Almanac OP The American Orthotic & Prosthetic Association
FEBRUARY 2011
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WWW.AOPANET.ORG
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
BEST PRACTICES FOR GERIATRIC SPINE CARE A holistic approach to orthotics treatment is crucial for compliance
Are Braces the BEST TREATMENT for Knee OA? Updates to MEDICARE CODES for 2011
Go from Therapy to Final Fitting...
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PERFORMANCE SOCKS & SHEATHS
A/K BRIM SHEATH For above knee patients, for all socket styles. Designed to separate and protect the soft tissue in the top brim of the socket. Used to bridge the gap between the top edge of any roll on liner and the groin. Will work on pin suspension and seal in liners. Brim sheath uses stretchy, slick nylon material, constructed in two angled sections to allow the fabric to fit the high lateral and lower medial shape appropriately. Includes gripper elastic to secure to outer socket. Patent pending.
A/K Brim Sheath
KNIT-RITE LINER-LINER® PROSTHETIC SOCK WITH X-STATIC® A prosthetic sock designed to be worn under a suspension liner next to the skin for skin protection. • Relieves skin shear irritations and improves comfort with liners • Tested and proven beneficial for amputees who wear liners as the primary interface
Knit-Rite Liner-Liner® Prosthetic Sock with X-STATIC®
• Ultra-thin material minimizes compromise to liner's suction grip on skin • Moisture-wicking fibers for a cool and comfortable garment • X-STATIC silver fibers assist in preventing odor in the garment • Washable interface keeps liner cleaner and helps control skin irritations • High stretch for excellent fitting qualities
For more information contact Knit-Rite at 800-821-3094 or e-mail customerservice@knitrite.com. Also distributed by:
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O&P Almanac CONTENTS
FEBRUARY 2011, VOLUME 60, NO. 2
DEPARTMENTS
COVER STORY
4
AOPA Contact Page How to reach staff
8
At a Glance Statistics and O&P data
10
In the News Research, updates, and company announcements
36
AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
18 Best Practices for Geriatric Spine Care
By Anya Martin Orthoses can provide significant pain-management benefits to elderly patients who suffer from a variety of spinal ailments. Hear the latest on comparative effectiveness research and discover tips for encouraging seniors to wear spinal braces.
FEATURE
28 To Brace or Not to Brace?
By Kim Fernandez Are braces an effective treatment for knee osteoarthritis? Surgeons may not think so, but practitioners and some researchers have found they can alleviate pain and improve function when used in conjunction with other best practices.
COLUMNS
14
Reimbursement Page Revised Medicare code policies for 2011
32
Facility Spotlight SCOPe Orthotics & Prosthetics Inc.
42
AOPA Membership Applications
44 Marketplace
Products and services for O&P
48 Jobs
Opportunities for O&P professionals
52 Calendar
Upcoming meetings and events
55
Ad Index
56
AOPA Answers Expert answers to your FAQs
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; e-mail: almanac@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. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, e-mail: dmather@mrvica.com. FEBRUARY 2011 O&P ALMANAC
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OP Almanac
AOPA CONTACT INFORMATION
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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
EXECUTIVE OFFICES
MEMBERSHIP AND MEETINGS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 ext. 26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com
Tom Wessel, director of business development, 651/724-8753, twessel@AOPAnet.org Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org
Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com
Ann Davis, office, meetings administrator, and associate editor, AOPA in Advance, 571/431-0876, adavis@AOPAnet.org
Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org
AOPA Bookstore: 571/431-0865
Ann Davis, staff writer, 571/431-0876, adavis@AOPAnet.org Teresa Tobat, editorial/production assistant, 703/914-9200 ext. 33, ttobat@strattonpublishing.com
Kathy Dodson, senior director of government affairs, 571/431-0810, kdodson@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org
Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION SERVING THE O&P FIELD FOR OVER 90 YEARS
Renew the Easy Way With AOPA ONLINE PAY Login to pay your dues and update your membership directory information at:
www.aopanetonline.org/profile
Renew Online Today! O&P ALMANAC FEBRUARY 2011
EDITORIAL MANAGEMENT Stratton Publishing & Marketing Inc. ADVERTISING SALES M.J. Mrvica Associates Inc. DESIGN & PRODUCTION Marinoff Design LLC PRINTING United Litho Inc.
BOARD OF DIRECTORS OFFICERS President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, LLC, Houston, TX President-Elect Bert Harman, Otto Bock Health Care, Minneapolis, MN Vice President Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
GOVERNMENT AFFAIRS
Joe McTernan, director of reimbursement services, 571/431-0811, jmcternan@AOPAnet.org
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PUBLISHER Thomas F. Fise, JD
DIRECTORS Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Rick Fleetwood, MPA, Snell Prosthetic & Orthotic Laboratory, Little Rock, AR Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen Levis, Pennsylvania Orthotic and Prosthetic Society, Allentown, PA Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI
NEW! UPDATE MEMBERSHIP DIRECTORY INFORMATION ONLINE
Mahesh Mansukhani, MBA Ossur Americas, Aliso Viejo, CA Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2011 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the 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.
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At a Glance
Common Geriatric Health Problems Women at Greater Risk… Estimated Lifetime Risk for Alzheimer’s AGE
MEN
Prevalence of Stroke
WOMEN
AGE
9.1%
65
40-59
17.2%
10.2%
75
18.5%
21.1%
85
20.3%
Source: Alzheimer’s Association 2010
$25.3 billion
The annual cost to treat osteoporosis-related fractures in 2025.
25%
Percentage of stroke victims who also have Alzheimer’s.
One in Three Number of adults age 65 or older who fall annually.
MEN
WOMEN
1% 2.7%
7.4% 7.5%
60-79
15.4%
80+
12.6%
Source: American Heart Association 2010
1:2
Ratio of women over 50 who will break a bone due to osteoporosis.
$140,048 Estimated mean lifetime cost of ischemic stroke care in the United States.
30%
Percentage of stroke victims over 65 who are unable to walk without assistance.
Source: National Osteoporosis Foundation 2010, American Stroke Association 2010, American Heart Association 2010, Alzheimer’s Association 2010, Centers for Disease Control and Prevention 2001,1994. 8
O&P ALMANAC FEBRUARY 2011
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In the News
Photo: Charlie Litchfield/ Idaho Press-Tribune
Photo: www.thinkstock.com
Technician Designs Musical Prostheses
Army Funds Research on More Efficient, Affordable Prostheses U.S. Army Medical Research Acquisition Activity has awarded Alion Science and Technology an 18-month, $1.4 million contract to design a more affordable and sophisticated robotic-controlled prostheses. Alion, a Virginia-based technology company, will first create a modeling tool for robotic, upper-limb prosthetics. This tool will be used to create a lightweight prosthetic device with added functionality for the user as well as a prolonged battery life. “This critically important program is expected to result in a model for developing a unique—rather than a
TRANSITIONS
O&P ALMANAC FEBRUARY 2011
Josh Lorimer, an amputee and prosthetic technician with Idaho Orthotic & Prosthetic Services, has created a prosthetic leg with a built-in MP3 player dock and speakers, which he dubbed a “Rock-It Socket.” An amputee since the age of 1, Lorimer created his leg with two built-in speakers and storage space for his iPod. He has a pocket-sized remote control that allows him to play music from the speakers in his leg. The current model of his Rock-It Socket is covered in glow-in-the-dark blue lightening bolts and is his second model. His first was created in 2009.
BUSINESSES IN THE NEWS
Amputee Coalition of America announced its 2011 officers and board of directors. Marshall J. Cohen of New York returns to the position of chairman; Pat Chelf of Minnesota returns as vice-chair; and Jeff Lutz of Louisiana returns to the position of treasurer. Each officer will serve a one-year term. Thomas Dennis Strickland, III, of Atlanta, joined the board, and the following people are continuing their service: David McGill, New York;
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one-size fits-all—robotic prosthetic device for an amputee, lower costs for embedding sensors within a limb, and an advanced integrated control system that allows for lighter, more comfortable, and more cost-effective prostheses,” says Richard Brooks, Alion’s distributed simulation group manager. Alion officials say the program strives to advance the creation of implantable electronic sensors as well as the application of virtual prototype simulation models, which will ultimately give the amputee greater control of the prosthesis.
Kathy Spozio, Pennsylvania; Jeffrey Cain, MD, Colorado; Scott Stevens, MD, Tennessee; Charles Steele, New York; Terrence Sheehan, MD, Maryland; and Tami Stanley, Utah.
DJO Inc., a global provider of medical device solutions for musculoskeletal health, vascular health, and pain management, announced the acquisition of Elastic Therapy Inc.
Dr. Comfort has partnered with the American Diabetes Association as a sponsor for the association’s 2011 cycling fundraiser Greater Milwaukee Tour de Cure. The partnership will raise awareness of diabetic foot problems.
Hanger Orthopedic Group announced a definitive merger agreement with Accelerated Care Plus. OPTEC USA has become an official supplier partner of OPGA.
Link Between Animal Movements, Energy Use Found Northeastern University researcher Richard Marsh has documented the link between muscle function of animal limbs and energy use, which may lead to breakthroughs in the development of prosthetic legs and ankles. Marsh’s study, published in the December 2010 issue of the United Kingdom-based biological sciences journal Proceedings of the Royal Society B, found that emus and ostriches walk with a narrow range of economical speeds—a pattern that continues even when they run. Marsh says that despite anatomical differences, humans follow the same pattern.
Biomechanical information from these animals can provide prosthetic developers with important insight into movement dynamics, which Marsh says has been oversimplified in previous research. Greater insight into the link has important future implications for furthering development of the next generation of lower-limb prosthetics, according to Marsh. “If we don’t understand the normal function of the limb, we can’t really hope to optimize rehabilitation strategies and fix problems,” he says.
O&P Almanac COMING NEXT ISSUE Health-Care Reform and O&P Adding Mobile Services to Your Practice Watch your mail for the March 2011 issue! For more information about the O&P Almanac and other AOPA publications, visit us online at www.AOPAnet.org.
FEBRUARY 2011 O&P ALMANAC
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In the News
Grants Spur Orthocare Innovations Toward Prosthetic Advances Orthocare Innovations received $1.4 million in federal research grants to advance prosthetic-limb technologies. The National Institutes of Health (NIH), the Department of Education, and National Center for Medical Rehabilitation Research, a division of NIH, each have awarded Orthocare grants to move the O&P field forward. As a result of the funding, Orthocare will be working on three diverse projects that aim to fill gaps in O&P research and to design better prostheses. Highlights and goals of each project include: • Quieter sockets. The National Center for Medical Rehabilitation Research, a division of the NIH within the National Institute of Child Health & Human Development, has given $771,000 to build a more advanced prosthetic socket system. The most sophisticated socket systems aim to both hold the prosthetic limb securely and comfortably. To effectively do so, a vacuum pump is used to maintain suction on the limb and hold the prosthesis in place. However, these pumps make a buzzing or humming noise that some users find bothersome. The pumps also must be adjusted depending on the type of activity the user is performing in order to exert pressure needed to complete the task. Orthocare aims to develop a noiseless, self-adjusting vacuum with a computer-controlled system that expands and shrinks to maintain the socket fit regardless of changes in limb volume that occur throughout the day.
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O&P ALMANAC FEBRUARY 2011
• Children’s prostheses. The NIH has awarded Orthocare $183,234 to advance the Advanced Biofidelic Lower Extremity Kids Prosthesis (ABLE Kids) project. The grant also is supported in part by the Eunice Kennedy Shriver National Institute of Child Health & Human Development.
