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The Prosthetics and Orthotics Podcast
The Prosthetics and Orthotics Podcast is a deep dive into what 3D printing and Additive Manufacturing mean for prosthetics and orthotics. We’re Brent and Joris both passionate about 3D printing and Additive Manufacturing. We’re on a journey together to explore the digitization of prostheses and orthoses together. Join us! Have a question, suggestion or guest for us? Reach out. Or have a listen to the podcast here. The Prosthetic and Orthotic field is experiencing a revolution where manufacturing is being digitized. 3D scanning, CAD software, machine learning, automation software, apps, the internet, new materials and Additive Manufacturing are all impactful in and of themselves. These developments are now, in concert, collectively reshaping orthotics and prosthetics right now. We want to be on the cutting edge of these developments and understand them as they happen. We’ve decided to do a podcast to learn, understand and explore the revolution in prosthetics and orthotics.
The Prosthetics and Orthotics Podcast
Undeniable Outcomes: Removable Rigid Dressings with Jim Reichmann
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Ever wondered how prosthetists can significantly influence the lives of amputees? Jim Reichmann shares his extensive knowledge in evidence-based medicine and the transformative role of removable rigid dressings. Through his numerous contributions to clinical guidelines and published articles, Jim unveils the innovative practices that are setting new standards in O&P.
In our conversation, we explore the critical role prosthetists can play in healthcare teams and how they can improve clinical outcomes for amputees. By drawing parallels between prosthetists and other healthcare professionals, we highlight the potential for more integrated, multidisciplinary approaches to patient care. We delve into postoperative dressing choices and the groundbreaking advantages of removable rigid dressings. Experimental approaches and studies reveal how compliant use of these dressings can lead to more successful prosthetic fittings, emphasizing the importance of innovation in the field.
We also tackle the challenges and opportunities in surgical amputation and prosthetic care, sharing personal anecdotes from residencies and discussing the complexities surgeons face. The episode underscores the importance of considering long-term patient outcomes, such as mobility and quality of life, rather than just immediate surgical success. We conclude with a call to action for better communication and education to maximize prosthetic outcomes, showcasing the benefits of removable rigid dressings in reducing hospital-acquired conditions and fall-related injuries. Tune in for an insightful discussion that promises to change the way you view prosthetic care.
This episode is brought to you by Advanced 3D and Limbguard.
Exploring Prosthetics and Orthotics Innovations
Speaker 1Welcome to Season 8 of the Prosthetics and Orthotics Podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal To share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you are here and hope it is the highlight of your day.
Speaker 2Hello everyone. My name is Joris Bieles and this is another episode of the Prosthetics and Orthotics Podcast. How are you doing, brent?
Speaker 1Hey, I'm doing well, Joris, you know what's crazy? I know we've said this before, but we are just a few episodes away from our 100th episode. Can?
Speaker 2you believe it. No, cannot believe it, cannot believe it. I still enjoy the hell out of this. I think it's wonderful. I think it's absolutely wonderful.
Speaker 1And we've learned so much. I mean that's the crazy thing.
Speaker 1And here's the other thing that's very interesting. You know, you have sometimes and I think it's just the human nature of some of this you have some preconceived notions of people that you interact with and then, or maybe you've heard something from someone or what have you, and then, like, you have them on a podcast, like what we've done, and it's like kind of shatters, the, the, the preconceived notion. And I would say you know, everybody that we've had on has been, you know, fantastic, generous obviously with their time, but, um, just just, it's just been great. You know, there's something about face-to-face and getting to know somebody that really humanizes the whole field as well totally agree, totally agree.
Speaker 2And this uh podcast episode is, of course, brought to us by advanced 3d. And what is advanced 3d? Uh, it's a. I think they do prototyping, they do MGF, they're like the workshop for the prosthetist and orthotist. Well, what do they do?
