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VOLUME 4, ISSUE 2  
 2021 

 

STAKEHOLDER  PERSPECTIVES 

Brandt JM. An operational perspective of the changing prosthetics & orthotics landscape. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, 

No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

This article has been invited and reviewed by Co-Editor-In-Chief, Dr. Silvia Ursula Raschke. 
English proofread by: Karin Ryan, M.A., B.Sc., P.T. 
Managing Editor: Dr. Hossein Gholizadeh 
 

SPECIAL ISSUE 

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Brandt JM. An operational perspective of the changing prosthetics & orthotics landscape. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, 
No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

 

 

 
STAKEHOLDER  PERSPECTIVES 

 

AN OPERATIONAL PERSPECTIVE OF THE CHANGING PROSTHETICS & ORTHOTICS 

LANDSCAPE 

Brandt JM.* 
 

Ability Prosthetics & Orthotics, 660 West Lincoln Highway, Exton, PA 19341, USA. 
 
 
 
 

 

 

  

 

 

 

 

 

 

 

INTRODUCTION 

The landscape of the prosthetic and orthotic (P&O) 

profession has changed dramatically over the past twenty 

years, along with the rest of the healthcare sector. For 

private P&O practices, these changes have represented 

advancements, challenges, and opportunities. Navigating 

these changes while continuously striding to provide the 

highest level of P&O intervention and patient care has 

required innovative thinking and adopting new perspectives. 

As a clinician and the founder of a private P&O practice, I 

have had the opportunity to lead an organization throughout 

this changing landscape. This has provided me unique 

experiences, which can inform the P&O profession about 

the future growth of the private practice sector and further 

advancement of the standard of care.  

 

 

 

ENTRY INTO THE PROFESSION AND 

INFLUENCES TOWARD A P&O PRACTICE 

MODEL  

In 1993, as a junior at the Pennsylvania State University 

(PSU), I first volunteered in a regional P&O department to 

‘see what the field was all about.’ To my good fortune, I 

shadowed a Certified Prosthetist Orthotist (CPO), who 

happened to be one of the American Board for 

Certification’s (ABC) early certifies who also possessed an 

undergraduate degree, though not required at the time.  The 

profession was in the midst of rapidly changing entry level 

educational requirements for P&O certificate programs.  My 

early mentor impressed upon me a need to sanctify the 

clinical care we provide as professionals by requiring 

advanced education, contributing to building research 

evidence, and measuring clinical outcomes to both quantify 

the benefit our P&O interventions provide to our patients in 

order to demonstrate the value of the care we provide. 

Upon graduating from PSU in 1995 with a Bachelor of 

Science in Psychology, I enrolled in a technical program for 

P&O fabrication, to further my knowledge and experience in 

 
OPEN  ACCESS Volume 4, Issue 2, Article No.19. 2021 

 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

 

ABSTRACT 

Leading the growth of a private prosthetic and orthotic (P&O) practice, as clinician and founder, 

I developed a unique perspective of this rapidly changing profession. Many positive influences 

from my early career shaped my vison toward an innovative practice model, as well as the 

need to elevate the standard of care through education and the use of outcome measures.  As 

the practice model expanded, advancements were made in electronic health records (EHR), 

best-in-class outsource fabrication, and clinical research. To better support clinicians and 

patients served, an organizational structure with an executive team was built. The practice 

model achieved operational efficiency through documenting best practices, developing a hiring 

and onboarding process, and establishing key performance indicators aligned with quality 

clinical care. As a regional clinical care organization, the practice model seized an opportunity 

to reach more patients through a partnership that brought the optimal strategic and cultural fit. 

Bringing our innovative P&O practice model together with expertise in lean facility design, 

scanning, fabrication, sensor technology, product development and clinical care experience 

from around the world, we can advance care standards and improve the patient experience in 

exciting new ways.     

CITATION 

Brandt JM. An operational perspective of the 

changing prosthetics & orthotics landscape. 

Canadian Prosthetics & Orthotics Journal. 

2021; Volume 4, Issue 2, No.19. 

https://doi.org/10.33137/cpoj.v4i2.35996 

KEYWORDS 

Prosthetics, Orthotics, Outcome Measures, 

Care Delivery Model, Automation, Evidence 

Based Care, Best Practices, Reimbursement,  

Health Economic  

 

Special Issue: Health Economics in Prosthetics & Orthotics 

 

* CORRESPONDING AUTHOR 

Jeffrey M. Brandt, CPO 
Ability Prosthetics & Orthotics, 660 West Lincoln Highway, Exton, PA 
19341, USA. 

