Normal Distribution Curve

What We Don’t Know

You may be aware that I am working on a new report for our OPIE Plus customers (OPIE customers that are on the OPIE Hosted platform).  We are getting closer to being able to send that report out and are excited to report that we have new metrics that are not included in the Choice Acuity reports.  One of those metrics is a new concept that we call the “Clean WIP Score.” I am encouraged by what the data is telling me!  When we get blindsided, we say “I didn’t see it coming!” There are a few reasons we don’t see things coming, but the most frequent (and frankly the best excuse) is that we don’t know what we don’t know, and so we can’t anticipate something coming from there.  Make sense?

Inquisitive people are always trying to peel back the layers to reveal what’s behind the curtain, to make discoveries and learn about those things we didn’t even know we didn’t know. So as we design data tools and reports, our goal is to shed light on important things that often go unnoticed.

We know that moving your patients effectively through your practice is critical to creating a scalable, sustainable O&P practice.  We also know that there are many opportunities for things to go wrong.  My experience tells me that practice size matters.  It probably makes sense at a gut level that what works for a large practice may be overkill for a small practice.  And small practices may not need all the structure that a large practice must have.  Those beliefs are reinforced when looking at the data we publish in our Acuity Reports.  So I was excited to get my hands on our first real data pull for this new report we are creating for our OPIE Plus customers.

Normal Distribution Curve

 

I can tell you within each of the segments I have identified and will report on, there is variation and there are some differences that I will talk about in the report, but when I look at the data from nearly 250 companies, fairly evenly distributed among size, I was blown away by how much you all have in common.  To get a little techie on you, I can tell you that the mean score on documenting the patient flow, where 100 is the most efficient you could theoretically ever be, is 35.8 with a standard deviation of 0.99.  That tells me that there is amazing consistency across the board in managing our patient workflow.

The other interesting thing is that of the 15 companies with the highest scores, only two were not part of the OPIE Choice education and best practice development process.  The top 15 companies include companies of all sizes.   Interestingly, the two that were not actively involved in the Choice leadership/education process scored #1 and #15 in the top 15.

The good news in all of this is that for the vast majority of the companies that use OPIE and are hosted, we know that we can help you with your processes.  To be clear, we do not have any access to your financial data, but I do know as a general rule, that reducing inefficiency can lead to greater productivity and subsequently greater profitability.  So as we are facing turbulent times, there is a tremendous opportunity to improve your processes and create a more scalable and sustainable O&P practice.

A ruler measuring success written in block letters

Motivation through Clarity

 

A friend sent me a meme today.  It said: “When there is no consequence for poor work ethic and no reward for good work ethic, there is no motivation.”  This struck me as sad at first, but then became the inspiration for this blog. We are facing unprecedented times, at least in my lifetime, with the economic outlook grim, unfilled jobs, record high inflation and our government about to try quantitative tightening to get a grip on things.  The post covid workforce fell in love with working from home and record gasoline prices make the commute to work unaffordable.  A couple of months ago I warned you about stagflation in this blog.  I still believe it is coming. As a manager, leader or business owner trying your best to maintain a productive workforce and navigate all the uncertainty, what can you do?

If you are self-motivated, it can be very difficult to empathize with or understand those who lack that inner desire.  Most likely, you did not get where you are if you did not have some sense of purpose, some motivation to achieve, some recognition that if you did not put forth the effort, you would not gain the prize. Now it seems that personal ambition, the desire to improve one’s standing or to go out and make a difference is frowned upon.  We have but one choice.  Roll over and allow the waves of apathy to wash over us, or stand up and say, “this is how we get stuff done!”  I vote for the latter.

If you are ready to take a stand then set some goals.  Let people know what you need them to do.  Provide clarity.  It seems we have lost the will to set and maintain standards.  This is not a new theme; Jim Collins talks about good being the enemy of great.  When you settle for ok, you can not be great.  It is illogical.  John Spence talks about accepting mediocrity, the same concept, and different words.  Whatever level of performance you accept is the highest level of performance you can expect to achieve. Period.

