Replies: Manufacturers who compete
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Title:
Replies: Manufacturers who compete
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ORIGINAL POST:
Some manufacturers have salespeople who go in to the doctor's
offices/clinics, do the fittings and sometimes charge less that they charge
us. Some of these companies ask us for the referring doctor on the order
form or will charge us sales tax unless we give them a copy of the
prescription with the doctor's name on it.
I know of one manufacturer which has contracts with large HMOs, directly
providing the prescription orthotic devices to the clients.
There are other companies who only sell to P&O offices. They apparently
feel that their device needs to be properly fitted to provide the function it
was designed to give. Regardless of the manufacturer of the device, it is up
to the practitioner to assure proper fit and function when it goes on the
patient.
In a court of law, an important criteria is whether an action was in
accordance to the standard practice of the community. Having salesmen do
castings and fittings in lieu of an ABC practitioner is questionable, and I'm
surprised that physicians allow this in their practices.
By the way, the Associated Press reported last month that the American
Medical Association recently adopted a policy that doctors should NOT be
selling health related products out of their offices for profit as it is
considered a financial conflict of interest. Unless the doctor discloses
their financial arrangement with the supplier, the items may be distributed
free or at cost.
I will post a list of manufacturers who do and do not bypass the P&O
practitioner based on what is submitted to me. Please forward what you know
from personal experience, not what you have been told or have heard.
REPLIES: (each is separated by a blank line) I have deleted names from the
posts unless approved by the authors as the responses were sent to me
personally
Don't forget, Innovation sports (CTI), Bledso, Medical Designs,Centec,
OrthoAmerica (I believe at least to hospitals) Generation II,
This is the only reason I would be in favor of O&P Liscencing. It is
dangerous patient care, but the docs get a cut or rebate so it is bottom
line oriantated medical service. I get refereals to adjust these orthoses
after they have been worn!!
Your post concentrates on the knee orthosis guys marketing to docs, which
is a problem to O&P.
My biggest concern is with companies who market custom orthoses to PT's.
Cascade
(of pediatric orthosis fame) markets aggressively to PT's, and will even
expedite billing for them.
While their orthoses are generally excellent, I will not give them business,
nor any other
company who markets devices (which are within a prosthetist's or orthotist's
scope of
practice) to other health care professionals. In my opinion there is, in
every case, a supplier of
equal quality which supports the O&P profession, and they get my business.
I passed my Orthotic boards in 1974, but no longer active in the A.B.C. After
selling my business, I worked 2 years with a Workmans Comp group, P.M.S.I. as
their O&P advisor. I then formed my own manufacturers rep company and
represented a large O&P company which owns a well known KO manufacturer.
After 2 years struggling against Don Joy
and others, I received a memo from the marketing manager, which said,
We don't need our reps calling on O&P shops. Direct your attention to the
following: Athletic Trainers, Buying Groups, Colleges & Universities,
Distributors, D.M.E Stores, Hospitals, Nursing Homes, Retail Health Stores,
Sports Clinics, Super Stores, Sports Teams, Private Industry, Pharmacies,
etc.
This is from a company buying every O&P shop it can, instructing it's reps
to compete against the very facilities it owns. They now own Seattle Systems,
and their money source, Chase, just bought DonJoy, probably to learn their
cutthroat marketing techniques. This large chain O&P company is to be
feared more than most practitioners and facility owners realize.
Personally, I cease doing business with them and represent only Townsend,
Phoenix Foot, etc. and call on O&P shops only. I did not apply for a Florida
State Orthotist license, and do no fittings, only selling to O&P facility.
I hope many U.S. practitioners read and respond to your letter. The
subject is far more of a threat to us that consolidation.
<< In a court of law, I understand that an important criteria is whether an
action was in accordance to the standard practice of the community. >>
Hi Randy, I handled the lawsuits for Otto Bock for over 15 years in many
states, and since leaving Otto Bock have been a consultant on another eight
cases. I am unaware of any standard practice of the community that would
apply to O&P. Would you be willing to refer me to your legal source for this
information?.
