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John: Welcome to another edition of The Impact Podcast. I’m John Shegerian, and I’m so excited to have with us today, Maggie Baumer. She’s the leader of enterprise patient advocacy at Hanger Clinic. Welcome Maggie, to the Impact Podcast.

Maggie Baumer: Thanks so much, John. I’m really happy to be here.

John: Well, I’m happy to have you because this is a topic that’s near and dear to my heart that we’ve never covered before in full on this show. So I think you are the perfect person to share everything that’s going on at Hanger Clinic that you’re doing with your colleagues, all the important work you’re doing. But before we get to that, share a little bit about your journey. Where did you grow up and what was your background? What inspired you to get involved with a great company like Hanger and do the great and important work that you’re doing in terms of patient advocacy there?

Maggie: Yeah, thanks so much for asking that. So I grew up in North Hampton, Massachusetts, which is a little college town about an hour and a half west of Boston, and I’m lucky enough to live here again. It’s a really great area, and my purpose in my career was always to help people. That’s what drives me. So I started out in psychology. I had a psychology degree from Tufts, and my first job after college was working in mental health. So I actually worked on an inpatient psychiatric ward as a mental health counselor for about two years. Yeah, and that was incredible work. Really meaningful, but also as you can imagine pretty draining and trying at times, and I wanted to feel a little more useful. Sometimes in that position, I felt like I wasn’t sure how much I was really contributing to the change in folks. So I started looking into other ways, other career paths that might be better for me. So at the time my sister-in-law was in law school, and we talked a lot about that and I thought, okay, this would be another way to advocate for people. That’s what lawyers do, they advocate. So I started thinking about that and applied to school and went to Cardozo in New York City. When I was in law school, I actually had a concentration in health law, and I worked a couple of summers, one at a place called the Long-Term Care Community Coalition, which is an advocacy group for people who need long-term care services. Then I also worked in the New York Attorney General’s office in the healthcare bureau doing advocacy there. When I finished school it was 2011, so we were still recovering from the 2008 crash and jobs were tough to come by and I was lucky enough to have a position and offer as an associate at an immigration firm that I had worked at previously as a legal assistant. So I was doing that for about a year, and then I experienced a traumatic injury where my arm was actually crushed by a trash compactor, which is long convoluted story, but it was very traumatic. I was in the hospital in New York and Hurricane Sandy actually happened while I was in the hospital.

John: Oh my God.

Maggie: Yeah. So it was just a whirlwind trauma on top of trauma where the first hospital I was in had to shut down. Was running on generator power, and I had to be transferred.

John: I was there then. I have known Sandy. New York almost shut down itself, which is unheard of in New York, right?

Maggie: Yeah, it was crazy. My brother and sister-in-law were living in Brooklyn, and they had trouble getting to me from Brooklyn and it was just a mess. But yeah, anyway, eventually my arm wasn’t amputated right away. I went through a process that many of us do called Limb salvage, where the physicians were doing whatever they could to keep my limb intact and that worked for about a month. But eventually, I had a bypass failure where a vein that they had taken out of my leg and put into my arm essentially failed, and I had an infection. So I ended up at Mass General and had my amputation there about a month after the initial accident. So I went through quite a period of recovery. I had to move back home with my parents, and I was 30 years old at the time. So it was an unexpected, and whirlwind for all of us. But I took some time to really figure out, okay, what are my next steps? I was lucky enough to have family that supported me and so for about a year I was really just focused on healing and also figuring out what am I going to do with my career? Because I’d already had misgivings and not quite sure about being a lawyer in a law firm full-time before this even happened. So what led me to Hanger and my current career was really a visit from what we call a peer visitor. So somebody who had lost his arm as a teenager, and he was in his fifties when I met him. So he had worn several different types of prostheses, had this full career and family life and so he really showed me what it could be like post amputation and that was really a catalyst for me meeting him. Then from there I started providing peer visits to other people. We have a program called AM Empower that you can get certified through to provide that peer visitation. So that was a volunteer position that I did for a while and then eventually I was hired by Hanger as a business development manager and did that for about five years before moving into being a clinic manager, and then eventually this current position in advocacy.