As the person in charge, you owe it to yourself, to your staff, and to the business to set and maintain clear standards of performance that are fair, objective, transparent and meaningful.  Then your job is to partner with and help everyone achieve those goals.  Help them connect their personal ambition with the objectives you have given them, whether it involves direct patient care or the incredibly important ancillary services that make patient care possible, the role they play, and the quality of their work is essential to business excellence.  Don’t settle for less, and don’t let the waves of apathy roll over you.

 

 

 

 

 

Arlington Cemetery

Memorial Day

This week I want to tip my hat to the families of the men and women who have lost their lives fighting for freedom.  Many people take freedom for granted in this country, and this weekend is a solemn reminder that the things we accept as normal were and still are in some cases, unheard of in other countries.  One of the greatest rights this country provides its citizens is the right to express an opinion that is contrary to the public opinion. The ability to freely express ideas, even unpopular ones, is fundamental.  So is the right to petition our government and to argue for the things we believe in.  These rights that were afforded to us in our Constitution are precious and fragile, but are a foundational aspect of what so many have died fighting for.

There are many widows, children who lost a parent, and parents who lost a child as a result of armed conflict. While not perfect, this great country has been a symbol of freedom and a beacon of hope for the entire world (well, not for dictators and tyrants).  We owe a debt of gratitude to the families of those who made the greatest sacrifice furthering those ideals.  This is a holiday weekend for most of us here in the US.  I am sure we will have good times, good food, and visit with good friends.  That is what this freedom has afforded us.  But please take a moment to remember those among us with an empty chair at the table.

Thank you, Vets!

 

Come back from this weekend with a renewed sense of the opportunities that you have.  Each of us has the opportunity to overcome our current circumstances – maybe not alone, but the opportunity is there.  If you need a hand, reach out.  Sometimes you need a nudge.  Sometimes you need a lot more.  Sometimes someone needs you.  At the end of the day, we are a people who need community and we are a community of people all serving a common goal to make other people’s lives better.  This is a noble cause and is worthy of using the freedoms we have been given to fight for its continued viability.  Read last week’s blog again.  We have the right to petition our elected representatives.  There are a great many rights we have that our Constitution affords us…each every bit as precious as the other — exercise them and remember we all have the same rights and the same opportunities.

So have a good weekend.  Refresh.  And come back to work next week ready to take on your challenges and make a difference in your part of the world.

And remember those who died so that you can be free.

Business owner headache concept, businessman with painful migraine in office, selective focus

Getting Paid Below Medicare

This week several of us went to Capitol Hill to speak for the O&P Clinical Profession. If you were there, thank you.  If not, you can still make a valuable contribution.  We spoke with our elected representatives to encourage them to support a bill that has high-powered bipartisan support.  While it may feel futile to try to get the US Congress to do anything meaningful, this bill seems to have a good chance of going through.  But it NEEDS YOUR support.  Membership in AOPA is not necessary to support this.  They are coordinating the effort, but they are not working in a vacuum.  All of the O&P national organizations support this effort as well as the national organizations of other healthcare professionals. In an O&P legislation rarity, there are no serious objections to the requests we are making.

For over two decades, people in this profession have complained about how unfairly Medicare treats them. And for the life of me, I do not understand how the private payers get away with “below Medicare” reimbursement for O&P services.  Maybe our profession is so disrespected because unless you have inside knowledge, people fundamentally do not understand that O&P is not DME…At least not from a real-life standpoint.  Unfortunately, when the Social Security Act was written, the omission of a couple of key words has cursed us into equal coexistence with sellers of diabetic test strips. This proposed legislation will make it crystal clear that the provision of orthotic or prosthetic Clinical Care is not the same as the provision of traditional DME.

Senators Mark Warner (D-VA), Steve Daines (R-MT), Tammy Duckworth (D-IL), Chuck Grassley (R-IA), John Cornyn (R-TX), Bill Cassidy (R-LA), John Thune (R-SD) C0-Authored the Senate bill, which has identical wording to the house bill.  Today, we are on the hill to encourage more cosponsors of these two bills, known as the “Medicare Orthotic and Prosthetic Patient-Centered Care Act.”

