MOST PEOPLE WHO ARE DRAWN TO O&P ARE ATTRACTED BY THE POTENTIAL TO HELP PATIENTS AND THUS HAVE FOCUSED THEIR EFFORTS ON PATIENT CARE AND IMPROVING OUTCOMES. BUT TO ENSURE THAT CLINICS CONTINUE TO THRIVE TO SERVE THOSE PATIENTS, PRACTICE OWNERS AND MANAGERS MUST IMPLEMENT MEASURES TO OPERATE EFFICIENTLY, PROFITABLY, AND IN COMPLIANCE WITH INCREASINGLY COMPLEX REQUIREMENTS AND REGULATIONS.
WE SPOKE TO O&P BUSINESS OWNERS AND ADVISERS TO GET THEIR SUGGESTIONS ABOUT BEST PRACTICES AND INSIGHTS INTO CURRENT TRENDS. WE ALSO SHARE PROFILES OF THEIR COMPANIES TO PROVIDE A VIEW OF THEIR ADMINISTRATION STYLES AND CORPORATE CULTURES.
Scott Schall, CP, the owner of Apex 360 Systems, Houston, is an Army veteran with two engineering degrees and 16 registered patents. He has owned or co-owned prosthetic companies since 2007 and now offers business consultation. His specialty is providing scored assessments indicating how O&P clients are handling the business aspect of their practices and then helping them through structured steps to optimal performance.
Schall has developed a trademarked tool, Apex 100, to do that. Based on best practices, he describes it as a sequential and continuous professional management system, not a software program, to help clients evaluate their choices.
The majority of his clients are owners who feel, as he once did, that they are losing control because they are growing so quickly—or because they are losing ground.
The improvement process starts with strategic planning, something an O&P business is wise to undertake every year, Schall advises. He cites a 2014 study that found lack of strategic planning is one of the top three reasons businesses fail.
In this annual planning effort, after assessing their strengths, weaknesses, opportunities, and threats, O&P businesses should prioritize “two or three make-or-break issues to leverage strengths, take advantage of opportunities, or combat threats,” he says.
The same process is key to successful expansion, and to deciding where you want to expand to, he says.
The process should not just involve the CEO. He suggests that a team should come together to discuss annual or expansion goals and problems, and then each action item should be assigned to one person.
Jessica Norrell, MBA, CPO, has more than 19 years in healthcare, and set up MOZN Solutions, Richmond, Virginia, after six years in information technology at OPIE Software, Gainesville, Florida.
MOZN offerings include project management, training in electronic medical records (EMR) and workflow, systems integration, and business development. About 80 percent of her clients are O&P companies.
Norrell’s background includes clinical practice, fabrication, and increasing a client base.
When it comes to business trends, she makes three points:
First, O&P practices are increasingly part of consolidations: selling to hospitals or choosing to partner with larger organizations and companies such as Hanger, Ottobock, and Össur. While some smaller O&P practices are looking to acquire other practices to scale their businesses, the larger practices are the focus in consolidations right now, she says. They are starting to partner more, especially ones with
owners who have long struggled with insurance companies and changing regulations, she says.
Norrell also notes that the former focus on building business leaders is changing.
“As in many firms now, my focus is on building teams. There’s more handholding, more one-to-one. It formerly was more hierarchical,” she says.
A third trend is that outsourcing of billing is becoming increasingly common because medical billing is extremely
complex. “You have to keep up. Billing turnover is high,” Norrell observes. Owners of healthcare practices use billing modules in management software, but too many owners do not understand how to make the best use of them. And while some clinicians may be more comfortable
leaving billing solely within an office manager’s purview, that could contribute to an inefficient process, she warns.
Emily Lund, CMF, is CEO and president of San Francisco Prosthetic Orthotic Service (SFPOS) and has 17 years of experience in healthcare. In addition to her mastectomy fitter certification, she has degrees in business administration and economics. Lund spent eight years running the business operations of SFPOS, which has one location, an on-site lab, and 12 staff members, before becoming the owner in 2018.
Those in O&P want to help people, she says, but it’s tight financially and hard to run a clinic. To succeed, you not only need to have up-to-date practice management software and use it effectively, you need superb teamwork to meet your goals and keep things running smoothly.
“Put the ball in the hands of your administrative staff; they’re the point guards. They’re controlling everything,” Lund says. Train them and trust them, she advises. Help them understand their jobs and each other’s jobs as well as the work of the clinical staff.
SFPOS has four administrators. They’re knowledgeable about tasks throughout the office and can fill in for one another. Lund rotates them through trainings and travel to conferences, offers them professional development opportunities, and similarly provides for the clinicians, sending them to coding and billing seminars, for example.
“Keep people out of silos,” she says.
Toward that end and in support of office morale, Lund uses each Thursday as an administrative day. Staff members do not see patients, the phones go directly to voicemail, and they use the time for weekly meetings and to catch up on work. The four administrators meet together with the clinical assistant.
The billing manager meets one-on-one with each clinician, and Lund meets with the fabrication staff.
Additionally, at 8 a.m. every Friday, the entire staff comes together for an hour, with those that work from home attending via Zoom. They go over the following week’s appointments and address important items for everyone to be aware of. Although she says it’s the most important meeting of the week, it’s quite informal. On site, “we all sit on a big sofa in the basement, cups of coffee in hand and dogs in laps,” Lund explains. In short, the SFPOS corporate culture shows the shift to team development others interviewed point to as a business trend, a change from a hierarchical structure common in the history of O&P.
