In The News

Commentary
State Licensure: O&P's Salvation or an Unnecessary Governmental Regulation?
By Joe Sansone

On my first day of work at my new job as a sales representative for an orthopedic supply company. I eagerly awaited my first day of training. As a fledging representative, I was to receive a few days of training on the product lines we represented before I was sent to my territory. I distinctly remember spending almost an hour in the back of a warehouse learning how to trace a patient for a custom-molded functional knee orthosis.

I was pleasantly surprised that as a sales representative I would be touching patients in such a manner as to measure and fit them for custom functional knee braces. I reasoned that I had been hired as a sales representative and wondered how I could become the medical expert providing knee orthoses for patients. I had always wanted to be a doctor, and now I was going to have the opportunity to work with patients. The sad thing is that less than a week later, I was completing my first tracing for a patients knee orthosis.

What's wrong with this picture? How could a recent graduate with a microbiology degree and a history of selling used cars now be providing medical services? The answer is simple. Until recently there were no laws or regulations in effect to restrict untrained individuals from providing orthoses and prostheses.

Service Over Experience

Why would a physician choose to use a young, inexperienced sales representative working out of his car and a one-bedroom apartment? Why would referral sources not choose a licensed medical professional, such as an orthotist with a fully functional O&P facility, staffed by full-time employees and the necessary accoutrements? At this time, throughout the country, a multitude of sales representatives were beginning to provide the same types of services and stealing an increasing portion of the market share. Why did this happen?

There were obvious reasons why physicians chose to use unlicensed sales representatives to care for their patients. In the early stages, it may have been that physicians and referral sources did not know the difference between a sales representative and an orthotist.

But soon thereafter, as practitioners lost business, they hastened to call on the physicians and educate them as to the ineptitude of the sales representatives. They educated the physician and informed them of the liability risks of using the services of an uninsured sales representative versus a licensed practitioner with expansive knowledge, and years of training and education. Still the physicians choose to use my services for their patients on absolutely every occasion.

Servicing Patients

Despite the protests of the practitioners, my physicians continued to allow me to service their patients. These customers chose to use my services rather than those of a licensed practitioner for several reasons. First, I had established myself as a credible source of information about bracing products and the latest technology. Second, I was willing to go to any extreme to provide service for physicians and their patients. Third, I actively pursued physicians business on a consistent and routine basis. Lastly, I was always available to the physician, his staff, and most importantly, his patients. In summation, I was always around when the physician and his staff needed me.

As a sales representative, I was simply filling a void left by other practitioners. If these customers had been serviced completely by their practitioners and satisfied with the level of service they received, then there would have been no market for my services. Free enterprise took over. When calling on a new account, the physicians' complaints against the O&P community were always the same. I knew exactly how to sell against the O&P industry and their professionals.

Complaints

What were O&P facilities doing wrong? The complaints received from my customers were always the same. I haven't seen an orthotist in more than three months,or sometimes, as a matter of fact, I do not even know the name of the orthotist fitting my patients Of ten times, the physicians would write a somewhat vague or ambiguous prescription for a product for a patient, and the patient customarily received the most expensive orthosis available. Physicians believed patients were being gouged. The horrible stories of patients being billed more than $2,000 for an orthosis that would have cost the physician $500 were commonplace. Most importantly, patients were not receiving adequate service. It would sometimes take weeks for patients to receive their orthoses from O&P facilities, and on many occasions, they were forced to wait for hours in O&P facilities awaiting a practitioner or pre-certification. Patient calls for follow-up visit care at any location other than the practitioner's office went unheeded. Requests for service other than between the hours of 8 a.m. and 5 p.m. Monday through Friday went unheeded until the next business day or were often ignored.

Level of Service

Contrast this level of service to what I was providing as a sales representative. While practitioners would repeatedly provide the aforementioned insufficient levels of service for $500 to $1000 gross profit, I would jump through blazing hoops to receive my $50 commission. I would travel to patient's homes, their offices, and even to the football field to service their needs. I went where the physicians asked me to go and where the patients needed me. Once a secretary walked in on her boss and me. She opened the door to his office, shocked to see our surprised faces, as he was sitting on his desk in his underwear. Embarrassed, I stumbled through the explanation that I was merely measuring him for a knee orthosis. It was not uncommon for me to provide patients with loaner orthoses for their upcoming football games with less than an hour's notice.

Currently, the thought of a non- licensed professional, much less a sales representative, providing O&P care, frightens and concerns me.

Meeting Patients' Needs

I became increasingly unpopular with O&P facilities. My once practitioner customers had become my newfound competitors. They did not like my answer to their questions as to why I was competing with them. I simply stated that if a physician asked for my services, I would not turn away the business. As time progressed, my physicians soon asked me to start billing third-party payers for these orthoses, thus greatly increasing the profitability of my services. Soon physicians asked if I could provide additional products, such as postoperative knee orthoses, AFOs, and even postoperative LSOs. Slowly but surely, I educated myself and my sales force, and began providing these services for my physicians.

I remember my nervousness upon fitting my first patient with a postoperative LSO. I took great care in making sure that everything was absolutely perfect and that the patient was comfortable. Upon following up with the patient a few days postoperatively, he thanked me profusely, stating that this was his third lumbar procedure and he had never had a similar experience with past orthotic practitioners. He said this was the most comfortable orthosis he had worn and thanked me for my care and concern.

Prior to this event, I had my doubts about the ethicacy of providing these types of orthoses. But after this patient, I was sold. At the time, I thought an untrained but conscientious sales representative with the desire to ensure that his patients and physicians needs are met far outweighed the services of a licensed, experienced professional slapping on an orthosis and then hopping to another treatment room to see his next patient.

Thousands of fittings later, I made a sales call on a pontificating, self-serving orthotist. He preached to me about something called state licensure and how, in the future, unscrupulous and unqualified sales representatives, like myself, would be at the mercy of practitioners. Lobbying efforts had been initiated at the state level to require licensure, so that so-called undeserving individuals, like myself, would no longer be able to provide orthotic and prosthetic devices. The thought repulsed me, and I was filled with resolve after leaving that sales call. I vowed to my sales representatives that I would do whatever it took to make sure that such a thing did not happen.

By this time, I had started a small DME business, and billing for orthotic products comprised 10 percent of my total sales. Not only could I not afford to give up the revenue, but there was an even bigger issue at stake. I could not allow my ability to earn a living to be placed at the mercy of this individual and those like him. I had opened a business to control my own destiny, not to be controlled by what I viewed as unnecessary governmental regulation and pontificating practitioners.

Change of Heart

Five years later, I am the employer of more than 10 licensed professionals and strictly prohibit any of my 20 sales representatives from fitting bracing products. I now realize the error of my ways as a young sales representative. Currently, the thought of a non- licensed professional, much less a sales representative, providing O&P care, frightens and concerns me. Why the change of heart? Please read the next issue of O&P Business News to learn more about what brought about this change of heart.

Joe Sansone is chief executive officer of TMC Orthopedic.