Taking Care of Business: Balancing Care and Profitability to Succeed in O&P

Running a successful O&P practice requires more than delivering exceptional patient care. It also demands regular attention to the financial and operational health of the business. To serve patients and stay viable, clinics must optimize profitability, craft effective marketing strategies, and build strong relationships with referral sources. Additionally, standing out in a competitive industry calls for creative approaches. Designing unique facilities and offering niche services are some of the ways that O&P care providers can set their practices apart. We talked to practitioners and industry experts about strategies to help O&P professionals balance their passion for patient-centered care with the need for business sustainability. While large corporate clinics have deeper resources and repeatable processes, managing the business side of O&P is often more challenging for the 1,300-1,700 independent practices currently operating in the United States. Sierra Prosthetics-Orthotics, California, is one of those. The clinic has been family owned for more than 30 years and operates two locations in rural Northern California. Office Manager Tanya Baer, CFom, knows firsthand the challenges of navigating the business side of a practice. She handles all the contracting and billing and keeps a pulse on Sierra’s marketing needs. “One of our biggest challenges is being able to get paid and keep the money,” Baer says. “We address [that] by following the guidelines set forth by Medicare and other insurance, as well as documenting clearly and correctly in our charts.” While that due diligence to support the claim creates more paperwork upfront, Baer says it makes for a better outcome in the long run. Sierra also focuses on education, with its referral sources and with its patients. For referral sources, this means informing them in real time when changes come about so that they understand and cooperate to provide necessary information and documentation. “We try to be upfront with the patients as well,” Baer says. “As soon as we get a referral, we request records, and we keep patients informed on the process so that they know what to expect with timelines. For bigger things like custom devices, we try to work through the paperwork while casting and fabrication are happening so that we are not just leaving the patient waiting while we’re doing paperwork.” Human Technology & Prosthetics operates eight full-time clinics—seven in Tennessee, spanning Memphis to Nashville, and one clinic in Southaven, Mississippi. It also has two part-time clinics. President Ramesh Dubey, CPO, says staffing is one of his biggest challenges. “Hiring clinical technicians and office administrators is challenging due to high turnover,” he explains. “They gain skills and often leave.” Low reimbursement rates from major insurance companies further strain profitability. “Component costs have risen, shrinking margins,” Dubey notes. To counter this and optimize finances, the practice created a master list to track commonly used components, manufacturer discounts, and reimbursement rates. “We never deny a patient’s needs,” Dubey says. “Even uninsured patients get the care they require.” Marketing Tactics Marketing a practice for growth is another area that can be particularly challenging for independent clinics to navigate. Without deep resources or dedicated staff, marketing is often put on the back burner. Many practices simply don’t have a solid marketing plan, particularly if there is a fairly steady referral stream to rely on. Still, existing relationships must be nurtured and new ones developed. Because referrals are Sierra’s main source of business, Baer says they place a lot of focus on building and maintaining relationships. “We regularly reiterate to referral sources that we are available for any questions, and we communicate with them a lot about ancillary services such as physical therapy.” That communication includes frequent personal visits. Baer employs tactics like delivering cookies at the end of the year, which she says opens the door for conversations and camaraderie beyond business. In her smaller community, she says this approach is still quite effective. “Those visits often end up with me being able to address something on the spot, so it’s important to keep the lines of communication open,” she adds. “Conversations are important to ensure no one is making assumptions about anything. They can just ask me direct questions and vice versa.” The referral network for O&P providers has become more complex in recent years, Baer points out, in part due to the fact that patients are seeing multiple practitioners. Any communication breakdown between a patient’s team of providers can add to the challenges for the O&P provider, she says. “These days, we have to put a lot more pieces together to get the information and documentation the insurance providers require,” Baer says. “As those requirements have gotten more stringent, it’s made the referral process more complicated—especially when there are many providers in the mix.” Sierra doesn’t currently do print or television advertising, but for several years it partnered with a now shuttered urgent care clinic for an ad on its closed-circuit television ad stream. Now, Sierra relies on the outreach and interactions it has with referral sources to build business and nurture existing business. Because Sierra is in an area that is not saturated with O&P practices, the clinic still benefits heavily from word-of-mouth marketing. She says people like the fact that it’s a family-owned business. “This is a close-knit community and there is a small-town feel.” Offering breast/mastectomy prostheses and compression services also helps Sierra differentiate itself as a niche provider of a service that patients would otherwise have to travel further to access. Baer says the fact that Sierra continues to offer diabetic shoe services is also unique as more providers opt to discontinue them. “We are a small community with a large geriatric population,” Baer says. “We try to stay informed about the overall demographic and continue serving those people the best we can even as those services become less profitable for us.” Continuing to do so is a testament to the value Sierra places on its reputation, which as Baer points out, is a marketing tactic in itself. Human Technology’s marketing strategy includes leveraging local TV ads, printed materials, social media, and Google advertising to build visibility. But Dubey says their personal approach is what truly sets them apart. “We have patient coordinators who visit doctors, nursing homes, and even amputees