Re: P&O products only to P&Os -- protectionism or quality of care?

Re: P&O products only to P&Os -- protectionism or quality of care?

John:

Hi again. You asked the following excellent question:

    Summary:

    Do your best to convince me that if I develop a new hernia truss (back
brace, thumb splint, etc.) I have a moral/ethical/professional obligation
to distribute it only through an orthotic/prosthetic facility.

    John T. Brinkmann, CPO


John, I've given this subject some degree of thought, as I've just come out
with a new product (the ACE Brace) that can be easily fit by almost anyone.
Its very-popular look-alike cousin, the CASH Orthosis, is currently
distributed to pharmacists, therapists and physicians. I know I can make more
money by selling to everyone, so why should I restrict sales to only
orthotists?

First off, I do believe a lot of the sentiment against selling only to P&O
people is protectionism. (In fact, it is clear to me that the current trend
toward licensing, while widely touted as an enhancer of service quality, is
mostly protectionist is nature.) However, whatever the motivations of its
proponents might be, licensing does appear, ultimately, to benefit the
patient, and the same can be said for limiting the sale of P&O products to
P&O professionals.

Here are the reasons why I think so:

1. P&O professionals are better trained to fit P&O products; therefore they
fit them better.

    I think this is true, although people arguing against this principle can
give specific examples of poor quality care from credentialed people and good
quality care from non-credentialed people. But specific anecdotes don't
change the fact that, in the main, people who are trained to do something do
it better than people not trained to do it.

2. P&O professionals have the equipment to modify ill-fitting P&O products.

    Even if a non-P&O-professional can properly fit a P&O product on the
average patient, what about the special patient who needs the product to be
modified? Only P&O providers have made the investment in tools and equipment
(not to mention training) to make such modifications. You might say, well, in
those special cases, send those patients to the P&O provider. But this would
be patently unfair because, if you do that, those who have made the biggest
investment would receive only the least profitable cases.

3. The P&O provider needs to be profitable for the good of the patient.

    This is an extension of the discussion in point #2. If P&O products are
sold to non-P&O-professionals, what products will go to those
non-P&O-professionals? The answer is, those which are the easiest to fit with
the least training and therefore afford the biggest and quickest profit for
those crossing the line into the O&P profession.

    What is wrong with the easy-to-fit products going to people who beat the
O&P professional's price? Isn't that to the patient's benefit? Well, to a
certain extent that is going to happen, no matter what (Adam Smith's
invisible hand, you know) and yes, patients will receive less expensive care.
However, if very much of that happens, P&O will become unprofitable.

    What's wrong with that? Well, besides the fact that the non-P&O
professionals will likely give the patients lower quality care for their
lower reimbursements, when the P&O profession becomes unprofitable, who will
be the first to leave? The best and the brightest, of course. They always
move toward better rewards. And when the highest-quality practitioners leave
the O&P field (or, more likely, stop entering it, which in the long run, is
the same thing) then quality of care will be reduced even further.

    Plus, there will always be patients who need special care, or who need
things that aren't made in great quantities, that is, things that aren't
profitable, things that the non-P&O interlopers don't want to mess with. When
the best and the brightest leave P&O, who will be left to care for those
unusual or difficult patients?

So there really is a moral argument for the protectionist sentiment in P&O.
If we don't stay healthy and profitable as an industry, patients eventually
will suffer.

Well, John, these have been my thoughts on this subject. I'll be interested
in hearing what others have to say.

David

David Hendricks, CPO
HOPE, Inc.
acebrace.com