17 minute read

Supporting Women’s Health

from October 2022 O&P Almanac

by AOPA

from October 2022 O&P Almanac, page 36

O&P Almanac Leadership Series

Why and how to add postmastectomy services and products at an O&P facility

By CHRISTINE UMBRELL

NEED TO KNOW:

• O&P facilities should consider adding or expanding postmastectomy services, or “breast surgery care,” to meet the needs of the more than 100,000 U.S. women who undergo some form of mastectomy each year. • Postmastectomy services typically involve fitting women who have had complete or partial mastectomies or breast reconstruction surgery with postsurgical camisoles, external breast prostheses, partial forms, and/or specialized bras. • Facilities that are just getting started in this space should research breast cancer to gain an understanding of the patient perspective, hire a certified mastectomy fitter, ensure their facility is properly accredited, and start off with just-in-time inventory. • Business owners and fitters in the postmastectomy space should stay educated on newer products and technologies, such as partial forms for women who choose breast-conserving surgeries, to provide patients with a full array of options. • Postmastectomy care can offer an added revenue source to O&P facilities that integrate services strategically—by tracking cost of goods, properly managing inventory, planning for repeat business, and analyzing data on patient encounters.

POSTMASTECTOMY CARE OFFERS O&P facilities an opportunity to provide much-needed women’s services while adding an extra revenue source to their business. Nearly 300,000 people in the United States are diagnosed with breast cancer each year, many of whom subsequently undergo partial or full mastectomies. A lot of these patients benefit from wearing various types of postmastectomy and lumpectomy prostheses, also called breast forms, available in a wide selection of types, shapes, sizes, and colors.

“Breast cancer accounts for more than 20% of cancer diagnoses,” says Rachel Brown, CFm, CMF, national sales trainer at Amoena USA. After mastectomy surgeries, many patients “really need one-on-one attention to get a good fit,” she says. Offering postmastectomy services, she says, “makes an O&P facility a more rounded practice and positions it as a more valuable avenue for care,” while adding to the facility’s bottom line.

Postmastectomy care is “a vital part of women’s healthcare that is often overlooked by our profession,” agrees Lesleigh Sisson, CFo, CFm, president of Prosthetic Center of Excellence in Las Vegas and founding partner of consulting firm O&P Insight. “It’s becoming more difficult for postmastectomy patients to access care.” Many boutiques permanently closed during the pandemic, says Sisson, so there is an increased need for facilities that meet the needs of women who have had breast cancer surgeries. O&P facilities that don’t currently offer these services—approximately 70% of O&P facilities, according to AOPA’s 2020 Operating Performance Report—can step in and fill the void.

Rachel Brown, CFm, CMF

Postmastectomy patients at Prosthetic Center of Excellence are fit in a special room, where products are displayed on a rolling cart.

Lesleigh Sisson, CFo, CFm

Contrary to what some believe about reimbursement, “there is ample coverage by insurance companies” for breast forms and related products, says Brown. In fact, the Women’s Health and Cancer Rights Act of 1998 provides various protections: Patients receiving benefits in connection with a mastectomy should be eligible for coverage of “prostheses and treatment of physical complications of all stages of the mastectomy, including lymphedema.”

Most insurance companies cover one silicone breast prosthesis per side every two years, and between four and 12 bras per year, according to Sisson.

Despite available insurance coverage for most patients, “a lot of traditional O&P facilities have not brought in” postmastectomy services, but “it’s an additional source of revenue, and it fills a need that is not going away,” says Margy Imlay, CFm, CMF, owner of Just Like a Woman. Imlay has been in the mastectomy services business for more than 21 years and teaches several courses to mastectomy fitters. “We need to expose O&P to how important it is to help women all over the country.”

What’s Involved?

Postmastectomy services typically involve fitting women who have had breast surgery—complete or partial mastectomies or breast reconstruction surgery—with postsurgical camisoles, external breast prostheses, partial forms, and/or bras with pockets or support, depending on the patients’ needs. While some prostheses are worn against the skin, others sit inside the pocket of a mastectomy bra or attached to the chest wall.