Researchers will create computerized hydraulic systems and control algorithms to build artificial limb components that are small enough for children to wear and
TRANSITIONS
will adapt to their dynamic growth movement patterns. • Prostheses that feel. The Department of Education has allocated $499,853 as part of a Small Business Innovative Research grant for the Haptic Feedback Improvements for Prostheses initiative. The project aims to create a haptic, or touch-based, system that will provide amputees with a sense of touch through their prosthetic device. The system will utilize artificial limb sensors, which will gather data about how much force a limb is producing. A computerized controller embedded in the limb will analyze data and translate it into vibration patterns that will buzz against the wearer’s skin. The vibration pattern, or haptic feedback, will inform the wearer of how much pressure is being exerted—the more powerful the pressure, the more intense the vibrations.
PEOPLE IN THE NEWS
Timothy Hendricks has been named Otto Bock HealthCare’s orthotics business development director.
Neuroscience and Neurological Recovery as a prosthetic researcher.
David Hensley, CPO, FAAOP, is now Orthocare Innovations’ director of sales.
Michelle Lucier is now Otto Bock HealthCare’s territory sales representative for Mobility Solutions and is responsible for the New England region.
Charla L. Howard has joined the staff of Methodist Rehabilitation Center’s department of Orthotic and Prosthetics and Center for
Sue Stout has joined Amputee Coalition of America as chief communications officer and director of public policy.
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Reimbursement Page By Kathy Dodson, AOPA government affairs department
Medicare Makes More Changes What you should know about the latest modifications to Medicare medical policies
T
he Centers for Medicare and Medicaid Services (CMS) often changes or updates the medical policies that govern how claims are processed, and the end of 2010 was no exception. Here are some of the most recent changes you need to become familiar with to ensure that you are billing correctly. These can be found in either the LCDs (local coverage determinations) or the accompanying policy articles. (Find LCDs online at www.cms. gov/DeterminationProcess/04_LCDs.asp.)
Least Costly Alternative Medicare will no longer automatically down-code and pay for a least costly alternative device, and a number
14
O&P ALMANAC FEBRUARY 2011
of the CMS medical policies were changed to reflect that decision. In the past, if you billed for Device A, but your DME MAC decided that a lesser item, Device B, would suffice for care of the patient, it would simply change the procedure code from that of Device A to Device B and process the claim. As of Feb. 4, 2011, however, this will no longer be the case. In such situations, the DME MAC will simply deny the claim for Device A as not medically necessary. A similar situation arises when a device is covered only if certain criteria are met; if they are not met, a lesser item is covered. Under the old policy, if all criteria were not met, the DME MAC would down-code the device to the lesser item and process the claim. However, under the new policy, if all criteria are not met, the claim will simply be denied. This new policy applies to: • Custom-fabricated AFOs/KAFOs: L1900, L1904, L1907, L1920, L1940L1950, L1960, L1970, L1980-L2034, L2036-L2108, L2126, L2128 • External breast prostheses, silicone or equal, with integral adhesive (L8031); custom-fabricated breast prostheses (L8035) • Knee orthoses with inflatable bladder (L1847); custom-fabricated orthoses (L1834, L1840, L1844, L1846, L1860) • Custom-fabricated therapeutic shoes for persons with diabetes (A5501).
Billing Upgrades To obtain partial payment for these types of claims, you can bill for an upgrade, using the following modifiers, as appropriate: • GK—reasonable and necessary item/service associated with a GA or GZ modifier • GL—medically unnecessary upgrade provided instead of non-upgraded item, no charge, no ABN. Unfortunately, this billing can get complex, depending on whose idea it was to provide an upgraded item. To review the requirements, see the accompanying chart from Medicare on page 16. In the two situations listed on this chart, in which the supplier will bill the patient, the claim line with the GA modifier will be denied as not medically necessary with a “patient responsibility” (PR) message. The claim line with the GK modifier will continue through the usual claims processing. The patient liability will be the sum of (1) the difference between the submitted charge for the GA claim line and the submitted charge for the GK claim line, and (2) the deductible and co-insurance that relate to the allowed charge for the GK claim line. The supplier’s charge for the upgraded item that is provided may not exceed the applicable fee schedule amount (if any) for that item.
Other AFO/KAFO Changes Code L4631 (AFO, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic
Reimbursement Page
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RECENT MEDICARE MEDICAL POLICY CHANGES ABN Required?
Required Modifier
DME MAC Payment
Patient Pays for Upgrade
If physician orders upgrade A. Supplier provides upgrade free of charge to patient
No
B. Supplier bills patient for upgrade
Yes
GL
*GA on first line for item that is provided
Medically necessary item only (GL line item)
No
Medically necessary item only (GK line item)
Yes
Medically necessary item only (GK line item)
No
Medically necessary item only (GK line item)
Yes
Medically necessary item only (GL line item)
No
GK on second line for item that is covered If patient requests upgrade A. Supplier provides upgrade free to patient
No
*GZ on first line for item that is provided GK on second line for item that is covered
B. Supplier bills patient for upgrade
Yes
*GA on first line for item that is provided GK on second line for item that is covered
If supplier provides upgrade for supplier convenience A. Supplier provides upgrade free to patient
No
GL
*Must be billed in this order on the claim.
or other material, includes straps and closures, custom fabricated), will only be covered for a diagnosis of 713.5 (arthropathy associated with neurological disorders). In addition, there are now coverage criteria for L4631. CROW walkers now must have all of the following characteristics in order to be covered: • designed to maintain the foot at a fixed position of 0 degrees (that is, perpendicular to the lower leg) • allows for varus or valgus deformity correction • contains a rocker-bottom sole with a custom arch support • incorporates a rigid anterior tibial shell
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O&P ALMANAC FEBRUARY 2011
• is used by a patient who is ambulatory • has a soft interface. Code L4631 covers all additions, including straps and closures, and no additional codes can be billed.
Other Knee Orthosis Changes Diagnosis code 844.8 (sprains and strains of the knee and leg, other specified sites of the knee and leg) has been added to the list of approved diagnoses for L1830 and L1832. Also, the policy clarifies that code L4002 (replacement strap, any orthosis, includes all components, any length, any type) is not to be billed with the initial orthosis; if it is, it will be denied as not separately payable.
Other Breast Prosthesis Changes Several new diagnoses have been added to the approved list for breast prostheses: V10.3 (personal history of malignant neoplasm, breast), 198.81 (secondary malignant neoplasm of other specified sites, breast) and 457.0 (post-mastectomy lymphedema syndrome). In addition, bras and similarly inherent bilateral items (L8000-L8002, L8015) are exempt from using the RTLT modifier.
Other Therapeutic Shoe Changes CMS has documented in policy several changes that went into effect in 2010 and 2011.
Effective July 1, 2010: • An in-person evaluation of the patient by the supplier at the time of selecting the items must include (1) examining the patient’s feet and describing the abnormalities that need to be accommodated by the shoes/inserts/modifications, (2) taking measurements of the patient’s feet, and (3) for custom molded shoes and inserts, taking impressions, making casts, or obtaining CAD-CAM images of the patient’s feet that will be used in creating positive models of the feet. • At delivery, an in-person evaluation of the patient must be conducted with the patient wearing the shoes and inserts; the evaluation must document that items fit properly. Effective Jan. 1, 2011: • The in-person visit with the prescribing physician must be within six months prior to the provision of the shoes/inserts/ modifications. • The certifying physician must do an in-person visit within six months prior to the provision of the devices; the certifying statement must be signed on or after this in-person visit, but no earlier than three months prior to the delivery of the shoes. There also has been a “clarification” of the documentation requirements for a certifying physician’s records, which must now include documentation of the management of the patient’s diabetes and detailed information about the other conditions that qualify the patient for coverage. Completing and signing the certifying statement is no longer sufficient documentation to validate the necessity of modifying the shoes or inserts. In order to meet this documentation requirement, the certifying physician must either: • personally document one or more of the qualifying criteria in his medical record of an in-person visit within six months before delivery
other MD or DO, physician assistant, nurse practitioner, or clinical nurse specialist that is within six months prior to delivery of the shoes/inserts, and that documents one or more of qualifying criteria.
Completing and signing the certifying statement is no longer sufficient
These changes in medical policies are complex, and it is extremely important to keep up to date on them. Sources of information include articles in O&P Almanac and AOPA In Advance, the newsletter that is e-mailed to AOPA members every other week. Also, visit your DME MAC Web site frequently and sign up for e-mail updates. Remember, once changes are announced, you will be held responsible for compliance. a
documentation to validate the necessity of modifying the shoes or inserts. of the shoes/inserts and before or on the same day as signing the certification statement; or • obtain, initial/sign, date (before or on the same day as signing the certification statement), and indicate agreement with information from the medical records of an in-person visit with a podiatrist,
Kathy Dodson is AOPA’s senior director of government affairs. Reach her at kdodson@ AOPAnet.org.
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BEST
GERIATRIC H
H
PRACTICES for
SPINE CARE A combination of careful fitting, follow-up, and sensitivity yields positive results
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O&P ALMANAC FEBRUARY 2011
BY ANYA MARTIN
W
ith the massive baby boomer generation on the threshold of retirement, it’s a good bet the need for spinal bracing is likely to increase dramatically. Already about 10 million Americans suffer from osteoporosis, and more than 44 million have low bone mass, putting them at risk for developing the disease, according to the National Osteoporosis Foundation. Often elderly patients end up seeing an orthotist because they simply don’t have sufficient bone density for corrective surgery. With older adults, it’s well known that spinal braces don’t deliver the dramatic corrective results seen with children, whose musculoskeletal systems are flexible and still developing. But orthoses can offer significant benefits to return seniors to an upright posture, prevent vertebral compression fractures (VCFs) due to osteoporosis, and alleviate pain due to scoliosis and fractures. The braces available today seem to be showing good clinical results for patients who use them as directed, but experts say more research is needed on the comparative benefits of bracing versus surgery and other treatments. And when it comes to stubborn seniors, sensitivity to environment and time spent on education may be just as important as brace biomechanics in achieving compliance—and success.
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In addition to ensuring practitioners have appropriate training, he advises them to clearly define the goal of the bracing before fitting, whether it be immobilization while a fracture heals, restoring someone who is bending forward to an upright position, reducing acute pain, or easing chronic pain over time. Don’t rely simply on X-rays that show the angle and locations of spinal curves or disk degeneration, Gavin adds. Make sure you’re also addressing any problems the patient tells you about, such as pain, and wants to see corrected.
Thomas M. Gavin, CO
Slow and Steady Despite the large numbers of seniors who may benefit from spinal bracing, it’s not as routinely performed as bracing limbs, so many orthotists do not have significant experience in fitting patients, says Thomas M. Gavin, CO, founder, president, and director of clinical services at Chicago-based BioConcepts Inc. One of the nation’s top experts on spinal orthotics, Gavin conducted a symposium on the topic at the 2010 AOPA National Assembly and often travels around the country teaching other orthotists about fitting spinal braces. “My point, or my caveat, is to beware,” Gavin says. “I don’t want people to think it’s easy. On the other hand, I want the takeaway to be, first, that it’s doable, and second, slow and steady.”
