2020 March O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

M AR C H 2020

What You Need To Know About CERT Audits P.18

In-House Versus Central Fabrication P.32 TION

AL SEC

SPECI

CTORY 2020 DtraIlRFEabrication of Cen .38 Facilities P

Studying Carbon Fiber and Fiberglass Prosthetic Feet

PREPARING FOR A PANDEMIC REVIEWING INFECTION CONTROL STRATEGIES AS COVID-19 SPREADS

P.24

P.52

Reimbursement Challenges for Cranial Orthoses

Quiz Me! EARN 2 BUSINESS CE CREDITS P.20

WWW.AOPANET.ORG

P.72

This Just In: What Prior Authorization of Prostheses Means for O&P P.22

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contents

MARCH 2020 | VOL. 69, NO. 3

FEATURES

COVER STORY

24 | Preparing for a

MARCH 2020 | O&P ALMANAC

Pandemic

Healthcare professionals across the globe are facing a new global health crisisâ&#x20AC;&#x201D;coronavirus disease 2019, or COVID-19. The Centers for Disease Control and Prevention has cautioned Americans to expect to see community spread in the United States. Given the uncertainties related to the novel virus infection, now is a good time to revisit infection control measures at O&P facilities. By Christine Umbrell

22 | This Just In

CMS Announces Prior Authorization for Prostheses

Beginning in May on a limited basis, six lower-limb prosthetic codes will be added to the codes that require Medicare prior authorization as a condition of payment. Learn what CMS has shared with AOPA regarding the change, and prepare for nationwide implementation, scheduled for later in the year.

32 | The Formula for Fabrication Eighty-five percent of O&P facilities rely on outside central fabrication for at least some of their fabrication needs, yet some companies prefer to keep these functions in-house. Learn the benefits and challenges associated with different approaches, and find out how several O&P companies have chosen to handle their fabrication needs. By Michael Coleman

38 | SPECIAL SECTION: 2020 Directory of Central Fabrication Facilities See the list of c-fabs, complete with contact information and details about the types of devices they specialize in.

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contents

PRINCIPAL INVESTIGATOR Leslie Gray, MEd, CPO, LPO, FAAOP................................................................... 52 Meet the director of the Prosthetics-Orthotics Program at the University of Texas Southwestern, and learn about a recently launched investigation of the properties of carbon fiber and fiberglass in prosthetic feet.

DEPARTMENTS Views From AOPA Leadership......... 6 Time for transformation

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

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

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

Research, updates, and industry news

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

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

Contractor Errors

How CERT audits impact O&P businesses CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Member Spotlight................................. 56 n

College Park Industries

Orthotic & Prosthetic Labs

P.14 AOPA News.............................................. 60 AOPA advocacy, announcements, member benefits, and more

O&P PAC Update .................................. 62 P.58

Welcome New Members.................. 62 Careers........................................................ 64 Professional opportunities

Marketplace............................................. 66 P.56

Ad Index..................................................... 69 Calendar..................................................... 70 Upcoming meetings and events

State By State........................................... 72 Reimbursement challenges for cranial orthoses

MARCH 2020 | O&P ALMANAC

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for Central Fabrication Supplies & Accessories!

VIEWS FROM AOPA LEADERSHIP

Transforming O&P Together

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

RANSFORMATION COMES FROM CHANGE, and change comes from opportunity. One such opportunity may be the recent announcement from CMS regarding prior authorization for six lower-limb prosthetic codes. Leveraging our established relationship with CMS, AOPA will monitor the implementation not only to provide feedback to CMS but also to best support our members. The entire organization will work to ensure that our patients’ access is not unduly delayed, and we continue to grow our partnership with CMS. I encourage you to read this month’s This Just In on page 22 for details—there are some upsides! Together we will use this change to transform our profession. As I’ve written in past columns, to me transformation means differentiation from durable medical equipment (DME). It means that O&P clinicians are universally considered an integral part of the healthcare team. It means that we get reimbursed for the care we provide. It means an adequate workforce to ensure patients can get the care they need, when and where they need it. It means that we are not vendors and ultimately not suppliers, but providers. In January, more than 120 leaders from within the profession gathered for the 2020 O&P Leadership Conference, “Transforming O&P Together.” AOPA has made significant progress in the direction of differentiating from DME, but we still have a ways to go. The 2020 O&P Leadership Conference provided an opportunity to plan and strategize regarding how we get there. The conference was broken into three sections: transforming and elevating the profession through data and research, investing in both the current and future workforce, and furthering our advocacy and regulatory needs. AOPA and others have made significant investments in growing the profession’s evidence base, by funding and conducting research that reinforces the clinical efficacy and cost effectiveness of O&P care. But funding and conducting the research isn’t enough. During the Leadership Conference, we heard about strategies to better disseminate and promote these efforts, including through collaborations with federal agencies, think tanks, and other healthcare organizations. A sustained investment in the workforce, current and future, has to be made. Conference participants discussed two ways to do this: first, ensuring we have a diverse, inclusive workforce that can be the catalyst for a better future and improve the care patients receive, and second, undertaking a continuous initiative involving all stakeholders to feed the pipeline. AOPA has worked to become a voice in Washington, pushing for federal policies that protect O&P businesses and preserve patient access to quality care—most recently with the introduction in the U.S. House of Representatives of the Medicare O&P Patient-Centered Care Act. Albeit a huge milestone, more needs to be done. Ways to double down on our legislative and regulatory efforts were discussed. Successful tactics to build relationships with payors that are based on collaboration and mutual trust were presented. An overall enhanced commitment to collaboration on all our policy and regulatory issues was a constant theme that we must implement. Having been in O&P for 35 years, I have experienced a lot of changes—but now, more than ever, I believe it is time for a transformation. In order for that transformation to come to fruition, all of your expertise and engagement is needed. Stay tuned as the AOPA Board of Directors and staff continue to dig into the content of the Leadership Conference discussions and develop initiatives based on those important conversations.

Jeffrey Lutz, CPO, is president of AOPA.

MARCH 2020 | O&P ALMANAC

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

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AOPA CONTACTS

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

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

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

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

REIMBURSEMENT SERVICES

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

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

Tina Carlson, CMP, senior director, membership, education, and meetings, 571/431-0808, tcarlson@AOPAnet.org Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org GOVERNMENT AFFAIRS Justin Beland, director of government affairs, 571/ 431-0814, jbeland@AOPAnet.org

Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

STRATEGIC ALLIANCES

COMMUNICATIONS, MEMBERSHIP & MEETINGS

Ashlie White, MA, director of strategic alliances, 571/431-0812, awhite@AOPAnet.org

Joy Burwell, director of communications and marketing, 571/431-0817, jburwell@AOPAnet.org

O&P ALMANAC

Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org

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

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com

Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org

Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com

Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net

Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org

MARCH 2020 | O&P ALMANAC

Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

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

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

NUMBERS

Company Profits and Profit Leaders O&P facilities saw boost in profit margins in latest AOPA “Operating Performance Report”

REVENUES PER NONOWNER PRACTITIONER

Net profit margins at O&P companies averaged 7.3 percent last year, rising to 16.9 percent among the “profit leaders,” defined as the top 25 percent of respondents to AOPA’s annual Operating Performance Survey. Based on 2018 data, the “2019 Operating Performance Report” captured the financial facts from 96 companies representing 1,025 full-time facilities and 200 part-time facilities. The report details net profit margins—net profit before taxes as a percentage of sales—as well as many other financial, profitiability, and operational numbers from participating facilities.

$598,548

$612,897

Median revenue generated per nonowner practitioner, up from $551,641 in FY2017

Median revenue generated per nonowner practitioner among profit leaders

PERCENT OF GROSS SALES BY CATEGORY

Average return on assets for all respondents

PERCENT

Prosthetics

Orthotics

Pedorthics

Durable medical equipment

Other

EMPLOYEE MAKEUP* *Numbers may not add to 100 percent due to rounding.

Average return on assets for profit leaders

Practitioner assistants/extenders Other job titles Owner practitioners Nonclinical owners/ managers

SALES GROWTH

Average sales growth among all respondents

Companies By Net Sales/Billing Up to $1 Million

12.4 Percent

Nonowner practitioners

FY 2017

14%

Office administration/ marketing staff

40%

5.1%

34%

FY 2018 6.6% 6.9% 7.0%

$2 to $5 Million

MARCH 2020 | O&P ALMANAC

Technicians

3% 3% 3%

Average sales growth among profit leaders

$1 to $2 Million Over $5 Million

PERCENT

50.7 Percent

5.2 Percent

PERCENT

O&P FACILITY NET PROFIT MARGINS

PERCENT

NET PROFIT BEFORE TAXES AS A PERCENT OF TOTAL ASSSETS

18.6 Percent

7.8% 7.4% 6.1%

7.8%

EDITOR’S NOTE: The “2019 AOPA Operating Performance Report” is now available through the AOPA bookstore. Visit www.AOPAnet.org. Plan now to take part in the 2020 AOPA Operating Performance Survey, coming this spring.

