Partnership for Patient Care

In the O&P profession, end users are patients, not customers, and
that has a definite impact on their treatment. But in the relationship between
O&P practitioners and
central fabrication facilities, practitioners are customers in
every sense of the word.

  Mark Dentler
  Mark Dentler

The way that central fabrication technicians approach this partnership
with practitioners sets the tone for patients throughout the process.

CFab customers

Just as with other aspects of the O&P profession, CFabs provide a
necessary service for patients. Patients rely on their practitioners to provide
them with quality care; practitioners who are unable or unwilling to fabricate
in-house often rely on CFabs to provide their patients with quality products.
Without a central fabrication resource, many practitioners would not be able to
do their jobs.

“Our customers look at us as a friend to turn to in time of
need,” Mark Dentler, owner of Spinal Solutions in Conyers, Ga., said.
“We will spend half the time taking the order and the other half catching

Many of Cascade’s customers are orthotists who use the company as their central fabrication facility, mostly for pediatric AFOs.
Many of Cascade’s customers
are orthotists who use the company as their central fabrication facility,
mostly for pediatric AFOs.
Image: Cascade DAFO

This type of relationship represents about 75% of Spinal Solutions’
customer base, with the rest consisting of customers who order infrequently.

Ohio Willow Wood in Mt. Sterling, Ohio, provides custom fabrication
services for small, medium and large prosthetic care facilities, while also
completing specific advanced fabrication jobs for another portion of their
customers. Others use the company’s capailities to digitize casts for
creating initial check sockets, and then fabricate the definitive socket in
their own facilities.

At Cascade Dafo Inc. in Ferndale, Wash., 90% of customers are orthotists
who use the company as their CFab facility, mostly for pediatric AFOs. The
majority of its customers are located across the United States, but Cascade
Dafo Inc. reaches internationally as well, to Europe, New Zealand and even

Although Fillauer’s customer base includes practitioners as far as
Israel and China, the company primarily conducts business with domestic patient
care facilities that specialize in providing custom orthotics and prosthetics,
instead of off-the-shelf designs, Michael Fillauer, CPO/L, president of
Fillauer, said.

Consistent messaging

The ultimate goal of the CFab-practitioner interaction is to ensure that
the product is right for the practitioner, so that it can be the right one for
the patient.

  Michael Fillauer
  Michael Fillauer

“We feel like we play a huge role in their patient care practices
because we keep our staff accessible to the practitioners,” Fillauer said.
“When they call in it is just like having their own personal technician to
help them.”

Fillauer, which is the parent company of Fillauer Central Fab in
Chattanooga, Tenn., also employs 12 certified orthotists and prosthetists who
visit customer facilities to consult on the company’s specialty products.

One way CFabs can establish a real-time experience with customers
without actually being present is through sharing videos and digital photos of
devices and other items.

  Bill Weymer
  Bill Weymer

“Utilizing technology, there are a lot of things that we can do
that we couldn’t do 10 years ago, that will still allow us to be an
integral part of patient care, even though we’re not physically
there,” Fillauer said.

Fillauer has implemented this file-fsharing technology across the board.
Cascade, too, recently began using Skype’s Internet video chat service.
Practitioners are able to discuss a particular orthosis or mold with
Cascade’s technicians the moment issues arise, just by holding it up to
their computer’s camera when chatting with a technician.

Cascade also takes steps to ensure customer satisfaction by including a
survey card with each order. These questionnaires, completed either by the
practitioner or by the patient, provide information about the customer
experience and fit of the device. Bill Weymer, president and chief executive
officer of Cascade Dafo Inc., said that he is the first to review the returned
cards, and he addresses all issues immediately. About 65% of those cards are
filled out by parents of children who use the fabricated device, which offers
the technicians an opportunity for feedback from the end user they otherwise
might never get, he said.

  Matt Williams
  Matt Williams

“[The cards are] a simple thing to fill out but it’s
important, consistent communication that we get from customers, even
customers’ interactions with the practitioner that they work with,”
Weymer said.

Spinal Solutions expects — and receives — the same positive
feedback from its clients about the customer service experience, because its
employees approach all contact with customers with the company’s
philosophy: treat customers like family and go to great lengths to help them,
Dentler told O&P Business News.

“You don’t have to be in the client’s office to
understand their situation,” he said. “Your disposition and attitude
have nothing to do with your demographics. Whether on the phone, fax, text,
chat or in person, our employees treat our clients with dignity and

Customers and patients

Central fabrication facilities differ from O&P practices in that
they are product-driven, not patient-driven, businesses. The
practitioner’s only goal is to best fit the patient. The CFab
technician’s ultimate goal is to create the best device for the patient,
but the true customer in that relationship is the practitioner.