Speaker 1Yeah, so really, what Advanced 3D does is try to meet clinicians, orthotic and prosthetic professionals, wherever they may be. They may have never scanned before, they may have never designed before. Maybe they're wanting to try to do test sockets or FDM something. Maybe they got a bamboo printer and they're like, hey, I want to do something more than thingy bursts, or they want to take it further than that and they want to get into definitive style devices that go on patients. We just want to meet you where you are and then come in alongside of you and help you with that journey wherever you are. But then again, like you said, we also do prototyping and that sort of thing, product development. So if you have an idea, we can bring that to life as well.
Speaker 2Sounds wonderful. So that's advanced 3D and then, yeah, I think it's interesting. We've learned so much about this industry. We've learned so much about these people. I think one of the things that is like we always start with this Because it's kind of like, universally, the backgrounds of the people are different. Everyone has really different types of thinking, ways of doing things and methods and stuff, but generally we can see that the paths to prosthetics and orthodox are really usually quite convoluted and like all over the place We've got tons of people coming to us from different directions and stuff, and so I think it's always exciting. It's never like I wanted to be a doctor since I was five years old and then I went to med school. You know, it's always like I did this and then I did this and then I saw this thing and then. So I'm always really excited for our first question which we're going to ask just about to ask for a first another new guest. Who's our next guest up, right?
Speaker 1yours. I'm so excited to have jim reichman on the show today. This is one that's going to be a little bit interesting, and I know I say that almost every time, but, um, jim actually just said that he has, uh, retired. He's switched over to a mac. Uh, I guess that's what you do when you retire, is you switch to Mac and iOS products. But what's interesting about him is he's not only been in O&P, he's also been prolific in the research side of things. He has over 19 PubMed articles. His stuff has been. Articles have been in things like the PM&R Journal, american Journal of Physical Medicine and Rehabilitation, journal of Vascular Nursing, the Prosthetics and Orthotics International, as well as Physical Medicine and Rehabilitation Reports. He's done a ton of kind of outcome measure type of things, evidence-based guidelines, clinical guidelines. So I think we're going to have a lot of fun today talking about that and kind of its role or potential role, current role in orthotics and prosthetics.
Speaker 2Awesome, awesome. So, jim, so yeah, you just heard me like yeah, people come to this industry from all sorts of walks of life, all sorts of backgrounds. How did you get involved in O&P?
Speaker 3Well, Joris, I'll tell you. First, I want to say congratulations on your near 100th podcast.
Speaker 3That's really a great milestone and thank you for having me. I really appreciate it. The way I got involved in O&P after a fairly long career of managing clinical services businesses One managed high-risk obstetrical patients. Another one managed complicated respiratory patients in the home. We have that relationship with the three Ps the payer, the patient and the physician. I managed a couple of those businesses and then was recruited and came to Hanger Clinic as the vice president of sales and marketing nationally for Hanger Clinic. So that's how I came to O&P and that's where I really discovered the topic that we're going to spend some time talking about today, which is removable rigid dressings. In my previous roles, joris and Brent, I had created evidence-based medicine, written articles, done some research and created stories, if you will, around the evidence that was already published and significantly well-known, usually to support the services that I offered or the products that I offered.
Speaker 2Okay. So what was it like coming in? Because you came in, you started with this big company like or for us it's a big company and this industry is a big company. What was it like? Did you survey the landscape and saying, like this is something that we should consolidate, or this is something that we should like spread quickly? Or were you just like really kind of in a you know?
Speaker 3going, you know, going really slow at the time. No, that's a great question, george. What I did was I looked at the Hanger clinics. Hanger has over 800 clinics throughout the United States and I looked at the Hanger clinics that were high performing clinics. And when I looked at those high performing clinics, I really wanted to look at where those clinics had deep penetration in prosthetics and had well-established relationships with physicians that were doing amputations. And when I looked at those and began to look for some common denominators, it wasn't always the case, but quite often it was the case that those were the clinics that used a removal rigid dressing.
Speaker 3The hanger device is called an ampu-shield, a removable rigid dressing, the hanger device is called an ampu shield. And when I saw that I was like, wow, that's very, very interesting. And so I went out and talked to the clinics. I went out and talked to the physicians that were using the devices and they had nothing but wonderful things to say. So I thought, well, let me go back to my previous background and let me look at the evidence. Let's see what the evidence shows on removable rigid dressings. And that's how I began, if you will, my journey around removable rigid dressings.
