2020 February O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

F E B R UARY 2020

Challenging Denials for Inpatient Billing P.20

Embracing Diversity in the O&P Worplace P.38

Studying Prosthetic Componentry for Swimming and Scuba Diving

INTUITIVE

INNOVATION STATE-OF-THE-ART UPPER-LIMB ADVANCEMENTS OFFER MORE OPTIONS AND FUNCTIONALITY FOR PROSTHETIC PATIENTS P.28

P.48

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This Just In: New Medicare Claims Require Standard Written Orders P.24

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contents

FE B R UARY 2020 | VOL. 69, NO. 2

COVER STORY

FEATURES

28 | Intuitive Innovation More individuals with upper limb loss are seeking prosthetic solutions, and the options are growing. Upper-extremity specialists share their experiences with advanced pattern recognition control technologies and new offerings in partial hands and digitsâ&#x20AC;&#x201D;and offer their predictions for the future of osseointegration and neuroprosthetics. By Christine Umbrell

24 | This Just In

Shifting to Standard Written Orders CMS recently announced a change to requirements for physician orders: Medicare claims now require a standard written order (SWO), rather than the traditional detailed written order. Find out what must be included in an SWO, and learn how this change may reduce instances of unnecessary claim denials.

FEBRUARY 2020 | O&P ALMANAC

38 | Inclusive O&P As companies across the nation recognize the benefits of more diverse workplaces, some O&P facilities are stepping up their efforts to be more inclusive in their hiringâ&#x20AC;&#x201D;and more reflective of their patient populations. Companies with staff members from different genders and racial and ethnic backgrounds may benefit from improved employee satisfaction and staff retention, as well as more creative and innovative teams. By Michael Coleman

“I focus on what I do have, instead of what I don’t have” Jami Marseilles Mother, Teacher and Athlete

lwl.ossur.com

contents

PRINCIPAL INVESTIGATOR Duffy Felmlee, MSPO, CPO, FAAOP..................................................................48

Find out how a University of Hartford professor has taken up scuba diving to conduct underwater investigations studying veterans with limb loss, and learn about his other research endeavors involving international telemedicine, O&P materials science, and more.

DEPARTMENTS Views From AOPA Leadership......... 6 Eight steps to differentiation from DME

AOPA Contacts.......................................... 8 How to reach staff

Numbers...................................................... 10 At-a-glance statistics and data

Happenings................................................12

Research, updates, and industry news

People & Places........................................16 Transitions in the profession

COLUMNS Reimbursement Page........................ 20

Three Types of Denials

Maximize reimbursement during inpatient stays and in other circumstances CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Member Spotlight................................. 52 n

Austin Prosthetic Center

Bort-Swiss Orthopedic Supply P.12 AOPA News...............................................56 AOPA meetings, announcements, member benefits, and more

O&P PAC Update ...................................58 Welcome New Members...................58 Careers........................................................ 60 Professional opportunities

P.54

Marketplace............................................. 64 Ad Index..................................................... 68 Calendar..................................................... 70 Upcoming meetings and events

State By State........................................... 72 P.52 4

FEBRUARY 2020 | O&P ALMANAC

News from California, New York, Minnesota, and more

AAOP WORKSHOP Date: Wednesday March, 4 Time: 3:30 PM â&#x20AC;&#x201C; 5:30 PM

VIEWS FROM AOPA LEADERSHIP

Nothing Is Constant but Change Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

ANUARY’S O&P ALMANAC FEATURE on change management, “How To

Change,” applied Harvard Business School Professor John Kotter’s eight steps for facilities needing to update their processes and procedures. When reading it, I couldn’t help but reflect on AOPA’s journey to see O&P differentiated from durable medical equipment (DME). 1. Create a Sense of Urgency: We can’t just focus on the urgent; we also need to focus on the important. Well, the urgent and the important have become one and the same in regard to ensuring the future of the profession. Collectively, we have acknowledged we need to separate from DME. 2. Build a Guiding Coalition: Thanks to our friends in the O&P Alliance, we are partially there. We could do better at including all levels of the profession, to ensure a diverse set of voices is represented. We also must engage allied healthcare professionals. AOPA has started this with initiatives like Orthotics 2020 and Prosthetics 2020 and the Medical Advisory Boards that guide them. 3. Form a Strategic Vision and Initiatives: The first step in executing our strategic vision is the Medicare O&P Patient-Centered Care Act that was introduced in the House in late November 2019. It outlines the vision, but now communication is key. It needs to be apparent to all stakeholders why we need to differentiate, specifically what the benefit is to them. To do this, we will constantly evaluate our vision and messaging of it, to ensure it’s responsive to the ever-evolving environment. 4. Enlist a Volunteer Army: For the vision to be realized, we need to build more excitement. All staff should be engaged, contributing to the transformation of the profession. How? For one, we can further our grassroots advocacy. More than 1,100 individuals took action on the Medicare O&P Patient-Centered Care Act. With the help of other organizations, we will continue to grow this base. 5. Enable Action by Removing Barriers: We need to determine if barriers or archaic practices are holding us back. The profession is innovative in regard to technology, but are we innovative in the ways we communicate with and educate payors and referral sources? Do we need to adapt systems? Do we need to compromise with regulators? 6. Generate Short-Term Wins: AOPA is working on generating and acknowledging short-term wins. All of our members are working on various aspects of the vision, all while doing their day-to-day work. Doing this helps motivate future action, but also provides the opportunity to reflect and make strategy changes if something is not working. 7. Sustain Acceleration: This is a marathon. We are going to need to sustain the momentum so that the change can be realized. This is where having a diverse coalition and large, enthusiastic volunteer base comes into play. 8. Institute Change: When change happens we need to celebrate, but we also need to thank those who helped us get to this point. We then need to document the value and return that we see post-change and share with all of those involved. The only thing that is constant is change, so let’s intentionally shape our future. As I enter the third month of my presidency, I’m inspired by the changes we’ve made to get us closer to differentiation. Although we have a ways to go, I know that if we refuse to stand still, we work together, and we are strategic, we will clearly separate our profession from DME. Getting legislation introduced is no easy feat. Thank you for continuing to advocate for the profession and its patients. Together, we can continue to improve the lives of those living with limb loss and limb impairment. Jeffrey Lutz, CPO, is president of AOPA.

FEBRUARY 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

It’s all about

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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, chief operating officer, 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 marketing, 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 Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 8

FEBRUARY 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 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

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 ymazur@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.

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!

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NUMBERS

Diversity in the Workplace O&P companies with diverse staffs may reap benefits

RACIAL AND ETHNIC DIVERSITY

35 Percent

Companies with significantly more racial and ethnic diversity are 35 percent more likely to outperform competitors.

45 Percent

Average innovation revenue—revenue generated from enhanced or new products or services— reported by companies with above-average diversity scores, compared to 26 percent for companies with below-average diversity scores.

WOMEN IN MANAGEMENT AT U.S. COMPANIES

21 Percent

87 Percent

79 Percent

68 Percent

Representation of women in the C-suite, up from 17 percent in 2015.

Percentage of North American organizations that say gender diversity is a high priority.

Percentage of senior and mid-management women who have the desire to reach a top management position, versus 81 percent of men.

Percentage of “best-in-class” organizations that actively support and nurture a gender diversity culture.

Majorities of Senior Leaders in U.S. Companies Prioritize Diversity in the Workplace

By gender, percentages of senior leaders who… Women Men

Believe gender diversity is a priority.

77% 71%

Believe racial diversity is a priority.

69% 67%

Have participated in unconscious bias training. 79% 74% Actively work to address diversity and inclusion. 47% 45% “Women in the Workplace 2019,” McKinsey & Co., October 2019

“Companies in the top quartile for gender diversity on their executive teams were 21 percent more likely to have above average profitability than companies in the fourth quartile. For ethnic/cultural diversity, top quartile companies were 33 percent more likely to outperform on profitability.” —“Delivering Through Diversity,” McKinsey & Co.

FEBRUARY 2020 | O&P ALMANAC

SOURCES: “Women in the Workplace 2019,” McKinsey & Co., October 2019; “Delivering Through Diversity,” McKinsey & Co., January 2018; “Taking the Lead for Inclusion,” McKinsey & Co., November 2019;“Diversity Matters,” McKinsey & Co., February 2015; “How Diverse Leadership Teams Boost Innovation,” BCG, January 2018.

Businesses are more likely to perform better financially if they are diverse, according to research from McKinsey & Co. Companies that make a concerted effort to include women and individuals from different ethnic backgrounds as employees and managers may see a rise in production and innovation.

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Happenings RESEARCH ROUNDUP

Microprocessor Knees May Have Positive Effect on Users’ Executive Functioning Microprocessor-controlled prosthetic knee technology may reduce cognitive effort when walking, according to researchers at Jonkoping University in Sweden. Led by Nerrolyn Ramstrand, PhD, an associate professor and associate dean of research, a team investigated the effects of prosthetic knee joint prescription on executive functioning to study how prostheses place increased cognitive demands on transfemoral amputees. The team measured executive functioning among individuals with limb loss during single-task level walking and walking while performing a dual-task key finding test. They found reduced executive functioning required for most participants completing these tasks after transitioning to a microprocessor-controlled knee. They did not identify a reduction in executive functioning among participants during simple trail walk tests.

The results suggest microprocessor-controlled prosthetic knees may have a positive effect on executive functioning for some individuals who have undergone a lower-limb amputation, according to Ramstrand and her team. They note that a follow-up study that includes more participants and careful control of extraneous variables is needed to confirm their results. The study was published in Prosthetics and Orthotics International in December.

Transfemoral Osseointegration Patients Report Improved Outcomes With Implants Patient-reported outcomes over a 15-year time period indicate improved outcomes for individuals with osseointegrated implants, compared to before treatment, according to researchers at the Centre of Orthopaedic Osseointegration at Sahlgrenska University Hospital in Sweden. The researchers, led by Kerstin Hagberg, RPT, PhD, a senior physiotherapist and associate professor at Sahlgrenska University Hospital, completed a cohort study of 111 patients with unilateral transfemoral ampuKerstin Hagberg, tation who had received the Osseointegrated RPT, PhD Prosthesis for the Rehabilitation of Amputees (OPRA) Implant System. All subjects completed a Questionnaire for Persons With Transfemoral Amputation (Q-TFA) before their surgery and at two-year, five-year, seven-year, 10-year, and 15-year follow-up visits. The researchers assigned a prosthetic activity grade to each patient and recorded mechanical complications at each time point. 12

FEBRUARY 2020 | O&P ALMANAC

Subjects’ Q-TFA scores at the two-year, five-year, seven-year, and 10-year intervals indicated significantly more prosthetic use, increased mobility, fewer problems, and an improved global situation compared to their baseline scores, according to Hagberg’s team. The survival rate of the osseointegrated fixture was 89 percent at the seven-year mark and 72 percent at the 15-year mark. Fifty-five percent of patients had experienced mechanical complications at some point, resulting in exchange of the percutaneous implant parts. “Compared with before treatment, the patient-reported outcome was significantly better and remained so over time,” reported the researchers in an article in the January issue of The Bone & Joint Journal. “Although osseointegration and the ability to transfer loads over a 15-year period have been demonstrated, a large number of mechanical failures in the external implant parts were found. Since these were related to higher activity, restrictions in activity and improvements to the mechanical properties of the implant system are required.”

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HAPPENINGS

RESEARCH ROUNDUP

O&P ADVOCACY

New Classification System Would Alter Protocol for Scoliosis Treatment Decisions

Coming Soon: Limb Loss Awareness Month Don’t forget—April is Limb Loss Awareness Month! Plan now to celebrate your patients and educate your community about the realities of living with limb loss and limb difference during the month of April. Each year, the Amputee Coalition works to get April declared Limb Loss Awareness Month in all 50 states. Many cities, counties, and municipalities also make this declaration. Whether your state officially recognizes the month or not, your facility can celebrate patients and reach out to referral sources and the local community to advocate on behalf of the limb loss population during the month of April. FAST FACT

Ambulatory disabilities account for the greatest number of disabilities among workers with a disability in the United States.

TYPES OF DISABILITIES AMONG U.S. WORKERS 34%

AMBULATORY HEARING

31%

COGNITIVE

29%

VISION

22%

INDEPENDENT LIVING SELF-CARE

16% 8%

*Some workers may have more than one disability. SOURCE: U.S. Census Bureau

FEBRUARY 2020 | O&P ALMANAC

“When we started this study, we looked for something that could determine bone age using information that was already available on the spine X-ray ... that would be beneficial to patients and would not increase the cost of the patient’s care.”

