Mobile O&P Clinic Brings Care to Patient’s Home

[caption id="attachment_234668" align="aligncenter" width="300"] Image: elana.bs/stock.adobe.com[/caption] As business models continue to evolve in the O&P profession, mobile clinics have emerged as a way to meet patients’ diverse needs. The O&P EDGE reached out to one such practice near its headquarters, Agile Orthopedics, Denver, for a firsthand, in-person look at how it is striving to make O&P mobile care a success. When Eric Neufeld, CPO, FAAOP, started Agile Orthopedics five years ago, he had no dedicated office space for the first twelve months and had to outsource almost everything. Neufeld started his company with a single mobile clinic, a full-size van fully equipped with everything he might need to treat patients. According to Neufeld, there is nothing glamorous about Agile Orthopedics’ 1,500 square feet of office space that the company moved into three years ago, which now includes an area for fabrication. Patients seldom come to the facility for care, he says. “We don’t see patients here,” he says. “We want to stay true to our model, which is bringing care to the home.” With Agile’s holistic approach to treating patients with upper- and lower-limb loss as well as orthotic needs, Neufeld and his mobile teams travel to the patient wherever that person may be—at home, in a skilled nursing facility, at therapy appointments, even in homeless shelters. “We’re all about the patient,” says Neufeld, whose patients are treated in the Denver-metro area, the mountain communities, Colorado Springs, and Northern Colorado, with plans to expand this year, Neufeld says. Agile also works with the Colorado Department of Corrections and homeless advocacy groups to provide care. A High No-show Rate The idea for an O&P mobile clinic business came to Neufeld when he was working for another O&P facility and noticed that the clinic had a consistently high no-show rate for its patients. “It could be as high as 40-50 percent,” he says. When questioning patients who did not show up for their appointment, Neufeld learned that often life got in the way, and patients were simply unable to keep their appointments because they had no one to take them. “They would tell me, ‘My brother would have to take the day off work to take me so I couldn’t come.’ So, I got the idea that I would go to them instead.” From that single mobile clinic and one clinician, Agile Orthopedics has grown to a staff of 14 employees with experience averaging more than 20 years, and five mobile clinics. Mobile Clinics [caption id="attachment_234664" align="alignright" width="260"] Neufeld works out of a mobile clinic. Photographs by Betta Ferrendelli.[/caption] Agile’s well-equipped, all-wheel-drive mobile clinics can cost nearly $50,000 each once fully outfitted, Neufeld says. The mobile clinics are transformed from nondescript white vans to intentionally designed vehicles, inside and out. They are equipped with full power in the cargo space, a floor-mounted router, dust collector, basic power, and a variety of hand tools. Keeping a small supply of casting liners, endoskeletal components, casting and scanning equipment, fasteners, and small amounts of padding and materials allows practitioners to get the most out of each on-site visit, Neufeld says. “Utilizing a fully electronic HIPAA-compliant iPad-based EMR system makes it efficient for us to capture documentation and information for the administrative side of things while in patient’s home or on-site elsewhere,” he says. In-home Healthcare Visits To get a firsthand look at the mobile clinic operation we accompanied Neufeld as he readied his mobile clinic and at an appointment with a patient who was having prosthetic socket and suspension issues. Cori Kohlhagen, 36, a mother of three young sons, fell down a flight of stairs in May 2019. She was holding her youngest son and badly broke her left ankle while she tried to protect him from the fall. Her ankle failed to heal properly, and in March 2020 she had a transtibial amputation. [caption id="attachment_234666" align="alignright" width="260"] Neufeld meets with Kohlhagen during an in-home visit.[/caption] Kohlhagen tried two other prosthetists as she started her prosthetic care, but neither were a match for her. Kohlhagen met Neufeld in April 2021 and says they work well together. She likes the convenience of Neufeld coming to her house for care. “With three boys and lots and lots to do, I love it that he comes to me. It’s a huge benefit,” she says. “I feel like Eric takes the time with me that I need. I feel like I am being heard.” Kohlhagen’s appointment took less than an hour, with Neufeld making minor adjustments to her device in his mobile clinic just beyond her front door. Appointments can vary, Neufeld says, ranging from twenty minutes to two hours, depending on the patient and the care. Mobile Mountain Care Allie Peterson, MSOP, CPO, started with Agile Orthopedics in November 2020. Peterson knew Neufeld through his involvement with Range of Motion Project (ROMP), where he is a founding member. In 2018, she traveled with him to Guatemala to participate in a ROMP O&P clinic. Her territory spans Summit and Eagle counties in Colorado’s mountains west of Denver. “But I will travel anywhere in the high country and the Western Slope if I have a referral, or I will coordinate with a patient to meet me halfway,” says Peterson, who is based in Summit County and was working as a certified nursing assistant at a home health agency when she learned about O&P care and went to school to become a prosthetist. A typical day for Peterson includes anticipating several factors. “I try and schedule patients according to their location so I can make the most out of each traveling day,” she says. “I have become more conscious of the daily weather, and I always make sure I pack enough