E-Mail: jeff.brandt@abilitypo.com 

ORCID ID: https://orcid.org/0000-0002-7377-9516 

https://doi.org/10.33137/cpoj.v4i2.35996
https://jps.library.utoronto.ca/index.php/cpoj/index
https://doi.org/10.33137/cpoj.v4i2.35996
mailto:jeff.brandt@abilitypo.com
https://orcid.org/0000-0002-7377-9516


 

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Brandt JM. An operational perspective of the changing prosthetics & orthotics landscape. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, 
No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

Brandt JM., 2021 CPOJ 

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the profession and ultimately pursue a career as an ABC 

certified practitioner.  What felt like a brief phase back then, 

my time training and working as a technician provided me 

with valuable insights into the role fabrication played in the 

P&O practice model at the time and informed my 

perspective on opportunities for innovative care models for 

the future. 

In 2000, I graduated from the Northwestern University 

Prosthetic & Orthotic Center with certificates in prosthetics 

and orthotics. I then embarked on residencies at the 

Rehabilitation Institute of Chicago (now Shirley Ryan Ability 

Lab) and AI DuPont Children’s Hospital in Delaware. In 

residency, I continued to develop my clinical skillsets in 

evaluation and measurement, as well as advance my 

clinical judgment around treatment decisions and 

component recommendation. As a newly minted 

practitioner, proper documentation and justification of my 

services remained a challenge. At that time, the P&O 

profession looked for ways to make more evidence-based 

decisions.   

I recall reading an influential article at that time entitled, 

‘Facing the Future of Orthotics and Prosthetics Proactively: 

Theory and Practice of Outcomes Measures as a Method 

for Determining Quality of Services’, by Andrian Pollack, 

PhD, MIPEM and Stefan Moser, CPO, CPed.1 This article 

captured the sentiment of the landscape and future direction 

of the P&O profession in 1997, twenty-four years ago.  The 

authors described the need for the profession to implement 

routine documentation of objective outcome measures to 

quantify the quality and evaluate the cost-effectiveness to 

secure the future success of the P&O profession. Little did I 

know at that time that the message from these authors 

would serve to guide decisions I would make almost two 

decades later. 

EXPANDING A NEW P&O PRACTICE MODEL 

THROUGH GROWTH AND RESEARCH  

In 2004, I founded Ability Prosthetics & Orthotics with a 

guiding mission of 1) providing patients with the most 

appropriate, affordable, and technologically advanced 

devices, 2) educating health care professionals, patients 

and payers on the latest innovations in P&O and 3) being 

held to the highest ethical and moral principles in 

accordance with corporate compliance and quality 

assurance plans.  The practice was built upon some unique 

propositions for patients and payer sources that include a 

lean patient care delivery model focused on utilizing an 

electronic health records system (EHR), routinely 

measuring patient outcomes, utilizing best-in-class 

outsourced manufacturing, and conducting clinical 

research.  With these practice attributes in place, I intended 

to move the profession from a very ‘device-centric’ focus to 

a more ‘patient-centric’ experience focus, with emphasis on 

consistent and repeatable care processes that producing 

measurable and meaningful changes in patients’ functional 

performances. It was my vision to pursue advancing 

Ability’s mission through organic growth.   

By late 2007, Ability had successfully opened four P&O 

facilities. This gained the attention of an article titled, 

Conceive-Ability: A New Model for an Old Practice,2 which 

highlighted the ergonomically designed offices to account 

for the needs of the patient population, as well as 

practitioner and staff clinical workflow instead of fabrication 

processes.  It was paramount to the practice model that the 

physical layout and build-out of the facilities be consistent 

across locations. This agile facility design concept and 

standardized workflow processes allowed rapid adoption of 

emerging technologies across the organization.  Much like 

a contract research organization (CRO) would function for a 

pharma company, we could offer the same value adds for 

manufacturer and academic research by facilitating access 

to patient populations.3 This same uniformity in physical and 

operational design and consistency attracted opportunities 

to conduct clinical research. Ability started conducting 

clinical research through sub-awards to government funded 

research grants with universities and technology 

developers. 