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One useful way to explain bracing’s benefits to a patient is to phrase it as achieving “restoration of ambulation,” Gavin offers. “They’re not just in pain; they’re also fatigued because the muscles have been stretched so long now that they are not capable of doing the job they were designed to do,” he explains. A big shortcoming is the lack of comparative effectiveness research— multicenter studies tracking large numbers of patients to determine whether current available orthoses lead to equal or better outcomes for senior patients when compared to pharmacological treatments, physical therapy, surgery, and any other alternatives. Some research on the subject has been done in the past but desperately needs to be updated to keep up with the latest devices, Gavin says, noting that BioConcepts is currently seeking funding to team up with physicians to conduct such a comprehensive study. Currently, he says, clinicians have to rely primarily on their own experience
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with patients to determine what works best. At BioConcepts, Gavin has had good success with thousands of elderly patients using a posterior shell thoracolumbosacral orthosis (TLSO), which he has been honing and testing for more than a decade with Kevin Meade, PhD, professor of mechanical engineering at Illinois Institute of Technology (IIT). The research takes place at the internationally renowned Musculoskeletal Biomechanics Laboratory at the Veterans Administration Hospital in Hines, Illinois, in collaboration with Avinash Patwardhan, PhD, director of the lab. Research efforts are focused on the scientific and clinical investigation of the biomechanics of spinal kinematics, pathomechanics, and device optimization to allow clinicians to improve spinal treatments and restore quality of life to people afflicted with spinal disorders. Gavin and Meade have spent many hours with a white board, calculating what’s needed biomechanically to compensate for a mechanical deficit, kyphosis (hump), or compression fracture. They have even developed braces for both of their elderly mothers. Gavin remembers how his, a retired nurse, was stalwartly opposed to bracing at first. “It took me a long time,” he says, “and now it’s the best idea she’s ever had.”
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Pain from Scoliosis More than 30 percent of people over age 60 have some scoliosis, and many of these experience significant pain, especially those who also have hypokyphosis resulting from osteoporosis, according to Andrew J. Mills, managing director of the SpineCorporation Limited in Chesterfield, United Kingdom. Unlike the corrective movement strategies for children, those for adults “are focused mainly on two planes, coronal and sagittal,” Mills says in an e-mail. “Research has shown that coronal imbalance in excess of 40 mm and anterior sagittal imbalance greater than 16 mm correlate highly with pain. [But] while Cobb angles may only be marginally improved as part of the overall corrective movement strategy, it is the reduction in coronal and sagittal imbalance that consistently correlates with reductions in VAS pain scores reported by our patients. Conversely, research has show that Cobb angle alone does not correlate with pain.” Degeneration of the spine in
adult scoliosis cases when combined with end plate obliquity is a predictor for pain, says Tim Cook, BSc Hones MCSP SRP, research physiotherapist/ clinical specialist at The Spine Corporation. “Improvement of the coronal and sagittal spinal balance is a consideration of both surgery and our treatment,” he adds. “We improve alignment and change forces externally versus what they do internally.” These findings led Mills, Cook, and their team to develop the only Adult SpineCor brace, a dynamic spinal brace designed specifically to reduce pain from adult scoliosis. Pain is reduced “by slowly and progressively reposition[ing] the spine, chang[ing] abnormal spinal loadings, and strengthen[ing] spinal muscles by encouraging the patient [to make] specific corrective movements during normal activities of daily living,” Mills explains, adding that its benefits can be reinforced and supported by a complementary physical therapy program. Another advantage of the brace, Cook says, is its flexible, garment-like, lightweight structure, which makes it easier and more appealing to wear.
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While many braces place a symmetrically equal amount of force on both sides of the body, the SpineCor uses four corrective bands that can be customized to wrap around the body in 12 different ways, depending on X-rays and clinical assessment, he adds. A software program helps determine the fitting, but it still requires a highly skilled practitioner to execute properly and assess appropriate tightness for the bands. The SpineCorporation is about to launch a two-year study comparing 60 men and women over age 50 who have scoliosis and pain and receive SpineCor bracing with a similar control group that does not use a brace, Cook says. The expectation is that the former will experience an improvement in pain and function and the latter will experience gradually worsening pain and spine curvature. The study will also evaluate differences in results among patients who receive bracing to assess which patients are the best candidates for bracing and whether there is more that clinicians can do. The practice also hopes to do a future study on SpineCor efficacy in osteoporotic patients.
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O&P ALMANAC FEBRUARY 2011
“There’s still so much to learn,” Cook says. “We know that the brace does help with pain and function but want to know more about the specific effect it has on spinal alignment in adults, which will help to keep improving our treatment in the future. This is an area that we could know more about in adults.”
Biomechanics and Environment Biomechanics has improved spinal brace technology and is essential to fitting, but to choose the best brace for a patient and achieve successful outcomes, practitioners need to consider the entire health picture and environment of the patient, Meade says. While he first became interested in spinal orthoses because of the math/engineering challenges, now it is the reward of helping people that has inspired him to make this pursuit a lifetime passion. After receiving degrees in mechanical engineering and applied mechanics, he earned a certificate in orthotics and has been working alongside Thomas Gavin in the clinic, as well as with Miguel Gomez, MD, an emergency room physician and licensed orthotist in Bogota, Colombia, who has been
experimenting with computer-assisted fabrication techniques. These experiences have shown Meade that practitioners need to consider the patient’s entire health picture when deciding which brace is best. One consideration, for example, could be evaluating whether a patient’s lower limbs need some kind of treatment, he says, as such issues as flat feet can affect spine problems.
“Sometimes one can change something in the living environment that would improve things a great deal.” ––Kevin Meade, PhD Another is assessing the patient’s home situation. “Sometimes one can change something in the living environment that would improve things a great deal,” Meade says. “One of the riskiest movements for the geriatric is simply getting out of a chair, and sometimes people will actually fracture a hip as a result. Sometimes people can afford a chair that helps them get up. If you just discuss this with a patient and/or show her a different way to get out of a chair, it can be helpful.” An important question for patients who live alone is whether they can put on their brace without assistance. If they have to be lying down when putting it on, would a reclining chair be helpful? Meade notes that for some patients, however—like his mother, whose hands were unsteady due to rheumatoid arthritis—aid will always be needed. “I’ve found my teaching experience is very handy in trying to educate a patient or a caregiver,” he adds. “It’s amazing how much of your time goes into that, and follow-up is very important. Depending on the
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circumstances, I’ll tell the patient, ‘I’ll call you next Tuesday to check in and see how you’re doing.’ They appreciate that, and usually you can get them to ask the questions they were reluctant to ask before.” Looking ahead, Meade agrees that comparative effectiveness research is essential. Other improvements in bracing or compliance could come from lighter-weight materials, although one also has to consider the trade-off if such materials are more expensive.
A Final Challenge Best practices aside, perhaps the greatest challenge facing practitioners when fitting seniors with spinal orthosis may simply be compliance, says Thomas Colburn, CO, and director of the Orthotic and Prosthetic Center at Tufts Medical Center in Boston. In other words, will the senior wear the device and receive its benefits? If it’s a matter of an orthotist just filling a prescription, giving basic instructions and sending the patient on his way, he says, the answer likely is no. “I had scoliosis and wore spinal bracing as a child, and so did both my children,” Colburn says. “I told them they were going to wear it, and they did. But for the senior, many have been healthy all their lives, and
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O&P ALMANAC FEBRUARY 2011
all of a sudden, this is a loss of their ability to be healthy without any external support. That’s a big deal for them and something we need to talk to them about and explain why they need it.”
Perhaps the greatest challenge facing practitioners when fitting seniors with spinal orthosis may simply be compliance. You may expect compassionate family members to encourage their loved one to wear the brace, he adds, but even that’s not guaranteed— people may see the orthosis as unattractive, cumbersome, and one more burden that requires their help with the patient. When Tufts Medical Center became a level-one trauma center two years ago, the hospital saw a dramatic increase in the number of elderly patients with spinal fractures, Colburn says. To ensure those patients would receive the best care and increase the likelihood they would follow treatment
recommendations, the hospital developed strong multidisciplinary protocols by which neurosurgery, physical therapy, nursing, and orthotic teams all collaborate closely to present a clear, cohesive message to the patient and family. For example, after the neurosurgery team makes its morning rounds, Colburn and others on the orthotics team will meet with them and review which patients they need to see. Then during the appointment and fitting, the orthotist and staff clearly discuss with the patient and any family members present what the brace is designed to achieve. For example, Colburn may explain that when a brace is used effectively for pain control, the patient may require less medication and overall achieve “a better quality of life.” Colburn also takes as much time as needed to demonstrate how to put on the brace and remove it until everyone understands the process clearly. Making sure the brace fits comfortably also is crucial for compliance, as is partnering with good, compassionate interpreters for patients who don’t speak English—and Tufts sees many such patients, Colburn adds. Neurosurgeons, physical therapists, and nurses all are trained to understand the benefits of bracing, reinforce the orthotist’s message, and ensure that the brace is being fitted and worn properly. All of this education may take more time, but you know it’s worth it when a patient returns after wearing the brace and has a positive outcome, Colburn says. He recalls one man who was vehemently opposed to bracing, but decided to give it a try after Colburn had carefully explained its potential to reduce his excruciating back pain. On a recent follow-up visit, the patient declared: “Yeah, I don’t like the looks of it, and boy, I don’t want to wear it, but boy, does it make my back feel good!” a Anya Martin is a contributing writer to O&P Almanac. Reach her at anya99@ mindspring.com.
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To Brace or Not to Brace? While the surgical community isn’t sold on orthotic treatment for knee osteoarthritis, O&P practitioners and some researchers tell a different story
I
n late 2008, the American Academy of Orthopaedic Surgeons (AAOS) released new guidelines for the treatment of osteoarthritis (OA) in the knee. Most of the recommendations were predictable—greater patient education, weight loss where appropriate,
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regular contact with doctors, exercise and strengthening, short-term taping, analgesics, and arthroscopic surgery in some specific cases. Not on the list? Knee braces. AAOS didn’t shoot them down completely, but the report said the academy couldn’t
recommend for or against their use because studies to date were inconclusive about their potential benefit. Unfortunately, the word among some doctors and patients spread that AAOS was against knee bracing, and patients who had already felt inconvenienced by the devices started refusing to use them, insisting instead on more invasive treatments, medications, or premature surgery. From their experience, O&P experts say that bracing can be life-altering for OA patients, regardless of the AAOS’ findings. However, myriad factors, from fit and the age of the patient to the specific brand of brace are critical to effectiveness. Educating themselves and patients, they say, is the first step to successfully advocating orthotics for treatment of OA.
Bracing Basics Nearly 10 million Americans suffer from knee OA, which damages both the cartilage and bone of the knee, along with the surrounding soft tissue. Symptoms include pain; stiffness lasting 30 minutes or longer; no warmth to the touch; grating, popping, or cracking sounds; joint enlargement; and bone tenderness, according to the American College of Rheumatology. Doctors who diagnose the condition have several routes they can take, including referring to a physical therapist, O&P practitioner, or surgeon, depending on the treatment they believe most helpful for the unique situation of each patient. Surgical options range from arthroscopic procedures to total knee replacements, which is why many patients are encouraged to try bracing or other treatments first. “It’s not that the AAOS is saying knee braces might not work very well,” says Thomas McGovern, co-owner, Heritage Medical, New York. He explains that the academy looked at two studies to make its recommendation: One study advocated braces, while the other found little to no benefit. “They can’t recommend for or against because of that,” he says, explaining that the studies used different braces. The study that found
against their use involved off-the-shelf braces meant for ligament stability. “Custom does a much better job,” he says. “You often see the wrong brace on the right patient, as was the population in the second study.”