Picture of the US Capitol

Referencing the document linked above and provided by AOPA, there are four key goals of this legislation:

  • Differentiate O&P Clinical Care from Durable Medical Equipment: The legislation would statutorily differentiate the clinical, service-oriented nature in which O&P care is provided from durable medical equipment (DME). DME is totally different than O&P care and should be treated separately in statute and regulations. O&P clinical care would no longer be viewed through a DME lens, permitting more appropriate regulation.

 

  • Refine Competitive Bidding of Off-the-Shelf Orthotics: the legislation revises the interpretation of “off-the-shelf” (OTS) orthotics for purposes of competitive bidding by clarifying that the Centers for Medicare and Medicaid Services may only competitively bid orthoses that require “minimal self-adjustment” by patients themselves, restoring congressional intent and ensuring that patients in need of custom fit orthoses will continue to have the clinical care necessary to achieve proper orthotic fit and function.

 

  • Exempt appropriately credentialed clinicians from Competitive Bidding: This bill would exempt certified and/or licensed orthotists and prosthetists from the requirement to have a competitive bidding contract to provide OTS orthoses to their patients, much like the law treats therapists and physicians. These orthoses would be subject to the competitive bidding rate so this provision would increase patient convenience without increasing Medicare outlays.

 

  • Prohibit “Drop Shipping” of Custom Fit and Fabricated O&P: The bill would reduce waste, fraud, and abuse by prohibiting “drop shipping” of all prosthetic limbs and orthotic braces that are not truly OTS (i.e., subject to minimal self–adjustment by the patient). This would save Medicare outlays and ensure the provision of clinical O&P care.

 

While these four goals may seem small, they are the crucial groundwork for further legislative action. Getting these measures codified will ensure orthotic and prosthetic (“O&P”) patients have access to quality care and will reduce fraud and abuse in the Medicare O&P benefit. Specifically, this legislation will fundamentally ensure that patients are receiving the best quality care by licensed, credentialed, and trained professionals, guarantee that patient care is easily accessible, and reduce fraud and abuse that carries both a patient care and financial cost.

To move this legislation forward, we need to garner as much support as possible for it. Please write to your Representative and urge them to support this important legislation – simply enter your information on the platform, personalize the letter as you see fit – it’s important to tell YOUR story – and click send. The process will take you just a few minutes; however, educating Congress on the issues surrounding the O&P profession is vital to businesses and more importantly patients – if we don’t advocate for our needs and the needs of patients, no one will.

Business colleagues discussing financial data working together in office. People entrepreneurs working with charts and tables on computer. Two people working together. Workmates talking about project

Size Matters

I am excited to be working on a new report that we will be sending to all OPIE Plus customers who have the OPIE Business Intelligence tools available to them.  As these reports take shape, there is a lot of discovery that has to take place.  Our goal is to create something that helps business owners ask the right questions and see where there may be opportunities to improve profitability, efficiency, or overall business health.  We have a decade of work behind our framework with knowledge gained from over a hundred different O&P practices working on the same challenges to arrive at an optimal “best practice solution.”

We learned early on that size matters.  The systems, processes, and resources available can be radically different among O&P practices. We have analyzed millions of data points from OPIE customers to identify groups of companies with similar profiles that we could group together to provide meaningful comparisons of operational data. Through this process we were able to create five distinct peer groups that we now use for benchmarking.

As we think about company health, one indicator is how effective we are at attracting new patients. But in order to answer that question you have to know what is reasonable.  What’s realistic? What can we do to influence the number? Should we spend more time trying to increase the number of new patients that come into the practice, or would we be better off focusing on a different aspect of our business?  I do not think there is one thing that you have to get right.  I think there are many things that have to work well, and like the “spinning plate” analogy, you have to keep everything in balance.  You know what matters to you based on your organizational goals.  If, for instance, business growth is a goal, then you may want to see your new patient count getting bigger each month.  But maybe you are happy with your patient volume.  You need a steady state to maintain your book of business so you might want your new patients to be consistent over time.  Not too many, not too few.  Or what if you are trying to emphasize your prosthetic business…then you may want growth in the number of new prosthetic patients and a steady sate or even a decreasing number of new orthotic patients.