–DANIEL COOPERMAN, MD

Faculty in the Yale Department of Orthopaedics and Rehabilitation have developed the Proximal Humeral Ossification System, a new bone classification system for assessing maturity in patients with scoliosis. Under the new system, medical professionals examine an X-ray of the proximal humerus—the upper part of the bone of the arm that meets the shoulder—to determine the maturity, or “bone age” of a patient. Traditionally, bone age—a critical factor in determining scoliosis treatment plans—is determined using the Sanders Hand System, which relies on hand X-rays. The Proximal Humeral Ossification System offers benefits in terms of reduced exposure to radiation for patients and reduced healthcare costs, and is just as accurate as the Sanders system, according to the Yale team. “Our technique uses spinal X-rays already obtained by physicians to look at the curve of the spine,” said Daniel Cooperman, MD, a professor and a pediatric orthopaedic surgeon, and an author of the study. “When we started this study, we looked for something that could determine bone age using information

that was already available on the spine X-ray … that would be beneficial to patients and would not increase the cost of the patient’s care,” Cooperman said. He and his team tested the new system by studying X-rays from 216 patients with scoliosis and comparing the radiographs to proximal humeral X-rays for 70 children from a historical collection. They found that the new system produced accurate results. The new classification system “can improve the prediction of peak height velocity in patients with scoliosis on the basis of a standard spine radiograph without a hand radiograph for the determination of bone age,” concluded the researchers. “This increased accuracy for predicting maturity will allow physicians to better assess patient maturity relative to peak height velocity and therefore can help guide treatment decision making without increasing radiation exposure, time, or cost.” The study was submitted in paper format to the Scoliosis Research Society and was awarded the Hibbs Award for Best Clinical Paper. Results were published in the October 2019 Journal of Bone and Joint Surgery.

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Rick Fleetwood, MPA, chief executive officer (CEO) of Snell Prosthetics & Orthotics, retired from the company January 31. The company’s owner, Frank Snell, CPO, LPO, FAAOP, will continue to serve as president Rick Fleetwood, and has assumed the CEO position. MPA Fleetwood joined Snell P&O in 1975 as general manager of its Little Rock office. He was promoted to CEO in 2000. During his tenure, Fleetwood helped oversee the expansion of the company from one single central location to 10 locations across the state. He also played a critical role in helping the company adapt to significant changes in reimbursement, regulation, compliance, educational requirements, and state licensure. Frank Oschell has been appointed vice president of U.S. sales at PROTEOR USA. He joins the company after 24 years in the medical field, including several years at Ottobock Healthcare. Oschell has expertise Frank Oschell in the development and training of consultative, solutions-based sales teams, and in cooperation with value-added marketing and clinically driven education. Oschell “is a seasoned sales professional with strong sales and organizational abilities that I had the pleasure of experiencing first-hand during our time together at Ottobock,” said Matt Swiggum, PROTEOR president and chief executive officer. Steve Sherman, who previously served as vice president of U.S. sales, will now focus on the development of new global distribution channels while reinforcing current partnerships. Sherman “has been very instrumental in building the RUSH business and has an entrepreneurial drive that will enable us to continue our rapid growth on a global level,” said Swiggum. The Board of Directors of the Board of Certification/ Accreditation (BOC) has announced the election of its 2020 Executive Committee and the election of three new directors to the board. The Executive Committee is comprised of the officers of the board. Following are the 2020 officers: • Chair: L. Bradley “Brad” Watson, BOCO, BOCP, LPO • Vice Chair: Mark L. Parris, Pharm.D, RPh, CFo • Secretary: David D. Regier, ATC, LAT, MS L. Bradley “Brad” • Treasurer: Daniel Griffis III, Pharm.D Watson, BOCO, • Member-at-Large: Diana Klunk, CMF BOCP, LPO • Immediate Past Chair: Wayne R. Rosen, BOCP, BOCO, LPO, CDME, FAAOP

FEBRUARY 2020 | O&P ALMANAC

Bill Chaudhry, CDME

Abel Guevara III, MHIM, CDME, RHIA

The three new BOC board directors are Bill Chaudhry, CDME, owner and managing partner of Freedom Medical and Mobility DBA Medi Mart in East Windsor, New Jersey; Abel Guevara III, MHIM, CDME, RHIA, a senior consultant for durable medical equipment prosthetics, orthotics, and supplies, and a healthcare executive; and William J. Powers, MBA, LFACHE, retired Air Force Medical Service Corp. officer and a nonprofit healthcare executive. “BOC is proudly governed by a committed Board of Directors whose diverse professional backgrounds encompass the interests and needs of BOC’s wide array of certified professionals and accredited businesses,” said Watson. “I am honored to lead this caring and dedicated group of knowledgeable professionals as we enter a new decade of continuing success for BOC.”

William J. Powers, MBA, LFACHE

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Allard USA has announced it is partnering with the FSHD Society, a research-focused patient advocacy organization for facioscapulohumeral muscular dystrophy (FSHD). FSHD is a genetic disorder that leads to weakening of the skeletal muscles. One of the symptoms of the disorder is foot drop, which, if not properly managed, can lead to falls. Together, the two organizations will work to educate the population served by the FSHD Society on how to best manage foot drop. “Allard USA is pleased to partner with FSHD Society in 2020; their commitment to improving the lives of those with FSHD is in line with Allard USA’s desire to provide support for better life,” said Dennis Williams, Allard USA chief executive officer. AOPA has returned as an OPAF Gold Corporate Sponsor for 2020. Corporate Sponsors enable the work of OPAF to continue providing adaptive recreation and education to individuals with a physical or mobility challenge. “The American Orthotic and Prosthetic Association is proud to continue our support of OPAF,” said Executive Director Eve Lee, MBA, CAE. “The life-changing experiences for individuals with physical and mobility challenges, education of healthcare professionals, and public awareness OPAF provides are critical to the O&P community and its patients.” “As one of our founding partner organizations, the support of AOPA means so much to OPAF, the industry, and individuals that we serve,” said OPAF Executive Director Robin Burton.

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PEOPLE & PLACES BUSINESSES (Continued) ANNOUNCEMENTS AND TRANSITIONS

Cascade Orthopedic Supply has announced an investment made in the company by Ottobock North America. The investment aims to strengthen the collaboration of the two companies to further improve access to products among O&P customers and drive efficiencies in supply chain operations to spur growth for the industry. “We share a like-minded mission with Ottobock to provide our customers with product, business, and service solutions that will improve the quality of patient care. This investment will ensure our ability to grow, scale, and deliver on this promise,” said Cascade President Jeff Collins. “The Cascade team brings a wealth of knowledge from the supply chain management and e-commerce arenas. Together with our subsidiaries in 59 countries, this investment will help us advance our logistics operations and support Ottobock’s global patient-care network,” said Hans Georg Näder, president and chairman of the board of Ottobock SE & Co. KGaA. “We believe that by leveraging the strengths we both bring to the table,” said Ottobock CEO Philipp SchulteNoelle, “we will be better suited to serve our customers and the individuals who depend on our products.”

FEBRUARY 2020 | O&P ALMANAC

Northern Arizona Adaptive Sports Association NubAbility Athletics Orthotics and Prosthetic Activities Foundation Power On With Limb Loss Project MEND Range of Motion Project ROCK—Ride on Center for Kids Spastic Paraplegia Foundation Spaulding Rehabilitation Hospital Sportable Richmond Adaptive Sports and Recreation Inc. Texas Rowing Foundation Inc. The Wounded Blue Travis Mills Foundation Wiggle Your Toes.

The international association INTERBOR was dissolved during the association’s general meeting in December. The association represented the International Association of Bandagists, Orthopedists, Prosthetists, and Orthopedic Shoe Technologists.

PHOTO: Nasdaq Inc.

The Hanger Foundation announced it awarded a total of $240,000 in 2019 to 32 nonprofit organizations over two grant cycles. The mission of the Hanger Foundation is to advance communities by supporting 501c3 organizations that help people with physical challenges live life as fully as possible. The following organizations were recipients of 2019 Hanger Foundation grants: • Adaptive Sports Foundation Inc. • Adaptive Sports USA • All Out Adventures • Amputee Coalition • Angel City Alliance • Arizona Disabled Sports • Association of Amputee Surfers (AmpSurf) • BlazeSports America • Camp For All • Camp No Limits • Catalyst Sports • Chesapeake Region Accessible Boating • CPATH—Cerebral Palsy Awareness Transition Hope • Down Syndrome Connection of the Bay Area • Down Syndrome of Louisville Inc. • LS Warriors National Amputee Baseball Team • Move for Jenn Foundation • New England Warriors Chapter of USA Warriors

• • • • • • • • • • • • • •

Össur President and Chief Executive Officer Jon Sigurdsson rang Nasdaq’s closing bell on December 16. To mark the 20th anniversary of Össur as a publicly traded company, Jon Sigurdsson, the company’s president and chief executive officer, rang the closing bell at the Nasdaq MarketSite in New York’s Times Square on December 16, as the market hit record highs. Upon its first day of trading on the Iceland Stock Exchange in 1999, Össur became Iceland’s largest Initial Public Offering. Since then, the company has transformed from a small Icelandic prosthetics provider to an international company offering orthopaedic technologies. “We are pleased to have achieved this milestone in our history as a publicly traded company,” Sigurdsson said. “Our strong growth and healthy financial performance have been fueled by our tireless commitment to innovation, and we remain steadfast in our dedication to help even more people enjoy a life without limitations.”

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REIMBURSEMENT PAGE

By DEVON BERNARD

Three Types of Denials Avoiding recoupments for items provided during an inpatient stay and other common billing problems

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 22 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

FEBRUARY 2020 | O&P ALMANAC

NE YEAR AGO, IN the February

2019 O&P Almanac, the Reimbursement Page article focused on the rules regarding when it is appropriate to bill Medicare when delivering an item to a beneficiary in a Medicare Part A covered inpatient stay. The article also discussed a report published in November 2018 by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) titled, “Medicare Improperly Paid Suppliers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Provided to Beneficiaries During Inpatient Stays.” The 2018 report covered the threeyear period from Jan. 1, 2015, to Dec. 31, 2017, and identified $34 million in improper Medicare Part B payments for DMEPOS services delivered to Medicare beneficiaries during a Medicare Part A covered stay. While $34 million represents a significant number, only $14.6 million, or 43 percent of the identified improper payments, involved claims for artificial limbs and braces, according to the report. Based on these findings, OIG made three recommendations to CMS: that CMS, in accordance with its own policies and procedures, should make attempts to recover the identified improper payments; that all suppliers should refund any deductibles and/or co-pays from beneficiaries who were improperly billed; and that CMS should identify and recover any improper payments to suppliers after the audit period. In addition, OIG suggested that CMS “correct the system edits to fully prevent or detect

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overpayments to suppliers for DMEPOS items provided during inpatient stays.” CMS agreed with most of the OIG’s recommendations and directed the durable medical equipment Medicare administrative contractors (DME MACs) to recover the $34 million in identified improper payments. Since the publication of the February 2019 Reimbursement Page article, there has been an uptick in recoupments for items provided during an inpatient stay, including when the original item was billed as a refused item due to the patient passing away. You may want to review the Reimbursement Page articles in the February 2019 O&P Almanac for questions about Part A billing, and in the September 2019 issue for a review of billing for refused items. This month’s Reimbursement Page focuses on how to handle the possible denial of a claim when the claim was billed as a refused item and the patient was under a Part A stay. It also touches on two other recent trends in claim denials and recoupments: reasonable useful lifetimes (RULs) and coding verifications for the Pricing, Data Analysis, and Coding (PDAC) contractor.

Inpatient Billing: Refused Items Part A coverage, inpatient billing, is based on benefit periods or spells of illness. The number of days included in these benefit periods is not the same for hospitals and skilled nursing facilities (SNFs), and these days are not automatic; they are what the beneficiary is eligible to receive.

REIMBURSEMENT PAGE

In other terms, the benefit period is a set of consecutive days during which Medicare beneficiaries are eligible to receive medical benefits for select covered services. For traditional hospital inpatient stays, these benefit periods include 60 days of full coverage, plus an additional 30 coinsurance days; and a set of reserve days. The SNF benefit period is 100 days. Any covered service provided during a benefit period is paid under a per diem rate, or prospective payment system.

and a day begins at midnight and ends 24 hours later, or midnight to midnight. Partial days, such as the day of admission, count as one full benefit day. So, even if the patient is not in the hospital or SNF from midnight to midnight, it still counts as a benefit day. However, an exception to this calculation is the day the patient dies. The day of death is not considered or counted as a benefit inpatient day, unless it occurs on the day of admission. This means that the day the patient passed away is not considered part of the inpatient stay, and the facility is not responsible for payment. So, if you have a denial for a refused item because you used the date of death as your date of service, but the facility claims the patient was an inpatient, you can challenge the denial. In your appeal, you may explain and show that the date of death is not considered an inpatient day.

Items Requiring PDAC Approval

Chapter 15, Section 20.3, of the Medicare Benefit Policy Manual states that if a custom item is ordered but cannot be delivered because the patient has passed away, then payment can be made based on the “supplier’s expenses.” Those expenses are to be considered incurred on the date of the patient’s passing, so you must use the date of death as your date of service. However, if the patient passed away during a hospital stay, this can cause an overlap or confusion regarding who is responsible for payment. This confusion can be alleviated when you review how the inpatient benefit days are counted or calculated—information located in the Medicare Benefit Policy Manual, Chapter 3, Section 20.1. The inpatient days are counted as full days,

This denial reason is common with the Target, Probe, Educate (TPE) audits, but also is found with recovery audit contractor (RAC) results. Not all O&P items or services require review and coding approval from the PDAC contractor, but there is a select set of codes for which the corresponding products must be reviewed and approved. The largest benefit categories of items requiring approval are spinal braces. For the custom items listed in the sidebar on page 22, there is an exemption to the requirement to have items listed and reviewed by the PDAC. However, the exemption comes with some conditions. Below is an excerpt from the Lumbosacral Orthosis/ Thoracolumbosacral Orthosis (LSO/TLSO) Policy: “Orthoses that are custom fabricated from raw materials and are dispensed directly to the beneficiary by the entity that fabricated the orthosis. These items do not have to be listed on the PDAC website in order to be billed. …. However, the supplier must provide a list of the materials that were used and a description of the custom fabrication process on request.”

