Delivery Timeframes

Delivery Timeframes

Paul Prusakowski

12/19/2001

Dear list,

I have been having some discussions with practitioners/business owners
regarding the amount of time that is typically involved in the
completion of a full spectrum of patient care from the initial
evaluation/casting through billable delivery of various orthotic and
prosthetic devices. I have worked in a number of different
environments, including non-profit institutions, hospital based O&P
departments, small private facilities, and mid size privately owned
facilities (I have not had any direct experience working for very large
companies such as Hanger, Novacare, or RDA), and have seen a WIDE array
of acceptable turn around times from initiation to completion. In the
non-profit hospital cash flow was never an issue, volume was extremely
high, the patients were not paying for their services so there was
typically a lot less pressure to provide rapid turn around. In the
not-for-profit hospital environment (all services were billed for) there
was a different expectation, but at the same time never really an
urgency to provide rapid service unless here was an inpatient in in need
of immediate care- cash flow was also never an issue since the hospital
basically provided a huge bankroll for the department. In the private
companies that I have worked for I have experienced extremes from the
work till 3 am every night to get it done in 2 days mentality to the
just put it in the queue and we'll get to it when we get to it
mentality. There were also situations that were in the middle grounds
of those two as well.

Since I have been the owner of a small (2 ABC practitioners/ 1 NCOPE
resident) practice, I have had the wonderful opportunity of experiencing
the joys and challenges of providing high quality care in a timely
manner, while balancing cash flow issues and productivity issues. It
can become very easy for projects to become extended at times, as days
easily turn into weeks, and we basically carry the burden of financing
the cost of care throughout the treatment period and the period between
submittal of claims and actually (or better put, FINALLY), getting paid
ONLY a percentage of what we have actually billed the insurance company
for the service. Include the cost of goods, overhead of running the
business, money we are losing by not having the cash in the bank, etc.,
and it becomes apparent that the longer we take to actually deliver a
device from the moment that we initiate the casting procedure/measuring,
the more we actually lose throughout the process. It becomes a lot
more complex than just how much we get paid minus the cost of parts,
and that isn't always as clear to the patient, referral source, or
practitioner as it should be. There is probably a break point somewhere
in the timeline where it actually starts to costs us money to deliver a
device due to extending the service for too long.

Although I have not made the investment yet, I believe that a good CAD
system in the hands of the right practitioner has the ability to
compress the cycle significantly, and have a positive impact on the
business and on patient satisfaction (based upon timeliness of care, and
not taking into consideration the practitioner's ability to make a good
socket with CAD, but that is another discussion for another day). Of
the practitioners and business owners that I have spoken with, the
individuals who have the best grip on the issue that I am investigating
are all business owners who are aggressively using CAD or CAD/CAM in
their offices. But since CAD is not part of our clinical operation yet,
I would like the focus of the responses to be based upon the traditional
O&P facility business model which includes primarily in-house
fabrication by a technician and the occasional utilization of central
fabrication.

I am hoping to gain a better insight into how things are being done in
other businesses, and to develop better monitors for within my own
practice for streamlining the company and working the most efficiently
and profitably.


Here are my questions:


1. Are you monitoring the timeframe of patient care in your practice?

2. What type of facility do you work in/own? Small private, non-profit,
hospital, large corporation, etc.

3. What are typical turn around times from initial evaluation/casting to
a billable delivery event for the various devices in your practice?
(assume the patients are visiting your office for the device versus
being seen in a rehab center or hospital for immediate care)

AFO
KAFO
TLSO
Scoliosis TLSO
FO
BK
AK
BE conventional
BE myoelectric
AE conventional
AE myoelectric

4. What timeframes do you feel would be optimal?

5. What have you found to be the most successful method of monitoring
your patient case load/timeframes for practices with more than one
practitioner?

6. What have you found to be the most helpful in reducing the number of
days between casting and delivery?



I hope that the responses help to shed some additional light on this
topic. I will summarize and repost, and will remove the names of all
individuals who have responded. Thank you very much, and have a great
holiday season.


Paul E. Prusakowski, CPO
O&P Clinical Technologies
Gainesville, FL