2020 October O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

O CTO B E R 2020

AOPA Unveils Diversity and Inclusivity Initiative P.10

Differentiating the Medicare Contractors P.18

Time To Revamp Your Financial Procedures? P.34

New Considerations for Emergency Preparedness P.38

THE PROGNOSIS FOR

U.S. HEALTHCARE AS WE LOOK TO RECOVER FROM THE PANDEMIC, SIX PREDICTIONS THAT MAY IMPACT O&P BUSINESSES

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This Just In: Highlights From AOPAâ&#x20AC;&#x2122;s Virtual National Assembly P.22

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Hear from the best in business education and advanced clinical programming. The Assembly has something for everyone…technical, orthotic, prosthetic, pedorthic, and business education all available.

National Assembly Content Available for Remainder of 2020

Earn over 100 CE credits. The platform will remain open until the end of 2020, so you have plenty of time to watch any and all sessions and peruse the exhibit booths. All of this is right at your fingertips on the easy-to-use Assembly platform that is mobile, computer, and tablet responsive. If you attended, just use your Assembly login. Registration is still available if you didn’t attend. Visit www.AOPAassembly.org to learn more.

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ADVOCACY | RESEARCH | EDUCATION

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Questions about the National Assembly? Contact AOPA at 571/431-0876 or email Assembly@AOPAnet.org.

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OCTOB E R 2020 | VOL. 69, NO. 9

contents

COVER STORY

FEATURES

COLUMNS Reimbursement Page.......................... 18

Unscrambling the Acronyms

The meaning behind some of the commonly used Medicare abbreviations

26 | The Prognosis for U.S. Healthcare The COVID-19 pandemic has changed the narrative on healthcare in the United States, according to AOPA Virtual National Assembly speaker and healthcare futurist Michael Lovdal, PhD. Find out what’s on the horizon regarding expansion of public health, telehealth adoption, hospital and health systems reinvention, and more. By Josephine Rossi

22 | This Just In

Learning, Recharging, Connecting Participants at this year’s AOPA Virtual National Assembly benefitted from top-notch education, exposure to the latest O&P products and services, and lively interaction—all in a virtual format. See photos and read highlights from the first-of-its-kind industry event.

34 | Cost-Effective Collections

Given escalating healthcare costs and a rise in provider bankruptcies, it’s time for facilities to re-examine their billing practices, adopt technologies to facilitate the process, and implement procedures that will lead to faster and more reliable patient collections. By Christine Umbrell

Opportunity to earn up to two CE credits by taking the online quiz.

Compliance Corner............................... 38

Contingency Planning During the COVID Pandemic

Emergency preparedness in a new era

Opportunity to earn up to two CE credits by taking the online quiz.

Member Spotlight.................................46 n

A Step Ahead Prosthetics

DEPARTMENTS Views From AOPA Leadership......... 4 Investing in O&P research

AOPA Contacts............................................6 How to reach staff

Numbers........................................................ 8

At-a-glance statistics and data

Happenings............................................... 10

Research, updates, and industry news

People & Places........................................ 14

Transitions in the profession

AOPA News............................................... 48

AOPA advocacy, announcements, member benefits, and more

PRINCIPAL INVESTIGATOR Nerrolyn Ramstrand, BPO (Hons), PhD................................................................... 42 Meet a prominent O&P researcher who also serves as advisor to the president of Jönköping University in Sweden. Ramstrand’s recent investigations have focused on the effects that prostheses and orthoses may have on attentional demand of users. 2

OCTOBER 2020 | O&P ALMANAC

O&P PAC..................................................... 50 Welcome New Members.................. 50 Marketplace............................................... 51 Careers......................................................... 56

Professional opportunities

Ad Index........................................................57 Calendar...................................................... 58

Upcoming meetings and events

State By State.......................................... 60

Arkansas, California, Kansas, and New York

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VIEWS FROM AOPA LEADERSHIP

Research—What’s in It for You?

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

WO YEARS AGO, I wrote in this column about the importance of research: why it was a

priority for AOPA and why all O&P professionals should care about it. Today, I reaffirm research’s value. Unfortunately, there is currently limited original O&P outcomes research happening. In order to advance both the evidence-based clinical practice and technological development aspects of the profession, as well as advance our legislative and regulatory priorities, we must continue to invest time, energy, and resources into research. AOPA has committed to addressing the lack of research, starting with the establishment of a Research Pillar and naming a dedicated research chair who guides the AOPA Board of Directors in decisions surrounding research. The most significant way AOPA invests in O&P research is by direct funding. In 2020 alone, AOPA awarded more than $139,000 in research dollars through the Center for O&P Learning (COPL): $94,000 in pilot grants and another $45,000 in supplemental funding. We were encouraged that we received more than double the submissions for grants compared to past years. This is a sign that there is more interest in conducting O&P research. The goals of AOPA pilot grant funding are twofold: first, to encourage newer researchers to continue their careers in areas of study that will contribute to the O&P evidence base, and second, to enable O&P researchers to develop the pilot data necessary to build larger studies and apply for funds from federal funding institutions. An example of a successful project maturation is the recent $2 million U.S. Department of Defense (DoD) award for the study of fall-related health outcomes in lower-limb prosthesis users, which includes the largest clinical trial of microprocessor-controlled knees to date. Previous AOPA-funded COPL pilot grant recipients at Hanger Clinic’s Department of Clinical and Scientific Affairs, the University of Washington, and the University of Illinois at Chicago are among the site leads for this project. These types of large-scale studies are necessary to build a robust evidence base that supports the clinical efficacy of O&P services. Other studies, like “The IMPACT Study: Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation,” also support the cost effectiveness of providing quality O&P care to patients. Another way AOPA is furthering research is through our relationships with our federal research partners at the DoD and National Institutes for Health. Through these partnerships, AOPA has the opportunity to provide insight regarding evidence gaps, areas of focus for profession-funded research, and projects designed to incorporate the evidence base into clinical practice. Additionally, AOPA advocates for the appropriation of federal dollars to ensure these programs continue to be available as viable sources of funding for O&P researchers. Finally, we promote the work being done in the field through the Principal Investigator column in O&P Almanac. Each month we highlight a researcher and what they are doing to advance the field. Furthering O&P research is critical to the profession’s future. It will reinforce the clinical efficacy and effectiveness that we as clinicians provide, help us define our value to healthcare, and, more importantly, improve the care we provide patients. So, what can you do? • Educate yourself on the value of research. Read journal articles and assist with recruiting subjects for studies. Then encourage your colleagues to do the same. • Apply what you learn from outcomes data to best treat your patients. • Collect outcome measures and get involved in studies that demonstrate the value of specific interventions. This information will be of interest as payors seek data to support coverage decisions. • Hire/encourage new clinicians who have learned about outcome measures and research techniques during school to help you facilitate research initiatives and/or develop collaborations with research institutions. Jeffrey Lutz, CPO, is president of AOPA. 4

OCTOBER 2020 | O&P ALMANAC

Board of Directors OFFICERS President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA President-Elect Traci Dralle, CFm Fillauer Companies, Chattanooga, TN Vice President Dave McGill, JD Össur Americas, Foothill Ranch, CA Immediate Past President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Treasurer Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA DIRECTORS J. Douglas Call, CP Virginia Prosthetics Inc., Roanoke, VA Mitchell Dobson, CPO, FAAOP Hanger, Austin, TX Elizabeth Ginzel, MHA, CPO Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Spring Lake Park, MN Rick Riley Span Link International, Bakersfield, CA Linda Wise WillowWood, Mount Sterling, OH NONVOTING MEMBERS Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX Eve Lee, MBA, CAE Executive Director/Secretary American Orthotic and Prosthetic Association, Alexandria, VA

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AOPA CONTACTS

American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

Publisher Eve Lee, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC

Our Mission Statement Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care.

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met. EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

Eve Lee, MBA, CAE, executive director, 571/431-0807, elee@AOPAnet.org

Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org

Tina Carlson, CMP, senior director, membership, education, and meetings, 571/431-0808, tcarlson@AOPAnet.org Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org GOVERNMENT AFFAIRS Justin Beland, director of government affairs, 571/ 431-0814, jbeland@AOPAnet.org COMMUNICATIONS, MEMBERSHIP & MEETINGS Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876

OCTOBER 2020 | O&P ALMANAC

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

STRATEGIC ALLIANCES Ashlie White, MA, director of strategic alliances, 571/431-0812, awhite@AOPAnet.org O&P ALMANAC Eve Lee, MBA, CAE, executive director/publisher, 571/431-0807, elee@AOPAnet.org

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2020 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac20 for advertising options!

NUMBERS

What Are Your Patients Seeking? Studies offer insights into consumer preferences in their healthcare experiences

Today’s patients prefer providers who listen and who demonstrate they care about their patients. Surveys from the Deloitte Center for Health Solutions offer a new understanding of U.S. consumers’ behaviors and attitudes toward health.

PREFERENCE FOR IN-PERSON INTERACTIONS

66 Percent Believe that a healthcare provider should physically examine them to understand their health needs

15 Percent

19 percent

Used virtual visits in 2019

Used virtual visits in early 2020

Don’t think they get the same quality of care/value from a virtual visit as from an in-person visit

USE OF TECHNOLOGY FOR HEALTH AND FITNESS

28 Percent

80 Percent

Used virtual visits in April 2020

Of those who used telehealth are likely to have another virtual visit

42 Percent

Have used tools to measure fitness and health improvement goals in past 12 months

WILLINGNESS TO VOICE DISAGREEMENT WITH HEALTHCARE PROVIDERS

51 Percent

Extremely/very likely

29 Percent

Somewhat likely

19 Percent

Slightly/not likely

Most Important Factors for an Ideal Experience With a Healthcare Provider A provider who listens to me and shows they care about me

44%

A provider who spends time with me and does not rush through the exam

42%

A provider who clearly explains what they are doing during the exam and what I need to do after the visit

39% 25%

OCTOBER 2020 | O&P ALMANAC

Providers who communicate with each other and coordinate treatment

28 Percent

Have used tools to monitor blood sugar, blood pressure, breathing function, or mood

“In our Deloitte research on consumer experience, we repeatedly found that the healthcare provider relationship remains the top priority for consumers.” —“Are Consumers Already Living the Future of Health?” Deloitte Insights, August 2020.

SOURCES: The Deloitte 2020 Survey of U.S. Healthcare Consumers and the Healthcare Consumer Response to COVID-19 Survey, Deloitte Insights, 2020.

GROWING USE OF TELEHEALTH

56 Percent

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Happenings

AOPA Debuts Diversity and Inclusivity Initiative

AOPA releases statement and announces plans to take genuine, meaningful action In late September, AOPA announced the launch of its Defining Diversity and Inclusion Initiative. The association will take several steps to address racism and increase diversity in the O&P profession. Following is AOPA’s full statement: The American Orthotic and Prosthetic Association (AOPA) represents a vast majority of the orthotics and prosthetics profession who aim to better the lives of individuals with limb loss and difference and those whose lives are improved by orthotic devices. As such, AOPA affirms that discrimination in all forms is unacceptable and will not be tolerated. This includes racism, sexism, ageism, ableism, and all other forms of discrimination and unequal treatment. Given that Black Americans lose limbs at higher rates than non-Hispanic white Americans, it is only right and appropriate that our profession ensures safe, fair, and equal treatment for these individuals. It also is right and appropriate that these and all individuals are fairly represented within our profession, ensuring patients see themselves reflected in those who care for them. In the coming year, AOPA will launch our Defining Diversity and Inclusion Initiative, taking genuine, meaningful action

to look inward and identify, define, and rectify points of inequality and discrimination and resolve to address racism and increase diversity in the profession. The initiative will begin with the hosting of dedicated roundtables, which will provide members an opportunity to discuss what actions they have in place, their feelings on how to further diversity and inclusion, as well as what AOPA can do to better support them, the profession, and patients in order to take meaningful action. To express interest in participating in a roundtable, please contact AOPA Director of Communications and Marketing Joy Burwell, jburwell@AOPAnet. org. We will follow up with specifics on the roundtables, including dates and times. Thank you for all you do for AOPA, the profession, and—more importantly—the patients. We look forward to working with you to address racism and increase diversity in the profession. Together we will make a difference.