By 2010, Ability was a self-proclaimed ‘super user’ of our 

EHR. The operational consistency and efficiency allowed 

Ability to expand to five practice locations, with plans for a 

sixth. The practice model continued leveraging outsourced 

manufacturing with growing success. However, one 

limitation to the practice model was variability and non-

standard approaches through which payers requested 

‘letters of medical necessity’ (LMN) and additional 

justification for the recommended components. By this 

point, the gap separating P&O technology advancements 

and the willingness or ability for third party payers to provide 

reimbursement for these interventions had grown into a 

wide chasm.  In response, Ability began to develop and 

submit extensive treatment plans to insurance companies 

on behalf of the patient to educate the payers and secure 

authorization. The treatment plans included thorough 

patient history and evaluation, baseline outcome measures, 

often the results of trial fittings comparing function of two 

potential components, images, video, and 

physical/occupational therapy plans. Additionally, the 

treatment plans included citations to the latest research 

publications, which rooted the treatment plans in evidence.  

The treatment plans were reviewed and countersigned by 

the referring physician, therapist and often a case manager.  

Ability also started routinely visiting and meeting with third 

party payers as frequently as possible. The intention of 

these meetings was not only to share new technology and 

treatment protocols. Moreover, these meetings served to 

keep payers informed of changes within the profession, 

such as the changing educational requirements that were 

leading to Master’s Degrees for all P&O educational 

programs by 2012.4    

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Brandt JM. An operational perspective of the changing prosthetics & orthotics landscape. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, 
No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

Brandt JM., 2021 CPOJ 

Special  

 

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While the educational requirements and research evidence 

in P&O were advancing, the landscape changed again as 

the Department of Health & Human Services’ Office of 

Inspector General (OIG) released a scathing but refuted 

report in 2011 entitled Questionable Billing by Suppliers of 

Lower-limb Prostheses.5 This precipitated at least a decade 

long trend towards various audits, lengthy appeal processes 

as well as severely limited L-code assignments for new P&O 

products. The 2011 OIG report and subsequent negative 

pressure caused Ability and others to redouble efforts to 

elevate the P&O profession. 

In response to demands for improved justification, Ability 

launched its first formal outcome measure protocol to begin 

collecting objective patient-centric data to inform treatment 

recommendations and the component selection process. 

Outcome measures allowed Ability to document patients’ 

capacities and limitations, improving defense against 

denied claims and audits. Simultaneously, the outcome 

measure results advanced the clinical judgement of Ability 

clinicians through interpretation of patient outcome 

measures and comparison against normative population 

data. For example, Ability began by administering the 

Amputee Mobility Predictor (AMPRO™ and 

AMPNOPRO™),6 the Prosthesis Evaluation Questionnaire 

– Mobility Subscale (PEQ-MS) and the Socket Comfort 

Scale (SCS) for patients receiving lower limb prostheses 

(Figure1); the Timed-up-and-Go (TUG)7 and Activities 

Specific Balance Confidence Scale (ABC)8 for patients 

receiving lower limb orthoses (Figure 2); and the Disabilities 

of the Arm Shoulder and Hand (DASH) and Patient Specific 

Functional Scale (PSFS) to patients receiving upper limb 

prostheses  

Ability’s Outcomes & Research Director was committed to 

consistent administration of the outcome measure protocols 

and also analyzing the data in meaningful ways to benefit 

both the patient and practitioner.  

Ability’s thought leadership around outcome measures 

gained attention within the profession and was captured in 

an editorial article from 2014 titled, Measuring the 

Usefulness of Outcome Measures.9  The article detailed the 

approach of using objective outcome measures, 

documented through Outcome Reports, to inform important 

clinical decisions, such as assigning a Medicare Functional 

Classification Level (MFCL) (Figure 3). Later on, the data 

across the entire practice could be queried to evaluate 

trends across large patient populations to verify the validity 

and utility of the outcome measure protocols and to gain 

knowledge about clinical practice not otherwise possible. A 

digital platform and automated outcome measure report 

generator was developed to streamline process of 

collection, interpretation, and sharing of patient outcome 

measure results with healthcare partners. Digital platforms 

provide the flexibility of allowing results to be presented in 

different formats (raw data, tables, graphs) depending on 

the use and audience for the information. 

Ability includes data visualization and automated score 

interpretation logic in our digital solution.  Data aggregation 

is done on an as-needed basis.  This work led to a peer-

reviewed journal publication of a retrospective chart review 

study, a ‘first’ for Ability’s blossoming clinical research 

program.10 The results from that publication supported that 

both the AMP and the PEQ-MS showed promise for 

assigning MFCL by stratifying patients’ capacity and self- 

Every amputee has concerns about receiving the 

right prosthesis. That’s why we’re pleased to 

announce Ability’s new outcomes-based practice 

protocol.  

In the past, prosthetic design was based upon 

subjective opinions of both the patient and the 

practitioner. This process was prone to errors, as 

well as to negative patient outcomes. Prosthetic 

technology was often over- or under-prescribed, 

leading to amputees receiving sub-optimal 

devices. 