The backbone running through this cooperative culture is OPIE practice management and medical records software that keeps everyone on the same page from prescription to delivery.
To free staffers for higher level work, Lund uses software add-ons to automate routine tasks. She has a revenue cycle management tool, another for patient relationship management, and a tool that does COVID-19 screening questions. They integrate with OPIE and save time and money, she says.
Whatever choice you make about software, Lund advises, look for a robust system, especially one that can assist you in creating medically strong records to send to insurance companies.
And finally, she advises, networking can be a learning tool for everyone at an O&P practice—but it’s particularly important for executives. “Introduce yourself to other owners. Attend as many professional gatherings as you can, locally, regionally, and nationally,” she says.
Chris Jones, CPO, is the owner and manager of Rebound Prosthetics, Denver, a small clinic with its own lab and five employees, including Jones and his wife Anastasia Jones. After working with hospitals and large practices that sometimes cut corners for corporate reasons, Jones decided in 2004 to start his own business so he could execute his exacting standards and act on his professional and personal values.
He gives an example: “An above-the-knee prosthesis can be difficult to fit, but insurance will only pay for two
diagnostic test sockets. I do three test sockets if needed and keep costs down by buying materials in bulk.”
Rebound has clients from around the globe and specializes in tough cases and professional, Paralympic, and local athletes with limb loss.
It isn’t an easy climate for a small business. Jones has two management suggestions for success.
First, deploy solid practice management and EMR software. Rebound uses OPIE, and Jones particularly values its mobile-friendly remote access since he often travels to visit clients and healthcare providers.
On the downside, he has had difficulties hiring an outside billing firm that could work well with OPIE’s complexities. His network helped him solve the problem. “I finally got on a [professional] listserv and asked practitioners what billing companies they used that had that experience.”
In addition to the billing firm, Jones keeps an attorney on retainer who has experience in corporate and international law and says that it’s worth the expense.
His second suggestion: “With any O&P business, to be successful you have to determine which team meetings are important and not skip them. We have weekly Rebound meetings with the whole team, and every few days I meet with the technical staff. What matters the most to me is everybody getting along and working together.”
Rebound also takes part in a weekly Limb Preservation Foundation meeting. The Foundation supports coordinated and comprehensive care for people with limb differences. So on Thursdays at 7 a.m., providers from multiple levels of healthcare in the Denver area come together to address a difficult and important case. They work to fashion good outcomes, to prevent or heal patient limb loss, and create best practices for practitioners. Jones is also part of a core cadre from the Thursday group: He’s one of a dozen providers who are actively treating individuals with limb loss and meet once a month to address issues in their patient case loads. In short, these regional meetings are teamwork writ large.
Jones also notes several O&P trends and issues that concern him. Schools are not teaching good fabrications skills, he says, and the residencies where students can learn them are increasingly hard to come by.
Additionally, although new prosthetists have a master’s degree, completed a two-year residency, and passed a certification exam, they are not trained in practice management.
A lack of business savvy or simply neglecting practice management, however, means “it’s the patients who suffer the most” if there are coding errors, delays in care, or delays in getting authorizations, Jones emphasizes.
If you can manage your practice well, though, the satisfaction rewards are great, something that does not always happen in the work world, he observes. Among those satisfactions, “Through friendships with long-term patients, they can become family,” Jones concludes.
Julie Palmer is practice manager for Prosthetic and Orthotic Associates and Handspring (POA/Handspring) headquartered
in Middletown, New York. Handspring specializes in upper-limb prosthetic services. She oversees administrative matters at Middletown, two other POA/Handspring patient care centers in New York state (all three with large labs), and two Handspring locations that offer both upper- and lower-limb prosthetics – Denver and Salt Lake City—as well as Handspring satellite clinics in Manhattan and Albany, New York, and Atlanta.
“I cooperatively manage all eight locations working closely with the company’s clinical director, assistant director and owner,” she explains. She hires the administrators for all the locations, and interacts with them on a regular, if not daily, basis. She has weekly conference calls with each location and acts as a problem solver, making sure that staff have the tools they need and checking billing and accounts receivable. “I recently made sure the paperwork was in order for a new patient at the Atlanta office,” she explains.
“I can do this because of the team we have,” she says. “Everybody, technicians, clinical, admin, works together.”
To have an O&P practice management system—or any O&P system—work well, she advises, you need a road map so all employees and processes are moving in the same direction. There needs to be an established way of doing it the same in all quarters. You also need to be flexible, she cautions,
and able to change if something does not work.
“We all use OPIE Software [at POA/Handspring],” but the practice also contracts with an electronic billing service that works with the software. Palmer has the assistance of several billing specialists, and the company uses additional contractors for finance matters.
Palmer says that the firm’s corporate culture feels almost like family even with its scattered locations. She says that approach comes from the top, from the firm’s founder, Tom Passero, CP, who will pick up the phone to pitch in and help out when needed. It’s supportive leadership, she explains, not justtelling people what to do, and “everybody follows that leadership lead.”
While POA is the largest company profiled here, its management practices and corporate culture echo those of the other firms profiled and are in line with Schall’s and Norrell’s recommendations and highlighted trends.
Carolyn Cosmos is a freelance writer and editor based in Boulder, Colorado.
