture O&P businesses strive for. “The staff that remained, demonstrating their genuine concern for the health and safety of each other and their patients, are closer to each other now. They respect each other in a different way, largely because they faced a crisis and solved it together,” he says. Their receptivity to thinking outside the box, recognizing individual strengths, enabled Opie’s team to be creative in solving patients’ needs—lessons that he hopes will carry forward. The pandemic’s start in early 2020 also marked the first wave of the Great Resignation—a phenomenon that has seen the rate of people resigning or retiring from the workforce rise to an all-time high. Williamson attributes many of these resignations to the tendency of people to re-prioritize their lives in the wake of an unprecedented and life-changing event of global proportions. Many O&P companies are losing long-tenured employees, including office administrators and managers, he reports. “If we have a culture that adapts,” he says, “we’re going to have to change the way we think about the employer-employee relationship—and be a bit more engaged with our employees, and sensitive to their needs.” Practitioner Anxiety and Burnout Gerald Stark, PhD, MSEM, CPO/L, FAAOP(D), senior clinical specialist, adjunct instructor, Ottobock, Austin, Texas, shares startling insights into the earlier-than-expected resignations of some young O&P professionals, and suggests that those choices may be traced back to education-related factors. Even prior to the onset of COVID, Stark had detected indicators of increasing anxiety in survey respondents, although the number of patients these clinicians were seeing had not increased. A subsequent survey to identify the sources of this anxiety revealed that the emergence of so many CPOs from O&P master’s programs had created a new demographic among O&P clinicians—smaller percentages of single-certified prosthetists and orthotists, compared to 68 percent of dual-certified practitioners—leaving newer CPOs feeling overwhelmed by the need to know it all. “The younger practitioners also experience a high degree of uncertainty and anxiety because they have higher student loans, they’re seeing more patients right away, they have earning concerns, and they’re discovering that the research opportunities they anticipated as CPOs are not materializing very quickly,” he says. His survey measuring happiness and fulfillment usually finds these feelings should be highest at the beginning of a career, bottoming out at 11-15 years, he notes, “because that’s when your expectations are higher, but the reality is that your salary is less, and you’re working harder.” The 2021 survey, however, found that while the 11- to 15-year veterans continued to experience the lowest rates of happiness, and highest rates of burnout and anxiety, the zero- to five-year practitioners ranked second highest in terms of burnout and anxiety—at a time when they should be happiest, says Stark. “What’s going to happen when they really hit the bad times?” he worries. “We’re starting to see evidence of some attrition. We’re losing practitioners right after they get their master’s degree—zero to five years. They find out there’s less opportunity for research than they thought, they’ve got $200,000 in debt—and COVID doubled down on those things.” During the COVID-fueled consolidation of companies, when even the owners were experiencing uncertainty, again the residents suffered increased anxiety, he says, “because the first person to get rid of during COVID isn’t the person with ten years’ experience, but the resident.” Older practitioners are leaving the field, too, and with their exodus comes a loss of knowledge, part of what Stark calls a collective understanding: “As we get older, we know we can make better guesses, better gambles, because we’ve seen scenarios before. So, the loss of confidence with the remaining practitioners after COVID has been immeasurable.” How to address this troubling climate of uncertainty for everyone? With the wake of the unknown still unfolding, Stark recommends building models that are more open to the possibility of unexpected things—like pandemics—and learning from what we have experienced. Although people may long for a return to the way things were, with in-person contacts replacing virtual connections, that may not be possible, he notes, now that we are doing more with less, achieving greater efficiency and economy. Workplaces as warehouses of people may no longer be necessary, leaving us to fulfill the essential human need for face-to-face time by creating opportunities that we need to make the most of, when they occur. “Recognizing this, Ottobock is changing its headquarters to a more efficient workspace. People don’t have permanent offices but will occupy a space as needed—they’ll sign up for a meeting room if they need one,” he adds. The Evolution of Pedorthic Services Dennis Janisse, CPed, National Pedorthic Services, West Bend, Wisconsin, recognizes the strength of people’s desire to relate personally and physically, following the prolonged pandemic period of social distancing and masks—and he stresses simple human kindness that’s a key factor in the success of his smaller, specialized business. After 51 years of successfully operating a business with 12 locations, he recently downsized to a single hometown office that handles complex referral cases, and he enjoys more business than he can handle. Although his practitioners stayed home, Janisse continued seeing patients throughout the pandemic and counts his patients’ greater appreciation as one of the consequences of COVID. “The pandemic was an eye-opener for me,” he admits. “It showed me we really don’t have control. It left a lot