“The knee brace is most effective when it’s used in conjunction with everything else that we know works.” —Eric Burns, CO Others agree. “The reality of it is that they do help,” says Eric Burns, CO, Hanger Prosthetics & Orthotics in Tucson. “The problem with a knee brace is that if you don’t do anything else with it, it’s a lifetime of wear. The knee brace is most effective when it’s used in conjunction with everything else that we know works such as exercise. If you use a knee brace by itself, it’s limited.”
Studies have found, however, that bracing and other devices (canes, crutches) and therapies can help stave off invasive surgery for long periods of time, and forever, in some cases. “I would wait until I desperately needed it and do what I could with everything else before I’d have surgery,” says Burns. “Most doctors want patients to have their first surgery as late as possible, and there are other therapies available to relieve their pain and give them their independence and function again.” Burns also admits that braces aren’t perfect, and many patients become less compliant over time. “An off-the-shelf [brace] might work for someone with a normal anatomy,” Burns continues. “The abnormal anatomy, that’s where O&P comes into play. You can get an off-the-shelf brace, but a custom might have the resources to do more. Each one works for a different patient, and the key is to pick the right brace for each person.”
Studying Outcomes While practitioners echo the benefits of knee braces, no single comprehensive study exists on the matter to date. But specialists at the Leon Root, MD, Motion Analysis Laboratory at the Hospital for Special Surgery in New York aim to change that. They have spent the last several years
FEBRUARY 2011 O&P ALMANAC
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taking a hard look at knee bracing for OA and will continue to do so for the foreseeable future. The lab is mainly looking at unloading knee braces, which puts specific points of pressure onto the thigh to “unload,” or remove, pressure from the knee, relieving pain and adding functionality to the natural joint. “The idea is to shift stress from the medial to the lateral,” says Yatin Kirane, D.Orth, PhD, who adds that the unloading braces are only designed to help with certain anatomies and certain knee problems within OA. “Symptomatically, people have shown that they give good results,” he says. “That’s what we’ve observed about halfway through the study. We cannot conclude yet and we’re limited at this point, but based on what we’ve observed, we’ve seen significant pain reduction with these braces.” The method for measuring pain in the study is simple: Patients are shown a line that’s about 100 millimeters long and asked to mark their pain on the line, where the left side is minimal pain,
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and the right side is “take me to the hospital” pain. “That method has been shown to be pretty accurate in grading pain levels,” he says. “We do it after staircase climbing, after fast walking, and after slow-paced walking.” Next, they obtain an OA outcome score by assessing the knee’s function under different conditions. Then, they conduct a gait analysis using a system of 12 cameras and a 3-D motion analysis system, with full body markers. “It basically makes a stick model that can accurately assess joint angles and movement,” he says. These tests are done at a zero baseline and repeated one week, one month, four months, and 12 months later using the same protocol. Two series of X-rays also are taken—one at the beginning and one at the end of the testing period—using a device that lets the patient stand and get an accurate view of the knee joint space. Knee fluid also is analyzed three times during the year. “Our patients are 45 to 80 years old,” says Kirane. “The one requirement
is that OA pain has to be in only one knee, and only on the medial side. That’s so we can make sure there are no confounding effects.” At present, he says, there are about a dozen patients in the study.
“Symptomatically, people have shown that [braces] give good results.” —Yatin Kirane, D.Orth, PhD “On one side, we get a very clean sample,” he says. “The results are more trustworthy. On the downside, it’s very difficult to recruit. People call in, and we have to send many of them back. OA usually affects both knees or both compartments of the knee.” He cautions that a plethora of complicating factors make it almost impossible for an organization like AAOS to recommend something like a knee brace. “They have to be sure,” he says. “In this case, it’s very difficult to conclusively say anything. In a case where you want to see the effects of a brace, it’s very difficult to conclude and say that this is what the brace does. We know the concept, but we don’t know exactly what it does. It’s not a straightforward path.” Surgeons, on the other hand, can go in and physically change the knee, offering solid outcomes that can be seen. Although patients say they feel a big difference from wearing a brace, some also have problems with its design and cosmetic appearance. Kirane says many of the participants he removed from the study because they’re not wearing their braces had an issue with fit.
Considering all the O&P options is equally important, McGovern points out. “Different manufacturers have different OA braces, and each one treats arthritis differently,” he says. “They’re all meant for different patients. So falling in love with one brace might not be the best course of action. You don’t want to put the same brace on a geriatric that you do on a younger patient.” Of course, simply listening to the patient leads practitioners on the right course of action. “It’s one of the few modalities for arthritis where you know if it works, and you know it instantly,” McGovern says. “Generally, you get instant pain relief if it’s right. Anybody that fits these braces knows that.” a “It doesn’t work well with all kinds of geometries,” he says. “We had one subject who had tapering wide thighs and very narrow calves. That means less muscle, and you need calf muscles to support one of the belts. So the brace kept slipping.” Despite repeated adjustments and workarounds, it simply never worked for her body shape.
Some people feel like it’s going out of our scope. It would be—if we started providing the therapy—but recommending it isn’t a bad thing.”
Kim Fernandez is a contributing writer to O&P Almanac. Reach her at kimfernandez@verizon.net.
Practitioner’s Role From his study so far, Kirane says he’s learned that initial fit is the No. 1 factor in a patient’s success with a brace. That translates into care and patience for the practitioner. “Any patient has a limited amount of patience [for readjustments and changes],” he says. “If orthotists do a good job initially, they might be more successful,” he says. Burns agrees, adding that practitioners should consider other options for their patients beyond what can happen in their own offices. “When we do an evaluation on a patient, it should be a complete evaluation,” he says. Thinking about patients’ diet, exercise, therapy, or medical pain control options and referring them to other specialists can make a world of difference, he says. “We all could be better at it,” he says. “We could be much better at it.
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Facility Spotlight By Deborah Conn
An Eye on Excellence Timely, proactive care and solid businesses practices keep SCOPe successful
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CPO (who retired five years proactive approach ago), had worked together at to patient care, plus another O&P company and a commitment to wanted the independence of effectiveness and efficiency, setting up their own business. are hallmarks of SCOPe From its small beginnings, Orthotics & Prosthetics. SCOPe has grown to employ Each of the company’s approximately 135 people, 13 shareholders manages including 36 certified practione office, an arrangement tioners, 12 technicians in its that “keeps the focus Kel Bergmann, CPO two labs, and administrative on providing good staff. While each office may skew and timely care,” says President and toward a particular age group or type Co-Founder Kel Bergmann, CPO. of patient, the practice as a whole treats Founded in 1982, SCOPe has the full gamut of patients: prosthetic grown from a single facility in San and orthotic, civilian and military, Diego to 13 offices spread across geriatric and pediatric, as well as San Diego, Imperial, Los Angeles, providing hospital- and trauma centerand Riverside Counties in Southern based care and office services. California. Bergmann and co-founders Bergmann believes the company’s Tony DiSanto, CP, and Loren Saxton,
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attention to hiring the best people sets it apart from others. “We’ve always felt it was important to have the right people for the job,” he says. “We don’t look for the least expensive employees, but the most highly skilled, to make sure problems are taken care of effectively and quickly.”
Proactive on PECOS Another distinguishing feature of the business is its willingness to take a proactive approach to looming challenges. For example, SCOPe, like many O&P facilities, has been anticipating the implementation of PECOS (the Provider, Enrollment, Chain, and Ownership System), a new Medicare enrollment policy. Physicians must enroll in PECOS to write prescriptions for Medicare patients to receive durable medical equipment and orthotic and prosthetic supplies. “What this means to us is that if our Medicare patient’s doctor is not registered on PECOS, Medicare won’t pay us for our services,” explains Bergmann. “And registering is not simple. I’ve heard it’s taken some physician’s offices three hours to complete the process.” Physicians have less incentive to register in a timely way since they can still bill Medicare for their own services. It is only some of their referrals that are affected. So to ensure the registration of all its referring physicians, SCOPe sent out this letter (see right) early on detailing the situation and asking doctors to register. The company followed up with personal phone calls and visits until nearly all physicians complied.
Remaining Diligent The Centers for Medicare and Medicaid (CMS) have delayed implementation of the policy twice, most recently an indefinite delay. Regardless of the implementation date, Bergmann and his colleagues had no intention of waiting for their Medicare claims to be rejected. They carefully collected data on physicians who had referred Medicare patients to determine who had not registered for PECOS.
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Dear Dr. Smith, We want to begin by thanking you and your staff for your continued support in allowing us to treat your patients. We realize you have a choice as to where you send your patients and we work very hard at meeting and trying to exceed your and your patient’s expectations. As an orthotic and prosthetic facility, we want to make you aware of a situation that will affect your ability to make referrals for Medicare patients. Recently, CMS (The Centers for Medicare and Medicaid Services) began the process of implementing new regulations that require all referring physicians to be enrolled in Medicare through the Provider Enrollment, Chain and Ownership System (PECOS) in order to be eligible to refer their Medicare patients for DMEPOS and other services. This system was established to manage, track and validate Medicare enrollment data. Currently on [insert date here], if you have not enrolled through PECOS, you will no longer be able to refer patients for durable medical equipment, orthotics, prosthetics, supplies and eventually clinical laboratory and radiological services. In addition, physicians who choose not to enroll through PECOS will have their ability to bill for Medicare patients revoked. In order to avoid this situation, you will need to re-enroll with Medicare through the PECOS system. You can find information on PECOS and how to enroll at the CMS Web site, www.cms.hhs.gov/MedicareProviderSupEnroll. For additional information, you can also access the CMS MedLearn Matters article at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6421.pdf (see page 3 under Key Points.) Please be assured that we regret any additional work that this new Medicare requirement may impose on your very busy practice. Unfortunately, unless you re-enroll with Medicare through the PECOS system, neither our office nor any other O&P facility will be able to provide care to your Medicare patients effective [insert date here].
“We spent a lot of time visiting Medicare sites to figure out the regulations and then going to physicians and explaining why they had to go through this onerous task,” says Bergmann. “Our job was to educate them in a nice way—not complaining or whining—why this was important. In the early days, no one had heard of PECOS. We sent out our marketing staff and got some pretty rude responses.
“It’s a balancing act,” he continues. “We have to protect our cash flow and our patients. I think we responded in an appropriate manner. We had monthly meetings to track the progress of physicians. We put in a lot of effort, and I think we’re in relatively good shape as far as PECOS is concerned.” a Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@ cox.net.
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AOPA Headlines AOPA WORKING FOR YOU
AOPA’s ‘Better Mousetrap’ It’s easier than ever to take advantage of O&P educational offerings
“I
f you build a better mousetrap, the world will beat a path to your door.” That’s how the old saying goes, but sometimes the world needs a little help. And in the world of O&P education, that’s where AOPAversity comes in. For O&P professionals with tight schedules and scores of distractions, finding time to take advantage of educational opportunities can be difficult. AOPAversity can help solve this problem by offering one-stop online education shopping, which delivers a wealth of O&P learning and the opportunity to earn professional credits. That makes www.AOPAnetonline. org/education a useful solution. The story of AOPA’s expanding educational offerings is one of the best-kept secrets in the field. The “Provide” part of AOPA’s strategic initiative—Provide, Protect, and Promote—embraces all of the opportunities AOPA offers O&P practitioners to meet the expanding education and learning needs of patient care and supplier members.