directly,” he says. “A couple of our coordinators are amputees themselves, which resonates deeply with patients. Patients see others walking confidently, and that motivates them,” Dubey adds. Those personalized visits also help to expedite getting paperwork from referral sources. Dubey says his coordinators often assist referral sources with filling out forms, which increases the chances that the coordinators can leave a visit with everything they need in hand. The practice also emphasizes education, providing a book on post-amputation care to patients and referral sources, and the company maintains a strong presence across Tennessee and northern Mississippi. Facility Design Elevates Patient Experience Dubey says Human Technology’s facilities are designed to enhance both care and patient experience. Its Wolfchase office in Memphis features a therapy gym with golf, a rock-climbing wall, and a punching bag, as well as a revolutionary gait-training lab. “Patients can practice on flat stone surfaces, inclined terrain, stairs, and uneven surfaces,” Dubey explains. “It’s about preparing them for real-world adventures.” The practice also boasts an outdoor amputee park for patients learning to use their prostheses in Southaven, Mississippi, with another coming soon in Jackson, Tennessee. These parks include specialized steps, ramps, and terrain like sand, mulch, grass, and even marbles, which allow patients to train themselves to walk in a realistic environment. “Most patients only practice walking in their practitioner’s office, but these spaces give them the confidence to navigate the real world,” Dubey says. The parks also feature basketball courts and golf. Of Human Technology’s ten facilities, eight have fabrication workshops with 3D printing and scanning. Fabrication is also done at two additional offices without dedicated workshops. That setup helps the company to control volume and maximize work while saving money. For Sierra’s part, Baer says its centralized location is close to a hospital, which elevates convenience and patient care. Both of its clinics feature wider doors to accommodate wheelchairs and parallel bars to assist patients as they get acclimated to walking on their new prostheses. In addition to hospital proximity, Baer says her clinics offer patients the option of sending a member of the Sierra staff with them to their physical therapy appointments. Conversely, they open their doors to therapists who want to come to the Sierra clinic with their patients. “If they want to bring them here while they’re getting fitted, we welcome that,” she says. “We are trying to encourage more patients to take advantage of this because it just eliminates so much back and forth.” In terms of innovations that help the business operate more smoothly, Sierra began digitally managing all its patient charts many years ago. That was a game-changer, according to Baer. “Everything is captured in a centralized place and it’s so much easier now to visualize patient information.” Specialized Services and Innovation In addition to its traditional O&P services, Sierra’s centralized facility features a dedicated mastectomy fitting room to support its breast/mastectomy prosthetics business. “People in the community are always pleased to learn that we offer this niche service, and we get a lot of referrals from that as well, as word travels about it,” Baer says. Human Technology has also introduced niche services like breast prostheses. The practice also offers cranial helmets and upper-limb prosthetic devices, including custom postural hands. “These innovations have helped us grow and improve outcomes,” Dubey says. Balancing Care and Business Goals For Dubey, compassionate care is non-negotiable. “Compassion comes from within, and I don’t think you can teach that,” he says. His team is trained to prioritize patient care while being mindful of costs. All his employees are informed about prices of different items and what the reimbursement amounts will be. Ultimately, he says the goal is providing the best care and service. “We constantly preach that if you take good care of your patients and referral sources, the money will follow.” Baer echoes that patient-first philosophy. For Sierra, she says, great patient care comes down to making sure there is enough time scheduled for each visit so that the practitioner doesn’t feel rushed and the patient feels seen and heard. “We want the practitioners to have time to connect with the patients,” she adds. “And the older demographic especially doesn’t always get out a lot; they like having that time to visit and get the reassurance they need.” Baer says her staff is also trained to triage—deciding which patients have to be seen this week and which can wait. That also helps with scheduling by prioritizing needs and allowing time to provide the highest level of care. To balance the business side, Baer’s staff is also trained to be cost-conscious and to understand reimbursements. Advice When asked what advice she’d give to other clinic owners, Baer says she would discourage them from dismissing services that might not be huge profit drivers, such as mastectomy care and diabetic shoes. “These are needed services in the community and that helps to build a good name.” Ultimately, she says you can’t simply focus on the bottom line. “That is important, but you can also really help by providing services that might be harder to find, especially if you are offering something that no one else in your area is. If you decide to specialize in a particular brace or prosthesis that can also generate more buzz.” Dubey’s advice emphasizes honesty and quality. “Take care of your patients and be honest about what you can and can’t do. Provide what you promise,” he advises. Consultants Weigh in As this year’s president of the American Orthotic and Prosthetic Association (AOPA), Rick Riley is passionate about helping O&P businesses thrive. He founded his consultancy, O&P Boost, to help practitioners and O&P product manufacturers/suppliers. His insights offer a roadmap for clinics to navigate financial challenges, strengthen referral relationships, and differentiate themselves in a competitive market. Riley says that maintaining and growing referral sources is among O&P clinics’ biggest challenges. He cautions that they should not simply rely on long-standing relationships with physicians because that pipeline can dry up as relationships fade or physicians retire. “Often they assume no news is good news, but they’re not following up with referral sources to ensure they’re aware of the quality of care being provided,” he says. He emphasizes proactive communication but encourages taking that even a step further by following up on