John: Okay. So let’s step back a little bit. It’s a fascinating and important journey, and I don’t want to skip any steps here. So you’re 30 years old and have this horrifically traumatic injury that you had to deal with. Was your psychiatric education, did you lean on that? Or were there other tools and other protocols that you leaned on to help you overcome what is an absolute trauma and tragedy to anybody at any given time in their life especially a young, vibrant beautiful woman at 30 years old? How did you work through that, the mental part of it? Well, then we’ll get into the physical, obviously, and with Hanger and all their great products and what you’re doing there.

Maggie: Yes. So I certainly, as you said, leaned on my background in mental health. My first order of business was finding a therapist, somebody qualified in trauma, somebody who I felt could really help me get through this recovery process. So I did that right away and met with her. My accident was on October 27th, 2012, and I think by December I had already met with her. So yeah, really, I saw her for about six years and knew that that was going to be an important piece and tool in my toolbox for recovery. So that was a big piece.

John: Got it.

Maggie: Also friends and family and my healthcare team, I really benefited from some very positive healthcare and positive feedback about my healthcare. I think we know now that people’s outcomes, and patients’ outcomes have a lot to do with their perception of what the providers are thinking and how providers present the situation to you. So my surgeons in Boston, my family, and I joke about this now, like the surgeon came in and said, “Well, we’ve done everything we can,” at this point my hand was black, it had this necrotic and said, “We’re going to have to amputate your hand, but you’re going to be fine.” We joked because he wasn’t saying it flippantly. It wasn’t like, “Oh, it’s no big deal, but it had enough of a, “And you’re going to be fine.” Like, “I’ve seen this before. This is not the end, don’t worry too much,” and he gave the same message to my family of like, “She’s going to be great. Yes, this is difficult, but she can do it.” So that was a really huge piece as well.

John: It was bad news wrapped with a bow of hope.

Maggie: Yes.

John: It was great.

Maggie: And genuine too, really.

John: Right. Genuinely. Not like you said, facetious or flippant hope, it was true hope based upon a person who had seen a lot of this in his life. A lot of these things in his life.

Maggie: Correct. Yes.

John: Wow. That’s says a lot about him and what a blessing, because as you and I know, regardless of the trauma that anyone’s going through a surgical or otherwise, if a doctor’s bedside manner is off, it could really spin a person in the wrong direction.

Maggie: Completely. Yes. Yeah, I was just really lucky all along the way to have pretty positive bedside manner and hopefulness from all my surgeons.

John: But it seems as though, and I’ve just met you, my money would be that you were prior to this trauma, a really positive, upbeat person to start with.

Maggie: I would say so, yes. I think I’ve actually become more positive and more upbeat post-trauma. It’s been 12 years, so I’ve grown a lot as a person. But yes, generally speaking, I was positive and I did have that background in mental health so…

John: That’s a good head start.

Maggie: Yeah. I had a head start. I was…

John: [inaudible] head start.

Maggie: I also made it a point to really thank my providers, look them in the eye, shake their hand, and say thank you I so appreciate you. I think that had a lot to do with it too.

John: Tell me, Maggie, how does it work? So that’s the mental-emotional side of it, when it comes to prosthetics as I shared with you off the air as you and I were just catching up a little bit and having a little conversation before we taped this episode, I never heard of Hanger Clinic, and obviously, they do over a billion a year in sales, 5,600 or so employees, a 160-year-old company, and they do all this important and critical work and orthotic and prosthetics and things of that such, and innovation. How then do you find the right prosthetic, post-surgery terms of quality and meeting the needs that you had post-surgery? Or do they have sort of a monopoly on the industry? Or are they a multitude of choices that you ended up at Hanger Clinic, or how does that work?

