5 Questions For...
Michael Hamontree and Sam Hamontree
Sam Hamontree, CP, is
the chairman
and founder of OrPro Inc., an O&P patient care company with
nine
facilities in four states. He was president of ABC in 1970, was a
founding member of the Academy, and has served on numerous AOPA
committees. Michael Hamontree, president and cofounder of OrPro, served
as AOPA president in 2004-2005 and has chaired several AOPA committees.
He currently serves on AOPA’s Government Relations Committee
and
chairs the 2008 Operating Performance Report Task Force.
1) Sam, you’ve been involved in the O&P industry for 51 years. Describe the changes—good and bad—that you’ve experienced along the way.
There is no doubt that advancements in materials and technology have resulted in lighter, stronger, and more effective devices for the patients we serve. But a key driver in this was the establishment of the Medicare and Medicaid programs in 1965. These social programs made it possible for more people who needed our services to receive them, and [the government] put adequate dollars into the field to support the research and development necessary to advance technology in O&P. However, for the last two decades, it seems that these programs, along with their private-insurance counterparts, have come full circle, as seen in their attempts to manage care through reduced reimbursement, limited coverage, and competitive bidding.
2) What innovations do you predict will occur in the next decade?
Michael: I believe we are going to see a shift in the way prosthetic and orthotic care is managed and provided. Throughout the profession, because of continued downward pressure on reimbursement, there has been a necessary concentration on reducing costs, primarily focused on two major areas—materials and overhead. The third major cost area, labor, has not had any significant change. Any reduction in labor costs is not likely to come in the form of reduced compensation. Rather, I think we will see the profession learning to operate under a different model that places a greater reliance on assistants or extenders delivering care under the direction of certified prosthetist-orthotists.
I also think we will see more encroachment into prosthetics by nontraditional providers, as has taken place in orthotics over the past decade. Every discipline in health care is feeling the pain of increasing competition and decreasing reimbursement and, because of this, is stretching further beyond their traditional boundaries to discover new sources of revenue.
3) What has been the primary driver of growth in your company?
Sam: The primary external factors are the aging population and the erupting epidemic of diabetes in our country. Internally, we have a strong focus on providing the very best in patient care, coupled with an insistence on operating in a financially responsible manner and a company culture that places the highest value on integrity.
4)What do you think about today’s cutting-edge technologies?
Michael: The entire field of O&P has survived over the last 15 years because of advancements in device technology coupled with new coding and reimbursement. As we now see changes in the coding arena that are aimed at severely limiting the issuance of new codes for new-device technology, it will have to look for innovations that reduce the cost of components and devices within existing codes and reduced reimbursement.
5)Michael, from your perspective in the AOPA leadership for several years, what is AOPA’s most important contribution to the field?
AOPA’s greatest value is its expertise and relationships in government relations, much of which is afforded by the funds and activities of the O&P PAC. One recent example was the victory achieved in limiting competitive bidding to only off-the-shelf orthotics. AOPA worked hand in hand with key congressional staff to write the specific language of the Medicare Modernization Act that defined those off-the-shelf items that would be subject to competitive bidding. This was a victory for patients in need of custom prosthetic and orthotic devices and, more importantly, in need of the expertise of certified clinicians with the education and training required to provide sound clinical care. It also makes an important victory for the profession. The alternative likely would have meant all prosthetics and orthotics would be competitively bid, so a patient wouldn’t have the freedom to develop a long-term relationship with the clinician responsible for providing a device that so intimately affects his or her ability to lead a full and productive life.
1) Sam, you’ve been involved in the O&P industry for 51 years. Describe the changes—good and bad—that you’ve experienced along the way.
There is no doubt that advancements in materials and technology have resulted in lighter, stronger, and more effective devices for the patients we serve. But a key driver in this was the establishment of the Medicare and Medicaid programs in 1965. These social programs made it possible for more people who needed our services to receive them, and [the government] put adequate dollars into the field to support the research and development necessary to advance technology in O&P. However, for the last two decades, it seems that these programs, along with their private-insurance counterparts, have come full circle, as seen in their attempts to manage care through reduced reimbursement, limited coverage, and competitive bidding.
2) What innovations do you predict will occur in the next decade?
Michael: I believe we are going to see a shift in the way prosthetic and orthotic care is managed and provided. Throughout the profession, because of continued downward pressure on reimbursement, there has been a necessary concentration on reducing costs, primarily focused on two major areas—materials and overhead. The third major cost area, labor, has not had any significant change. Any reduction in labor costs is not likely to come in the form of reduced compensation. Rather, I think we will see the profession learning to operate under a different model that places a greater reliance on assistants or extenders delivering care under the direction of certified prosthetist-orthotists.
I also think we will see more encroachment into prosthetics by nontraditional providers, as has taken place in orthotics over the past decade. Every discipline in health care is feeling the pain of increasing competition and decreasing reimbursement and, because of this, is stretching further beyond their traditional boundaries to discover new sources of revenue.
3) What has been the primary driver of growth in your company?
Sam: The primary external factors are the aging population and the erupting epidemic of diabetes in our country. Internally, we have a strong focus on providing the very best in patient care, coupled with an insistence on operating in a financially responsible manner and a company culture that places the highest value on integrity.
4)What do you think about today’s cutting-edge technologies?
Michael: The entire field of O&P has survived over the last 15 years because of advancements in device technology coupled with new coding and reimbursement. As we now see changes in the coding arena that are aimed at severely limiting the issuance of new codes for new-device technology, it will have to look for innovations that reduce the cost of components and devices within existing codes and reduced reimbursement.
5)Michael, from your perspective in the AOPA leadership for several years, what is AOPA’s most important contribution to the field?
AOPA’s greatest value is its expertise and relationships in government relations, much of which is afforded by the funds and activities of the O&P PAC. One recent example was the victory achieved in limiting competitive bidding to only off-the-shelf orthotics. AOPA worked hand in hand with key congressional staff to write the specific language of the Medicare Modernization Act that defined those off-the-shelf items that would be subject to competitive bidding. This was a victory for patients in need of custom prosthetic and orthotic devices and, more importantly, in need of the expertise of certified clinicians with the education and training required to provide sound clinical care. It also makes an important victory for the profession. The alternative likely would have meant all prosthetics and orthotics would be competitively bid, so a patient wouldn’t have the freedom to develop a long-term relationship with the clinician responsible for providing a device that so intimately affects his or her ability to lead a full and productive life.
