American singer-songwriter and lyricist Bob Dylan began singing “the times, they are a changin’” in 1964—and the times have continued to change. With today’s O&P landscape being vastly different from what it looked like five, ten, or 15 years ago, these words couldn’t be truer. As a whole, the O&P industry represents a relatively small portion of healthcare in the United States. According to figures released by the Amputee Coalition, there are about two million Americans living with limb loss. And, according to the Centers for Medicare & Medicaid Services (CMS) National Health Expenditure Projections 2011–2021, of the nearly $3 trillion spent on U.S. healthcare in 2012, O&P represented less than 1 percent of those dollars. Less than five cents of every U.S. healthcare dollar spent goes to “other medical services,” of which O&P is a part.
But despite its small economic footprint, O&P remains an integral player in the healthcare arena and must learn to play with the ever-evolving sets of rules. We are facing issues and regulations including the Health Insurance Portability and Accountability Act (HIPAA), CMS accreditation standards, the Office of Inspector General (OIG) scrutiny, and now Recovery Audit Contractor (RAC) audits, all of which are the same issues large hospital systems and multispecialty clinics face. As provisions of the Affordable Care Act (ACA) move toward implementation, O&P will also have to define itself within the realms of essential health benefits, accountable care organizations, and state health insurance exchanges.
In light of this, now is the time for O&P practices to follow Alexander Graham Bell’s advice: “Before anything else, preparation is the key to success.”
How to Prepare?
Think Strategically
Plan for the possibility that the changes affecting other aspects of healthcare will affect O&P. For example, RAC audits, which were started in 2003 as Congress’ way to assess the prevalence of fraud and abuse in the Medicare system, were statutorily designed to allow third parties to audit certain healthcare services and the utilization thereof. Because of the greater financial impact of audit findings, hospitals had to adapt processes and procedures quickly to comply with the applicable regulations. Noncompliance posed greater financial risks.
Where Does Your Health Insurance Dollar Go?
Almost ten years later, RAC audits are affecting O&P. While we are feeling their initial impact, we are simultaneously learning how to adapt our daily practices. Some practices have created templates for prescribing physicians to use. Others delay scheduling patients until they receive the requisite medical records that document medical necessity. Thus, by following the trends in other healthcare areas and proactively implementing processes, the impact of these changes may be lessened.
Maintain Your Patient Base
Consumers of O&P care have choices. Now, more than ever, people who use O&P devices and services rely on social media and other forms of communication to network with peers. Like any other customer- or patient-centric service, word of mouth is a reality and using that feedback will bolster process improvement.
So, survey your patients and find out how you are doing. Implement customer satisfaction surveys and use them every time a patient is seen at your practice. But don’t stop there. Look at the data. Mine it and find trends. See what gaps exist and fill them. Directly respond to any negative comments by telephone or in person to get to the root cause. The results will not only show where you fall short but they will more than likely show your strengths.
Invest in Practice Management Systems
Patient safety initiatives at both the CMS and state levels are driving hospitals and medical clinics toward implementing electronic medical records (EMR). The goal of fully integrated EMR systems is to improve patient safety and healthcare efficiency by reducing potential areas for human errors, eliminating redundant intake processes and paperwork, and providing better documentation. As with other healthcare trends, O&P will likely face the same expectations in the future for EMR implementation so procuring O&P-appropriate practice management systems may yield a good return on investment.
Practice management systems are different than billing systems. Billing systems have their value, but investing in practice management systems may be a better long-term solution. Currently, there are several O&P-tailored practice management software systems. Some O&P practice management systems design their software to comply with Medicare local coverage determinations (LCDs). This means that the LCD documentation requirements contain note fields that have prompts, or reminders, for the practitioner to input data or to document the patient visit in a certain manner to comply with the documentation needs.
Invest in Key Administrative Staff
As many small-business owners will attest, there are only so many dollars that can be spent on personnel. Therefore, it is not uncommon for a clinician to do some of the administrative tasks as well. While it may not be a financially feasible option for all, investing in highly qualified administrative personnel will allow clinicians to work with patients and focus their efforts on patient care. Invest in key administrative personnel and pay them on par with your practice clinicians. Make them a partner in the business wherein their focus on growing and maintaining the business will complement patient care.
Market Your Brand
Your brand is your image. It is how the world sees your practice. It is how consumers choose your practice. For many small-business owners, marketing is something to do when things start to trend downward or dedicated marketing dollars may be few. But many business strategists advise taking a proactive approach to marketing early and often. Hire a marketing consultant. They are often brilliant diagnosticians who can assess your practice’s strengths and weaknesses as well as determine an action plan. And like many other proactive business approaches, an effective marketing plan may be a viable preventive measure.
Give Back to the O&P Community
Invest in the causes that affect O&P. At both the federal and state levels, there is great impetus for passing insurance fairness laws for prosthetic care and coverage. While many clinicians are passionate advocates for their patients, many just don’t have the time to fight for the various causes. Fortunately, many state O&P associations and the Amputee Coalition have groups leading these legislative efforts. Thus, by helping financially, taking an active membership role, or spreading the word, you are playing a role in effectuating change that will improve the lives of people with limb loss.
Network. Network. Network.
Recognize that O&P is a small community and that we can all learn from one another. Share your own successes and learn from the successes of others. Engage subject matter experts for advice. Be the subject matter expert. In a profession as small as O&P, networking amongst ourselves will strengthen the business that we do and the people we serve.
As many of us are in this profession of providing O&P care for very personal reasons, we all recognize what an amazing profession it is. Fortunately, O&P will never go away. Instead, it will continue to change with the times and success can only result from preparing for the changes.
Leslie Pitt Schneider, JD, RN, has 22 years of regulatory compliance, legal, and healthcare experience. She is currently the clinical and regulatory affairs manager for Ottobock Healthcare, Minneapolis, Minnesota. Pitt Schneider is also involved in the amputee community as cofounder of Amputees Getting into Life Energetically and as a member of the Amputee Coalition board of directors and chairman of its government affairs committee.