If you have any questions, please contact Joy Burwell at jburwell@AOPAnet.org. 10

OCTOBER 2020 | O&P ALMANAC

HAPPENINGS

RESEARCH ROUNDUP

Study Finds Improved Quality of Life for Osseointegration Patients

PHOTOS: Getty Images

Despite the occurrence of adverse of particular importance, according to events, health-related quality of life sigDavid Reetz, MSc, MD, a study author nificantly improves after bone-anchored and resident at Radboud. According to prostheses are implanted in individuals Reetz, infection is regarded to be the with transfemoral amputation who most threatening complication, with experience limitations from their socket, potential loss of implant. “In the medical according to a new study. Published in field, unfortunately, many physicians the Journal of Bone and associate a bone-anchored Joint Surgery in August, a prosthesis with chronic long-term investigation infections and septic of individuals using implant loosening,” he osseointegrated prossaid. Among study partictheses indicated overall ipants, “most infections positive outcomes for seemed to occur within amputees with implants. the first two years and did Researchers at not lead to deep infecRadboud University tions”—instead they were Medical Center in the soft tissue infections that Netherlands conducted could be managed with a study of 39 patients simple measures. “No deep who had undergone infections leading to septic implantation of a implant loosening were press-fit osseointegration Closeup of osseointeregistered in this cohort,” gration surgery stoma implant between May Reetz added, citing 2009 and November advances in the surgical 2013. The researchers looked for soft tissue approach to create the adverse events, including infectious stoma, as well as advances regarding complications (grades 1 to 4), aseptic durability of implants, as possible loosening, breakage, stoma-redundant reasons for fewer negative outcomes. tissue, and stoma hypergranluation. “It is important to address that In studying five-year postimplant bone-anchored prostheses are not records of the subjects, the Radboud replacing socket-prostheses,” added team found that 77 percent of patients Reetz. Implants are “an excellent presented with some level of infection, alternative for patients suffering from with 95 percent classified as less critical socket-related problems.” He also grades 1 or 2; 5 percent as grade 3; and noted the important role played by 5 percent as grade 4. There were no prosthetists after the osseoointegrainstances of septic loosening. Softtion procedure: “Even if there is no tissue refashioning was needed for 14 socket … prosthetists are the profesof the 39 patients. Scores for median sionals to select and align the artificial prosthetic use improved significantly. leg and service the connector and The low levels of severe infections are other parts of the implant system.”

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Patients With Diabetes and Gout Face Increased Amputation Risk

Researchers have identified an increased risk of amputation among individuals with diabetes who also have gout. Gout is a disease in which defective metabolism of uric acid causes arthritis, especially in the smaller bones of the feet; deposition of chalkstones; and episodes of acute pain. Led by Brian Lamoreaux, MS, MD, from Lake Forest/USA, a research team evaluated 190 million data sets from a patient database to study amputation trends. They divided patients into four groups: patients with gout, patients with diabetes, patients with both gout and diabetes, and patients with neither disease. The amputation rates of patients suffering from neither disease was 0.03 percent; those with gout was 0.16 percent; those with diabetes was 0.46 percent; and those with both was 0.77 percent. “Patients suffering from either gout or diabetes have a significantly increased risk of amputation,” said Lamoreaux. “In patients | with both diseases, this effect is further amplified.”

O&P ALMANAC | OCTOBER 2020

HAPPENINGS

PRIOR AUTHORIZATION

DME MACS Begin Accepting Requests for Prosthetic Codes The DME MACs began accepting prior authorization requests (PARs) for codes L5856, L5857, L5858, L5973, L5980, and L5987 for all beneficiaries in California, Michigan, Pennsylvania, and Texas on Aug. 18, 2020, for items delivered on or after Sept. 1, 2020. The early submission date allowed for the 10-day processing time for all PARs. Here is quick recap of the prior authorization process: • Complete your DME MAC’s PAR coversheet for LowerLimb Prosthetics. • Submit the coversheet and all supporting documentation (the standard written order and any additional records to support medical necessity) for review. Submissions may be completed by fax, mail, or DME MAC web portals. • Receive either an affirmative or nonaffirmative decision and a unique tracking number (UTN). • If you received a nonaffirmative PAR, you may attempt to fix any errors and resubmit your PAR.

CODING CORNER

CMS Clarifies Resumption of Audit Activities CMS recently announced that the resumption of certain audit activity on Aug. 3, 2020, would be carried out in a phased approach to allow suppliers time to prepare and adjust. The audits began with limited durable medical equipment Medicare administrative contractor (DME MAC)-based postpayment reviews and involve only claims with dates of service prior to the beginning of the declared public health emergency on March 1, 2020. CGS, the DME MAC for Jurisdictions B and C, announced it would be conducting a complex postpayment review

for L0650, an off-the-shelf lumbosacral orthosis. The review would be for claims with dates of service prior to March 1, 2020. If you receive additional documentation requests as part of this review, be sure to respond to them; however, be advised that CMS has implied that the DME MACs may allow for flexibility with extensions and the cancellation of audits based on an individual supplier’s ability to complete the audit. Currently, no timeframe has been announced regarding when the Target, Probe, and Educate program and other audits will resume.

PARALYMPICS PREVIEW

Competition Schedule Revised for 2021

L L59 856FACT 3 7 L5FAST L59

International Olympic Committee (IOC), confirmed in early September to news agency AFP that the Olympic Games would start on July 23 next year. The IOC may limit spectators and simplify the Opening and Closing Ceremonies, according to Tokyo 2020 Chief Executive Toshiro Muto, depending on the spread of COVID-19 next summer.

Reamputation Risk After Toe Amputation In a study of nearly 18,000 veterans who had undergone initial toe/ray amputations related to diabetes,

34 percent had another amputation on the same limb within one year, including 10 percent who had a major ipsilateral amputation.

SOURCE: “Risk of Ipsilateral Reamputation Following an Incident Toe Amputation Among U.S. Military Veterans With Diabetes, 2005-2016,” Diabetes Care, March 2020.

OCTOBER 2020 | O&P ALMANAC

PHOTO: Clive Rose/Getty Images

The Tokyo 2020 Organizing Committee has announced a new competition schedule for the delayed 2020 Paralympic Games, to be held Aug. 24 through Sept. 5, 2021. The Games will feature 539 events across 22 sports contested at 21 venues, and 4,400 athletes are expected to compete. The schedule features a midway point, August 29, when 63 medal events If you received an affirmative will be held—the most of any day during PAR, you may submit your comthe 2020 Paralympics. Two new events— plete claim for payment; be sure to 5856 L badminton and taekwondo—will debut include your UTN on the claim. 858 987 during the latter half of the Games. Visit 5 L 5 7 6 https://tokyo2020.org/en/paralympics/ L585 5980 L 8 L585 6 to see the full schedule. 7 L585 5973 L 7 L585 L598schedule L John Coates, vice president of the 5 58 80

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Kathleen DeLawrence, chief operating officer of Ability Prosthetics & Orthotics in Exton, Pennsylvania, has been selected as the 2020 O&P Woman of the Year. Orthotic Prosthetic Group of America (OPGA) presented the award to DeLawrence during a special virtual event on Sept. 9, 2020, during the AOPA Virtual National Assembly. Kathleen DeLawrence “What an honor to be selected as the OPGA Woman of the Year!” said DeLawrence. “I am humbled by the opportunity to represent all women working in our amazing profession. Most importantly, to the Ability team, this award is a reflection of you and your incredible efforts treating our patients.” Under DeLawrence’s leadership, Ability has matured and is poised for growth while focusing on serving patients. DeLawrence also spends time coaching and mentoring executives, owners, and staff within the profession to help them bring better solutions and leadership to their organization. Mark M. Jones, MD, has been appointed to Hanger’s Board of Directors, increasing the size of the board to 10 members. Jones currently serves as chief of orthopedic surgery at Johnston Willis Hospital in Richmond, Virginia, and is a practicing orthopedic surgeon at OrthoVirginia. “As a respected physician with more than 20 years of experience in a field linked closely to the orthotics and prosthetics profession, Dr. Jones brings invaluable expertise and firsthand knowledge of patient care to our board,” said Vinit Asar, president and chief executive officer of Hanger. “Dr. Jones will provide a valuable leadership addition to our board, particularly regarding Hanger’s commitment to clinical research and driving superior patient outcomes. His expertise will also help the company execute as we continue moving forward into the future of value-based care.” Sam Liang has announced his intention to leave his position as Hanger Clinic president and retire, effective November 13. During his tenure, Liang “led many key initiatives that helped progress the operations of Hanger Sam Liang Clinic, and has been a clear champion for our patients, epitomizing our value of being patient focused,” said Hanger Chief Executive Officer Vinit Asar. “Most recently, Sam has shown great leadership for our Hanger Clinic teams, ensuring they have the resources and support needed to provide our patients with essential and critical orthotic and prosthetic care, despite the global 14

OCTOBER 2020 | O&P ALMANAC

pandemic we’re navigating. Sam is certainly very deserving of this next phase of his life, and we wish him the very best.” Michael Oros, CPO, LPO, FAAOP, has been named Hanger Clinic zone vice president at Hanger Inc. The promotion will be effective Jan. 1, 2021, and at that time, Oros also will serve as part of Hanger’s Operating Team. Michael Oros, Oros, a past president of AOPA, has more CPO, LPO, FAAOP than 30 years of industry experience, beginning his career as a staff clinician and taking on roles of increasing responsibility throughout the years. Most recently, he spent 24 years at Scheck & Siress, where he joined as a lab manager and clinician before serving as corporate vice president, president, and eventually chief executive officer, a role he held for six years. Oros joined Hanger Clinic earlier this year as regional vice president through the acquisition of Scheck & Siress. Oros is active in AOPA, having served on the Board of Directors, and as vice president, president, and immediate past president of the organization. He also served as chairman of clinical content for AOPA’s National Assembly from 2018 to 2019.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Union Orthotics & Prosthetics Co. and De La Torre Orthotics and Prosthetics, both located in western Pennsylvania, have announced the completion of a merger of the two clinical providers. The combined company will continue to operate under both the Union and De La Torre brands. Ann Moss, president of Union, will serve as the president of the new combined company. Paul De La Torre, CPO, chairman, and Ed De La Torre, president, will work with the management team through the transition to a single organization. “Our shared culture as successful family businesses, combined with our complementary capabilities in both orthotics and prosthetics, made this merger an ideal fit for serving our patients throughout western Pennsylvania,” said Moss. “This merger of equals will ensure that the high level of patient care on which both companies have built their reputations will continue for many years to come,” said Paul De La Torre. VGM Insurance Services has been named one of Business Insurance magazine’s Best Places to Work for 2020. The program recognizes employers for their outstanding performance in establishing workplaces where employees can thrive, enjoy their work, and help their companies grow. “We are humbled to once again be recognized as one of the Best Places to Work in the insurance industry,” said Mike Kloos, president of VGM Insurance. “It’s a testament to our team of employee owners that foster a culture encouraging collaboration and professional growth, which ensures exceptional service for our customers.”

Tel: 727.528.8566 Tel: 800.574.5426 www.easyliner.com info@easyliner.com

Please read our pledge and join us by taking similar, impactful actions to create a more inclusive profession that will ultimately better serve all. Questions about our efforts or how to get started? Contact: Lisa Lodyga-Uhl

Director of Talent Management, Inclusion, and Engagement at Hanger, Inc. LLodyga@Hanger.com

HANGER.COM/DIVERSITY

HANGERâ&#x20AC;&#x2122;S DIVERSITY & INCLUSION PLEDGE It is imperative that we as a healthcare profession come together to publicly condemn social injustices and enact meaningful change against racism and inequality. We are a profession that stands for inclusion and respect for each and every person, irrespective of race, gender, disability, religion, sexual orientation, or any other trait that makes us unique from one another. We are a profession that restores hope, mobility, and independence, and that does not stop inside the walls of our organizations. We must also be a group of people committed to cultivating a culture of inclusion and empathy not only in our workplaces with our colleagues, our patients, and allied care providers, but also in our communities, each and every day and in each and every interaction.

At Hanger, including Hanger Clinic, ACP, and SPS, we are taking the following initial, tangible actions that will help contribute to the dismantling of systemic racism, interrupt bias, and in turn, create a more inclusive profession that will ultimately better serve all:

DEDICATED RESEARCH: Data indicates that within the United States, amputation is significantly more prevalent among people of color, so as a starting point, we will dedicate clinical research to this area of focus.

DIVERSE RECRUITMENT: While we strive to recruit diverse candidates across Hanger for all positions, there is currently an underrepresentation of people of color, particularly Black students, graduating from O&P programs; we are committed to being part of the significant change to attract more diverse candidates into these programs.

HANGER DIVERSITY & INCLUSION COUNCIL: Chaired by President and CEO Vinit Asar, the Hanger Diversity & Inclusion Council will identify specific actions we can take to increase diversity and foster inclusion at Hanger and within the O&P profession.

UNCONSCIOUS BIAS TRAINING: We will continue to expand upon our unconscious bias training throughout the organization to bring awareness to individual biases and better address them in the workplace.

AFFINITY GROUPS: We recognize employee affinity groups can play an important role in fostering a more inclusive work environment, by providing spaces for employees and allies to connect, collaborate, and share professional and personal resources. We will continue to encourage employee participation within our existing groups created for individuals with disabilities, people of color, LGBTQ, veterans, and women, and will continue to launch new groups of interest to our team members.

We are committed to continuing and expanding these efforts, and ask that you join us by embarking on similar, impactful actions to serve as a continuation of statements already released by many healthcare organizations on this important topic.

REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

Unscrambling the Acronyms O&P providers should understand the abbreviations associated with the Medicare program to ensure claims are processed quickly and correctly

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.20

HE MEDICARE PROGRAM HAS no

shortage of acronyms to describe its various programs and initiatives. From the government agency that oversees the Medicare program (CMS), to the coding systems that are used to submit claims (CPT, HCPCS, ICD-10), to the types of healthcare services Medicare covers (DMEPOS, ESRD, ASC, etc.), acronyms are everywhere. This month’s Reimbursement Page takes a closer look at some of the acronyms used to describe the various contractors that the Medicare program uses to process claims, perform audits and appeals, and conduct program integrity functions. Each contractor serves a unique and specific function. While O&P providers may interact with some contractors more often than others, it is important to understand the role that each contractor plays in the complicated—and often confusing— world of the Medicare program.

DME MAC:_ Durable Medical Equipment Medicare Administrative Contractor

OCTOBER 2020 | O&P ALMANAC

PHOTO: Getty Images

DME MACs are the contractors with which O&P providers interact the most. The DME MACs are responsible for processing all traditional Medicare (fee-for-service) claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). DME MACs are split into four regional jurisdictions. Jurisdiction A covers the northeast, Jurisdiction B covers the central and midwest,

Jurisdiction C covers the south, and Jurisdiction D covers the western states. DME MACs are part of the regional contractor system that was created in the early 1990s to consolidate claim processing responsibility for certain Medicare services among a small number of specialized regional contractors, rather than having to train multiple state-based Medicare contractors to process DMEPOS claims. While the DME MACs are divided into four regional jurisdictions, the contracts are currently held by only two different contractors: Noridian (Jurisdictions A and D) and CGS (Jurisdictions B and C). In addition to processing all traditional Medicare O&P claims, the DME MACs are responsible for the Medicare redetermination process. Redetermination is the first level of the Medicare claim appeal process. To ensure that redeterminations are conducted fairly, DME MACs must conduct redeterminations separately from initial claim determinations—meaning that clinical reviewers who conduct Medicare redeterminations may not have participated in the initial claim decision. Another important function of the DME MACs is the development of local coverage determinations (LCDs) and policy articles (PAs) that, together, make up the medical policy that governs Medicare coverage of O&P and other services. The development of these medical policies is coordinated by physicians that serve as medical directors for each of the four DME MAC jurisdictions. While the LCDs

REIMBURSEMENT PAGE

and PAs are technically autonomous documents specific to each jurisdiction, the DME MACs collaborate on the development of these policies to ensure that they are consistent, if not identical, in both their format and content.

PDAC:_ Pricing, Data Analysis, and Coding Contractor

After the DME MAC, the PDAC is the Medicare contractor most likely to interact with O&P providers. The PDAC is responsible for all coding review for the Medicare program, including the coding verification process. This process allows interested parties to submit products to the PDAC for the purposes of assigning or confirming accurate procedure codes to describe the products. The coding verification process can be voluntary, or it can be required as a condition of payment in individual medical policies. Regardless of how a coding verification is initiated, it is binding on the Medicare provider community—meaning that once a product has had its coding verified by the PDAC, claims for that product submitted to Medicare must be coded in a manner that is consistent with the PDAC verification. In addition to performing coding verifications, the PDAC also is responsible for performing data analysis and identifying utilization trends. The DME MACs and other contractors use this information to help develop medical review strategies. The current PDAC contractor is Palmetto Government Benefit Administrators, which also performs the contract work of the National Supplier Clearinghouse (NSC) and Competitive Bidding Implementation Contractor (CBIC).

PHOTO: Getty Images

QIC:_ Qualified Independent Contractor

The QIC is a Medicare contractor that is responsible for facilitating the second level of the Medicare appeal process, also known as reconsideration. The current QIC for Medicare DMEPOS

claims in all four jurisdictions is Maximus Federal Services. While the first level of appeal, redetermination, is coordinated through the DME MAC, reconsideration is handled by the QIC, which provides an additional level of independence in the appeals process. When requesting reconsideration by the QIC, providers may continue to submit additional information that may not have been considered during the initial claim review or the redetermination process. If the QIC overturns previous claim denials, the claim information is returned to the DME MAC for payment.

Since 2016, the QIC has been tasked with operating a telephone reconsideration discussion program designed to help providers understand and correct errors that could result in denial of the reconsideration request. This program has been both successful and popular— and was recently reauthorized by CMS to continue through December 2021.

RAC:_ Recovery Audit Contractor

The RAC program was established by Medicare as part of the Medicare Modernization Act of 2003. The program

began with the creation of a pilot program in 2005 that recovered more than $1 billion in Medicare overpayments. As a result of the success of the pilot program, the RAC program was expanded and made permanent in 2009. Initially, there were separate RAC contractors for each DME MAC jurisdiction, but the DMEPOS RAC program was eventually coordinated through a single, nationwide contractor— currently, Performant Recovery Inc. RAC audits are always performed on a postpayment basis, meaning that only claims that have previously been paid by DME MACs are reviewed by the RAC contractor. The RAC contractor is highly incentivized to identify claim payment errors as it receives a generous percentage (approximately 9 to 12 percent) of any money that it identifies for recovery as a contingency fee. RAC contractors are the only Medicare contractors that are paid this way; all other Medicare contractors are paid based on pre-established milestones. The RAC contractor payment system has been a source of controversy for years and has led to concerns about RAC processes and procedures in identifying Medicare overpayments. In response to ongoing concerns regarding the fairness of the RAC program, CMS now requires RAC contractors to obtain CMS approval before initiating audit activity on a new product category or type of service. In addition, RAC contractors must publish any active audits on their website. Current issues under review by Performant can be found on their website here: www.performantcorp.com/solutions/ healthcare/cms-rac-resources/ cms-approved-audit-issues/ default.aspx#Region-5.

CERT:_ Comprehensive Error Rate Testing

The Medicare CERT program is unique in the fact that CERT contractors are not actually performing audits on the providers themselves, but rather are evaluating the performance of the contractor that is responsible for processing and paying Medicare claims. O&P ALMANAC | OCTOBER 2020

REIMBURSEMENT PAGE

In the case of O&P services, CERT contractors evaluate the performance of the DME MACs. While CERT contractors are not directly evaluating the performance of an individual provider, CERT audits that identify Medicare overpayments are communicated to the DME MACs for recoupment. In 2019, the Medicare CERT program reported an overall Medicare improper payment rate of approximately 7.25 percent. When reporting only DMEPOS claims, the error rate is significantly higher, approximately 30.7 percent. Unfortunately, the CERT program does not differentiate the O&P-specific error rate from the overall DMEPOS rate. While it is important to respond to all Medicare audits, a timely response to CERT audits is especially important as CERT results are a significant factor when DME MACs and other contractors develop their medical review programs. Failure to respond to a CERT audit will result in

an automatic denial of the claim and contribute to the established error rate for the specific product category.

SMRC:_ Supplemental Medical Review Contractor

The SMRC contractor is a highly specialized Medicare contractor that performs additional postpayment medical review for all Medicare programs. SMRC reviews are based on the identification of specific areas of potential vulnerability to overutilization, fraud, or abuse. Issues that are identified for additional review by the SMRC contractor usually are the result of patterns and trends identified through other audits, such as DME MAC reviews, RAC audits, or CERT audits. The current Medicare SMRC contractor is Noridian. While Noridian also serves as the Jurisdiction A and Jurisdiction D DME MAC, its role as the SMRC contractor is separate and independent of its role as DME MAC.

Do Your Homework

While the Medicare contractors discussed above represent the majority of contractors with which O&P providers interact on a regular basis, the list of acronyms and contractors is long. AOPA continues to work closely with all of the Medicare contractors and the Medicare program itself to ensure that O&P providers continue to be able to provide high-quality, clinically appropriate care to Medicare beneficiaries. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: www.bocusa.org

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This Just In

Learning, Recharging, and Connecting O&P stakeholders enjoyed the opportunity to convene—virtually—during the AOPA National Assembly in September EARN

Opening General Session

CE 100+dits cre

Exhibits Open

OCTOBER 2020 | O&P ALMANAC

This Just In

OPA MEMBERS AND O&P stake-

and share clinical recommendations and business tips while taking part in cutting-edge learning—but it also facilitated the more casual conversations that have been an integral part of past AOPA Assemblies. Virtual attendees appreciated the opportunity to connect during a year when in-person interactions have been limited. After several pre-show workshops, the 2020 Assembly kicked off Wednesday, September 9, with an introductory session headlined by AOPA President Jeffrey Lutz, CPO, and Executive Director Eve Lee, MBA, CAE, who recognized AOPA’s 2020 Lifetime Achievement Award winner, Arturo Vasquez-Vela(deceased), and Legislative Advocacy Award winner George Breece. They also introduced AOPA’s 2020 AWARD WINNERS keynote speaker Michael 2020 Lovdal, PhD, who spoke on “What Has Changed in

holders took advantage of the first-of-its-kind AOPA Virtual National Assembly to meet and network in a unique online setting, overcoming challenges associated with uniting during the global pandemic. Participants attended educational sessions featuring clinical and business content, experienced the latest technologies and products via the virtual exhibit hall, and connected during live chats as well as informal social gatherings. O&P professionals enjoyed interacting in real time using the chat feature available in each session. This feature enabled participants to ask questions

Opening General Session AOPA President Jeffrey Lutz, CPO, presents the 2020 AOPA Lifetime Achievement Award to Arturo Vasquez-Vela (deceased), accepted by his brother, Eduardo Vazquez-Vela.

Legislative Advocacy Award winner George Breece

American Healthcare, and How Will the Pandemic Affect the Future?” (see p. 26). The session was followed by a Grand Opening Virtual Welcome Reception, featuring several AOPA board members in Las Vegas-themed costumes, and the opening of the virtual exhibit hall. Thursday’s itinerary began with the “best of show” Thranhardt lectures, presented this year by Anton Johannesson, PhD, CPO, and the team of Caitlin Doem, PT, DPT, and John Frederick Jr., CPO, LPO. These lectures kicked off the pedorthic, orthotic, prosthetic, technical, and business educational sessions, offered concurrently over a three-day span. The move to a virtual meeting allowed AOPA to record each session. Participants may visit the library of presentations in the Assembly portal to view sessions they missed. AOPA recently announced that Assembly participants can view the content throughout the remainder of 2020, and will be able to earn more than 100 CE credits. Exhibitor booths also remain accessible. Preparations are underway now for the 2021 AOPA National Assembly, scheduled for Sept. 9-12, 2021, in Boston.

Award-Winning Thranhardt Lectures

BESTof

SHOW

O&P ALMANAC | OCTOBER 2020

This Just In

GENERAL SESSION—AOPA Membership Meeting and Awards Program

AOPA President Jeffrey Lutz, CPO

Eve Lee, MBA, CAE, announced the debut of AOPA Connection

SYMPOSIUM: “Impact of Prosthetic Interventions on Musculoskeletal Pain in Individuals With Lower-Limb Amputations”

Andreas Kannenberg, MD (GER), PhD

BEST BUSINESS

AOPA President-Elect Traci Dralle, CFm “Understanding the Wound Healing Continuum and Its Considerations in Returning Quality of Life With O&P” Naz Wahab, MD

Hamontree Business Education Presentations Winner, Dale Berry, CP, LP, FAAOP

ABSTRACT

Exhibit Passbook Winners • John Nakatsu, CO, LO— $200 Gift Card • Michael Meramo— Registration to the 2021 AOPA National Assembly in Boston • Tanya Baer, CFo, CFm— AOPA 2020 Coding Suite (Illustrated Guide, Coding Pro, & Quick Coder)

OCTOBER 2020 | O&P ALMANAC

This Just In

GENERAL SESSION—Workplace Sexual Harassment: Dialogue and Creating a Respectful Environment

“Is Your Socket Strong Enough? How Do You Know?”

Maggie Baumer, JD, clinic manager, Hanger Clinic

Katie Johnson, MS, CPO/L Robin Seabrook

Exhibitors

O&P ALMANAC | OCTOBER 2020

COVER STORY

The Prognosis for

U.S. Healthcare AOPA National Assembly speaker and healthcare futurist analyzes the latest healthcare trends in light of the COVID-19 pandemic By JOSEPHINE ROSSI

EDICARE FOR ALL, public health overhaul, telehealth

expansion—these are just some of the short-term

possibilities on the horizon in the United States as a result of the COVID-19 pandemic, according to healthcare futurist Michael Lovdal, PhD, who delivered the opening keynote address for the 2020 AOPA Virtual National Assembly. A well-respected and long-time fixture at AOPA leadership and annual meetings, Lovdal tapped his 35-year consulting career at Oliver Wyman, where he concentrated on healthcare serving providers, payors, pharmaceutical companies,

Michael Lovdal, PhD

and public health organizations, to discuss the impact of the pandemic on healthcare and the implications for O&P businesses. The now adjunct professor at Columbia Business School encouraged all participants, regardless of their businesses’ size or focus, to plan for changes and to simulate different scenarios in the months ahead. Here’s a look at those predictions and what they mean to the O&P profession.