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REIMBURSEMENT PAGE

Codes Requiring L A V O R P P A C A D P Ankle-Foot Orthoses and Knee-AnkleFoot Orthoses:

Lower-Limb Prostheses:

L5969

L1906 and L2006

Diabetic Shoes and Inserts:

Lumbosacral Orthoses and Thoracolumbosacral Orthoses:

L0450, L0452, L0454-L0472, L0480-L0486, L0488-L0492, L0622, and L0624-L0640

Surgical Dressings:

A6545

Functional Electrical Stimulators:

E0770

So, if you are fabricating the custom item in-house and providing it directly to your own patient, then you are not required to have the items reviewed and approved by the PDAC. But you must be sure you have the ability to demonstrate that the items you provided meet the definition of a custom item—for example, by supplying a list of materials used and a description of your fabrication methods. You don’t have to submit this information with your claim, but it should be available. If you don’t have a description or definition of your fabrication methods in your procedure manuals, consider adding it as soon as possible. If PDAC approval is required, and the item you provided has not been reviewed by the PDAC or you are unable to demonstrate you fabricated the item in-house, your claim does not meet policy criteria and is subject to denial or recoupment. To avoid the denial, be sure to verify the PDAC, or have your fabrication process clearly defined and 22

Knee Orthoses:

L1845 and L1852

FEBRUARY 2020 | O&P ALMANAC

A5512, A5513, and A5514

Cervical Orthoses:

L0174

available for review if done in-house; otherwise, you must use the noncovered code A2970 for your claims. As a side note, the Ankle-FootOrthosis/Knee-Ankle-Foot Orthosis Policy has been updated to reflect the introduction of the new code L2006: “knee-ankle-foot device, any material, single or double upright, swing and/or stance phase microprocessor control with adjustability, includes all components, any type activation, with or without ankle joint(s), custom fabricated.” The L2006 requires PDAC approval. The policy also states that the L2006 is an all-inclusive code and no addition codes may be added. This policy update is effective for all claims with a date of service on or after Jan. 1, 2020.

Reasonable Useful Lifetime: Irreparable Damage

This denial reason is very common among the current slate of RAC audit issues, but it is seen in other reviews and

audits as well. The RUL for orthotics and most other items is determined through program instructions, such as regulations or medical policies. If there are no established program instructions, the DME MACs may determine the RUL; however, it cannot be less than five years. In other words, unless published somewhere, the default RUL is five years. During the RUL period, a patient may not receive a new or similar item and have Medicare reimburse for it, unless the replacement was provided due to one of three possible scenarios: change in patient condition, the item was lost or stolen, or the item suffered irreparable damage. The first two scenarios are pretty straightforward; the scenario that causes the most confusion and denials is replacement due to irreparable damage. Irreparable damage means damage that can be pinpointed to one specific event or accident—not damage that cannot be repaired due to everyday wear and tear, which Medicare does not cover under the RUL rules. So, when replacing an item due to irreparable damage, be sure to document one key thing: What event caused the damage? This may include statements from the patient explaining how the item broke (ran over it with a car, etc.), or statements from the patient and his or her home insurance carrier if it was damaged in a fire, flood, or accident. Be clear that the damage was not caused by everyday normal wear and tear, and that the damage necessitating the replacement was caused by one specific event. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@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:

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This Just In

Shifting to Standard Written Orders CMS announces significant changes to requirements for physician orders

S PART OF ITS overall effort to

reduce provider burden, CMS has announced a significant change to the requirements for physician orders for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The change is effective for claims with a date of service on or after Jan. 1, 2020, and eliminates the need for an initial/ dispensing order for Medicare DMEPOS services. Going forward, Medicare claims will only require a standard written order (SWO), which must be received prior to claim submission and contain essentially the same elements as the traditional detailed written order that has been part of the longstanding Medicare requirements for compliant DMEPOS claims.

FEBRUARY 2020 | O&P ALMANAC

Required elements of the new SWO include the following: • Beneficiary name or Medicare Beneficiary Identifier • Order date • General description of the item: 8 This can be a general description, a Healthcare Common Procedure Coding System (HCPCS) code, an HCPCS code narrative, or a brand name/model number. 8 All separately billable features, additions, options, or accessories must be listed separately on the SWO. 8 All separately billable supplies must be listed separately on the SWO. • Quantity to be dispensed, if applicable • Treating/ordering practitioner’s name or National Provider Identifier • Treating/ordering practitioner’s signature. While initial/dispensing orders are no longer required for services to be reimbursed, medical records must continue to support the medical need for O&P services that are provided. Medical need must clearly

be established prior to the provision of O&P care, so O&P providers should confirm that medical need is well documented before providing care to Medicare beneficiaries. And for any claims with a date of service prior to Jan. 1, 2020, the former rules remain in effect; in most cases, an initial/ dispensing order and a detailed written order must be received in order to maintain compliance with Medicare regulations. AOPA believes the changes in order requirements will significantly reduce instances of unnecessary claim denials and supports the recently announced change. CMS’s efforts to reduce unnecessary administrative burdens on legitimate providers will allow providers to focus on providing efficient, clinically appropriate care to Medicare beneficiaries without getting caught up in unnecessary and unreasonable administrative requirements. AOPA will continue to pursue opportunities to work collaboratively with CMS and other agencies to ensure that Medicare beneficiaries continue to have access to high-quality, clinically appropriate O&P care delivered by properly qualified and credentialed O&P providers.

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COVER STORY

Intuitive

INNOVATION

Upper-limb experts share their insights on the latest prosthetic advancements—and offer predictions on what’s to come By CHRISTINE UMBRELL

FEBRUARY 2020 | O&P ALMANAC

COVER STORY

NEED TO KNOW • Prosthetists have a lot to consider as they choose the most appropriate device options for upper-extremity patients, ranging from body-powered devices to advanced pattern recognition technologies to multiarticulating hands to transhumeral implants and more. • In recent years, more surgeons have refined their surgical techniques to include nerve reassignments, paving the way for some patients to take advantage of targeted muscle reinnervation and pattern recognition control technologies. • Upper-limb specialists are seeing an uptick in patients with partial hand and digit loss, due to advances in targeted solutions as well as recognition that this patient population has been under-served in the past. • In one current early feasibility study, transhumeral patients are being fit with the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA™) Implant System. The procedures performed so far have had positive results, anecdotally, with no implant-related adverse events or infections. • Brain-computer interface technologies are evolving. In a breakthrough last summer, a study of a mind-controlled robotic arm demonstrated the capability for humans to continuously control a prosthesis using noninvasive electroencephalogram signals. • The long-term future of upper limb will focus on more closely replicating the human hand, using stronger materials. But this will be a challenge, since the human hand is an incredible piece of engineering.

S WE LAUNCH INTO the 2020s,

technologies are advancing quickly within the upper-limb space, opening up more options and opportunities for individuals with arm, hand, and digit loss. “Most people, especially new amputees, want the most advanced prosthesis you can get,” says Rob Wagner, CP, an upper-limb specialist at Wright & Filippis. “With upper extremities, there’s a lot of trauma, so they’re often looking for very advanced devices.” Patients have become more aware of advanced options after seeing images in the media of veterans and athletes using the latest designs, says Wagner. Even older patients are starting to make the switch from “traditional”

electric devices to more advanced articulated bionic hands. Fortunately, some of these devices are beginning to be covered by some of the private payors, he adds, rendering newer technologies more cost-effective than in years past, at least for some patients. Prosthetists have a lot to consider as they choose the most appropriate device options for upper-extremity patients. From advanced pattern recognition technologies to multiarticulating hands to transhumeral implants and more, the array of devices designed to improve control and function is becoming wider year-by-year. Here’s a look at some of today’s trends, and a preview of some of the technologies expected to be available in the future. O&P ALMANAC | FEBRUARY 2020

COVER STORY

PHOTO: Tim Russo, CPO, LPO

Tim Russo, CPO, LPO, works with an upper-limb patient at Scheck & Siress.

Pattern Recognition—A New Normal

More patients than ever are being fit with devices that integrate with pattern recognition control systems— systems that utilize electrode arrays that capture data on the patient’s residual limb muscle contractions. These systems enable users to “train” their prostheses to work in the way they want it to work, via electromyography (EMG) information that allows for more complete and intuitive control of a prosthesis.

Kevin Barnes, CP, CTP

“More surgeons are refining their surgical techniques to include nerve reassignments,” enabling these patients to take advantage of targeted muscle reinnervation as well as the added benefits of pattern recognition, explains Kevin Barnes, CP, CTP, an upper-extremity prosthetist at Prosthetic Orthotic Solutions International in New Jersey. The results of these relocated biologic 30

FEBRUARY 2020 | O&P ALMANAC

Hugh Gill, BSc (Hons), HonFIES

amplifiers can allow more patients to experience improved EMG prosthetic control, according to Barnes. Devices that enable pattern recognition “eliminate switching modes,” so patients can automatically create a pattern that makes them feel like they’re able to open their hand, explains Wagner. “A lot of patients like pattern recognition,” and it’s becoming more available from a wider array of manufacturers. “Now, one pattern can simultaneously pre-position the wrist while entering hand grip’s position,” says Wagner. Pattern recognition is “the holy grail of prosthetics,” according to Hugh Gill, BSc (Hons), HonFIES, vice president of research and development, upper-limb prosthetics, Össur. Gill, who is credited with pioneering the first myoelectric hand, notes that the most recent advancements in this arena include updated algorithms for use in training devices to do what a user intends.

While early pattern recognition systems leveraged surface-mounted electrode arrays, the next step will be integrating implantable myoelectric sensors (IMES), says Gill. IMES technology consists of a multichannel EMG sensor system. IMES sensor capsules are placed intramuscularly through a minimally invasive surgical technique. “Implantable IMES technology moves [upper-limb prosthetics] to a level where the system is more robust,” explains Gill, who is developing new technologies in this arena and is planning clinical trials soon. “I want to give users as much control as we can give them. “This is where artificial intelligence, machine learning, and adaptive learning all come into play,” Gill adds, to empower a user “to robustly do what the patient intends.” He believes advanced iterations of the IMES technology will be fine-tuned after clinical trials and ultimately become commercially available over the next five years.

Prosthetic Digits—Rising Interest Over the past year or so, Tim Russo, CPO, LPO, an upper-limb expert at Scheck & Siress, has seen a “really significant increase in partial hand cases.” Some of the uptick is attributable to advances in technology, and some of it has to do with the fact that this limb-loss population has been overlooked in the past, he says. Russo, who works closely with an orthopedic trauma group, notes that a high percentage of this patient population has lost partial hands or fingers due to work injuries. “The accepted answer in the medical community in the past was to just ‘work with what you’ve got,’” he says. This is an important consideration, as the individual needs to learn to optimize function with the remaining anatomy, but certain prosthetic options may allow for increased function not possible without a device, Russo says. With the emergence of new components that offer improved function from several manufacturers that make digits and partial fingers, there are more options—and more patients seeking solutions.

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COVER STORY

The manufacturers continue to refine and upgrade their digit options with improved weight, strength, and wear characteristics, along with improved scale, according to Barnes. “Patients are finding more of a restorative grasp pattern” with the new designs, he says. “Acceptance rates, durability, and longevity are improving.” He notes that patients missing multiple digits may benefit the most from the improved hand balance offered by the latest digit technologies.

Rob Wagner, CP

Tim Russo, CPO, LPO

Russo says that some newer devices offer a modular grasp, allowing the user to change position or shape—and the device remains stable once it’s in the desired position. “I often fit custom opposition prostheses offering a specific structural shape to serve a dedicated purpose”—but they are not adaptable on the fly like some of the newer solutions, he says. With this opportunity to treat more hand and finger amputees comes some difficulties for prosthetists. “It’s a challenging population to fit well— often the most significant challenge is not getting in the way of the function 32

FEBRUARY 2020 | O&P ALMANAC

PHOTO: Rob Wagner, CP

Wagner also has noticed an increase in patients with questions about individual fingers, and he expects he will be fitting more partial fingers and digits with microprocessors in the coming year. “It’s all about the function” with finger prostheses, says Wagner. Someone using a computer, for example, can be challenged by typing when they’re missing the distal end of their finger, and some manufacturers are offering more options for patients in need of partial digits, he says.

Rob Wagner, CP, right, works with upper-limb patient Ryan Steel at Wright & Filippis. the individual has,” says Russo. Some patients function “pretty well” without prostheses for many tasks—but find that other tasks are made much easier by prostheses—so patient care requires a lot of time and understanding of users’ unique needs. Russo also notes that the palm shape “can change so much with movement of the hand,” so it becomes a challenge to find areas of the palm that are stable enough to anchor to. For this reason, he has found it beneficial to use HTV [high-temperature vulcanized] silicone for the inner flexible socket for some of his patients. HTV silicone is “an especially compliant material, so it moves well with the anatomy. It also is very durable, and a great anchor point for the rigid structure of the prosthesis,” he says. “I find this especially important with the partial hand level, as the residual hand may change shape dramatically with various prehension patterns. With a major goal of ‘not getting in the way’ of prehension, it is crucial to allow these complex shape changes.”