Because not all patients need full breast prostheses, “I prefer to use the term ‘breast surgery care,’ rather than postmastectomy care,” explains Brown. “With the surgical advances we have had recently, we’ve found that more women are choosing breast-conserving surgeries,” which require partial breast forms and are “a little trickier to fit,” she says. “So, it’s not just mastectomy patients, but any breast cancer surgery patient” who may require products and tailored care best provided by certified fitters. “We can’t exclude women who have both breasts from our care.”

Some facility owners may be hesitant to add postmastectomy services because the revenue may be less than for traditional O&P care. But Sisson—whose facility has offered postmastectomy care for several years—notes that it can be a profitable addition. She encourages owners to carefully examine the cost of goods, consider how long it will take to see patients, look at profit margins, take into account the benefits that come from repeat business as patients need new bras, and keep a limited but appropriate inventory to maximize profits. “Then analyze your data” on each patient encounter to understand the profitability and adjust care as needed.

On top of additional revenue, O&P facilities that decide to add postmastectomy services will become an important resource, says Brown. “It will build your standing in the community since there is such a wide group of women who deal with breast cancer.”

Take the First Steps

To ensure a smooth transition when adding postmastectomy care, Imlay recommends building gradually. “You need to crawl before you walk,” she says. Examine the patient demographics within your geographical location: “This understanding of your area will assist you in selecting proper products and services,” she says. “Start slow, then increase offerings as your knowledge grows, and as you see what your geographic area needs.”

Sisson recommends that facility leaders research breast cancer and talk to people in this space, such as sales representatives and manufacturers, before jumping in. It’s important to get a full understanding of how sensitive the topic is and how critical it is to respect the patient journey. “This is a way to serve the women of your community, and you can be profitable in doing so,” she says. “It doesn’t have to be a loss leader—you can make it into a viable business.”

Advice for Ideal Patient Care

Fitting patients with postmastectomy products can be a sensitive undertaking. To provide optimal care, “think about the experience of patients right after their diagnoses, and what the patients will be dealing with for a long time,” says Rachel Brown, CFm, CMF, national sales trainer at Amoena USA.

Brown and other experts share these tips for facilities offering postmastectomy care:

• Be educated about the postmastectomy patient journey and prepared to answer client questions. “When we see patients prior to surgery, sometimes they are overwhelmed, and not everything has been explained to them as well as it could be,” says Lesly Garcia, CFo, CFts,

CFm, a fitter at Valley Institute of Prosthetics and Orthotics. She takes time to share her knowledge, and to answer questions with an empathetic ear.

• To better understand the postmastectomy business, seek out advice from business owners that are already providing postmastectomy care. In addition to requesting tips on what works best, “be sure to ask what reports can be run in an EMR system to aggregate and analyze data and keep the business profitable,” says Lesleigh Sisson, CFo, CFm, president of Prosthetic Center of Excellence in Las Vegas and founding partner of consulting firm O&P Insight.

• If possible, meet with new patients even prior to their surgery, so that they understand the full range of postmastectomy prostheses and bras. “Knowledge helps take a lot of the fear away,” says Margy

Imlay, CFm, CMF, owner of Just Like a Woman. It also can influence customers’ decisions to decide for or against reconstruction, she says.

“Once you share your knowledge and compassion, they will come back to you for all their future needs.”

• Understand the patient demographics within your geographical location to ensure you provide the most appropriate products. “What

I see in Oregon and what I see in Texas are different” in terms of what patients need, trends in surgeries, and the demographics of the patient base, says Imlay. Sometimes, the sizes of bodies trend larger or smaller in different areas. In addition, “if your patient base is mostly Medicare patients, stick to allowables,” she says.

• Recognize that it may be a long journey, and that patients may require new sizes or shapes as they recover. “Bodies change with time, and some patients may need additional surgeries and need new products,” says Brown. “Position yourself as the resource for what a patient needs for breast care on a long-term basis.”

When you’re ready to make the move, start by earning accreditation specifically for providing postmastectomy services by either the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, or the Board of Certification/Accreditation. In addition, make sure postmastectomy care is part of the services included in your facility’s Medicare application, says Sisson.