Learning at Home It’s time to shine a big spotlight on the abundant opportunities to advance your own knowledge, train employees, and earn needed Continuing Education (CE) credits. While ABC and BOC award up to 34 credits for attending the National Assembly each year, AOPAversity offers additional opportunities for earning CE credits without leaving home. Start with AOPA’s monthly audio conferences, which feature timely subject matter and knowledgeable experts. Completing the short quiz after the conference call nets 1.5 CE credits. Participating in all 12 calls means a total of 18 credits can come your way. The great economy of the audio conferences is that one modest registration fee buys access for as many people as you can gather in one location around your telephone. A bonus of the audio conferences is their flexibility. Your schedule may conflict with the Wednesday 1:00 p.m. time for the conference, but no problem. You can order a CD that includes the lecture and the important question-and-answer period, and you can still get credits by returning the quiz. Then there are two webcast training opportunities—the
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nine-module Mastering Medicare series and the justlaunched Practice Management series. Three modules are now available for that series, and six more are on the way. Each module offers 1.5 credits, again after completing a short quiz.
Lectures, Papers, and More AOPA’s sophisticated information technology system has made possible a new educational opportunity—online videos of many lectures and presentations from the 2009 and 2010 National Assemblies. Ranging from the clinical to the business management side of O&P practice, these learning tools can be accessed 24/7 and in some cases are eligible for CE credits upon successful completion of a short quiz. For a limited time only, AOPA members have free access to all of these National Assembly programs. Just visit www.AOPAnetonline.org/education. The AOPAversity home page also has a selection of monographs and white papers. Titles include “Buying or Renting Business Assets,” “Are There Ways to Reduce Your Insurance Costs?” and “O&P Professional Liability Malpractice Primer.” These and other helpful papers are all free for AOPA members to download. Another valuable learning opportunity is the Mastering Medicare seminar series. Las Vegas was the site of the Advanced Coding and Billing Seminar, which drew 145 people in October 2010 for two days of intensive scrutiny and learning about the always-changing L Code system and how to make sure you get properly reimbursed. This course alone earns 14.5 credits. Hot topics in Las Vegas were what lies ahead in the new health-care reform law and how it will be implemented by
CONFIDENCE to stand at every angle.
EP L K Orthotic Knee Joints OTS Corp. • 1.800.221.4769
> Ten locking positions throughout knee flexion > Helps to increase the knee range of motion > Provides stability for standing before reaching full extension > Designed for knee flexion contracture management > Unlocks to enable sitting and reclining > Effectively blocks flexion while allowing free extension > Unparalleled strength plus a nickel plated finish for extra durability
Fillauer LLC • 1.800.251.6398
Centri® • +46 8 505 332 00
Hosmer • 1.800.827.0070 AD296 07-02-10 / 09-13-10
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AOPA Headlines Optimizing Your Business
Downtown San Antonio
CMS and other involved agencies—concerns that will no doubt continue to arise at this year’s seminars. The 2011 seminar schedule kicks off in Las Vegas on May 19-20, 2011, at the Mirage Hotel and Resort ($125 per night). The second seminar will be June 16-17 in San Antonio. The final seminar is in Baltimore, Oct. 20-21, 2011, at the convenient Sheraton Hotel and Resort right near Baltimore/Washington International airport.
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SAVE THE DATE SEPTEMBER 19-22, 2011
O&P ALMANAC FEBRUARY 2011
]
One of AOPAversity’s biggest value propositions is the dynamic Business Optimization Analysis Tool (BOAT), introduced in 2007 after two years in development. It is now the go-to place to provide data for the biannual Operating Performance Report instead of completing the hard copy survey form. Participating members are learning that entering their data into their secure online BOAT management tool builds a readily accessible performance history, invaluable in creating budgets and developing new management and marketing strategies. A tutorial accessible from the BOAT login page provides a preview of all the tools and how to use them. Practice management information, a self-executed benchmarking tool covering the basics of providing patient care, and a competitive analysis instrument are just a few of the hidden gems. With such valuable information only a mouse click away, every patient-care facility executive can make those important decisions affecting the future. Considering this wide array learning opportunities, it’s clear that AOPAversity offers a terrific solution to continuing education and accessing the tools you need to improve efficiencies and maintain certification. a
For more information, visit our Web site at www.AOPAnet.org.
Do your footdrop patients need knee control but refuse a KAFO? Allard USA has evolved custom KAFO technology to provide you the components to fabricate a KAFO your patients will wear! A Dynamic functional orthotic solution for the management of genu-recurvatum accompanied with footdrop. Introducing COMBO…Innovative KO attachment for ToeOFF® or BlueRocker™ • Like all ToeOFF® Family Products, COMBO is lightweight – less than 2 pounds! • Low Profile • Comfortable hyperextension control interface • Easy to don and doff • Easily removed when wearer is relaxing (watching T.V. etc.)
View fabrication instructions and patient videos on www.allardusa.com
Your O&P Partner
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AOPA Headlines
Advanced Medicare Coding and Billing Session in Las Vegas AOPA will host a Mastering Medicare: Advanced Coding and Billing Techniques seminar on May 19 and 20 at the Mirage Resort and Casino in Las Vegas. The Mirage is offering the rock-bottom price of $125 per night for participants. During this session, AOPA experts will provide up-to-date information about coding complex devices, including repairs and adjustments, through interactive discussions with experts and colleagues to O&P practitioners as well as office billing staff. This advanced two-day event will feature break-out sessions for practitioners and office staff to concentrate on group-appropriate materials. The cost for seminar tuition is as follows: Member (early registration) $525; Non-Member (early registration) $725; Member (later registration) $550; Non-Member (later registration) $750. Additional Attendees (more than one from the same office) cost: Member (early registration) $475; Non-Member (early registration) $675; Member (later registration) $500; Non-Member (later registration) $700. Early registration ends on April 20. For more information, contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854. Register online at https://aopa.wufoo.com/forms/2011-mastering-medicare-las-vegas/.
The same seminar will be presented October 24 and 25 at the Sheraton Inner Harbor in Baltimore. Register at https:// aopa.wufoo.com/forms/2011-mastering-medicare-baltimore/. Contact Ann Davis at adavis@AOPAnet.org or 571/4310876 with registration questions.
IN MEMORIAM
Jeffrey Krueger, CO Jeffrey Krueger, CO, who worked at Northwest Prosthetics and Orthotics and Preferred Orthotics and Prosthetics in Tacoma, Washington, died Nov. 1, 2010, after a long illness. After graduating from New York University’s prosthetics and orthotics program, Krueger took a job at Northwest Prosthetics and Orthotics and Preferred Orthotics and Prosthetics in 1984 and he remained with the company until his death. Krueger grew up in the United Kingdom and learned to ski in the Swiss Alps where he developed his love of the great outdoors. Krueger was an expert skier and scuba diver and enjoyed traveling to exotic places like the Great Barrier Reef in Australia.
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He is survived by his wife Cindy, his brother and sister, as well as friends and colleagues in the Puget Sound area. Condolences and memories can be emailed to his wife Cindy at cindykru@yahoo.com.
Michael L. Teter, CPO Michael L. Teter, CPO, owner of Teter Orthotics & Prosthetics, died Jan. 6, 2011, in Traverse City, Michigan. He was 49. Teter Orthotics & Prosthetics, headquartered in Traverse City, has more than 15 offices throughout Michigan. The company has been providing O&P care to Northern Michigan for 45 years. Teter purchased the company in 1991.
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AUDIO CONFERENCE:
Using Lower Limb Medical Policy to Your Advantage Do you find Medicare policies hard to understand and confusing? Want to reduce unnecessary claim denials? For answers to your most vexing questions, join AOPA on Feb. 9, 2011, at 1 p.m. EST for the AOPAversity audio conference “Using the Lower Limb Prosthesis Medical Policy to Your Advantage.” This conference will discuss the Medicare Lower Limb Prosthesis Local Coverage Determination (LCD) and Policy Article to help you gain a better understanding of what and when O&P services are covered. Audio conference discussion topics include: • prosthetic functional levels • coverage of initial, preparatory, and definitive prostheses • Skilled Nursing Facility Prospective Payment System (SNF PPS) exemptions • adjustments and repairs • replacements • useful lifetime restrictions.
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AOPA Applications
The 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. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million 42
This is just a small sampling of the issues that will be presented. Don’t miss this opportunity to improve your understanding of this important medical policy during the audio conference. The cost of participating is always just $99 per line for AOPA members ($199 for nonmembers) and any number of employees may listen on a given line. Listeners can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least an 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at https://aopa.wufoo.com/forms/2011telephone-audio-conferences/. Contact Ann Davis at adavis@ AOPAnet.org or 571/431-0876 with registration questions. a
O&P ALMANAC FEBRUARY 2011
Corpus Christi Prosthetics Inc.
OpalStar Strategies
1326 Santa Fe Street Corpus Christi, TX 78404 361/888-7752 Fax: 361/888-7424 Category: Patient Care Facility Scott Vicknair, CP, LP
1409 N.E. 166th Court Shoreline, WA 98155 206/200-6705 Category: Supplier Level 1
Forensic Prosthetic and Orthotic Consulting
672 Como Avenue St. Paul, MN 55103 607/643-002 Category: Patient Care Facility Marita Dorsch Carozza, CP, FAAOP
3071 Seafarer Way Suamico, WI 54173 920/737-5462 Fax: 920/737-5462 Category: Supplier Level 1
National Prosthetic & Orthotics 4200 Alexandria Pike, Ste. C Cold Spring, KY 41076 859/442-0400 Fax: 859/442-0158 Category: Patient Care Facility Farah Ghazala, CPO, LP
OPRM Orthotic Prosthetic Resource Management
Reliant Prosthetics 1110 W. Shore Drive Richardson, TX 75080 972/470-0300 Fax: 972/470-0301 Category: Patient Care Facility Eric Loposer, CO
“I JOGGED THREE TIMES A WEEK”
Losing a limb doesn’t mean losing your identity. Our latest innovation is true energy in motion. With an innovative multiple spring design, the Soleus® produces a natural movement and smooth transition from a walk to a jog. Custom built for each individual’s ideal outcome, you can always trust College Park to create the best foot for your needs.
individualized solutions. thousands of possibilities.
800.728.7950
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www.college-park.com
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Marketplace
ORTHOTIC MANAGEMENT OF GENU RECURVATUM COMBINED WITH FOOTDROP Allard USA introduces COMBO, a thigh cuff/knee brace attachment for ToeOFF or BlueRocker that offers a lightweight, low-profile, functional orthotic solution for the management of genu recurvatum or chronic knee instability, accompanied with footdrop. Combine COMBO with ToeOFF or BlueRocker to fabricate a KAFO, customized to meet your patient’s needs. Uprights with dual-axis joints are easily shaped and adjusted to optimum height for the patient. Adjustable knee control popliteal interface for genu-recuvatum control. Modular components allow you to accommodate variances in thigh and calf circumferences. For more information, call 888/6786548, e-mail info@allardusa.com, or visit www.allardusa.com.
APIS
Apis is dedicated to providing great services and products to our valued partners. Mt. Emey custom orthoses program is a leading program to help healthcare professionals with their pedorthics needs. Currently Apis offers limited-time free shipping for all custom orthotics orders and $75 for three pairs. Your patient will be compliant in less time. Whether you need to order the orthotics only or with the great selection of therapeutic or diabetic shoes, we offer great package deals, call us to find out and you will not be disappointed. Our friendly CSRs are standing by at 888/937-2747.
THE VENTURE® FOOT FROM COLLEGE PARK The Venture® combines College Park’s trademark multiaxial design with a higher frequency dynamic response for more active users. The highly functional, custom Gait Matched design includes CPI’s exclusive Stride Control™ feature providing quick and easy gait adjustment without disassembly. In addition, increasing the toe lever to match the length of the anatomical foot allows for natural energy distribution. Key features include: • True multi-axial function with transverse rotation for natural feeling performance • Extended toe lever facilitates immediate power and increased response with each stride • Adjustable Stride Control™ helps fine-tune gait • Scaled design allows for more natural proportions • Same-day, custom built to order. For more information, call 800/7287950 or visit www.college-park.com.