Speaker 2Okay, but I think it's interesting that you clearly want to talk about this dressing thing. We'll go into that a bit, but it's interesting. You picked out this one data point as being so significant. So why do you think this is the? What is this removal, redressing, and why is it so significant for the performance of the clinic in your opinion?
Speaker 3Well, I think I think the real issue and this is an important message for all your listeners is that it allows the clinician that either the prosthetist or the sales rep if they have a sales rep in place or a marketing person in place to sit down and no longer think about acquiring the next patient from that surgeon, but rather acquiring that surgeon's practice, because the removal rigid dressing allows the OMP provider to establish themselves within the protocol of that surgeon so that they do the same thing every time. So consequently, you get all that surgeon's referrals, not just one or two of them. Then the next one goes to the next guy and they bounce them around, and so that was significant.
Speaker 1Hey, we're going to stop right there for just a second to recognize one of our new sponsors for the Prosthetics and Orthotics podcast, and that is LimbGuard. Limbguard is essentially a helmet for somebody's limb right after they've had an amputation, and research shows that it dramatically reduces the need for revision surgeries, which not only costs hospitals, physicians and insurance companies thousands of dollars per patient. One of the neat things is that you, as a prosthetist, don't have to stock a bunch of different sizes and sides. One of the other cool things is that you can put your clinic name and contact information right on the limb guard itself, and so once the patient discharges from the hospital, they know exactly who started with their care. Patient discharges from the hospital, they know exactly who started with their care. It's a great way to become part of the clinical team by providing this care upfront and, ultimately, a great outcome for the patients. So check them out and thank you for sponsoring us, limbguard. Let's get back to the interview.
Speaker 2Okay, I like that because it does seem like a bit of a kind of it is a bit kind of random that one time they'll go to you, the other time they'll go to someone else and maybe they'll they'll forget about you, and that seems like. I think, if you look at that at a constant revenue stream, that's nice, but it also does it also deepen the relationship? Does it also mean that now he knows your name, now we trust you more? Does it also like do that or?
Improving Prosthetic Outcomes Through Innovation
Speaker 3Oh, absolutely, and I'm sure Mike from Limuard spoke about this. It allows you to, as I said, you become a part of their standard operating procedure for an amputation. They do the amputation, they call in the provider with the removal, rigid dressing and right away and it's either applied in the operating room or in recovery and you've already tagged that patient, if you will to you establish a relationship with that patient so that ultimately you're most likely going to get that prosthetic recovery and you're now in the clinical practice. So when I talk about, I used to talk to the prosthetists at Hanger and I would say prosthetists have an opportunity to go the way of respiratory therapy or go the way of pharmacy, and by that I mean and I've had experience with both.
Speaker 3By that I mean the respiratory therapists continue to bow to the surgeon or the physician to say what should I do? Tell me what to do next, I'll do whatever you say. And the pharmacist is a clinical consult, an equal clinical consult with the physician on medications. Physician leans on the pharmacist to say what drug should I use in this situation? Or if they get a call and say, hey, there's an interaction with these drugs, what do I need to do? And the process has the ability right now, instead of crossroads. They can either do what the doctor says and just follow orders and become like a respiratory therapist, or they can become like a pharmacist and be an important component of the clinical practice of the surgery.
Speaker 2So what should we do and how do you do it? Because, okay, I'm thinking you're leaning towards a certain choice here, but how do you actually do that? Because that sounds like a really difficult thing to actually implement.
Speaker 3Well, I think the way you do that is, you bring something new and different to the practice, something that will absolutely, without question, improve the clinical outcomes, and consult with the physician on that procedure. So, when you look at amputations, for example, there's four things that affect the clinical outcome of a trans-tibial amputation. And that's the surgical technique and I always joke about you know who the best surgeon in the United States is right, it's the one you're talking to and so surgical technique, post-operative dressing, site of discharge and duration and intensity of physical therapy those are the four things that that affect the outcome of a transdivine amputee, one of those the prosthetist has tremendous influence over, and that's the post-operative dressing choice. And so, when you look at post-operative dressing choices, there's removable rigid dressings, there's soft dressings, there's hard casting or non-removable rigid dressings, and then there's immediate post-op iPops, post-op weight-bearing devices.