If your OPIE system is hosted by OPIE Software, you are considered an “OPIE Plus” customer.  You have a dedicated Customer Success Manager who is here to help you navigate the data and the BI tools.  You can reach them here. They will make sure you are set up for data and eligible to get this new report.

In addition to the new patient information, we will be looking at a new metric called the “Clean WIP Score.”  This score will allow you to dig into the biggest challenges to moving a patient through your system from intake to delivery and highlight opportunities to improve your patient flow.

I look forward to getting this report into production and out to you!

Checking your Progress

Here we are, starting another month… and just like that, we are a third of the way through 2022!  It’s time for an assessment. How are you doing?  When you look back at your goals for this year, how have you done?  (How’s that diet plan working out?) Even if you didn’t create business goals for 2022, it’s not too late — the second half of the year is fast approaching–sit down with your team and make a plan for what you want to accomplish.

I talk about the importance of accountability, the need to align the job descriptions to the company mission, and the need to hire people who believe in the mission. When setting goals, they should be designed to support your mission.  Let’s say your mission is along the lines of providing the best practical O&P care to the people in your community. How would you define the “best practical care?” I imagine we would think about timeliness of care, we would certainly have to think about affordability and profitability. After all, if the patients can’t afford it and you can’t make money on it, then you won’t be helping anyone!

So let’s look at some numbers.  The WIP: Aim for Success tool is designed to help you visualize and strategically manage your patient load. This tool has many uses, but for this, let’s look at two ways we can monitor your progress. Let’s say the goal this year is to bill $2million in services.  I can look at this image and see that I have about $102k scheduled for delivery in the next 30 days.  To reach my goal, I need to be billing at least another $65k every 30 days. Knowing that I have about $406k in potential deliveries (see the red zone), I can reach out to the admin team and have them work to identify and schedule deliveries for those who have been seen and had codes selected.  This requires coordination with and cooperation from the clinical and technical teams, as well as patient coordination.  The goal would be to keep the “bucket” filled with enough work to keep the lights on.

Another way we can look at this is volume.  Perhaps you elect not to share the dollar amounts with the staff. This same tool is available without financial information. We can see that there are 5 deliveries scheduled in the next thirty days. Maybe our goal is to have at least 12 scheduled deliveries every 30 days.  Now I rephrase my question to the team.  I would ask them to identify 7 or 8 patients in our WIP that we can get scheduled for delivery in the next 30 days.

This tool, and this approach, allow our company to strategically manage the patient load to help us meet our corporate financial goals. It has the bonus of perhaps providing care to our patients in a more timely fashion, which should lead to better physical outcomes and increased patient satisfaction.  Both of which will help your reputation in the community and should help attract more patients.  Learn more about our Business Intelligence here.

Business People Looking At Computer At Office

Uncertainty: Revisited

A year and a half ago, I wrote about uncertainty and the need to embrace it to drive your business forward. I introduced you to the World Uncertainty Index and I thought it would be interesting to see where the index is today as we emerge from the pandemic and enter this new phase of global unrest and hostility. While doing my research, I investigated why this matters to the O&P profession. 

Nicolas Bloom is an economist at Stanford and is a developer of the “World Uncertainty Index,” which was created for the International Monetary Fund (IMF). Compared to the last time I wrote about it, the degree of uncertainty has diminished significantly. Up through the 4th quarter of 2021, the data was showing a fairly steady decrease in uncertainty. New data shows that there was a significant uptick in the index during the first quarter of 2022. It is not as high as it was in October 2021 when I wrote about it, but, there was interesting data in the movement of the numbers. 

The National Bureau of Economic Research says that “innovations” in the Index “foreshadow significant declines in output” (Ahir, 2022). What this means is that given the rapid increase in uncertainty documented in the index in Q1 2022, we can expect economic activity to decrease. And what that means is that supplies will be further limited, supply chain problems will continue to arise or even be exacerbated, costs will continue to rise, and the economic recovery will be further delayed. 