THE MANUSUPPORT.FIX
Euro International proudly presents the newest addition—the ManuSupport. fix—to their range of products. The volar wrist support ManuSupport.fix holds middle hand, wrist, and forearm in a neutral resting position; its modification and adjusting varieties allow for an optimal and individual adaptation to the injured wrist. The product has been manufactured according to the latest functional anatomic and orthopedic developments and knowledge.
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The ManuSupport.fix is simple to apply and its material combination allows for easy care for: • Tendovaginitis • Carpal tunnel syndrome • Postoperative resting position. For more information, call 800/3782480 or visit www.eurointl.com.
CUSHIONED CORE-SPUN BY THERAFIRM® GRADIENT COMPRESSION SOCKS Therafirm’s Core-Spun Gradient Compression Socks now include a cushioned sole for exceptional comfort. Core-Spun by Therafirm™ Cushioned Support Socks are made with the unique technology of core-spun yarns for a patent-pending, true gradient compression sock that is ultra stretchy, easier to put on, and more comfortable to wear. Core-Spun look and feel like comfortable everyday active socks while delivering a controlled amount of pressure greatest at the ankle and gradually decreases towards the top of the sock to promote better circulation, reduce swelling, and energize tired legs and feet. Moisture-wicking fibers create a superior wicking effect so moisture evaporates from the skin quickly, therefore providing a comfortable coolness. The comfort top is non-restrictive while staying in place. Available in white and black in Mild Support 15-20 mmHg. Available in Moderate Support 20-30 mmHg soon. For more information, contact Knit-Rite at 800/821-3094 or e-mail customerservice@knitrite.com.
ENTEGRA SV BY HOSMER The Entegra SV has hydraulic swing phase control and is constructed with durable, lightweight aluminum alloy. Its compact design is perfect for smaller patients and cases where clearance and weight are a concern. • Aluminum alloy frame • 7 in (18 cm) tall • 135 degree range of motion • Integrated kneeling pad • Rugged thru-bolt design • Maintenance-free Oilite® sleeve bearings • Four proximal attachments • ISO tested and rated for 220 lb (100 kg). For more information, contact Hosmer at 800/827-0070 or visit www. hosmer.com.
INTRODUCING KISS REPLACEMENT KITS! AVAILABLE IN BEIGE OR BLACK. These kits are designed to replace key components, without the need to purchase a distal base! CMP32/A: Includes a velcro sewn placard, proximal nut and screw, proximal strap, and distal strap. CMP31/A: Includes an adhesive-ready placard, proximal nut and screw, proximal strap, and distal strap. For more information, contact KISS Technologies LLC at 410/663KISS or visit www.kiss-suspension.com.
FEBRUARY 2011 O&P ALMANAC
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NEW FROM MOTION CONTROL: NEW TRIAD PREAMP
• • • • •
Three mounting options Water-resistant case High interference rejection Gain adjustments on preamp Compatible for use with: ❍❍ Utah Arm 3 and 3+ (kit: p/n 4050214) ❍❍ Utah Hybrid Arm (kit: p/n 4050214) ❍❍ ProControl Systems (kit: p/n 4050216) ❍❍ Otto Bock electrode cables. For more information call 888/6962767, e-mail info@UtahArm.com, or visit www.UtahArm.com.
FUSION FOOT NOW WITH TORSION RECEIVER Natural movement is something amputees continually strive for in their prostheses after amputation. A new Torsion Receiver proximal adapter for the Fusion™ Foot now exists that can help in attaining this goal. The Torsion Receiver provides a sense of natural movement. The receiver is designed to provide 24 degrees rotation internally and 24 degrees rotation externally. This rotation lets wearers turn in or out just as they do on their sound side. The patient weight limit for a Fusion Foot with a Torsion Receiver is 300 lbs. For more information, contact Ohio Willow Wood at 800/848-4930 or www. owwco.com.
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NEW OPTEC USA CATALOG WITH PDAC APPROVED CODES Call us today at 888/982-8181 to request our new 2010-2011 catalog! OPTEC USA consistently offers cutting-edge products of the highest quality. Beyond offering innovative orthosis at a fair price, OPTEC USA works to help your practice be successful by submitting our braces to the PDAC (Pricing, Data Analysis, and Coding) for review and determination. PDAC recently reviewed OPTEC USA’s products with the following determinations: VertaMax – L0627, Stealth TLSO with DLK – L0462, Stealth TLSO with ATE – L0464, Oasis LSO and Oasis LSO LP – L0637. Find out more about these and other products online at www.optecusa.com or call us today at 888/982-8181!
OPTEC’S CUSTOM BRACES— READY WHEN YOU ARE— 24/7/365
For nearly 15 years, OPTEC USA has been a leader in custom spinal orthotic manufacturing. We provide the highquality products and services you need from your central fabricator. With around-the-clock technical support, quality products at a fair price, and availability to take orders anytime, you will find that OPTEC USA fits your needs. Further, you will get your custom brace when your patient needs it and just the way you want it. Try OPTEC USA for your next custom orthosis! Find out more about these and other products online at www.optecusa.com or call us today at 888/982-8181!
THE NEW PROPRIO FOOT® WITH EVO™ BY ÖSSUR: STABLE, SMOOTH, AND COMFORTABLE The newly redesigned PROPRIO FOOT with EVO utilizes intelligent ankle flexion to help users walk confidently and naturally without watching the ground, alleviating having to think about every step for fear of tripping and falling. It also features the exclusive EVO (Energy Vector Optimization) technology for improved dynamic response, enhanced comfort, and excellent stability throughout the gait cycle. The life-like ankle movement enables this foot to adjust for normal sitting and standing, and automatic alignment for adapting to various types of footwear. Suggested Medicare assigned billing code is L-5973. For more information call 800/2336263 or visit Össur at www.ossur.com.
THE NEW 6Y512 ANATOMIC 3D PUR LINER Get Otto Bock’s most advanced off-the-shelf liner, with Anatomic Specific Geometry. This new liner maximizes patient comfort through an anatomical shape and varying wall thicknesses – thicker in typically sensitive areas and thinner in other areas for increased flexibility. In addition, the liner is pre-flexed 20 degrees, reducing wrinkles behind the knee while providing easier flexion. Polyurethane (PUR) ensures even pressure distribution and a precise and comfortable fit, ideal for sensitive, bony, or scarred residual limbs. Everyone from low to very high mobility grade will benefit from the advanced design of the 6Y512
Anatomic 3D PUR Liner. Available in Uncovered and Integrated Fabric Sheath versions for use in vacuum and suction socket systems. To learn more, contact your sales representative at 800/328-4058 or visit www.ottobockus.com.
service specialist at 800/321-1264, by fax 800/222-6176, or e-mail customerservice@ pelsupply.com. Order online at www. pelsupply.com.
RIBBY® ORTHOSIS AVAILABLE FROM PEL SUPPLY
The new Re-Flex Rotate with EVO™ from Össur is a durable, highperformance foot that provides both vertical and rotational shock absorption. This combination is ideal for very active or moderately active users, especially those participating in activities such as golf. • Vertical shock absorption and dynamic energy return – NEW titanium coil spring offers more than 14 mm of vertical travel
The new Ribby® Articulating Ankle/Foot Orthosis from Anatomical Concepts is now available from PEL Supply. The Ribby® incorporates the functions of Ambulation, Stability, and Positive Positioning into one AFO. If necessary, the ankle can be locked out while continuing to provide static adjustability of dorsiflexion or plantar flexion to optimize patient function. The unique quick disconnect design permits rapid transition between various lining options and the use of a more conventional walking shoe. The quick disconnect mechanism ensures a positive connection for each application to maintain the AFO’s integrity during ambulation. The Ribby® is a fantastic and creative way to display your facility’s ability to provide excellent orthotic care that can address rehab patients’ needs 24/7 in a most cost-effective and yet profitable manner. PEL Supply has more than 50 years of success as one of the nation’s largest independent wholesale distributors of high-quality pedorthic, orthotic, and prosthetic products, components, tools, and accessories. PEL offers one-stop shopping/shipping convenience and same-day shipment on most popular items. For information on the full line of Anatomical Concepts’ products, contact any helpful PEL customer
NEW RE-FLEX ROTATE AVAILABLE THROUGH SPS
designed to absorb vertical shock forces and reduce pressure on the residual limb. The dynamic energy return of the coil spring gives the Re-Flex Rotate a lighter and more responsive feel. • Rotational shock absorption – designed to dampen shear forces and pressure on residual limb for increased comfort. The rotational shock absorption is particularly beneficial for users whose daily routines involve frequent side-toside and turning movements. • Ease of use – Shock absorption unit requires no adjustment by the user or the prosthetist. The shock kit is offered in 8 categories to match each user’s specific needs and the height adjustment for the Re-Flex Rotate is very simple. Contact SPS Customer Service at 800/767-7776 ext. 3 for more information. a
DYCOR
RENEWING INDEPENDENT LIFESTYLES Partial Feet
Dycor's toe filler (L5000) and ankle height (L5010) partial foot prostheses incorporate custom silicone liners (L5681) and advanced composite sockets (L5629). Advanced composite sockets are available in semi rigid, semi flexible and rigid. With the ankle height version, a flexible keel can be extended from the socket into the forefoot (L5972). The liners are available in soft, medium and firm, 4, 5 and 6 mm. thickness and taper to .5mm. at the trim line. In the ankle height version, the liner remains full thickness at the trim lines to avoid chaffing. Optional zone padding available. EVA toes can be individually thermo-molded to the shoe. Cast the residuum inside the appropriately fitting shoe and on top of the corrective device, if used. Provide indicated trim lines, ML/AP vertical reference and a tracing of the contra lateral foot. Also provide the shoe in which the cast was taken. Low definition protective covers (L5962) are available in tan or brown, urethane or silicone. Allow ten working days for processing.
For additional information call Dycor Technical Services at 1-800-794-6099 or visit www.dycormfg.com. FEBRUARY 2011 O&P ALMANAC
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Jobs Northeast
INCREASE EXPOSURE AND SAVE!
Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
CPO, CO, Board-Eligible Orthotist or Prosthetist, BOCO or BOCPO, C.Ped Maine • Are you looking for something more? • Do you want to be more than a number? • Do you want a great life and a great job? • We are a terrific practice looking for some nice people. • Is this you? We are a well-established, patient-oriented, ABC-accredited facility seeking to strengthen our staff. Competitive salary offered, with bonuses commensurate with productivity, and renumeration for required educational credits. Offices located in picturesque Maine, just a short distance from our coast and mountain regions. Learn more about joining our team of dedicated specialists by contacting:
O&P Ad 25356 O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899
Use our map to find which region you fit into!
CLASSIFIED RATES Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, e-mail and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Non-member Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or e-mailed to srybicki@ AOPAnet.org., along with a VISA or MasterCard number, the name on the card and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. JOB BOARD RATES Visit the only online job Member Non-member board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140 Save 5 percent on O&P Almanac classified rates by placing your ad in both the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.