Next, hire or train a certified mastectomy fitter to see patients. “A lot of facilities will find they already have someone in their facility who could take the training to become a certified fitter,” Brown says. “Choose a staff member to lead this effort carefully— empathy is very important.”

Sisson suggests training an in-house staff member, such as an office manager or orthotic/therapeutic shoe fitter, if that staff member has the time to pick up mastectomy fitting duties and is willing to get certified.

In terms of inventory, Sisson recommends “just-in-time” stocking: Keep two breast prostheses in the most common sizes, then order again once those are purchased, she suggests. She also advises stocking items that are eligible for reimbursement. “It’s important to understand when you can bill for these items, and to plan to provide these items when stocking your inventory,” she says. And be sure to return unclaimed products: “If a patient orders something special and doesn’t keep it, send it back” for a refund.

Imlay recommends an initial inventory of molded cup bras, as well as cut-and-sew bras in appropriate size ranges to suit the needs of more women. “Have one fully weighted

Margy Imlay, CFm, CMF

silicone breast prosthesis” that will assist with symmetry, back health, and balance. Lightweight breast forms should also be included in opening inventory for smaller-breasted women or those who have had bilateral mastectomies. “Have a size run of lightweight breast forms, and a size run of fully weighted breast forms,” she says. It also helps to have an agreement with your manufacturers: “If you bring in styles that don’t move, you can swap them out for more appropriate ones,” Imlay suggests. “Also keep in mind that you don’t have to be brand specific. Mixing it up a bit offers more choices for your clients.”

The physical space of the facility also matters for postmastectomy care. At Professional Orthotic and Prosthetic Services in Manhattan, Kansas, postmastectomy patients are seen twice a week in a dedicated room, says Cindy Smith, who is preparing to take the certified mastectomy fitter exam.

Valley Institute of Prosthetics and Orthotics in California has a special room for postmastectomy patients, which is stocked with chairs, a mirror so patients can look at themselves, and fitting robes, according to fitter Lesly Garcia, CFo, CFts, CFm. The postmastectomy inventory room is located nearby.

Prosthetic Center of Excellence also has a dedicated mastectomy room, which is designed for extra comfort, with a full-length mirror and some plants. “It’s a little bit softer” than other patient rooms, Sisson says. The facility uses a rolling wardrobe cart to show patients what’s available, so customers can “feel” different types of bras and order in colors that suit them. Wheeling in the cart prevents sources from plastic surgeons,” because many patients choose reconstruction surgery.

Sisson suggests identifying the breast cancer resources located within your community, then asking that they include your facility within their literature and on their website as a resource for postmastectomy fittings and products. She also recommends “reaching out to support groups to offer educational in-services.”

At Professional Orthotic & Prosthetic Services, patients come from several towns away due to robust word-ofmouth recommendations, in addition to referrals from local family doctors and cancer center surgeons, says Smith. The facility also sees patients through referrals such as the Department of Veteran Affairs, local cancer care centers, and church groups.

Lesly Garcia, CFo, CFts, CFm Imlay conducts several courses each year to educate fitters and others about mastectomy products and solutions.

the certified fitter from running in and out of the room with different samples. Plus, “you can stock white, black, and beige bras, and allow patients to order other colors—but you don’t have to keep all the colors in stock,” Sisson says.

Make Connections

To ensure a profitable business, it’s important to market your new services and seek out referral sources. “Use social media to spread the word about new offerings,” says Brown.

She encourages facilities to spread the word among current patients who visit the facility for orthotic and prosthetic services—many of whom may eventually need mastectomy services or know someone who will. “Begin with the community you already have,” she says. “Send an email blast and contact local news organizations to share about your expanded services.” Networking within the community can also bring in new customers. Brown suggests reaching out to local cancer centers, oncologists, and patient navigation centers at hospitals. And “don’t exclude referral Offer Options, New Technologies

Just as with orthotics and prosthetics, it’s important for business owners and mastectomy fitters to learn the full range of products and to stay current on the latest technologies and trends.

Nicole Flores, CFm, shows a sample to a patient at Prosthetic Center of Excellence in Las Vegas.