The HTV material also allows for unique suspension designs, like zippers or suction, according to Russo. When fitting finger and partial hand prostheses, the best approach may be to offer patients more than one option, each with its own intended purpose, says Russo.

Body-Powered— Continuing Interest

While many of today’s patients prefer electronic options, there are still many patients who choose traditional body-powered prostheses. Wagner has found that many bilateral upper-limb amputees prefer body-powered, as they like the proprioception. Body-powered devices are functional and reliable, and have very little breakdown, according to Wagner. Some appreciate the light weight and skeletal look of some of the body-powered endoskeletal systems for upper-limb users, according to Barnes. And there are more options, colors, and styles of terminal devices than ever before.

COVER STORY

Osseointegration— Clinical Trials

While osseointegration in the United States initially focused on lower-limb implants, researchers at the Department of Defense (DoD) Osseointegration Program, directed by Jonathan Forsberg, MD, PhD, are conducting a U.S. Food and Drug Administration (FDA) early feasibility study that focuses on individuals with transhumeral amputations; it is currently enrolling up to 12 patients. Osseointegration via a one-stage or two-stage surgical procedure, to receive a percutaneous implant to which a prosthesis can be attached, is becoming more commonplace in the United States. While some Americans are participating in clinical studies, others are receiving custom implants or traveling outside the country to get implants. At this point in time, most individuals who undergo surgery to receive implants do so because

traditional socket technology has not worked well for them. Patients in the transhumeral DoD study, which is one of just two active U.S. clinical studies focusing on osseointegration, are being fit with the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA) Implant System, which requires a two-stage surgery. But osseointegration techniques are evolving, and Forsberg believes the OPRA technology could soon require only a single surgery.

Jonathan Forsberg, MD, PhD

While it’s too early for comprehensive results from the transhumeral clinical study, Forsberg says the procedures performed so far have had positive results, anecdotally. “We

haven’t seen any implant-related adverse events; there haven’t been any infections,” he says. “We’ve had no device failures or removals, and there’s been no need for implant revisions” yet, he says. “The vast majority of patients are thrilled with their decision to have an OPRA implant.” Eventually, Forsberg hopes the results of the transhumeral study will be used to inform a pivotal Investigational Device Exemption. “That may lead to the FDA approving transhumeral osseointegration,” he says. The OPRA system is effective in managing soft tissues, according to Forsberg, who also leads the Multidisciplinary Osseointegration Clinic at Johns Hopkins Outpatient Center. The procedure has advanced to the point that “we’ve figured out the bone/implant interface,” but more work needs to be done on the skin/ implant interface, or transdermal interface. “That’s where we’re going

O&P ALMANAC | FEBRUARY 2020

COVER STORY

PHOTO: Bin He, PhD

Bin He, PhD, left, works with his students and a robotic arm for the neuroprosthetics project at Carnegie Mellon University.

to see advances in the next 10 years, optimizing that interface, and also working on the terminal device control and artificial sensory feedback.” Taking a long-term view, Forsberg envisions osseointegration becoming the standard of care for the majority of patients with amputation— perhaps even beyond patients who are challenged by traditional socket technology. “This technology is not for everyone,” he says, “but one day it may be expanded to more functional patients. … But before we expand these indications, we need to know more about the complications. We need to conduct clinical trials. And even when we think we’ve got it all figured out, we still need an international registry to make sure the outcomes are durable.” Toward that end, Forsberg is leading an effort to develop an International Osseointegration Registry. In its initial stages, Forsberg’s 34

FEBRUARY 2020 | O&P ALMANAC

team at DoD has already enrolled 75 percent of its osseointegration patients in the registry, in addition to 150 cases from the Osseointegration Group of Australia. The team also plans to import data from a registry assembled by the Swedish government. Soon, they will start to compare different implant systems. “And we’ll also be able to help identify early failures, so other innovators don’t make the same mistakes,” he says.

Neuroprosthetics— Increasing Possibilities

Bin He, PhD, head of the Department of Biomedical Engineering at Carnegie Mellon University, reported a breakthrough in noninvasive brain-computer interface (BCI) technologies last summer. He and his team demonstrated a mind-controlled robotic arm that demonstrates “for the first time, to our knowledge,” the

Bin He, PhD

capability for humans to continuously control a prosthesis using noninvasive electroencephalogram (EEG) signals. “My research is trying to develop a neuroprosthetic limb with a noninvasive approach,” says He, whose lab was the first to fly a drone using this technology. He is designing a system that allows for mind control of prosthetic limbs without the need for surgery or brain implants—technologies that have risks and that have been shown to degrade over time. “I wanted to develop a wearable approach,” rather than require amputee patients to undergo brain surgery for thought control of prostheses.

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In the past, noninvasive BCIs have shown promise in performing distinct actions but were unable to achieve continuous action. Subjects in past studies have been able to, for example, push a button, but not to track a cursor on a computer screen without disjointed movements. “With a prosthetic limb, you want to be able to control it continuously,” he says. In a recent study, a subject was able to use He’s technology to control with his mind a robotic prosthesis to track a cursor on a computer screen, and the prosthetic finger followed the cursor in a smooth, continuous pattern, similar to a natural finger. While the subject in He’s study wore a computer-wired EEG cap during the demonstration, He says that in the future, the cap may be replaced with a smartphone app programmed with EEG recordings and wireless electrodes. So far, the technology has been tested among six subjects using the LUKE Arm, but the system can be 36

FEBRUARY 2020 | O&P ALMANAC

adapted to various prostheses, He says. He believes this research may pave the way for thought-controlled robotic prostheses without the need for brain surgery, by decoding “intention signals” from the brain. Next steps include refining the technology to make it faster and more reliable, and to apply it in the clinical setting and test it with amputee patients in the Pittsburgh area. Looking at prosthetics and neuroengineering, He says the field is changing much faster than anyone could have anticipated. “The future should bring some happy surprises for O&P patients,” he says.

Lofty Goals

Advances in pattern recognition control and more options for partial hand patients are providing improved function for today’s upper-limb patients, and the future of technologies such as osseointegration and neuroprosthetics will evolve the field even further. But when working with today’s

patients, it’s important to remember that appropriate expectations should be set early on. “We are doing our best to emulate the function of an anatomical body part. Prostheses should be viewed as devices designed to do so,” explains Russo. The long-term future of upper limb will focus on “trying to replicate the human hand,” says Gill. He expects future prosthetic hands to be made of titanium and stronger materials, “so they will be able to touch and hold things better than the human hand, in terms of the amount of heat and human forces they can take.” While a prosthesis that replicates most of the functions of a human hand is the ultimate goal, “this will be an extremely difficult challenge,” says Gill, “since the human hand is an incredible piece of engineering.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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FEATURE

Inclusive O&P O&P facilities that are more intentional about building diverse staffs offer benefits to both patients and the bottom line By MICHAEL COLEMAN

FEBRUARY 2020 | O&P ALMANAC

FEATURE

NEED TO KNOW • The O&P profession has made significant strides in adding gender diversity to the field, but improvements are needed in ethnic, racial, and LGBT-related inclusion. • Issues surrounding diversity in the workplace—including inherent or unconscious bias, cultural misunderstanding, and subtle power dynamics—can be tricky to navigate, especially for some industry veterans accustomed to doing things certain ways. • When employees feel included, they become more invested in the company, and may be more inclined to speak up in groups and add their voices to discussions—resulting in more collaborative and innovative teams and O&P practices. • Some facilities are striving to be more reflective of their patient populations. For example, businesses that see a lot of Hispanic patients may employ Spanishspeaking clinicians.

• Implementing a diversity and inclusion program could save money for O&P practices by promoting job satisfaction and reducing turnover, and it could aid in preventing harassment lawsuits. • With more diverse workplaces come increased opportunities to improve communications among employees from different backgrounds and to combat any inherent biases among staff members when working with patients. • Promoting the profession and educating students in junior high and high school about O&P could draw a more diverse pool of students toward careers in the field.

O&P ALMANAC | FEBRUARY 2020

FEATURE

Nina Bondre, CPO

HEN NINA BONDRE, CPO,

launched her career as a firstyear orthotics and prosthetics clinician in 2015, a candid colleague gave her a well-meaning warning. “One of my mentors told me, ‘You have three strikes against you: You’re young, you’re female, and you’re Indian,’” says Bondre, who was part of a panel discussion on diversity and inclusion in the O&P industry at the January AOPA Leadership Conference. “They said, ‘That’s not a bad thing, but you may be treated differently.’” As it turned out, the mentor was right. Sometimes Bondre’s patients made irrelevant comments or assumptions about her race, or were dismissive of her young age. Instead of allowing these interactions to distract her, Bondre reminded herself that no one intended hostility. She just focused on the work. Now 28 years old and a clinical educator at Cascade Orthopedic Supply in Baltimore, Bondre says her O&P training came in handy in uncomfortable situations. “We were taught to focus on success and outcomes,” she says. “It wasn’t about race or gender; it was very much work-oriented, so that was helpful. I made an effort to share my culture because some patients were curious and would ask questions. It came from a harmless place. They just wanted to get to know [me] and feel comfortable and safe.”

FEBRUARY 2020 | O&P ALMANAC

The Drive for Greater Diversity

In its effort to remain vibrant and relevant in the 21st century, the O&P industry has made significant strides in adding gender diversity to the field. Indeed, according to the National Commission on Orthotic and Prosthetic Education, nearly half of students in O&P schools are women, and the number of female clinicians is at an all-time high. But ethnic, racial, and LGBT-related diversity and inclusion has been harder to come by. Issues surrounding inclusion and diversity in the workplace— including inherent or unconscious bias, cultural misunderstanding, and subtle power dynamics—can be tricky to navigate, especially for some industry veterans accustomed to doing things certain ways.

Jack Steele, CO, FAAOP Diversity in O&P is more prevalent than it was when Jack Steele, CO, FAAOP, director of the Center for Orthotics & Prosthetics in Memphis, Tennessee, began his career 40 years ago—but it still has a long way to go, he says. “You could see that lack of

diversity and the lack of inclusion when I started,” explains Steele, who is African-American. “Then when I started my own practice, I made a concerted effort to make sure I had diversity and inclusion, and we’re still building it. I’ll be the first to say we’re nowhere near where I would like to be to achieve that goal.” Still, exactly what percentage of U.S. orthotists and prosthetists are minorities or other groups is unclear. Although the Bureau of Labor Statistics researches and publishes combined employment and wage data for both occupations, it does not track demographic characteristics for O&P. The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) began focusing intently on increasing diversity and fostering inclusion in the O&P workplace about two years ago, after delving into issues of gender diversity and harassment, according to Maggie Baumer, JD, who is a secretary on the NAAOP Board of Directors and manager of a Hanger Clinic facility in Springfield, Massachusetts. Many individuals working in the O&P profession—especially newer practitioners—realize the profession should be more reflective of the people it serves, says Baumer. NAAOP’s goal is to foster diversity and build a more culturally sensitive climate in the workplace and the overall industry.

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FEATURE

In Pursuit of Gender Parity While the O&P schools are now seeing almost equal numbers of male and female O&P students, men still comprise a majority of certified professionals. Here are the latest percentages of individuals currently certified by the American Board for Certification in Orthotics, Prosthetics, and Orthotics (ABC).

19%

26% 74%

81% Prosthetists

31%

29%

Orthotists

21%

69%

71% Prosthetists/Orthotists

87.5%

69%

79%

12.5%

Pedorthists

Assistants

Technicians

Fitters

Men Women

SOURCE: American Board for Certification in Orthotics, Prosthetics, and Pedorthics

“Incorporating more diverse perspectives into our field will help us to think more creatively and become more innovative technologically, managerially, and in the care we provide to our patients,” Baumer says. “It provides us with the opportunity to expand our reach to more patients, as well as raise our profile.” Raising the industry’s profile is a goal that Steele has been thinking about a lot. His experience in recruiting tells him that the O&P industry has an identity problem: A lot of young people, and especially young people of color, have no idea what O&P is. “A big question is, how do we get the young African-American, Hispanic, or Asian person involved? How do you get them to know about this field?” Steele asks. “We’ve done school fairs and job fairs to get the young people interested. They don’t know what [O&P is]. The counselors don’t know what it is. 42

FEBRUARY 2020 | O&P ALMANAC

Maggie Baumer, JD “From an information standpoint, we as an organization need to get that understanding of O&P to a lower level,” Steele adds. “We can get it out to the colleges, but what about the kids in junior high and high school? That’s a big gap that we, as an organization, are missing. It’s a big issue.”

The Benefits of Inclusion

Inclusion is important to our personal and professional health and applies to both the big and small picture—"to

the health of our industry and the health of our individual employees,” Baumer says. When employees feel included, they become more invested. “They become more likely to speak up in groups, to contribute their voices to the discussion. With more voices included, we all learn more, which helps us to innovate as teams and as an industry.” Steele says that his facilities serve a large number of African-American patients, so it makes sense to have African-American practitioners. “We want to put the patient in the position to be comfortable,” he says. “We don't necessarily try to pair [African-American clinicians with African-American patients], but they are available. And just by having that diversity and inclusion, I think it really helps the community and patients have this sense of feeling that we really care about them.”