Maggie: Yeah, great question. So Hanger is the largest ON, we say ONP, which is orthotics and prosthetics provider in the nation. But we don’t have a monopoly per se. There are a lot of other providers in the space, and depending on the region, we could be a small portion of that market. But the way it works, referral-wise and prosthetically is a really important question because in our space, the people with limb loss and limb difference and orthotics and prosthetics, we know that there are people that “fall through the cracks” and don’t get the referrals to an orthotics and prosthetics provider that they need, and we’re not totally sure why. Sometimes those people might not be, “candidates”, so they might not be anatomically appropriate for a device. Sometimes that happens. But a lot of people probably should get referred on and simply don’t for probably structural barriers in the healthcare system. So one thing I would say is the Amputee Coalition, which is a nonprofit organization that is all about promoting advocacy for people with limb loss and limb difference, they are with the Government Accountability Office doing a study right now to find out the answers to that question. How do people get missed? How do they fall through the cracks? How many of them are there? So that should be coming out hopefully soon, and we can get more answers to that. In my case, my surgeon, as I was telling you, is excellent, and so one of the things he did was he invited this peer to come to one of my follow-up appointments. So that person talked to me about prosthetics, what it’s like to wear one. Then my provider gave me a list of options of prosthetic providers in the state, in the area. We recommend that you go through those lists and you interview folks and you pick a provider because when you’re an amputee, you’re going to need prosthetics for the rest of your life and typically they last three to five years approximately it depends on the person, but let’s say three to five years. So it’s like a primary care doctor. You’re going to have a long-term relationship with your prosthetist or orthotist. Hopefully, that’s the ideal scenario is that you find somebody you like and you stay with them for a number of years. Yeah, I was just lucky to be referred on to Hanger and I met folks at Hanger that were so welcoming and so kind, and had lots of ideas about what would work best for me. So that’s an ideal scenario is when you get directly connected to folks and you get a chance to interview different providers.

John: For our listeners and viewers who want to find Hanger Clinic, they can go to www.hangerclinic.com. So talk a little bit about how you’re a lawyer, you also have that mental health background, and now you’re recovering from this great trauma at 30 and you are introduced to the Hanger Clinic people, talk a little bit then your evolution and journey going from being a patient to becoming an employee and eventually an advocate at Hanger Clinic.

Maggie: Yes. So like I said, the people that I met at Hanger were just so wonderful and welcoming, and I really found that the culture was just very positive, and everybody was there for the same reason that I laid out is my career purpose, which is to help people. That’s really what seemed to motivate everyone that I met there. So that felt like a perfect fit for me. So another funny story about the surgeon, he’s great. So I was at a follow-up appointment with him, with this peer visitor Mike, and my doctor turned to Mike and said, “Why don’t you guys hire her.” At the time, Mike had only been with the company a year or something, and he really wasn’t in a position to hire me but he did eventually make an introduction to the regional vice president in our area whose name was Dennis Heisman, and Dennis and I met and he offered me a job as a business development manager and just went from there. It was…

John: I’m liking your surgeon more and more. I think of this guy’s really cool, by the way. Give him a shout-out. What’s his name? He’s…

Maggie: Yes, Dr. Curtis Catrulo from Mass General. Woo, shout out to him.

John: There you go, Dr. Catrulo. You rock man. That’s awesome. You not only fix Maggie up, but you also helped her career path. He is a multipurpose doctor there. He is great. I love the guy.

Maggie: He is wonderful. Yes.

John: That’s great. So you got a job you got a new position in advocacy or business advocacy or development for [inaudible]…

Maggie: Yeah, business development manager. So it’s basically a sales position. But sales in our industry is mostly about relationships. It’s not a commission-based role, it’s about building relationships with hospital systems and other partners so that they’re aware just to the point you were making earlier, how do people get connected with orthotics and prosthetics? And part of what we do in that role is to make sure people are aware of our availability and our presence in their area. So we work on sometimes hospital contracts. We work with doctors, PTs or physical therapists, and occupational therapists and host a lot of in-service educational events so that they’re aware of our services. Yeah. That was a great role for me to start in because you and I were talking before the show of like, you don’t know about this space necessarily until you encounter it personally.

John: Right.

Maggie: There was so much to learn, and I didn’t know much about anything of it before this happened to me. So in the business development role, I really learned a lot from the ground up of not only what happens as a patient, but what happens in the healthcare pathway of people who face amputation and all the different providers that you need to encounter and how that works throughout your patient care journey. So that was a really good place for me to start and to learn.

John: How long were you in that position until you started to evolve into more advocacy work and talk about the importance of advocacy in this field?