Speaker 3And if you look at the market the way it is right now and I published on this in PM&R Journal in 2018 in a comprehensive review article on removal rigid dressings About 85% of the market is soft dressings with a neomobilizer. Usually 14% is removal rigid dressings and less than 1% are post-operative devices. I mean, yeah, ipops devices. I mean, yeah, ipops. And so it just is a shocking discovery when you look at that market share, when you go through the evidence and find that there are 20 peer-reviewed published studies that have been published since the beginning of time, starting with Dr Wu, who invented the procedure at Northwestern in 1979, all the way to current day. There's been four published studies since 2020, and yet there's only 14% market share.
Speaker 1So there's a lot of white space, and I think the other thing that's interesting, though, when you're talking about all that stuff, is it really becomes a multidisciplinary approach to care and outcomes, and I tie a little bit of this to the podcast that we just did a little bit ago of the osteointegration stuff, which is they understand that you have to have a really good surgery, right, and you've got to have recovery, you've got to have great PT, and then you've got to have somebody that can do the alignment. Yes, you're not talking about a socket anymore, but the prosthetist is still really, really involved and is at the same level of all that, and it sounds as though not only is there white space that we can get better at just instead of a neomobilizer and an ACE bandage, now we can actually provide a clinically relevant solution but it also gives us an opportunity to really make ourselves a valuable part of the rehab team Exactly.
Speaker 3I could not have said it better, brent. And it's just such. The outcomes, the postoperative goals, are all they're the same. Everybody wants, you know, to prevent damage to the residual limb due to falls. Everybody wants faster healing, volume reduction, avoiding re-hospitalizations and expediting prosthetic fitting. Everybody wants those things, and here's a device that can help bring those things to life.
Speaker 1I have a question for you on that, and I know it was happening during my residency, which was the early 2000s, and you may or may not know about it, but there were some experimenting not only with the removable rigid dressings, but they were doing liners, non-covered liners, right up against the skin, essentially, and then if it got blood or anything on it, you just wash it off and dry it off and put it back on and it still had a protector around it. Any data or anything on that? I'm trying to remember what the context was, but I always found that very interesting.
Speaker 3There was one study there's not a lot of data on that, I am, I am aware of it and I've actually been in a room when one of those was applied to a patient and and and, um, there's, the one study that was done was actually they, they applied the liner and then over that they put a clamshell device. So that's one of the removal rigid dress dressing studies that I actually quote and it was performed at wash u in st louis by an elite author's name is duari and he did a, a match control trial, a level three study that showed that you know if patients that were compliant was an important study, because it know if patients that were compliant. It was an important study because it showed that patients that were compliant with a prefabricated RRD or removal rigid dressing were significantly more likely to be successfully fit with prosthesis. Oh, interesting, and he's the only one that showed that. And so 72,. They took all comers, everybody, if you can imagine that. And so 72% of those fitted with the RRD eventually ended up in a successfully fit with a prosthesis, as opposed to only 42% when they were done with a soft dressing.
Challenges and Opportunities in Surgical Amputation
Speaker 3And there's a variety of reasons for that, but nevertheless that was statistically significant. So that was a great study and obviously all prosthetists want the patient to get up in their prosthetic and be successfully fit. Just an enormous finding. The downside with the liners I will say this is they're just really tight. They're really tight and at least the case I was in it's an N of one. I'm a study guy but that's an N of one, a sample size of one. But man, the only person sweating more than the patient was me watching it and listening to her scream.
Speaker 1So I remember when I was in my residency I think Hanger. So I did my residency with Hanger. This was the Kiwi, that's the one they were using.
Speaker 3Oh okay, that's the one I just quoted.
