How much of your practice is fitting off-the-shelf or prefabricated orthoses?

In this office, about 70 percent of what we do is fitting off-the-shelf or prefabricated orthoses—knee braces, lumbosacrals, CASH braces, wrist splints, [and] masectomy bras.

As far as change, I don’t know if more doctors are sending patients to us or if they are writing more prescriptions, but it’s increased here.

Jan Myers, CFm
Cook’s Orthopedics
Springfield, Tenn.

It’s increased. It kind of depends on the nature of your practice. We’re rehab-based, so we’re forced to do custom-fitted [rather than custom-made] stuff. Our other offices, which are more private retail, don’t see it so much.

The increase came with the advent of CAD, turnaround times, and insurance pressures to get people out of the hospital. I still believe in custom orthoses, because they definitely fit better. But if the doctor says “I want that brace on today,” we can’t turn [a custom] brace around.

It’s so disappointing, because we’ve opened up the whole field. You can go to the grocery store or Wal-Mart and get a knee brace. But we’ve made our own bed, and now we’re going to have to lie in it.

Medicare data shows that patients requiring O&P increased by more than 40 percent between 1999 and 2002, while the overall Medicare population increased by only 7 percent. Over this same time, Medicare O&P expenditures increased by more than 50 percent, but our company’s revenue increased [only] marginally.

This tells me that either more patients are receiving off-the-shelf devices rather than custom-fitted or custom-fabricated devices, or more off-the-shelf [devices are] being provided by non-traditional providers.

The bottom line is that off-the-shelf devices may not be appropriate for all the patients receiving them.

Rod Cheney, CPO, FAAOP
American Prosthetics & Orthotics Inc.
Clive, Iowa

[With foot orthoses], we mainly do custom. Most of the podiatrists and orthopedic surgeons around here, if they prescribe off-the-shelf [foot] orthoses, they’ll take care of that or send them to a drugstore.

We still do a lot of CAM walkers, Aircast walkers, off-the-shelf compression hose, ankle braces, OrthoWedge®. It seems like we’re doing more, but we’re getting busier every day. The percentage is probably about the same.

We don’t see too many back braces anymore. If we do get a back brace, it’s usually an unusual size, a large size, or something custom. I feel like here lately we’ve seen more custom stuff.

Paul Halkiades, CP
Reynolds Prosthetics & Orthotics
Maryville, Tenn.

About 20 to 25 percent of our business is off-the-shelf and prefabricated orthoses, but they’re all custom-fitted.

That percentage hasn’t increased or decreased, but in the last 10 years we’ve seen more requests for custom-fitted versus custom-made items. HMOs are asking for more of these items because they’re less expensive.

For instance, L1930 is the cheapest item you can supply for an AFO. A lot of times, the doctor is not specific enough. The doctor may ask for an AFO with an articulated ankle, an L1970, but since the [referral] department is not necessarily medically trained, they’ll look up the general category of AFOs and look down their pricing line and submit the least expensive item.
It happens a lot with knee braces. A doctor may prescribe an unloader knee brace and the referral will be for an L1800, an elastic pull-on lace-up. The referral source doesn’t know what they’re asking for.

Melinda Janowitz, COF, CMF
Office manager/part owner
Antelope Valley Orthotics & Prosthetics
Palmdale, Calif.

I don’t have specific numbers for you, but it’s definitely gone down. If you go back 10 to 15 years, the number of manufacturers was pretty small. Now you have an endless amount that’s readily available to those outside the O&P industry. And some of those products are very good products.
We have not focused on off-the-shelf [or prefabricated] products for several years. The current availability for those to be done outside is fairly significant. We focus our energy on our talent, which is fitting custom devices.
I think in the future [orthotists are] going to partner more with physicians on implantable electrodes that coordinate with external braces, computer-controlled leg braces—things that just won’t be available off-the-shelf. The field is expanding and becoming much more scientific.

Jonathan Naft, CPO
Geauga Rehabilitation Engineering Inc.
Chardon, Ohio

Have a question?

If you’d like to suggest a question— or answer one—for this column, contact Becky Kesner at bkesner@AOPAnet.org or (571) 431-0815.