of people frightened and confused—but when our patients came in, they would mention how pleasant it was there, with our staff working together. ‘Everyone seems to enjoy what they’re doing, and they really care about us,’ was the perception. I think if you can accomplish that, it’s probably more important, at this stage, because people are more sensitive to being cared for and want somebody who cares.” “So much of everything has gone to virtual methods,” he observes. “It’s still at that point, with virtual office visits, and I think a lot of people don’t feel like they’re getting proper care because they can’t go in and see somebody. I treat chronic patients—people with more serious problems—and some of them are frustrated because they should have seen a doctor months ago, but they couldn’t get in the door to be seen. I’ve been very hands-on throughout, and people so appreciate what we do for them now, because we’re willing to see them and touch them.” He expanded the length of his appointment blocks to prevent overlaps in the waiting room; patients also enjoy the less hurried approach to their care. “A lot of the patients we’re seeing are people with obesity and comorbidities, and we had to respect that.” Since many insurers offer poor or no coverage for pedorthic care, Janisse adopted a self-pay model of care some time ago, and he identifies this as a growing trend, appreciated by pedorthic customers. While a transtibial prosthesis might cost thousands of dollars, he explains, a pair of foot orthotics may be an affordable $300 or $400. “I’ve never had as many multiple pairs ordered as I have since I went to straight pay. Customers with insurance never did that; they’d pay their $25 copay, I got paid a minimal amount, and they’d wait until the next year to get another pair. Last week, a lady ordered three pairs. She’s doing great with one pair and wants three more pairs.” According to Janisse, this is good news for those who hope to make a living in pedorthics. “I think the pedorthic industry has evolved enough that somebody can become a pedorthist and actually make a good living,” he says. He points to schools that are considering adding an associate degree program for pedorthists, noting that much of the education will be presented online, so students need not devote two years to class attendance. “I’d like to think the pedorthic industry is really going to rebound and take off, because all the chips are in the right place, and we can make that happen once we get the schools up and running now.” Finding Flexibility Jeffrey M. Brandt, CPO, director, business development, Ottobock Patient Care; chairman and founder, Ability Prosthetics & Orthotics, is a prime example of the evolution of O&P culture. After 17 years of working largely seven days a week, his whole life was invested in Ability. Eight weeks after the January 2020 sale of his company to Ottobock, the pandemic provided a major complication. “Trying to integrate and grow a new venture with Ottobock, all while remote, wasn’t necessarily the best way to build new relationships and trust, but you build resilience, leverage new tools, and in 2021 we were able to safely get together in person and ignite as a team around our initiatives,” he reflects. Some of the social aspects of coming to an office disappeared, and connectedness was replaced by expediency, he notes. “Patients came in, got what they needed, and left. People texted from their cars, and someone would run out a new prosthetic liner to the patient that already fit, and they’d hand it to them through the car window. “Some patients still prefer a fast visit, and don’t want to spend a minute longer than necessary in an office. Others missed the social interaction and connectedness. The culture right now is trying to find that balance coming back,” Brandt says. He identifies this as an opportunity to develop personalized solutions that patients prefer. “There’s even a bit of a cultural shift toward going to patients’ homes, along with ‘at-home’ health companies that have appeared, ready to start doing certain hospital procedures, then send patients home to recover from acute outpatient procedures.” The pandemic has offered more opportunities for efficiency by opening practitioners’ eyes to time formerly wasted on trivial pursuits no longer possible—or necessary, he reports. But the pandemic also robbed businesses of older practitioners who chose to retire, leaving owners/managers with less seasoned staff, and potentially a shortage of mentors, and amplified labor shortage problems by making potential candidates reluctant to relocate. Brandt reports continuing issues with filling patient care coordinator positions. Labor shortages further magnify the pandemic’s impact by delaying transmission of documentation from physicians’ offices because physician practices are also in need of administrative people; and delayed documentation results in patient-care delays. Because many referral sources went virtual due to COVID—and continue serving patients virtually only on specified days—their administrators cannot expedite paperwork because the physician will not be available until his or her next in-office day. Employers in other industries are competing for employees, Brandt notes, some offering $40,000 a year with incentives up to $100,000 to work as manager in a fast, casual restaurant. Why spend time and money on an O&P master’s degree to prepare for a residency that will likely pay less, he wonders, yet leave one with $100,000 in student loans to repay? The challenges to O&P employers are numerous, including a high clinician burnout rate, and they demand innovative solutions, he says. Brandt wonders why O&P businesses don’t offer more convenient hours to serve