Using Accreditation Standards to Increase Productivity and Revenue

“Accreditation is to help people run their business more efficiently,” Hornfisher said. “It is [about] putting in place programs and policies that make companies more successful.”

Markgren agreed adding that he initially set out to educate practitioners about the performance management and improvement standards so they could take control of business practices and monitor activities that could be costing the business money. He went on to conclude that better management breeds a happier employee who in turn engages in more productive work.


The introduction to the ABC Comprehensive Orthotic & Prosthetic Accreditation Standards performance management and improvement standards states: “… opportunities to improve most often are associated with deficits in processes and the underlying systems that support patient care. Consequently, organizations, without avoiding corrective actions to improve knowledge and personal skill, should focus upon the underlying processes that influence the delivery of quality patient care. Based upon these principles, the standards motivate organizations to engage in a comprehensive monitoring and evaluation process that assesses important aspects of care, establish indicators which, if not met, will trigger further evaluation of the important aspect of care, and require actions to be taken when problems or opportunities to improve are identified.”

Piggy bank
© 2008 iStock International Inc. /René Mansi

Documentation and monitoring are the key factors that drive the ability to increase performance and revenue. In order to build greater success, business owners need to measure the successes they are already achieving as well as monitor and improve those areas where deficits are defined.

“A key word that I have used my entire life is people do what you inspect, not what you expect,” Hornfisher told O&P Business News“By tracking information and posting it, it makes people conform or become more productive.”

With the quality standards in mind and incorporating the expertise of quality gurus Philip Crosby and W. Edwards Deming, they have made some suggestions about how business owners can start to play an active role in the success of the business and meet some accreditation requirements simultaneously.

Accounts receivable

When incorporated into a business correctly, documentation can protect a practice as well as raise the ambitions of that business, Hornfisher explained.

“We are in health care but the bottom line is we are a business,” Hornfisher said. “If you are not making any money – regardless of how great a practitioner you are – you are not going to be around for long.”

Begin the documentation process with your accounts receivable. Some of the things to look for regarding these accounts are money collected and resubmitted claims.

Once you determine how much money your business is collecting on a weekly or monthly basis, compare that figure to the amount billed in that same time frame.

“If . . . you are collecting a million dollars a year, you are doing a great job but then if you see you billed for $4 million and only collected a million, then why was that?” Hornfisher said.

This is when you will need to look further into the cause of the discrepancy and research the days outstanding, and other factors depending on your specific findings within the business.

Front office or billing staff should keep track of each billed patient, paying special attention to those with outstanding statements, and how much money they bill versus how much money has been collected.

“We are spending more time chasing the money,” Markgren said. “It probably costs a small business $30 to $40 to resubmit a claim.”

While it may not necessarily break the physical bank, the money poorly allocated in research time – to see why a claim needed to be resubmitted; and payroll time–to have a staff member perform that function – can catch up with the business. Low reimbursement rates make resubmitting especially costly if you discover the rate is lower that the money put forth to collect it.

As you begin to monitor your billing items, the problems will surface and you will know what to track next.

FAQs About Accreditation

What is the first thing I need to do to become accredited?

The first step is to read the ABC accreditation standards and determine whether or not your organization is in compliance. The standards are available at the ABC Web site, or by calling ABC at (703) 836-7114. We can also email an electronic version of all accreditation publications or send a hard copy.

How much is the application fee?

The application fee for a single orthotic, prosthetic and/or pedorthic organization is $825. For secondary locations, known as affiliates, the application fee is $600. This fee includes all administrative and survey fees.

Is there a deadline for accreditation?

While no date has been announced as of press time, it is anticipated that CMS will announce a date by which interested organizations must apply for accreditation or they will be ineligible for accreditation by the Sept. 30, 2009 date.

How long does accreditation take?

It takes on average of 2 to 4 months from the time your application is received until the survey is completed. However, it is important to remember that by applying, you are stating that your organization is in compliance with the standards and is ready for survey. All surveys are unscheduled, so you’ll need to be prepared at all times.

Do I need to be accredited if I am not participating in competitive bidding?

Yes, accreditation is mandatory for all eligilbe DMEPOS suppliers.

