Report from the AOPA National Assembly - Part 2
Business Education Sessions - Part 2
A View to the Future
This standing-room-only session was one of the most spirited discussions of the entire meeting, which began with a series of short talks about the future of the field presented by a cross section of clinical and business leaders.
Tom Kirk PhD from Hanger discussed "What Ever Happened to Pluto?" to illustrate how the world of P&O care has changed compared to the traditional practice. Market share is shifting from small practices to fitters and manufacturer's representatives for many items, in part because payer's desire to reduce payments has coincided with new technology that allows less sophisticated services to be provided by new competitors. Existing P&O practices will have both high volume low cost income streams as well as the traditional highly skilled work. Tom concluded by admonishing us to demonstrate that our service is worth the cost, and urging the use of legislative skills and careful prioritization to focus on the critical issues and not being distracted by all the peripheral problems.
John Michael CPO from CPO Services, Inc. followed with "The Future of P&O: Providing Quality Care in a Changing Environment". My thesis was that the coming years will be characterized by less and less physician involvement and profit margin, combined with more and more regulation and competition as well as higher and higher standards for care and requirements for reimbursement. Specific strategies to cope with these trends could include focusing on patient management not just the device; mandating business education at the entry level; using electronic methods and multi-tasking to increase efficiency; empowering CPOs with marketing skills; actively participating in research to drive Evidence Based Practice; and development of an academic infrastructure within the field so we can direct clinical research and outcomes measures in productive directions. This presentation concluded with a warning that we must keep a close eye on the state of P&O care in other countries, particularly in Europe, since the globalization of health care means that regulatory initiatives can be imported into the USA as easily as our ideas can be exported.
Eythor Bender from Ossur spoke about the future of orthopedics devices, which is a $2 billion dollar market with P&O representing at most 15% of the total revenues. He argued that innovation can protect a field, as has been the case in prosthetic practice, but noted that there has been much less innovation in the orthotic field. Eythor recommended leveraging the positive position of the prosthetic experience to enhance the future of orthoses in like manner.
Bill Clover from Otto Bock looked at the "Future of Prosthetic Manufacturing" and suggested that the demand for higher function from patients can be met by technological advances, the demand for proof of outcomes can be met by clinical research, and the demand for changes in the delivery of care can be met by the development of appropriate standards. Bill concluded by noting that component manufacturers face similar challenges to those of practitioners, and that we can learn from each other's successes as we face our own problems.
Brian Gustin CP wrapped up the session with the "Tale of Two Frogs", warning that CPOs have become comfortable tolerating small changes in the environment and taking no action, much like the frog of folklore who stayed quietly in his bucket of water as the temperature increased insidiously and almost imperceptibly until he was cooked - literally! Brian believes that the answer to both technological and economic challenges is to "grow our brains", noting that clever organizations will look and act quite differently in the future. Brian concluded by suggesting that patient care across the globe has three primary components: high quality care, rapid access to services, and low financial costs to the healthcare system. Any two of the three can be optimized but it is impossible to maximize all three simultaneously.
Other Business Presentations
Elizabeth Mansfield gave a very droll talk laced with rapid-fire slide changes titled "Everything I Learned About Marketing I Learned from McDonalds". Elizabeth used the McDonalds' "Happy Meal" to illustrate how to package and advertise the same items as everyone else provides in a way that distinguishes your company. She recommended a patient management program that had these characteristics:
- Suggests product or service benefits to the users
- Is simple, memorable, and reputation enhancing
- Fits the image of the company
- Has positive connotations for the target market
- Is easy to pronounce and visualize
This presentation concluded with specific examples of how the use the added value of information about diabetic foot care to make local diabetes educators aware of the services your practice can offer their patients.
Peter Thomas explained the newly formed "Orthotic & Prosthetic Alliance", which is a voluntary coalition between the American Academy of Orthotists & Prosthetists, the American Board for Certification in O&P, the American Orthotic & Prosthetic Association, and the National Association for the Advancements of Orthotics & Prosthetics. The goal is to present a single, unified and coordinated message to policy makers on key issues, where broad consensus exists, to increase our chances of influencing government policy to benefit patients and the profession. Each constituent group will continue to function independently to accomplish their own agenda while pooling their efforts on legislative matters. Recent efforts included obtaining $20 million in additional funding for P&O schools, commenting on the federal research agenda, and opposing legislative efforts to eliminate state mandated healthcare coverage.