In our profession, we seem to be constantly dealing with change. The good news is that at least we have a good idea of what the next big change is…more of the same! This means your business strategy is more important than ever. Things are going to get tougher before they get better. Here at OPIE, we know that data-informed decision-making

is critically important to your business’ success. We do it all the time with our patients, but we trust our guts regarding the operation of our business. Please don’t rely solely on this! Watch your data, look for trends, and make your decisions based on what your data shows! 

But also, don’t fall into the trap of thinking that with just a little more information or just a little more time, you can make a more informed decision; that just leads to paralysis. The line to tow is thin, but that’s what we’re here for at OPIE. If you want to learn more about how to do this, join us for our educational events! Look at our Events Calendar here. 

Keep in mind that your business is always facing uncertainty. You are paid to have a long-term view and think strategically. Assume the worst and have a plan. If nothing bad happens, then you are that much better off. But if something does happen, you have a contingency in place and will be able to respond to it because you have already thought about how the constant force of change might impact your business. 

Don’t hide from the uncertainty monster. Embrace it and drive your business forward through it. 

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Don’t Fleece Your Staff

If you are a boss or a leader, guess what? According to the American Psychological Association, about a third of your staff do not think you are always honest and truthful with them. About one in four does not trust you.  We have been told that the solution is transparency. Transparency builds trust.  It increases employee engagement and boosts morale.  But what does transparency really mean, and can we achieve it in an O&P business? 

According to Slack, “82% of knowledge workers say it is important that their organization is transparent. But only 19% consider their company to be ‘very transparent’.” I think a key reason that staff does not trust leadership is that leadership often gives lip service to transparency.  Everyone knows it is important, and many say they are transparent, but studies continue to show that there is a real lack of trust in the ranks.  Presumably, you do not hire dummies. So, are they on to something? 

Fast Company says that a “transparent workplace moves beyond the hierarchical companies of the past that thrived on departmental silos and need-to-know, reactive information sharing. Leading with transparency, managers eliminate murky processes and vague expectations that lead to disconnected, ineffective employees.” And as awesome as this sounds, few companies are able to open themselves up to true transparency.  Transparency is bi-directional and requires mutual accountability. Most leaders are not willing to go that far.  So, they talk about transparency, but they really are pushing “visibility.” Committing to transparency over visibility requires a high degree of leadership vulnerability.  

But all is not lost! At OPIE Choice, we have come to know John Spence pretty well, and he has come to know O&P pretty well. He teaches business excellence and one of his topics is “high-performing teams.” Do not get me wrong…trust is key. And transparency is desirable. But transparency without an alignment is not sufficient. So, I go back to my oft-mentioned need for authentic Vision, Mission, and Value Statements for the company. It is crucial that those depict the true desire for what the company will do. Create objective statements and tie job descriptions to achieving them. That creates your transparency. Your Value Statement lays down the guardrails. Hire the right people; people who not only understand your Vision, Mission, and Value statements — but who are motivated by them and who embody the values you profess. With those people on board, there should be no doubt in your mind that they are solidly on your team and therefore you will know that success is only possible when they have all the information possible to accomplish their objectives. 

As a leader, your biggest challenge will be to get out of their way once they have the tools they need! 

female-entrepreneur-2021-08-30-06-01-17-utc

Transitioning To Leadership In O&P

As a clinician or an administrative worker in an O&P practice, your primary focus is on doing the work that comes across your desk or your table. You went to school or at least took classes to learn the basics of the job and you have perfected your skills over time. As good as you may be in your role, the transition to management or leadership requires a totally different skill set. But I think the transition can be less intimidating and stressful for all involved with a few simple ideas.   

Vinod K. Sahney, Ph.D., a Senior Fellow at the Institute for Healthcare Improvement, compares becoming a leader to buying a house. He says “When you buy a house, you do an assessment or walk-through. You have to do the same when you become a leader. You have to figure out the most important issues to tackle, and what new training, technology, and facilities are needed.” I don’t have his credentials, but for me, I like to think of the practice as a patient. You conduct an assessment using both subjective and objective criteria to document the current condition. You then determine the goals for the “patient.” In your practice, those goals are documented through your Mission Statement. Once you have all that information, you create a “plan of care” or your business execution strategy. The tricky part in patient care is executing the plan. 