Speaker 1Okay, so I remember being in the OR. The patient had just had the, I mean. So I was in the OR. They wanted us to put the removable rigid dressing on, or it was the kiwi, but I remember you know you go in with the binder clips and the surgical tubing and all that stuff and, um, I forget what the the outcome of was that or how it went, but it was actually very, very cool to do it right in the operating room as well.
Speaker 3Right. And the other problem with that technique is that if the wound does get infected or there's the suture line tears open or something happens, inevitably it's that device's fault. Oh, of course, inevitably. So don't delude yourself into thinking the surgeon's just. That's all me. I didn't close as well as I should have.
Speaker 1So on that note, though. So I mean, you talk about all the different studies and such. Do you feel like it really resonates with the surgeons or the doctors treating the patients to see some of this data? I mean, they probably don't know that it exists, so I know you probably as far as, like me, as a prosthetist, say, I'm wanting to have a conversation with a doctor, or it's a referral source that I already have and we're not doing this sort of thing, do you find that this resonates with them?
Speaker 3You know it depends where I am, and so I've had some incredible success stories. So I did. I was invited, I did a presentation and a PM and our doc happened to see my presentation and it was actually to a bunch of Hanger folks.
Speaker 3It was at Hanger's Ed fair and their annual ed fair and this physician was in the back of the room at the end of the when I and I went through every bit of evidence in excruciating detail, which I'm not doing here Sometimes I like to beat them into submission and um and so, uh, at the end of it she said I want you to do grand rounds at, uh, tier Herman Memorial hospital in Houston with me and we'll do it together. I said I'm, I'm all in, I'd be happy to do it. So we did vascular grand rounds and we did orthopedic grand rounds. They both did amputations. At Grant Rounds, they both did amputations. Both departments did amputations and they converted almost overnight to removable rigid dressings.
Speaker 3But that's an extreme case, you know, I guess I'll get into this because it's a great time, a great lead-in. But you know, guess I'll get into this because it's a great time, a great lead in. But you know, people ask why the evidence is overwhelming and I'm dumbfounded by this. It's just overwhelming. And yet why don't? Why is it the adoption rate better? And it's a valid question. Why isn't the adoption rate better? I'd say the first thing is nobody's out really selling it as hard as they can, because you can't make any money with this. The only reason a prosthetist would do this, I think the Medicare rate is $500. Well, you got to go out to the hospital. You got to fit the patient, you got to do all this stuff, get time away from the clinic for 500 bucks. That's not the way to look at it. The way to look at it is I've made an impression on the patient. I'm, I'm uh. Everybody remembers the story about the the, the dog who goes by the pond, and that's the first thing that the chick sees. And all of a sudden the chick thinks the dog's his mother, the um. It's the same thing with this. If you're the first one in there, they you're the one they're probably going to get the prosthetic with. And quite often like LimbGuard is a great example They'll actually put the name of the O&P on the device and the phone number. So they keep their patients.
Speaker 3But the question is why don't people do that? It's cumbersome to call an allied health professional and bring them into the hospital Very cumbersome. And you got to time it right, you got to remember it. And these are surgeons. They're doing amputation, amputation, amputation, vascular reconstruction, broken leg, you know if it's an orthopod. They got 10 surgeries that day and the clinical staff is just trying to clean the OR and get back into the OR. So that's one thing. And then the second thing is that removal rigid dressing does touch the wound and and the doctors, the surgeons, sometimes go I don't, I don't know, I got a low infection right now. My patients do great, you know, I don't.
Speaker 3I don't want to add something in the equation and I encourage the surgeons to think of the outcome different, because their endpoint is and I gave this talk at the Society of Vascular Surgeons, I don't know, five years ago. I said you guys are all out there, your endpoint is a fabulous surgery, a terrific suture line that's uninfected, when the patient gets discharged, when they leave the hospital. I'm encouraging you to think beyond that and think can I get this person up walking again, can I get them to activities of daily living? And when you start to think like that as a surgeon, you want them to walk in to see you six months for their follow-up visit, shake your hand and have you go. Did I amputate this guy or this woman Because they're so adept with their prosthetic? That should be the end point. And so there's a little bit of a disconnect between the research and what's done in clinical practice, because of the cumbersome nature of RRDs and because it touches the surgical wound. Nevertheless, it can be done, okay.