OCTOBER 2020 | O&P ALMANAC

COVER STORY

ANALYSIS

National healthcare will become the main public policy debate of 2021. Major changes to national healthcare policies are afoot, and O&P suppliers and patient-care facilities should be planning for the effects on their business models now, according to Lovdal. While the November election results will dictate priorities, the pandemic’s impact on the healthcare system has forced significant debates. Lovdal cited six potential areas of policy change. First is the elimination of “surprise” out-of-network patient billing, which has had strong bipartisan support in the past. “This is the one that I think has the greatest probability of being [addressed] soon after the election,” he noted. Second is the “significant endorsement, expansion, and funding for the Federally Qualified Health Centers,” which provide care to underserved areas across the country. These safety net facilities have received little attention in the past; however, there’s now growing bipartisan support “in recognition that Federally

Qualified Health Centers are a critical aspect of the healthcare infrastructure in the United States,” he said. The drug pricing debate is going to continue after the election, too, according to Lovdal. However, the much-talked-about “most-favorednation” approach, which would assure the lowest price for drugs sold to the government, will be a “more difficult achievement,” he says, due to strong opposition from the pharmaceutical industry and the most-favored-nations, such as Canada. Similarly, the Affordable Care Act (ACA) will see significant debate next year as well. Lovdal predicted it will again go to the Supreme Court and will likely be upheld. (Note that Lovdal made this prediction before the passing of Supreme Court Justice Ruth Bader Ginsburg.) The pandemic has caused many Americans to turn to the ACA exchanges after losing their employer-sponsored health insurance.

O&P ALMANAC | OCTOBER 2020

COVER STORY

“Depending on how the election goes, it may be strengthened,” he said. “There’s been a lot of discussion about returning to some of the foundations of the Affordable Care Act—things like the risk corridors and risk adjusters that were essential parts of the fabric of the Affordable Care Act.” Medicaid funding reform also will receive attention next year, but “gets more problematic” because of the amount of money involved and the wide variance in reimbursements at the state level. Medicaid rolls have grown substantially due to the pandemic, which will exacerbate the disparities among the states. “I’m not sure, as the administration has pointed out, that the funding reform will take the form of block grants. It may. In fact, some states would welcome that,” Lovdal explained. Finally, Lovdal predicted that Medicare for all will be “the toughest” conversation. Because a true singlepayor system that would have the federal government footing all healthcare bills requires radical change for all players in the healthcare system, the odds of it coming to fruition any time soon are “very low,” regardless of who wins the election. A number of “subvariants” to the conversation, such as lowering the age of Medicare eligibility or creating a public option, are “distinct possibilities,” however, he said.

OCTOBER 2020 | O&P ALMANAC

ANALYSIS

The nation will rebuild its public health system.

Among its many consequences, the pandemic has underscored the role of public health, which has historically been underfunded in the United States. Startling statistics, including the high number of COVID-related deaths in this country, “reflect a deep crisis in our public health system,” according to Lovdal. Public health agencies were “ill-equipped to carry out even basic functions, let alone to serve as the last line of defense against the most acute threat to the nation’s health in generations,” he said, citing a recent Washington Post article. Lovdal referenced the $5 trillion forecast for benefits- and discretionarybased healthcare spending in 2020. “Public health has historically been about 3 percent of the total benefits spend; it’s never gone much more. So, 97 percent of our total [healthcare] spend in this country is on … reactive healthcare—not on public health.” Experts agree that a minimum 6 percent of a nation’s health spending should be devoted to public health efforts. Moreover, he argued for more integration between healthcare and

public health, as is the case in most other industrialized countries. They offer universal medical coverage that “enables them to provide many common public health services as part of their main healthcare delivery system,” he explained. Better funded and more coordinated at the federal, state, and local levels, an improved public health system would move the United States toward preventative population health management. “The important thing for the O&P community, if you’re willing to and able to, is to help participate in rebuilding U.S. public health. Look at your state, try to figure out what the infrastructure is like, try to find a unique role in public health for the O&P community,” Lovdal encouraged attendees. “Let’s think about a dialogue. Mobility—it becomes a basic right of our public health world and [is central] to the mission and purpose of O&P. So, I think we have a chance to contribute here to rebuild public health, but also to help our own profession as that process starts.”

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COVER STORY

ANALYSIS

Health systems and hospitals will reinvent their revenue and operating models.

The American Hospital Association recently issued a report on how the pandemic has damaged the country’s healthcare infrastructure, projecting losses to hospitals and health systems to be at least $323 billion in 2020. Although the Coronavirus Aid, Relief, and Economic Security (CARES) Act provided a one-time cash infusion, “there’s expectation that if the current situation continues into 2021, the losses will continue to mount,” Lovdal explained. “Mayo Clinic, for example, made a billion-dollar surplus in 2019 and is currently forecasting a $900 million loss in 2020. And that goes all the way down, from large health systems to the 100-bed hospital perhaps in some of your communities,” he said. The problem stems from the fact

that at least one third of hospital revenue comes from deferrable procedures, such as colonoscopies, gastrointestinal surgeries, and basic cardiovascular procedures, which have been put on hold with hospital shutdowns. People also are avoiding emergency room visits, which further cuts into revenue from less deferrable emergency and trauma care. “The big question, obviously, for most hospitals is will that come back? How fast will it come back? Will there be some kind of catch up? Experts have speculated that certain things that have occurred will perhaps never be returned to the level they were before.” The dilemma is further compounded because most health systems have “very little knowledge” about their costs structure, said

ANALYSIS

Telehealth and home health will take on more permanent roles.

“Significant forces … are moving us to telehealth as a permanent part of the healthcare delivery process,” said Lovdal. “Some people have said we’ve succeeded in doing in six months what forecasters said would take at least six years or more pre-pandemic.” Reimbursements for telehealth, which were facilitated by the CARES Act, will continue to evolve. “Medicare, for example, will reimburse telehealth only if a Medicare recipient is homebound, not at home. We’ll see changes that will, I think, begin to loosen up Medicare and even other aspects of reimbursement as we stabilize at 20 or 25 percent telehealth use going forward,” he said. Further, telehealth will merge with home health. With a disproportionate amount of all COVID-19 deaths tied to nursing homes, assisted living facilities, and memory care facilities, state 30

OCTOBER 2020 | O&P ALMANAC

Lovdal. Combined, those factors have generated the significant losses currently being experienced and will force hospitals and health systems to reevaluate their services from a revenue and profitability perspective. This may include narrowing their scope and becoming specialized surgical hospitals or centers of excellence. As they begin to focus on core capabilities, hospitals and health systems may look to more functional or departmental outsourcing and potential labor contract flexibility. “Other new types of reinvention [are] to be determined, but you will see significant change in most health systems as response to the financial stress from the pandemic over the next year or two,” said Lovdal. “I encourage the O&P community to get involved, figure out where you are, [and] figure out what your leverage is, as you see this reinvention process start.”

officials are looking to telehealth as a “bridge from the home to the healthcare community,” especially primary care, Lovdal said. “Home health, primary care, telehealth will become part of one conversation.” Given the plethora of telehealth software currently available, O&P businesses will need to become proficient not only in several platforms, but also in answering patient questions. “…Focus on your patients and helping them become fluent users. …What’s a typical patient ask? And they want to know, number one, what are my options? Is it a phone call? Is it a visit? Do I need an app? Do I have to call my insurance company? Does the other person at the other end of the call know who I am and how I need to be treated? Are there enough clinicians, et cetera, et cetera?”

COVER STORY

ANALYSIS

Millions of Americans have and will continue to migrate out of commercial insurance into Medicaid, individual, and uninsured segments. At the end of 2019, almost half of Americans had employer-sponsored insurance; 17 percent had Medicare; 22 percent had Medicaid; 10 percent were uninsured; and 5 percent were in the individual market through the exchanges, according to Lovdal. Under different economic and unemployment scenarios, those numbers could change dramatically. For example, the number of uninsured could reach nearly 45 million if unemployment goes to 30 percent, according to Oliver Wyman projections. While it’s hard to predict the trajectory of unemployment numbers, especially if the country experiences a second wave of COVID-19 cases, Lovdal urged business owners to model their pay and revenue mix under different economic recovery scenarios. He encouraged owners to determine profit margins given different payor sources. As the pandemic situation evolves, doing so will become “essential” for revenue lines, he said.

ANALYSIS

The shift to value-based healthcare reimbursement will quicken.

The move from fee-for-service to value-based care has been slow over the past decade, said Lovdal. Why? Because while the concept is widely embraced, the new revenue model that goes with value-based care raises a lot of questions. “There’s always going to be significant questions about who controls the revenues, who distributes the revenues, and will my organization, or will I, win or lose under value-based care?” Before the pandemic, the U.S. Department of Health and Human Services strongly supported the value model. Now, employers, payors, and providers have jumped on the bandwagon. Employers are aggressively trying to control costs, and payors “would love to have a medical expense structure fixed to revenues, particularly now with unprecedented, unpredictable COVID-19 costs,” said Lovdal. With patients deferring procedures and overall utilization rates down—perhaps never to return to pre-pandemic levels—providers are

increasingly looking for more predictable revenues rather than “the uncertainty that’s going to be associated with fee-for-service going forward.” If they have not already, O&P businesses should prepare for value-based care and reimbursement. “You will have a new revenue model—the ecosystem is going to be coming. It’s going to be coming faster than it has in the last 10 years, I guarantee you that. You’re going to be part of a bundled or capitated payment plan,” said Lovdal. “You will see either or both as part of the value ecosystem. “Again, as I’ve said in the prior points, try to understand what’s going to happen,” added Lovdal. “Try to get ahead of these possible changes and try to anticipate what they mean for your business model.” Josephine Rossi is editor of O&P Almanac. Reach her at jrossi@ contentcommunicators.com.

EDITOR’S NOTE: Registered participants of the 2020 Virtual National Assembly can access Mike Lovdal’s keynote session and all other educational and exhibitor content online until December 31. Visit https:// aopa-virtual-national.pathable.co and login using your registration credentials.

O&P ALMANAC | OCTOBER 2020

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Cost-Effective Collections Tips for updating financial policies and processes to ensure faster payments and more reliable income

OST HEALTHCARE PROVIDERS

NEED TO KNOW • Given escalating healthcare costs and a rise in provider bankruptcies, now is the time for facilities to re-examine their billing and collection practices. • Some facilities are setting the expectation that a copay is due at the time of visit and requiring that a credit card be kept on file for future balances. • Whether adopting new billing software or just revamping existing procedures, it’s important to work closely with staff members and patients to explain new policies. • To ensure a smooth transition to new collections procedures, O&P facilities should offer flexibility in how visitors pay their bills—including accepting payments online. • When accepting credit card data, facilities must remain in compliance with rules set forth by the Payment Card Industry Data Security Standards.

OCTOBER 2020 | O&P ALMANAC

see their primary goal as helping patients get well—or, in the case of O&P clinicians, helping patients improve mobility and return to activities. But healthcare providers are being forced to focus on their bottom lines as facilities become increasingly dependent on out-of-pocket payments from consumers while the U.S. economy continues to struggle. “As the healthcare industry is changing, it’s forcing providers to not only be empathetic to patients’ needs, but also to collect, because patients now have higher-deductible plans, or they can’t afford insurance—let alone pay for the equipment or the materials they’re getting,” says Jennifer Leon, Jennifer Leon vice president of Brightree’s Patient Collections Divisions and a speaker at AOPA’s Virtual National Assembly in September. In addition, many O&P facilities continue to use outdated collections processes that rely heavily on paper—while many of their patients have adopted new technologies and online bill payment methods at home. Eighty-three percent of consumers prefer electronic methods for medical bills, according to the 2019 InstaMed Consumer Healthcare

Payments Survey. And 66 percent of consumers are willing to consider switching providers for a better payment experience. Right now, the timing may be perfect for O&P facilities to re-examine their billing practices, adopt technologies to facilitate the process, and implement procedures that will lead to faster and more reliable patient collections, according to Leon. She recommends implementing a new policy at the end of the year or beginning of a new year, because patients understand that policies and insurance coverage usually change at that time. “This really is the key time to do it— when you’re starting a fresh new year.” As O&P facilities seek to upgrade their collections procedures, Leon suggests a four-pronged approach: change, coach, cater, and collect.

reinforces to patients that insurance is unlikely to cover 100 percent of their appointments and devices. “And if you take that a step further and you not only set the expectation, but you also save a card on file for future use, then you’re almost at 100 percent guaranteed you will get paid—unless, of course, if the card declines or expires.”

