January 9, 2016

Vinit AsarCEO, Hanger

O&P –Is it a profession, an industry, a service or a business?

And so are our patients, referrals, payers, manufacturers, employees and the world around us…

O&P is Evolving

Regulatory Changes

LCD

Prior Authorization

Competitive Bidding

Medicare Audits

Reimbursement Contraction

Is our Complexity Unique?MPK

MPF

Exoskeleton

Osseointegration

3D Printing

Manufacturers – Providing care

Providers – Manufacturing

Referrals – Providing care

Payers – Providing care

Retailers – Providing care

Portfolio Approach to Services

Increase use of Fitters/Assistants

Billing/Collections Competencies

Systems/Processes

Consolidations

Business Leaders/Clinical Leaders

Regulatory changes

LCD

Prior Authorization

Competitive bidding

Medicare Audits

Reimbursement contraction

Is our Complexity Unique? NO.MPK

MPF

Exoskeleton

Osseointegration

3D Printing

Manufacturers – Providing care

Providers – manufacturing

Referrals – providing care

Payers – providing care

Retailers – providing care

Portfolio approach to services

Increase use of fitters/assistants

Billing/collections competencies

Systems/Processes

Consolidations

Business leaders/Clinical Leaders

• Predicted what happened

• Witnessed what happened

• Wondered what happened

Industry has 3 Groups; Those that;

What Should We:

Stop

Continue

Start

• Driving the change we want to see• Accepting

need for more diligence in our clinical documentationwe are not unique from other health care providers

• Developing outcomes based technologies for our patients (not just new technologies with new features)

We Must Start Start

• Hoping that change won’t happen

• Mediocre clinical documentation

• Living in the past

• Playing the victim

We Must Stop Stop

• Providing consistent high quality patient care

• Supporting industry initiatives that pave the way for outcomes generation

• Speaking to regulators and lawmakers with one voice

We Must Continue Continue

YES

In Conclusion

O&P –Is it a profession, an industry, a service or a business?

Evolution of O & P Clinical Service Model V2

Michael Oros CPO,FAAOPPresident & CEO Scheck & Siress

1

• Patient‐Centric• Flexible • Information (Data Driven)

– P & L– Patient Satisfaction/Clinical Outcomes – Cost effectiveness of interventions

• Effective Communicators• Team players‐partners

Go forward attributes of Successful Practices

2

ChallengeProfessional response to Triple Aim:‐ Lowering cost ‐Increased satisfaction ‐Improved outcomes

Translation:• Doing more with less• Keeping pt. experience neutral to the changes

• Determine and Document

Doing More with Less = Efficiency

Adaptive changes that may be required‐

• Clinical service model• Administrative function

• Technical/production models

‘s to Clinical Model: “I can see 15 patients but…..” 

• Layered service model‐‐ Who

• Improve efficiency of patient interaction‐ How

Who: Based on educational model

How: Patient interaction 

Dissemble the process:• Technology: pt demo.and Hx “in the system”

• Technology: Anthro meas. and shape‐ Cped, Orthotics, Prosthetics‐ Email‐vs UPS‐ Ordering components 

• Technology: patient instruction 

‘s Administrative/Operational 

‘s  Administrative/Operational 

• Staff education: content expertise

• Centralized vs. local functions

• Kobayashi• Communication, communication, communication

‘ s Administrative/OperationalWhat:– Focus on Pre –delivery 

process metrics (in addition to the usual  suspects)– Held Revenue‐Backlog($$ and count)‐ Specific area of process

– Age AR by Payor

• Cfab =    rev./practitioner– Digital communication – CAD for production– Fab technique: 3D printing 

‘s Technical/Production

Improved Patient Satisfaction???

• Patient Engagement– MD documents – Prior auth– Finance

Changes in coverage based on plan design

• Maintain or improve ptsatisfaction

Outcomes:• Which ones matter?

‐Functional: AMP pro, TUG etc.‐Service level: ‐Quality of life: ‐Economic benefit: cost effectiveness of intervention vs. alternative  

• Start with KISS principle• Does PMS allow for easy data 

collection and retrieval?

Determine and Document: Clinical Practice Standards /documenting outcomes

Respect the past ….

• Continue CPO brand change as providers• Continue to embrace and advocate for new technology‐ with outcomes to support 

• Push for reimbursement models that are commensurate w/ value delivered

The future: