Stock$Bill Part 2
Description
Collection
Title:
Stock$Bill Part 2
Text:
Stock And Billl REsponses, all seperated by $$$$$. Enjoy.
Obviously this is another intrusion into the P&O field. I find it amazing
that the soft good companies are willing to bill for 25-75 dollar braces. I
find that to be a nuisance in my office and difficult to collect on. I dont
know about you but it costs 15-20 dollars just to bill
and track a patient. I think it will run its course when the soft good
companies realize the size of their receivables and what little profit they
are making. The Dr's in my area claim they get nothing out of this.Its for
the convenience of the patient. What irks me is we get the 250lb and up
patient that the Dr can't fit.
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Hi Ralph-
We definitely should not band together and collectively boycott or take
actions against any manufacturer as long as what they are doing is legal. (It
would appear too self-serving)
If anything they're doing is illegal, our professional state or national
organizations should take action to protect the patients.
I feel that every office should ask their own reps if they participate in
stock and bill practices in their areas. We tend to support the reps who
educate the doctors to the fact that orthotists are best qualified to
determine and assure proper fit and function. (It makes sense for the reps.
to do this, because a poorly fitted KO and a complaining patient will
discourage future use of that brand.)
In a court of law, consideration is given to the standard of the
community and a salesman or a back-office nurse usually doesn't have the
level of orthotic training that an orthotist has. Therefore, a physician may
be taking a risk by allowing this practice to occur in his office. I believe
the AMA has stated it's position against this type of practice.
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
I actually work in an orthopedic office that does some stock & bill.
The sales rep is never to be found. I fit all the patients and then fill
out a form for the sales rep to send in for billing. Mostly off the shelf
products from arm slings to wrist supports to ROM post-surg knee braces to
walking cast boots. Once in a while the rep gives me a nice crisp $100 bill.
I have now set up my own company with the Docs blessing to take the sales
rep out of the loop. I told the Doc, either I do this or I can't afford to
stay with him. I am more important than the few bucks he receives for
rent from that big orthopedic manufacturer. There are companies that will
do my billing and authorizations for me for a percentage so that leaves me
all my time for patient care.
This is the wave of the future. The orthotech will have a little business
within the ortho office and throw the S&B out. But I will still send the
more complex custom stuff to the orthotist. I am sure most orthotists are
over qualified for or don't even want to see a simple wrist support or ROM
knee brace in their waiting room. Or do you$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Mr. Nobbe,
I am writing in response to your quesions about the stock and bill programs.
I thought I might share my viewpoints, since I am a former bracing
manufacturer's rep.
First, your description of the program is accurate with one exception: Your
labeling of paying rent as a kickback. Would you let another company set
up shop in your office without charging them anything? With my old company,
we would only pay reasonable market rates per square foot for the actual
space taken up by the products. For example, if the supplies were in a 10'
x 15' room, they paid for the area taken up by the shelves containing the
products, not the whole 150 square feet. At one time, another company was
rumored to be paying for cubic feet (square feet times the height of the
space used), but I am pretty sure that got snuffed out over legal concerns.
With regard to the legalities, we were told that the product manufacturer
and the billing entity were liable in the event of product failure. If the
patient were to sue, I am sure they would sue all parties involved, but the
orthotech who fitted the product would be acting as an agent of the billing
company, just as a manufacturer's rep is acting as an agent of both the
manufacturer and your facility if you call him in for assistance with a
problem product or patient.
By the way, the two entities I just mentioned may not be the same company.
For example, a doctor may have a stock and bill program with one company
that buys products from many others to put on the shelves and bill out. Of
course, they would prefer that everthing be theirs, but many are willing to
buy other brands to keep the business.
Lastly, I wish to question your outrage at this practice. How much business
are you losing due to these programs? The majority of products you weren't
getting anyway, the doctor's office was buying them, fitting them and
billing for them. The only difference is where the bill comes from. What
they are doing is (in theory) perfectly legal. Medicare has reviewed it
thoroughly and found the system to be legal. Of course that is not saying
there are no individual situations where wrongdoings occur, but that is true
anywhere.
If you are losing functional bracing business due to these programs, talk to
the doctor about it, and emphasize your expertise. Tell him to keep sending
the wrist splints and cast boots through them, but to script the higher end
products that require professional fitting to you. Tell him that you would
be happy do provide the same brand as the rep, and remind him that the rep
will still get his commission.
The main focus for these programs for the bracing manufacturers is to keep
the competition out of the office, not to hog all the billing. If DonJoy,
for example, is doing the stock and bill in an office, it is awfully hard
for the Breg rep to get in there and make a dent in his numbers. However,
that doesn't mean the braces have to be done in-house, as long as the script
says the right manufacturer on it. Like you said, you are still a customer
of DonJoy. If your facility does a lot of bracing from other facilities,
you might want to remind the rep that he might make a higher commission on
those few braces, but if the doc were to script them out to you, that you
might be inclined to do more of his company's braces on scripts from other
docs or on generic scripts. Food for thought, at least!
However, if the program is run by anyone else (soft goods manufacturer
without a bracing line, independant company, etc.), they will fight tooth
and nail to keep those high ticket items. It is up to you to convince the
doc to let them have the nickel and dime stuff, but your expertise is the
value-added feature that makes it worthwhile to script it out to you.
Finally, I must make one comment, and I mean absolutely no disrespect by
saying this, but here goes: I am amazed at the response from the O&P
community to competition! I couldn't begin to count the number of times
this listserv has contained the frustrated rantings of an orthotist who has
lost business to someone outside of O&P. stock and bill programs, PT's
making foot orthoses,OT's making hand orthoses reps billing for braces, etc.
are prefectly legal (and should be, for that matter!)! Even the new
legislation Medicare is considering would not effect these products!
Many services provided by the O&P community should be restricted by law,
without question. But your profession does not have the right to demand
that you should be the only profession allowed to do EVERYTHING that you do!
No other medical field can say that! In those areas where fields overlap,
and products or services can be found through multiple outlets, it comes
down to good old-fashioned fair market competition. You have to earn the
business, you can't just demand it.
In most of the situations I have been involved in, the O&P shops have lost
bracing business to competitors due to the perceptions of slow service and
overpricing in the eyes of the PT's and doctors who are the decision makers.
THAT is your problem, not the competitors who offer an alternative. And
please, don't respond with the arguement about poorly fitting products,
because as a manufacturer's rep I was called in to redo more braces from O&P
shops than any other outlet! There are good and bad apples in every barrel,
time will weed out those that can't deliver as promised.
OK, I am off my soapbox now! Again, I mean no disrespect, I just wanted to
provide another viewpoint. I would appreciate your thoughts, provided it is
somewhere above the namecalling level! By the way, you may repost this to
the list, but please remove my name and e-mail address. The last thing I
need is 50 hatemails a day for the next week!
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Sounds like you have encountered Don-Joy. If you read some of Townsend
designs ads they state that they are the only brace manufacturer that does
not bill for braces. This does not mean that some of their agents, myself
included do not bill directly for these braces. We have 4 locations in
########### and employ 6 O&P practitioners. We also participate in several
stock and bill programs. IN MY OPINION the programs offered by most
national companies are a violation of the Stark Rules. If you would like I
would be happy to talk to you further about this issue. Please feel free to
call me at ***************** or e mail me.
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Continues in Part 3.
Ralph W Nobbe CPO
Obviously this is another intrusion into the P&O field. I find it amazing
that the soft good companies are willing to bill for 25-75 dollar braces. I
find that to be a nuisance in my office and difficult to collect on. I dont
know about you but it costs 15-20 dollars just to bill
and track a patient. I think it will run its course when the soft good
companies realize the size of their receivables and what little profit they
are making. The Dr's in my area claim they get nothing out of this.Its for
the convenience of the patient. What irks me is we get the 250lb and up
patient that the Dr can't fit.
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Hi Ralph-
We definitely should not band together and collectively boycott or take
actions against any manufacturer as long as what they are doing is legal. (It
would appear too self-serving)
If anything they're doing is illegal, our professional state or national
organizations should take action to protect the patients.
I feel that every office should ask their own reps if they participate in
stock and bill practices in their areas. We tend to support the reps who
educate the doctors to the fact that orthotists are best qualified to
determine and assure proper fit and function. (It makes sense for the reps.
to do this, because a poorly fitted KO and a complaining patient will
discourage future use of that brand.)
In a court of law, consideration is given to the standard of the
community and a salesman or a back-office nurse usually doesn't have the
level of orthotic training that an orthotist has. Therefore, a physician may
be taking a risk by allowing this practice to occur in his office. I believe
the AMA has stated it's position against this type of practice.
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
I actually work in an orthopedic office that does some stock & bill.
The sales rep is never to be found. I fit all the patients and then fill
out a form for the sales rep to send in for billing. Mostly off the shelf
products from arm slings to wrist supports to ROM post-surg knee braces to
walking cast boots. Once in a while the rep gives me a nice crisp $100 bill.
I have now set up my own company with the Docs blessing to take the sales
rep out of the loop. I told the Doc, either I do this or I can't afford to
stay with him. I am more important than the few bucks he receives for
rent from that big orthopedic manufacturer. There are companies that will
do my billing and authorizations for me for a percentage so that leaves me
all my time for patient care.
This is the wave of the future. The orthotech will have a little business
within the ortho office and throw the S&B out. But I will still send the
more complex custom stuff to the orthotist. I am sure most orthotists are
over qualified for or don't even want to see a simple wrist support or ROM
knee brace in their waiting room. Or do you$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Mr. Nobbe,
I am writing in response to your quesions about the stock and bill programs.
I thought I might share my viewpoints, since I am a former bracing
manufacturer's rep.
First, your description of the program is accurate with one exception: Your
labeling of paying rent as a kickback. Would you let another company set
up shop in your office without charging them anything? With my old company,
we would only pay reasonable market rates per square foot for the actual
space taken up by the products. For example, if the supplies were in a 10'
x 15' room, they paid for the area taken up by the shelves containing the
products, not the whole 150 square feet. At one time, another company was
rumored to be paying for cubic feet (square feet times the height of the
space used), but I am pretty sure that got snuffed out over legal concerns.
With regard to the legalities, we were told that the product manufacturer
and the billing entity were liable in the event of product failure. If the
patient were to sue, I am sure they would sue all parties involved, but the
orthotech who fitted the product would be acting as an agent of the billing
company, just as a manufacturer's rep is acting as an agent of both the
manufacturer and your facility if you call him in for assistance with a
problem product or patient.
By the way, the two entities I just mentioned may not be the same company.
For example, a doctor may have a stock and bill program with one company
that buys products from many others to put on the shelves and bill out. Of
course, they would prefer that everthing be theirs, but many are willing to
buy other brands to keep the business.
Lastly, I wish to question your outrage at this practice. How much business
are you losing due to these programs? The majority of products you weren't
getting anyway, the doctor's office was buying them, fitting them and
billing for them. The only difference is where the bill comes from. What
they are doing is (in theory) perfectly legal. Medicare has reviewed it
thoroughly and found the system to be legal. Of course that is not saying
there are no individual situations where wrongdoings occur, but that is true
anywhere.
If you are losing functional bracing business due to these programs, talk to
the doctor about it, and emphasize your expertise. Tell him to keep sending
the wrist splints and cast boots through them, but to script the higher end
products that require professional fitting to you. Tell him that you would
be happy do provide the same brand as the rep, and remind him that the rep
will still get his commission.
The main focus for these programs for the bracing manufacturers is to keep
the competition out of the office, not to hog all the billing. If DonJoy,
for example, is doing the stock and bill in an office, it is awfully hard
for the Breg rep to get in there and make a dent in his numbers. However,
that doesn't mean the braces have to be done in-house, as long as the script
says the right manufacturer on it. Like you said, you are still a customer
of DonJoy. If your facility does a lot of bracing from other facilities,
you might want to remind the rep that he might make a higher commission on
those few braces, but if the doc were to script them out to you, that you
might be inclined to do more of his company's braces on scripts from other
docs or on generic scripts. Food for thought, at least!
However, if the program is run by anyone else (soft goods manufacturer
without a bracing line, independant company, etc.), they will fight tooth
and nail to keep those high ticket items. It is up to you to convince the
doc to let them have the nickel and dime stuff, but your expertise is the
value-added feature that makes it worthwhile to script it out to you.
Finally, I must make one comment, and I mean absolutely no disrespect by
saying this, but here goes: I am amazed at the response from the O&P
community to competition! I couldn't begin to count the number of times
this listserv has contained the frustrated rantings of an orthotist who has
lost business to someone outside of O&P. stock and bill programs, PT's
making foot orthoses,OT's making hand orthoses reps billing for braces, etc.
are prefectly legal (and should be, for that matter!)! Even the new
legislation Medicare is considering would not effect these products!
Many services provided by the O&P community should be restricted by law,
without question. But your profession does not have the right to demand
that you should be the only profession allowed to do EVERYTHING that you do!
No other medical field can say that! In those areas where fields overlap,
and products or services can be found through multiple outlets, it comes
down to good old-fashioned fair market competition. You have to earn the
business, you can't just demand it.
In most of the situations I have been involved in, the O&P shops have lost
bracing business to competitors due to the perceptions of slow service and
overpricing in the eyes of the PT's and doctors who are the decision makers.
THAT is your problem, not the competitors who offer an alternative. And
please, don't respond with the arguement about poorly fitting products,
because as a manufacturer's rep I was called in to redo more braces from O&P
shops than any other outlet! There are good and bad apples in every barrel,
time will weed out those that can't deliver as promised.
OK, I am off my soapbox now! Again, I mean no disrespect, I just wanted to
provide another viewpoint. I would appreciate your thoughts, provided it is
somewhere above the namecalling level! By the way, you may repost this to
the list, but please remove my name and e-mail address. The last thing I
need is 50 hatemails a day for the next week!
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Sounds like you have encountered Don-Joy. If you read some of Townsend
designs ads they state that they are the only brace manufacturer that does
not bill for braces. This does not mean that some of their agents, myself
included do not bill directly for these braces. We have 4 locations in
########### and employ 6 O&P practitioners. We also participate in several
stock and bill programs. IN MY OPINION the programs offered by most
national companies are a violation of the Stark Rules. If you would like I
would be happy to talk to you further about this issue. Please feel free to
call me at ***************** or e mail me.
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Continues in Part 3.
Ralph W Nobbe CPO
Citation
“Stock$Bill Part 2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/217006.