Speaker 1So a couple, a couple of questions follow up on that. So, getting the surgeons on boards super important and you know it is it needs to be kind of part of the plan of care. And if there's like a operating procedure, essentially it's like hey, did you call the prosthetist, do this? And it's just essentially it's like hey, did you call the prosthetist, do this? And it's just, it's just part of the, the journey.
Speaker 1Um, you know one of the things that, uh, we had somebody on where they talked about how much a doctor actually gets reimbursed for an amputation, which is it's, it's, it's.
Speaker 1I think he said seven, eight hundred dollars, like it's not a lot, and and so it really becomes so this idea that, hey, I'm improving an outcome, um, and there's no money in it for anybody, uh, other than the outcome, um, it that's a tough, I mean, for me, like as, as a surgeon, you know, I want, yes, I want, I don't want them back in my office because the minute they come back in I'm probably losing money for follow-ups or whatever like that. So you know, that would be one case for, you know, a removable ridge dressing, but I don't know. Like I think it's important to to tell the data. But then I think what you said is take it a step further is like hey, when you're doing their six-month post-op, okay, there's not a lot of money that you're going to get for them walking in without a limp or whatever, but how cool is it for somebody to come in and be walking after you know whatever happened to cause the amputation?
Speaker 3Right? Well, I think you're onto something. I think I think that's the story and the picture that you have to paint. Um, because, yeah, they do make. Surgeons get paid something like seven or $800 by Medicare to to amputate a leg. And I remember a discussion I had with a surgeon. It was like those guys who do billboards for taking out varicose veins make $2,000.
Speaker 1Yeah.
Speaker 3To take out varicose veins. I'm getting paid $700 to amputate a leg. The interesting thing and I'm sure you know this is that amputations are done by the last guy that was hired in the group. None of them like doing them. They're a failure, you know. They're a failure for vascular surgeons and they're just nobody likes doing them. And and just a little bit of epidemiology here on on the field 82% of amputations in the United States are scheduled amputations due to vascular insufficiency and most of the remainder are trans-tibial amputees, are accidents and then a very small portion are cancer oncology patients.
Speaker 3But one of the ways I think to hit home I think you asked a good question and it's a good way to transition is to start to talk about falls, protection from falls. When I went out and saw patients, saw physicians who used Amphishield, they would tell me I tried to learn from them. They would tell me the only reason I use it is falls. I would talk about what about faster healing? And they go okay, yeah, false. And I'd say, what about? What about shaping the residual limb? Yeah, yeah, yeah, false, false. That's why I don't want the patient to fall, and so what's interesting is to look at the statistics around falls and amputees in an inpatient setting and I'll go through this data as quickly as I can In an inpatient setting and I'll go through this data as quickly as I can.
Speaker 3In an inpatient setting, the acute care setting. It's already been published 16.5% of the trans-tibial amputees experience a fall within the six or seven day window that they're in the acute care setting 16.5. It's the highest fall rate of any patient in the acute care setting. That's higher than stroke. Now. So it's a small number of patients, but it's an incredible fall risk In the inpatient rehab, depending upon what study you read. But somewhere between 19% and 32% of patients fall inpatient rehab and this device protects them from damage due to falls and in the community setting pre-prosthetically. So from the time of amputation to ambulation, about 60.9% of the patients have fallen either in the acute care setting, rehab or in the community setting in the pre-prosthetic phase.
Speaker 3So it gets worse.
Speaker 3Three to four and a half and this is all published in the literature three to four and a half percent of the patients require revision surgery, which means they you know that's a euphemism they go back to the hospital to get their leg cut off a second time, and if it's in the acute care setting a second time that week and then in the literature, about 47% of those patients end up losing their knee.