Maggie: Yes. So I started with Hanger in 2014, and I think around that same time is when I started doing some advocacy through a group called the Trauma Survivors Network. So that is a program of the American Trauma Society. So I was on the Trauma Survivors Network advisory board for a while and then got onto the American Trauma Society Board. I was connected to that group through a gentleman named Peter Thomas, who is a managing partner at Powers Law Firm in DC. He’s also himself, somebody missing both his legs below the knee. So he is a very well-known advocate in our space and somebody connected the two of us and he suggested that I get involved in those two groups. So I did, which was great. I’m so grateful to him for making that connection and that was my first board that I’d ever been on and the American Trauma Society is all about providing resources to not only patients who face traumatic injury but also nurses and physicians in the trauma space.

Then from there, Peter also introduced me to another organization called the National Association for the Advancement of Prosthetics and Orthotics, and that’s a board that I am still currently on, the immediate past president of that board. Yeah. To your other question about advocacy in this space, so the NAOP is part of a group of organizations called the Orthotic and Prosthetic Alliance. There are about five organizations in that group, and we really work collaboratively to figure out what our policy agenda is federally. So the things that we’re working on at the federal level have to do with medicare coverage and reimbursement, and so it can get a little nuanced and complicated, but essentially we’re always advocating for better coverage specifically on some of the newer technologies that come out. So there’s been some successes recently one of which is Medicare. Medicare proposes sometimes these local coverage determination policies, and so they proposed one recently that Hanger and other groups commented on, and then they finalized that rule, and essentially it’s saying that microprocessor knees are now available to more amputees, more people with limb moss. Because initially you had to qualify for a certain level of ambulatory ability in order to get a microprocessor knee and now they’ve expanded it. In part based on research that has shown that microprocessor knees help prevent falls. So those are the things we’re working on.

John: Do me a favor, please unwrap the terminology of microprocessor knee, because right now it sounds exciting. I’d like to have one myself because [inaudible] years old, my knees aren’t through the greatest. So what is a microprocessor knee for our listeners and audience to understand, because it is important to unwrap that a little bit.

Maggie: Yeah. So it’s just a higher-end technology in terms of prosthetics. So if you’re missing your leg above the knee, then your prosthesis is going to have a knee element to it, and so basically a microprocessor knee uses a microcomputer system to control the knees, what we call flexion and extension during the gate. Yes.

John: So it is what it sounds like it is, it’s using technology to help just the improve the whole experience of the prosthetic.

Maggie: Exactly. Yes.

John: Again, I’m not at all being facetious when I ask these questions, I really am very, first of all, genuinely interested. Second of all, fascinated by this, how far away are we from obviously you and I, Maggie cannot turn on our TVs or pick up the newspaper or read our stuff online without ever getting through a day and hearing the terminology now, AI, which probably when your trauma happened, AI was not part of our vernacular or lexicon. So how much is AI going to play a role in the future of prosthetics and are we moving towards more of what look like very futuristic and almost outer space-type stuff when Terminator came out? Are we moving closer to those type of limbs in the future that will even operate better than anything we’ve seen in the last 25 years?

Maggie: Yeah, it’s a good question. I don’t know that I’m the most qualified person to answer that question, but I will say just briefly. In terms of AI at Hanger, the way that we’re starting to incorporate it is clinically so when you go to a doctor’s appointment now you can use AI with the permission of the patient to record the conversation of the visit. That helps in cutting down on paperwork and administrative time. So the goal with that is to really enhance the patient experience in the room with the clinician so that they can have that face-to-face conversation that we should be having instead of half typing on the computer during the visit. So that’s one element. As far as technology goes, prosthetic technology as many people know, has improved dramatically and continues to improve as time goes on. Microprocessor knees have actually been around for a while and there are also what we call myoelectric hands, which is essentially the hand version of that. Which that technology has also been around for a while, and some of them do look robotic, as you say, sort of futuristic looking. Those are continuing to improve as well. So as far as AI in that space, I’m not totally sure that would probably be a better question for a clinician or a researcher, but I can’t imagine that it’s completely excluded.

John: Of course. For our listeners and viewers who’ve just joined us, we’ve got Maggie Bauer with us today. She’s a leader of enterprise patient advocacy at Hanger Clinic. To find Maggie and all of the great people at Hanger Clinic and the important work they’re doing in innovation and orthotic and prosthetic devices, please go to www.hangerclinic.com. Maggie, looking back now with 12 years or so in your rearview mirror on this, what’s the greatest lesson you’ve learned from this trauma that you want people to know about limb loss and limb difference, and why you do the work that you do now as a patient advocate? Why is this work so important in terms of bridging gaps that we have in information across our society of 330 million great American people?