By taking a new approach to prosthetics 

evaluation, focused on outcomes-based 

measures, Ability can now objectively determine 

which prosthetic components are ideal for each 

amputee initially, as well as over time. 

Ability has adopted an objective outcomes-based 

protocol for EVERY amputee prosthetic 

evaluation.  

❖ Amputee Mobility Predictor (AMP) – a 
series of tasks measures patient potential 
to ambulate with a prosthesis 

❖ StepWatch ankle bracelet – this “heart rate 
monitor equivalent for prosthetics is worn 
by the patient as it collects data to 
objectively determine function level 

❖ Prosthesis Evaluation Questionnaire – 
continually evaluates function and value of 
prosthesis 
 

Ability is the first prosthetics practice to 

standardize the application of concurrent use of 

these measures across its many, mutli-region 

patient care offices. 

Using an outcomes-based prosthetics practice 

model ensures:  

❖ Accurate, objective and consistent clinical 
prosthetic evaluations 

❖ An optimal prosthetic device matched for fit 
and function 

❖ Provider accountability and validity 
❖ Patient satisfaction with prosthesis 
❖ Improved efficiencies: costs, time, materials, 

resources 
 

Use of outcomes-based protocols advances 

prosthetics practice from “art-form” to “state-of-

the-art.” 

THE NEED THE PROCESS THE SOLUTION 

100% of Ability’s Prosthetists are trained in 

Outcomes Measures by the American Academy 

of Orthotists & Prosthetists 

A New Approach to Prosthetics Evaluation and Ongoing Care 

Figure1:  Ability’s Lower Limb Prosthetics (LLP) outcome measure protocol. 

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Brandt JM. An operational perspective of the changing prosthetics & orthotics landscape. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, 
No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

Brandt JM., 2021 CPOJ 

Special  

 

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rated mobility. Impactful publications, such as this, resulted 

in more widespread adoption of outcome measures 

throughout the profession.   

This development of Ability’s practice model coincided with 

a concerted progress within the P&O profession toward 

Evidence-Based Care (EBC). Subjective assessments and 

ad-hoc or unvalidated evaluation forms designed to satisfy 

supplier requirements, such as the PAVET,11 were replaced 

with objective, valid, and reliable instruments. This new data 

source posed an opportunity to evaluate the patient 

experience and examine the benefit of various products and 

technology in a real-world clinical setting, as opposed to 

testing with small sample sizes conducted in manufacture 

or institutional labs. Ability soon sought opportunities to 

conduct Institutional Review Board (IRB) approved 

comparative effectiveness research protocols to evaluate 

new P&O products. 

By 2015, the profession would be faced with perhaps one of 

its toughest challenges yet, a proposed draft by Health and 

Human Services (HHS) for a new Local Coverage 

Determination (LCD) policy regarding requirements for 

Medicare beneficiaries to qualify for prosthesis coverage.12  

Among others, a change to the definitions of the MFCL K-

levels within the LCD policy posed the gravest threat to 

patient access to prosthetic technology. Ability’s nearly two 

years of amputee outcome data provided quantifiable 

evidence of the detrimental effects of the draft LCD, and a 

report was submitted by Ability during an open comment 

period to protest the proposed changes.  After nearly three 

months of petitioning the changes, the profession was able 

to reverse the proposed draft LCD and HHS agreed to 

assemble an interagency workgroup to further assess the 

need for refined medical necessity policy and the current 

state of evidence in the profession.13   

This moment represented a turning point within the 

company culture at Ability, as practitioners had a ‘front row 

seat’ in experiencing the value of objective patient clinical 

outcome data and the ultimate potential impact on 

healthcare policy. Ability’s role in reversing the draft LCD 

and protecting patient access to the prosthetic technology 

energized its practitioners and staff to recommit their efforts 

to diligently collect outcome measures and demonstrate 

how P&O interventions improve patients’ functional 

performance.  

 

Every patient has concerns about receiving the 

appropriate orthosis. That’s why we are pleased to 

announce Ability’s new outcomes-based practice 

protocol in orthotics. 

In the past, orthotic design was based upon 

subjective opinions of both the patient and the 

practitioner. This process often times left the patient 

with an orthosis that either over or under-braced their 

condition, leaving them unable to reach their highest 

potential and creating negative patient outcomes. 

By taking a new approach to orthotic evaluation, 

focused on outcomes measures, Ability can now, 

objectively, determine which orthotic design 

characteristics are ideal for each patient initially, as 

well as over time. 

Ability has adopted an objective outcomes-based 

protocol for ANY lower-extremity orthotic evaluation.  