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FEATURE

Karen Edwards In diverse communities, hiring employees of different races may help improve communications between patients and healthcare providers. Bondre recalls working at a clinic in a Baltimore suburb with a racially diverse clientele—including some patients that didn’t speak English. “We saw a lot of Middle Eastern patients that came from abroad ... and we certainly saw a need for Spanish-speaking practitioners. Practitioners with those skills can be hard to come by,” she says. Spanish-speaking clinicians are in massive demand across the industry, according to Steele. “We are desperately trying to find a [Spanishspeaking] practitioner,” he says. “We have Spanish interpreters who come and work with the patients.” Interpreters can help clear the language barrier in many—but not in all—cases, says Bondre. “It’s a different skill, learning how to condense your communication and use less medical terminology, and making sure your

FEBRUARY 2020 | O&P ALMANAC

message is actually being communicated,” she notes. “The translation can be very frustrating because some of the words [in O&P parlance] don’t even exist in other languages.” In addition to benefiting employees and patients, implementing a diversity and inclusion program could save money for O&P practices by reducing job turnover and job dissatisfaction. It also may help save money in the legal sense. From 2010 to 2015, employers paid $698.7 million during the Equal Employment Opportunity Commission’s (EEOC’s) prelitigation enforcement process to employees alleging harassment, which is a form of employment discrimination, on the basis of sex, race, disability, age, national origin, or religion. In just one year, EEOC secured $125 million in its prelitigation process and $39 million in litigation for employees alleging harassment. Despite the advantages seen in inclusive workplaces, it can be challenging for some O&P facilities to focus on driving diversity. Bondre says she believes O&P practices across the country are struggling with the nuts-and-bolts of running a business and are not particularly focused on increasing diversity. “It will take a long time to be racially diverse,” she says. “I think the average clinic is focused on just surviving and dealing with reimbursement problems, and this may not be at the top of

their list, which is understandable. … I think it will happen more naturally over time.”

The Unconscious Bias

With more diverse workplaces come increased opportunities to improve communications among employees from different backgrounds and to combat any inherent biases among staff members when treating patients. Unconscious bias is a major hurdle in the workplace and can be an impediment when recruiting and retaining diverse talent, according to Karen Edwards, senior area manager of prosthetics at Össur and director of the Össur Women's Leadership Initiative. Unconscious biases are learned stereotypes that are automatic, unintentional, deeply ingrained, universal, and able to influence behavior. These biases— unknown to the person exhibiting them—can lead to mistrust, hurt feelings, and even lawsuits in the workplace. And almost no one is immune, it seems. At the Leadership Conference, Edwards explained it this way: “We all have it ... and the only way we can counter our unconscious bias is to become conscious.” She encouraged all clinicians to “think about your interactions with people and ask yourself, ‘Did I treat these [patients] the same way, or I did I treat them differently?’”

FEATURE

Bondre always strives to be pleasant with her patients, but says she makes a concerted effort to keep her questions and comments focused on their care—avoiding questions related to race, socioeconomic status, and similar topics. “I try to make sure I don’t ask questions of my patients [that are not] relevant to their care, and the way I get around that is really focusing on questions that are directly related to their progress,” she explains. “It’s: What are your goals? What do you want to do? What do you do for work? What does a typical day look like for you? I focus on what we’re trying to accomplish.” If a remark slips out that’s possibly offensive, it’s OK to cut yourself some slack. “Give yourself a little break. These [unconscious biases] all come from how we grew up, and our cultures

and the people around us,” Edwards says. “These are things that we, in 2020, need to recognize—but you don’t have to constantly walk on eggshells and worry if you're going to offend somebody. Take ownership if someone says, ‘That offended me,’ and recognize that maybe that was wrong.” Baumer agrees and says the notion of squelching unconscious bias isn’t an attack on any one person or group. “We’re not trying to come down on people and say, ‘You’re a terrible person, and you’re doing something wrong,’” she explains. “It’s more that these are issues we all have—and how do we recognize them and come together and try to make them a little better? We want to keep the tone congenial and collaborative rather than punitive.” As America’s population continues to diversify, it makes good business sense for O&P practices to follow suit. “Creating an inclusive culture can reduce job turnover and job

dissatisfaction and save money,” Baumer says. “Inclusiveness allows for the incorporation of more diverse ideas, communication styles, and faces. People can see others who look, and sound, like them. And when people can relate better to their teams, they become more invested in their teams—and everyone on the team has the opportunity to learn. Honoring a diverse and inclusive workspace also promotes innovation as we hear and embrace new ideas. “If we don’t [embrace diversity], we’re going to lose momentum and people, and that affects the rate of return,” adds Baumer. “It's an exciting time, even though it may present some discomfort at certain junctures.” Michael Coleman is a contributing writer to O&P Almanac. EDITOR’S NOTE: Read more about how diversity improves bottom lines in our Numbers data, page 10.

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PRINCIPAL INVESTIGATOR

Underseas and Overseas Investigations Duffy Felmlee, MSPO, CPO, FAAOP, conducts O&P research in unexpected settings

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.

NIVERSITY OF HARTFORD (UH)

Associate Professor Duffy Felmlee, MSPO, CPO, FAAOP, is working on several projects designed to help improve the device options and safety for individuals with limb loss and limb difference. He also is involved in a project designed to ramp up telemedicine in developing countries. These projects keep him busy—as does traveling to different settings to complete his studies when he is not at the university or performing clinical duties.

Multitasking

At UH, Felmlee teaches several courses in orthotics, materials and methodologies, fabrication science, and scientific inquiry. He serves as director of the

FEBRUARY 2020 | O&P ALMANAC

Adult Balance Lab, where he oversees testing and supervision of rotational perturbation platform and 3D motion analysis equipment, as well as director of the Cromwell Fabrication Lab, where he works on design and the acquisition, maintenance, and coordination of equipment used by MSPO students. He also spends time at the University of Connecticut, where he is pursuing a PhD from the Department of Kinesiology, with a specialization in exercise science. He serves as a guest lecturer there, speaking on O&P coursework. His dissertation focuses on direct quantification of balance among limited community ambulators using microprocessor prosthetic knees. On top of his academic affiliations, Felmlee is a regional clinical consultant for Hanger Clinic. In that capacity, he assists local and regional clinicians in some of the specialized lower-extremity orthotic componentry, such as stance control knee braces and solutions for complex patients. Felmlee enjoys having a variety of responsibilities. He initially pursued an O&P career because he wanted to blend hand skills with intellectual ability. “After a few years in the clinical aspect,

I wanted to assist in influencing future clinicians in learning from my successes and failures,” he explains. He was asked to stay on board at UH’s MSPO program as adjunct faculty, eventually becoming full-time faculty in 2015. “After mentorship with fellow faculty, I began to lead my own scientific inquiry groups, and this set in motion my understanding of the value of research providing direction in certain aspects of the industry,” Felmlee says. “Being full-time in the academic community has allowed me the time and resources to begin to investigate certain questions that should help the O&P industry and patient care.”

Researching While Scuba Driving

Some of Felmlee’s most unique projects keep him motivated to go to work every day. For the past four years, he and Michael McCauley, MSPO, CPO, have represented the UH Department of Rehabilitation Sciences in partnering with the Combat Wounded Veteran Challenge in a project centered around studying amputees’ performance with and without their prostheses in an underwater scuba-diving setting. Felmlee says the research team, which

PRINCIPAL INVESTIGATOR

PHOTO: Matilde Simas

travels to the coast of Looe Key, Florida, to conduct its studies, has completed development of a protocol to be used in future research. “We are expecting to have a multiyear study in which we investigate various interventions relating to prosthetic componentry and already available swim items, such as fins, thrusters, and buoyancy control devices,” he explains. “We will initially begin with modifications to currently available swim or water activity-intended componentry, and institute best practices for individuals with lowerextremity limb loss to participate in submerged swimming with scuba.” The research team has developed some unique investigation tools using items in an off-brand nature, which has allowed the team to quantify certain swim ergonomics underwater. And their work is getting noticed: Researchers from NASA “have observed our procedures in an effort to utilize them in achieving their goals,” says Felmlee.

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Duffy Felmlee, MSPO, CPO, recently spent time in the Philippines working with under-served patients.

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PRINCIPAL INVESTIGATOR

Felmlee, left, positioned inertial sensors on a subject alongside Michael McCauley, MSPO, CPO, during an underwater data collection session. The scuba research also has provided a unique platform for individual case studies, one of which is a harness that enables paraplegic divers to keep anatomical position in neutral buoyancy. The team also has designed a custom device for a diver who is a bilateral short transfemoral amputee; the design allows him to use trunk flexion extension as a method for propulsion. As this project moves forward, “we are excited to finally begin testing hardware modifications to the current standards available on the market for water-submerged or swimming prostheses,” Felmlee says. “Having a reliable protocol will allow us to change some of the variables on certain trials in the expectation that a certain combination of suspension, socket, knee (if applicable), and foot will be able to yield a more symmetrical swim pattern as well as improved experience by the diver.” At the global level, Felmlee is currently participating in a project that involves protocol development and initial

FEBRUARY 2020 | O&P ALMANAC

stabilize the subjects at different trunk segmental levels,” he explains. The field trial portion of the study involved an off-label use of an orthotic intervention—a swivel walker—used in custom segmental control for patients to use in their homes, in tandem with a specific therapy protocol for each of the subjects. “This intervention option was so well accepted by the subject and families, the researchers are moving forward into finding a more end user-friendly design by using a modular system currently available on the market.”

Increasing Access

In another key investigation, Felmlee and his team at UH are in the preliminary stages of subject recruitment to test a novel method for data collection of K2 ambulators using their prescribed knees compared to K3 microprocessor componentry. This work is supported by a grant from the U.S. Department of Defense. “It is our expectation that the data sets collected, both patientreported and quantified, can provide useful information to clinicians to

PHOTO: Idee Belau

Dryland Duties

application of validating the efficacy of telemedicine in developing countries related to prosthetic use. He is working with the international organization Dreaming and Working Together and researchers at Hartford Healthcare in this endeavor. The research is designed “to promote the capability of utilizing technology to allow for remote clinician consultation for challenging international cases.” Refinement of this protocol and publishing of resultant data “may yield exciting opportunities for domestic and international clinicians to be able to collaborate using technology to improve the quality of life of the patient and to improve the educational exposure some clinicians may not have access to, due to geographic limitations,” predicts Felmlee. Another area of interest is materials science. His first supervised project “utilized my skills of knowing how materials will interact with soft tissue” to study patients with cerebral palsy. “My involvement was in the construction of a superstructure onto a perturbation platform that would

PRINCIPAL INVESTIGATOR

help justify the utilization of currently limited access componentry for our patients,” he says. This research could have widespread implications. “As we begin initial investigation into the K2 users’ feasibility of K3 componentry, we are very excited about the potential of using this methodology in various different types of componentry, such as ankle-foot orthoses, knee-ankle-foot orthoses, and other prosthetic systems.” Felmlee believes the results of this investigation could have reimbursement implications. “Fall prevention is a serious consideration for third-party payors related to many aspects of healthcare,” he explains. “Our investigation protocol may be able to quantify how componentry has a direct effect on reducing the likelihood of falls.” Depending on the findings of this initial investigation, the data may have impact on qualifications of users for certain microprocessor-based knee units, according to Felmlee. In the future, Felmlee would like to see additional research in this area move into the realm of orthotics. “Reduction

in falls, or providing increased stability during walking and static activities, should come as a benefit to the O&P industry.”

Training Gen Z

In addition to his research and clinical responsibilities, Felmlee spends a great deal of time working with undergraduate and graduate students and research assistants. “Students are graduating with a significant amount of literature review experience and becoming intelligent consumers of research,” he says. “It is our hope and expectation that all newly minted clinicians will be able to take published literature and apply it toward the justification procedures in an effort to obtain a successful outcome for the patient—and, of equal importance, be able to apply clinically evidence-based methods toward patient care.” In his off-time, it comes as no surprise that this undersea adventurer enjoys outdoor activities—and cycling in particular. “I enjoy traveling to different mountain bike destinations,

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visiting with friends, and sampling different types of beverages at breweries around the country,” Felmlee says. And he makes sure to save some time for charitable endeavors. “I have been very fortunate to be included with different international organizations, providing my abilities in both clinical and educational avenues to help further a very significant and worthwhile endeavor of sharing resources, which I have been advantaged to, with others around the world.”

EDITOR’S NOTE: To read more about the underwater research being conducted by Duffy Felmlee, MSPO, CPO, and the University of Hartford Department of Rehabilitation Sciences in conjunction with the Combat Wounded Veteran Challenge, see the article “Diving Into O&P Research” in the October 2018 issue of O&P Almanac.

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O&P ALMANAC | FEBRUARY 2020

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Austin Prosthetic Center

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Patient Wes Webb, who lost both legs below the knee in a skydiving accident, surfs wearing his prostheses.