 

Clinicians had to learn clinical expertise to provide competent O&P care. It only makes sense that you would have to learn leadership skills to provide competent leadership. One of the biggest challenges people face when assuming a leadership position is the appropriate delegation of responsibility. So much of the work you did in the “worker” role is your own. Now you need to motivate others to be your helping hands. It can be very hard to let go of those things that you have always done. But if you do not let them go, if you do not delegate, you are not leading and you are not helping others in the organization to grow professionally.  

If you read back through my blogs, you will see a consistent theme of competencies needed to effectively lead. Among them is emotional intelligence. It is the awareness of your own and other peoples’ emotions and the skill to effectively align the company’s goals with the emotional drivers of the people you work with. It is crucial to successful leadership. Having a strong self-awareness is another critical success factor in leadership. An understanding of your own strengths and weaknesses can help leaders avoid blind spots and find the appropriate people to assist them. It is also important for a leader to understand how others see them, so they can adjust, as necessary. 

Along with those skills comes the need to influence people. To move others along in new directions, and to get others to carry out your decisions, leaders sometimes need to use influence rather than direct power. In order to cultivate influence, leaders need to understand that people represent different areas, interests, and opinions. They also need to be able to work through that complexity to reach a goal. 

The last thing that can help O&P leaders succeed is a strong network to help throughout the transition and beyond. Just as clinicians seek consultations from specialists, they benefit from consulting other “subspecialties of management” to help them carry out their goals and be the best leader they can be. That is where your participation in the OPIE Choice program pays you incredible dividends. Reach out to me to learn more about how Choice can help you and your practice thrive. 

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You Have To Suffer To Be Beautiful

Such a simple statement, uttered a little sarcastically, became a rallying cry for a championship team. A friend of mine was teaching a Bible class this past Sunday. He is a Marine and was an accomplished wrestler. There was a sign hung by his coach, Jare Klein, in the Olivet College wrestling team gym where he trained. On it was the phrase, ‘you have to suffer to be beautiful.’  

The coach, he said, defined beauty as winning. Trophies, matches, personal goals, whatever you are striving for, winning is doing what you set out to do. And to realize your beauty, you must suffer. You need to put in time, effort, and discipline to overcome the challenges and the opposing forces to make it so. Later in life, as my friend was talking to his former coach, he learned where those words of wisdom originated. One day, the coach’s wife was having one of those days where getting ready for work was an ordeal. Everything she was doing seemed to not have its desired effect; hairdryer, curling iron, straightening iron, mousse and all the trimmings were actively working against her. As she was finally finishing her routine, she quipped to him, “See, you have to suffer to be beautiful!” 

On the surface, it is funny — but with just a little thought, you can see how those words can have a profound meaning. Virtually nothing worth having comes easily. Why should we expect to get something for nothing? Maybe beauty is watching a patient perform a task after your intervention. Or it is the flawless execution of the workflow that keeps the patients progressing toward their own goals. Patients do not just walk on their own. Heads do not reshape on their own, nor do curved spines straighten on their own. We do not regrow limbs. Your hard work and sacrifices gave you the ability to create the beauty of your patient care. Their suffering, hard work, and dedication allow them to achieve their goals. Overcoming the challenges is ultimately a team effort where each person suffers to reveal their beauty. 

The same is true in managing your practice. The team often suffers through the process of creating beauty. But we push through, we know that there is something we are creating that motivates us to overcome the challenges in pursuit of the beautiful outcome we are seeking. It is critical to know that the suffering can be significant. Real pain manifesting in hurt feelings, personnel changes, anger, frustration, and more can arise. This is why a clearly articulated definition of beauty is so important to success. We have to understand why we are suffering, and we have to see the beauty ourselves. Your missions, vision, and values statements work together to paint the definition of beauty in your practice. If the staff cannot see it, they will not be able to endure the suffering and the beauty will not be realized.