Some CFabs have begun using videos and Internet chat programs to discuss issues with practitioners as they arise.
Some CFabs have begun using
videos and Internet chat programs to discuss issues with practitioners as they
Image: Cascade DAFO

“In a sense, it is easier to deal with one personality than
several. We understand the needs of the patient through the practitioner,”
Dentler said.

Regardless of turnaround times, Spinal Solutions will
fabricate a custom device to a practitioner’s specifications.

“In our world, pressure is a constant,” he said. “Working
with certified practitioners … we have complete confidence that the
information we need to make the best fitting orthotic possible is in our hands.
That takes a good bit of pressure off us and makes our job a whole lot

Fillauer addresses this issue by accessing its own team of
practitioners, who understand the process of fitting patients. As a
practitioner, Fillauer can relate to the situations that practitioners
encounter with patients on a regular basis.

On the other hand, the fact that practitioners are experts in matching
patients with the correct devices also benefits the group. While dealing with
expert customers brings its own challenges, most CFabs see working with
practitioners as an advantage.

“We sometimes can learn from them as much as they learn from
us,” Fillauer said.

Since the customers are just as knowledgeable as the companies, the
conversation runs more smoothly. Each party knows the right questions to ask
and information to provide, and, in the end, whether the products will be
correct for the patients.

“We see that as an asset,” Fillauer said.

Long history

Ohio Willow Wood also employs a team of in-house prosthetists, who
consult with technicians on a daily basis. Combined with the technicians’
own formal training and on-the-job learning, the company offers a solid
understanding for what its customers need, Matt Williams, RTP, supervisor of
Ohio Willow Wood’s custom fabrication and design liner departments, said.

Information from the practitioner’s experience aids the process.
Practitioner suggestions for matters involved in fabrication orders provide
technicians with a starting point for creating componentry.

But practitioners also benefit from having a strong relationship with
their CFab facilities, Williams said, because central fabrication facilities
bring their expertise to each job they fabricate.

Spinal Solutions technicians work with practitioners’ schedules to fabricate custom devices, regardless of short turnaround times.
Spinal Solutions technicians work
with practitioners’ schedules to fabricate custom devices, regardless of
short turnaround times.
Image: Spinal Solutions

“Customers will ask for our advice on fabrication suggestions and
tap into the expertise our team has cultivated from being in business for so
long,” he said. “The ultimate outcome is positive for everyone …
especially the patients.”

Many of Cascade’s technicians have been with the company for
decades. Tom Escovar, who leads its tech support group, has worked with the
company for 20 years. He and each of the other technicians accompany
Cascade’s clinicians to fittings to experience face-to-face interaction
with patients. Weymer said they travel together on a regular basis because it
is a valuable educational opportunity for the technicians.

Cascade also offers educational workshops for practitioners new to
fabrication with the company, and encourages the practitioners to extend this
opportunity to the physical therapists on their teams. Both of these options
together help form a common vocabulary among all of the members of the patient

Governmental concerns

It remains unclear as to how the new health care overhaul will affect
the O&P profession. One thing is for sure: all O&P practices are
preparing for the next steps.

For now, people seem to remain tentative about getting new devices,
preferring to “wait and see.”

Despite patients’ apprehension about the future,
however, Weymer said he feels that the O&P profession has been fortunate
among the other health care sectors thus far.

Cascade provides opportunities for its technicians to see the end result of their work by meeting with practitioners and patients.
Cascade provides opportunities
for its technicians to see the end result of their work by meeting with
practitioners and patients.
Image: Cascade DAFO

Most custom fabrication facilities do feel the impact of today’s
economy, Williams said. Ohio Willow Wood’s customers are working to keep
their costs stable, and the company aims to help them achieve this goal.

Dentler said he hopes to avoid a market where CFabs bypass O&P
practitioners and sell prefabricated products directly to the surgeon or the

“Ultimately, the patient is the one most negatively impacted by
this,” he said.

As a result, he said Spinal Solutions will only sell its spinal products
to trained, certified orthotists who are best qualified to fit and maintain

Cascade Dafo Inc. has felt the dip in the economy, with
a slowed growth rate in 2009 and in 2010 so far. Weymer, too, said he does not
know what to expect from health care reform.

“The fact that more people will have health care may increase our
business,” he said. “On the other hand, kids usually have a pretty
good source to health care through state Medicaid and [other programs], so we
don’t expect a large increase.”

He said he does foresee an increase in costs, however, based on early
information about a tax on manufacturers and devices.

“We have to wait and see.” — by Stephanie Z.

For more information:

Editor’s Note:

  • This article includes a small representative sample of central
    fabrication facilities. O&P Business News does not intend to
    promote any particular facilities or products, nor to achieve an industry wide
    consensus on the issue.

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