by Deborah Conn

It’s getting crowded out there. The world of O&P care is populated not just with certified practitioners and accredited facilities, but with a host of other professionals—therapists, pharmacists, athletic trainers, physician assistants—who are providing orthotic or prosthetic services.

How can you, as a trained and qualified practitioner, distinguish your services and expertise from others who are providing similar services? 

Accreditation still stands out
For many years, accreditation has been the way for facilities to demonstrate their ability to provide superior care.

“This has been a voluntary process,” explains Cathy Carter, executive director of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), an accrediting body. “People enter into it if they want to show their patients, third-party payers, and referral sources that they meet what we call the gold standard: the profession’s self-set, highest standards.”

“We want to [draw] a road map for the efficient management of an O&P facility,” says Scott Williamson, ABC’s director for facility accreditation. To gain the ABC stamp of approval, facilities must comply with standards that encompass facility safety, supplier compliance, and organizational structure. But the main emphasis, Williamson says, is on patient management: the appropriate care of O&P patients.

The first step in gaining ABC accreditation is to submit an application, which is followed by an on-site evaluation by a trained ABC surveyor.  Williamson believes that survey is part of what distinguishes ABC accreditation. “Our surveyors are O&P certified practitioners—they’ve been through it,” he says. “And our process is consultative. We get continual feedback that the on-site survey is an invaluable component of the process.”

Tom Derrick, director of public relations, marketing, and professional discipline for ABC, agrees. “We have a tremendous amount of information to convey to practice managers and organizations to achieve accreditation,” he says. “We also believe in providing affordable accreditation.”

The Board for Orthotist/Prosthetist Certification (BOC) also requires facilities to submit a comprehensive application, which is followed by an unannounced site survey. Jim Newberry, BOCPO, LPO, past interim executive director of BOC, explains that in most cases, facilities that come up short will have an opportunity to correct deficiencies to gain BOC accreditation.

CMS complicates the scene
These voluntary accreditation programs have been in place for decades. But, says Carter, “the facility accreditation world has changed dramatically since CMS [the Centers for Medicare and Medicaid Services] got into the accreditation business.” Last August, CMS named 11 organizations (now 10, after ABC and BCP integrated) that would have the authority to accredit providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). (See sidebar on page 54). Once CMS determines a deadline, providers must be accredited by one of these entities to bill CMS for services by that date.

The list of accrediting bodies includes ABC and BOC, as well as eight other groups, most of which, says Williamson, have no experience accrediting prosthetics and orthotics. “Many are used to doing DME, and there’s a huge difference between setting up an oxygen concentrator and a computerized knee,” he says. “O&P requires far more patient management.”

Peter Thomas, Esq., is general counsel for the National Association for the Advancement of Orthotics and Prosthetics (NAAOP). “This is a big step up for DME,” he says, “because they had no accreditation at all, except in the area of high-end rehab wheelchairs. But the O&P field has had a well-defined accreditation pathway since the 1940s. The impact on O&P may be the opposite of what was intended; it may embolden a lot of suppliers to get the government’s seal of approval to bill under the O&P fee schedule and start billing O&P just because they can.”

Derrick notes, “A few of the groups were established for the express purpose of becoming a CMS-deemed accrediting body—to make money. Unlike ABC, which has always been non-profit, a number of the approved groups are of a private, for-profit nature.”

“We are happy CMS is supporting accreditation,” says Kathy Dodson, senior director of government affairs at AOPA, “but we don’t think they have been appropriately selective as to who is qualified to accredit facilities.”

Weakening accreditation’s impact
The problem, says BOC’s Jim Newberry, “is that CMS is diluting ABC and BOC accreditation.”

 “It will be harder for ABC to stand out from nine other agencies,” agrees Cathy Carter. “Insurers will care that a facility is accredited, but they may not care by whom.

“ABC-accredited facilities will have to show stakeholders that they are accredited by an organization with a long history of accrediting P&O and [with] time-tested standards, specific to P&O patient care, that distinguish our program from the others.”

Derrick notes that many insurance companies already require ABC accreditation. “Blue Cross/Blue Shield in Michigan, Tennessee, and North Carolina require that facilities in their provider networks be ABC-accredited,” he says, “and we are working to expand that to other states.”

The O&P Alliance, which comprises NAAOP, ABC, the American Academy of Orthotists and Prosthetists (AAOP) and AOPA, is engaged in ongoing discussions with CMS in an effort, says NAAOP counsel Thomas, “to get them to do the right thing and protect beneficiaries.”

Licensure: a possible solution?
Licensure is another tool that may—or may not—help O&P professionals stand out in the crowd. Licensure efforts are underway in a number of states, and at press time, 12 states had passed legislation establishing O&P licensing boards and standards.

O&P practitioners are divided on the benefits of licensure. “It is another way to distinguish ourselves as experts,” says BOC’s Newberry. “But it can be expensive.”

“That’s one of the negatives,” agrees Anita Liberman-Lampear, director of the University of Michigan Orthotics and Prosthetics Center. “You have to raise a lot of money to get the bill through the state legislature, and then the state has to fund its operation.” Typically, practitioners must pay steep annual fees to maintain their licenses.

Anthony Filippis, CPO, president of Wright & Filippis in Rochester Hills, Mich., believes that the issue of licensure is looming because practitioners dropped the ball. “If we had done our due diligence nationally, working with payers to educate them on the importance of facility accreditation and certification, we would not be having this debate now.”

According to Filippis, ABC-certified practitioners went to large payers in Michigan—such as state employees and retired teachers—in the 1970s to make the case for ABC certification. Today, both Blue Cross/Blue Shield and Medicaid require ABC certification before they will reimburse for certain L codes.