KNOW NO LIMITS

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Happenings CALL FOR RFPs

O&P Research Proposals Due April 30 AOPA, working in conjunction with the Center for Orthotic and Prosthetic Learning and Outcomes/Evidence-Based Practice (COPL) and its Board of Directors, has announced the 2020 Request for Pilot Grant Proposals in 10 potential areas of orthotic and prosthetic research, including an open topic. For 2020-2021, AOPA and COPL are seeking proposals at two funding levels for one-time grants: $15,000 and up to two exceptional proposals for $30,000 for one year. Preference will be given to grants that address evidence-based clinical application in orthotics and prosthetics. Visit www.AOPAnet.org to view the RFP topics and guidelines or to apply online. The deadline for all proposals is April 30, 2020. Visit www.AOPAnet.org/resources/ center-for-op-learning for more information.

MARCH 2020 | O&P ALMANAC

Researchers Study Algorithms To Inform Design of Upper-Limb Prostheses Researchers in the Department of Industrial and Systems Engineering at Texas A&M University are studying machine learning algorithms and computational models to gain insight into the mental demand placed on upper-limb prosthesis users, with an ultimate goal of improving the current Lead researcher Maryam Zahabi, PhD, left, interface in prostheses. and PhD student Junho Park collaborate Led by Maryam Zahabi, on upper-limb research. PhD, an assistant professor, the team is studying prostheses psychomotor performance and patients’ that use an electromyography (EMG)interaction with these technologies.” based human-machine interface. The The researchers have hypothesized electrical activity generates signals that that the greater cognitive demand trigger the interface, translating the signals in prosthetic device use will lead to into unique patterns of commands to reduced motor learning potential and allow the user to move the prosthesis. The reduced skill retention based on device Texas A&M team is collaborating with training. While they are in the initial researchers from North Carolina State phases of the study, the results from the University and the University of Florida. researchers’ prior studies in this domain The three-year project, funded by showed that a prosthetic device with the National Science Foundation, will pattern recognition-based controller focus on a combination of cognitive was more intuitive, reduced cognitive performance modeling, machine load, and was more efficient to use as learning algorithms, and virtual reality compared to the direct-control mode. and driving simulations to identify the “The outcomes of this research cognitive workload of EMG-based can increase accessibility and utility prosthetic devices. “Our models can of prosthetic devices for supporting provide information regarding why fundamental motor skill rehabilitation certain technologies may lead to higher or performing activities of daily living,” or lower workload, which will ultimately said Zahabi. “Using the findings of the help in providing engineering and design current project, we hope to investigate guidance for less mentally demanding the possibility of customized interfaces prosthetic devices,” said Zahabi. “This for prosthetic users accounting for project investigates cognitive workload specific user needs in our future studies.” of prosthetic devices and how it impacts

PHOTO: Maryam Zahabi, PhD

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

RESEARCH ROUNDUP

NO.

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HAPPENINGS

RESEARCH ROUNDUP

Sensory Feedback Aids Amputees in ‘Feeling’ Their Bionic Leg from the prosthesis that is delivered to nerves in the user’s residual limb. The stimulation improved mobility, decreased falling episodes, and increased the perception of the prosthesis as part of the body. In one activity, study subject Djurica Resanovic wore a blindfold and A researcher adjusts the smart electronics on earplugs, but could the intact ankle of a study participant. “feel” the bionic leg prototype due to the sensory information that was at their prosthesis as they walked. delivered wirelessly via electrodes The scientists demonstrated that surgically implanted into the nervous sensory feedback is crucial for relieving system via the residual limb. “I could the mental burden of wearing a prostell when they touched the [big toe], thetic limb, resulting in improved the heel, or anywhere else on the foot. I performance and ease of use, according could even tell how much the knee was to the researchers. “Our results demonflexed,” reported Resanovic. All three strate the induced sensory feedback can study subjects were able to maneuver be integrated at supraspinal levels to through obstacles without looking restore functional abilities of the missing

PHOTO: Stanisa Raspopovic

A study participant steps over an obstacle with a prosthesis connected to nerves. 14

MARCH 2020 | O&P ALMANAC

leg,” reported the authors. The work paves the way for future investigations into how the brain interprets different artificial feedback strategies, and will aid in the development of fully implantable sensory-enhanced leg neuroprostheses. “We showed that less mental effort is needed to control the bionic leg because the amputee feels as though their prosthetic limb belongs to their own body,” said Stanisa Raspopovic, ETH Zurich professor and co-founder of SensArs Neuroprosthetics, who led the study. “We believe intraneural electrodes are key for delivering biocompatible information to the nervous system for a vast number of neuroprosthetic applications. Translation to the market is just around the corner.” Details were published in October in Science Translational Medicine.

PHOTO: Francesco M Petrini

Three individuals with lower-limb amputations have reported feeling that they were able to “merge” with their bionic prosthesis, according to scientists from a European Consortium led by Swiss Institutions, ETH Zurich, and SensArs Neuroprosthetics, a spinoff from the Ecole Polytechnique Fédérale de Lausanne. Researchers from the consortium, working in Belgrade, Serbia, designed a leg neuroprosthesis that provides real-time tactile and emulated proprioceptive feedback, and conducted a three-month clinical trial to fit the device on three transfemoral amputees. The researchers hypothesized that restoring sensory feedback into the sensorimotor loop would markedly improve the life of patients. The study subjects performed active tasks designed to evaluate whether the new approach promoted improved mobility, fall prevention, and agility. Study subjects reported using and feeling their bionic leg as part of their own body, facilitated by sensory feedback

HAPPENINGS

MEETING MASHUP

FAST FACT

Hanger LIVE 2020 Debuts in Nashville

Diabetes Rates Rise Among Minority Patients The percentage of adults living with diagnosed and undiagnosed diabetes in the United States varies significantly by race, particularly among Hispanic and non-Hispanic Asian subgroups, according to new research from the Centers for Disease Control and Prevention.

Aneesh Chopra gave a presentation on transforming patient care through data and innovation.

PHOTOS: Hanger

Several supplier partners were recognized during the Hanger Partner Awards.

More than 1,100 Hanger employees and 370 exhibitors took part in the newly revamped Hanger LIVE event in early February. Themed “New Frontiers,” the event featured clinical keynote sessions from medical professionals and the debut of a continuing education track for physical and occupational therapists. Previously hosted in Nevada, the conference relocated in 2020 to the Gaylord Opryland Hotel and Convention Center in Nashville. Local Hanger teams, partners, and patients were spotlighted during the event. Following the Opening Ceremony, the Hanger Partner Awards recognized supplier partners whose products help Hanger Clinic teams deliver exceptional O&P care and empower patients’ lives. The following partners were recognized with awards: • Blatchford US was honored for “Operational Performance,” in recognition of the company’s 97 percent on-time delivery rate and 91 percent purchase order fulfillment rate in working with Hanger Clinic. • Freedom Innovations was the recipient of the newly created “Clinician’s Choice” category,

in recognition of Freedom’s dedication to patients, product education, and customer service. • WillowWood received the “Collaboration” award, in recognition of the company’s outstanding contributions that resulted in shared success, including WillowWood’s early adoption of Hanger’s Supplier Advantage Program and Hanger Clinic’s patient satisfaction with WillowWood’s products. • Open Bionics was honored with the “Innovation” award. • OssKin was recognized as a “Rising Star.”

ADULTS LIVING WITH DIABETES IN U.S.

Prevalence of Diagnosed and Undiagnosed Diabetes Among Major Race/Ethnicity Groups

Hispanics 22%

Non-Hispanic Blacks

20%

Non-Hispanic Asians

19%

Non-Hispanic Whites

12%

SOURCE: Centers for Disease Control and Prevention

More than 150 instructors presented 100 courses throughout the week. Highlights included the outcomes-focused clinical keynotes; courses on creating a positive patient experience; and a presentation on transforming patient care through data and innovation by Aneesh Chopra, president of CareJourney. Additionally, Hanger’s “Women in Leadership” series featured a workshop that was livestreamed outside the conference to women in O&P across the country. O&P ALMANAC | MARCH 2020

PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Elbert “Bert” Harman has been appointed as an additional member of the WillowWood Board of Directors. Harman, former president and chief executive officer (CEO) at Ottobock North America, will serve as an independent member on the company’s board, lending his industry knowledge and expertise to facilitate strategic growth. “Bert is one of the strongest leaders I have come across within the O&P industry and has a proven track record,” said Mahesh Mansukhani, WillowWood CEO. “For a time, we served on the AOPA Board [of Directors] together, which was where I gained a good sense of his capabilities and his strong thought process. Having Bert join us will be a great asset.” Harman served as president and CEO of Ottobock North America from 2000 through 2011. He retired from the medical device industry in 2016 after serving as president and CEO of Data Sciences International, an implantable telemetry device company. As an independent member of the WillowWood board, Harman is expected to apply his expertise toward strategy, execution oversight, and key relationships.

iOrthoticsUSA, a central fab 3D printing hub, has opened in Astoria, New York. The company is a venture between Hersco Ortho Labs and iOrthotics Australia, a 3D-printing company. iOrthoticsUSA has invested in HP Fusion Jet technology. This is the first U.S. location for iOrthotics Australia.