Maximizing Prosthetic Outcome Through Communication
Speaker 3They get revised up to a higher level and amputee fallers. So the hospital should be concerned about this too, because amputee fallers experience a length of stay in the hospital 32 days longer than a non-faller. So add 32 days to the six or seven days and oh, by the way, it's a hospital-acquired condition, so Medicare doesn't pay for it, they're not paying for it, they don't pay for it and there's nothing you can do to prevent these falls. All you can do is prevent the injury from falls and there's three studies that show, when an RRD is used, that the damage due to falls revision surgeries are eliminated and people go. Well, you can't say that I go, I can't tell you yours are going to be eliminated, but I can tell you the data on three studies show that not a single patient fell with an RRD and went back for revision surgery.
Speaker 1That's amazing, it's pretty compelling.
Speaker 3I don't know where you go with this. That story is another one that needs to be told.
Speaker 1Yeah, by the prosthetist I think from like also my, my side of things, when you say, okay, the removable rigid dressing, yes, it costs you time to go into the hospital, it's uh, you know, reimbursement it's essentially a break even. Uh, it's not a break even when you include the time. But for us so like I'm thinking about East point and we do removable rigid dressings at the hospital that we're at, um, I think we do it from a little bit of a selfish role as far as because we do. We're in a rural north carolina so we do a lot of home care and such, and it's super important for outcomes, for the patients not only to be ready but to understand some of the prosthetic education side of things and that sort of thing.
Speaker 1So the reality is, is our rate of follow-ups, due to whatever is probably significantly less because of the protocol that's in place. And then we've got somebody with a more mature limb, somebody that's, you know, understands the process a little bit more, and so for every appointment where we don't have to send out a van because of something small, it's a big deal to us and so for me that's what resonates. So it's not that initial investment up front, but it's really on the backside. When we go and do a definitive prosthesis, we actually do save money because our trucks aren't on the backside. When we go and do a definitive prosthesis, we actually do save money because our trucks aren't on the road to go see these patients. For I say silly appointments, but you know what I mean when I say that appointments that could be avoided otherwise.
Speaker 3Right, right, I mean, that's an excellent point. I think the PM and um, the PM and our story and the process story is uh, get, help, help me, help you. Give me a better limb to work with, give me a limb that matures faster, give me a limb that's really well-shaped and I'm sure you remember from your Kiwi experience that the shape of those limbs was like textbook. They were ridiculously great and um great. And so you know you bring up a good point and I think the data is clear that the patient's mature, their limb matures about 60 days faster than using RRD, compared to soft dressings.
Speaker 3I published all this false data with a surgeon, an orthopedic surgeon out at UC Davis, in current physical medicine rehabilitation reports just this past year and we were invited to. The editor of the journal had seen some of the work we had done and he invited us to write an article exclusively on the problem of falls and lower limb amputees and I conclude that by saying do something to protect this limb from falls, because there's nothing you can do to protect the person from falling. It's no surprise that they fall, but when you put those into real numbers, that's when it gets it's jaw dropping. You know, I talked about percentages earlier, but in acute care setting there's 150,000 trans-tibial amputees in the year in the United States and 24,750 fall during the first six days in the hospital. And as you start to look at that, what exactly does that mean? It means that 2,250 people in the US every year just in inpatient I'm sorry 2,115, up to 3,172 lose their knee, lose their knee and about 6,750 need revision surgery, unnecessary revision surgery, and then all those added hospital days.
Speaker 3The other thing that's interesting is you know, know, sometimes the hospital's on the hook for this device. They have to pay for it because the insurance won't cover. They say ah, it's covered under the drg. Medicare doesn't pay for it, for example. Uh, for the hospital, the hospital can't bill it. So the um, so the, the I put together a return on investment. So if a hospital does 100 amputations a year, about 3% of those patients will fall and require revision surgery.
Speaker 3Revision surgery now is estimated. There was just an article published. I used to use the number 30,000 or 35,000 for unreimbursed amputation, trans-civil amputation, but there was just a fabulous article that was published, peer-reviewed and published as an abstract in Value and Health. That shows that it's more like $50,000 that it costs the hospital in unreimbursed amputations. So now that means they spend $150,000 for every 100 patients. They have to eat $150,000. For every 100 patients, they have to eat 150,000. That more than covers any costs that they would have to put the removal rigid dressing on every single patient and the ROI the return on investment is somewhere $6 to $10 saved for every dollar spent. So it makes sense for the hospital to pay for this as well.