FACILITY: Austin Prosthetic Center OWNERS: Tracy Russ, M.Ed, Brian Houchin, and Matthew Harris Jr., CPO, LPO LOCATION: Austin, Texas HISTORY: Six years

Patient Katie Jackson, a dentist and Grade V para-equestrian dressage rider, lost her leg in 2015 due to sarcoma.

functional lab, and accessibility. Patients have plenty of parking spaces, and those in wheelchairs can easily enter the building.” APC’s patients include a mix of those with traumatic and disease-based amputations. “We see a number of veteran patients, athletes, and adolescents,” says Russ. “Many of our patients come because they were dissatisfied with the care they had been getting, and they found us through word-ofmouth and internet searches.”

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

Patient Trey Aldridge lost his leg in a car accident in high school but continued playing football wearing his prosthesis.

PHOTOS: Austin Prosthetic Center

of Austin Prosthetic Center (APC) Tracy Russ, M.Ed, began her career in durable medical equipment (DME) sales. She found herself dissatisfied working for such a large company and wanted more patient involvement, so in 2014 she launched APC, along with clinician Matthew Harris Jr., CPO, LPO, who serves both as a clinician and as practice manager. Soon after, Russ persuaded her brother, Brian Houchin, to join the team as office manager. Houchin came to the O&P field after working as a paramedic and in the business office of an ambulatory surgery center. “I took on the role of compliance officer at APC. The duties didn’t translate exactly from my previous work, but AOPA offered many tools and strategies to make it easy for me to understand what we needed to be aware of,” he says. The facility focuses on upper- and lower-extremity prosthetics, although both Harris and Ben George, CPO, LPO, are dual-certified and will build orthoses as needed for their prosthetic patients. Two years ago, APC moved into a new 4,000-square-foot building. The 3,000-squarefoot first floor features a lobby; fabrication lab, where all devices are made; patient rooms; and administrative offices. The second floor has a conference room and employee lounge. “We got to build the space to our specifications,” says Russ. “As a result, we have good-sized rooms, an extremely

Russ’s experience with DME sales translated well into marketing the facility’s services, and she keeps to an active schedule of visiting physicians, nurses, physical therapists, and other referral sources. She maintains an active Facebook page, posting frequent photos of patients and staff, as well as tending Instagram and Twitter feeds. The APC website features video testimonials from patients as well as a list of online resources for amputees. Lydia Manriquez is a patient advocate on staff, with certification from the Amputee Coalition as a peer visitor. An amputee since 2009, Manriquez works with patients and their families—both before and after surgery—to offer advice and encouragement. She often arranges social occasions for patients both from APC and other facilities. “We have an amazing team,” says Russ. “Everyone gets along, which makes it a comfortable place to be.” Further down the line, Russ would like to add another clinician, but for now, “we are right where we want to be,” she says. “We always put the patient first, and they know it.” “For us, the greatest reward is seeing our patients outside the office,” says Houchin, “just living their lives.”

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MEMBER SPOTLIGHT

Bort-Swiss Orthopedic Supply

German Design South Carolina supply company sells braces made overseas

OLFGANG BORT OWNS

FEBRUARY 2020 | O&P ALMANAC

Lumbar brace

COMPANY: Bort-Swiss Orthopedic Supply OWNER: Beth Swiss LOCATION: Anderson, South Carolina, with offices nationwide HISTORY: 13 years

Beth Swiss

Sports offerings include wrist, elbow, back, thigh, and knee braces, all with the company’s proprietary SOFTflex 3D-knitted fabric, a moisture-wicking system, and the Stabilo strap with a proprietary fastening mechanism that enables users to adjust stabilization and pad pressure. Many of the products intended for sport-oriented clients incorporate Coolmax fabric, which helps dissipate sweat and release body heat. The company has a network of dealers throughout the United States, Mexico, and Canada. Each dealer handles its own marketing, as do distributors. The company has a dedicated social media specialist who maintains a presence on Facebook, Twitter, Instagram, and Pinterest. Its website allows customers to order online and features a link to Facebook Messenger, enabling them to chat with support staff. In total, Bort-Swiss offers more than 370 products in 15 different sizes, three different colors, and close to 10,000 distinct SKUs. It offers a hefty inventory at its 6,000-square-foot headquarters facility in Anderson, South

Carolina, shipping many items within 24 hours of ordering. Less common sizes and colors may need to come from Germany, which takes about three weeks. “If we have regular customers who prefer a particular color, for example, we’ll be sure to maintain stock in the U.S.,” explains Swiss. She notes that most older clients prefer beige orthopedic products, while younger customers lean toward black. The company has grown significantly since its start, she says, noting its responsiveness to the market. “Insurers stopped covering a number of items, such as nonhinged braces,” Swiss notes. “We responded by developing alternative products that do qualify for an L code and reimbursement.” Bort-Swiss works closely with Bort engineers in Germany to bring in or phase out items, depending on demand. “We are constantly changing and evolving and moving. We never sit still,” says Swiss. “We respond to our customers’ needs by improving products, adding variations—even changing colors to meet demand.” And in the United States, the company has increased its line to include 4X sizes to accommodate larger patients. Many of Bort-Swiss’s clients are unable to have surgery because of their age, weight, or lack of insurance, and the company will help customize items to meet their needs. Swiss is confident that her company will continue to grow, saying, “There is a big need for orthopedic products in the U.S., and Bort is responding to that need by continually developing new and improved items.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Bort-Swiss Orthopedic Supply

Bort Medical, an orthopedic manufacturing firm in Weinstadt, Germany, founded in 1981. When he decided to expand to the United States, Bort offered Beth Swiss the opportunity to head up U.S. operations. In 2006, BortSwiss Orthopedic Supply opened to sell Bort Medical products throughout North America. “All our products are made in Germany,” says Swiss. “German engineering is known for its quality, and our products must meet higher standards to comply with stringent German regulations.” Bort produces innovative sports and injury braces, orthoses, splints, and compression stockings. The company works closely with orthopedic, rehabilitation, and sports medicine experts to develop new technologies. Among them are a knee brace that features a side zip fastener and wrist braces with zippers, all designed to help patients don products more easily and with greater comfort. “The knee brace is particularly useful for patients who may have difficulty bending down to pull the brace up over the ankle,” says Swiss. Bort-Swiss has products for every age group, from children to older adults. “We are one of very few brace companies that makes pediatric products,” says Swiss. “And one of few in North America who have hernia trusses.” The company also offers a dedicated line for older clients that includes wraparound products and simple strap configurations, making braces easier to put on and take off.

By DEBORAH CONN

Who is an innovator? Who is held to the highest O&P standards? Who is committed to life-long learning? I AM. I am a big part of great possibilities.

I AM ABC. Visit ABCop.org today to find out what ABC can do for you. 703.836.7114

AOPA NEWS

A Look Back at AOPA’s 2019 Legislative Wins AOPA secured several legislative victories in 2019, positioning the association to achieve even more success in the second session of the 116th Congress, which convened January 7. Below are highlights of AOPA’s legislative achievements ILL last year: DING B N U F D y In May, Congress introduced the Wounded Warrior DO RP CDM Workforce Enhancement Act, which would authorize $5 million per year for three years to provide limited, one-time competitive ADVA grants to qualified universities to create or NCED expand accredited advanced education O&P E Wo DUCA ics programs in prosthetics and orthotics. und T thot r I O e O N d AOPA has been working closely with W W icare tics Enh orkfo arrior Med Prosthe red anc both the Veterans Affairs Committee rce em nte and ent and the Armed Services Committee t-Ce t Act n e i Pat are Ac to speed passage of the bill in 2020. C y Related to workforce shortages, AOPA worked with the Military Construction and Veterans Affairs Appropriations Subcommittee to add language to y On November 22, the House introduced HR 5262, the its FY2020 spending bill that directs the U.S. Department Medicare Orthotics and Prosthetics Patient-Centered of Veterans Affairs (VA) to “work with outside industry Care Act. While the bill enjoys broad bipartisan support, experts to survey and examine the latest data available AOPA is working to add as many cosponsors as possible, on the current extent of orthotics and prosthetics care to illustrate the importance of the bill to legislators. Nearly provided outside of VA facilities and provide projections 1,100 advocates wrote to members of Congress in support on requirements over the next decade based on overall of the bill. A high priority for AOPA, this bill would: population growth among veterans with orthotics and Restore congressional intent by revising the overly prosthetics needs.” The subcommittee has requested a expansive regulatory interpretation of the meaning report to both the House and Senate by June, and AOPA of “off-the-shelf” (OTS) orthotics to clarify that is working with VA staff to provide input to the report. competitive bidding may only apply to orthoses that y AOPA secured a bipartisan letter, led by Reps. Elaine require minimal self-adjustment by patients themLuria (D-Virginia), Tim Walberg (R-Michigan), Greg selves, not the patient’s caregiver or a supplier. Steube (R-Florida), and Brad Wenstrup (R-Ohio), to Distinguish the clinical, service-oriented nature in the chair and ranking member of the House Veterans which O&P is provided from the commodity-based Affairs Appropriations Subcommittee, urging the nature of the durable medical equipment (DME) subcommittee “to include language to let veterans with benefit. O&P care includes a patient-care component limb loss continue to choose to receive their care from that is decidedly more in-depth and personal than the provider who best meets their needs.” In the final simply supplying DME. Most orthotic and prosthetic bill language, the subcommittee noted that the VA is devices are custom fabricated or custom fit and require “expected to ensure veterans continue to receive the the expertise of an orthotist or prosthetist who has prosthetics services that best meet their needs,” and received a master of science degree and residence will continue to work with the VA to ensure veterans training before becoming a certified practitioner. have a choice regarding where they receive their care. Reduce the likelihood of waste, fraud, and abuse in y AOPA worked with Congress to secure a 50 percent the Medicare program by prohibiting the practice of increase (to $15 million) in the Department of Defense’s “drop shipping” (shipping an orthosis or prosthesis funding bill for the Congressionally Directed Medical to a beneficiary without first receiving direct patient Research Program (CDMRP) to advance research in care from a trained, certified, or licensed healthcare prosthetic and orthotic outcomes, and priorities for practitioner) of orthotic braces that are not truly OTS. research to fill those gaps. AOPA will work closely with CDMRP to ensure they’re receiving high-quality AOPA will share additional information and actions grant proposals and funding the best available research members can take. Plan to attend the AOPA Policy Forum, opportunities. May 5-6 in Washington, D.C.

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AOPA NEWS

2020 AOPA National Assembly Call for Papers Submit Abstracts By March 20 Contribute to high-value clinical and scientific offerings and share your expertise with more than 2,000 orthotic, prosthetic, and pedorthic professionals. Submit your proposal for AOPA’s 2020 National Assembly, which will take place Sept. 9-12 in Las Vegas. AOPA is looking for: • Clinical Free Papers—The top-scoring papers will compete for the prestigious Thranhardt Award. • Technician Program • Symposia • Business Education Program—The top papers will be considered for the prestigious Sam E. Hamontree, CP(E), Business Education Award.

Abstracts will be considered for both podium and poster presentations and must be submitted electronically; email or fax submissions will not be accepted. Each submission will be graded by the Review Committee via a blind review process, based on the following criteria: • Relevance, level of interest in categories • Quality of scientific content • Quality of clinical content • Quality of technical content. What are you waiting for? Advance your career. Gain recognition. See your name in lights. Submit your abstract by March 20. Questions about the submission process or the AOPA National Assembly? Contact AOPA at 571/431-0876.

AOPA Co-OP

Webinars U P C O M I N G W E B I N A R / / U P C O M I N G W E B I N A R / / N EUWP C O M I N G W E B I N A R

WEDNESDAY

Clinician’s Corner: Orthotics

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Join AOPA on March 11 for the first installment of the new Clinician’s Corner. Learn about the latest techniques in orthotics and take away practical tips for treating your patients for optimal results. And as a bonus, earn some scientific credits. Clinician’s Corner will be presented by one of AOPA’s many honored National Assembly presenters.

MAR. 11

UPCOMING WEBINAR // UPCOMING WEBINAR // UPCOMING WEBINAR

WEDNESDAY

A Policy Review: LSO/TLSO

This one-hour webinar will offer an in-depth review of the Lumbosacral Orthosis/Thoracolumbosacral Orthosis (LSO/TLSO) Policy and certain portions of the Standard Documentation Article. It will help answer the following questions and more: • When is approval by the Pricing, Data Analysis, and Coding contractor required? • When is it appropriate to bill the hospital/skilled nursing facility for LSOs and TLSOs? • What type of documentation and ICD-10 codes are required for coverage?

APR. 8

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 team-building, 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 bit.ly/2020webinars.

Co-OP

A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. This searchable database provides up-to-date information on developments in Medicare policy, state-specific legislation, private-payor updates, and more. Members can access detailed information on everything from modifiers to product-specific L codes and associated policies. Register for the next Co-OP Live Tutorial hosted by AOPA Director of Strategic Initiatives Ashlie White, who will demonstrate how to use the Co-OP and answer all of your questions. Any employee of an AOPA member firm is welcomed to join this free tutorial. Co-OP Live Tutorial Webinar • February 14 • March 13 Registration at bit.ly/Co-Op2020.

O&P ALMANAC | FEBRUARY 2020

O&P PAC UPDATE

HE 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*:

• • • • •

George Breece Tina Carlson, CMP Eve Lee, MBA, CAE Dennis Williams, CO, BOCO Scott Williamson

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 Jan. 15, 2020, and includes only donations and contributions made or received between Jan. 1, 2020 and Jan. 15, 2020. Any donations or contributions made or received on or after Jan. 15, 2020, will be published in a future issue of O&P Almanac.