Change Your Outlook

Capturing payment data at first visit—in a way that adheres to Payment Card Industry (PCI) Data Security Standards (DSS) (see sidebar)—is a new way of operating at many facilities, but such a transition could be easier than you think. At Specialized Orthopedic Solutions (SOS) in Chatsworth, California, staff members began collecting card data at first appointments when it switched to a new patient portal solution in early 2019. “Now, we obtain a credit card and keep it on file” within the PCI-compliant system, says Micah Davis, the facility’s operations manager. SOS has seen a rapid decline in unpaid bills and accounts sent to collection since it implemented this process, according to Davis.

As patients’ expected contributions to their healthcare costs are growing, O&P facilities must adopt strategies to collect that money—beginning with the first visit. Studies have shown that 60 percent of patients leave a healthcare facility without paying any money, which is a mistake, according to Leon. She points to the example of newer walk-in healthcare clinics. Many set the expectation upfront that a copay is due at the time of visit, and they require that a payment card be kept on file for any future balances that insurance may not cover. These facilities are doing their due diligence to secure their assets and to facilitate the collection process for future balances, says Leon. She suggests that O&P facilities consider similar models. “Once you set the expectation up front that the patient is going to have a balance due, chances improve you’re going to get paid,” she says. This also

Coach to Your New Policy

After deciding to adopt new billing software or revamp existing procedures, it’s important for leaders to

work with both staff members and patients to explain the new policies. First, meet with key stakeholders among staff to discuss the need for the change, suggests Leon. “You have to be transparent with your staff. You have to tell them exactly how much debt the facility wrote off last year.” Then explain the plan to fix the problem— which may include discussing financial obligations and capturing credit card information at first visits, adopting a new PCI-compliant billing portal, and/ or setting up patient payment plans—and the importance of every staff member working together to implement new processes. Staff education is key because embracing new collections procedures represents a culture shift, says Leon. “Your staff are going to say things like, ‘We’ve never had to do this before, why are we doing it now?’ So be clear with your communication; be upfront with why you’re changing.” After educating staff, “you have to coach your patients that your policy has changed,” says Leon. Provide staff with clear and concise scripting and talking points for communicating with patients. “It really doesn’t need to be hard,” says Leon. “We need to keep it simple” when explaining the new policy to patients. “Educate patients that they will have a balance due for these services,” and offer payment plans. She recommends that O&P facilities draw up financial agreements before offering services to consumers. “If you are letting them walk out the door with any type of service, and there’s a chance that they may not pay you for it because you are billing them later, you need to secure a financial agreement to hold that patient responsible for services rendered,” she says. O&P ALMANAC | OCTOBER 2020

Payments Experts Explain PCI Compliance O&P facilities that accept credit cards are required to comply with the Payment Card Industry (PCI) Data Security Standard (DSS) requirements, a set of requirements intended to ensure that all companies that process, store, or transmit payment card information maintain a secure environment. In order for a healthcare facility to be PCI compliant, it must “have the appropriate technology, personnel, and processes in place to limit opportunities for credit card account data to be compromised or stolen,” explains Richard Rohena, PCI-ISA, manager of compliance services at Global Payments Integrated. “There’s a big myth that only large providers have to be PCI compliant,” says Zach Gleason, healthcare sales manager at BillingTree. In fact, small healthcare providers are particularly vulnerable and more susceptible to breaches of card data because “hackers are looking for small companies that don’t have large IT departments,” he says. While there is some concern among healthcare providers that PCI compliance is costly, “it actually saves companies from huge breaches that would be much more costly,” according to Gleason. He points to fines, the loss of patient trust, and the future inability to accept credit cards as potential outcomes of a data breach. Gleason recommends that O&P facilities use a PCI-compliant solution to input card data. “Your credit card processing terminal, your online processing system—all must be PCI compliant,” he says. Rohena offers the following “do’s and don’ts” to facilitate PCI compliance:

Do’s:

Don’ts:

• Do work closely with your acquiring bank and thirdparty service providers to ensure all security protocols meet PCI requirements.

• Don’t transmit or send cardholder data through channels that may not be secure, such as messaging technologies like chat or text.

• Do limit storage of cardholder data, when possible, to reduce the risk of data being compromised and dissuade bad actors.

• Don’t allow any default, shared, or guest accounts to be enabled on systems within the cardholder data environment.

• Do implement proper policies, procedures, and training to ensure data security is part of your businessas-usual operations.

• Don’t forget to routinely inspect point-of-interaction devices for unauthorized or suspicious activity.

OCTOBER 2020 | O&P ALMANAC

Financial agreements should be presented during a “financial consultation” when seeing new and existing patients, says Leon. “We jump right away to just helping the patient without looking at the entire picture from a 30,000-foot perspective,” she says. After meeting with new patients for the first time, facilities should go over the diagnosis and O&P intervention, “then move into how we are going to accommodate and help you pay for this,” says Leon. New payment policies will be easier to implement if facilities offer price estimates up front, adds Leon. Price estimates help patients understand their financial responsibility, recognizing that both the total amount of care and expected contribution from insurance represent estimates—not exact amounts.

Cater to Patients’ Needs

To ensure a smooth transition to new collections procedures, O&P facilities should “cater” to patients by offering both transparency about expectations and flexibility in how patients pay their bills—while adopting strategies that increase the likelihood of being paid, says Leon. Studies have shown that 75 percent of consumers are confused by their healthcare bills, according to Leon. She encourages facilities to examine their bills from a fresh perspective: “If you received one of your bills in the mail, would you understand it?” she asks. Bills should be easy to read, right to left, and top to bottom. Using an alpha-split system, according to patient last name, to send bills throughout the month could improve a facility’s collection strategy and result in more staff time to respond to billing questions and concerns, according to Leon. For example, if you send out bills for patients with A-F names the first week, G-N names the second week, etc., “that will produce a steady stream of cash flow while preventing a deluge of billing questions at one time during the month,” she says.

To ease the transition in requiring cards on file, Leon recommends accommodating various types of payments, including flexible spending cards, debit cards, checks, ACH payments, and credit cards—“because the last thing the patient wants to find is you weren’t willing to accept” their preferred method of payment. Of course, when accepting payment card data, facilities must remain in compliance with rules set forth by the PCI DSS. “You cannot store credit card information in your laptop or in a binder; it has to be secured in a locked space and the card numbers encrypted, which is usually facilitated via a PCI-compliant software solution,” Leon explains. When a patient is ready to give their card number, a receptionist can log on to a PCI-compliant virtual billing Zach Gleason terminal and input the credit card info directly into the system, rather than write it down or input it into an Excel spreadsheet, says Zach Gleason, healthcare sales manager at BillingTree, which provides integrated payments solutions to healthcare and other vertical industries. “Then it will be tokenized, encrypted, and secured, with only the last four digits viewable to facility staff,” and it will be accessible for future transactions, Gleason explains. An alternative method of collecting patient card data is via secure PIN-pad devices that are EMV-chip enabled and offer point-to-point encryption, says Gleason. These devices can be made available at the counter for patients to input their own credit card data without any staff ever seeing card information. Leon also recommends e-delivery of the notification of the patient’s monthly statement—but not the actual statement, due to HIPAA and privacy rules. E-mailed notification can drive patients to the facility’s online bill pay

site, resulting in faster cash flow back to the office. “Patients want transparency, and many want to view and pay their bills at their leisure,” says Leon. O&P business managers should create a simple online payment process, too. “Patient portal payments have increased approximately 34 percent each year,” says Leon. “If you are not allowing your patients to pay their healthcare bills online, or even giving them easy ways to pay,” they may move on to another provider that does. She recommends that facility websites feature an easy “Pay Online” button on their home page. A prominent pay button lets patients know exactly where to go to pay their bills, says Leon. In addition, setting thresholds in the payment portal for minimums due can help businesses cope with decreased cash flow from outstanding balances and payment plans. “Because O&P care can be costly, we need to be able to accommodate payment plans that fit our patients’ ability to pay” while balancing our books, says Leon. But “the last thing you want to do is take a $5 payment on a $10,000 balance,” she says. Longer payment plans should be the exception—for struggling patients— rather than the rule. As an alternative to paying online, consider offering patients the ability to pay by SMS text or through interactive voice responses, a telephony menu system, says Gleason, who notes that these options could also help to reduce staff time. Of course, mail-in payments should continue as an option for those patients preferring traditional methods.

to collection agencies, and fewer writeoffs. “We love the ability to set up payment plans and the ability for patients to manage payments on their own,” says Davis, adding that patients appreciate the flexibility and transparency of their new processes and procedures. “It’s a seamless process.” The cost of implementing these new systems “is insignificant compared to the value that it brings,” says Davis. “It’s well worth the investment.” Most importantly, involving all employees in the collections process is key to boosting collections. “Many clinicians expect this to be ‘billing’s job,’ but that’s the wrong attitude,” says Leon. To see their companies stay profitable, all employees should collaborate in the collections process, and refrain from giving away products or services. “Clinicians must understand that it’s OK to be empathetic to patients’ situations, but they need to involve the financial consultation team when discussing payments,” she says. Ultimately, business owners should hold staff accountable to the objectives and goals of the new collection strategy. “We’re one team,” says Leon. “We have one message.” Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

Collect—and Boost Profits

Once a facility has adopted new processes—and perhaps implemented new technology such as a PCI-compliant billing solution and patient portals for credit card acceptance—it can expect to see improved cash flow. At SOS, implementing a new system last year has led to an increase in patient collections, a significant drop in the number of accounts referred

EDITOR’S NOTE: Missed this session at the 2020 Virtual National Assembly? Registered participants can access all educational and exhibitor content online until December 31. Visit https://aopa-virtual-national. pathable.co and login using your registration credentials.

O&P ALMANAC | OCTOBER 2020

COMPLIANCE CORNER

By MATTHEW GRUSKIN, MBA, BOCO, BOCPD, CDME

Contingency Planning During the COVID Pandemic COVID-19 teaches us that emergency preparedness goes beyond regulatory requirements

Editor’s Note: Readers of CREDITS Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 40 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.40

OCTOBER 2020 | O&P ALMANAC

HE WORLD IS QUITE a different

place now than it was a year ago. COVID-19 has impacted lives and workplaces in ways that were once unimaginable and, without a doubt, has tested the preparedness plans we built and intended to rely on during times of crisis. As we continue to navigate uncharted territory, the need to be flexible and innovative—while maintaining compliance to regulatory standards—has underscored the importance of contingency plans that allow us to continue caring for patients who rely on us every day, pandemic or not. Like many other healthcare professionals, orthotists and prosthetists have made some critically important decisions and adjusted to “the new normal” since the onset of COVID-19. Fortunately, every accredited O&P practice has a contingency plan on file, as required by Section 1 of the CMS Quality Standards. Ideally, the plan helped provide much needed guidance and direction as the COVID-19 virus rapidly spread. More likely, the plan lacked the level of detailed guidance needed during a global pandemic, and instead served as an outline for important discussions and decisions.

During the plan’s initial implementation phase, many O&P practitioners recognized the need to expand contingency plans, adding details and outlining new and revised procedures to guide operations during the pandemic. Now is the time to reassess what we put (or didn’t put) on paper, as well as what we’ve learned from COVID-19. Preparing now for future coronavirus surges, or any other crises, can help safeguard the health and safety of our employees, patients, and businesses.

Challenges Presented by COVID-19

Without a doubt, COVID-19 changed the way we think about crisis management and the steps that healthcare providers must take to be prepared. Prior to 2020, most contingency plans were designed in anticipation of things like tornados, hurricanes, workplace violence, or security breaches—specific events, each with an identifiable beginning and end, followed by a period of recovery. Most practitioners never considered the possibility of a global health pandemic that would impact operations for weeks, months, or even years.

COMPLIANCE CORNER

Contingency plans written before COVID-19 certainly did not provide clarity and direction on delivering patient care with universal masking policies in place or how to maintain social distancing in the office. The magnitude of challenges presented during the pandemic has been eye-opening in many ways and reveals that much more time and thought must be devoted to thorough, action-oriented contingency planning as we think ahead to the future. The pandemic has forced all of us to quickly adapt to new ways of operating. It has forced healthcare providers to put systems in place to sustain services in the midst of the crisis, while strategically planning for recovery. It has affirmed that “checking the box” on the regulatory side (e.g., creating and filing a contingency document because it is required) cannot sufficiently prepare anyone when the world shuts down and the health and safety of employees and patients are on the line.

Create an Actionable Contingency Plan

As you rethink your facility’s contingency plan, leveraging key takeaways and lessons learned from the COVID-19 public health emergency is critical. Your experience should guide you in developing an updated version of your contingency plan that is relevant and actionable. Building your plan for the future, however, is a process that requires time, thought, and energy. It’s important to be as detailed as possible because unexpected events can be disorienting and chaotic. This is the document you will retrieve, reference, and live by every day.

