Emphasize clinical components of O&P

Home medical equipment companies looking to compete effectively in the orthotics and prosthetics market need the right people in place to conduct this business. That means having certified O&P professionals on staff to work with clients in this field.

Having certified staff seems like a no-brainer, but HME companies that don't have them are being heavily scrutinized by the Office of Inspector General for “huge increases” in billing for off-the-shelf back and knee braces going back to 2014. The OIG reports that 90% of the O&P billings were from HME providers without certified professionals on staff.

Orthotics and prosthetics is a clinically intensive field, so having the appropriate clinical personnel is integral to the business. The two main accrediting bodies for O&P are the Board of Certification/Accreditation International (BOC) and the American Board for Certification in Orthotics & Prosthetics (ABC). Both groups require facilities to be staffed with board certified or licensed personnel appropriate to the scope of services they provide.

“My assumption is all referring physicians, and certainly their referral staff, are aware of whom they are referring their patients to for these ancillary medical services that are part of their current post-acute care plan,” said Todd Eagen, president of the Orthotic Prosthetic Group of America. “Accreditation by these two bodies, which have a long standing and solid commitment to the profession of orthotic and prosthetic providers, can certainly act as a solid proof source that your care team is credible and qualified to provide the necessary care.”

The federal government is addressing the importance of certification in O&P, as recent congressional legislation included in a provision that privileged certified and/or licensed O&P practitioners patient notes, as they related to medical necessity, are a valid and permanent part of the patient's medical record.

“This is a big step in recognizing certified O&P practitioners as the medical professionals that they are,” Egan said. “Certified O&P providers must meet the same medical education requirements as other ancillary medical professionals, such as advanced registered nurse practitioners and physician assistants. A four-year undergraduate degree, postgraduate degree and residency in the desired discipline are requirements.”

Historically, the model for HME providers on getting into the O&P market has been to start with off-the-shelf orthotics and, in time, add custom orthotics and eventually evolve to prosthetics. But Egan says the industry needs to put more emphasis on hiring qualified people. If they do that, he says “I do believe that O&P is a viable additional revenue source for HME suppliers, provided they have qualified and certified O&P practitioners on staff.”

Generating referrals

Once an HME provider has the qualified personnel available, the mission is to find the right referral sources, says Ryan Ball, director of the VGM Market Data program.

“In today's world of providing custom orthotics and prosthetics, with audits, endless documentation requirements and declining reimbursement, independent O&P providers must leverage business from more physicians to remain relevant and thrive in difficult times,” he said.

Doing that means identifying where O&P referrals originate. VGM research found that vascular surgeons make up the largest pool of referral sources, followed by podiatrists, family practitioners, physical medicine, rehabilitation and geriatric physicians. However, “the frequency fluctuates depending on the individual market,” Ball said.

Ball and his team conducted an analysis of which procedures and diagnoses are most utilized by these types of physicians. The list begins with above- and below-knee amputations, revisions, upper extremity amputations, hip and ankle disarticulation, post-amputation status codes, infections of the stump, diabetes and gangrene.

“After identifying the top referral sources in your market, you also need to segment them into manageable contact groups based on their potential value to your practice,” said Ball. “Some common strategies include segmenting your target physicians into three basic groups, each with its own value and marketing contact plan.”