Justin Moore, PT, DPT, chief executive officer of the American Physical Therapy Association (APTA), has been elected to serve a four-year term on the Board of Directors of the Amputee Coalition. Moore will join 11 other board members who advise the organization on initiatives including federal policy outreach, insurance protections for patients, the organization’s National Limb Loss Resource Center, summer youth camp, and hospital partnerships. “I am honored to have been elected to the Board of Directors of the Amputee Coalition,” Moore said. “Clearly the coalition’s mission closely reflects APTA’s own vision—transforming society by optimizing movement to improve the human experience—which makes this position all the more significant to us. I look forward to working with the coalition to advocate for those they serve.”

MARCH 2020 | O&P ALMANAC

THE LIGHTER SIDE

NIGHT MODE

OU R F U L L L I N E O F VA LV ES . N OW AVAI LAB L E I N M I D NI GH T B L ACK .

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REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

Contractor Errors How CERT audits impact your business and your bottom line

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

CREDITS

OMPREHENSIVE ERROR RATE TESTING (CERT) audits are often

misunderstood as just another type of audit in the acronym alphabet of today’s Medicare healthcare marketplace. While CERT audits are very different from other audits in purpose and design, they may have a significant impact on your company’s cashflow and revenue stream and should be taken seriously. This month’s Reimbursement Page focuses on the role of the CERT audit and what recent results tell us about Medicare payment for orthotic and prosthetic services.

Gaining Ground

The CERT audit program began with the passage of the Improper Payments Information Act of 2002 and has been strengthened over the years through the passage of additional legislation and the release of several executive orders. Prior to the passage of the 2002 legislation, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (DHHS) calculated a single national claims payment error rate that was used to determine what efforts were needed to ensure that Medicare was only paying for services that were medically necessary and reasonable. With the passage of the legislation, responsibility for calculating payment error rates shifted to CMS, which began calculating multiple error rates both nationally and by categories, including by contractor, by service, and by provider type. Calculating multiple error rates provided data that CMS and OIG could then use to further 18

MARCH 2020 | O&P ALMANAC

E! QU IZ M EARN

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focus efforts to control fraud and abuse within the Medicare program. The primary difference between CERT audits and other types of Medicare audits is that the primary focus of a CERT audit is not the provider but rather the contractor who processed and paid the claim. CERT audits are designed to measure the performance of the contractors that process Medicare claims and identify areas of vulnerability within their systems. While this may seem like a good thing, it is truly a double-edged sword as providers are required to refund payments that are determined by the CERT audit results to be improper. In addition, the results of CERT audits are used by the contractors to determine the service categories that will be subject to increased scrutiny on a go-forward basis. When an area of vulnerability is established by CERT results, contractors are required to take corrective action to address the claims processing errors, usually resulting in increased scrutiny of claims on a prepayment basis.

What Does the Data Tell Us?

DHHS publishes an annual report that discusses the overall Medicare improper claim payment rate and provides detailed data on what types of claims and provider groups contributed to the improper payment rate published in the report. The “2019 Medicare Improper Payment Rate Report” uses claims data from July 1, 2017, through June 30, 2018, as the basis for the report. The overall Medicare improper claim payment

REIMBURSEMENT PAGE

Claims that are denied through the CERT audit process not only result in the potential of lost revenue for your business today, but may contribute to lost revenue long into the future.

rate for this period was 7.3 percent. Of the claims identified through CERT audits as improperly paid, 59 percent were denied due to insufficient documentation, 19 percent were denied due to medical necessity, and 14 percent were denied due to improper coding. Further analysis of the report offers some alarming trends regarding O&P services and their contribution to the improper claim payment rate. Of all durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

claims identified as being paid improperly, lower-limb orthoses were the most prevalent, with almost $300 million in identified overpayments. This represented an overall improper payment rate of 63.5 percent. Lower-limb prostheses came in fifth place, with $166 million in identified overpayments and an improper payment rate of 25.5 percent. Lumbosacral orthoses were in sixth place, with $121 million in identified overpayments and an error rate of 32.9 percent. Diabetic shoes were in seventh

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place, with $98 million in improper payments and an overall error rate of 72.6 percent. While all of the improper payments for O&P services published in the report represent only about 2.6 percent of the total Medicare overpayments in the report, it is concerning to see O&P services as having some of the highest improper payment rates for Medicare DMEPOS services. It may be important to note that the time period that is reflected in the report was a time of significant Medicare fraud as a result of the criminal activity involving the improper provision of knee and spinal bracesâ&#x20AC;&#x201D;fraudulent activity that was ultimately exposed through Operation Brace Yourself. The complete 2019 DHHS report on Medicare improper payments may be accessed on the www.cms.gov website. This report contains volumes of valuable information that may be useful to you in developing your CERT audit strategy going forward.

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REIMBURSEMENT PAGE

Getting Ready for CERT Audits Preparation for CERT audits is the same as preparation for other types of postpayment reviews, with one very important exception. CERT audits are designed to establish contractor error rates on paid claims so they are, by definition, always performed on a postpayment basis. They differ from other postpayment audits because if a CERT audit results in a determination that the claim should not have been paid, it counts toward the error rate for the contractor, regardless of whether or not the decision is overturned on appeal. While a successful appeal will ultimately result in you being reimbursed for the service you provided, the error rate will have already been established based on the initial audit determination, which may lead to further audits down the road. With this in mind, it is extremely important that you prepare every claim that you submit with the expectation that it will be subject to a CERT audit and take appropriate measures to ensure that you do not contribute to an unacceptable error rate.

Below are three tips to help ensure that your claims make it through the CERT process successfully. 1. Have a full and complete understanding of the medical policy that governs the service you are providing. These policies usually consist of two equally important segments, the Local Coverage Determination (LCD) and the Policy Article. These documents are readily available on the websites of the four durable medical equipment Medicare administrative contractors and contain very specific information regarding the types of documentation that must be maintained to support the medical necessity of the services you provide. And remember that medical policy is not static; it is frequently changed to reflect new requirements and regulatory changes. At a minimum, you should review the LCDs and Policy Articles on a quarterly basis to ensure that you are following the coverage requirements in effect at the time you deliver an O&P device. Outdated or incorrect information may lead to consistently noncompliant practices

that not only put your claims at risk but contribute to a poor error rate for the contractor as well. 2. Improve communications with referral sources. Medicare expects that documentation within the medical records of referring providers contain specific information that discusses the medical need for the services you provide. While this is often difficult to control, if you expect the documentation of your referral sources to contain necessary information to support your claim, you must make sure you communicate to them specifically what Medicare is looking to see. 3. Perform regular internal audits of your own files. It is always better to discover errors yourself than it is to wait for someone else to find them. Regular internal audits provide you with the opportunity to discover minor problems and correct them before they become major ones. Small errors that go undetected eventually become part of your common procedures and may result in tremendous exposure in an audit situation. CERT audits represent a unique subset of postpayment audits because their impact is twofold. Claims that are denied through the CERT audit process not only result in the potential of lost revenue for your business today, but may contribute to lost revenue long into the future as a result of corrective action and additional audits on a prepayment basis, as well as calculation of error rates that may lead to Recovery Audit Contractor review. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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MARCH 2020 | O&P ALMANAC

This Just In

CMS Announces Prior Authorization for Prostheses Six lower-limb prosthetic codes will be subject to prior authorization beginning in May

MS ANNOUNCED ON FEBRUARY

7 that six lower-limb prosthetic codes will be added to the codes that require Medicare prior authorization as a condition of payment. The official announcement was published in the February 11 Federal Register. AOPA has actively communicated concerns about Medicare prior authorization and its potential to cause unnecessary delays in timely and efficient O&P care with CMS, through the submission of formal comments and during in-person meetings with CMS officials. In response, prior to the release of the Federal Register publication, AOPA received an email communication from a high-ranking CMS official that addressed its concerns.

Specifically, the email communication stated the following: • CMS does not intend to significantly expand the number of lower-limb prostheses subject to prior authorization in the future. • CMS understands the need for timeliness in making prior authorization decisions. • The durable medical equipment Medicare administrative contractors (DME MACs) will provide education to providers when prior authorization requests are not initially approved. • Affirmative prior authorization decisions will guarantee payment and reduce likelihood of audits down the road.