Maggie: Yeah, I think a few of the things that I’ve learned just about trauma and recovery and disability is truly the adaptability of the human spirit, right? Our ability to overcome really intense and severe obstacles at times, and part of what enables us to do that is our creativity. So thinking about different ways of doing things. People with disabilities know this firsthand because even though the Americans with Disabilities Act was passed back in the 90s, we still face a lot of accessibility issues in our country. Physically in terms of wheelchair accessibility and other things but also I think culturally our mindset about disability. So my big takeaway is that personally, and I’ve seen this in a lot of other people who have faced similar circumstances to mine, is you can overcome this trauma and not just be okay and not just survive, but you can actually thrive. There’s a concept of post-traumatic resilience, which is when you have this renaissance period after you go through this trauma, and I certainly experienced that where I joined a women’s speaking group, I took an improv class, I took singing lessons. I just was like, “Let me just try all the things.” It really was a creative and rebirth moment for me that helped me regain confidence and just find my place in the world as a person with a disability. Yeah. Sorry.

John: When you first learned that the vein transfer, I’m saying it wrong of course, but I know what you just said earlier, when the vein failed and you were going to have to have an amputation situation, what was the thing that you thought to yourself that you did in the past, that you weren’t going to be able to do in the future, that eventually you overcame and said, okay, when you decided that you knew you had to get on with it and overcome this horrific situation that you then achieved in the future again, that you were able to do that what you thought you weren’t going to be able to do. What were some of the great milestones that you set for yourself on the recovery side that you started ticking off the list and saying, “Oh, I didn’t think I was going to be able to do that, but I got that done. Now I’m going to go and get this done, and now I’m going to do the next,” as you said, what did your renaissance recovery, which I just love that, that terminology. What did that look like that kept giving you breadcrumbs of hope in that journey that just kept moving forward and moving upwards?

Maggie: It’s a great question. When I first found out that I was going to have the amputation, I don’t recall thinking about specific things that I wouldn’t be able to do, I was just really facing the sadness and the trauma of this loss. So I got dragged out, as I said, there was like a month before the actual amputation, and there were different points where there was one point at a hospital in Western Mass where they said, “Okay, we’re going to have to amputate,” and I just spent the night crying just grieving. That was my plan for my mental health background. I was like, “All right, I need to just sit in this and really deal with it.” So I just cried myself to sleep all night, and this wonderful nurse I woke up in the morning and she had brought a bouquet of roses and put them on my, yeah. So yeah, that was one element. Then I think later on when I was in that renaissance phase, I think I just gained strength from each thing that went right. So the first thing was to join this women’s speaking group which just gave me a place to feel safe and have a voice and start talking about all that I had gone through and it was of course, really difficult to talk about in the beginning. It’s still difficult to talk about sometimes and so having that safe place was like a little cocoon that I then blossomed from. So that group was all about public speaking, and we actually hosted an event on International Women’s Day where I was the MC and giving these talks. So that was another thing. I didn’t really think that I’d ever do public speaking in a large venue and I started doing that. Then when I started with Hanger, that was part of my job, is like speaking to groups of people. So I’ve been doing that more and more on larger stages. Yeah, and I think one thing I didn’t mention before that was huge in my recovery was physical activity. So I was a competitive swimmer growing up from starting at age four all the way through high school. I was just talking with my parents the other day about this is like, I never thought that swimming was all that much fun. We put a lot focus on she should do things that are fun but it was valuable. It taught me so much about endurance and sticking with things and perseverance and there were fun elements of it. I liked racing. But swim practice is like a grind of an hour and a half of just swimming back and forth. It’s not that much fun. But I had done that for so many years. That was part of my personality of like, “Okay, you just keep going. You just keep going.” So that was a lot of my recovery too, was going back to the gym and being physical and sticking with things.

