In The News

Starting over

When patients began complaining, Joe Sansone, CEO of TMC Orthopedic, decided to give the company's prosthetics division a complete overhaul

Houston Business Journal - September 7, 2007 by Casey Wooten Special to Houston Business Journal

It takes a lot to break from the status quo, especially when it means reshaping how you run your business.

But when Joe Sansone, founder and CEO of TMC Orthopedic LP, found out in 2004 that his patients were dissatisfied with his prosthetic division, he decided to rebuild from the ground up. After identifying what patients felt was missing from their experience with prosthetists, Sansone sought to combine every improvement he could find under one roof, advancing the care and provision of prosthetics to a new level.

What emerged was The Amputee and Prosthetic Center -- a subsidiary of TMC Orthopedic designed specifically to meet the needs of amputee patients. Sansone's idea paid off. Since its creation the center has produced increasingly impressive revenue, from around $1 million in 2005 to a projected $4.1 million in 2007.

The renewal process started after patients from his amputee division began contacting Sansone, frustrated at how they were being shuffled back and forth and given little personal attention. It was a problem, he soon found, that was common throughout the industry.

"I got wind of a couple of patients who were not happy with the level of service we were providing," Sansone says. "At that time I realized that, on a company level, we weren't meeting the patients' needs, and also, on the practitioner level, that they weren't meeting the patients' needs."

He set up a focus group that yielded page after page of complaints from patients.

The problem wasn't confined only to TMC Orthopedic, though. Sansone says some of the patients told him they had been to several different prosthetic companies in search of "someone who cared." The stories patients told about other prosthetic centers were strikingly similar to the TMC experience. "The biggest problem was that they felt like they were on an assembly line of care." Sansone says.

Patients were becoming lost in the system. They were seeing up to five doctors to care for their amputation and prosthesis and were being given little or no emotional support. Sansone looked around for ideas but, while finding a few good ones at other practices, he didn't find a program that encompassed all that he -- and his patients -- were looking for.

So he built one. The core of Sansone's new program is meeting the emotional needs of the patients -- one of the biggest complaints among patients in the focus group. Two new staff positions -- nurse advocate and peer visitor -- provide someone who will assist the patient throughout all phases of care. Nurse advocates offer a bridge between the various health care providers a patient may see. They stay with the patient throughout the process, offering preoperative consultations and assistance in obtaining wheelchair ramps and other aids. Peer visitors, trained by the Amputee Coalition of America, are fellow amputees who meet with patients and discuss what life will be like after the loss of a limb. Sansone says that often when a peer visitor walks in, the patient doesn't realize they are an amputee.

"When the person talking to them, who seems to act normal, lifts up the leg of their pants and says, 'Look, I'm an amputee just like you,' their eyes light up," Sansone says. "They can ask them questions they were too embarrassed to ask, or they didn't even think to ask their medical provider."

Nurse advocates and peer visitors have produced striking results, Sansone says. Their ability to connect with patients on a different level from doctors or practitioners has eased an otherwise difficult experience.

"For our patients, their fears are skeletons in the closet, and they are afraid to look in," Sansone says. "But once they meet with a peer visitor we can dispel those fears." Sansone's peer visitors come from all walks of life. Some have themselves been patients at The Amputee and Prosthetic Center.

Jody Wallace came to the center after a below-the-knee amputation following an automobile accident four years ago.

At first, Wallace was frightened about her future. "I didn't think I was ever going to walk again," Wallace says. "I didn't know anything about prosthetics. I didn't know anything about what was going on. I just didn't know what to expect." Initially, Wallace was sent to another practice, but her insurance wouldn't approve it, so she was referred to The Amputee and Prosthetic Center.

Wallace says her experience at the center was drastically different from what she had experienced previously. Her practitioner at The Amputee Center, Wallace says, provided more than just a prosthesis. "I loved it. I felt like I had a better relationship," Wallace says. "He was so upfront about everything and gave me all the information that I needed that I felt more comfortable asking him questions."

Wallace was impressed. So much so that when she heard Sansone was looking for patients to join his new peer visitor program, she jumped at the chance. Now, Wallace meets with patients who are in the same situation she was, providing information about living with a prosthesis, or simply being there for the patient to talk to.

The easygoing atmosphere of The Amputee Center draws patients in, making them feel comfortable enough to speak candidly about any problems, she says. "I always tell my patients that they have to have a good relationship with their practitioners," Wallace says. "They've got to voice their concerns if they are uncomfortable. They've got to make sure that they feel comfortable enough to say if something is wrong."

The new program is popular with doctors as well.

Travis Hanson, an orthopedic surgeon practicing in northwest Houston, says it's rare to find so many services at the same facility, and that is the primary reason he sends patients there.

"It's very uncommon," Hanson says. "A lot of services will tell you that they have amputee patients who are available to talk to, but when you send someone over to The Amputee Center you know for sure that's going to be available."

Hanson says he sees Sansone's more personal, full-service program catching on with other providers.

"The population of diabetic patients is exploding, unfortunately, and it seems to me that this is the right model. I could definitely imagine that this would be a trend toward the business of prosthetics in general," Hanson says. Diabetes is a common cause of limb amputation.

Because of the success of his new model and the increase in patients it has generated, Sansone and his team recently completed construction of an 8,000-square-foot headquarters in north Houston, believed to be the largest prosthetic facility in Texas.

Noticing the need to provide a comfortable space for his patients that didn't feel like a doctor's office, Sansone designed his new waiting room with a laid-back, social atmosphere. "It's got the largest waiting room I've ever seen in an orthopedic and prosthetic facility," Sansone says. "It looks like a Starbucks, complete with the coffee bar. Patients feel instantly at ease waiting for our practitioners."

The new building also houses a state-of-the-art gym designed with the amputee in mind, as well as a library featuring 140 different books dealing with amputee issues. Sansone believes it is the first facility in the country to combine all these services under one roof. Prosthetic centers are generally quite profitable businesses, Sansone says, but offering the amenities and services he does nearly doubles expenses for the provision of care. He hopes the increase in patients will make up the difference.

Today, Sansone estimates about 30 percent to 40 percent of The Amputee Center's patients have come to the practice after being unhappy with their previous prosthetic provider.

"As we started offering more and more services to our patients word got out and patients started to come to us," Sansone says. "Then I decided to jump in head first and not worry about the profits -- to take care of the patients and hope that the profits would come later."

The Amputee and Prosthetic Center

Casey Wooten is a Houston-based freelance writer.