Maintaining Professionalism in a Competitive Climate

In the O&P world of shrinking reimbursements and an often uncertain future, practices are under more pressure than ever to attract new patients and grow their businesses. But the pressure of surviving financially while still sticking to ethical principles can be a tough tightrope for any practice to walk.

The troubled climate that has put some practices out of business has consequently reduced competition for those still in business, says Matt Bulow, CP, CEO of BCP Group, headquartered in Nashville, Tennessee. But the lower reimbursement rates and tough business atmosphere also make each new patient more valuable to a practice than before.

"I don't think there's more competition out there, but we're all under a tougher environment," Bulow says. "People feel the pressure to continue to maintain or even grow their business because they are under more financial pressure."

O&P practices tend to be harder hit than other healthcare fields because most are so small. "The O&P industry is quite unique in that it is such a small industry and very specialized," says Shane Ryley, BOCP, BOCO, area clinic manager for Hanger Clinic, in Torrance, California. "I think larger companies have the edge with challenges related to reimbursements versus cost in that they can often use their size to get volume discounts on products. With a larger network they can also offer services state- or even nationwide."

It is under this kind of strain that ethical lapses can occur. O&P practices may try to cut corners by providing devices that are better for reimbursement value than for the patient. Businesses may try to undercut one another in their efforts to attract new patients.

Instead of falling to temptation, experts say that practices should put ethics and professionalism at the core of their work by making their quality and patient care the center of everything they do. Once that happens, business will follow, they say.

"The good practitioners are driven by patient care," says Wayne R. Rosen, BOCP, BOCO, CPO, CPed, FAAOP, PA, area VP of the State of Florida for Orthotics and Prosthetics by Design, headquartered in Winston-Salem, North Carolina. "When that goes well, everything else falls into place."

Professionalism and Ethics

Ethics and a professional code of conduct are spelled out clearly by credentialing organizations, such as the Board of Certification/ Accreditation (BOC) and the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC), but the experts say that much of the behavior detailed in these documents comes down to good patient care.

"In O&P, I believe this to be the application of the codes of ethics and mission statements set out by our certifying bodies...," Ryley says. "In simpler terms, it is essentially providing excellent care to patients from start to finish, in appropriate environments, and with devices that meet their needs."

When patient care is at the center of the practice, then professionalism comes easily, the experts say. If the practice does a good job, then there's no need to speak ill of others. In the end, businesses will benefit, and most of all, practices can be proud of the job they have done.

"Part of the responsibility that goes with being a BOC certificant is to follow the BOC Code of Ethics, which promotes compassion and excellence in patient care; you should live and die by that," Rosen says.

Staying Ahead of the Competition

O&P professionals shouldn't be worried about competition, the experts say. It can be a good thing, says Kevin Carroll, MS, CP, FAAOP(D), vice president prosthetics, Hanger Clinic, headquartered in Austin, Texas.

"It's critical to have competition," he says. "It gives our patients and payers choices. We work harder because of competition."

But competition doesn't mean that practices have to try to bring each other down. Instead, they should all be striving to do their best in the hope of rising to the top, Rosen says.

"I have a practice that is directly across the street from two competitors," Rosen says. "We all buy the same components, the same feet, and knees, and belts, and screws, and rivets. It's what you do with those things that make you better. In this world, you make or break yourself."

If a practice doesn't do a good job, then it deserves to have its patients move on, he says.

"You are competing against yourself," Rosen continues. "If you can't produce the quality and care you need with a professional touch, then you don't deserve the practice and you lose. Nobody can take anything away from you. You lose it."

The truth is, Bulow says, winning a patient over the competition should not be the bottom line for O&P practices. Instead, they should be striving to do well in the long run by staying true to their principles.

"We just got two new patients who chose us over our competitor," Bulow says. "That's great. Those things come and go. But your ethics and who you are as a person, that stays."

Keeping New Patients Through Professionalism

Making one practice look better by trying to make another look bad is one of the worst ways to keep patients, the experts say. For example, many times a patient will choose a new O&P professional because he or she has been dissatisfied with previous care, and may even speak ill of his or her former clinician. However, professionals should not feed into that negative talk, the experts say.

"I don't comment on negative reports a patient may share with me," Rosen says. "I listen objectively and develop a new plan for the patient."

In many cases, that patient may have been dissatisfied for reasons that were out of the former clinician's control, Carroll says. "Sometimes a patient may get angry with their progress and misdirect the blame to a prosthetist," he says. "Or, sometimes a patient may want to try something new, but it may not be the most clinically appropriate [device] for the patient; a professional has to be objective."

Sometimes, Ryley says, the story being told by the patient isn't always the whole truth. An O&P professional should try to refrain from judgment.

"Try to give your peers the benefit of the doubt and refrain from using negative language," he says. "There are many factors that can affect a patient's long-term outcome, such as physiological changes since [the patient was] fitted, change in activity level, insurance constraints on component selection, and so on. My general approach is to assess what concerns the patient has to determine if there is room for improvement based on all of the variables present."