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O&P ALMANAC FEBRUARY 2011
New York Orthotics and Prosthetics Part-Time Orthotic Fitter New York City Area Immediate opening for CO in the NYC area. Job requires two days at clinic working with orthopedic and rehabilitation doctors. Submit your resume to:
E-mail: nyorthotic@verizon.net Fax: 212/504-3066
Southeast CPO Georgia An experienced CPO is needed for a well-established, ABC-accredited facility in Georgia. The individual must be licensed (or eligible) by the state of Georgia. This position is for three of our central-Georgia locations, and has opportunities for advancement. Benefits include full health insurance (including dental), life insurance, and a company-sponsored retirement plan. Send resume to:
C. H. Martin Company, est. 1912 Fax: 404/525-9819 www.chmartinco.com
Mid-Atlantic
Inter-Mountain
Certified Prosthetist/ Certified Prothetist/ Orthotist – Board Eligible
Certified Prosthetist/Orthotist (licensed or eligible)
We are an accredited, privately owned O&P facility with offices in Philadelphia and South Jersey and have an excellent reputation. We are seeking a self-motivated, skilled, and experienced practitioner with a strong clinical background who is patient oriented. Competitive salary and benefits package offered. Send resume to:
Austin Known as “The Live Music Capital of the World,” Austinites love the mild winters which allow them to continue enjoying biking, outside venues, lakes, etc. Austin has been selected as the No. 2 Best Big City in “Best Places to Live” by Money magazine and also the “Greenest City in America” by MSN and according to Travel + Leisure magazine, Austin ranks No. 1 on the list of cities with the best people! If you are ready for a change, possess what it takes to be a great practitioner, and have always wanted to live in Austin…grab the brass ring and join the Hanger family! To apply for this position, please visit:
Bill Penney Philadelphia Orthotics & Prosthetics Inc. 709 Somerdale Road Voorhees, NJ 08043 Phone: 856/428-4201 Fax: 856/428-4204
www.hanger.com/careers
AVAILABLE POSITIONS Orthotist
Why do I work for Hanger?
“
I like working for a company that cares for its employees as much as they care for their patients. That’s why I’ve been with Hanger for the past 28 years. When Hurricane Katrina hit my hometown of New Orleans, Hanger was there for me. They gave me as much time as I needed—with pay—and helped me relocate to Atlanta. By working at the largest prosthetic and orthotic company in the nation, I have more than just career opportunities. I have an employer that treats me like family.
”
Tony Thaxton Jr., CPO, LPO, Certified Practitioner, Orthotist-Prosthetist
To apply for any of these positions, visit www.hanger.com/careers Hanger Orthopedic Group, 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. Residency Program or Certificate Primary Education Program Info, contact: Robert S. Lin, CPO/Dir. of Academic Programs. Hanger P&O/ Newington O&P Systems, Ph. 860.667.5304; Fax 860.667.1719
Denver, CO Urbana, IL Evansville, IN Michigan City, IN Paducah, KY Methuen, MA Duluth, MN Springfield, MO
New York City, NY Tahlequah, OK Lancaster, PA York, PA Houston, TX Milwaukee, WI Wheeling, WV
Prosthetist Waterbury, CT Albany, NY Port St. Lucie / Melbourne, FL New York City, NY Hays / Salina, KS Enid, OK Hattiesburg, MS Green Bay, WI Jackson, MS Austin, TX Meridian, MS
Prosthetist/Orthotist Little Rock, AR Lodi, CA Long Beach, CA Salinas, CA Miami, FL Pensacola, FL Atlanta, GA Louisville, KY
Baltimore, MD Albany, NY Akron, OH Bremerton, WA Lakewood, WA Olympia, WA Port Angeles, WA Green Bay, WI
Certified Pedorthist
Stratford, CT Willoughby, OH Tahlequah, OK
Tacoma, WA Parkersburg, WV Wheeling, WV
FEBRUARY 2011 O&P ALMANAC
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Jobs North Central
Certified Orthotist Green Bay and Appleton, Wisconsin Monroe BioTechnology is seeking a talented certified orthotist. This individual must possess a bachelor’s degree, have completed an NCOPE residency, and have an additional three years of clinical experience. We are a two-office privately owned facility in Green Bay and Appleton, Wisconsin, offering prosthetics, orthotics, and high-definition silicone restoration. We have our own in-house lab and make full use of the BioSculptor CAD system. A successful candidate would be passionate about clinical orthotics, have excellent communication skills, be computer literate, and dedicated to using all their clinical skill and talent toward the pursuit of excellence in all areas of orthotics. If you desire to work as a respected clinician with other skilled, respected clinicians, please send your resume to Stephanie Sheedy at:
E-mail: Stephanie@monroebiotech.com www.monroebiotech.com
Certified Orthotist Michigan City, Indiana We invite you to join the family of the oldest orthotic and prosthetic patient care company in the world. If you are seeking a new start and want security, support, and the benefits of the lastest technology, we need to talk! We offer a very competitive compensation and benefit package accompanied by Hanger’s famous Ed Fair, opportunities for growth, support of more than 1,000 practitioners and sales and marketing, a corporate office to support your HR, accounting, and real estate needs. If you possess excellent communication and patient care skills and are ready to make a change, we would love to discuss our needs in Michigan City! To apply for this position, please visit:
www.hanger.com/careers
Certified Prosthetists, Board Eligible Orthotists, Board Eligible Prosthetists, Certified Pedorthists, Residents Illinois Immediate openings and excellent opportunities for independent, motivated, and ABC-certified practitioners for a well-established, multiple location O&P practice in Illinois. The ideal candidate will be ABC-certified and must be eligible for Illinois state licensure. We would also like to speak with candidates seeking residency in Orthotics and Prosthetics. Our fast paced, energetic atmosphere is a rewarding place to establish a great career. We offer a very competitive salary and benefits package commensurate with experience. If you have what it takes to be a part of a successful and well organized team then we would love to speak with you. Management experience is a plus! Multiple locations available. Forward your resume, in confidence, to:
Recruitment Manager Comprehensive Prosthetics & Orthotics, Inc. 741 W. Main Street Peoria, Illinois, 61606 Fax: 309/676-2279 E-mail: jim@cpousa.com
Pacific Certified Orthotist/Board Eligible Orthotist Richmond, California Howard Orthopedics Inc. is seeking a self-motivated certified orthotist and board eligible orthotist for its growing practice. Candidates must have excellent communication and organizational skills and be patient oriented. We offer a competitive salary, health benefits, 401(k), and profit sharing. Please send resumes to:
E-mail: alexa@howardorthopedics.com
Renew the Easy Way With
AOPA ONLINE PAY
www.aopanetonline.org/profile 50
O&P ALMANAC FEBRUARY 2011
Pacific Certified Orthotist/Certified Prosthetist Orthotist California Do you want to work for an established, growing company in an environment that values clinical excellence, and work/life balance? Do you want to live in one of the most desired and diverse areas in the country, beautiful Southern California? SCOPe has a career opportunity for you. We are a leading orthotics and prosthetics company looking for an energetic and motivated CO and/or CPO to provide comprehensive assessment, treatment, and follow-up for our patients. SCOPe offers competitive salaries as well as an excellent benefits package for full-time employees. Salary is commensurate with experience. All communications will be held in the strictest confidence. Interested parties can send resumes via e-mail to:
Fax: 858/292-5496 E-mail: jobs@scop.net www.scop.net
Certified Orthotist Northern California Do you dream of earning six figures? Receiving a significant sign-on bonus and to work for the oldest and one of the most respected orthotic and prosthetic patient care companies in the world? Are you looking for security? In addition to the above, we offer competitive benefits, world-class education fair, latest technology, and a family of more than 1,000 practitioners in addition to the support of HR, sales/marketing, accounting, etc. Our core values are: • Integrity • Clinical and operational excellence • Unsurpassed customer satisfaction • Flexible and entrepreneurial operations • Creativity and innovation • Shared success. If you have the skills, drive, and ambition…let’s talk! Contact, in confidence:
Certified Prosthetist-Orthotist or Certified Prosthetist-Facility Manager Southern California Exceptional opportunity for a CPO/CP to manage our satellite office in California’s beautiful Santa Clarita Valley. Are you looking to grow your career and take on more responsibility? We are a well-established, multi-facility company with an immediate opening for an experienced practitioner (CPO or CP with orthotics experience) to run and grow our practice in Santa Clarita. This ABC-certified practitioner must be self-motivated, patient-oriented, and possess sound clinical, organizational, and interpersonal skills. Familiarity with OPIE software and chartless environment is a huge plus. A minimum of five years’ clinical experience is preferred. We offer a highly competitive salary, incentive program, and outstanding benefits package. If you are ready to take the next step in your career and relocate to one of the safest and most desirable places to live in the nation, please send your resume with cover letter to:
Valley Institute of Prosthetics and Orthotics Siri Khalsa, Administrator E-mail: skhalsa@vipoinc.com www.vipoinc.com
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION SERVING THE O&P FIELD FOR OVER 90 YEARS
Renew the Easy Way With AOPA ONLINE PAY Login to pay your dues and update your membership directory information at:
Sharon King E-mail: Sking@hanger.com
www.aopanetonline.org/profile
Renew Online Today!
NEW! UPDATE MEMBERSHIP DIRECTORY INFORMATION ONLINE
FEBRUARY 2011 O&P ALMANAC
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Calendar
2011 ■■
PROMOTE EVENTS IN THE O&P ALMANAC
CALENDAR RATES Telephone and fax numbers, e-mail addresses and Web sites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Member Non-member Words Rate Rate 25 or less $40 $50 26-50 $50 $60 51+ $2.25 $3.00 per word per word Color Ad Special: 1/4 page Ad $482 1/2 page Ad $634
$678 $830
BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or e-mail srybicki@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. For information on continuing education credits, contact the sponsor. Questions? E-mail srybicki@AOPAnet.org.
AOPA-sponsored activities appear in red.
52
O&P ALMANAC FEBRUARY 2011
■■ FEBRUARY 9 AOPA Audio Conference: “Using the Lower Limb Medical Policy to Your Advantage.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.
■■ FEBRUARY 9 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5:00pm – 6:00 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ FEBRUARY 15 Ohio Willow Wood: Providing Elevated Vacuum Suspension with LimbLogic® VS, 2:00 pm CT. United Forum of the Americas, San José, Costa Rica. Learn how to create comfortable and secure suspension for lower-limb amputees using LimbLogic VS. Features, operation, and fabrication techniques for laminated and thermoplastic sockets will be presented. ■■ FEBRUARY 17 Ultraflex: Adult UltraSafeStep™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology. Call 800/220-6670 or register at www.ultraflexsystems.com.
■■ FEBRUARY 17 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 10:30 – 11:30 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ FEBRUARY 17–19 PrimeFare West Regional Scientific Symposium 2011. Salt Lake City. Salt Palace Convention Center. Contact Jane Edwards at 888/388-5243. ■■ FEBRUARY 22 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Call 800/220-6670 or register at www.ultraflexsystems.com.
■■
FEBRUARY 28–MARCH 4
Spring 2011 SuperCourse at Motion Control, Inc. Salt Lake City. In-depth training of Utah Arm/U3+/ Hybrid Arm; ProControl2; Hands-on experience with user interface software so bring your laptop. CEUs: 34 (estimated) awarded by ABC; First Look at NEW Li-Ion Battery for U3/ U3+/Hybrid, NEW Electric Wrist Rotator, NEW TRIAD Preamps; Plus an overview of the NEW and EXCITING Motionfoot® from Motion Control. The Spring 2011 SuperCourse is a 5-day event. The fee is $1,350. For more information or to register, call 888/696-2767, e-mail info@ UtahArm.com, or visit www. UtahArm.com.