John: You had the right angels that you came across, i.e. your surgeon, that nurse with the roses during some very inflective moments while you were going through this whole trauma journey. Talk a little bit about the critical importance of what I call the gentleman who created the 12 Step Program, wrote a poem called Standing By the Door and how once you come through addiction recovery, you don’t ever want to get so far away from it where you don’t remember the journey itself, so you’re not able to help other people through it. I assume part of the recovery process, the important part of the recovery process is for great people like you, great advocates like you, and many others that have come along this journey and done so well and turned, as you said, a survival into thriving are able to turn back and grab the hand or the heart of the next person that’s going through this and say, “Hey, I went through this. You’re going to get through this. I’m going to help you through this, and you’re going to be just fine.” Is that a big part of this whole sort of symbiotic recovery process that you went through and that others go through on a regular basis who do well on the other side?

Maggie: A hundred percent. Yeah, that was very well said. As I mentioned, I had Mike Benning, who was my peer visitor, who I met in the very beginning, who talked to me about what it’s like to wear a prosthesis, and how to do everyday things as well as Carrie Davis, who is also works for Hanger and she’s our vice president of Patient experience, and she was born without her left arm below the elbow, and I’m missing my left arm below the elbow. So being able to talk with both of them was really important for me. Then like I mentioned, I started also providing peer visits to people who are newer. So our program recommends, and the Amputee Coalition has a peer visitor program as well where we recommend that you’re at least a year out from your amputation so that you’ve had some time to process your own recovery and trauma. Then you go through a training of do’s and don’ts of what to say in a peer visit and mostly you’re there as a listener, but then you can also speak from your own experience. So I went through that and I provided peer visits to other people who were just starting out. Then I started a support group in our area, which I recently handed off to my colleague who’s doing an excellent job with it. So yeah, I think that is a huge part and piece of recovery is you become part of the community of people who understand what you’re going through. There’s diversity of course within our space too, so not everyone’s story is exactly the same. Missing an arm is different than missing a leg, but there’s still a common piece, a common thread of understanding what this process is like. So now in my advocacy role, I’m not running a support group anymore, but I do still do peer visits occasionally, and now I’m giving back through the advocacy, which is trying to change laws and coverage for prosthetics and orthotics.

John: Is that on a state-by-state basis besides on a national, federal basis?

Maggie: Yes, it’s both. So my focus through my role at Hanger is mostly on state-by-state initiatives right now, although there is federal work as well. But the big one right now is a really exciting movement close to my heart. It’s called, so Everybody Can Move. Yeah. But it’s very [inaudible]

John: I like it. I love it.

Maggie: Yes. Essentially, this movement is national, but it’s based on, like you say, state-by-state legislation. The ethos behind it is that movement is medicine and that access to physical activity is a right not a privilege, and what we’re seeing though across the board, which has been the case for a long time, is that most commercial payers and Medicaid did not provide coverage for prosthetics and orthotics for physical activity. So what does that mean? Well, you’re seeing now on the Olympics and the Paralympics people wearing those curved running blades. Those are not covered by insurance I should say, unless sometimes the VA will cover them. So veterans do get some coverage for those, and sometimes workers’ comp do as well, but the commercial payers and Medicaid, we don’t have access to that. So we really believe that that’s discriminatory that…

John: That explains to me what their intent of lack of coverage is for them just to- is it just a total money grab or do they have some sort of theoretical reasoning that they even could put forward that would make any sort of sense whatsoever?

Maggie: Yes, good question. Their theory is based on the definition of medical necessity. So they believe that medical necessity has to do with your ability to complete what we call activities of daily living. So brushing your teeth, showering, walking and so their argument is that if somebody can walk, that’s sufficient. They don’t need to be able to run, and here’s part of the problem is that let’s say you’re missing your leg and you wear a prosthetic leg, the prosthetic leg that you wear for everyday use just to walk around is not designed for running. That’s why that running light looks completely different. So if you run on your everyday prosthesis, you can cause yourself injury, dislocated joint, cause hip problems, get blisters, get infections, it’s just not a good idea because you could cause yourself problems. But as you mentioned having a second device, which I will say I have access to through Hanger. Thank you, Hanger. Because my everyday prosthesis is not designed for physical activity. I have what we call, you can see it at this great here, a silicone restoration device. So it is a passive hand. It doesn’t grab things, but it matches my body weight, and my skin tone. It allows me to [inaudible], yeah. But I also have a totally different device made out of carbon fiber that has what we call detachable terminal devices. So those terminal devices are things that are made for specific activities like skiing or there’s a paddle one that would wrap around a paddle so I could row, or there’s one for weightlifting. There’s also one that’s just a round rubber piece that I use for yoga. So they’re two totally different things and we need two in order to live full lives.