Some important things to consider: 1. Put yourself in the shoes of a patient who relies on you. Consider the patient journey under normal circumstances, when there is no crisis in play. Think about the experience your patient has, and all the processes they go through, from the time they schedule their first appointment to the time they are released from your care. Start by identifying standard processes and procedures—such as the physical exchange of clipboards, paperwork, and insurance cards— and consider a digital exchange of information that can be completed prior to the office visit.

2. Build a process map that identifies potential changes to the patient journey. With that list of standard processes and procedures in hand, consider how each step could change when typical daily operations are impacted by a crisis. For example, with limitations on the number of individuals who can be in a waiting room, what directions do you want patients to follow when they arrive for an appointment? What kind of signage should be posted? What adjustments do you need to make to optimize your practice’s functionality? Can technology be used for nonbillable, nonacute patient interaction, such as confirming if a brace is being worn correctly? What procedures would you need to put in place to maximize both patient experience and outcomes, both short and long term? 3. Consider how COVID-19 has impacted patient and provider interactions. What questions and concerns do your patients typically have? Are they delaying

care due to fear of potential virus exposure? What steps have you taken to provide continuity of care in a new or different way? 4. Use your process map and scenario planning to document improvements to your actionable contingency plan. Based on your answers to the questions above, start writing. Document any new or revised processes. Include scenario-based sections to address the specifics, such as appointment check-in and check-out procedures. Will you establish a reception desk outside the facility door to collect paperwork and perform patient temperature checks? Incorporate as much detail as possible, whether you are creating a brand new contingency plan or improving an existing version. 5. Account for timing. Create a detailed timeline, noting milestones that will be important on day one, day two, and through the 30-, 60-, and 90-day timeframes. Planning should account for a full 12-month period as well as adjustments that may be required if dynamics change or another crisis strikes. 6. Identify the turning point. Monitoring local, state, and federal mandates is important as you make decisions on how to pivot your practice from “management of the crisis” to “recovery from the crisis.” Stay informed about what’s happening in the world, in your community, and within your patient population. This will help you determine when to implement gradual changes and allow you to resume to “business as usual” over time.

Assemble an Implementation Team You Can Trust

It’s one thing to put a great plan on paper. It’s another to have the right people in place, informed and ready to act immediately when a crisis occurs. It is a good idea to proactively identify members of your team who remain level-headed when times get tough. O&P ALMANAC | OCTOBER 2020

COMPLIANCE CORNER

Assembling an implementation team you can trust is critically important and should be completed long before your practice operates in crisis mode. The people you will rely on in the midst of a crisis are likely the same people who offer valuable perspectives as you consider scenarios that could occur. Ask them to be involved in the process of creating your contingency plan. Encourage open, honest dialogue about what should be included in the plan and alternative approaches to consider, based on their valuable experience and knowledge. Also, bear in mind that those who hold various roles within your organization will have different perspectives to offer. Your receptionist will contribute differently from an administrative manager, who will contribute differently from clinical staff members. This level of inclusion will create an open environment that demonstrates all opinions are valued. Along those same lines, put some thought into who will lead your practice

through the crisis. Is it you? Or is the job best suited for a trusted colleague who has demonstrated an aptitude for success when the pressure is on? Think about the roles and responsibilities your designated leader will take on, and the system of support that needs to be built around that person. Who else from your practice should be assigned key roles? Who will be responsible for training? Who will oversee communication? Be sure to account for skill sets, capacity, and ability to adapt under stressful circumstances. These planning processes and conversations not only will help you build and improve your plan; they also will ensure everyone understands process changes that go into effect during critical incidents and is prepared to respond quickly, when necessary.

The Time to Plan Is Now

Living through COVID-19 has emphasized the importance of emergency preparedness and the

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need for a solid contingency plan, packed with actionable details. The time to plan and anticipate the next crisis is now. Matthew Gruskin, MBA, BOCO, BOCPD, CDME, leads the direction, strategy, policies, and day-to-day operations of the business accreditation and professional certification programs at the Board of Certification/Accreditation. With a focus on credentialing program standards and the delivery of excellent customer service, he also shares his experience and expertise with audiences as both a speaker and an author. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: www.bocusa.org

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OCTOBER 2020 | O&P ALMANAC

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PRINCIPAL INVESTIGATOR

International Collaborator Australian/Swedish researcher studies how O&P patients leverage their attentional capacity to manage their disabilities and complete tasks

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

OCTOBER 2020 | O&P ALMANAC

ERROLYN RAMSTRAND, BPO (HONS), PhD, believes collabora-

tion is one of the keys to advancing O&P research. In fact, she has pursued several international partnerships over the course of her career. An orthotist/prosthetist with dual citizenship in Sweden and Australia, Ramstrand currently serves as a professor of prosthetics and orthotics at Jönköping University in Jönköping, Sweden—the only higher education institution in the country offering education for clinical prosthetists and orthotists and O&P technicians. “Most of my time is spent on research and administrative duties within the university,” explains Ramstrand. She recently served as associate dean of research, until she began a new role in September as advisor to the president of Jönköping University. “In my new position, I will focus on strategic issues related to internationalization for the whole university for 50 percent of my time and will continue with my research for the remainder of my time.” Throughout her career, Ramstrand has fostered working relationships with several O&P experts in the United States—both privately and through her work with the International Society for Prosthetics and Orthotics (ISPO). She has collaborated with U.S researchers

and clinicians on numerous occasions, including working on systematic reviews with Phil Stevens, MEd, CPO, FAAOP; as a team member developing systematic review guidelines for the American Academy of Orthotists and Prosthetists; and in developing numerous symposia in conjunction with Stefania Fatone, BPO (Hons), PhD. Ramstrand currently serves as one of four editors-in-chief of Prosthetics and Orthotics International, together with Fatone; Brian Hafner, PhD; and Michael Dillon, BPO (Hons), PhD.

Dual Interests

Ramstrand, who grew up in Australia, says her career choice was a “natural combination” of her parents’ professions: Her father worked as a civil engineer and her mother was a nurse. “The O&P profession appealed to me at the time as it was very much hands-on, and I wasn’t sure that I was ready for a desk job,” she says. After completing her bachelor’s studies in O&P at La Trobe University in Australia, she realized that research appealed to her, and she applied for a government scholarship to pursue a doctorate. She earned her PhD from La Trobe in 2000—while sharing an office with Fatone, another La Trobe graduate—and completing

PHOTO: Nerrolyn Ramstrand, BPO (Hons), PhD

PRINCIPAL INVESTIGATOR

a doctoral thesis on “Visual Search Strategies and Decision Making in Observational Gait Analysis.” Over the past two decades, Ramstrand has taught many undergraduate O&P courses. Some topics at Jönköping University have included “O&P Introduction,” “O&P Theory,” “Models and Perspectives on Health and Disability,” and “Clinical Gait Analysis,” among others. Included in her teachings is an emphasis on the importance of research, according to Ramstrand; the O&P curriculum in Sweden carves out time for research-related activities. “Our students are taught about the principles of evidence-based practice in the first semester of their studies,” she says. “Throughout the education, they are encouraged to motivate clinical decisions with evidence from research.” She explains that the university’s researchers are actively involved in teaching, and research findings are presented to students in all levels of the program. “In their final year of studies, our bachelor students are required to conduct a major research project,” she says. Jönköping University also offers a recently introduced master’s program in product development, specializing in assistive technology. The master’s is open to graduate prosthetist/orthotists as well as engineers and is conducted in close collaboration with industry partners. “Within the program, partners are invited to submit manufacturing and design problems, which the students are required to work with and present a solution back to the partner organization.”

Ramstrand’s Research

PHOTO: Nerrolyn Ramstrand, BPO (Hons), PhD

Over the past five years, Ramstrand has become interested in exploring the effects that prostheses and orthoses may have on attentional demand of users, and whether design alterations can affect the attentional load required to perform specific tasks. “The premise of this work is that an individual with disabilities must use a large proportion of their attentional capacity to manage their disability, and that this significantly affects the extent to which they can attend to other tasks,” she says.

Ramstrand discusses design of an ankle-foot orthosis with her colleague, Christoffer Wadman. To measure attentional load, her team in Jönköping has been working with portable brain imaging technology (functional near-infrared spectroscopy) to record patterns of activity in the prefrontal cortex, which plays a key role in performance of functions such as switching attention, working memory, and inhibiting inappropriate responses. “To date, most of our research has focused on studying brain activity during gait of individuals fitted with microprocessor-controlled knees versus mechanical knees, but we have begun to explore other types of O&P interventions,” she says. These include the effects of finger orthoses on hand function—a study that was recently accepted and will be published in Prosthetics and Orthotics International—as well as the effects of virtual reality training for myoelectric arm prostheses under a grant recently received with collaborators from Orebro University and Chalmers University. Ramstrand anticipates that the attentional load research will provide evidence for payors regarding the benefits of one prosthesis design over another or, in the case of orthoses, “the research may provide evidence to support prescription of a device over no device.”

In another study, Ramstrand recently received funding for a collaborative project to study means of better incorporating end-user design preferences into service provision and manufacturing of O&P devices. “Product design is a new area of research for me,” she says, “and I am enjoying learning about different approaches that could be applied in O&P applications.” After some interesting qualitative research conducted with O&P users in Cambodia, Ramstrand also has applied for funding with partners from Queens University, Belfast, Exceed Worldwide, and the Royal University of Phnom Penh, to study the mental health of O&P users in Cambodia. “Cambodia has a severe shortage of mental health workers, and our intention with this project will be to identify and test screening tools that can be applied by O&P clinicians and to train community health workers to provide basic mental health services,” she explains. Looking to the future, “I would like to see more research focusing on the relative effects of O&P devices on individuals’ ability to participate in activities that they feel are important,” says Ramstrand. “As a profession, we are quite good at focusing on body functions and the biomechanical effects O&P ALMANAC | OCTOBER 2020

PRINCIPAL INVESTIGATOR

of devices we prescribe, but we often forget that we are also likely affecting other very important aspects of a person’s life.” While she concedes that it’s difficult to measure the potential benefits of O&P devices on outcomes related to participation, “I would like to see us incorporating these types of outcomes into our research.”

Notable Works Nerrolyn Ramstrand, BPO (Hons), PhD, co-editor-in-chief of Prosthetics and Orthotics International, is the author or co-author of dozens of peer-reviewed articles and conference presentations. Some of her most impactful contributions include the following: • Ramstrand, N., Rusaw, D., Möller, S. “Transitioning to a MicroprocessorControlled Prosthetic Knee—Executive Functioning During Single- and Dual-Task Gait.” Prosthet Orthot Int, 2020; 44:1:27-35. • Möller, S., Rusaw, D., Hagberg, K., Ramstrand, N. “Reduced Cortical Brain Activity With the Use of Microprocessor-Controlled Prosthetic Knees During Walking.” Prosthet Orthot Int, 2019; 43:3:263-271. • Ramstrand, N., Ramstrand, S. “Competency Standards for Newly Graduated Prosthetist/Orthotists in Sweden.” Prosthet Orthot Int, 2018; 42:4:387-393.

Out-of-Office Activities

In addition to her responsibilities at Jönköping University, Ramstrand has spent time as an ISPO member for several years, and served as a consultant for ISPO on the development of an O&P program at the University of Zambia. She also stays busy working as a consultant to the Swedish police since 2009, serving as an expert witness providing forensic analysis of gait in criminal cases. She is called to court to testify once or twice a year—including during a high-profile “helicopter robbery,” which made national news.

Ramstrand is married to a Swedish orthotist/prosthetist, Simon Ramstrand. The couple shares two sons, ages 9 and 12. The family pursues non-O&P-related projects as they renovate a “run-down bed-and-breakfast” they recently purchased, located by a large lake. “Among my academic qualifications, I could add basic plumbing, tiling, carpentry,

and painting,” she says. “I also got myself certified as a chimney sweep.” Amid all of these activities, Ramstrand keeps an eye out for new opportunities to connect with professionals across the globe. She continues to search for ways to expand the O&P research well with studies that are inclusive and involve many perspectives.

EARN

CEs

Y TER B REGIS R 20 BE OCTO EIVE A EC AND R

Virtual Coding and Billing Seminar

FREE CK QUI 2020 ER. COD

NOVEMBER 9-10, 2020 Get the latest on coding, billing, and reimbursement policy, join our experts November 9 and 10 for the AOPA Virtual Coding and Billing Seminar. It is what you’ve come to expect from our Coding and Billing seminars but tweaked and condensed slightly to offer it virtually. Content will be presented from Noon-4:00 PM ET both days.

COST:

Before October 20: $295 for members $395 for nonmembers. After October 20: $320 for members $420 for nonmembers.

Earn 8 CE credits.