❖ The Timed-Up-And-Go (TUG) is a valid 
measure of patient mobility, balance, walking 
ability and fall risk based on the amount of time 
required to complete the test. 

❖ The Activity Specific Balance Confidence Scale 
(ABC) is a validated patient self-report measure 
of balance confidence in performing several 
everyday activities. 

❖ G-Walk Sensor allows the practitioner to track 
and analyze gait deviation before and after 
receiving an orthosis to help determine the most 
appropriate intervention and to validate 
improvements in their gait cycle. 
 

Ability is the first orthotics practice to standardize the 

application and concurrent use of these measures 

across its many, multi-region patient care offices. 

Using an outcomes-based orthotics practice model 

ensures:  

❖ Accurate, objective and consistent clinical 
orthotic evaluations 

❖ An optimal orthosis matched for fit and function 
❖ Provider accountability and validity 
❖ Patient satisfaction with orthosis 
❖ Improved efficiencies: costs, time, materials, 

resources 
 

Use of outcomes-based protocols advances orthotics 

practice from “art-form” to “state-of-the-art.” 

THE NEED THE PROCESS THE SOLUTION 

100% of Ability’s Orthotists are trained in 

Outcomes Measures by the American 

Academy of Orthotists & Prosthetists 

 

A New Approach to Lower Limb Orthotics Evaluation and Ongoing Care 

Figure 2:  Ability’s Lower Limb Orthotics (LLO) outcome measure protocol with a sample Pre and Post Outcome Measure. 

Average TUG Pre and Post Orthotics: Jon Doe Average ABC Pre and Post Orthotics: Jon Doe 

Fall Risk Cut-off 

Fall Risk Cut-off 

ABC Score Second 

TUG-Pre 

1.Jan.0000 

TUG-Post 

1.May.0000 

ABC-Pre 

1.Jan.0000 

ABC-Post 

1.May.0000 

22 

13 

46 

59 

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No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

Brandt JM., 2021 CPOJ 

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Outcome Report 

Current Overall Ability Patient Satisfaction Rating 95% 

Office: Exton, PA   Timeframe: March – April 2013 

 

Patient Referred to Ability P&O:  Jon Doe (0/0/0000) 

Consultation till Prosthetic Delivery: 5 weeks                Revision surgeries: 0            Readmissions: 0 

Amputee Mobility Predictor (AMP): a series of tasks measures patient potential to ambulate with a prosthesis 

 

 

 

Patient Assessment Validation Evaluation Test (PAVET): ADLs, functional requirements, physical capabilities, 

special considerations 

PAVET Recommendation Rationalization 

 
47 

 
MPK Stance Indicated 

A PAVET™ score between 40 and 49 would indicate a median 
score for ADLs, Function, and Prosthetic Reliance. This score 
would suggest the patient requires a higher activity level to 
accomplish ADLs and also displays the ability to perform the 
required functions. Typically a score between 40-49 will indicate 
the patient requires the microprocessor knee to provide maximum 
stability and security to enable the patient to accomplish activities 
of daily living (ADLs). 

 

 

 

AMPnoPRO Score 
 Patients (Jon  
AMPnoPRO Score 

Jon Doe 

Patient K3-A 

Patient K3-B 

Patient K3-C 

Patient K3-D 

Patient K3-E 

Patient K3-F 

Patient K3-G 

Figure 3: Example of Ability’s ‘Early Years’ individual patient outcome measure reports, with summary of delivery timeline and 

revisions/readmissions, AMPnoPRO results presented in graphic form with seven other K3 (randomized, anonymous) patients for 

comparison, PAVET score interpretation, and overall satisfaction survey rating, based on an in-house standardized, satisfaction survey.   

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ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

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Special  

 

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While most in the P&O profession were reeling from the 

recent existential threats from reimbursement policy and 

aggressive auditing practices, Ability recognized the need 

to expand its clinical research capabilities to address the 

increasing demand for research evidence. With twelve P&O 

facility locations by this time, Ability had a reliable access to 

a large patient population for research recruitment. 

Additionally, the consistent workflow operations across the 

organization began to attract interest in developing 

partnerships to conduct clinical research. Ability developed 

formal research collaborations with universities, medical 

practices, and technology developers to seek and secure 

funding to make clinical trial opportunities available 

throughout its practice footprint. Ability’s practitioners and 

patients both appreciated clinical research opportunities as 

a ‘value add’ that further differentiated the Ability practice 

model within the P&O landscape.14  

One example of the research conducted at Ability is a 

clinical trial that evaluated patient-reported and 

performance-based outcome measures in transtibial 

amputees with a novel microprocessor-controlled ankle 

component.15 The study was sponsored by the 

manufacturer, Freedom Innovations, and represents one of 

the largest investigations of that technology class to-date. 

