This post is sponsored by PEL Supply
O&P practitioners are facing many challenges from keeping up with technology to using Big Data to help address problems. Many are also working to make operations and business models more efficient to keep up with industry changes.
Mike Sotak, president and CEO of PEL, LLC, brings 22 years experience to the medical products industry. Here he talks about changes in the O&P industry and how companies can best position themselves in the new operating environment.
Question: Industry data show that Medicare coverage of advanced prostheses has declined, and a proposed Durable Medical Equipment Medicare Administrative Contractor (DME MAC) local coverage determination last year would reduce patients’ access to advanced lower limbs. Technology keeps moving forward, but no one seems to want to pay for it. How can the O&P industry get payers to realize the value that advanced devices bring?
Mike Sotak: It’s tough for O&P practitioners to get payers to realize the value of advances in technology. We don’t have much historical outcome data demonstrating the real value and benefits to patients versus alternatives. For example, wheelchairs may increase patient mobility, but overall patient health and well-being is rarely, if ever, compared with the greater health benefits of prosthetics. Payers would likely respond positively to evidence data showing patients with prostheses tend to be healthier and live longer than patients limited to wheelchairs.
Q: Among research breakthroughs last year were prosthetic hands with a more sensitive grip, prosthetic skin with a sense of touch and robotic exoskeletons that allow paralyzed individuals to walk again. What do you think is the most significant technological advance in the past year? What do you think is next on the horizon?
MS: As a supplier that works to help O&P practitioners offer better patient care, I would say all of these advancements are significant. Ultimately the value of the technology is relative to the life improvement enjoyed by the patient recipient. As for what’s next, we’re in the business of helping practitioners match innovations to their patients, so I look forward to seeing more products reach the market.
Q: Health care in general is buzzing about the possibilities for Big Data. How do you think data analytics can best be used in O&P? What problems could it address?
MS: Outcomes data can provide evidence that specific O&P solutions improve the quality of patient life. Historically, the O&P industry has not collected data on a large scale to support the value of its solutions. If we can better organize historical data and isolate similar patient types, we could demonstrate the order of magnitude specific solutions bring to patient life quality. That would be huge. Data demonstrating measureable improvement versus alternative solutions would address many of the payer questions challenging the industry today.
Q: Medicare has signaled its interest in moving from fee-for-service payments to value-based care. How is this affecting O&P? How can practitioners use this trend to highlight the added value they bring to the provision of O&P?
MS: Initially, moving to a value-based care model would be a significant shift. Today, O&P practitioners are judged predominately on delivery of products and not on the comprehensive care they provide. The industry needs to reinforce the point of view that practitioners are in the patient care business. Practitioners are focused on making their patients’ lives better not trying to sell them a product. Today, practitioners cannot submit reimbursement until the patient is fitted with a product. Fundamentally, we need to shift the conversation away from products to outcomes.
Q: What can O&P practitioners do that they are not already doing to make their operations more efficient?
MS: Practitioners need to apply the same principles used for documenting processes and procedures for achieving clinical compliance to their business model. Generally, people entering the O&P profession focus on care giving, not on running a business. I would encourage practitioners to take a step back and apply the same documenting process to their business flow. Identify the best referral process. Determine how best to arrive at compliant patient solutions and how to best manage the reimbursement process.
It’s important to identify and document your best processes prior to determining who will be responsible. Start with the process then determine the human resources and qualifications needed to efficiently run your business model. For those who may feel overwhelmed by this type of analysis, I would recommend hiring a business consultant to evaluate the processes required to achieve compliant solutions. Today, the path of patient care and business economics are intersecting. It is important practitioners apply the same rigor of analysis to their business as they do their patient care.