John: But that makes total sense now that you explained it, who’s just going to live almost a singular purpose life just to do the bare- it almost sounds like they’re willing to support or finance the bare minimum threshold of getting through life functionally. But all the other things that everybody else gets to enjoy are literally precluded because the device is not set up to allow participation.

Maggie: Exactly. You got it 100% right.

John: That’s not.

Maggie: That’s discrimination. Yeah.

John: Geez. Now I get it. So talk to me about solutions. We have a fairly large audience in the United States and around the world. How do we go about working and joining forces with great people like you and the organizations that you’re working with and working together with so everybody can move and others, so we can make a society that’s more equitable for those who have disabilities, limb loss, limb difference and things of that such, how can we all participate in bridging these gaps?

Maggie: Yes. Well, as far as so everybody can move goes, it’s really exciting to say there have been eight states that have passed laws in three years. So it’s catching on. It’s a really exciting mobile movement, and if you go to this, soeverybodycanmove.org website, there is a map on there that shows the eight states that have passed laws, eight more have introduced bills, and 17 or more other states are working on building coalitions.

John: We’ll put that in our show notes. We’ll put a link to that in our show notes for sure. That’s great.

Maggie: Excellent. Yeah. So that’s my shameless plug is for people to go to that website and there’s a way that you can contact the group to say that you’re interested and want to get involved so everybody can move in your state. So that’s one way.

John: Got it.

Maggie: I would say another way is, like you mentioned, disability at large when we’re working on, So Everybody Can Move or other initiatives, we often want to partner with organizations that aren’t so specific to amputees, maybe like adaptive sports groups or a lot of people that we service have MS or diabetes, other health conditions like that. So any of those organizations we’d love to partner with. So if people want to find me on LinkedIn or I can provide my email address in the notes as well.

John: Perfect.

Maggie: But we’d love to connect with folks that way too.

John: That’d be awesome. Talk a little bit about you have a fascinating background, obviously legal training, and mental health training. When you wake up every day and you do this semi-new role that you’re in as leader of enterprise patient advocacy at Hanger Clinic, what do you lean more on now? Is it your legal background? Is it your mental health background? Is it a healthy soup of both? How does that work in terms of your career as it’s evolving here?

Maggie: I love that question. Nobody’s asked me that before. I think a soup of both. I’m a very strong believer in mental health, self-care, and self-awareness. So that’s a big part of just who I am and my everyday practice. I like to meditate before I start working. So yeah, that’s a big piece. But the legal piece you know this too, having gone to law school, I think the legal education, at least for me it wasn’t totally natural. It’s a whole other language. When you start reading Kislaw Law, even though it’s written in English, the older cases are written in this archaic old English verbiage and you’re kind of like, “What are they saying?” So it took a minute for it to click, and then once it clicks, then you can start reading the cases a lot faster. I just always note after law school that it’s a mindset. It’s a way of thinking that I didn’t have before and I think it’s really valuable to me because again, not necessarily my default way of thinking, but now that I’ve learned it, it’s like you can’t unsee something. So it’s really useful to me in making decisions, in weighing evidence, in…

John: Critical thinking.

Maggie: Critical thinking, analyzing arguments, figuring out what’s really true and right. So yeah, it’s a big part of what we do.

John: Hanger is doing such important work and they have great people like you on the front end of this patient advocacy. Let’s give some shameless plugs to Hanger Clinic now. What are they working on? Or give us a little preview of some cool innovations or initiatives that you’re jazzed about that you could share with our audience that they’re working on right now to help… how do we say this the right way? Enhance and prove the lives of individuals who have these traumatic events happen to them, these tragedies happen, and who are going to overcome them because of Hanger’s great innovations and products.