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MARCH 2020 | O&P ALMANAC

AOPA is encouraged by CMS’s efforts to address its previously stated concerns regarding prior authorization and will closely monitor the prior authorization process to ensure that it does not lead to unnecessary delays in delivery of clinically appropriate prosthetic care to Medicare beneficiaries. The initial implementation of prior authorization for the six codes, scheduled for May 2020, will occur on a very limited basis in one state in each of the four DME MAC jurisdictions (Pennsylvania, Michigan, Texas, and California). Nationwide implementation is scheduled for late 2020. The six codes that will require Medicare prior authorization are listed in the chart on this page. The selected codes represent three microprocessor-based prosthetic knees, a microprocessor-based prosthetic foot, and two functional Level 3 prosthetic feet. AOPA will continue to monitor communications from CMS and the DME MAC contractors regarding the Medicare prior authorization process and will provide additional education to AOPA members as details regarding the prior authorization process are released. Questions regarding this issue may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

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COVER STORY

Preparing for a

Pandemic

As coronavirus disease 2019 spreads globally, O&P facilities share best practices for employee and patient health and safety By CHRISTINE UMBRELL

NEED TO KNOW • As we begin to see the community spread of COVID-19 within the United States, healthcare facilities are being asked to review and improve their infection control measures. • At many O&P facilities, a large segment of patients have compromised immune systems or comorbidities, so it’s particularly important to limit exposure to both airborne and bloodborne pathogens. • Some O&P practices have developed infection control manuals as well as OSHA binders that include documentation of their exposure control plan. Many companies have designated a staff member to serve as the facility’s infection control coordinator. • The O&P lab poses a unique set of health and safety challenges because components may be carried from patient exam rooms to the lab and back, increasing the possibility of cross-contamination. Both of these areas should be included in a facility’s infection control plan. • Much remains unknown about COVID-19 and the impact it will have in this country, so O&P professionals should pay close attention to information released by the U.S. Centers for Disease Control and Prevention, the U.S. Safety and Health Administration, and the World Health Organization as it becomes available.

MARCH 2020 | O&P ALMANAC

COVER STORY

HE CORONAVIRUS DISEASE 2019

(COVID-19) has arrived in the United States, bringing with it fear and uncertainty to the entire healthcare community and general public. The COVID-19 outbreak that began in Wuhan, China, spread quickly to other areas of China and beyond— including some imported cases in the United States. The World Health Organization reports the outbreak has reached the “highest level” of risk for the world, and the United States has declared a national public health emergency and taken unprecedented steps related to travel. As of press time, approximately 90,000 cases of the disease had been confirmed, and more than 3,000 people had died from the virus worldwide.

Allen Forbis

With cases of COVID-19 formally diagnosed in the United States, the U.S. Centers for Disease Control and Prevention (CDC) has warned Americans to expect to see community spread. Healthcare professionals are being asked to step up their infection control protocols and to be on the lookout for new cases. While it is known that the virus that causes COVID-19 spreads person-to-person mainly by respiratory transmission, it is unclear how easily the virus is transmitted between persons, according to CDC. “Close contact” that puts individuals at risk of exposure is defined as being within six feet of a patient with COVID-19 for a prolonged period of time, or having direct contact with infection secretions from a patient. Signs and symptoms, which may occur within two to 14 days after exposure, include fever, cough, and shortness of breath. Preliminary data suggest that older adults and persons with underlying health conditions or compromised immune systems might be at greater risk for severe illness from this virus.

All healthcare professionals should have a basic understanding of the disease and ensure they are adhering to their infection control plans. “There is still too much unknown about the coronavirus to properly gauge the true threat to the O&P industry,” says Allen Forbis, senior risk manager at Hanger. “This is a fast-developing and changing situation. Facilities should closely follow the recommendations of the CDC and their local governmental authorities as it relates to prevention measures.” (See sidebar, “Protecting Your Facility.”) Some facilities are already feeling the repercussions of the global outbreak in the form of missing shipments. “Some manufacturers that O&P

Kim Lewis

facilities use had to shut down their factories until further notice—that in itself will delay patient care,” says Kim Lewis, compliance officer and training manager at Wright & Filippis. “I think if it continues to spread at a rapid pace, we will continue to see this happen.” She agrees that it is critical that O&P employees are educated on preventative steps from the CDC, proper hand washing, and disinfecting.

Protecting Your Facility The U.S. Centers for Disease Control and Prevention (CDC) recommend that healthcare personnel caring for patients with confirmed or possible COVID-19 should adhere to the following recommendations for infection prevention and control: • Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and isolating them in an Airborne Infection Isolation Room (AIIR), if available. • Use Standard Precautions, Contact Precautions, and Airborne Precautions (see the CDC website) and eye protection when caring for patients with confirmed or possible COVID-19. • Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of personal protective equipment (PPE), including gloves. Use soap and water if hands are visibly soiled. • Practice how to properly don, use, and doff PPE in a manner to prevent self-contamination. • Perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR.

O&P ALMANAC | MARCH 2020

COVER STORY

Hand Hygiene and Glove Use for Healthcare Providers The U.S. Centers for Disease Control and Prevention (CDC) offers the following clinical indications for the two methods for hand hygiene, alcoholbased hand sanitizer and washing with soap and water. Alcohol-based hand sanitizers are the most effective products for reducing the number of germs on the hands of healthcare providers and are the preferred method for cleaning your hands in most clinical situations, according to CDC. During routine patient care, CDC recommends using an alcohol-based hand sanitizer in the following situations: • Immediately before touching a patient • Before performing an aseptic task, including placing an indwelling device, or handling invasive medical devices • Before moving from work on a soiled body site to a clean body site on the same person • After touching a patient or the patient’s immediate environment • After contact with blood, body fluids, or contaminated surfaces • Immediately after glove removal.

CDC recommends that healthcare professionals wash their hands for at least 20 seconds with soap and water, and to make sure you clean all areas of your hands and fingers, including under fingernails. Hand washing is recommended in these circumstances: • When hands are visibly soiled • After caring for a person with known or suspected infectious diarrhea • After known exposure to spores—for example, B. anthracis or C difficile outbreaks.

CDC also recommends that healthcare providers wear gloves, according to standard precautions, when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin, or contaminated equipment could occur. If a task requires gloves, healthcare providers should perform hand hygiene prior to donning gloves, before touching the patient or the patient environment. Gloves should be changed if they become damaged or become visibly soiled with blood or body fluids following a task, and when moving from work on a soiled body site to a clean body site on the same patient or if another clinical indication for hand hygiene occurs, according to CDC. Healthcare providers should never wear the same pair of gloves in the care of more than one patient.

MARCH 2020 | O&P ALMANAC

Given the growing threat of COVID-19, and to ensure facilities are doing all they can to prevent the spread of both airborne and bloodborne pathogens, O&P companies should take this time to review their infection control processes and procedures and take steps to minimize patient and employee exposure.

Limiting Exposure

Because COVID-19 is such a new threat, it’s important for O&P facilities to revisit infection control procedures already in place for influenza and other risks. “The biggest concern about the coronavirus is that it is so new, and much is not yet known about it,” explains Goeran Fiedler, PhD, an assistant professor in the Prosthetics and Orthotics Program at the University of Pittsburgh School of Health and Rehabilitation Sciences. “It may turn out to be not worse than the flu, but it could also be much more serious. I do not think there is reason for O&P care providers to panic, but I do believe it is good occasion to revisit infection control measures.”

Goeran Fiedler, PhD

“O&P providers, like all employers, have a duty to provide a safe workplace for their employees,” agrees Forbis. “This responsibility is shared equally by both the employer and employee to create a culture that is committed to a safe work environment.” Visitors to O&P facilities may be at heightened risk. Some O&P patients are elderly or frail, and some may have complicating comorbidities or dry skin, which makes them more susceptible to infection—so medical personnel should take precautions to prevent the transport of infection from one patient to the next, or from patients to practitioners, says Fiedler. “Some of this cannot be controlled,” he says, “but the use of gloves, clean tools, replacing linens, and handwashing”

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can all help reduce risks. (See sidebar, “Hand Hygiene and Glove Use for Healthcare Providers.”) “Like other healthcare service providers, we interact with children and families on a daily basis,” agrees Cindy Mowatt, MS, CPO, CFm, senior clinician at Cranial Technologies Inc. “In a general O&P practice, it’s possible that patients may present with chronic illnesses, open wounds, or common illnesses such as colds.” From wearing appropriate protective gear to appropriate sanitation practices, Mowatt’s facility has implemented procedures and practices to minimize the risk of illness or injury. All employees at Cranial Technologies take annual training on bloodborne pathogens to reinforce the policy of using universal precautions. Personal protective equipment is required when making contact with compromised skin and grinding bands. Treatment areas are sanitized after each use, and hands are sanitized before and after contact with patients or orthoses. Handwashing is required in case of contact with visible contaminants and

MARCH 2020 | O&P ALMANAC

after using the restroom or eating. “We have biohazard procedures for our facilities that describe the process to secure the affected area or facility and implement disposal and clean-up protocols through our contracted medical waste company,” adds Mowatt. “Our safety and infection control policies have been informed by the standards” of the U.S. Occupational Safety and Health Administration (OSHA), CDC, the U.S. Food and Drug Administration, and the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC). The best guideline to avoid the contamination or spread of any infectious material is to practice universal precautions, as outlined by CDC, and treat all bodily fluids as if they are infectious, says Forbis. “Create a physical barrier between yourself and the fluid. This could include gloves, goggles, or face shields, depending on the situation.” To ensure O&P staff members are adhering to protocols, most facilities keep OSHA binders that include documentation of their exposure control plan and the rules and responsibilities of their designated infection control coordinator, who develops written procedures to prevent and manage infections in the workplace. Some facilities have created internal infection control manuals. Wright & Filippis, for example, maintains a manual and sends out monthly reminders to employees about compliance issues, often focusing specifically on infection control, says Lewis.