Randy's Response: My attorney told me that most lawyers are familiar with
this standard of care arguement in the negligence area. (not just O&P)
>> Having salesmen do castings and fittings in lieu of an ABC practitioner is
questionable, and I'm surprised that physicians allow this in their
practices. >>
Sad but true - but in most cases ABC practitioners are perceived as
salesmen (vendors) who sell limbs and braces to their patients.
Suppliers who compete with P&O has been going on for years. I would not
see it so much as competing with O&P as eliminating the middleman. Some
even use different names for different markets. With more manufacturers,
tighter markets, and changing technology I would expect this to increase
until you see a major paradigm shift occur in the delivery of P&O
products/services. I have presented and written on this topic in the past.
I agree 100% with what you are saying.
Ace Medical, halo supplies to hospitals.
Bremmer Medical, halo supplies to hospitals.
I see a variety of soft goods in hospitals from all different suppliers.
When they are stuck, complicated cases, or problems arise, the hospitals will
turn to the O and P community to help, otherwise, the sales reps will
inservice and assist with halo applications.
I guess the final answer is to get behind the higher ups in your state
organization and the national guys to pass licensure. I'm in Florida and
down here these guys CANNOT operate. Licensure is the key. If the reps do
not have an ABC certification, CO or CPO for orthotics only and CP or CPO for
prosthetic equipment only, they are working outside of the law. We have been
actively pursuing the reps and the doc who is using their services. It's
pretty much stopped.
A comment about the Associated Press report: My grandaughter in Pennsylvania
hurt her knee playing soccer. Had micro surgery. Few days after surgery back
in the doctors office, doctor decided she needed a brace. Nurse comes out of
the stockroom with a DonJoy Legend, size medium. Too tight. Nurse comes back
with a Legend, size large. Too large. Doctor grabs hold of joints and
squeezes. Now it fits. The joints are now about 20 degrees out of square
(whatever the term is). He then bills my daughter $ 1150 for a L-1846 (not
the correct L-code, but $ 500 more allowable than the correct L-1845). I'm
sure that is just one of thousands of stories of abuse, but it happened to me.
dear sir,
I am writing from India and I agree with you that there are lot of nonP&O
who compete with us in India here. since it is only over 15 years that
degree graduates have come passed out the situation is more frustrating for
fresh graduates, who have to compete with unscientific mindset of the
referring docs and their demand and encouragement for those who nod heads to
their needs(sometimes may not be P&O correct).this sometimes drives a fresh
graduate to adopt unscientific means and also compromise on the principles
just to gain confidence of the docs who would other refer cases to a nonP&O.
though the experence of the nonP&O qualified people has to be respected
because of the only reason that during their days there was no formal
training program, but otherwise this practice has to stop. we in India try
and discuss to find a method but have not been able to implement the best
method . Since i find that the situation is slightly better but similar (as
per the mail), I request your ideas to try and put an end to this type of
practice and effect a good change to the mindset of the docs. also could you
suggest of methods which we should adopt. I may appear nave but it is just
to get the desire and dire need to get a better respect and recognition to
our field.I am sure you will help your collegues in India.
Otto Bock has strict rules for their O&P sales ...to only ABC Certified
Practitioners..... they won't even sell O&P componenetry to BOC. THey do
have a line of materials pre-fab insoles and shoes that are also sold to
CPeds.
The last time I looked, this was a free (depends on how you define free)
country. They have a right to sell to whom they please. You have a right not
to purchase from them. It's called free choice. We have given up to many of
rights already at the alter of protectionism.
Being a supplier/distributor, your email caught my eye this morning. I agree
with you that O & P practitioners should be the people fitting these devices.
It is not ethical for the companies selling to Dr's and O & P shops and
P.T's (and another way to sell them has now popped up - keep reading)
continue to do this. It is bad business and also why we deal with none of
those type companies and we only sell to O & P facilities.
In fact, while visiting a mall in Springfield, Mo. I came across a store
(in the mall) selling Lenox Hill braces among several other major brands.
