Imagine running a practice that has been shut out of the local hospital’s O&P contract for years. You have built a good reputation, served your patients well, and developed the business without that relationship. Then, during contract renewal season, the hospital specifically invites you to submit a proposal. “Your patient outcomes have caught our eye,” they say. After all those years, the invitation means more than an opportunity to add business.
Let’s call this fictional practice Ridgeway O&P. It regularly shares the positive results patients report through its outcomes measures. Predominantly an orthotics practice, Ridgeway also has an established prosthetics service and one prosthetist. The proposed contract includes inpatient coverage and post-discharge O&P services, potentially requiring an expanded prosthetics service and responsibilities the practice has not previously carried.
The owner is enthusiastic but cautious. Before deciding how to win the contract, the owner wants to understand what accepting it would mean for the practice Ridgeway has built and the practice it intends to become.
What would make this viable?
Before considering staffing and finances, Ridgeway needs a reason to pursue the opportunity. Does it fit the practice’s mission, advance its vision, and offer a way forward without compromising its values? Those are the first guardrails for the decision. A contract worth pursuing should support the practice’s purpose and direction, not simply make it larger.
A practice can choose to remain small and still make meaningful progress. It can strengthen its services, develop its people, and improve the patient experience without adding another location or substantially increasing volume. The distinction is whether remaining the same size reflects a deliberate choice or whether familiar ways of working have become boundaries nobody questions.
Perhaps developing prosthetics has been part of Ridgeway’s direction for years, and this contract could provide a reason to invest. Perhaps the invitation introduces a possibility the owner has not seriously considered. Either deserves examination. Would it help Ridgeway meet a patient need, strengthen a service, or build a more sustainable business?
Those goals should remain meaningful even if another practice wins, although Ridgeway might pursue them differently or on a different timetable. They also provide a basis for examining a more personal question: How much of the owner’s interest comes from what the contract could make possible, and how much comes from finally having a chance to win it?
“We have waited years for this”
For Ridgeway’s owner, the invitation may bring several feelings at once. There is pride that the hospital has noticed the practice’s patient outcomes, relief at finally being considered, and perhaps some satisfaction at the prospect of displacing a competitor. If the owner believes that competitor unfairly kept Ridgeway out and limited its growth, winning could feel like setting something right. Those feelings can exist alongside a sincere interest in serving the hospital’s patients.
I would not ask the owner to pretend that history does not matter. Acknowledging years of effort and frustration makes for a more honest conversation. The important distinction is between what winning would mean personally and what fulfilling the contract would mean for the practice. The owner can value the first while still requiring a sound case for the second.
Would the same contract be attractive if it came from a hospital where Ridgeway had no history and no rival to beat? The owner does not need to feel less enthusiastic, but should be able to explain the opportunity’s value without relying on the satisfaction of finally winning. That explanation should hold up when the conversation turns from being selected to delivering what was promised.
The hospital has already recognized Ridgeway’s work by specifically inviting a proposal based on its patient outcomes. That acknowledgment does not disappear if the discussions reveal a poor fit or terms the practice cannot responsibly accept. The owner can appreciate the recognition and still decide that this particular contract is not the right next step.
Give the opportunity a fair examination
The possibility of a poor fit is not a reason to avoid looking. Ridgeway may not have the people or arrangements in place to fulfill the proposed responsibilities today, but that does not settle whether it could prepare to do so or whether the investment would be worthwhile. Once the owner sees a possible fit with the practice’s direction, the next step is to examine what would have to change.
Research on small-business planning supports combining preparation with continued learning: a review of multiple studies found a positive relationship between planning and performance, while emphasizing that circumstances matter (Brinckmann, Grichnik, and Kapsa, 2010). For Ridgeway, I would give the investigation some structure while leaving room for the answers to change the owner’s thinking. The purpose is to assess the opportunity, not justify a decision already made.
A page with three headings would be a useful starting point: “What we know,” “What we are assuming,” and “What would change our decision.” Ridgeway knows why it was invited and understands the broad scope of the proposed contract. It still needs to clarify the hospital’s expectations and what meeting them would require. The team does not need to solve every staffing or financial question yet, but it should identify which assumptions could change the decision.
The owner can involve the people who would help fulfill the commitment, assign responsibility for the unanswered questions, and set a review date that fits the hospital’s bid calendar. At that meeting, the team should explain what it has learned, what remains uncertain, and whether to continue toward a bid, seek clarification or different terms, or stop. Time spent investigating is not wasted if it gives Ridgeway a sound basis for that choice.
A decision to learn, not a promise to grow
For now, Ridgeway’s owner has decided the opportunity deserves a serious look. Its potential is enough reason to investigate, but not yet enough reason to commit. The owner can approach the discussions with genuine enthusiasm while remaining willing to change course as the details become clearer.
That investigation can be valuable beyond the contract itself. By examining what the opportunity would require, the owner may uncover capabilities worth developing, assumptions worth revisiting, or commitments that need to be protected. Ridgeway might decide to expand its prosthetics service, make improvements within its existing business, or conclude that its current direction remains the right one. In each case, the owner would be making a more informed choice rather than allowing either familiar routines or the excitement of winning to determine the practice’s future.
Think about an opportunity facing your own practice, whether you have been reluctant to consider it or eager to pursue it. Looking into it does not obligate you to move forward, and deciding against it does not mean the effort was wasted. What could examining that opportunity teach you about the practice you want to build, and what would you need to learn before making a commitment?
Next week, Ridgeway turns to the question behind the opportunity: What would the hospital actually expect the practice to provide? The owner is already considering another prosthetist or perhaps an assistant but choosing the hire before clarifying the commitment could mean solving the wrong problem.