The Wright & Filippis manual covers infectious waste disposal, gloving policy, patient infectious disease diagnosis, bed bugs, and related topics. The gloving policy is particularly important, says Lewis, for all employees—not just clinicians. “Many times, patients will bring in an item, such as a brace, that has come in contact with the patient,” she explains.

Cindy Mowatt, MS, CPO, CFm

“Whenever an item comes in contact with the patient, before taking that item back, all staff must glove up at all times.” Lewis notes that her facility’s locations keep gloves at the front counter, in patient rooms, and back in the lab for easy access.

Preventing CrossContamination in the Lab

O&P companies that apply for accreditation from ABC must address the prevention of cross-contamination, the use of universal precautions, storage of items to prevent cross-contamination, and a plan for investigating reports of an infection potentially acquired from a patient’s device. But there is no standard protocol to be followed regarding infection control, and it is up to facilities to self-govern, says Ashley Kubinski, MSPO, CP, a clinician at Restore POC in WinstonSalem, North Carolina. The O&P lab poses a unique set of health and safety challenges for O&P healthcare providers, according to Kubinski, “because we see patients

COVER STORY

in exam rooms and then carry their devices to other locations, whether it be walking through the rest of the office, transporting them in our cars, or using communal tools to service them,” she says. Traversing from patient rooms to the lab area and back opens up the possibility of cross-contamination between the two areas, including the risk of spreading bloodborne pathogens and fungal infections—especially worrisome considering the compromised O&P patient population. As an MSPO student four years ago, Kubinski researched this topic to find out how well O&P professionals are doing in their cross-contamination efforts. She conducted an anonymous survey of more than 100 O&P clinicians, residents, students, and technicians regarding their practices, and found some disturbing results: Almost two-thirds of participants believed that O&P patients are at risk of cross-contamination from their devices. But about half of respondents admitted they do not wash their hands for as long as they think is recommended by CDC; just 54 percent reported washing their hands for longer than 15 seconds. In addition, 44 percent reported cleaning patient devices brought into the fabrication laboratory about half of the time or less frequently. About two-thirds of respondents reported always cleaning casting liners, ill-fitting liners, or off-the-shelf orthoses before putting them back in the box to be fit on another patient. Kubinski also found that about three-quarters of participants leave their primary facilities to treat patients in other locations at least once a week, which increases the number of treatment locations where disease may spread. The presence of a designated infection control coordinator in the workplace, however, had a positive impact on awareness, according to Kubinski. More respondents at facilities with coordinators reported washing their hands more frequently and for longer lengths of time; they also washed their tools more often.

CLINICIAN CURRICULUM:

Teaching Health and Safety at the O&P Schools Many of the O&P master’s programs incorporate infection prevention into their curricula. The O&P Program at Baylor College of Medicine devotes a portion of its “Foundations in O&P” course to infection control, personal protective equipment (PPE), bloodborne pathogens, and ways to protect patients and practitioners, says Ashley Mullen, MSAT, CPO, LPO, director of the O&P Program and an assistant professor in the School of Health Professions. Students also study the wear and care of devices, and learn how to clean liners correctly and how to evaluate skin irritations that could be bacterial, according to Mullen.

Ashley Mullen, MSAT, CPO, LPO

The Baylor O&P students also take part in a “Health Behavioral Counseling” course where they learn how to engage with patients to ensure they are adequately cleaning and caring for their devices and themselves, says Mullen. Mullen often refers to the OSHA website when questions about facility health and safety arise, and she also encourages students and residents to study the ABC Facility Accreditation Standards. “We’re working with a patient population that has comorbidities that affect their ability to fight infection,” says Mullen. “We have to do our due diligence to make sure the equipment and devices we’re using” are clean and safe.

Matthew Parente, MS, PT, CPO, FAAOP At the University of Hartford, “we encourage a mindset of protection,” says Matthew Parente, MS, PT, CPO, FAAOP, program director of the MSPO program. The use of PPE such as gloves at all times, and masks and safety glasses when working with devices or in the lab, creates a “two-way barrier” of protection. “Clinicians always think PPE helps keep them safe from the patients— but the patients also need to be kept safe from clinicians,” Parente says. “Clinicians may have come in contact with” contaminants or bacteria in working with previous patients, and PPE can help minimize any threats. “We emphasize universal precautions and best practices— every time you come in contact with a socket or brace, you should clean the surfaces,” says Parente. “The environment that we create orthotically and prosthetically is conducive for bacterial growth, so it’s important to clean surfaces between patients,” he adds. Parente also teaches students to use PPE in the lab, by wearing safety glasses, and wearing a mask when cutting or grinding—and maybe even a respirator, when appropriate. “Plus, make sure you’re using clean equipment to prevent cross-contamination. After you touch a hex wrench with your gloves, you should also clean your hex wrench. O&P ALMANAC | MARCH 2020

COVER STORY

Employee Safety Concerns On top of airborne and bloodborne infection risks, the O&P lab can be hazardous to O&P professionals’ health and safety when equipment is defective or is used improperly, according to Allen Forbis, senior risk manager at Hanger. While hazards associated with resins, carbon fiber, and plaster are well known and easily mitigated with proper ventilation and, if needed, respirator use, “the focus should really be on the individual employee and how to train them to complete their jobs using safe work practices,” Forbis says. “A back-to-basics approach on how to properly cut and handle tools, lift heavy or awkward items, maintain good housekeeping, and design your workspace [properly] is a great place to start any new safety initiatives.” Forbis also notes that repetitive injuries pose a real threat to O&P employees. “The O&P industry is similar to the greater U.S. workforce in that it is an aging workforce, but it is also unique in that those individuals who choose to work in O&P are often making a lifetime commitment to their job,” he says. “Special care should be taken in the ergonomics of how each individual operates on a day-to-day basis as they complete their tasks to prevent repetitive injuries as they progress in their careers.” In a follow-up paper on her survey, Kubinski posited that some of the inconsistencies can be attributed to the lack of OSHA standards specific to O&P. “Health safety and standards that apply to other healthcare facilities may be followed completely” in O&P patient exam rooms, offices, and waiting areas, but because there are no regulations specific to the O&P profession itself, the same protocols may not be followed in laboratory and storage areas, Kubinski noted in her paper. O&P falls under the medical category of OSHA, and practitioners must undergo bloodborne pathogen training, “but most undergo it for patient rooms—they don’t talk about when you have to bring a device out of the room,” she says. Kubinski believes the risk of bloodborne pathogens in O&P should be taken seriously, as clinicians may 30

MARCH 2020 | O&P ALMANAC

Ashley Kubinski, MSPO, CP

accidentally cut their finger working on a device and draw blood. Open wounds, diabetic ulcerations, and even HIV and hepatitis can cause problems when spread via bloodborne pathogens. “But there are also the day-to-day infectious diseases, such as MRSA, osteomyelitis, and staph infections, that we should be concerned with—especially among patients with compromised immune systems or pre-existing conditions,” Kubinski says. In addition, skin infections may be spread through improper decontamination. “People don’t realize that skin flakes can be infectious.” For these

Ashley Kubinski, MSPO, CP, seen here with a patient, encourages facilities to minimize cross-contamination when transporting O&P devices from patient rooms to the lab and back. reasons, Kubinski advises all O&P facilities to develop standard procedures for infection control that address the nuances of every aspect of daily life as an O&P professional, specifically with regard to indirect treatment of patients in the lab and storage areas. As O&P professionals look to shore up their health and safety precautions to protect both employees and patients, they can look to OSHA, ABC, CDC, and state-specific licensure bodies to ensure their compliance with various rules and recommendations. “When it comes to protecting against a wide variety of infectious diseases, the CDC is the best resource available,” says Forbis. “They have dedicated and in-depth information on both influenza and COVID-19.” Of course, it will help to keep things in perspective. Says Fiedler, “The current [epidemic] is not the first scary virus to make headlines, and it will most certainly not be the last.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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FEATURE

THE

FORMULA

FOR FABRICATION Most O&P facilities outsource fabrication for at least a portion of their devices, but some companies still see value in keeping some of the work in-house By MICHAEL COLEMAN

NEED TO KNOW • Some facilities make the decision to outsource fabrication to keep staffing and overhead costs down, preferring to focus on patient visits and contain costs associated with employing technicians. • Other O&P companies keep fabrication work on-site, benefitting from increased control of scheduling, quick turnaround times, reduced shipping costs, and fewer visits per patient. • Industry changes have prompted some companies to alter their outsourcing decisions—for example, keeping work in-house to form lower-limb sockets directly onto patients. • The “right” outsourcing decision should be made by each facility based on the unique needs and capabilities of the care provider.

