O&P Consulting and the Gift of Prophecy

Outcomes Driving Change I believe that we’re going to continue to see vertical integration; the trend of manufacturers owning practices is not going to go away. We’re at the front end of that becoming the norm. I do think the field as a whole is starting to legitimately move forward with capturing patient outcomes data and using it to improve patient care. We’ve been talking about patient outcomes for 20 years; we’re now starting to see how that data becomes actionable. A great example of that is the Limb Loss and Preservation Registry. That’s going to become a very valuable educational tool for the profession, to help explain to people outside of our profession what we do and how it helps patients, because if we don’t figure out how to explain in other people’s language what we are doing, we are going to continue to see commoditization of our services. The biggest concern I have is the necessity for this field to focus on separating O&P from durable medical equipment in the eyes of Medicare. That’s a huge challenge, but if we don’t do it, our ability to be regarded as medical professionals driven by our patients’ results will never matter. Because we’re categorized the same as the guy who’s selling you a walker. -- Mark Ford, president, Catdaddy Consulting Documentation Defense Technology is changing, but the emphasis on documentation has not changed. For ten years I was involved with doing denial reviews at the upper level. A record that did not have a lot of information in it made it very difficult for me to defend the fact that that person needed to have that different type of device that had been denied. If it was a very clean record that had all the documentation in it, it was very easy for me to attest that this was a proper procedure and a proper device ordered by the physician—this was indeed the proper device the person should be getting. I know we tend to talk about that a lot, but it’s a real-world reality: As Medicare rules apply, if it’s not documented, it didn’t exist. -- Terry Supan, CPO(E), FAAOP, FISPO(E), Supan Prosthetic Orthotic Consultations Compliance Vigilance I’ve been around the O&P industry my entire life, and I would say that the focus now, more than ever, is on compliance: ensuring that facilities are following all payer requirements no matter how complex they are becoming, so that they can actually keep what is being collected. I have seen an increase in both prepayment claim reviews as well as postpayment payer audits. Healthcare organizations don’t want to be in a situation where payments are received, but six months or years later the payer is asking for their money back due to a lack of documentation. I believe that the payers are focused on cost containment and therefore will find any reason to either not pay claims initially or to recoup already paid claims using external auditing firms. O&P facilities must be laser-focused on the revenue cycle—starting from the verification of benefits to the authorization, to clean claim billing and then collecting from the payer. It’s almost like the owners and practitioners are taking a deep breath and hoping that everything has been done correctly to get paid for the high-quality services they are providing to their patients. -- Roger Lehneis, LO, MBA, Lehneis Consulting Services Plan Ahead Practice owners who’ve been in this for a long time need to ensure that they’re keeping up on current policies and investing in their employees. They need to decide what to do with their practice in the future—whether they’re going to shut the doors, hand it down to a family member, or be acquired by another entity—and develop a succession plan. If they’d like to retire in five years and don’t have a succession plan in place, they need to start now: They should not only get their compliance and their process efficiency well-established to ensure that they have maximum profitability, but should also look at the cost of goods, make sure their accounting is in order—at least three to five years before their succession plan will be implemented. -- Lesleigh Sisson, CFo, CFm, CEO, O&P Insight Keeping Up With the Times People tend to hold onto the old—and we can’t operate the same way now that we did ten or 20 years ago. A lot of focus now needs to be on building relationships, not just with our employees, but with the patients and referral sources. Having a budget is a must for businesses, although many O&P practices do not have one. They can’t be profitable without knowing their P&L (profit and loss) and having a strategy for their growth. They may be operating—but not necessarily operating well. -- Dana Glover, director of operations, O&P Insight Patient Expectations What I have gleaned from the work that I do is that the technology in our profession is advancing faster than perhaps the clinical justification for it. And one of the things that I observe in my role in catastrophic care management is that we don’t have a good idea of a rehab treatment plan. Patients look at Google, for example, to find out what’s available; and if we don’t promptly provide the latest and greatest technology when they come in, they may go across