patient outcomes with the referring physician. A photo of a patient using a new device, accompanied by a brief success story, can leave a lasting impression, he says. “It’s not only about sitting down with a doctor for 30 minutes to talk about your services—it’s about framing the conversation around the patient’s story.” Riley also encourages clinics to engage with the entire healthcare team, not just the physicians. “Sometimes, the staff is the best target,” he says. “Host an educational lunch or invite them to your clinic for a tour. Building relationships with the people who interact with patients daily can be just as impactful.” Riley tells his clients that marketing should not be an afterthought. “For many O&P clinics, it’s a hope and prayer.” He says effective marketing doesn’t have to be expensive or time consuming. He suggests simple, creative strategies like sending cards or gifts on unexpected holidays, such as Valentine’s Day instead of Christmas, or sending one-page case studies with patient success stories. “Every day in a clinic, there’s a story,” he adds. “Use those stories to educate the community and build your brand.” Riley also highlights the importance of facility design in shaping a clinic’s brand identity. From the waiting room to the exam room, every detail contributes to the patient’s perception of care, he says. “Take a critical walk through your clinic,” he says. “What impression are you making? What emotion are you creating?” He tells his clients that small changes like updating outdated décor or providing educational materials in the waiting area can make a big difference. Tracking Profitability Without Compromising Care Riley says that clinic owners must have a clear understanding of their revenue streams and referral data to ensure their long-term sustainability. “[Many clinics] don’t have a three- or five-year run rate to analyze trends,” he says. Regular business assessments can help identify which patient categories and services are most profitable, allowing clinics to allocate resources more effectively. He also advises clinics to think creatively about patient engagement. Programs that involve patients before surgery—such as mobility assessments—can improve outcomes and strengthen relationships, for example. “It’s about showing you care, and that can be personally and financially rewarding.” Ultimately, Riley is driven by a desire to see the O&P profession thrive. “I love talking to people—whether they’re near the end of their careers or just starting out—about their business and how they can prepare for the future.” Ryan Ball, vice president, VGM Market Data, has spent over a decade helping O&P providers identify opportunities and optimize their market strategies. He equips practices with data and intelligence to find referral sources, assess market share, and make informed business decisions. The first step to growth, he says, is understanding where business comes from and where else it could come from. “Your biggest opportunity might not be a new referral source,” Ball points out. “It could be a doctor you’re already working with, so knowing which physicians drive the most volume is key.” VGM Market Data provides practices with insights they might not uncover on their own, such as identifying which competitors are receiving referrals from high-volume physicians or pinpointing geographic areas where there is untapped potential for new business. “I am a big proponent of ‘know before you go,’” Ball says. “If you can focus on where you’ll have the most success and biggest impact, you can execute on your growth plan faster.” He encourages clients to create targeted sales and marketing plans based on data. “You can’t treat every referral source the same,” he adds. “Data helps you prioritize your time and resources.” For example, knowing how referral sources prefer to communicate—whether through patient success stories, educational materials, or direct outreach—can make a significant difference in building and maintaining relationships. He also stresses the importance of practices finding their niche in the market. “What sets you apart? How do you make the lives of referral sources and patients easier? These are the questions practices need to answer to stand out,” he says. By focusing on how to best support physicians, such as by keeping patients healthy and streamlining the referral process, O&P providers can position themselves as indispensable partners. For VGM Market Data, every client interaction begins with a market analysis to look at everything from current practices, referral sources, potential new locations, and new products and services. This analysis helps to develop a clear growth plan, whether through geographic expansion, new services, or strengthening existing referral relationships. Ball stresses the importance of tracking and measuring progress. “It’s not just about having a plan—it’s about executing it and then evaluating the results,” he says. Ball also sees a lot of opportunities for O&P providers to better understand the reimbursement landscape and adapt to potential changes, such as a push toward standardized reimbursement models. “The more you know about your market, your referral sources, and your specialty, the better equipped you’ll be to navigate these changes.” He sums up his advice to O&P practices in a simple, yet powerful way. “Be the smartest person in the room,” he says. “Having the right information will help you do that.” When it comes to advising their clients, Riley and Ball agree that by focusing on proactive communication, intentional marketing, and strategic business planning, O&P clinics can achieve the delicate balance between compassionate care and operational success. Looking Ahead In terms of the future for Sierra and Human Technology, both are poised for growth and are cautiously optimistic. By expanding its amputee parks and continuing to innovate, Dubey says Human Technology is setting a new standard in O&P care. As he puts it, “We’re not just providing prosthetics; we’re giving people the tools to live active, confident lives.” For Baer’s part, she says she will continue to lean into the community Sierra supports and always keep listening to the patients and nurturing referral relationships. “New things are always coming about, and I am excited to see how our clinics progress,” she says. “I like going to the AOPA assemblies to see all of the new products and procedures and network with others to share ideas. It’s great to learn how we can incorporate those things into our practice and ensure we don’t become complacent about our business.” Tara McMeekin is a writer and editor based in Colorado.

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