customers who have weekday jobs. “We have evening hours one night a week—but that’s as progressive as we have gotten. And its four slots are filled months out, because people want flexibility with their work schedules. We could probably have somebody working 7 to 3 every day, and the 7 to 9 a.m. slots would be filled because people would want to see us before they go to work.” “So I think we’re probably due for some continued changes in our culture, which the pandemic has opened up.” Maybe, he speculates, the most significant cultural shift might be that people have become more flexible—with practitioners exploring their options a little more thoughtfully. Taking a Fresh Approach Frank Snell, CPO/L, FAAOP, president, Snell Prosthetics and Orthotics, Little Rock, Arkansas, says that the pandemic’s greatest surprise was the labor shortage—and not just within healthcare. “This is a situation where people who were once working are no longer working, therefore they’re not covered under insurance plans. Many more have gone on institutional public insurance programs like Medicaid, and in our state, one out of every three Arkansans is on Medicaid. Medicaid reimbursement is the lowest in the industry, making the profitability of our business that much more challenging.” Like the layers of an onion, he notes, the problems continue as you slice through each barrier, revealing further issues including increases in pay necessary to retain those in lower-paid administrative positions, which also cuts into the profitability of the company. “And when you draw in the supply chain challenges, where we’re now having to wait longer for certain items, that interrupts production, patient visits, and cash flow.” Snell’s family-owned company has survived 110 years of wars, economic turbulence, and political vicissitudes, but he regards the pandemic challenge as a unique threat. In a state where the percentage of vaccinated population was still under 60 percent at the end of 2021, he chose a unique response. Allowing employees to work remotely is not in his playbook: Although a dozen workers have gotten COVID, no cases have been life-threatening and all have recovered well in due course, he reports, as they followed CDC guidelines for home recovery and a ten-day quarantine. “People unaccustomed to working amid the distractions of a home environment aren’t as effective,” he says. “The insurance companies’ adjustors, their processors and decision-makers aren’t as effective, I feel, when they work remotely on our claims. It takes longer to get authorizations, reimbursements, even answers to questions. I’ve seen examples of this in both the private and government sectors. “We’ve tried to be good stewards, but everybody who is on the more understanding side of how to deal with the pandemic is just burned out—they’re just tired of it.” “The only good things that have emerged from the pandemic, from the business standpoint,” Snell says, “are the CARES [Coronavirus Aid, Relief, and Economic Security] Act stimulus program, from which I did receive a substantial amount of PPP [Paycheck Protection Program] money to preserve our business from economic fragility, and that has been a blessing—and also CMS’ suspension of the 2 percent reduction in Medicare sequestration, restoring full reimbursement to providers.” Since so many aspects affecting day-to-day O&P business have been negatively impacted by the pandemic—supply chain, labor shortages, claims processing, employee health and productivity—Snell does not anticipate a return to pre-pandemic life as it was. However, forging a fresh approach to an improved future continues to offer possibilities as well as challenges, he notes. Embracing Technology and Bouncing Back Anthony Wickman, CTPO, Freedom Fabrication, Havana, Florida, is grateful that while the healthcare industry in general reported $50.7 billion per month in lost revenue as a result of COVID (per the National Institute of Health), and many businesses were forced to close or sell, his own considerable losses began turning around in late summer 2021 and were recovered by year’s end. “We’ve bounced back pretty well. We’ve been incredibly stable with the help of some PPP business loans that enabled us to continue paying people even when we didn’t technically have the work. The biggest thing has been the ability to keep people on the payroll. We’re actually hiring now to fill two new positions, and with a lot of other industries losing employees, I’m not finding it hard to find candidates looking for stable, lucrative positions with good benefits.” Technology is one key that has forever changed the way business will be done in the future, he says. “Once you push people to a point where they have to replace their customs with technology, often the technology turns out to be so attractive that we never go back. As much as people complain about Zoom meetings, they’re a quick, efficient, and inexpensive way for us to do continuing education. I’ve got a number of Zoom presentations lined up for 2022, and no in-person sessions. It saves money for our clients, and for us.” Although he anticipates an eventual return to live meetings and in-services, they will probably be rarer. “I think we’re starting to realize when and where live contact has value and where it doesn’t.” While each of the people we interviewed offered a unique perspective on the impact the past two years have had on O&P, it is safe to say that the experiences of the pandemic have changed the future of the profession. Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.

From COVID Chaos, Change Is Afoot

A. A. Marks and Modern Prosthetic Practice

Supporting Your Patients Beyond Their Devices

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