Observation Deck: Six Simple Steps for O&P Success

Breast prosthetic products and services bring new opportunity to HME providers.


More than 182,000 women are diagnosed with breast cancer every year. The good news is that early detection and medical advancements are helping many of these women lead healthy and productive lives. Women who have undergone lumpectomy, reconstructive, or mastectomy surgery all have post-surgical needs. These women need and are searching for products that offer a sense of femininity, balance and confidence.

The provision of post-breast surgery products and services, including prostheses, symmetry shapers and related soft goods offers a unique opportunity for home health and HME providers to fill an important need for these women. It also allows providers to increase their revenue, presence and reputation within the marketplace.

Orthotic and Prosthetic (O&P) reimbursement rates with Medicare increased 5 percent in 2009, while HME reimbursements continue to decrease. With these trends and the slumping economy, now is an important time to consider adding new services to your business’ portfolio. Here are six simple steps home health and HME providers should take when entering the breast prostheses marketplace:


1. Know the Marketplace and Products

If you are only familiar with the heavy, rubber-like prostheses of a few years ago, it’s time to take a new look at available products. Breast prostheses from today’s top manufacturers are comfortable, lightweight, fashionable and designed to fit women of any age and lifestyle.

Once you decide to enter the market, you will need to become a Certified Mastectomy Fitter (CMF) or Certified Fitter of Mastectomy (CFM). Both certifications require a manufacturer’s course prior to taking the exam. Several manufacturers offer the required courses. A certified fitter on staff is required for facility accreditation. To find out what else is required as a supplier, be sure to review the inventory requirements set forth by CMS. Many home health and HME providers are already accredited, or in the process of meeting the Sept. 31, 2009 accreditation deadline.


2. Find the Right Partner

Post-breast surgery products are a logical revenue stream for HME businesses. More than a dozen manufacturers provide post-breast surgery products in the United States. Finding the one that best meets your needs and that will become your partner in success requires some research. You want to find manufacturers that have experience, strength and credibility in the marketplace. Conduct a database search, talk to other providers, review trade publications and contact manufacturers directly. Identify the companies that have the credentials to help you build and support your business.

Once you have selected a product partner, the manufacturer will work with you to help obtain the product inventory needed to meet your budget parameters. For businesses that qualify, most manufacturers offer a line of credit. Your initial product stocking needs will vary based on your marketplace needs and any particular niche you identify. However, it’s important to note that CMS requires you to carry sufficient stock to fit most women.


3. Invest in Your Success

Speaking of budgets, they typical initial investment for post-breast surgery O&P ranges from $2,500 to $10,000, depending on your business goals and marketing efforts in this business segment. In addition to providing product, you will be offering an invaluable service by spending time working with customers to understand their needs and helping them to identify the optimal solution. This can be a highly rewarding experience. Many fit specialists and customers develop lifelong professional bonds. Factoring in product and time, most providers achieve a profit within a few months. The ROI varies based on the size and needs of your market, as well as the initial investment. Ask the manufacturer for marketing case studies and ask to speak with other customers in comparable areas.


4. Market Your Service Thoroughly

Start your marketing efforts with the people you know and those in your own backyard. Contact your local physicians, surgeons and cancer support organizations, as well as your existing base of patients and other providers. Letters, postcards, e-mails and even fashion shows highlighting products are all effective and affordable marketing strategies. In addition, the top industry manufacturers will assist you with marketing your products.

Look for ways to foster awareness of the newest materials and technologies for post-breast surgery products. Educating physicians, surgeons and patients about the various products available at each stage following surgery, including the benefits of high quality breast prostheses or symmetry shapers, helps women make better post-surgical choices.


5. Insurance and Reimbursement Needs

As you seek to educate your community, make sure providers and patients are aware that post-surgical garments, breast prostheses (including symmetry shapers) and bras are all reimbursable by most insurance companies. (In general, most insurance providers cover a percentage, less the deductible.) A physician’s prescription is required.


6. Provide Outstanding Service

Women who have breast cancer surgery are eligible for prostheses and other post-surgical products yearly to bi-yearly, depending on their coverage. This provides a significant opportunity for repeat business and customer loyalty. Treat your customers well, provide them with high quality products, and you will retain a core base of loyal customers.

With the slumping economy, savvy businesses are looking for ways to build and maintain profitability. Becoming an O&P provider is an ideal strategy for HME and home health companies looking to offer an important and rewarding service to their community, while they ensure the sustainability of their businesses.


This article originally appeared in the April 2009 issue of HME Business.

About the Author

Chris Webb-Lacey is contracts manager for Amoena, a vendor of post-breast surgery products and services. She can be reached at 800-926-6362.

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