O&#038;P Consulting: Value on Both Sides

Even with the aid of Wikipedia and Google, it’s impossible to gain and contain all knowledge about O&P and its diverse and specialized areas—clinical care, coverage disputes, administrative issues, and new business development. Professional O&P consultants, however, bring to their work a rich history of experience and exposure to a broad array of challenges, offering valuable knowledge, analysis, and guidance to those who often don’t know what they’re missing. We asked consultants to share insights regarding their own specialty areas of O&P and the rewards their mentorship brings to both client and consultant. Who Needs a Consultant? Like others in her profession, Lesleigh Sisson, CFo, CFm, CEO, O&P Insight, agrees that many O&P businesses who could derive value from working with a consultant don’t recognize where their true needs lie. “We discover that they not only need help with a compliance issue or an audit, but that they don’t know how to use their software correctly, or that their A/R [accounts receivable] is way out of hand, or they have people issues—with not enough people, or maybe the right people but in the wrong seats.” She describes suggesting a client reassign a new employee from front desk to billing and accounts receivable, where the employee became a key player in the practice’s success—this, as an aside to Sisson’s original mission of assisting with their billing and compliance issues. Finding the right resource in the wrong place is common, she notes. “Most places also don’t have a written job description, or an on-boarding or training plan for employees—something that our own growth has prompted us to develop for ourselves, and for other practices as well.” Even consultants need a consultant, she admits. “Because we’re small and we can’t afford a full-time HR person, I have two ‘people people’ that I use—one is a local HR consultant with nearly 30 years of experience; a marriage and family therapist and corporate wellness person also helps us, as needed.” The most common client problems she encounters involve understanding policy and getting paid “and staying paid,” she adds. In a 2018 American Orthotic and Prosthetic Association presentation, Sisson detailed the “Top Ten Ways to Get and Keep Your Money,” which defined a revenue cycle process that includes administrators, billers, and clinicians and focuses on correct documentation at every level. “One small technical error can throw out a whole claim,” she emphasizes. “It’s about people; it’s about your processes and using your tools (NIMBL, OPIE, etc.) and electronic insurance company portals effectively.” “It’s not just one thing, it all comes down to compliance and working well together, so we don’t just look at compliance, we look at all aspects of the practice, if needed, from our clinician’s perspective, as well.” Roger Lehneis, LO, MBA, Lehneis Consulting Services, recognizes that profitability has been a pain point for O&P practices for years, and since most owners are clinicians who are understandably concerned first about their patients, they may not have adequate time to focus on the business aspects of their organization. “Because their first goal is to provide quality patient care, other business objectives may be delayed due to the focus on clinical services. A consultant can deliver unique value by navigating the complexities of the current, fragmented healthcare environment, someone with a breadth and depth of experience who could handle aspects that they don’t really have the time to attend to. I’ve been around the industry all my life, having worked in a family-owned and -operated O&P practice and having been a consultant for organizations from coast to coast; everybody can benefit from an impartial outside sounding board for their organization.” His relationship with clients can range from support for the short term to an ongoing, holistic review of their entire organizations. An initial request for help with insurance contracting might lead to a discussion of practice management implementation, financial benchmarking, or revenue cycle management to improve collections and reduce unnecessary claim write-offs. Mark Ford, president, Catdaddy Consulting, serves two distinctly different groups of O&P clients. “We have a small number of practices that we provide with analytics work, reviewing their data on a quarterly basis and providing feedback about how they might improve their practice,” he explains. “Our second and larger market includes many small, early-stage companies who are developing new technologies for the O&P profession. We help them to get their ideas ready for market, and start them off with selling, marketing, and branding their companies and their products within the US O&P market. “We work a lot with younger, smaller companies to help them to develop all the pieces that they need to know. Their young CEOs are very smart—a lot of them are engineers who are really good at creating a new product, having an idea and turning it into something tangible. Getting it ready to take to market is another step in the process, and that’s where we come in to help.” Like Lehneis, Ford notes that practice owners are clinicians who don’t have a lot of business experience and training, so his team offers necessary specialized functions like billing, process management, and analytics; based on their data, he suggests improvements. “Consultants bring a level of business perspective to the practice without the cost of a full-time salary plus benefits and taxes,” Ford says, “so the owners can spend more time where their passion lies—in clinical care.” As practices grow, they can afford to hire full-time help; so if consultants serve effectively, they’ll be replaced, he explains. “On the manufacturing side, I’ve actually helped two clients hire my replacement as a full-time person. Fortunately, in