The study results were accepted for publication in a peer-

reviewed journal, and the presentation at a national 

conference earned the Thranhardt Best Paper Award 

award.16  This success demonstrated that clinical research 

posed an opportunity for Ability and the P&O profession to 

contribute to research evidence at the highest level.  

ESTABLISHING BEST PRACTICES & 

ACHIEVING OPERATIONAL EFFICIENCY  

By 2017, the practice model had matured, and Ability was a 

strong regional patient care provider and healthcare 

company.  Navigating the P&O environment and healthcare 

landscape was not done without challenge.  Ability 

expanded office locations at times and closed or sold 

locations at other times.  Ability had acquired a P&O 

practice and integrated it into the practice model. The 

organization endured several cashflow crunches, outlasted 

the 2008 economic recession, reacted to countless 

Medicare policy changes and continues to innovate in the 

face of the global COVID-19 pandemic.  

Through this phase, Ability continued to make significant 

steps to build the executive management team to include a 

full C-suite (i.e Chief Operating Officer, Chief Financial 

Officer, Chief Information Officer, and Chief Compliance 

Officer), along with Clinical Regional Directors and a Clinical 

Outcomes & Research Director.  The onboarding process 

was refined to better prepare new hires to excel in the 

practice model. The residency program was expanded, as 

Ability was now attracting residents and board-eligible 

clinicians with master’s level degrees.  A management 

scorecard was developed to include both clinical and 

financial Key Performance Indicators (KPIs) to more closely 

align patient, practitioner and management on the shared 

goal of advancing patient care. This investment in 

organizational and management structure was necessary to 

support the financial success of an expanding practice 

model and to provide a dimension of visibility and 

accountability that Ability’s patient care facilities and 

practitioners were supported in fulfilling the company’s 

mission.  

The company invested in and led a branding refresh to 

update the image of the organization. Ability assembled a 

Patient Advocacy Council (PAC) from the patients it serves 

to provide guidance and raise awareness of key patient 

issues, concerns, and opportunities for the organization. 

Practitioners and the PAC collaborated in evaluating the 

patient journey and the care processes that contribute the 

greatest value to the patient experience. Furthermore, it’s 

been my experience that our profession could also benefit 

from a similar and evidence-based professional approach to 

‘onboarding’ new and existing staff by focusing on 

communication skills in P&O.17 These steps in the process 

were memorialized as Ability’s ‘Patient Care Pathway’.  

Clinical Best Practice (BP) procedures and training manuals 

were developed to expand upon and provide actionable 

guidance for each step in the Patient Care Pathway. The 

Best Practice manual was implemented in the onboarding 

process and referenced by experienced practitioners to 

support repeatable delivery of the most vital patient care 

processes. This activity and the resulting Patient Care 

Pathway and Best Practice manual were vital in capturing 

the shared clinical experience and ‘tribal knowledge’ of the 

organization in a tangible and useful form.  It’s been my 

personal experience, practices historically onboard 

practitioners with ‘tribal knowledge’, rather than taking a 

more formal, repeatable approach.   

By the beginning of 2018 and still today, the organization 

had made significant progress internally through 

documenting Best Practices and continuously improving 

clinical processes; including our ability to collect, interrupt 

and report patient data as illustrated with our most recent 

outcome report. Ability was on solid financial ground, but 

any P&O practice could always stand to improve the 

balance sheet.  By this time, I had transitioned away from 

much of the ‘day to day’ operations of the organization and 

was focusing more on business development initiatives, 

‘culture mining’, and coaching others within the 

organization.  Ability reached a certain operational maturity 

across the organization for the first time with the executive 

management team fully in place. Timing was good to 

explore how Ability might extend the practice model to reach 

more patients.  Exploring opportunities with a partner on a 

larger scale emerged as a potential approach to future 

growth. 

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ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

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Around this time, I also had the opportunity to serve on the 

American Orthotic & Prosthetic Association’s (AOPA)18 

board as well as on an executive panel for the National Limb 

Loss & Preservation Registry.19 These roles provided me 

with a new perspective from the ten-thousand-foot view of 

the entire P&O profession and also from a glimpse of how 

the rest of the healthcare sector views the P&O profession. 

These unique experiences influenced my beliefs about the 

role and impact that Ability could have in re-defining the care 

delivery model and advancing the standard of patient care. 

