“How do you think O&P practitioners need to adapt to stay profitable in a changing field?”

I think the biggest thing you can do to fight against your reimbursement [problem] is to be able to see more patients. Instead of seeing four or five patients a day, we’re changing our workflow process so practitioners are able to see 10-15 patients a day.

We looked at what each practitioner was doing: Are they doing their own fab work? Are they doing their own modifying work? And then we were able to hire people at a lower cost to do some of that work so that the practitioners aren’t spending four hours a day doing that.

Each patient is being treated the same way each time they come here. The front office staff knows what to expect from the practitioners, and the practitioners know what to expect from the front office.

It gets down to a system where you’re doing your charting and your notes immediately after you see a patient; you’re not letting that stuff build up until the end of the day.

I can actually see 10-12 patients a day and be less stressed, because I’m not back [in the shop] modifying four AFOs and trying to squeeze in that kind of stuff between seeing patients.
Shawn Jewell, CO, Clinical Director
Dothan Brace Shop Inc.
Dothan, Ala.

Instead of incurring the cost of next-day-air shipping because you waited until the last minute, you save $35-40 on shipping costs because you planned ahead. The difference between $20 and $30 shipping is going to make the difference in your profit margin at the end of the year.

You can [say to] your fabrication team, “Look, these are the vendors I like to work with, and until something else comes up that’s better, I’ll stick with this.” You know what you’re going to order, you know what you’re going to fabricate and you have a reasonable expectation of the outcome.

It’s not that all patients fit into a cookie-cutter system; but just standardize the process by which you select your components. Have vendors that you’re familiar with, know their shipping costs, know their shipping rates, and plan ahead so you can order these items and not have to incur the higher costs because the patient’s coming in and you didn’t have a leg fabricated in time.

Use local vendors for your plastic. If you live in a metropolitan area, chances are there’s a vendor that can get you the plastic you want and deliver it to your door with no delivery fee. That’s what we do here.
Stephen Marfia, CP, RTP
Lifestyle Prosthetics & Orthotics Inc.
North Andover, Mass.

One of the keys is [to hire] an assistant to take care of some of the more mundane things that you do: take the patient history, make minor adjustments, just be that extra pair of hands for you and follow you through the day.

I have an assistant who was in the technical program, so she has good hand skills, and I felt she had good people skills, so I brought her along. It’s just working fabulously. She can replace the hydraulic units, change bumpers, order all my [supplies], do the warranty work, do all those things that slow us down.

I’m the busiest practitioner here. I just couldn’t keep up with my practice, and I was putting people off for two to three weeks to get their appointments. I’m getting more and more referrals, but if I can’t see someone for two weeks, that’s bad for business.

Now I can double-book for certain minor things. I can be doing casting while she does repairs. Now I can schedule much tighter and I can see many more patients, and I don’t have to work as many hours.

The cost of the assistant is much less than hiring another practitioner, and at the same time, that patient is still feeling that they’re seeing me.
John Ruzich, CP
Scheck and Siress O&P Inc.
Hickory Hills, Ill.

Profitability is simple: pay less and sell high. But we can’t get the prices higher, because we’ve had a freeze. And the easiest way to pay less is to buy junk, which most people don’t want to do.

So the only thing left is to expand your area of expertise. We’ve gotten back into diabetic shoes after 20 years, and that’s become a fair amount of the business. You can also get back into DME. We sell some wheelchairs.

But I think a hard thing is the outside competition. It’s easier to compete against those who do business the way you do. Treat people right and do your job well, and you’ll be fine. But I can’t compete against the people who’ve come in the last three or four years.

There are really only three things: broaden your horizons, lower costs or raise your prices.
Ben Pulizzi, CP
Williamsport Orthotics & Prosthetics Co. Inc.
Williamsport, Pa.

We were founded four years ago, and we’ve opened four offices in three and a half years. We only hire formally trained, ABC-certified practitioners who have done residencies. In the long term, we’ve found that they make fewer mistakes, are more intelligent about cases—there’s very little trial and error.

O&P has had an element of [trial and error] over the years. In the ‘80s, when things were gangbusters, we could bill for an AFO until we got it right. Now that we can’t do that, we need to have our “A” game ready as soon as patients walk in the door.

We also use OPIE so that there’s very little double data entry. That way, our office staff isn’t calling our practitioners and saying “You forgot to enter these L codes.” In fact, practitioners can’t move on to the next case until they meet certain requirements in the software. It’s about efficiency and accuracy—that way we’re not getting denials after 30 days [from Medicare]. We have very few second submissions.

We just started using the scanner for certain devices. It saves two days in shipping to the manufacturer. And many of them say that it’s easier to work from an image than from a mold, because working from a mold involves labor.
Jeffery Brandt, CPO, President
Ability Prosthetics & Orthotics
Gettysburg, Pa.

When it comes to the billing, [you need] an administrative person who’s been involved with billing in O&P for many years. For me, that’s hard to find in the area. [Or] you need to find a billing company that has all that experience and is devoted specifically to just O&P, is familiar with the software to submit this stuff efficiently and knows how to diagnose the problems to the primary and then the secondary [payers].

That might be a way to get it done, but it costs you a lot. What is the balance of what offsets what?

I’m just learning to analyze different business models in that way. I wish there were better resources, because I feel like I’m reinventing the wheel, and I think people are doing it all different ways.
Rich Jesteadt, CPO
POPPS Prosthetic Orthotic Corp.
Lake Park, Fl.   

The biggest problem for profitability we have is that companies like UBI and Spectre are coming into the doctors’ offices and doing all of the off-the-shelf stuff. And I think suppliers like Ossur and DonJoy are selling to them directly.

To adapt, I’m trying to get in more doctors’ offices by doing clinics. The face time seems to pay off. Bigger groups, like the University of Toledo Orthopedic, have other companies come in.

We can’t do lunches and dinners anymore, so through service, we get to know the doctors. It can get frustrating, but persistence works. And it’s not only doctors writing the orders—sometimes it’s residents or nurses. It’s just getting them to know who you are.
Michael Stevens, CPO
Marshall-Kloene Orthopedics Inc.
Toledo, Ohio

I think the main thing we’re going to have to do is keep up, education-wise. [There are] different materials and different techniques throughout the entire scope of the field, so I think [we need] education on the latest and greatest. Initial education is needed in the extreme, and the way our students are being taught is changing, but I’m talking more along the lines of continuing education for current practitioners.

I think we’re making leaps and bounds in a lot of the prosthetic things, and there’s more [scope for] courses there. I’m an orthotist, and the courses that I have benefited from are the Charleston and the Boston, which aren’t changing per se, but it’s always nice to get the refresher and see things that they might be doing to upgrade, and make sure that I’m up-to-date too.

 [The field] constantly changes in how they look at treating different things. Keep track, in your particular scope of practice, of [what products and companies] you’re dealing with, and take the courses you need to keep up within your area.
John Lartonoix, CO
Prosthetic and Orthotic Care Inc.
Fairview Heights, Ill.