Learn more and register at www.aopanet.org/education/coding-billing-seminar. Questions? Contact Devon Bernard at dbernard@AOPAnet.org. FOLLOW US @AmericanOandP

OCTOBER 2020 | O&P ALMANAC

www.AOPAnet.org

Co-OP

AOPA’s Co-OP The O&P Compendium

An online reimbursement, coding, and policy resource, the site includes a collection of detailed information with links to supporting documentation for the topics most important to AOPA Members. O&P’s best kept secret, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of the membership.

Resources include:

We ARE AOPA

•

State-specific insurance policy updates,

•

L-code search capability,

•

Data and evidence resources,

•

And so much more!

Learn more and sign up at www.AOPAnet.org/co-op.

ADVOCACY | RESEARCH | EDUCATION

The Co-OP is a FREE member benefit.

MEMBER SPOTLIGHT

A Step Ahead Prosthetics

By DEBORAH CONN

Adapting Care During COVID-19 New York prosthetic facility debuts remote assistance program

WNER ERIK SCHAFFER, CP,

OCTOBER 2020 | O&P ALMANAC

A Step Ahead’s main office is based in Hicksville, New York.

FACILITY: A Step Ahead Prosthetics LOCATIONS: Hicksville, New York, and Boston OWNER: Erik Schaffer, CP HISTORY: 21 years

Owner Erik Schaffer, CP, works on a device in his facility’s 6,000-squarefoot fabrication lab.

fruition, all in-house.” The result, he says, is an exceptional approach to specialty work and fully customized devices, all in record time. The large gait area in the New York facility features hydraulic ramps, a treadmill, a gym, and the Solo-Step ceiling-mounted harness training system. A new space is devoted exclusively to training upper-extremity amputees. Schaffer believes in a multidisciplinary team approach to prosthetic care, and he works closely with surgeons to ensure optimal outcomes for amputees, including osseointegration, when appropriate. “We work with hospitals on approvals [from the U.S. Food and Drug Administration] and IRBs [investigative research boards] to bring technology to fruition,” he says. The SkinTones™ division of A Step Ahead offers handmade silicone prosthetic covers as well as replacements for the breast and maxillofacial areas, including ears and noses. “Our approach to creating anatomically correct prostheses includes the adoption

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: A Step Ahead Prosthetics

founded A Step Ahead Prosthetics more than 20 years ago, after 14 years in the industry. While his focus was helping patients of all ages gain their mobility, he quickly became known for pushing the development of sports devices for amputee athletes. Business grew rapidly, and today the facility provides a full range of upper- and lowerextremity prosthetic solutions. The main office, in Hicksville, New York, occupies more than 20,000 square feet, including a 6,000-square-foot fabrication lab and a division dedicated to creating lifelike silicone skins. A sister office in Boston has expanded the company’s geographic reach; it occupies about 10,000 square feet and offers the same services, except billing, which is centralized in New York. A Step Ahead, with 32 employees, serves patients from nearly every state in the United States in addition to countries on every continent, Schaffer says. The size of the facility gives it certain advantages. “The complexity of our research and development department is unique to the industry,” he says. “We have a full-time biomechanical engineer and product designers on staff. Our New York lab is equipped with a five-axis CNC carving router, 3D printers, and a complete metal shop with mills, lathes, and other specialized equipment,” Schaffer says. “We take ideas from concept through

of high-end 3D scanners that allow us to create mirror-like images of existing limbs,” he says. About 10 years ago, one of Schaffer’s four daughters had the idea to fit a doll with a prosthesis as a gift for her friend with limb loss. Schaffer took on the challenge, modifying the doll to fit it with a custom-made prosthetic leg that matched that of the friend. The idea took off, and today A Step Ahead is the official prosthetic provider for American Girl® dolls. “I’ve made thousands since then,” says Schaffer, who invites children with limb loss to send in their American Girl doll for a fitting, free of charge. Thanks to donations, A Step Ahead gives away a certain number of dolls to children whose families can’t afford them. During the pandemic, Schaffer developed the facility’s remote assistance program, which enables patients to schedule a virtual consultation and then ship their prostheses or skin covers to the facility for repairs and adjustments. During the lockdown, they extended the service to nonpatients as well. “We’ve done virtual consultations with amputees in Panama, Sri Lanka, and Ethiopia, as well as those all over the United States,” he says. Schaffer is most proud of his facility’s approach to insurance. A staff of billing specialists and practitioners develops and implements strategies to ensure the best possible outcome for patients. “We fight for our patients’ rights,” he says. “The insurance companies are dictating care, and caregivers are conceding to whatever they will allow. While I still have air in my lungs, I will continue to fight for my patients and their right to the most appropriate treatment for their situation.”

As social distancing keeps us apart, we all stand strong in our mission to serve — making us more united than ever.

WE ARE ABC. Let us help you navigate this uncertain time. Visit ABC’s dedicated COVID-19 page today at ABCop.org.

AOPA NEWS

Webinars UPCOMING WEBINAR WEDNESDAY

NOV. 11

During these one-hour sessions, AOPA experts provide up-to-date information on a specific topic. Webinars are perfect for the entire staff—they’re a great teambuilding, money-saving, and educational experience! Sign up for the entire series and get two conferences free. Entire Series ($990 Members/ $1,990 Nonmembers). Register at http://bit.ly/2020AOPAwebinars.

RAC Audits: What Are They Looking At?

The November 11 webinar will examine the rules governing the recovery audit contractor (RAC) program, the different types of audits conducted by the RAC, and what areas the RAC is currently auditing. Hear an expert discuss these issues and tips for avoiding potential RAC audits.

UPCOMING WEBINAR WEDNESDAY

DEC. 9

New Year: New Codes, Fees, and Updates

Don’t miss one of the most anticipated webinars of the year. AOPA’s coding and billing experts will provide up-todate analysis and interpretation of the newest HCPCS codes and changes for the upcoming year. Presenters will recap the 2020 Medicare changes and share updates on what to expect in 2021.

Download Data From the CMS Data Portal Looking to develop a new product? Want to see who is currently using what product? AOPA members can access the CMS Data Portal to access comprehensive, easy-to-use, easyto-read, Medicare Part B orthotic and prosthetic claims data from the last five years; previous years are available with special request. You can download customized reports for use in your own reports and marketing material. The data is updated annually to ensure you have the most recent data at your fingertips. Just set your search parameters, and in a matter of minutes you’ll get data to help you do the following:

OCTOBER 2020 | O&P ALMANAC

• Understand the current market in terms of size, geographic distribution, and provider specialty. • Predict growth and opportunities. • Compare historical and projected growth rates in Medicare. • Identify new product opportunities. This CMS Data Portal is free to AOPA members. To access it, all you need is your AOPA member username and password. Visit the AOPA website, or contact Devon Bernard at dbernard@AOPAnet.org.

DATA AT YOUR FINGERTIPS

AOPA NEWS

FREE ACCESS

AOPA Offers Members Free Access to AOPAversity

AOPA knows you and your employees are being tremendously impacted by COVID-19. To help, we are offering you, our AOPA members, the ability to access our online learning management system, AOPAversity, for free for the rest of 2020. It is our hope that this will make it easier to navigate the current unprecedented situation. What does this mean? You and your employees can now access all 72 online offerings, which are prerecorded videos available on demand. If you do not currently have an AOPAversity account, visit https://myaopaconnection.org to create a profile. You will need your AOPA member ID and the Zip code affiliated with your membership when you create your profile to access the free offering. Already have a profile? Log in at www.AOPAnetonline.org/aopaversity. Your username is the email used to create your profile. This offer is valid through Dec. 31, 2020, and excludes any refunds to purchases made prior to the start of this

offer. We hope this benefit offers you additional support during this uncertain time. Contact Ryan Gleeson at rgleeson@AOPAnet.org with any questions.

AOPA Offers COVID-19 Responses, Guidance, and Resources AOPA leadership has continued to closely follow the spread of the coronavirus disease (COVID-19) and its widespread impacts. We also have been taking your calls and emails and hearing firsthand how extremely difficult and uncertain things are for you, your businesses, and your patients. To that end, we are responding with support. We are responding with outreach to legislators about how they can best support the O&P profession. We are responding by providing guidance on regulations like documentation, telehealth, and stay-at-home orders. We are responding by pulling together resources. We are responding by creating a space on the Co-OP to share your experiences and strategies with one another. All of this information can be found on the newly developed COVID-19 Response and Resources webpage,

www.AOPAnet.org/resources/covid-19. We will be updating this webpage frequently with actions, guidance, and resources, and will be pushing out updates via email, Smartbrief, and AOPAâ&#x20AC;&#x2122;s social media channels. As the situation evolves daily, we encourage you to also follow the guidance being issued from the Centers for Disease Control and Prevention (CDC), the World Health Organization, and your local, state, and federal government. The CDC website features resources and guidance for healthcare facilities; visit www.cdc.gov/ coronavirus/2019-ncov/healthcare-facilities. Thank you for all you continue to do for your patients and the O&P profession. The AOPA Board of Directors and staff are here to support you. If you have questions, concerns, or needs, do not hesitate to reach out to any of the staff at info@AOPAnet.org. O&P ALMANAC | OCTOBER 2020

O&P PAC

O&P PAC Update The O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: • Curt Bertram, CPO

• Wendy Miller, BOCO

• Jeffrey Brandt, CPO

• Matthew Nelson, CPO

• George Breece

• Ricardo Ramos, CP, LP

• Terri Bukacheski, CP

• Bradley Ruhl

• Erin Cammarata, CTO

• Michael Schlesinger

• Tina Carlson, CMP

• Lesleigh Sisson, CFo, CFm

• Christina Cox

• Bernie Veldman, CO

• Steven Ehretsman

• Regina Weger

• Don Foley

• Dennis Williams, CO, BOCO

• Eve Lee, MBA, CAE

• Scott Williamson, MBA

• Jim Liston, CP • F. Daniel Luitjohan, CP • Jeff Lutz, CPO

• Larry Word, CPO • Ann Yamane, CO • James Young Jr., CP, LP, FAAOP

• Brad Mattear, CFo, CPA, LO

• Claudia Zacharias, MBA, CAE

• Martin McNab, CPO

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/aopapac. *Due to publishing deadlines this list was created on Sept. 14, 2020, and includes only donations and contributions made or received between Jan. 15 and Sept. 14, 2020. Any donations or contributions made or received on or after Sept. 14, 2020, will be published in a future issue of O&P Almanac.

NEW MEMBERS

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of the American

Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. Fourroux Prosthetics Inc. - STL 9665 Page Avenue Overland, MO 63132 314/551-2341 Affiliate

OCTOBER 2020 | O&P ALMANAC

Grace Rehab Inc. 901 N. McDonald Street, Ste. 906 McKinney, TX 75069 972/984-1851 Bobby Bailey Patient-Care Facility

Streamline Orthotics and Prosthetics LLC 615 S. Vandeventer Avenue St. Louis, MO 63110 314/289-9100 Kelly Vogl Patient-Care Facility

Point Designs 1216 Commerce Court, Ste. 3 Lafayette, CO 80026 720/600-4753 Levin Sliker Supplier

Walker Orthotics and Prosthetics 205 Redmond Road Rome, GA 30165 706/232-4383 Grant Espy, MBA Patient-Care Facility

MARKETPLACE ALPS Prosthetic Socks The ALPS prosthetic sock is lightweight and soft, providing cushioning and comfort for a superior fit. Available in one-, three-, and five-ply, the socks are manufactured with Coolmax® fibers to create a moisture management system that moves perspiration away from the body and through the fabric, where it can evaporate quickly. They accommodate volume fluctuation and can be worn alone or with one’s prosthesis. The Coolmax® fibers allow a cool, comfortable wear. These socks keep their shape over time; minimal stretch and will not mat down. Ones with a distal hole are only available with plastic reinforcement. The plastic reinforced hole prevents fraying of the seam around the distal hole. This sock is offered in various length and thickness, and you can choose between Narrow, Medium, and Wide. Call us or visit www.easyliner.com for more information.

Fabtech Epoxy Meter Mixer Making your fabrication life easier! Our Epoxy Meter Mixer offers a faster, cleaner, and accurate way for you to meter your RESTECH+ Epoxy resin ratio every time! • Our resin pump meter mixing system has one-gallon resin reservoirs, for the A and B sides, for a total of two gallons. • Keeps your mixing station clean and organized! • Accurately dispenses up to three quarts of unmixed two-part RESTECH+ epoxy resin per minute. • All you have to do is mix the resin. • No more gram scale! Call for more details! Contact 800/322-8324 or visit www.fabtechsystems.com.

The Original Preflexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement. For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com.

Apis

LEAP Balance Brace

Apis custom program offers practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words. Call us at 1-888/937-2747.

Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com. O&P ALMANAC | OCTOBER 2020

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac20 for advertising options.