These were openly sold to the average consumer/patient and fitted by, well,
your basic shoe salesperson - no background in orthotics what-so-ever. Ok,
maybe a 3-5 day training seminar. I have no idea if a prescription was
needed to buy these products. I would imagine the comsumer/patient just came
in, told the salesperson about their knee aches, and the prettiest brace (and
most expensive) was then recommended. And the prices!!! Wonder if the
consumer/patient knows they may be able to turn their purchase into their
insurance with a prescription... Guess not, huh?
Then again I could be wrong... Makes you want to run to the nearest
mall, huh? You are now competing with less than experienced individuals and
not just salesmen going behind your back to the Doctors office!
If you were mad before, this should really up set you - it sure did me and
all the O & P practitioners in Springfield, MO.
I resent the Co. or Its sale team that will do want ever it takes to make a
sale. In FL. you have to be licensed to fit any orthotic device. I have
warned salesmen that if I find out they are doing fittings I will report
them. Thus Co's that have fitters on staff are my competion and I have
disassociated myself with them (Don Joy ) I will not recommend thieir knee
brace. I tell my referring Dr's that when a patient recieves a knee orthosis
from a sales rep. in his office the patient believe that the Dr's staff is
providing it and if there is a problem ,the patient will complain to you.
Most Dr's don't want to deal with it.
In response to your letter, we here in FLORIDA have to have a license and
certification. We also know a manufacturer (Breg) who has a big hmo contract
and
its representatives are fitting orthotics at the physicians offices, not
only are
they selling to non P&O but also breaking the law I believe.Please add them
to your list.
Yours is an excellent question. When I was working for a small but busy
one office practice, this issue was always on our minds. Luckily, we had
the reputation and confidence of the docs to allow us to control the
problem somewhat. The biggest problem seemed to be with the knee brace
companies. Some even have stock and bill programs set up in the physicians
office. I have seen
many ill-fitting braces come out of these situations. Then, the doctors
expect you to fix and/or repair them. One more question for you. What
about other O&P competitors that own distribution companies (i.e. Hanger).
Otto Bock, Knit rite, flex-foot, college park, Century (total knee) do not
compete with us. If they do, I would like to know about it. Yes, let me know
which Manufactures compete against us in the open market. If they have ABC
practitioners, that may is another issue.
Some manufacturers have salespeople who go in to the doctor's
offices/clinics, do the fittings and sometimes charge less that they charge
us. Some of these companies ask us for the referring doctor on the order
form or will charge us sales tax unless we give them a copy of the
prescription with the doctor's name on it.
I know of one manufacturer which has contracts with large HMOs, directly
providing the prescription orthotic devices to the clients.
There are other companies who only sell to P&O offices. They apparently
feel that their device needs to be properly fitted to provide the function it
was designed to give. Regardless of the manufacturer of the device, it is up
to the practitioner to assure proper fit and function when it goes on the
patient.
In a court of law, an important criteria is whether an action was in
accordance to the standard practice of the community. Having salesmen do
castings and fittings in lieu of an ABC practitioner is questionable, and I'm
surprised that physicians allow this in their practices.
By the way, the Associated Press reported last month that the American
Medical Association recently adopted a policy that doctors should NOT be
selling health related products out of their offices for profit as it is
considered a financial conflict of interest. Unless the doctor discloses
their financial arrangement with the supplier, the items may be distributed
free or at cost.
I will post a list of manufacturers who do and do not bypass the P&O
practitioner based on what is submitted to me. Please forward what you know
from personal experience, not what you have been told or have heard.
REPLIES: (each is separated by a blank line) I have deleted names from the
posts unless approved by the authors as the responses were sent to me
personally
Don't forget, Innovation sports (CTI), Bledso, Medical Designs,Centec,
OrthoAmerica (I believe at least to hospitals) Generation II,
This is the only reason I would be in favor of O&P Liscencing. It is
dangerous patient care, but the docs get a cut or rebate so it is bottom
line oriantated medical service. I get refereals to adjust these orthoses
after they have been worn!!
Your post concentrates on the knee orthosis guys marketing to docs, which
is a problem to O&P.
My biggest concern is with companies who market custom orthoses to PT's.
Cascade
(of pediatric orthosis fame) markets aggressively to PT's, and will even
expedite billing for them.