the street and get it there. It’s not that we should just say no; we should, however, have a better way of explaining what is going to happen within a realistic timeframe, and clearly explaining to the patient that even the latest state-of-the-art prosthesis is not a replacement for their leg—it’s going to have some deficits and this next best thing is not going to solve their problem. They’re going to feel better, they’re going to get better, but they’ll never be 100 percent of what they were. As prosthetists we enjoy the benefit of getting somebody up and going quite immediately, whereas our physical and occupational therapist colleagues are doing the grueling ongoing work of getting them to where they need to be. We get immediate gratification, but in upper-limb prosthetics especially, what often happens six weeks after we provide that advanced prosthesis, is that the amputee realizes that it didn’t—and can’t—give him or her what they expected. They don’t have their hand back. In lower-limb prosthetics it’s a little different, but it’s similar in that after we fit the device we often hand off the physical and occupational therapy that has to happen with these cases, instead of engaging the therapists early as our allies. We often hang the success or failure of a prosthetic fitting just on our knowledge instead of inviting our PTs and OTs to be our wingmen and help us. -- Karl Lindborg, CPO/LP , prosthetic and orthotic clinical practice consultant, upper-limb prosthetic specialist Wages and Inflation When the American Orthotic and Prosthetic Association (AOPA) gave me access to their data going back to 1977 so I could explore how the reimbursement and wages relate to how we’re doing as a profession, it was kind of alarming. What I’m seeing is that the technicians are getting hosed; their wages are not keeping up with inflation at all. Since 2008, when AOPA started keeping track, wages are only up 6 percent; since inflation is up 19.31 percent, they’re not making enough. What’s going to help them is technology, but they’re going to have to use it to make more stuff in order to make their time valuable. They’re going to have to be out there running 100 digital scanners at a time to make all this stuff. I’m seeing a different trend in the clinicians’ wages: From 1977, they’re tracking pretty much with inflation, which is good for the clinicians. But the problem is that the revenue for the company is not keeping pace with inflation. In 1977, the average O&P company was making between 15 and 17 percent profit, which is normal for most small businesses. But now that average O&P company is only making a 6 percent profit. Because inflation is worse now than it was, if that trend continues, there’s going to come a point in ten years or so when the amount of profit a company brings in is going to decline to where they’ll have to start cutting clinician wages to make it worth keeping a company open. If you don’t make at least 2 percent, it’s not worth keeping a company open. Walmart makes 2.4 percent; Target makes 3.6 percent. Your options are selling your practice to Hanger or watching clinicians’ wages flatline and create a crisis. Because smart people are going to say, “I’m worth more than this”—and they’re going to go someplace else. -- Nathanael Feehan, LPO, business consultant and CEO, Master’s Orthotics and Prosthetics Artificial Intelligence The other thing that’s coming on the horizon is artificial intelligence (AI). A neighbor who runs an AI company believes that all white-collar jobs are going to go away in the next five years. By white collar, I mean paralegals, your insurance staff, receptionists—every insurance company’s staff is going to be artificial intelligence. All of the AI is going to change this world in the next five years in ways we can’t imagine—just like the industrial revolution changed the world in ways they couldn’t imagine when they were an agrarian society. Everything changed; and it’s going to be the same thing with this revolution. Unless we’re on the front end of it, we’re going to be left behind. The fact that we can fire all our administrative staff could save our industry, but in O&P we have a heart for people or we wouldn’t be making them legs and braces. How we care for our team members is going to matter, and we’re going to have to do the best we can to keep them fed and housed, because in the next five years, whoever comes up with the O&P insurance, AI is going to make a whole lot of money by eliminating a lot of jobs. -- Nathanael Feehan, LPO

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Certified Prosthetist / Prosthetist-Orthotist (CP/CPO) Gates Prosthetics + Mobility Clinic — Mountain Home, AR

Clinic Manager – Certified Prosthetist Orthotist (CPO) – Rogers, AR

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Related posts:

Four Steps to a Fulfilling Workplace

The Power of Peers

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Certified Prosthetist / Prosthetist-Orthotist (CP/CPO) Gates Prosthetics + Mobility Clinic — Mountain Home, AR

Clinic Manager – Certified Prosthetist Orthotist (CPO) – Rogers, AR

CPO

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