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Healthcare reform, in whatever machination, is now a reality, and the question for O&P is what direction it will take us in or, more importantly, what path O&P will follow. Maintaining the status quo is not an option. It seems to me O&P has thought of itself as an organism amongst organisms relative to healthcare, when in reality it is but a cell of one organism and, as such, can only respond to stimuli from the organism.
At the time of this writing, no one knows what kind of stimuli the new healthcare bill will send to us, but one thing is certain: reimbursements will not rise; they are more likely to decrease. There will be more demand for medically effective treatment protocols which can be documented. And believe it or not, the industry is trending down, according to the American Orthotic & Prosthetic Association (AOPA) Operating, Performance, and Compensation Survey. Medicare expenditures for O&P have dropped, the number of hospital discharges per 1,000 with a primary diagnosis of diabetes for lower-limb amputation have been trending down since 1996, and only 27 percent of all orthotic base codes were billed by providers who had a certified practitioner of any education level. So how will O&P cope with these and the many other changes which are sure to come? Will O&P boldly go where it has, unfortunately, gone before—forward into the past, getting more of the same with added expense?
To ensure its viability in the face of change, the average facility will need to focus on its internal operations, specifically process flow. This means taking a long, hard, dispassionate look at everything we do and determining if each step really adds value. For example, is the addition of CAD/CAM or electronic recordkeeping a step forward, or does it simply create the appearance of progress? In other words, if one simply replaces an inexpensive tool with an expensive one and does not change the process, what value has been added? If expensive practitioners perform all aspects of patient evaluation and impression-taking, as they commonly do now, it is not necessarily an improvement to replace an $8 roll of fiberglass cast tape with an expensive image scanner and mouse. There is only a façade of technological improvement, when in reality the process is exactly the same as it has always been. The same holds true for electronic recordkeeping.
I recently read an article chronicling one facility's journey into electronic recordkeeping. The impetus was the business' files were taking up so much space, the facility was looking at additional cost to rent a storage space to store their records. However, what was missing was any mention of an analysis of the total process of how a patient is processed from the time of the initial order or contact through final delivery of service. So what was achieved—or will be after years of file conversion—was the substitution of rental storage space for expensive and time-consuming electronic storage space; this is what I mean by going forward into the past.
So how does one avoid these pitfalls and truly move forward? Most small business owners would rather get a root canal than work on their financial statements, but understanding them is one of the most important things you can do. It's essential to learn how your four financial statements—the income statement, balance statement, cash flow statement, and retained earnings statement—interrelate and to understand key sustainability ratios. Once you understand your financials, understand your practice mix. What kind of business do you get and, more importantly, is this business profitable? Many times, O&P business owners are happy to take any kind of contract for any kind of business, simply to stay busy; however, being busy does not equate to being profitable. The easy part of making contracts is saying "yes," the difficult part is saying "yes but…," and the excruciating part is saying "no"—but remember this: far too often, far too many people place far too much value on what "is" and far too little value on what could be if only they let go.
The future of our field is not going to be more of the same. Healthcare and O&P are inside a giant snow globe which has been turned upside down and is being shaken. The shaking has not stopped, and the way to the future is not yet clear, but we can prioritize now the things which will actually help us survive the shaking and truly move forward into the future.
Brian Gustin, CP, is president of Forensic Prosthetic and Orthotic Consulting, Green Bay, Wisconsin. He is immediate past president of the American Orthotic & Prosthetic Association (AOPA) and has been an active member of AOPA's Coding and Reimbursement Committee for more than 10 years.