Many patients start their relationship with postmastectomy care even before they undergo mastectomy, when they come in to be fit with special camisoles with drains they will need immediately after their operation. According to Sisson, “we can’t provide immediate post-op camisoles that hold drains until postsurgery,” in compliance with delivery requirements by Medicare and insurers. But if patients are fit ahead of time, “we can deliver it to the surgery center” once the surgery is complete, or plan for family members to pick up camisoles postsurgery, she explains.

Manufacturers are continuously expanding their offerings, making their products available in a wider range of fits, according to Imlay. Breast prostheses have come down in weight, with lighter-weight forms now available for bilateral patients, she says, and “there have been amazing advancements in fitting technology.” Some breast forms even allow you to pump air in or out, for adjustable sizing.

Of note, more options in partial forms, or “balancers,” have come on the market. More women are choosing breast-conserving surgeries, says Imlay. Some patients are having only part of their breast removed, and then usually undergoing radiation. “There are different partial forms with different shapes and sizes” that enable patients to achieve symmetry and satisfaction, which is really the goal, she says. Partial forms also are appropriate for women who have had significant breast tissue removed via lumpectomy, who may choose to wear partial forms with pocketed bras, according to Sisson.

In addition to over-the-counter options, “there are custom breast forms” that require 3D scanning to

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produce a form that matches the removed tissue, says Imlay. “Some patients even end up looking more symmetrical than prior to surgery.” Custom offerings can also allow for matching nipple color and sizes, according to Imlay. With some custom prostheses, patients will not need to wear pocketed bras, and can instead wear the same bras they wore prior to their breast cancer diagnosis.

“Many O&P professionals have experienced making other custom products, so it is not that hard for O&P professionals to make custom breast prostheses,” says Brown. Some products require only an iPad and scanner on an app to scan and photograph patients, with a quick turnaround, made in the exact profile of the existing breast, she says.

Custom breast prostheses are covered by some insurance plans, according to Sisson. In some states, including Maine and Pennsylvania, insurance companies are required to cover custom breast prostheses.

Brown adds that new “contact” breast forms will be available in 2023; contact technology allows breast forms to be worn adhered to the chest wall.

When working with patients who would benefit from specialized products, Brown suggests educating patients about all of their options. “Consider new technology offerings,” she says. “Don’t limit it to what’s on hand in your space; offer custom technology, Adapt Air technology, or cooling technology” when warranted, she says. “Provide access.”

Cindy Smith

Focus on the Patient

Just as in providing O&P care, focusing on the best outcomes for the patient will lead to success for both customers and clinicians. “These patients need just as much guidance and hope as everybody else, and should have someplace local to get optimal care,” says Smith.

“If we can provide postmastectomy services and be diligent and efficient in how we do it and in stocking inventory,” O&P facilities can boost their revenues while providing valuable services to women, says Sisson.

When all of the pieces come together in a fitting, says Imlay, “you know that you’ve really changed people’s lives at the end of the day.”

Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

View the 2022 Assembly Sessions From the New Postmastectomy Track Before December 18

Educational content from the AOPA 2022 National Assembly in San Antonio will be avail-able virtually from October 17 until December 18. Be sure to check out the following sessions that were offered in this year’s new Postmastectomy Track: • Opening and Patient Journey,

Rachel Brown, CMF, CFm • ABC Custom Breast Prosthesis:

What’s in It for You? Nikki

Giamarino, CFm • Postmastectomy Care: How To Add

Revenue and Be More Visible in Your

Community, Rachel Brown, CMF, CFm, and Lesleigh Sisson, CFo, CFm • Keeping Pace With Surgical

Advancements—Partial Forms Play a Key

Role, Margy Imlay, CFm, CMF, Rebecca

Weldon-Martin, CFm, CMF, Rachel

Brown, CMF, CFm, Alicia Correa, CMF, and Tanya Baer, CFom • Business Proposition: Providing

Postmastectomy Care, Lesleigh Sisson,

CFo, CFm • Certification and Accreditation—What

You Need To Know, Jim Lawson • Medicare LCD and Policy Article for