food, water, and warm clothing when I am on the road.” Mountain conditions in Colorado can change rapidly, and Peterson says she must be prepared for any type of driving conditions. To be prepared for these changing conditions, her mobile clinic is equipped with snow tires and sandbags in the back during the winter. “I have to ensure I have enough weight over the wheels for bad road conditions,” she says. “It is no fun being stuck on I-70 due to road closures or bad weather,” says Peterson, who drives around 1,500 miles per month to her patient’s appointments. Peterson treats adults and children, and she says the demand for pediatric in-home O&P care has grown. “Many families [who live in the mountains] are still travelling to the Front Range to get O&P services. And we have been working hard to spread the word to continue connecting with providers in the mountain communities so I can be a resource for those families, so they don’t have to travel hours and take time off from work to get the care their child needs from an orthotist or prosthetist.” Her adult cases have kept her busy as well, she says. She has treated those with amputations who have traveled to the mountains, others with sports injuries and neurological conditions such as multiple sclerosis, amyotrophic lateral sclerosis, and pain caused by cerebrovascular accidents. Southern Colorado Care John Rosner, CP, learned about Agile Orthopedics through a former colleague. “I reached out to Eric to get an understanding on what he was doing in Denver, and he invited me out on a call and then eventually on the team, and here we are now.” A typical day for Rosner starts in Colorado Springs and includes scheduling patients, clinical documentation, fabrication, and final assembly, as well as ordering and inventory. He can travel to Pueblo, Cañon City, Woodland Park, Divide, Calhan, and Castle Rock. There are no snow tires on his mobile clinic, which is all-wheel drive, and he estimates that he travels up to 1,200 miles a month treating patients. “I see a large variety of patients from pediatric to geriatric and everything in between. I see folks in million-dollar homes and those who are experiencing homelessness,” he says. “The mobile aspect appeals to all, but particularly those who cannot transport themselves to appointments.” Multitalented, Multitasking Since Peterson and Rosner spend so much of their working day alone and on the road, they agree the demands of the job are not for everyone. It takes a unique skillset to do their job with efficiency, they say. Problem solving, multitasking, strong communication skills, being able to communicate quickly and clearly, solid understanding of insurance protocols and procedure for specific devices are a must for their positions, Peterson and Rosner say. Rosner, who worked as a physical therapist assistant for seven years before getting his master’s degree in O&P, says being able to foresee any problem or need that could happen during a patient visit, improvisation when things do not go as planned, and being nonjudgmental when working in someone’s personal space are essential. Maintaining flexibility for last-minute changes and schedule adjustments is also paramount, says Rosner, who is also working toward his orthotic certification. In addition, there are rare occasions when Peterson or Rosner are unable to help a patient during a home visit. “I would say that every time I see a patient it’s a benefit, as education is a foundation for all my visits,” Rosner says. “Yet, if something just so happens to be missing, the appointment will be rescheduled, and I will return as soon as I am able.” If the situation arises for Peterson, she says she discusses the problem with her patient and why she cannot help at that current visit. “I make a plan to follow up with them and bring the resources needed to help to the next appointment,” she says. And it’s also best as an in-home healthcare provider if you are not allergic to cats or are not afraid of dogs, Rosner says. “Being okay with overly friendly or fierce dogs is a must,” he says. Neufeld says hiring the right person for O&P mobile care is challenging. “It’s hard recruiting. It’s not as easy as you think,” he says. “It requires the practitioner to be the front office, the practitioner, and the technician. It requires the ability to improvise and remain organized and flexible.” The Allure of the Job [caption id="attachment_234663" align="alignleft" width="300"] An Agile Orthopedics mobile clinic.[/caption] Peterson and Rosner find their roles as mobile O&P clinicians appealing and unique to who they are personally and professionally. “I like the completion of seeing the device work properly in its intended environment,” Rosner says. “The challenges of being a satellite of the mobile clinic are intimidating but keeping the lines of communication open with the team to get up-to-date information on authorization, fabrication, clinical experience, etc., are all a click away.” For Peterson, she says it’s the freedom of not being locked into a nine-to-five job and the freedom to schedule her own patients that makes the job a good fit. With her mobile clinic, Peterson says she has made great relationships with other allied healthcare providers such as physical and occupational therapists, nurse practitioners, and social workers. “On difficult cases, we can collaborate together on the best possible clinical outcome goals for a patient,” she says. Peterson and Rosner also agree that in-home healthcare will continue to gain popularity. “COVID certainly has played its part, but the value of seeing a patient’s home environment is critical,” Rosner says. “The evaluation really comes to life when seeing environmental barriers, truly seeing the corridors, stairs, uneven terrain, toys on the floor, and dogs.”

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