both cases they’ve asked me to begin a different kind of project with them.” Choosing a Consultant Nathanael Feehan, LPO, business consultant and CEO, Master’s Orthotics and Prosthetics, has experience with consulting from the client and advisor perspectives. As a client, he’s invited a number of experts to offer advice and improvements to his own practice. “The ones that have been most helpful are those that have come from an O&P background. Even the medical consultants haven’t been that helpful because our field is so unique. We’ve had some Six Sigma people come through—some industrial engineers—and when we show them the complexity of our system, they pretty much glaze over and say, ‘Wow, that’s ridiculous!’” “Getting a consultant is like advertising,” Ford cautions potential clients. “If you want to do it once and be done, don’t even start. You need to develop an ongoing relationship so that consultant can understand your business in great depth and give you better advice. I suggest working with them on a quarterly basis. If they’re reviewing your practice, your data, your financials quarterly—and making suggestions based on what they see, then coming into your practice once or twice a year to spend time to talk to people, see how things are flowing, understanding where the challenges are, and searching for solutions—that would be a huge step forward for a lot of practices and a much more affordable solution than hiring a business manager. “The really good consultant provides action-oriented feedback that suggests a solution and specific steps to follow, based on what they’ve seen,” he says. Experience Makes Experts—and Expert Witnesses Karl Lindborg, CPO/LP, prosthetic and orthotic clinical practice consultant, upper-limb prosthetic specialist, observes that prosthetists who don’t have an upper-limb program don’t realize how different the workflow is from a lower-limb prosthesis. His assistance might be limited to simple coding or clinical justification, but in most cases, his 15 years of specialized upper-limb expertise is applied to expedited fittings on externally powered prosthetic devices that are complex, costly, and require a lot of coordination. He has worked, for example, with a clinician to create a treatment plan for a partial hand that would gain insurance approval and could also serve as a template in future cases, saving the client additional costs. “There’s a huge rejection rate in upper-limb prosthetics,” he reports. “Not so much because the amputee refused it or found it too heavy or too hard to put on and take off, but likely because we, as prosthetists, didn’t seek advice with a complex case and an unfamiliar device, which we probably should have referred to an expert. “Sometimes it’s simply the timing: If it’s not something that you do every day, it may be taking too long to make it comfortable for the patient. Most clinicians will go the distance and get it done. But if that required 24 visits, the upper-limb amputee probably lost interest at visit number ten, wondering why the prosthetist was taking so long, when an expert could have gotten things resolved sooner, and the fitting would have been a success. “The reason for the rejection may not be apparent to the prosthetist. Because they’re not familiar enough with the process, they may say, ‘Well, I’m never doing that again, because it went sour on me.”’ Lindborg has recently gotten involved in catastrophic case management, working with a third-party administrator group that manages work-related injury claims for the workers’ compensation carrier. Claims can exceed $1 million and can include head injury with internal organ injuries with an amputation and potential substance abuse and/or emotional issues. His job is to help the team develop a care plan, practicing all the things he’s experienced in his career by interfacing with the treating clinician. “The average clinician doesn’t often see those kinds of catastrophic cases,” he notes, “and often we’re so focused on the prosthesis that we can’t see the forest for the trees.” Lindborg also provides his expertise to manufacturers new to the market and trying to understand the specifics of the US healthcare system, and notes that there’s always a need for expert witnesses for both defense and prosecution. As such, he develops a needs assessment for, usually, an injured worker, which may or may not agree with the treating clinician’s findings. His services do not, however, include actuarial work—that’s the job of another skilled specialist. Terry Supan, CPO(E), FAAOP, FISPO(E), Supan Prosthetic Orthotic Consultations, retired from clinical practice in 2008 and from consulting in April, and now only offers referrals to other O&P specialists; but, like Lindborg, his role as expert witness has been solicited in higher-cost injury cases. A clinician whose patient’s physician is involved in a malpractice suit might need to contact a consultant to get their advice, he explains, as might a clinician whose patient has entered into litigation concerning the cause of their amputation, spinal injury, or other injury. The consultant then writes an independent evaluation of what the patient’s future needs will likely include. This evaluation is then perceived by the attorneys, judge, or jury as more impartial than an assessment from the patient’s prosthetist. Supan has most often been consulted relative to personal injury cases, wherein the client is interested in learning what their life expectancy and care costs will be, based on the projected technology they should be receiving; but like Lindborg, he abstains from providing true actuarial numbers, which factor in complex lifetime influences like inflation. “If someone is injured when they’re young, and they may have 20, 30, or 40 years’ worth of prosthetic or orthotic care going forward, those can be significant numbers,” he points out. The