NEW MEMBERS

Welcome New AOPA Members

SAVE THE DATE

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. Collier Orthotics & Prosthetics 3830 Auburn Blvd., Ste. A Sacramento, CA 95821 916/479-9729 Affiliate

Skyland Prosthetics & Orthotics Inc. 583 Asheville Hwy., Ste. 3 Sylva, NC 28779 828/631-1379 Affiliate

Progressive Prosthetics & Orthotics 6511 E. 46th Street Tulsa, OK 74145 918/663-7077 Patient-Care Facility

Transcend Orthotics & Prosthetics 417 Fernhill Drive Fort Wayne, IN 46805-1039 260/203-2959 Affiliate

FEBRUARY 2020 | O&P ALMANAC

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YOUR CONNECTION TO EVERYTHING O&P

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Fillauerâ&#x20AC;&#x2122;s NEXO line provides simple, innovative alternatives for patients with transradial and transhumeral limb loss. All NEXO systems are easy-to-build and up to 50% lighter than existing prostheses.

www.fillauer.com ÂŠ 2019 Fillauer LLC

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Certified Orthotist/Prosthetist

Job location key: ---

Northeast Northeast Mid-Atlantic Mid-Atlantic

-- Southeast Southeast -- North North Central Central -- Inter-Mountain Inter-Mountain -- Pacific Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. 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. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Member $482 $634

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

Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word

Nonmember $678 $830

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Member Nonmember $85 $150

For more opportunities, visit: http://jobs.aopanet.org.

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

FEBRUARY 2020 | O&P ALMANAC

Marquette, Michigan Certified orthotist/prosthetist needed to join our team at a busy, full-time orthotics and prosthetics practice. Responsibilities are to supervise and participate in the design, fabrication, and fitting of orthotic devices for patients with congenital/acquired deformities of the body and disabling conditions of the limbs and spines. Eligibility for, or completion of, the certification examination by the American Board for Certification in Orthotics and Prosthetics is necessary. If you are looking for a long-term career with a company of dedicated professionals, come join our team in beautiful Marquette, Michigan. Job type: Full-time. Respond by email only to: Email: rfettig@teterop.com Visit our website at: www.teterop.com

Pacific Certified Orthotist/Prosthetist

Color Ad Special 1/4 Page ad 1/2 Page ad

Job Board

North Central

Alaska

Work and Play in Alaska A wide variety of interesting patients, a great support staff, and upward growth opportunities await outgoing and energetic ABC-certified CPOs who are passionate about patient care. Come explore the Last Frontier in a family-friendly city where the great outdoors are just minutes away and you can make your mark with a well-established, Alaskan-owned company. CPOs with a minimum of two years’ experience post-second certification will receive a relocation allowance, sign-on bonus, salary starting at ~$85,000 (DOE), and extensive benefits as well as paid continuing education, all while enjoying the ability to play in the beautiful state of Alaska. Email your résumé and inquiries to Marsha Foy at mfoy@northo.com.

Website: www.northo.com

CL MB The path to the top isn’t always easy. But at Hanger, no one has to do it alone. And there’s no limit to how high any of our team members can climb. Hanger is the clinical leader in orthotic and prosthetic care because we hire the best and the brightest. We provide vast resources, opportunities for career advancement, and the most innovative technology in our field to help them do what they do best: care for our patients. We’re passionate about the life-changing, fulfilling work we do to empower our patients to take on life’s challenges with increased mobility, independence and self-confidence. We know this important work starts by supporting our employees. Empower your career. Apply today and climb higher at Hanger.

Hanger.com/Climb

Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state, or local law.

2020 MONTHLY WEBINARS

www.bocusa.org

2020 Webinars MARCH 11

AUGUST 12

New Scientific Credits— Clinician’s Corner: Orthotics

Contracting 101: Understanding the Basics

Join us for the first installment of our new Clinician’s Corner. Learn about the newest techniques in orthotics or how to best treat your patients; bonus earn some scientific credits. Clinician’s Corner will be presented by one of AOPA’s many honored National Assembly presenters. APRIL 8

What can you do to make sure that the contract is beneficial to you? During this webinar, learn the basic steps in locating and negotiating contracts with payers. SEPTEMBER 2

Outside the Norms: Outliers and Situations Where the Rules are Different

This one-hour webinar will provide you with an in-depth review of the LSO/TLSO policy and certain portions of the Standard Documentation Article.

Everyone assumes they know the rules, but what about those special instances when the common rules don’t apply. When is your date service, not the same as your date of delivery? When is your place of service not the home (12)? Get the answers to these questions and more.

MAY 13

OCTOBER 14

A Policy Review: LSO/TLSO

Social Media Mayday: Increase Your Footprint

Are you getting the best return from social media? This webinar will provide you with tips and resources on which properties are best for your business and how you can better use them to reach your patients, your payers, your referral sources, and your community. Make sure you are putting your best digital foot forward! JUNE 10

New Scientific Credits— Clinician’s Corner: Prosthetics

New Technical Credits— Clinician’s Corner: Fitters and Techs

Join us for the last installment of our new Clinician’s Corner of 2020. Learn about the newest tips and techniques for fitters and/or technicians or learn how to best treat your patients; and earn some scientific credits. Clinician’s Corner will be presented by one of AOPA’s many honored National Assembly presenters. NOVEMBER 11

Join us for the second installment of our new Clinician’s Corner and learn about the newest techniques in prosthetics or how to best treat your patients; and earn some scientific credits. Clinician’s Corner will be presented by one of AOPA’s many honored National Assembly presenters.

RAC Audits: What Are They Looking At?

This webinar will examine the rules governing the RAC program, the different type of audits they may conduct, and what areas they are currently auditing. Learn about these issues and how you may avoid potential RAC audits. DECEMBER 9

JULY 8

The ABCs of Appeals: Know the Players and Get the Tips

New Year: New Codes, Fees, and Updates

DME MAC, QIC, ALJ, etc. Learn the ins-and-outs of the five levels of the Medicare appeals process, including what type of claims can and cannot be appealed. You’ll find out the best way to craft a successful agreement to ensure success in your appeal.

www.AOPAnet.org

Don’t miss the most anticipated webinars of each year. AOPA’s coding and billing experts will provide you with an up-to-date analysis and interpretation of the newest HCPCS codes and changes for the upcoming year. The webinar will also include a recap of 2020 Medicare changes and updates to except in 2021.

CAREERS Pacific Certified Orthotic/Prosthetic Technicians Alaska

WANTED! A few good businesses for sale. Lloyds Capital Inc. has sold over 150 practices in the last 26 years. If you want to sell your business or just need to know its worth, please contact me in confidence.

Work and Play in the Last Frontier Are you an accomplished ABC-certified CTPO looking for opportunities to showcase your skills in thermoforming, lamination, and leatherwork? Can you work well with others multi-tasking in a fast-paced lab that serves a large geographical area? Come explore Alaska in a family-friendly city where the great outdoors are just minutes away and you can make your mark with a well-established Alaskanowned company. CTPOs with a minimum of five years’ experience post-certification will receive a relocation allowance, sign-on bonus, and extensive benefits as well as paid continuing education, all while enjoying the ability to play in the beautiful state of Alaska. Salary DOE. Email your résumé and inquiries to Marsha Foy at mfoy@northo.com.

Website: www.northo.com

Pacific CO/CFo

Pleasant Hill, Oakland, East Bay Area, California Collier O&P is a full service orthotic and prosthetic patient care facility with on-site fabrication. We are searching for a CO/CFo. The appropriate candidate will operate in a multi-office environment, so some travel is required. We offer a competitive salary/benefit structure commensurate with experience; it includes health, vacation, continuing education and 401K. Email your résumé to:

Email: john@collieroandp.com

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

AOPA’s O&P Career Center Connecting highly qualified O&P talent with career opportunities EMPLOYEE

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

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 O&P ALMANAC | FEBRUARY 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.

ALPS Silicone Pro Liner The ALPS Silicone Pro is a medical grade silicone liner that is one-fifth the friction of regular silicone liners. Protected by ALPS knitted fabric, the fabric allows for extended durability and helps to reduce pistoning. It is available in locking or cushion suspension and will comfortably suspend patients in their prosthesis and allow for freedom of movement. For more information please call us at 800/574-5426 or visit us at www.easyliner.com.

Apis

2nd Generation Coapt Control Gen2 is the all-new and reimagined myoelectric pattern recognition control system from Coapt. Compatible as an add-on system to virtually every powered upper-limb prosthetic configuration, Gen2 unleashes an unprecedented level of personal, intuitive control for its wearers. Coapt’s Gen2 has enhanced the performance of the COMPLETE CONTROL pattern recognition core and introduces unrivaled new features, changing the field once again: • CONTROL COACHTM—An onboard A.I. companion guiding the wearer through accelerated learning and adoption of their prosthesis control • ADAPTIVE ADVANCETM—An extra machine learning layer capable of continuously improving Gen2’s harmony with its wearer. For more information, visit www.coaptengineering.com.

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.

A Perfect Fit for You and Your Patients

Coyote Prosthetics & Orthotics

Coyote Composites has HUGE price cuts again this year! • Costs less than carbon fiber • Little to no itch • Tougher than carbon fiber. Increased buying power has lowered our costs and your price. For more information, contact Coyote Prosthetics and Orthotics at 208/429-0026 or visit www.coyotedesign.com.

FEBRUARY 2020 | O&P ALMANAC

Consistently capture true anatomy under weight-bearing conditions with the Symphonie® Aqua System, available through Cypress Adaptive. This innovative, hydrostatic technology replicates the exact forces one would experience while standing in a prosthetic socket. The accuracy of the weight-bearing impression eliminates the need for cast modifications and enables the practitioner to achieve consistent outcomes and efficiently provide the patient with a comfortable, well-fitting socket. For more information, contact Cypress Adaptive at 888/715-8003 or visit our website, www.cypressadaptive.com.

MARKETPLACE 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.

Solvent Replacement Wipes +PLUSeries® Solvent Replacement Wipes are specifically designed to replace the use of acetone and other toxic solvents in your work environment, greatly reducing your exposure to harmful toxic chemicals. You have a choice. Be safe! For more information, call 800/322-8324 or visit www.fabtechsystems.com.

New! Bondtek Adhesive Introducing Bondtek Urethane Adhesives: Great for any situation when you need something glued quickly and easily. Bondtek is the costeffective go-to adhesive for all your fab needs. Sets fast, holds shape, and no sag, with 30- and 60-second set times. Standard 50- and 220- ml sizes. Prop 65 free material. Learn more at 800/322-8324 or visit www.fabtechsystems.com/ bondtek.

NEXO

NEXO provides two wrist options: the USMC-style quick disconnect wrist, previously only available for use in an exoskeletal system, and a lightweight friction wrist. For more information, contact Fillauer at 800/251-6398, 423/624-0946, or visit http://fillauer.com/Upper-ExtremityProsthetics/nexo.php.

Motion Control’s Next-Generation ETD2 A U.S. Department of Defense grant, awarded to Motion Control of Salt Lake City, Utah, funded development of a new Electric Terminal Device and wrist system. For many in U.S. military hospitals, the ETD is the first-choice hand replacement for function and versatility. The ETD is the only device that achieves true resistance against water, dirt, dust, and grease. The next generation ETD2 is available now. For more information, contact Motion Control, a division of Fillauer, at 1-888/696-2767, or visit www.UtahArm.com.

LEAP Balance Brace 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 | FEBRUARY 2020

MARKETPLACE 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.

Arizona AFO’s Moore Balance Brace Check out the latest peer-reviewed, published study substantiating the efficacy of Arizona AFO’s Moore Balance Brace. This randomized controlled trial investigated the long-term impact of a balance ankle-foot orthosis, the Moore Balance Brace, on balance, fear of falling, and physical activity in older adults. Researchers reported not only a decrease in fall risk, but a meaningful reduction in fear of falling, leading to an increase in physical activity. Check out the full study at arizonaafo.com/baylor.

Announcing the Newest Unloader One® Brace From Össur Össur’s Unloader osteoarthritis (OA) knee braces have been the industry standard OA knee brace for close to four decades. Over the last few years, our R&D team worked on the future development of OA knee bracing. By keeping the positive features of the Unloader One, integrating new engineering options, and even developing new innovative production methods, we were able to create a brace that will be the standard for the decades to come. Learn more at https://go.ossur.com/ unloader-one-x-opa.