Maggie: Thank you for asking that. Great question. So Hanger does a lot, and we’re continuing to grow and evolve and enhance our space. So one of the ways we do that is we host regular events one of which is called Empower Fest. It moves around to different parts of the country. I’m not sure at this point how many we have a year. It might be one per year, but they’re essentially conferences for people with limb loss and limb difference to come and learn and come and see from other people and things like how to fall. If you’re missing a leg or two legs and you’re wearing a prosthesis, it’s important to know how to fall correctly in case you didn’t know that was a thing because you could fall and really injure yourself or you could fall and just absorb the shock and be okay and less inclined to injury. So those in Power Fest events are great learning opportunities. They’re great social opportunities. They build community. We also have an event called BAKA, which stands for Bilateral Above Knee Amputee Bootcamp. So you can imagine if you’re missing one leg, you still have the other that’s sound and can help you ambulate. So when you’re missing both of your legs, it presents more challenge and it’s more taxing on your body to wear two prostheses. So that event really helps people who are missing both legs, again, to learn to see from other people who are in the same boat about how to do this, how do I actually walk onto prosthesis? So those are important events that we host. We also have our clinical and scientific affairs department, which has published a lot of research in the last five or 10 years. So that’s another area of our website that people can explore. That research is key in helping me do what I do advocacy because now we have published evidence to show, for example, why a microprocessor is appropriate for different groups of folks that are missing their leg. So that’s another piece that we’re really proud of at Hanger is the research we’re putting forth to help change policy. We also, along with that, collect a lot of outcomes. So we use what are called outcomes assessment tools to measure folks and say, “Look, here was your quality of life and your walking ability before you got the prosthesis. Here it is after, and here’s what it looks like six months, a year down the line.” That helps both the person with limb loss to set goals for themselves, but also the clinicians to see, okay, it’s going really great here, oh, but now some things changed, maybe we need to make an adjustment in the prosthesis, or maybe I need to ask more questions about what’s going on with this person to figure out if there’s a problem we can solve.

John: That’s fascinating. How about for you personally? This is a new role for you. You’re still obviously very young and very brilliant and you have a long road ahead of you. What are your specific goals in the next… we’re coming to the end part of 2024. What are you looking forward to the most in 2025 and 2026 to accomplish in this new and important role that you have at Hanger Clinic, Maggie?

Maggie: I am really looking forward to continuing to promote so everybody can move, passing more laws in more states, and hopefully introducing some federal legislation so everybody can move one of the taglines with that. Which again, this just to be clear So Everybody can Move is not a Hanger initiative. It’s a group initiative of partners in the orthotics and prosthetic space, but I’m very focused on it in my role. So one of our taglines is 28 by 28, meaning we want to get 28 state laws passed by 2028, which is when the Olympics and Paralympics will be in Los Angeles here in the US. But I think maybe perhaps we could get a federal law passed sooner or try to introduce one sooner than that. If we were able to do that, then that federal law would trump the state law and we would have less work to do and more people to support through that advocacy. So that’s one thing. Then the other thing is to really work on Medicaid coverage and reimbursement there. Some states do really well. Other states are really suffering in that space. So that’s a big focus of mine in 2025.

John: That coverage would be helping people get covered both for their prosthetic that allows them to live on a day-to-day basis, functionally, but also then the second limb that allows them to do the things that we all love in life and that they should also have access to and many of them are now being excluded from because of lack of resources in coverage.

Maggie: Correct. Exactly.

John: Well, my money’s on you, Maggie, I’ll tell you that right now.

Maggie: Thank you.

John: So I don’t think it’s anything that you can’t do, and I think that you’re going to get to achieve that 28 by 28, unless you transcend it with the federal law, which would even be more fun too to see you do that. But you’re always welcome back on this show to continue sharing your journey and the journey at Hanger Clinic in this very, very important work that you’re doing of patient advocacy and also making a more equitable country and world for all of us to live in. So we all have access to really fun things that make life worth living. Your work is just absolutely critical. I’m so glad we had a chance. For this conversation today for our listeners and viewers, we’re going to put a lot of the organizations and important information that Maggie discussed during this show in our show notes. We’ll make links to all that. Maggie, I just want to say again, thank you for your time today, which was just delightful for me to understand and get a better understanding with our audience of what you’re doing and why you’re doing it. But thank you sincerely for making the world a more equitable and a better place.

Maggie: Thank you so much, John. I really appreciate being on the show and meeting you and having some time to chat with you. I really appreciate it.

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