When a practitioner does not stoop to talking bad about others, it makes the practitioner look more professional ultimately helps the patient, Bulow says. "[There were cases when] I didn't jump in and bad-mouth their former prosthetists and later on the patient and the family thanked me and complimented me for that," he says. "Also, from the patient's standpoint, what good does it do to dwell on past negatives when you can get them mentally prepared for a fresh start?"

Marketing can also be done without bringing down another business, experts say. O&P businesses should market in ways that keep their practices at the top of their patients' minds and gives a personal touch. By doing this, practices can attract and keep patients without undercutting one another.

Carroll says his dentist's office stays in touch with him regularly through the year, sending out reminders about services needed and e-mails that have an article he might be interested in reading.

"My dentist gets ahold of me many times a year," he says. "Is that marketing? Absolutely. He has soft points of contact that help build solid, lasting relationships with his patients."

When a patient is happy with a clinic, that is often the best kind of marketing, Carroll says. For example, one of his satisfied patients was a greeter at a local store and asked for business cards she could pass out whenever someone asked about her care. Carroll was more than happy to comply.

"That type of advertising is incredibly professional," he says. "You cannot beat someone else simply by saying you're good, but if your patients do the bragging for you, or your [referring] physicians do the bragging for you, that's all you need."

"Your message shouldn't be that your competition is no good," Bulow says. "It should be showing objective results on how you are doing. Hang your hat on what you do and your functional outcomes and not on tearing your competition down."

Providing the Best Care, and Maintaining Business Health

According to the ABC Code of Professional Responsibility, the services provided by the practitioner should be "based on the needs of the individual receiving the services and not primarily for personal financial gain."

That said, there has to be some financial gain, otherwise a practice would not be able to pay employees or its bills. Finding that balance of providing the best device for the patient in this age of lower reimbursement rates can be a challenge Rosen says.

"Are we working harder and making less money? Yes," he says. "But the O&P profession is not the only one suffering from this situation. Every healthcare profession is feeling the pinch." How practices try to overcome that pinch can vary, Bulow says.

"There are two routes of thinking you can go," Bulow says. "You can go the route of thinking of each individual case as a financial outcome and you need to get the best financial outcome you can out of a case. Or you can take the approach that... you are going to give the clinician the product choice they feel is best for the patient."

In his business, Bulow says, he chooses the latter. "I'm certain we leave money on the table by doing that, but that's our business model and that's who we are," he says. "You will win in the long run by being the go-to place for the best care."

Carroll says it's the O&P professional's job to help the patient to the best of his or her ability. If the co-pay is too big, or insurance won't cover something, then practitioners need to try to help in whatever way they can and seek out other options. He does not dismiss patients if they don't have insurance; instead, he tries to educate patients about available resources to help get the person a much-needed prosthesis.

Sometimes the office staff has to help walk the patient through the insurance and co-pay process, he says. "In the meantime, that patient still has to get up and walk. And we have to do our best to provide the most appropriate care for that individual. They might not get a microprocessor knee, but they will get the best we can [offer]. The art of this will be getting the best solution for the individual."

To try to make up the difference between providing the best device and getting the best reimbursement, Bulow says his business cuts corners in ways that won't impact patient care.

"One way we're trying to bridge that gap is that as we grow in scale, we can have shared expenses," he says. "We can have one chief compliance officer instead of seven. [And] we buy in bulk."

Rosen says his business also tries to save in ways that won't impact patient care.

"When the cost of something is going up and reimbursement is going down, you deal with it appropriately," he says. That might mean keeping a little less stock on hand or trying to negotiate with manufacturers. "The bottom line is you have to be smart about what you buy."

In his case, Rosen says he flew out for an inperson visit with one of the manufacturers with which the practice contracts and promised to pay them every ten days in exchange for a lower rate on devices.

"It became a win-win," he says. "The manufacturer wins because they have cash flow. You win because you have a discount. And the patients win because they have quality service and quality care. There are creative ways to meet your patients' needs."

Attracting Patients Through Professionalism

Just like the Field of Dreams adage, "If you build it, they will come," the same philosophy will work for an O&P practice the experts say. If you build a professional and ethical practice, the patients will come. It doesn't matter how much money a practice spends on advertisements or if it tries to undercut the competition, the experts say, having the utmost professionalism is the best thing any practice can do to attract new patients.

"The greatest business comes through word-of-mouth marketing," Rosen says.

Carroll agrees. The word of someone else is much more valuable than a clinician talking about him or herself. This can be tougher than a quick ad buy, but it's ultimately more valuable for the practice, he says. "You have to earn that respect. It takes time and it will not happen overnight."

Even the best marketing team in the world can't be as effective as happy patients who tell others about the professionalism and great care they received from an O&P practice.

"To go to company X instead of company Y, the difference is not the salesman who goes knocking on the door," Rosen says. "The difference is your reputation in the community, and if you are known as a professional with integrity."

The professional standards that are already in place by credentialing bodies are easy to accept and follow, despite how tight business may be or the obstacles a practice has to overcome, Rosen says.

"Regardless of what the times are, those are the standards," he says. "If you do not meet those standards, you shouldn't be in business. If you meet or exceed those standards, there is no concern about competition, because people will come to you."

Maria St. Louis-Sanchez can be reached at .