Would licensure help set practitioners apart? “If licensure is required,” says Filippis. “The intent is to even the field. At first, anyone out there who is practicing today could get licensed; otherwise you couldn’t get lawmakers to pass the legislation. So it wouldn’t help at first, but over the long term, it has the potential for helping us stand out.”

Marketing makes the difference
Accreditation, certification, licensure—no matter how much these credentials establish your qualifications, they can’t set you apart unless you spread the word. Marketing your expertise to referral sources, third-party payers, and patients is essential if you are to succeed.

Keith Senn, COO of the Center for O&P Care in Louisville, Ky., has had a marketing expert on staff for the past three years.

“Our efforts consist mainly of getting to know our referrers better,” he says. Senn and his staff arrange luncheon visits at doctors’ and therapists’ offices and hospitals—and they provide the lunch. “It gives us the chance to talk with the referrers, explain what we do, and answer any questions they may have,” he explains. “We find out what’s important to them.”

The center also has an extensive amputee education program. “We go into patients’ rooms and sit down and talk with new amputees about what they can expect. We bring in a lot of literature and help them connect with amputee support groups such as the ACA. There’s a lot of help out there, but most people are not aware of it.”

Senn credits his marketing efforts with helping to build a successful practice, but says marketing cannot stand alone. “You have to back up what you market with quality providers and quality service,” he emphasizes.

Networking is also a large part of the marketing strategy of Reynolds Prosthetics and Orthotics Inc., in Maryville, Tenn. President John Reynolds, CPO, says, “We are visible in the community. Through our fitness clinics for amputees, we get a lot of media exposure. We also support a number of fundraising events related to medical issues.”

The facility serves as a referral source for PT clinics for the rehabilitation of amputees and stroke victims, which, says Reynolds, is a form of marketing as well.

“We really push for a team approach to what we do,” says Reynolds. “It keeps us out in front of those who [write] the referrals. But no matter what else you do, you have to provide good service.”

Find a niche
Rhonda Turner, BOCPO, CFom, of the Prosthetic Center in Houston, deliberately set out to distinguish her practice from others by focusing on women. “As a woman-owned business, with two women practitioners, I wanted to set up a practice that was less clinical and more comfort-based,” she explains. “We have natural furniture, waterfalls, many plants, and lots of color, so it’s definitely not a sterile setting.

“This plays into our marketing efforts as well. We promote ourselves to women’s care groups. We regularly participate in the women’s health seminars offered by a local hospital. In our newsletters, we market specifically to women doctors, and I’m active among local women in business.

“When I started, we had no women patients. Now about half our patients are women. We have male technicians and CPOs on staff, too, so people always have a choice.”

Turner also uses the Internet as a communication and marketing tool. “We are revamping our Web site, so that doctors as well as patients will find it useful. We have a back end, where referrers can chat online with our practitioners. So if doctors have an issue and want to log on at 2 or 3 in the morning, they can check the status of a patient or leave an e-mail.

“Like many other practitioners, we try to get to groups for educational purposes. We’ll talk to amputee groups about what we do and answer questions, both in English and Spanish because we have two fluent Spanish speakers on staff. We try to make O&P less scary, and it has created a lot of good will.”

Seizing every opportunity
When Warren Mays, CPO, president of Artisan Orthotic Prosthetic Technologies Inc., in Portland, Ore., first created his company’s Web site, he saw it as a tool to educate patients. “We decided our audience would be our patients, and we have tried to make it very informative,” he says. “We explain our services and talk about our philosophy of doing business, offer patient testimonials, and provide educational and care and maintenance information that patients can download and print out.

“We put up the site about a year ago, and we never thought about it being a sales and marketing tool. But in fact, we have received new business from our Web site. We’ve included a page where people can contact us, and we get questions from people all over the country—even internationally. One of our patients, who found us through the Web site, drives six hours [each] way to see us.”

Mays uses other marketing tools as well, often with a little twist to set his practice apart. “We send holiday cards and fruit or candy to our referral sources at Thanksgiving, rather than waiting for the December holidays,” he says. “That way we’re not lost in the onslaught of mail everyone gets at Christmas.”

Artisan sponsors a bicycle racing team, providing jerseys emblazoned with the company’s name. “We’ve tried to attract some amputees and brace wearers to the team,” he says, “and we have people who ride with us who don’t race. One young woman with a C-Leg regularly rides her bicycle to work, in shorts so that her prosthesis is visible, wearing an Artisan jersey.”

Mays also believes it’s important to get his name out within the O&P community. “I have a new patient moving here from Michigan, who was referred to me by another practitioner who had heard of me through my work in the field,” he explains.

He co-authored a chapter on prosthetics in the upcoming Orthopedic Knowledge Update 9 and has worked with other companies in product development. “Last year I worked with Hope Orthopedic in Orlando to develop a new TLSO for hospital situations. Now we have an Artisan TLSO, a system for orthotists to get a brace on a patient as quickly as possible.

“At the end of the day, you just have to look at things in front of you and seize on them, take advantage of every opportunity to get your name out there among patients, referrers and your colleagues in the industry.”

Quality always stands out
If marketing makes the difference, are accreditation, certification and licensure worth it?
Of course. Sources for the article emphasized that marketing means nothing without the quality to back it up.

“You have to come up with the goods,” Mays says. “You’re only as good as the last device that goes out your door. You have to put in the time and energy and focus into each and every device, because that’s what we are all about.”

Deborah Conn is a freelance writer based in Falls Church, Va.