It became apparent that to achieve the full potential of the 

practice model and to reach the goals the organization set 

out to achieve, Ability would be best served by collaborating 

with like-minded P&O practices in a nationwide US network 

with a strategic partner. Such a partnership could allow a 

collective response to external forces within and external to 

the P&O profession and a concentration of resources and 

expertise that individual organizations would not otherwise 

be able to harness.  

FINDING A STRATEGIC PARTNER  

So how does one go about finding a strategic growth 

partner? Ability’s board of directors recommended following 

a simple principle: Look for strategy, financial and cultural 

alignment that will help identify a solid foundation from 

which to pursue growth in a true partnership.    

I believed that the most likely option for alignment on culture 

and mission, with the best opportunities for accelerated and 

sustainable growth, was a strategic partnership with an 

organization within the P&O industry. While the allure of 

private equity (PE) backed funding can be exciting, I don’t 

believe the P&O profession can provide the expansion 

expectations and sought-after return on investment in a 

short enough timeline to satisfy the goals of PE groups.  

Other hybrid style lenders do exist, who could entertain 

moderate growth plans. However, those financial lending 

services require more debt. Partnering with an organization 

within the P&O industry matched the recommendation from 

Ability’s board of directors best. 

Ability had been approached by and had several meetings 

with other large P&O practices over the recent years. We 

had opportunities to become a part of a larger P&O practice 

organization, but that alternative always seemed to stifle the 

organizations entrepreneurial spirit and limit the influence of 

Ability’s unique practice model. When manufacturers within 

the P&O industry began to show a definitive interest in 

strategic partnerships with direct patient care practices in 

the US, it became very clear how a strategic partnership 

with a manufacturer presented several synergies. Ability 

could continue the thoughtful growth trajectory that the 

organization has enjoyed. Ability’s best-in-class clinical 

practice platform could assist in launching a venture into 

patient care, and the clinical research and outcome 

measure competencies of the organization could be 

additive to improving the products and services available to 

the P&O profession and patients it serves. 

In early 2020, Ability consummated an investment from the 

world’s largest prosthetics manufacturer, Ottobock 

Healthcare. Ability became a cornerstone in the newly 

formed business unit, Ottobock Patient Care.  Together, we 

can now advance patient care standards in the US by first 

working to strengthen our practitioners use of evidence to 

make evidence-based and data-informed clinical decisions 

regarding treatment plan and component recommendation.  

We can leverage Ottobock’s vast experience in P&O patient 

care around the world, product technologies, clinical 

research and reimbursement experience, growing amputee 

data lakes and existing Best Practices in the areas of lean 

facility design, scanning and fabrication, as well as quality 

assurance.  We can accelerate data capture through real-

time sensors and further automatic current processes, 

thereby bringing meaningful translation of the data; to bring 

those ‘daily practice’ efficiency gains to the practitioner, 

saving them time and providing a more individualized 

experience to the patient. (Figure 4) 

 

Figure 4:  Real real-time sensors to aid in data capture, developed 

specifically for orthotics and prosthetics are used at Ability as part 

of daily clinical practice. A: Ottobock Bionic Pro; B:ModusTM 

StepWatch; C: Real-time, untethered gait analysis being carried out 

using the Bionic Pro and StepWatch. Persons in image have given 

informed consent to publication. 

CALL TO ACTION  

As P&O patient care providers, we must learn how to 

maximize digital options, including automation and artificial 

intelligence to create local clinic practitioner efficiencies.     

We must have access to meaningful and actionable data 

that supports risk-adjusted, evidence-based treatments and 

quality improvement that will be paramount in providing 

A 

B C 

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Brandt JM. An operational perspective of the changing prosthetics & orthotics landscape. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, 
No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

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individually optimized patient care- which in itself further 

defines our value proposition to patients and payers alike in 

which to continue to advance the profession.   

I would call for more manufacturer sponsored, IRB-

approved clinical research during product development 

cycles.  We should also use the translation of the data we 

collect to spur additional research as well as to inform 

governmental and commercial payer P&O policy changes.   

