“Nobody showed me. I figured it out.” If you’ve ever thought that when an employee asked the same question again, you’re not alone. Expecting initiative is fair. But does your response build resourcefulness—or just send the question to someone else? There’s a difference between doing an employee’s thinking and teaching them to think. This week’s blog explores how to keep standards high, make accountability clear, and build a team you can trust to handle the work.

"We need another practitioner." Sooner or later, every owner hears it. And the fastest answer, yes or no, is usually the wrong place to start. In the 1920s, a PR man sold more bacon without ever making a sales pitch. He changed the question instead. Nearly a century later, the same idea can help you make better hiring decisions and develop office managers who think like owners. What are the two questions to ask before you approve the hire?

You've been meaning to address it. The incomplete charts. The missed handoffs. The referral paperwork your staff keeps chasing. But everyone's busy, and you don't want to make things uncomfortable. Meanwhile, someone in your practice is doing extra work to keep the peace. 

This week, I look at what leadership silence actually costs, why working around a problem can become the bigger problem, and how to start the conversation you've rescheduled twice. You may be protecting your own comfort at someone else's expense without noticing. 

If I asked you what you would do if you knew it couldn't fail, you’d probably be able to answer me in about four seconds. You already know. Is it hiring a new clinician? Opening another location? Buying another practice? Selling? Why is the list still a list? Usually because we've labeled something impractical when the real word is frightening, and those two need very different responses. This week, I’m going to tell you about the time someone took my downside away and what I learned about my own excuses. 

In 1996, the U.S. military coined a term for something every business competes on but rarely names: information superiority. The idea was blunt — whoever acts on accurate information faster wins. But after two decades of expensive lessons, they learned something uncomfortable: better data doesn't guarantee better decisions. Somewhere between the information arriving and the decision getting made, the truth quietly gets cleaned up. 

How good is the information that reaches you?  

The idea you carried home from Las Vegas has about a nine-day life expectancy. Not because it's a bad idea — because it never gets built into how the week runs. That changed this year. Want a required new step in your KAFO fabrication process? Ten minutes, and it's live for your whole team. Here's the recap from the show floor.

There's a modifier that's supposed to get your claim out of prior authorization. Half the practices about to lean on it don't know it triggers prepayment review 50% of the time. That's not a workaround — that's a coin flip you're volunteering for.

Someone in your office is retyping a patient's history into an AI tool right now to get an answer about a patient OPIE already knows everything about. That stopped being necessary this year. It's one of over 100 things that changed since last year, and at least two of them will increase your profitability. Give me five minutes and read this blog!

Are you legacy, or are you a fossil? They sound the same, but one is your greatest asset and the other is exposure with a good story attached. The checklist nobody's questioned since 2019, the "we've always done it this way" that used to be wisdom — that's the fossil talking. This week, a look at how proven practices stay proven: not by holding still, and not by chasing whatever's newest, but by doing the harder thing in between. 

UnitedHealth just poured $20 million into neighborhood health hubs built around diabetes and blood pressure, no new payment code required. It is the same instinct primary care chased a decade ago with the patient-centered medical home movement, just moved further into the community. Good O&P practices have been running a quieter version of that model for years, coordinating gait, comorbidities, and follow-up care one patient at a time. The real question is not whether you fit this model. It is whether your community knows you belong. 

Practice owners often struggle with operational decisions because they think that making the wrong one may be a costly mistake. Should you keep stocking a product line as margins tighten? Send more work to central fabrication or hire another technician? Stop incomplete orders before they clog the schedule? This week’s blog explores why smart leaders overthink, how to separate productive deliberation from the loop that drains time, and a simple decision check your team can use right away, starting today. 

The person stealing from your practice isn't the shifty new hire. It's the one you'd never suspect — twelve years in, never takes a vacation, knows your billing system better than you do. The typical practice loses 5% of revenue this way, and the median case runs $145,000, enough to wipe out a year's margin. Most of it hides in plain sight, in habits you've always read as loyalty. This week: nine quiet warning signs, and the fifteen-minute check that catches them. 

The audit letter lands on your desk Monday morning. Or your only technician suddenly quits. Watch what you do in the first ten minutes — do you rush to fix, rally the troops, or go cold and logical? You have a default reaction under pressure, and in a small practice where you're usually the only one at the wheel, that unnamed reflex runs the whole show. Knowing your reflex and making sure you're not the only one who can handle a crisis might be the cheapest resilience you can buy. 

CMS just proposed dropping traditional MIPS and pushing more doctors into ACOs. You don't bill Medicare that way, so why should you care? Because every referring surgeon you work with is about to get judged on outcomes you're already creating and probably not measuring. There's research proving your care saves the system real money. The question is whether you can prove it about your own patients, or whether you're leaving that conversation to someone else. Here's the sixty-day fix. 

Competitive bidding program is coming back for 2028…and now requires mail order!  What started as just two O&P categories in 2021 has grown to three, with no clear sign of stopping. Nobody's published real numbers on what practices lost last round, but the rules for who gets paid are about to get more strict. If you fit OTS back, knee, or upper extremity braces, this could reshape a chunk of your revenue before you even see it coming. 

Next week, don’t let your momentum slow down. As we hit the halfway point of the year and celebrate America’s 250th birthday, it’s the perfect time to take a hard look at what’s actually moving your practice forward and what’s holding it back. In this midyear reflection, we break down the simple habits, processes, and leadership behaviors that separate steady practices from stressed ones—and how to refocus your team for a stronger, smoother second half before the year gets away from you. 

Think compliance is just paperwork? A single audit slip, accreditation miss, or False Claims Act misstep can cost your O&P practice thousands. Discover how Medicare audits, accreditation rules, and the FCA collide in real practice life—and what daily habits actually protect you. You’ll learn the workflow gaps that can trigger red flags, why “busy” is not a defense, and how smarter documentation and billing tools can be your best shield against regulatory disaster. Don’t wait for an audit letter to find out you’re exposed. 

Insurance companies aren't saving money when they deny a prosthesis. They're just moving the cost — onto your patient, onto the system, and often right back onto themselves. The research is unambiguous. The problem is what you do about it at the practice level, today, with the staff and systems you already have. Here's a practical look at what may help. 

You just hired a new clinician.  Fresh out of residency, this person you found seems ideal. They are smart, they believe in your vision…maybe they will take the reins someday. You’re training them, introducing them to your patients, trusting them with your reputation. And statistically, there's a real chance they won't be in your clinic in ten years. That's not pessimism. That's the first real data we've ever had on O&P career attrition — and it's worth your attention.