FEBRUARY 2020 | O&P ALMANAC

C-Soft Plus V1.8 Update C-Soft programming software has been updated and is available online. The new version is required for all new C-Legs and is also compatible with older C-Legs. What’s Changed? • New factory settings for C-Leg 4 require the input of body weight, knee-center to ground measurement, and calibration. Important: New C-Legs will not work without the manual entry of these details. • New feet are available—Taleo, Triton Side Flex, and Empower • Warning notice if patient weight entered is above limit of 136 kgs (300 lbs) • Automated calculation suggestion for stance flexion resistance and safety mode flexion resistance. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

Ottobock CCAFO Ottobock’s expertise in custom orthotic fabrication and carbon composites come together to produce custom AFOs. Crafted from carbon prepreg, this lightweight and low-profile AFO provides a solution for individuals with plantarflexion weakness and those needing triplanar support for the foot and ankle. The design stores and returns energy for propulsion while providing function of the soleus muscle and third rocker mechanics. This CCAFO is custom-made for your patient’s specific height, weight, and activity level. Benefits: • Lightweight, low-profile design • Energy dynamics of carbon prepreg for improved gait and energy return • Custom design for greater stability and the ability to control deformities. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

MARKETPLACE Discover PROTEOR USA

Delivering an extensive, progressive product line that includes everything today’s active amputees need to live the life they love. Offering an innovative portfolio that includes everything from the virtually indestructible RUSH Foot collection to the world’s first microprocessor-controlled hydraulic four-bar knee with both stance and swing functionality, the ALLUX. The EASY RIDE, multiuse extreme sports knee, to the KEASY, renowned prefabricated cones. The K2 GERY foot, to the flexible, all-terrain, DynaTrek foot. Discover the exciting PROTEOR USA product line today! A whole new look. A whole new vibe. A whole new world. #HumanFirst. Visit us at proteorUSA.com.

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 Scoliosis® 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 From TurboMed Orthotics This unique ankle-foot orthosis (AFO) was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe. The Xtern is HCPCS code L1951 validated. Turbomed innovative products are now available through distributor partnerships in more than 26 countries. Its unique design and material composition give another meaning to walking and running. There is no limitation with the Xtern for the customers—not even a weight limit! For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the Xtern in less than five minutes. Available in USA from Cascade Supply, SPS, Lakes Medical Innovations, Kevin Orthopedic, and Physio Tech. For more information, visit www.turbomedorthotics.com.

O&P ALMANAC | FEBRUARY 2020

AD INDEX

Advertisers Index Company ALPS South LLC American Board for Certification in Orthotics, Prosthetics, and Pedorthics

Page Phone 13

800/574-5426

www.easyliner.com

703/836-7114

www.abcop.org

Amfit

800/356-3668

www.amfit.com

Apis Footwear Company

888/937-2747

www.apisfootwear.com

ARTech Laboratory Inc.

888/775-5501

www.artechlab-prosthetics.com

Board of Certification/Accreditation

877/776-2200

www.bocusa.org

Coapt

45 844/262-7800

www.coaptengineering.com

College Park Industries

800/728-7950

www.college-park.com

ComfortFit Orthotic Labs Inc.

888/523-1600

www.comfortlabs.com

Coyote Design

800/819-5980

www.coyotedesign.com

Cypress Adaptive LLC

888/715-8003

www.cypressadaptive.com

ESP LLC

888/WEAR-ESP

www.wearesp.com

26, 27

800/FABTECH

www.fabtechsystems.com

810/688-4292

www.ferrier.coupler.com

Fabtech Systems LLC Ferrier Coupler Inc. Fillauer Companies Inc.

11, 59

800/251-6398

www.fillauer.com

Flo-Tech O&P Systems Inc.

800/356-8324

www.1800flo-tech.com

Hanger

61 512/777-3814

www.hanger.com

Hersco

1 800/301-8275

www.hersco.com

Kingsley

15 800/854-3749

www.kingsleymfg.com

Naked Prosthetics

www.npdevices.com

OHI

25 877/780-8382

www.ohi.net

Ã&#x2013;ssur

3 800/233-6263

www.ossur.com

888/977-6693

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

19 855/450-7300

www.proteorusa.com

Spinal Technology Inc.

800/253-7868

www.spinaltech.com

The Bremer Group Company

800/428-2304

www.bremergroup.com

TurboMed Orthotics

888/778-8726

www.turbomedorthotics.com

WillowWood

21 800/848-4930

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

COMPLETE CONTROL

Website

FEBRUARY 2020 | O&P ALMANAC

www.willowwoodco.com

THE PREMIER MEETING FOR ORTHOTIC, PROSTHE TIC, AND PEDO RTHIC PRO FESSI O NAL S.

CALLING ALL

EXHIBITORS MANDALAY BAY RESORT

Grow your customer base and introduce new products at the country’s oldest and largest meeting for the orthotic, prosthetic, and pedorthic professions in North America.

WHY EXHIBIT?

EXHIBITOR BENEFITS

• Build your customer base and increase

• Two exhibitor full conference badges

sales by meeting with decision-makers.

• Get face-to-face time with existing customers

to answer questions and build new relationships.

• Enjoy sponsored networking opportunities, including the opening welcome reception and closing patient demonstration event in the exhibit hall.

• Increase your exposure through a wide variety of advertising and sponsorship opportunities

• Speak to AOPA reimbursement experts who can

answer all your O&P coding, reimbursement and compliance questions.

(per 10x10 exhibit space) which includes admission to all education sessions, CE credits, meeting materials, and welcome reception.

• Additional discounted full conference badges. • Ability to receive CE credits. • FREE breakfast and lunch during show hours. • Private lounge exclusive to exhibitors.

• Much more!

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

Want to take advantage of an exhibit and/or sponsorship opportunity? Contact Kelly O’Neill at 571/431-0852 or kelly.oneill@AOPAnet.org.

www.AOPAnet.org

CALENDAR

APPLY ANYTIME! BOC Certification. Apply anytime and www.bocusa.org test when ready for the orthotic fitter, mastectomy fitter, and DME specialist certifications. To learn more about BOC’s nationally recognized, in-demand credentials and to apply today, visit www.bocusa.org.

Cascade Dafo Institute

Nine free ABC-approved online continuing education courses for pediatric practitioners. Take anytime, anywhere, and earn up to 14.25 CE credits. Visit cascadedafo.com or call 800/848-7332.

March 19–21

Georgia Society of O&P. Alpharetta, GA. Visit www.georgiasop.com.

March 30 SEMINAR

www.AOPAnet.org.

Medicare 101: Get To Know the Basics. Rosemont, IL. For more information, visit

April 1

ABC: Practitioner Residency Completion Deadline for Spring 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/certification.

April 1

2020 February 10–11

Coding & Billing Seminar. Las Vegas. For more information, visit www.AOPAnet.org.

SEMINAR

February 12 WEBINAR

visit www.AOPAnet.org.

O&P Coding & Billing Myths: The Truth Out There. For more information,

February 14–15

PrimeFare Central Regional Scientific Symposium. Renaissance Hotel and Convention Center, Tulsa, OK. For more information, visit www.primecareop.com, call 888/388-5243, or email primecarepruitt@gmail.com.

ABC: Application Deadline for Spring 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/certification.

ABC: Practitioner Residency Completion Deadline for April 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/certification.

March 11

WEBINAR

A Policy Review: LSO/TLSO. For more information, visit www.AOPAnet.org.

April 8–13

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/certification.

International African–American Prosthetic Orthotic Coalition Annual Meeting. The Shriners Hospital for Children-Houston. Houston. For more information, contact Amandi Rhett at 404/754-4337, email arhett1@gmail.com, or visit www.iaapoc.org.

April 27–28

March 1

visit www.AOPAnet.org.

April 8

April 23–25

March 1

WEBINAR

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

New Scientific Credits—Clinician’s Corner: Orthotics. For more information,

FEBRUARY 2020 | O&P ALMANAC

SEMINAR

May 1

Coding & Billing Seminar. Charlotte, NC. For more information, visit www.AOPAnet.org.

ABC: Practitioner Residency Completion Deadline for June 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/certification.

CALENDAR August 12

May 5–6

AOPA Policy Forum. Washington, DC. For more information, visit www.AOPAnet.org.

Contracting 101: Understanding the Basics. For more information, visit

WEBINAR

www.AOPAnet.org.

May 13 WEBINAR

visit www.AOPAnet.org.

Social Media Mayday: Increase Your Footprint. For more information,

September 2

Outside the Norms: Outliers and Situations Where the Rules Are Different. For more information, visit www.AOPAnet.org. WEBINAR

May 13–15

NYSAAOP Meeting. Schenectady, NY. Visit www.nysaaop.org/meeting.

May 15–16

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/8367114, email certification@ABCop.org, or visit ABCop.org/certification.

May 29–30

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/8367114, email certification@ABCop.org, or visit ABCop.org/certification.

September 9–12

AOPA National Assembly. Mandalay Bay, Las Vegas. For more information, visit www.AOPAnet.org.

October 3

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Plaza Hotel, New York LaGuardia Airport, 104-04 Ditmars Blvd., East Elmhurst, NY 11369. Contact Drew Shreter at 800/946-9170, ext. 101 or email dshreter@pomac.com.

October 14

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

June 10

New Scientific Credits—Clinician’s Corner: Prosthetics. For more information, visit www.AOPAnet.org. WEBINAR

WEBINAR

July 8 WEBINAR

visit www.AOPAnet.org.

The ABCs of Appeals: Know the Players and Get the Tips. For more information,

July 31–August 1

PrimeFare East Regional Scientific Symposium. Renaissance Hotel and Convention Center, Downtown Nashville. For more information, visit www.primecareop. com, call 888/388-5243, or email primecarepruitt@gmail.com.

Calendar Rates CE For information on continuing education credits, contact the sponsor. Questions? Email ymazur@AOPAnet.org. CREDITS

November 11

RAC Audits: What Are They Looking At? For more information, visit www.AOPAnet.org.

November 4–6

New Jersey AAOP. Harrah’s Resort Atlantic City. For general inquiries, contact Brooke Artesi at 973/696-8100, brooke@sunshinepando.com, or www.NJAAOP.com.

WEBINAR

www.AOPAnet.org.

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

Let us share your next event! Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email ymazur@AOPAnet.org along with VISA or MasterCard number, the name on the card, 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.

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

O&P ALMANAC | FEBRUARY 2020

STATE BY STATE

State by State Updates from California, New York, Minnesota, and More

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

NEW FOR

2020! California

The California Orthotics and Prosthetics Association (COPA) and the Amputee Coalition are planning a Hill Day in Sacramento on March 18. AOPA has been working with COPA on efforts to address the MediCal fee schedule and potential access issues that could be created by the inability of O&P providers to continue providing services at current rates. For additional information, email state@amputee-coalition.org. 72

FEBRUARY 2020 | O&P ALMANAC

Illinois, New Mexico, Montana, Oklahoma, and Texas

BlueCross BlueShield (BCBS) Health Care Service Corp. (HCSC), which incorporates BCBS organizations in Illinois, New Mexico, Montana, Oklahoma, and Texas, released new policies for Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses, effective Nov. 15, 2019. AOPA has reached out to HCSC to express concerns about contradictions in the policy language and inconsistencies during the claims review process across the five states. AOPA believes that the new policy, as written, has the potential to exclude coverage for patients with deformational plagiocephaly. Email awhite@ AOPAnet.org if you have additional concerns or information about these policies.

Minnesota

New Lower-Limb Prosthetics and Upper-Limb Prosthetics policies have been released by BCBS Minnesota (BCBS MN), effective Nov. 4, 2019. AOPA members Teri Kuffel, JD, and Charles Kuffel, CPO, FAAOP, of Arise Orthotics and Prosthetics, met with BCBS MN representatives to discuss concerns about restrictive language in the policies. BCBS MN was open to discussing the policies to ensure that BCBS beneficiaries are receiving appropriate coverage. In addition, BCBS MN increased reimbursement for S1040 from $1,700 to $2,728.80 after Arise O&P objected to the fee schedule rate and requested BCBS match the MN Medicaid rate. The rate increase was granted, retroactively effective July 1, 2019. For additional information, visit the AOPA Co-OP.

New York

AOPA members in New York are organizing an effort to address the outdated Medicaid fee schedule, which has not been adjusted for 33 years. Additionally, members report that New York Medicaid no longer covers the 20 percent coinsurance, which it historically covered. Visit the New York page on the AOPA Co-OP for additional information.

Submit Your State News

To submit an update for publication in the State by State department of O&P Almanac, email awhite@aopanet.org. For up-to-date information about whatâ&#x20AC;&#x2122;s happening in O&P in your state, visit the AOPA website.

THE PREMIER MEETING FOR ORTHOTIC, PROSTHE TIC, AND PEDO RTHIC PRO FESSI O NAL S.

Call for Papers Contribute to high-value clinical and scientific offerings and share your expertise with over 2,000 orthotic, prosthetic, and pedorthic professionals.

We are looking for:

Submit your proposal for the American Orthotic and

• Business Education Program The top papers will be considered for the prestigious Sam E. Hamontree, CP (E) Business Education Award.

Prosthetic Association’s 2020 National Assembly, September 9-12, 2020, in Las Vegas, NV.

• Clinical Free Papers The top scoring papers will compete for the prestigious Thranhardt Award. • Technician Program • Symposia

• Relevance, level of interest in categories • Quality of scientific content • Quality of clinical content • Quality of technical content

What are you waiting for? Advance your career. Gain recognition. See your name in the Vegas lights.

Submit your abstract by March 20, 2020, at bit.ly/AOPA20Paper.

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

Questions about the submission process or the National Assembly? Contact AOPA at 571/431-0876.

www.AOPAnet.org

Myo Plus

Unlock hidden potential.

Introducing Myo Plus pattern recognition - Embrace the key to individualized control. Myo Plus is compatible with bebionic, Greifer, and SensorHand Speed. professionals.ottobockus.com