Human Element More people are becoming aware of their need for consultant assistance, Sisson says, pointing to her own team’s growth—from two people five years ago to 13 today. Their 2022 Lead the Way conference featured the human resource and human relations consultants that serve her own company, and preregistration response for the second annual November event shows healthy interest. “A lot of what we talk about is leading people, and the people aspect of our business; and that’s resonating with business owners,” she says. Monthly follow-up webinars have focused on human resources, mergers and acquisitions, marketing, and advocacy. Feehan, likewise, recognizes the power of human energy and commitment, as reflected in his own O&P practice, where he applies the principles of the Great Game of Business in addition to sharing them with others through consultancy. The philosophy of motivating employees by making them partners in success resulted in a reported 600 percent increase in the practice’s profits compared to the previous year. Although it’s similar to an employee stock ownership plan, it doesn’t have to be run in that way, he explains. “People want to win, people want to be successful, so if you can take that, harness that power and give them a stake in the outcome so it’s not just their paycheck; it’s a little more than that, then they will pull together, and that changes your culture, and it changes your bottom line, as well. I’ve seen it happen at other companies where the people start getting excited about coming to work. Salaried people will work overtime, people will do those little extra things that a business owner does because they see how it benefits them. “At this point, we’ve been able to give raises to people, we’ve been able to start new benefits—things that we dreamed of but hadn’t been able to do. Those are the kind of things that as a business manager I’m excited about,” Feehan adds. That human element is also key to the successes Lehneis enjoys in his efforts to negotiate with insurance payers and acquire contracts on behalf of his client companies. “Typically, most of my referrals are through word of mouth,” he notes. “Just like other relationships that I’ve developed in the industry—for example, I work with contracting representatives and managers to either obtain a new contract or obtain better rates on an existing contract. “I reach out to my network because this is a very personal industry. As that O&P provider becomes like a member of their prosthetic patient’s family for their lifetime, that’s how I treat the consulting aspect—by developing a rapport with the owner, or the key people within that organization, so they feel comfortable to reach out to me with a variety of questions or issues they are confronting.” His methods have led to increases in clients’ top-line revenue by getting contracts they hadn’t been able to before or by rate increases across the board with an existing contract—sometimes a reported 5 or 10 percent. “And that drops right to the bottom line when you consider that as money that they didn’t have before,” he points out. Client problems, too, are most often rooted in human issues, Ford finds, “specifically, a lack of thorough training, and attention to the flow of information and people actions. “Most practices have a very well-described or very well-understood workflow when it comes to fabrication. But everybody in your company should also understand that flow from the time when your patient first calls you to set up their first appointment to the delivery of the device. How do you want that to flow? Then you should make sure that everyone understands their role and is trained to accomplish it. It really gets hard for a practice owner to have the time and the information to do that; this is where consultants can help.” The Bottom Line How much difference might a successful consult make to a business that hadn’t expected that it needed one? Sisson offers the example of her first paying client, who had just hired a diligent new biller. “Together, we went through their A/R, and because we worked hard at it, they collected more in the last two months of that year than their business had in the previous ten months. They went from being in the red on their profit and loss to being really positive.” She also points out that when she and husband, Ed Sisson, CPO, bought their practice in 2015, it had been collecting at about 74 percent. “After we took over, we began collecting between 96 percent and 98 percent—even without bringing any more sales in the door.” Ford previously started and ran OPIE’s former business consulting services division, and he recalls practices that were able to improve their bottom lines by 15 to 30 percent by taking time to dig into their data and make adjustments, or to look at their processes and find a better way to do things. “We regularly found that we were able to go into long-standing practices and point out things that allowed them to significantly improve their bottom lines over the next six to 12 months.” Supan reflects that even an expert witness assessment can be profitable. “If the litigation is successful, the prosthetic or orthotic patient will receive a more optimum prosthesis or orthosis, and the amount of care will be at a higher level—for which the practice will be reimbursed.” And the bottom line for the consultant? It’s not only the standard reimbursement for services, but the joy of mentoring and the satisfaction of helping not only individual clients, but the O&P industry and profession by passing on the years’ worth of hard-won experience, the historical lessons observed and learned, and the wealth of knowledge that even the sharpest new knife in the drawer can benefit from. 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. Images: peshkova/stock.adobe.com

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