Diabetes drives demand

Work, for some, is more than a job.

It's a calling.

Dan Haney, president of Ultra Prosthetics and Orthodics, has fitted amputees with artificial limbs for 44 years."When you love what you do, it's play," he says.

The company provides an average of four people a week with new limbs.

Each job includes the initial interview, the manufacture of a custom limb and a personal fitting conducted in the home.

Yes, Haney makes house calls.

Limbs are fitted in home because that's where an elderly person can become comfortable with the limb, he says.

Plus, he can see how the limb will be used will they need to navigate steps, a high threshold or a heavy carpet? The home environment is so different from that of a clinic,with a smooth tile floor and safety rails.When older people get home, and a helper unloads the new leg from the trunk of a car, the amputee often sits at home and simply looks at it, feeling uncertain, and too often decides to stay in the wheelchair.

That doesn't happen if they first get fitted in the home, says Heaney.

While he travels to provide the personal touch,Haney's team at a 1,800-square-foot lab in Mound House crafts the appendage.

Three employees include a pre-med student, a mechanical engineer and a crack mechanic.

The company, founded in San Jose, came to Carson City in the dust of a Ferrari hill climb at Virginia City.A racing aficionado, Haney had been invited to the event by a friend and decided "This is a neat place."He moved the business to Carson City in 1993 and last year moved to the present Mound House location to nab a workspace twice the size at half the price.

Who makes up the market for arms and legs? People over age 50 create 70 percent of the demand, while diabetics make up 70 percent of that group.

The remaining 30 percent suffer from congenital birth defects,workplace accidents and car wrecks.

(More information is at the Web site www.ultraprosthetics.com.) A simple leg prosthetic, attached below the knee with no complicated joint, costs $15,000 to $20,000.Medicare pays about half that, and requires the patient's secondary provider to pick up 20 percent of that half.

If the patient can't pay,Haney often writes off the loss.

Some customers never pay.Haney doesn't expect them to pay.

"I fit kids who are obviously illegal aliens and I know they will never be able to pay," he says.

And, growing kids need constant replacements because they outgrow their limbs just as they outgrow their clothes.

But Haney isn't in business strictly for the money.

"My interest is getting people back and moving," he says."If you don't have a heart for that sort of thing, go sell real estate."

Business comes from a variety of sources: From an ad in "In Motion"magazine, which is read by amputees.

From physician and patient referrals.

From a contract with the Veterans Administration hospital.

The downside of the business is financial, says Haney.

The manufacturing components are expensive.

Completion of a job can be strung out for months if an already sick person gets sicker and can't sit for the final fit.Haney can't bill until the job is done.

Then, payment from an insurance company can take another six months."I can have huge accounts receivable but still must make payroll," he notes.

"Fighting with insurance companies is no fun," he acknowledges.At least Medicare, although it only pays part, pays within 13 days.

"All these companies will put as many rocks in the road as they can to slow the payment process," he adds."They present an endless stream of requests for pieces of paperwork.

You can't get nasty or they get even slower.

Insurance companies are huge.

They can put you on hold or not call back."

On occasion,Haney has traveled to insurance company headquarters to say, in person, "I want to get paid."He's taken up residence in the waiting room with a sandwich and a fat novel.

That ploy brings out the comptroller to write a check on the spot.

"Another difficulty," he says,"is getting patients to call for any reason: it hurts, it rattles."

Haney wants them to call; there is no additional charge for extra work.He attributes the call reluctance to the general public's inability to get through to busy doctors or insurance firms.

Life tends to steer one to a calling.

After a Marine Corp discharge,Haney took a series of unskilled jobs.He drove an ambulance for a funeral home where, he says,"I learned a bit about empathy."He worked as the maintenance man at a prosthetics company.

There, he had time to become a technician.

Soon he was running the arms department.

"Back then, a lot of farmers lost arms," he recalls.

The technology was simpler."We made them out of wood."Now, prosthetics are made from space age materials such as carbon fiber and titanium."A lighter leg means more steps in a day." Haney was hooked on the work.

To learn more, he took classes at the Rehabilitation Institute of Chicago, offered at Northwestern University."It was not so regulated back then," he says.

Now, a bachelor's degree in prosthetics is required.

One must know physiology and anatomy.

Plus, complete a year-long internship.

And work a year under a licensed practitioner before taking the exam to become a certified prosthetist.

"There's always a shortage of experienced people in this business," he says.

In future,Haney says,"I see getting more people like my present employees, who want to work even if I'm not there."

He considers having field reps in place nationwide so he can stop flying to custom fittings.

Instead, he would recruit and send certified prosthetists who have sold a business and signed a "do not compete" clause with the new owner.

Or, he may fly people to his location and have them stay in a motel during the fitting.

However it happens,Haney's calling will continue.

Charity begins at home and travels around the world The Afghan Christian Technical Services (ACTS) is a non-profit organization that Haney formed after the Sept.

11 attacks when U.S.

troops went into Afghanistan.

The country was littered with landmines left by the Soviets.

The result: A shocking percentage of the natives are maimed.

Plus, they can't travel for medical care, because there are no roads.

Haney sees it as a parallel situation to his custom-fitting work in the U.S.

"What I'm doing here needs to be done there," he says.

He first wrote to President Bush, offering to go help the Afghani people, but got no reply.

Then serendipity: The pastor of a Midwestern church got a load of used limbs from the VA hospital.

This country does not allow reuse of a prosthetic device, but the Third World has no such compunctions.

Armed with a Leatherman and a set of Allen wrenches, Haney flew to Afghanistan to fit 60 amputees with artificial limbs and distribute 600 wheelchairs.

ACTS is currently seeking funding to continue the program.

The Web site is www.oneacts8.

com.