MARCH 2020 | O&P ALMANAC

COVER STORY FEATURE

S WE BEGIN A NEW DECADE of O&P,

there is still no one-size-fits-all approach to the fabrication decision for orthotic and prosthetic practices. While some facilities continue to fabricate virtually all of their devices using in-house labs, others outsource the vast majority of their fabrication needs. Meanwhile others utilize a hybrid model for providing patients with the necessary componentry. Still, it’s clear that outside fabrication for at least some devices is vastly preferred by O&P providers today. In 2018, a whopping 85 percent of all companies responding to AOPA’s 2019 Operating Performance Survey said they rely on outside central fabrication (c-fab), which includes the outsourcing of any item custom-made for a patient, while 15 percent did not. That’s up almost 10 percent from 2011, when 77 percent of surveyed O&P companies said they contracted with an outside c-fab for their O&P devices.

The numbers are higher among the top 25 percent of profit leaders in the O&P industry. Almost all of them—95 percent—reported relying on outside c-fab for some of their devices in 2018, while 67 percent of the profit leaders reported doing so in 2011. Although more facilities are outsourcing fabrication, there’s no “right” or “wrong” way to acquire or fabricate devices, says J. Douglas Call, CP, president and chief executive officer of Virginia Prosthetics & Orthotics based in Roanoke, Virginia. The decision depends on the unique needs and capabilities of each care provider. “Having a good, solid reputation for providing appropriate care for the patient is paramount,” Call says. “Whether you do that with central fabrication or do it in-house, I really don't think it matters that much to a patient. The only thing that truly matters is the patient outcome.” O&P ALMANAC | MARCH 2020

FEATURE

Embracing Outsourcing Brooke Artesi, CPO, LPO, founder of Sunshine Prosthetics and Orthotics in Wayne, New Jersey, believes the choice to fabricate in-house or use central fabrication depends on the business model and philosophy. She contracts out for all device manufacturing at her 7-year-old clinic. “I don’t know if I think [central fabrication] is better; it just works better for my lifestyle,” she explains. Artesi made the decision to outsource when she opened her small facility because “we don’t get paid to fabricate,” and she has a “very digital” office. “We basically rely on scanners, for the most part. Everything is outsourced—laminations, test sockets, carvings, issue,” she says. “If it’s a test and ankle-foot orthoses. socket, it’s a couple of days’ Currently, the only thing turnaround. Lamination we really make in-house is takes about five days … a second test socket.” at the most” because she She does make excepsends her lamination work tions if she receives a to a facility in Long Island, device from a c-fab that New York, with one-day needs minor modificashipping. She has experiBrooke Artesi, tions. “We do that by hand enced minor delays during CPO, LPO ... and make it in-house,” busy times or over holidays, she says, pointing to “but really [what] holds the small amount of time it takes to things up is not fabrication; it’s insurcomplete the modifications. ance authorization.” Artesi has heard other clinicians Artesi has been fortunate in express concerns that central fabricaavoiding problems with devices tion takes too long. But that hasn’t been arriving from a c-fab with defects or her experience. “It’s quick—it’s not an other errors. “There is so much quality

MARCH 2020 | O&P ALMANAC

control. And even the customer service is great. If I have some problems, like [the device] is de-laminating for some reason, they’ll replace it.” She has never had to reject an outsourced device or make it herself in-house. That’s not to say Artesi never does her own fabrication. “The only thing we do in-house is [a] second or third test socket,” she explains. If a patient comes in and asks for a socket to be duplicated, “I would alginate their socket while they wait and then give them back their socket and go,” she says. “If you come back for a test socket, we pull that in house.” Artesi notes that outsourcing is “a newer practice model,” so younger clinicians are embracing it. And it can be a great time-saver. “We are spending so much more time on documentation than we used to. So, we're better off working on the documentation to get something covered than sticking our hands in plaster when we can just send it out and be done.” At Sunshine P&O, the use of c-fab has been nothing but a positive. “It’s quality of time, … quality of life for me,” Artesi says. “I'd much rather be hanging out with my kids or doing something else than working in the back room all day when I’m not getting paid for it. It’s all cost of goods …. That’s just how I envisioned it” when she first opened Sunshine P&O. “And it’s worked.”

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FEATURE

Success With Hybrid Approaches At Virginia Prosthetics & Orthotics, Call has overseen a shift in the facility’s fabrication practices. Up until about two years ago, the company outsourced 90 percent and kept only 10 percent of the fabrication in-house. Today, the company, which has a full clinical staff and nine orthotic and prosthetic technicians, fabricates about 60 percent of its devices in-house and contracts 40 percent to c-fabs, according to Call. The reason for the change is innovation-driven: The clinicians are now forming transfemoral and transtibial sockets directly on the patients during their visits. “It's almost like a surgical procedure,” explains Call. “You know all the insurance authorization is done. We order liners, feet, the knee—whatever is going a reasonable profit. With to need to be utilized continuing increases in for the patient.” The overhead and technology, facility generally fits O&P facilities must and delivers devices in constantly invest in new about an hour and a half technology, new techfor transtibial patients niques, and education and and two-and-a-half training. “So, we have to hours for transfemoral get more efficient in our J. Douglas Call, CP patients. This in-house delivery and timeliness of approach “cuts down our delivery,” Call says. on inventory and increases patient satisfaction,” Call says, “and we’ve had Keeping It On Site great results with the direct socket At Coachella Valley O&P in Indio, from a transfemoral and transtibial California, manager Jose Ledezma, standpoint.” CPOA, CFo, is not surprised to Long term, Call believes this see many clinics outsourcing. approach will change the way the “Practitioners are moving to a central business model works, especially fabrication model because they're cost in prosthetics with direct sockets. effective for them,” he says. “That’s Keeping fabrication in-house for these because they don't have to employ lower-limb prostheses is a matter of the technicians, or pay for all the practicality and maximizing profits, wages and insurance and all the other he says. overhead that comes with having the “As reimbursements go down, we technicians in-house.” At Coachella, have to become more and more effihowever, “what works for us is having cient in our delivery, and we have to the technicians here do the bulk of the document our patients’ satisfaction,” work,” including adjustments. Call explains. “With the increasing Coachella keeps the vast majority costs of doing business, in order for of fabrication in-house but outsources a business to still provide exemplary orthoses for stabilizing the ankle, taloservice and please the medical commu- calcaneal, and midtarsal and subtalar nity as well as the patient, we have to joints, as well as scoliosis bracing, be as efficient as we can” while making casts, and a few other specialty 36

MARCH 2020 | O&P ALMANAC

items. Within the last 18 months, the company acquired a scanner, which is getting a lot of use. “We have a shop and all the machinery,” says Ledezma. “We have a lab that’s about 2,500 square feet where we have belt sanders, drum sanders, and a big oven, and we have two pouring stations and a cast room where we do all of the modifications,” he says. The lab features four separate benches for technicians, and there is a shipping and receiving area for off-theshelf stock. “Instead of pouring the cast, we used to take and have them be modified and then pulled,” Ledezma explains. “Now, we're doing most of our modifications on the computer and sending the carvings out to get made.” Once the carving comes back, the technicians finish the device. Coachella O&P employs four fulltime technicians who work in a shop on-site. While the technicians are primarily focused on fabrication, they are also readily available to confer with patients and clinicians, and to modify patient devices on the spot, if needed. Ledezma says the full roster of technicians allows clinicians to focus strictly on the patient without the distraction of doing device modifications themselves.

FEATURE

In-house fabrication capabilities also are helpful for repair work. “The patient can bring their prosthesis in for repair and they don’t have to come back for another fitting,” Ledezma says. “They can get taken care of that same day. If there's a problem, we can address it while they're here.” Patients benefit from less time spent travelling to and from the office. And it provides a marketing advantage, as well. Advertising to patients that repair work can be done in one visit “seems to work to our advantage,” he says.