Speaker 3It's just that hopefully your listeners will get inspired by this I know we're getting ready to wrap up. Hopefully they'll be inspired by this and go out and talk to their surgeons about the removal rigid dressings and capture these patients. Limbguard has a fantastic product that is available for the independent OOPs Hanger. I would encourage the hanger clinics any hanger people that are listening to this to use the Ampushield and put that device on and, of course, the FlowTek device. The big three are Ampushield, limbguard and FlowTek. Share that 14% 15% market share and I would encourage them to go out and try to enroll their surgeons in a protocol that involves a removal bridge addressing Jim, I have some questions for you, just more about marketing and sales expertise.
Speaker 2Let's say I have an individual clinic. A lot of these guys just seem to be like we're here, let's wait until people walk in the door. What would you advise people to do on sales and marketing to really make sure that more people walk through the door?
Speaker 3Well, it's not hard to sales and marketing is only difficult if you make it difficult. By that I mean, you know, if you set aside a day a week or a day a month, you know, start out a day a month and list the surgeons that have referred to you in your marketplace and go out and visit those surgeons either cold call them or make appointments to go see those surgeons. Go out and talk about the patient you've shared with them already. So how do you turn one patient a year ago into 10 patients this year? You go talk about the success of that one patient and it's a shared experience. You both have had success with that patient and you can bring videos of that patient when they're in the clinic walking, but surgeons don't always see that. So how do you open that curtain and say there's the patient. That's what happened eventually.
Speaker 3Your surgical technique was impeccable impeccable. We overcame the fact that you put a soft dressing on the patient and the patient had tremendous physical therapy and prosthetic fitting and this is what we ended up with. That person today is now 40 pounds less than they were when they came into your office. Their A1C is down. You know two points and it doesn't look like we're going to have to take the other leg. Doctor, you are phenomenal. Do you have any other patients that I can help you with like that? Don't sell, just tell, tell them about the patient. Don't sell, just tell, tell them about the patient. They're patient and I think that that's the best way to do it. Joris, but that's a fabulous question because it doesn't come naturally to most prosthetists.
Speaker 2Yeah, I think a lot of people are prosthetists that we've met through the show. Not a lot of them are very salesy. Is there a book they should read or is there an attitude they should adopt where you think like, okay, you may be not that natural born salesperson, but a lot of salespeople aren't, so is there any advice you'd give them on improving their sales ability at the time?
Speaker 3You know, I don't have one particular thing that I would point to to say you know, go study this, but don't think about it as sales. I guess that would be my message. It's not sales, it's not marketing. It's going out and talking about a patient that you, together, have had and with that, all you have to do to make it a sales call. All you have to do is end that conversation with is there anybody else in your practice I can help you with? Please think of me next time you have a patient that we'd like to have together. We'd like to have the same outcome for, because you're not closing, this isn't one of those hard I call them press hard, five copies close. This isn't like that. This is a clinical discussion and you're the clinician that's helping, and that's again that gets you closer to the pharmacist than the respiratory therapist. If all you do is wait for the orders to come in, you're not moving that, you're not pushing the ball that direction.
Speaker 2All right, jim. I think that's absolutely fantastic advice. Thank you so much for your time with us today.
Speaker 3Thank you, thanks Brent, thanks Joris, I really appreciate it. And again, congratulations on your near 100th podcast and thank you for having me. I've really enjoyed it.
Speaker 2Thanks for being here today, Brent.
Speaker 1Oh, this was great. I mean, if this doesn't get people fired up about really great patient outcomes via something very simple to add to your practice, I don't know what will.
Speaker 2Cool, cool, cool. And thank you so much for listening you guys to the Prosthetics and Orthotics podcast. Have a great day.
Speaker 1Hey, thanks for tuning in and a special thanks to LimbGuard and Advance3D for sponsoring this episode. If you enjoyed it, don't forget to like, subscribe and share it with your friends and, if you feel so inclined, please leave us a review. Your feedback helps us improve and reach more listeners. Have a great day.