Exhibition Hall - Part 2
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As noted previously, although there were no earth-shaking innovations that debuted at this meeting, there were a fairly large number of clever incremental improvements in the exhibits. One that caught my eye almost immediately was the new corrugated roll-on silicone liners from OSSUR. A series of Patient Care Clinics held immediately after the AOPA meeting presented an opportunity to have patients try this new liner configuration, and their enthusiastic response confirmed the clinical value of this geometry.
The "circumferential waves" are similar to the bendable section of a drinking straw, and patient feedback is that this decreases pressure on the patella and bunching in the popliteal when the knee is flexed. The "Wave" liners are available in both Stabilo and Dermo configurations in a 3 millimeter wall thickness, and can be retrofitted for standard Ossur locking liners of the same thickness.
KnitRite had a roll of very fine knitted nylon material at their booth, for use as a vacuum wick or for finish laminations, called FeatherStretch. Available in two sizes, for up to 26" and 56" circumferences, this product from Rx Textiles in North Carolina looks like a good alternative to hosiery seconds for the lab. It also being distributed by Cascade, PEL, and SPS.
Otto Bock had three new orthotic joints this year, which must be a record of some sort! The first is called the "E-MAG Control Joint", and it is an elegant-looking electronic locking knee joint that offers several different biofeedback options for the patient to verify that the knee is safe. As we routinely fit increasingly frail patients, the clinical value of vibratory, auditory, or visual feedback [from miniature LEDs] will become increasingly recognized. The wireless controller can be mounted on the orthosis, tucked in the patient's pocket, or integrated with the elegant Bock forearm crutches. The relatively low weight limits of 121 pounds for a single side bar system and 187 for a two bar KAFO make this particularly suitable for the very petite poliomyelitis survivor.
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They also have a new series of unilateral knee joints [17LK1] that come in three sizes, accommodating patients who weigh up to 220 pounds. The basic configuration is a spring-loaded lever lock, but Perlon cabling can be added for a remote release or the locking mechanism can be deleted to create an offset free motion joint. The unilateral ankle joint [17LA1] has a unique geometry that allows the use of simple polyurethane O-rings to provide dorsiflexion assist. Interchangeable internal stops are available from 0-15 degrees. It is nice to see some sleek-looking modern designs for orthotic joints after so many years of rapid advances in prosthetic technology.
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The Otto Bock electronic elbow, the Dynamic Arm, is finally available commercially, and seems to be very well thought out. In short, it incorporates a high speed electric motor into the proven Automatic Forearm Balance mechanism. In combination with the electronically-controlled infinitely variable transmission, the clinical result is a powered elbow that is smooth, quiet, and almost twice as fast as prior e-elbows while at the same time offering greater life lift capabilities: clearly the Austrian gnomes have put many long hours into this design! In typical Bock fashion, it is compatible with a wide range of myoelectric, switch, and servo controllers.
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Finally, the new generation of the C-Leg has reached the US shores. Recognizable by its charcoal color, it now offers patients a new Standing Mode, in addition to a wireless remote control to switch between normal walking and second mode settings. If the amputee stands for a short while with the knee bent [between 7 & 70 degrees], the C-Leg switches into Standing Mode, which means that the knee will not flex any more. This lets the patient "rest" on the prosthesis for as long as they'd like. Normal walking mode is automatically re-engaged when the patient rolls over the toe of the foot in the course of taking a normal step. The service interval has doubled, with the new C-Leg [and the new Compact] requiring factory inspection only every 24 months. And, the new Bluetooth "BionicLink" makes adjustments easier than the earlier tethered systems. Unfortunately, it is NOT possible to upgrade existing C-Legs to have these new features: a fact that will disappoint some amputees who have earlier generation C-Legs that still have several years of warrantee period to go.
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Additional marketing hype on these products, along with a small amount of clinically useful information, is available in gibber-English buried deep within the cluttered Otto Bock web site.