Naked Prosthetics Naked Prosthetics designs and manufactures high-quality prosthetic devices specifically for finger loss. Our mission is to assist people with digit amputation(s) and positively impact their lives with fully articulating, custom finger prostheses. Our product aims to restore the ability to perform most tasks, supporting job retention and an active lifestyle. Our customers have lost fingers to power tools, equipment malfunctions, injury in the line of military service, random accidents, and infections; in some cases, multiple digits have been lost. NP provides a viable functional prosthesis, as opposed to a passive cosmetic solution. Our design mimics finger motion and utilizes the remainder of an amputee’s digit to power the device. For more information, visit www.npdevices.com.

Proteor Rush Rogue® The PDAC approved RUSH ROGUE® provides the most realistic and dynamic foot and ankle motion available. The Vertical Loading Pylon (VLP) provides vertical shock relief while offering +/- 8 degrees of torsion, allowing the user to push the foot and themselves to the limits. The RUSH ROGUE is made of our advanced fiberglass composite, which is 3X more flexible than conventional prosthetic feet. The roll-through characteristics of the foot provide exceptional energy return with no “dead spot.” The RUSH ROGUE is also available in the EVAQ8 elevated vacuum and H2O models. #goROGUE

OCTOBER 2020 | O&P ALMANAC

The Harmony System: A Strong Connection As an active vacuum volume management system for transtibial prostheses, the Harmony P4 System creates vacuum between the liner and socket, resulting in an unprecedented socket fit. Compared to a valve or pin system, benefits include: • Reduced volume fluctuations • Improved suspension • Reduced forces within the socket • Improved proprioception • Promotes residual limb blood circulation. To learn more, call your sales rep or visit professionals.ottobockus.com.

WalkOn® Carbon Fiber AFO WalkOn ankle-foot orthoses (AFOs) are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally. WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return. WalkOn offers a full range of AFO sizes and designs, including the WalkOn Reaction junior pediatric sizes. Fast and easy to fit, the WalkOn footplate is trimmable and can be shaped with scissors, often requiring only one office visit. Contact us at 800/328-4058 or professionals.ottobockus.com for details.

MARKETPLACE Spinal Technology Inc.

Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Nocturnal ScoliosisÂŽ System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis. For information, contact 800/253-7868 or visit www.spinaltech.com.

The Xtern Foot Drop AFO by Turbomed Orthotics Think outside the shoe! This oneof-a-kind orthosis (AFO) is a game changer for foot drop patients: the Xtern is totally affixed outside the shoe to maximize comfort, prevent skin breakdown and rubbing injuries. Its flexibility promotes maximal ankle range of motion and calf muscle strength. The Xtern allows running, walking, and even mountain hiking as long and as far as you want without any restrictions, and moves from sandals to boots flawlessly. Turbomedâ&#x20AC;&#x2122;s innovative products are designed in Quebec, Canada, sold in over 26 countries, and distributed by Cascade in the United States. Visit turbomedusa.com to get your life back!

AOPA Supplier Plus Members Thank you to our 2020 AOPA Supplier Plus Members for their continued support of the association.

MAKING LIVES BETTER

Tel: 727.528.8566 Tel: 800.574.5426 www.easyliner.com info@easyliner.com

O&P ALMANAC | OCTOBER 2020

MARKETPLACE

Play like a pro.

Support for Better Life! allardusa.com

Meet the AllPro: the most naturally active, flexible, energy-returning foot from Fillauer.

info@allardusa.com P: 888-678-6548 F: 800-289-0809

AD_AOPA_Product_Directory_FEB2019.indd 1

2019-02-11 08:05:32 AllPro Quarter.indd 1

PERSONAL. INTUITIVE. COMPLETE CONTROL. Our Gen2 System is the industry best in pattern recognition technology

DISTRIBUTION REIMAGINED Product Selection • Customized Solutions • Excellent Service

www.cascade-usa.com | 800-888-0865

OCTOBER 2020 | O&P ALMANAC

coaptengineering.com

3/25/20 9:02 AM

MARKETPLACE

INNOVATION IMPLEMENTATION TRAINING Offering the most advanced Ponseti Method clubfoot braces in the industry. Providing unsurpassed customer service and support throughout the entire clubfoot journey. Developing hands-on training tools to better equip practitioners around the globe. Enabling children with clubfoot to take the Next Steps 2 New Feet — that’s the MD Orthopaedics way!

orthopaedics

w w w. m d o r t h o p a e d i c s . c o m

AOPA directory.indd 2

3/24/2020 2:02:53 PM

Watch Video. Pass Test. Earn CEUs.

Working Together for Better Outcomes WillowWood is committed to partnering with clinicians to drive innovation and improve the quality of care for amputees.

SPS is here to make your job easier, which means having continuing education available at your fingertips. Expand your skills at your own pace by enrolling in SPS Online CEU Courses today. To get started, visit

info.spsco.com/ceu

800.767.7776 | SPSCO.COM

800.848.4930 www.willowwood.com

O&P ALMANAC | OCTOBER 2020 2020_ 3.5x4.5'' Corporate Ad.indd 1

3/30/2020 9:58:43 AM

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

WANTED! A few good businesses for sale.

Job Location Key: - Northeast

Lloyds Capital Inc. has sold over 150 practices in the last 26 years.

- Mid-Atlantic - Southeast - North Central

If you want to sell your business or just need to know its worth, please contact me in confidence.

- Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge.

Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com

Refer to www.AOPAnet.org for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

Listing Word Count 50 or less 51-75 76-120 121+

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board 50 or less

Member $85

A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.

Connecting highly qualified O&P talent with career opportunities EMPLOYEE

• Research who is hiring • Apply online for job openings • Free résumé review

Nonmember $280

For more opportunities, visit: http://jobs.AOPAnet.org. SUBSCRIBE

AOPA’s O&P Career Center

EMPLOYER

• Post your job in front of the most qualified group of O&P professionals • Search anonymous résumé database to find qualified candidates • Manage your posted jobs and applicant activity easily on this user-friendly site.

LOG ON TODAY! https://jobs.AOPAnet.org 56

OCTOBER 2020 | O&P ALMANAC

CAREERS

Career Opportunities... California

CO-Sacramento CO-Modesto CPO-Salinas Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services.

Oregon CPO –Corvallis & Salem

The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others.

To apply, submit resume to: careers@pacmedical.com

A competitive salary, benefits and profit sharing are offered based on position/experience.

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremost as demonstrated by our positive attitude, teamwork and professionalism.”

AD INDEX

Advertisers Index Company ALPs

Page Phone 15 800/574-5426

American Board for Certification in Orthotics, Prosthetics, & Pedorthics 47

703/836-7114

Website www.easyliner.com www.abcop.org

Amfit

13 800/356-3668

www.amfit.com

Apis Footwear Company

888/937-2747

www.apisfootwear.com

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

ESP LLC Fabtech Systems LLC Ferrier Coupler Inc. Hanger Hersco

888/WEAR-ESP

www.wearesp.com

32, 33

800/FABTECH

www.fabtechsystems.com

810/688-4292

www.ferrier.coupler.com

877/4HANGER

www.hanger.com/diversity

16, 17

1 800/301-8275

Naked Prosthetics

888/977-6693

Ottobock

C4 800/328-4058

www.hersco.com www.npdevices.com www.professionals.ottobockus.com

PROTEOR USA

9 855/450-7300

www.proteorusa.com

Spinal Technology Inc.

800/253-7868

www.spinaltech.com

Tamarack Habilitation Technologies

763/795-0057

www.tamarackhti.com

TurboMed Orthotics

888/778-8726

www.turbomedorthotics.com O&P ALMANAC | OCTOBER 2020

CALENDAR October 27–29

OT World.connect 2020. A Virtual World Congress with more than 250 participants from more than 20 countries will be accompanied by digital presentations on industry innovations. For more information, visit www.ot-world. com/index-en.html.

November 1

APPLY ANYTIME. TEST ANYWHERE. Become a BOC-certified orthotic fitter, mastectomy fitter, or durable medical equipment specialist. Exams are offered year-round: in-person at test centers and select conferences and online from the location of your choice with a live, remote proctor! Visit www.bocusa.org/certification/apply. www.bocusa.org

Cascade Dafo Institute

Nine free ABC-approved online education courses to enhance your clinical practice. Take anytime, anywhere, and earn up to 14.5 CE credits. Visit cascadedafo.com or call 800/848-7332.

November 1

ABC: Practitioner Residency Completion Deadline for December Written & Simulation Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

November 9–10 AOPA Virtual Coding and Billing Seminar. Join our experts, get the latest on coding, billing, and reimbursement policy. For more information, visit www.AOPAnet.org. SEMINAR

November 11 WEBINAR

2020

visit www.AOPAnet.org.

RAC Audits: What Are They Looking At? For more information,

December 1

October 8–10

South Carolina Society of Orthotists and Prosthetists (SCSOP) NC/SC Combined Meeting. SCSOP hosting. Greenville, SC. For more information, visit https://scsop.org.

October 1–31

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and technicians in 350 locations nationwide. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

October 14

New Technical Credits—Clinician’s WEBINAR Corner: Fitters and Techs. For more information, visit www.AOPAnet.org.

October 15–17 (New rescheduled date; online)

Tennessee Society of Orthotists and Prosthetists (TSOP) Annual Meeting. Rescheduled from April. Now online. For more information, visit www.tennsop.org. 58

ABC: Application Deadline for Winter CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/ individual-certification.

OCTOBER 2020 | O&P ALMANAC

ABC: Application Deadline for February Written & Simulation Exams. Applications must be received by December 1 for individuals seeking to take the February written and simulation certification exams. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

December 1

ABC: Practitioner Residency Completion Deadline for Winter CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

December 9–14

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 350 locations nationwide. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

CALENDAR May 12–14 WEBINAR

www.AOPAnet.org.

New York State Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Rivers Casino & Resort, Schenectady, NY. For more information, visit nysaaop.org/meeting.

December 9 New Year: New Codes, Fees, and Updates. For more information, visit

September 9–12

AOPA National Assembly. Boston. For more information, visit www.AOPAnet.org.

2021

November 1–4

ISPO 18th World Congress. Expo Guadalajara Convention & Exhibition Centre in Guadalajara, Mexico. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

January 1

ABC: Practitioner Residency Completion Deadline for February Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

January 10–11

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@ABCop. org, or visit ABCop.org/individual-certification.

January 24–25

THE LIGHTER SIDE

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

February 1

ISPO 18th World Congress Deadline for Symposia and Instructional Courses. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

March 29

ISPO 18th World Congress Deadline for Free Papers. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

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For information on continuing education credits, contact the sponsor. Questions? Email info@aopanet.org.

O&P ALMANAC | OCTOBER 2020

STATE BY STATE

Championing the O&P Agenda Updates from Arkansas, California, Kansas, and New York

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/resources/co-op.

COVID-19 Updates AOPA is maintaining statespecific updates related to the coronavirus disease (COVID-19) on all state pages of the Co-OP. Please visit your state’s page for additional information.

Prior Authorization Reminder

CMS began Medicare prior authorization for six prosthetic codes in the four states previously selected for the initial rollout— Pennsylvania, Michigan, Texas, and California—on September 1. The prior authorization program for prosthetics will be implemented nationally on Dec. 1, 2020. 60

OCTOBER 2020 | O&P ALMANAC

Arkansas

Blue Cross Blue Shield (BCBS) Arkansas has updated its Myoelectric Prosthetic and Orthotic Components for the Upper Limb Medical Policy with the addition of an investigational statement for osseointegrated lower-limb prosthetic devices, with or without microprocessor control: An osseointegrated upper-limb prosthetic device does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness. For individuals with/without primary coverage criteria, an osseointegrated upper-limb prosthetic device is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage. AOPA has reached out to BCBS Arkansas with a request for additional information regarding this policy update—specifically, the implications of this policy for patients with osseointegrated implants and their access to prostheses and prosthetic services.

California

In light of the ongoing COVID-19 pandemic, the efforts of the California Orthotic and Prosthetic Association (COPA) toward increasing the Medicaid fee schedule have been put on hold. COPA’s Board of Directors has shifted its focus to protecting access to prostheses and orthoses for Medicaid beneficiaries, given the expected budgetary impacts as a result of the

pandemic. The organization has scheduled meetings with state legislators. For additional information, contact the COPA Board of Directors at admin@californiaoandp.com.

Kansas

AOPA has requested a medical review of BCBS of Kansas’s current Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses Medical Policy, citing contradictions in the policy language—similar to those in the Health Care Services Corp. policy successfully challenged by AOPA and others, and subsequently revised earlier this year.

New York

AOPA continues to work with the New York State Chapter of the American Academy of Orthotists and Prosthetists (NYSAAOP) to help O&P practices fight for change to the orthotics and prosthetics Medicaid fee schedule, which is more than 33 years old. Members of NYSAAOP have secured two state legislators to champion efforts to raise the Medicaid fee schedule for O&P. To learn more about how you can get involved, email ted@carecrafters.com.

Submit Your State News

To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org.

DATA AT YOUR FINGERTIPS

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2020 October O&P Almanac

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Cost-Effective

The Prognosis for U.S. Healthcare