■■ MARCH 2 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8:00 – 9:00 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/2206670 or register at www. ultraflexsystems.com. ■■ MARCH 7 Ohio Willow Wood: Discover LimbLogic® VS via WebEx, 1:30 pm ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/ 2.0 BOC. To register online, visit www.owwco.com/webinar.php. ■■ MARCH 8 Ohio Willow Wood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use. Credits: 2.5 ABC/2.0 BOC. www.owwco.com/webinar.php. ■■ MARCH 9 AOPA Audio Conference: “Enhance Your Claims Success, Two Letters at a Time.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
MediCare Approved Diabetic Shoes (A5500) & Inserts (A5512)
$59.50/set 1pairs shoes+3 Pairs of inserts
Lady’s
9205
9213
9206
9214
9207
Toll Free:1-888-937-2747 Men’s
9215
9208
708-L
9605-Tan
505
9606
9601 A5512
9209
9211
9605
888-V
A5512
9210
TM
Each pair is packed with 3 pairs of diabetic inserts, (PDAC A5512), these shoes are made with high-grade genuine leather with fabic lining and solid EVA outsole. Extremely light weight, come in 3 widths & added depth.
Sizes & Widths: B/D(M/W):5.5.5-11 3E(WW):5,5.5-11 5E(XW):5,5.5-11
9602
9602-BRN
9701-1L
Package Includes: (Same as Men’s) 9212
$59.50/set Each pair is packed with 3 pairs of diabetic inserts, (PDAC A5512), these shoes are made with high-grade genuine leather with Leather lining and solid EVA outsole. Extremely light weight, come in 3 widths & added depth.
Sizes & Widths: D/2E(M/W): 7,7.5-11.5,12-15 4E(XW): 7,7.5-11.5,12-15 6E(XXW): 7,7.5-11.5, 12-15
Diabetic Socks $5.95/Pair 9701-3V
Colors:Black,White, Brown, Navy, Ruby Red, Beige, Taupe. Refer to catalog for more details & call us to get free sample kit for 28 styles Apis Footwear Company
2239 Tyler Ave. South El Monte, CA 91733
Tel: 1-888-937-2747 Fax: 1-888-990-2245
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Calendar
■■ MARCH 9 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5:00 pm – 6:00 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ MARCH 16 Ohio Willow Wood: Alpha Liner Family: Selecting and Evaluating for Successful Patient Outcomes Manufacturer Workshop, 1:30 pm ET at 2011 Academy Annual Meeting. Orlando. Workshop curriculum includes case studies, features and benefits, and evaluation criteria to help choose the optimum liner for patients. ■■ MARCH 16–19 37th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663 ext. 208 or dragusa@oandp.org.
MARCH 22 Ultraflex: Adult UltraSafeStep™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■
■■ MARCH 24 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic
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O&P ALMANAC FEBRUARY 2011
rehabilitation goals and restoring range and function. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ MARCH 28–APRIL 2 Association of Children’s Prosthetic-Orthotic Clinics 2011 Annual Meeting. Park City, UT. The Canyons. For more information, call 847/698-1637, e-mail acpoc@ aaos.org, or visit www.acpoc. org. ■■ APRIL 7 Ohio Willow Wood: LimbLogic® VS Applications Practitioner Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.0 BOC. Registration deadline: 3/17/2011. Contact: 877/665-5443. ■■ APRIL 7-9 Rehabilitation Institute of Chicago: Advances in Rehabilitation for the Patient with a Lower Extremity Amputation. Chicago. Approved for 17.50 ABC CEUs. Contact Melissa Kolski, 312/238-7731; www.ric.org/ education. ■■ APRIL 8 Ohio Willow Wood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting. Fabricate sockets following recommended techniques for airtight socket designs. Credits: 12.25 ABC/12.0 BOC. Registration deadline: 3/17/2011. Contact: 877/6655443.
■■ APRIL 11-12 2011 AOPA Policy Forum. Washington DC, L’Enfant Plaza Hotel. To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org. ■■ APRIL 13 AOPA Audio Conference: “Improving Clinical Documentation.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.
■■ APRIL 15 Ohio Orthotics and Prosthetics Association Annual Spring Meeting. Columbus, OH. Hilton Columbus. Contact Dianne Farabi at 614/659-0197 or dfarabi@columbus.rr.com. ■■ APRIL 15–16 Ohio Chapter, American Academy of Orthotists and Prosthetists (AAOP) Annual Spring Technical Meeting. Columbus, OH. Hilton Columbus. Exhibits included. Contact Richard W. Butchko 614/659-0197 or butchko1@ columbus.rr.com. See Web site at www.ohiochapteraaop.com.
APRIL 27–29 New York State Chapter of AAOP Educational Program. Albany, NY. Albany Marriott Hotel. Contact Joann Marx, CPO at Marx4nysaaop@aol. com. ■■
■■ MAY 6-7 The Northwest Chapter of the American Academy of Orthotists & Prosthetists. Seattle. The Bellevue Courtyard by Marriott Hotel. For information contact Tim Shride, CPO, LPO at 612/2030936 or nwaaop@gmail.com or visit www.regonline.com/ nwaaop_2011.
■■ MAY 11 AOPA Audio Conference: “Which Box to Check? The Negative Effect of the 855Son Reimbursement.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.
■■ MAY 11-14 PA Academy of Orthotic & Prosthetics Spring Conference. Pittsburgh. Sheraton Station Square. Contact: Beth Cornelius or Joseph Carter at 814/455-5383. ■■ MAY 12–14 Western and Midwestern Orthotic Prosthetic Association/California Orthotic and Prosthetic Association Annual Meeting. Reno, NV. (New) Peppermill Hotel. Contact Steve Colwell at 206/440-1811 or Sharon Gomez at 530/521-4541 or visit www.wamopa.com. ■■ JUNE 3–4 PrimeFare East Regional Scientific Symposium 2011. Nashville. Nashville Convention Center. Contact Jane Edwards at 888/388-5243. ■■ JUNE 8 AOPA Audio Conference: “Preventing Audit Disasters.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
■■ JULY 13 AOPA Audio Conference: “Don’t Rile the OSHA Police.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
■■ AUGUST 10 AOPA Audio Conference: “How to Get Paid for Miscellaneous and Repair Codes.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
SEPTEMBER 14 AOPA Audio Conference: “Don’t Run Afoul of the KO Rules.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
■■ SEPTEMBER 19–22 AOPA National Assembly. Las Vegas. Mirage Hotel. Exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/431-0852, or koneill@ AOPAnet.org.
■■ NOVEMBER 9 AOPA Audio Conference: “Happy Holidays: Kickbacks and Gifts in O&P.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.
■■
■■ OCTOBER 12 AOPA Audio Conference: “Developing Your Medicare Billing Compliance Plan.” To register contact Ann Davis at 571/431-0876 or adavis@ AOPAnet.org.
■■ DECEMBER 14 AOPA Audio Conference: “Are You Ready for the New Year? 2012 New Codes and Policies.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
2012 ■■ MARCH 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, ext. 208 or dragusa@oandp.org.
2013 ■■ FEBRUARY 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, ext. 208 or dragusa@oandp. org. a
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Ad Index
COMPANY
PAGE
PHONE
WEB SITE OR E-MAIL
Advanced O&P Solutions Allard USA Inc. ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics Anatomical Concepts Inc. Apis Footwear College Park Industries Inc. Daw Industries Dr. Comfort Dycor Euro International Fillauer Companies Inc. KISS Technologies LLC KNIT-RITE Motion Control Orthotic and Prosthetic Study and Review Guide OPTEC Orthomerica Products Ossur® Americas Inc. Otto Bock HealthCare PEL Supply Company Spinal Technology Inc. SPS
11, 45 39 33
866/914-AOPS 888/678-6548 800/574-5426
www.aopsolutions.com www.allardusa.com www.easyliner.com
23 31 53 21, 43 1 5, C3 47 15 37 41 2 35
703/836-7114 800/837-3888 888/937-2747 800/728-7950 800/252-2828 800/556-5572 800/794-6099 800/378-2480 800/251-6398 410/663-5477 800/821-3094 888/696-2767
www.abcop.org www.prafo.com www.bigwideshoes.com www.college-park.com www.daw-usa.com www.drcomfortdpm.com www.dycormfg.com www.eurointl.com www.fillauercompanies.com www.kiss-suspension.com www.knitrite.com www.utaharm.com
17 6, 7 888/982-8181 25 800/446-6770 C4 800/233-6263 C2 800/328-4058 27 800/321-1264 9 800/253-7868 13 800/767-7776 Ext. 3
www.oandpstudyguide.com www.optecusa.com www.orthomerica.com www.ossur.com www.ottobockus.com www.pelsupply.com www.spinaltech.com www.spsco.com FEBRUARY 2011 O&P ALMANAC
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AOPA Answers
Medicare Nuances Members ask staff about benefit limits and the two-day rule AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, e-mail Editor Josephine Rossi at jrossi@strattonpublishing.com.
Q:
We provided a diabetic patient with a pair of therapeutic shoes in December, and the patient returned in January with a prescription for another pair. Will Medicare cover the second pair of shoes since it is a new calendar year?
A:
The Medicare benefit for diabetic shoes is limited to one pair of off-the-shelf or custom shoes and up to three inserts per shoe per calendar year. In order for Medicare to cover a new pair of shoes, there must be a medical need for the new shoes. In the scenario described above, if the shoes delivered in December still meet the patient’s medical need, Medicare will most likely consider the second pair of shoes not medically necessary.
Q:
I am frequently approached by representatives of in-patient facilities who want to discuss the two-day rule in regards to billing for O&P services. What is the two-day rule, and can it be used to bill the DME MAC for O&P services delivered during an in-patient admission?
A:
The two-day rule allows a DMEPOS supplier to deliver a completed device to a Medicare patient within the last two days of his or her inpatient stay and bill the item to the DME MAC as a covered Medicare Part B service.
That said, in order for the two-day rule to apply, 10 specific circumstances must exist. As published in the Medicare Claims Processing manual, the 10 circumstances are: • The item is medically necessary for use by the beneficiary in the beneficiary’s home. • The item is medically necessary on the date of discharge, i.e., there is a physician’s order with a stated initial date of need that is no later than the date of discharge for home use. • The supplier delivers the item to the beneficiary in the facility solely for the purpose of fitting the beneficiary for the item, or training the beneficiary in the use of the item, and the item is for subsequent use in the beneficiary’s home. • The supplier delivers the item to the beneficiary no earlier than two days before the day the facility discharges the beneficiary. • The supplier ensures that the beneficiary takes the item home, or the supplier picks up the item at the facility and delivers it to the beneficiary’s home on the date of discharge. • The reason the supplier furnishes the item is not for the purpose of eliminating the facility’s responsibility to provide an item that is medically necessary for the beneficiary’s use or treatment while the beneficiary is in the facility. Such items are included in the Diagnostic Related Group (DRG) or Prospective Payment System (PPS) rates. • The supplier does not claim payment for the item for any day prior to the date of discharge. • The supplier does not claim payment for additional costs that the supplier incurs in ensuring that the item is delivered to the beneficiary’s home on the date of discharge. • The supplier cannot bill the beneficiary for redelivery. • The beneficiary’s discharge must be to a qualified place of service (e.g., home, custodial facility), but not to another facility (e.g., in-patient or skilled nursing) that does not qualify as the beneficiary’s home. If any of these ten circumstances do not apply, the in-patient facility remains responsible for paying for the device under its PPS agreement with the Medicare program. a
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O&P ALMANAC FEBRUARY 2011
OVER ONE MILLION DOLLARS IN SHOES DONATED FOR HAITI RELIEF
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