I would call for changes in the MSPO curriculums to include 

the teachings of Health System Science.20 This will better 

prepare the clinical leaders of tomorrow to become better 

interrupters with meaningful patient data to inform their 

patients, payers and healthcare team members.  This will 

also help to develop the clinical leaders we’ll need in an 

evolving healthcare delivery system.21    

We will need to demonstrate and publish frequent progress 

on the above-mentioned fronts to further advance 

comprehensive P&O legislation that sanctifies what we do 

as clinical care providers- not as device-centric and off-the-

shelf brace suppliers.  That will allow us to use this progress 

to help define a collaborative scope with Medicare around 

competitively bid commodity products vs. the value of 

evidence based clinical care.  We should consider 

transitioning P&O practitioners to the healthcare provider 

status in Medicare’s eyes with prescribing capabilities.  A 

big challenge will be to continue to update the L-code 

reimbursement system to assimilate newer technologies at 

an equitable reimbursement rate in a timelier manner.  We 

should advance concepts that support the transition to a 

fee-for-value (FFV) reimbursement structure and work to 

adapt, support and inform PDAC verification changes that 

actively affect our profession.    

ACKNOWLEDGEMENTS 

I would like to thank all former and current Ability staff as well as 

the executive team for their commitment and contributions to 

advancing this vision for patient care. I would additionally like to 

acknowledge the ongoing leadership and support of Brian Kaluf 

CP, FAAOP, Ability’s Clinical Outcome & Research Director, for his 

dedication and commitment to excellence in the pursuit of objective 

and actionable patient outcome measure data. 

DECLARATION OF CONFLICTING 

INTERESTS 

The author is the founder, employee and a shareholder of Ability 

Prosthetics and Orthotics, Inc. The author is an employee and 

shareholder of Ottobock Patient Care. The author is a business 

advisor and a shareholder of Impulse Technology, LLC. 

SOURCES OF SUPPORT 

Industry funding was provided by Freedom Innovations to carry out 

a clinical trial that evaluated patient-reported and performance-

based outcome measures in transtibial amputees referred to in this 

paper.  

 

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10.Kaluf B. Evaluation of mobility in persons with limb loss using 

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No.19. https://doi.org/10.33137/cpoj.v4i2.35996 

ISSN: 2561-987X 
AN OPERATIONAL PERSPECTIVE OF THE CHANGING P&O LANDSCAPE 

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Critical-Role-of-Clinical-Leaders-Transforming-Care-Today-and-

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AUTHOR SCIENTIFIC BIOGRAPHY 

Jeffrey M. Brandt, CPO, Chairman & Founder, Ability Prosthetics 

& Orthotics; Director, Business Development, Ottobock Patient 

Care. 

Jeffrey M. Brandt, founded 

Ability Prosthetics and Orthotics, 

an evidence-based P&O 

practice that has grown to twelve 

offices across three states.  

Since its inception in 2004, 

Ability has led the advancement 

and implementation of outcome 

measures in daily practice, 

founded Lifenhanced magazine, 

and assembled a patient 

advisory council to inform of 

patient-centric best practices.  

Through Brandt’s leadership, 

Ability has prioritized a focus on 

patient care, outcomes data, delivery of care, business analytics, 

community based adaptive programs and comparative 

effectiveness product research and development. In addition to 

founding Ability, Brandt is a co-founder of Kinetic Revolutions of 

which the most notable product is the height adjustable pylon for 

use on prosthetic limbs. After graduating from Penn State 

University in 1995, Brandt completed the prosthetics technician 

program at Spokane Falls Community College in Spokane, 

Washington and became an ABC certified technician. He then 

attended Northwestern University’s Feinberg School of Medicine’s 

Prosthetic & Orthotic program in 1999. He subsequently completed 

his orthotic residency at the Rehabilitation Institute of Chicago and 

his prosthetic residency at Lawall P&O in Delaware, where he 

serviced A.I. DuPont Children’s Hospital.  As a student, Brandt was 

awarded the Gunther Gehl Prosthetics Scholarship by the Midwest 

Chapter of the American Academy of Orthotists and Prosthetists 

(AAOP) and has been named to the O&P News 175.  Brandt 

currently serves on the American Orthotic & Prosthetic 

Association’s (AOPA) board, Limb Loss & Preservation Registry 

External Collaborative Panel (ECP) and as a business advisor to 

Impulse Technology.   

 

 

https://doi.org/10.33137/cpoj.v4i2.35996
http://www.abilitypo.com/our-story/clinical-research-and-academics/
https://www.aopanet.org/about-aopa/awards/.awards
https://www.aopanet.org/about-aopa/aopa-leadership/
https://www.llpregistry.org/panel-members
https://www.scribd.com/document/374050383/The-Critical-Role-of-Clinical-Leaders-Transforming-Care-Today-and-Tomorrow
https://www.scribd.com/document/374050383/The-Critical-Role-of-Clinical-Leaders-Transforming-Care-Today-and-Tomorrow
https://www.scribd.com/document/374050383/The-Critical-Role-of-Clinical-Leaders-Transforming-Care-Today-and-Tomorrow