While their orthoses are generally excellent, I will not give them business,
nor any other
company who markets devices (which are within a prosthetist's or orthotist's
scope of
practice) to other health care professionals. In my opinion there is, in
every case, a supplier of
equal quality which supports the O&P profession, and they get my business.
I passed my Orthotic boards in 1974, but no longer active in the A.B.C. After
selling my business, I worked 2 years with a Workmans Comp group, P.M.S.I. as
their O&P advisor. I then formed my own manufacturers rep company and
represented a large O&P company which owns a well known KO manufacturer.
After 2 years struggling against Don Joy
and others, I received a memo from the marketing manager, which said,
We don't need our reps calling on O&P shops. Direct your attention to the
following: Athletic Trainers, Buying Groups, Colleges & Universities,
Distributors, D.M.E Stores, Hospitals, Nursing Homes, Retail Health Stores,
Sports Clinics, Super Stores, Sports Teams, Private Industry, Pharmacies,
etc.
This is from a company buying every O&P shop it can, instructing it's reps
to compete against the very facilities it owns. They now own Seattle Systems,
and their money source, Chase, just bought DonJoy, probably to learn their
cutthroat marketing techniques. This large chain O&P company is to be
feared more than most practitioners and facility owners realize.
Personally, I cease doing business with them and represent only Townsend,
Phoenix Foot, etc. and call on O&P shops only. I did not apply for a Florida
State Orthotist license, and do no fittings, only selling to O&P facility.
I hope many U.S. practitioners read and respond to your letter. The
subject is far more of a threat to us that consolidation.
<< In a court of law, I understand that an important criteria is whether an
action was in accordance to the standard practice of the community. >>
Hi Randy, I handled the lawsuits for Otto Bock for over 15 years in many
states, and since leaving Otto Bock have been a consultant on another eight
cases. I am unaware of any standard practice of the community that would
apply to O&P. Would you be willing to refer me to your legal source for this
information?.
Randy's Response: My attorney told me that most lawyers are familiar with
this standard of care arguement in the negligence area. (not just O&P)
>> Having salesmen do castings and fittings in lieu of an ABC practitioner is
questionable, and I'm surprised that physicians allow this in their
practices. >>
Sad but true - but in most cases ABC practitioners are perceived as
salesmen (vendors) who sell limbs and braces to their patients.
Suppliers who compete with P&O has been going on for years. I would not
see it so much as competing with O&P as eliminating the middleman. Some
even use different names for different markets. With more manufacturers,
tighter markets, and changing technology I would expect this to increase
until you see a major paradigm shift occur in the delivery of P&O
products/services. I have presented and written on this topic in the past.
I agree 100% with what you are saying.
Ace Medical, halo supplies to hospitals.
Bremmer Medical, halo supplies to hospitals.
I see a variety of soft goods in hospitals from all different suppliers.
When they are stuck, complicated cases, or problems arise, the hospitals will
turn to the O and P community to help, otherwise, the sales reps will
inservice and assist with halo applications.
I guess the final answer is to get behind the higher ups in your state
organization and the national guys to pass licensure. I'm in Florida and
down here these guys CANNOT operate. Licensure is the key. If the reps do
not have an ABC certification, CO or CPO for orthotics only and CP or CPO for
prosthetic equipment only, they are working outside of the law. We have been
actively pursuing the reps and the doc who is using their services. It's
pretty much stopped.
A comment about the Associated Press report: My grandaughter in Pennsylvania
hurt her knee playing soccer. Had micro surgery. Few days after surgery back
in the doctors office, doctor decided she needed a brace. Nurse comes out of
the stockroom with a DonJoy Legend, size medium. Too tight. Nurse comes back
with a Legend, size large. Too large. Doctor grabs hold of joints and
squeezes. Now it fits. The joints are now about 20 degrees out of square
(whatever the term is). He then bills my daughter $ 1150 for a L-1846 (not
the correct L-code, but $ 500 more allowable than the correct L-1845). I'm
sure that is just one of thousands of stories of abuse, but it happened to me.