Maintaining Control

Austin Prosthetic production schedule. Center in Texas is “It's more cost effecanother facility taking tive, I believe, and more a hybrid approach. The efficient, not having to practice keeps about 90 pay any kind of shipping percent of its prosthesis costs, and you don't work in-house—but have to wait on shipping just 10 percent of its times,” he says. Harris orthotics fabrication. appreciates being in Matthew Harris, “We specialize in control of all aspects of CPO, LPO taking the time necesproduction and schedsary for prosthetics,” uling. “If I have to ship which is the company’s specialty, says a device off and it takes a week to Matthew Harris, CPO, LPO, founder get there and then it takes them two of the company. For this reason, weeks to fabricate it and a week to most prosthetic work stays on-site send it back, that’s four weeks of while most orthotics work is sent to a time I've lost,” he says. “When I keep trusted c-fab that is familiar with his it in-house, I have the same technitechniques and standards. cians that are working on a device Harris believes in-house fabricaand I know their schedule. I know tion beats central fabrication for its that if I go back there and give them

something today, I can have it ready in a week.” In-house fabrication also leads to improved quality control, according to Harris. “The technicians that I have here are fabricating devices using the same techniques under the same standards that I am used to,” he says. “If I send it to the central fab, they might employ 20 technicians, and they may all do things a little bit differently and have different methods or different standards. You’re going to get some variables.” He concedes that practices that do all or most fabrication in-house using clinicians who also are responsible for patient consultations can get over-extended. But that’s not a problem at Austin Prosthetic Center. “We're set up so that our clinicians are seeing patients all day. … We have guys that are dedicated to just fabricating all day.” Harris, Call, Artesi, and Ledezma each have their own approaches to fabrication, appreciating the benefits that come from their methodologies. Whether they have chosen in-house, outsourced, or hybrid fabrication, they all agree that the decision is different for each business—and what works well at one facility may not work at another. Carefully considering the benefits and challenges associated with each approach can help a facility decide how to move forward with fabrication and best meet patients’ needs. Michael Coleman is a contributing writer to O&P Almanac. O&P ALMANAC | MARCH 2020

TION

AL SEC

SPECI

2020 DIRECTORY

CTORY 2020 DtraIlRFEabrication of Cen

Facilities

of Central Fabrication Facilities The following companies offer orthotic and prosthetic central fabrication services. Each company listing includes address, phone number, website, email address, and, where available, a description of the types of O&P devices they fabricate. Please contact the facilities directly with any questions.

ACME BRACEWORKS LLC

ACOR ORTHOPAEDIC INC.

Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity, Stance Control, UpperExtremity Elbow, Upper-Extremity Wrist, Hand, Finger

Orthotic Categories: Foot Orthoses, Lower-Extremity Thermoplastics, LowerExtremity Leather Corset and Gauntlet, Crow Walkers

ADAPTEC PROSTHETICS LLC

ADVANCED O&P SOLUTIONS

411 NE Baker Road Stuart, FL, 34994 777/934-6943 www.acmebraceworks.weebly.com Email: acmebraceworks@comcast.net

1501 West Campus Drive, Ste. J Littleton, CO 80120 720/433-1212 www.adaptecprosthetics.com Email: rae@adaptecprosthetics.com Orthotic Categories: Thermoplastics Lower-Extremity, Thermoplastics Foot Orthoses Lower-Extremity Prosthetic Categories: Below-Knee Endoskeletal, Knee Disarticulation Endoskeletal, Above-Knee Endoskeletal, Partial Hand Upper-Extremity, Wrist Disarticulation Upper-Extremity, Below-Elbow Upper-Extremity, AboveElbow Upper-Extremity, Below-Elbow Endoskeletal, Elbow Disarticulation Endoskeletal, Above-Elbow Endoskeletal, Other—Vacuum Sockets Utilizing 5280 Internal Vacuum Systems

18530 S. Miles Pkwy. Cleveland, OH 44128 800/237-2267 www.acor.com Email: orderentry@acor.com

Prosthetic Categories: Lower-Extremity Partial Foot

8647 W. 95th Street Hickory Hills, IL 60457 866/914-2677 www.aopsolutions.com Email: mangelio@aopsolutions.com Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Extremity Custom Cranial Helmets, Upper-Extremity Shoulder, Upper-Extremity Elbow, Upper Hand Extremity Wrist, Hand, Finger, Other—Protective Face Mask

Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, Upper-Extremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Shoulder Disarticulation, External Power Devices, Other ALATHEIA PROSTHETICS

504 Grants Ferry Road Brandon, MS 39047 601/919-3112 www.alatheia.com Email: info@alatheia.com

Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity BelowKnee, Lower-Extremity Above-Knee, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, UpperExtremity Above-Elbow, Upper-Extremity Shoulder Disarticulation, Other—AboveKnee and Below-Knee Covers

Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics 38

MARCH 2020 | O&P ALMANAC

2020 Directory of Central Fabrication Facilities

ALTERNATIVE PROSTHETIC SERVICES INC.

191 Bennett Street Bridgeport, CT 06605 203/367-1212 www.alternativeprosthetics.com AMERICAN CENTRAL FABRICATION

3240 Mabel Street Shreveport, LA 71103 318/636-3751 Email: americancenfab@aol.com

Prosthetic Categories: Lower-Limb Prostheses, Upper-Limb Prostheses AMFIT INC.

3611 NE 68th St. Vancouver, WA 98661 360/573-9100 www.amfit.com Email: sales@amfit.com Orthotic Categories: Foot Orthoses AOD CFAB

12315 Judson Road, Ste. 200 San Antonio, TX 78233 210/657-8100 www.advancedorthopedicdesigns.com/ c-fab.php Email: info@aodcfab.com Orthotic Categories: Spinal, Lower-Limb Orthoses Prosthetic Categories: Lower-Limb Prostheses APIS FOOTWEAR CO.

2239 Tuler Avenue South El Monte, CA 91733 626/448-8905 www.apisfootwear.com Email: sales@apisfootwear.com Orthotic Categories: Lower-Limb Orthoses

ARIZONA AFO INC.

4825 E. Ingram Street Mesa, AZ 85205 480/222-1580 www.arizonaafo.com Email: info@arizonaafo.com Orthotic Categories: Foot Orthoses, Lower-Extremity Thermoplastics, LowerExtremity Leather Corset and Gauntlet, Crow Walkers Prosthetic Categories: Lower-Extremity Partial Foot ARTECH LABORATORY INC.

309 W. Avenue F Midlothian, TX 76065 888/755-5501 www.artechlab-prosthetics.com Email: mholt36107@aol.com Orthotic Categories: Upper-Extremity Wrist, Hand, Finger, Other—Custom Cosmetic Silicone Restoration Fingers and Hands, Below-Elbow and Above-Elbow Passives, Below-Elbow and Above-Elbow Myos and I-limbs, Ears and Noses

Prosthetic Categories: Other—CAD/CAM Carving, Services, and Supplies BECKER ORTHOPEDIC APPLIANCE CO.

635 Executive Drive Troy, MI 48083 248/588-7480 www.beckerorthopedic.com Email: cbecker@beckerorthopedic.net Orthotic Categories: Spinal Metal and Leather, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Extremity Shoulder, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger BEST MADE SHOES

Prosthetic Categories: Other—AboveKnee and Below Knee Covers for Feet, Toes, Heels, Custom Cosmetic Silicone Restorations

5143 Liberty Avenue Pittsburgh, PA 15224 412/621-9363 www.bestmadeshoes.com Email: footcare@bestmadeshoes.com

ATLANTA PROSTHETICS

Orthotic Categories: Foot Orthoses, Custom Shoes

1625 Rock Mountain Blvd. Stone Mountain, GA 30083 800/543-7660 www.aibracing.com Email: mhortman@deroyal.com Orthotic Categories: Cervical, Spinal Thermoplastics, Spinal Scoliosis—Milwaukee ATLANTIC RIM BRACE MFG. CORP.

25B Progress Avenue Nashua, NH 03062 603/886-8130 www.spinalbraces.com Email: sales@spinalbraces.com

BIO-MECHANICAL COMPOSITES INC.

2505 McKinley Avenue Des Moines, IA 50321 515/554-6132 www.phatbraces.com Email: nchladek@aol.com

Orthotic Categories: Lower-Limb Orthoses Prosthetic Categories: Lower-Limb Prostheses

Orthotic Categories: Spinal Thermoplastics, Spinal Scoliosis— Milwaukee, Other—CAD/CAM Carving, Supplies Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P ALMANAC | MARCH 2020

2020 Directory of Central Fabrication Facilities

BOSTON ORTHOTICS & PROSTHETICS

20 Ledin Drive Avon, MA 02322 800/262-2235 www.bostonoandp.com Email: customerservice@bostonoandp. com Orthotic Categories: Spinal, Cranial CASCADE DAFO INC.