How do I apply for accreditation?

Applications are available at the ABC website or by calling ABC at (703) 836-7114. We can also email an electronic version of all accreditation publications or send a hard copy.

–Scott Williamson, CAE
Director of Facility Accreditation and Information Services for ABC


Technician tracking

Similarly to documenting your accounts, business owners will want to track practitioner progress as well. Tracking patient appointments, paying special attention to adjustments and remakes, and tracking materials are great ways to start pulling in the reigns on the clinical and fabrication side of business.

A busy patient schedule does not necessarily equate to a full wallet. Since O&P businesses are paid based on devices delivered and not per visit, time-consuming adjustments and remakes can weigh heavily on business income.

Begin tracking your fabrication and materials by, for example, measuring plastic usage within your facility. An elevated plastic usage can suggest a number of different things: heating errors, poor staff training, new staff, or equipment breakdown, Markgren said.

By measuring this number per person, you can make educated adjustments or seek out further training for individuals on staff who could benefit most from that continued education.

Also keep in mind the cost of plastic and overall loss experienced when unnecessary errors occur. Just like with accounts receivable, you need to consider the extra costs that do not show within the bank account itself but in the loss of productive staff time as well.

Practitioner tracking

When tracking practitioner progress, it is helpful to institute a tool that allows you to track patient visit purposes and with whom they meet. Williamson suggested including this information on a sign-in sheet for appointments as a simple way for front office staff to track this data. This will also help you to determine how long patients typically wait to see their practitioner as well as the frequency of their visits.

“We want to take care of patients and we want to do it right the first time,” Williamson told O&P Business News adding that it is not only the bottom line in consideration. “Their time is valuable too.”

Answering some of the simple questions can help you determine where the weak links are within your business and how you can strengthen them to grow a stronger business.

Business owners should also track how much money is generated per practitioner each year and consider why their may be some discrepancies among employees. Again, do not assume that the busiest practitioner is bringing in the most money within your company. Consider remakes and revisits when you are tracking this information.

Is it a fabrication issue or a clinical issue? Further investigation will help lead you to the necessary adjustments.

“There is a lot of practitioner time used in non-reimbursable ways … [when] there are more efficient ways to do things,” Williamson said. “If we are not aware of how much we spend on these non-revenue generating services, you can’t make improvements.”

Contribute to a Future Article With ABC

Do you have a specific question regarding how your practice can use the accreditation standards to help increase productivity and revenue within your business? Send it to Jennifer Hoydicz at and ABC will address your question in a future issue of O&P Business News. Please include your name, e-mail and telephone in the event we need to contact you. This information will not be printed without your consent.

Or if you are currently attending AOPA National Assembly, please stop by O&P Business News at booth 226 to pick up a form and submit your questions on site. Please submit all questions by October 15.

Based on the number of responses we receive, we will do our best to address all questions submitted.


Adding it up

“All of these things that are small make a huge difference,” Williamson said. “We are trying to make people aware of that and how just spending a couple of minutes a day documenting makes it easy to start identifying trends and making improvements that can save you lots of money.”

To give you an idea of just how much money, consider Crosby’s price of nonconformance which as explained by Williamson’s presentation: “ …puts a dollar value on all waste and wasted effort caused by a lack of quality.”

Williamson also cites that the price of nonconformance in manufacturing is 20% to 25% and the price of nonconformance in service is 30% to 40%. He went onto explain that when you apply these figures to the most recent American Orthotic and Prosthetic Association findings which report that the average O&P facility brings in $1.8 million in sales, the potential losses total more than $250,000.

By beginning to slowly track some of this information and add new criteria as time goes on, you can save a lot of money that would otherwise be wasted.

Sources advised picking one measurable factor for each position and track it for a few months and as you become more comfortable, add additional components until you are tracking the whole business.

They also advise that you share this information with your staff so they can see the improvement levels within the company.

“The ABC standards are written in the language of regulatory compliance. In our presentations, we break the requirements down into practical solutions that the average O&P facility can understand and implement,” Markgren told O&P Business News. “What we are trying to say is to do things that matter. Measure the things that count for you.”

For more information:

Jennifer Hoydicz is a staff writer for O&P Business News.

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