dear sir,
I am writing from India and I agree with you that there are lot of nonP&O
who compete with us in India here. since it is only over 15 years that
degree graduates have come passed out the situation is more frustrating for
fresh graduates, who have to compete with unscientific mindset of the
referring docs and their demand and encouragement for those who nod heads to
their needs(sometimes may not be P&O correct).this sometimes drives a fresh
graduate to adopt unscientific means and also compromise on the principles
just to gain confidence of the docs who would other refer cases to a nonP&O.
though the experence of the nonP&O qualified people has to be respected
because of the only reason that during their days there was no formal
training program, but otherwise this practice has to stop. we in India try
and discuss to find a method but have not been able to implement the best
method . Since i find that the situation is slightly better but similar (as
per the mail), I request your ideas to try and put an end to this type of
practice and effect a good change to the mindset of the docs. also could you
suggest of methods which we should adopt. I may appear nave but it is just
to get the desire and dire need to get a better respect and recognition to
our field.I am sure you will help your collegues in India.
Otto Bock has strict rules for their O&P sales ...to only ABC Certified
Practitioners..... they won't even sell O&P componenetry to BOC. THey do
have a line of materials pre-fab insoles and shoes that are also sold to
CPeds.
The last time I looked, this was a free (depends on how you define free)
country. They have a right to sell to whom they please. You have a right not
to purchase from them. It's called free choice. We have given up to many of
rights already at the alter of protectionism.
Being a supplier/distributor, your email caught my eye this morning. I agree
with you that O & P practitioners should be the people fitting these devices.
It is not ethical for the companies selling to Dr's and O & P shops and
P.T's (and another way to sell them has now popped up - keep reading)
continue to do this. It is bad business and also why we deal with none of
those type companies and we only sell to O & P facilities.
In fact, while visiting a mall in Springfield, Mo. I came across a store
(in the mall) selling Lenox Hill braces among several other major brands.
These were openly sold to the average consumer/patient and fitted by, well,
your basic shoe salesperson - no background in orthotics what-so-ever. Ok,
maybe a 3-5 day training seminar. I have no idea if a prescription was
needed to buy these products. I would imagine the comsumer/patient just came
in, told the salesperson about their knee aches, and the prettiest brace (and
most expensive) was then recommended. And the prices!!! Wonder if the
consumer/patient knows they may be able to turn their purchase into their
insurance with a prescription... Guess not, huh?
Then again I could be wrong... Makes you want to run to the nearest
mall, huh? You are now competing with less than experienced individuals and
not just salesmen going behind your back to the Doctors office!
If you were mad before, this should really up set you - it sure did me and
all the O & P practitioners in Springfield, MO.
I resent the Co. or Its sale team that will do want ever it takes to make a
sale. In FL. you have to be licensed to fit any orthotic device. I have
warned salesmen that if I find out they are doing fittings I will report
them. Thus Co's that have fitters on staff are my competion and I have
disassociated myself with them (Don Joy ) I will not recommend thieir knee
brace. I tell my referring Dr's that when a patient recieves a knee orthosis
from a sales rep. in his office the patient believe that the Dr's staff is
providing it and if there is a problem ,the patient will complain to you.
Most Dr's don't want to deal with it.
In response to your letter, we here in FLORIDA have to have a license and
certification. We also know a manufacturer (Breg) who has a big hmo contract
and
its representatives are fitting orthotics at the physicians offices, not
only are
they selling to non P&O but also breaking the law I believe.Please add them
to your list.
Yours is an excellent question. When I was working for a small but busy
one office practice, this issue was always on our minds. Luckily, we had
the reputation and confidence of the docs to allow us to control the
problem somewhat. The biggest problem seemed to be with the knee brace
companies. Some even have stock and bill programs set up in the physicians
office. I have seen
many ill-fitting braces come out of these situations. Then, the doctors
expect you to fix and/or repair them. One more question for you. What
about other O&P competitors that own distribution companies (i.e. Hanger).
Otto Bock, Knit rite, flex-foot, college park, Century (total knee) do not
compete with us. If they do, I would like to know about it. Yes, let me know
which Manufactures compete against us in the open market. If they have ABC
practitioners, that may is another issue.
Citation
“Replies: Manufacturers who compete,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/212630.