1360 Sunset Avenue Ferndale, WA 98248 800/848-7332 www.cascadedafo.com Email: bized@dafo.com

CRAFT MASTER LLC

1825 N. Willow Hwy. Lansing, MI 48917 517/886-5798 Email: khartman@yahoo.com Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Tone-Reducing AFOs—Pediatric, Crow Walkers, Reciprocating Gait Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger CREATE O&P

Orthotic Categories: Lower-Extremity Tone Reducing AFOs—Pediatric, Knee Orthoses, Upper-Extremity Wrist, Hand, Finger COYOTE DESIGN

419 N. Curtis Road Boise, ID 83706 208/429-0026 www.coyotedesign.com Email: lab@coyotedesign.com Orthotic Categories: Lower-Extremity Thermoplastics, Lower-Extremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs—Pediatric Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee

7 Old Military Road Lake Placid, NY 12946 518/302-9198 www.createoandp.com Email: info@createoandp.com Prosthetic Categories: Lower-Limb, Other—CAD/CAM Services CUSTOM COMPOSITE MFG. INC.

21 Palmer Avenue Cranston, RI 02920 401/275-2230 www.cc-mfg.com Email: info@cc-mfg.com

Orthotic Categories: Lower-Extremity Laminated Carbon Composite Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s EARTHWALK ORTHOTICS LLC

500 Vista Avenue SE Massillon, OH 44646 330/837-6569 www.earthwalkorthotics.com Email: brigham.earthwalk@gmail.com

EASTERN PODIATRY LAB INC.

1702 5th Street Trenton, NJ 08638 800/327-8763 www.eplorthotics.com Email: eastpod@verizon.com

Orthotic Categories: Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs—Pediatric, LowerExtremity Stance Control Prosthetic Categories: Lower-Extremity Partial Foot ELITE ORTHOTICS INC.

705 West Beaver Street Zelienople, PA 16063 877/922-8225 www.eliteorthotics.com Email: eo@zoominternet.net Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Tone-Reducing AFOs—Pediatric, LowerExtremity Stance Control, Crow Walkers, Knee Orthoses, Other EPICA APPLIED TECHNOLOGIES

2753 Camino Capistrano, Ste. A101 San Clemente, CA 92672 949/238-6323 www.epicatech.com Email: sales@epicamed.com Orthotic Categories: Cranial, Spinal, Lower-Limb, Other—CAD/CAM

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics 40

MARCH 2020 | O&P ALMANAC

2020 Directory of Central Fabrication Facilities

FABTECH SYSTEMS LLC

FREEDOM FABRICATION INC.

GLAZE PROSTHETICS

Orthotic Categories: Lower-Extremity Laminated Carbon Composite, Other— PDE Dynamic

Orthotic Categories: Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone=Reducing AFOs—Pediatric, Lower-Extremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Knee Orthoses, UpperExtremity Wrist, Hand, Finger, Other

Prosthetic Categories: Upper-Limb

P.O. Box 2248 Everett, WA 98213 425/349-9557 www.fabtechsystems.com Email: scott@fabtechsystems.com

Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other—PDE Dynamic Partial FARABLOC DEVELOPMENT CORP.

3030 Lincoln Avenue, Ste. 211 Coquitlam, BC V3B 6B4 Canada 866/941-4711 www.farabloc.com Email: info@farabloc.com

Prosthetic Categories: Upper-Limb, Lower-Limb, Other—Materials and Lamination Supplies

815B N. Main Street Havana, FL 32333 850/539-4194 www.freedomfabrication.com Email: freedomfab@aol.com

FREEDOM INNOVATIONS LLC

3 Morgan Irvine, CA 92618 888/818-6777 www.freedom-innovations.com FRIDDLE’S ORTHOPEDIC APPLIANCES INC.

12306 Belton Honea Path Hwy. Honea Path, SC 29654 864/369-2328 www.friddles.com Email: c-fab@friddles.com Orthotic Categories: Spinal Thermoplastics, Spinal Scoliosis— Milwaukee, Other—CAD Carving Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other—CAD Carvings

Ul Pradnicka 12 Krakow 30002 Poland +48 501 290 485 www.glazeprosthetics.com Email: hello@glazeprosthetics.com

GRACE PROSTHETIC FABRICATION INC.

7928 Rutillio Court New Port Richey, FL 34653 727/842-2265 www.gpfinc.com Email: grace@gpfinc.com Orthotic Categories: Cervical, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Custom Shoes, Knee Orthoses, UpperExtremity Shoulder, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other—Grace Plate

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P ALMANAC | MARCH 2020

2020 Directory of Central Fabrication Facilities

GRUBBS ORTHOTIC & PROSTHETIC LABS INC.

3065 Park Circle, Ste. 1 Jupiter, FL 33458 888/958-5363 www.grubbsoandplabs.com Email: grubbs@aol.com

Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Stance Control, Crow Walkers, Knee Orthoses. Upper-Extremity Elbow Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation HANGER / DBA HANGER FABRICATION NETWORK

5251 Convoy Court San Diego, CA 92111 858/292-6045 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs—Pediatric, LowerExtremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Custom Shoes, Knee Orthoses, Upper-Extremity Shoulder, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger

Prosthetic Categories: LowerExtremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal BelowKnee, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity BelowElbow, Upper-Extremity Above-Elbow, Upper-Extremity Should Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

HANGER NATIONAL LABS—HOUSTON

3260 Willowbend Blvd., Ste. 1118A Houston, TX 77054 281/824-3210 www.spsnationallabs.com Orthotic Categories: Cervical, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Custom Shoes, Knee Orthoses, UpperExtremity Shoulder, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger Prosthetic Categories: LowerExtremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal BelowKnee, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity BelowElbow, Upper-Extremity Above-Elbow,

Upper-Extremity Should Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

HERSCO ORTHO LABS

34-28 Crescent Street Long Island City, NY 11101 800/301-8275 www.hersco.com Email: fastorthotics@hersco.com Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, , Lower-Extremity Tone-Reducing AFOs—Pediatric, LowerExtremity Stance Control, Crow Walkers, Spinal Scoliosis-Milwaukee, Custom Shoes, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Upper-Extremity Below-Elbow, UpperExtremity Above-Elbow

HITEK

222 Turner Blvd St. Peters, MO 63376 636/385-6372 www.hitekmobility.com Email: sbright@hitekmobility.com Orthotic Categories: Spinal, Lower-Limb Orthoses, Upper-Limb Orthoses Prosthetic Categories: Lower-Limb Prostheses, Upper-Limb Prostheses

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HUTNICK REHAB SUPPORT SERVICES INC.

161 Keyland Court Bohemia, NY 11716 631/467-3725 www.thehutnickcenter.com Email: hutnickcfab@optimum.net Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity AboveElbow, Upper-Extremity Should Disarticulation, Endoskeletal BelowElbow, Endoskeletal Elbow Disarticulation INDEPENDENT TECH SERVICE LLC

13701 24th St. E., Ste. A8 Sumner, WA 98390 253/891-1976 www.itsfabrication.com Email: chad@itsfabrication.com

Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Upper-Extremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity Below-Elbow, UpperExtremity Above-Elbow, Endoskeletal Below-Elbow, Endoskeletal Elbow

Disarticulation, Endoskeletal AboveElbow, Other—BOA Closure System INFINITE BIOMEDICAL TECHNOLOGIES

8 Market Place, Ste. 500 Baltimore, MD 21202 443/451-7175 www.i-biomed.com Email: dan@i-biomed.com Prosthetic Categories: Upper-Limb JIM SKARDOUTOS C-FAB INC.

5765 Winfield Blvd., Ste. 7 San Jose, CA 95123 408/472-7914 www.limbcraftercfab.com Email: limbcrafter@comcast.net Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Upper-Extremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other—Custom Shape Cosmetic and Custom Spray-On Skin

KINETIC RESEARCH INC.

5513 W. Sligh Avenue Tampa, FL 33634 800/919-3668 www.kineticresearch.com Email: email@kineticr.com Orthotic Categories: Lower-Limb KLM LAB INC.

28280 Alta Vista Avenue Valencia, CA 91355 661/295-2600 www.klmlabs.com Email: scottmar@klmlabs.com Orthotic Categories: Foot Orthoses KNEE CENTRE

10733 124th Street Edmonton, AB T5M OH2 Canada 800/387-5053 www.khager.com Email: nhayday@khager.com Orthotic Categories: Knee Orthoses L.A. BRACE CENTER

164320 Ventura Blvd., Ste. 304 Encino, CA 91436 818/570-1611 www.thelabrace.com Email: labrace@thelabrace.com Orthotic Categories: Spinal Scoliosis— Milwaukee, Other—The L.A. Scoliosis Brace

JOINT ACTIVE SYSTEMS

2600 S. Raney Street Effingham, IL 62401 217/342-3412 www.jointactivesystems.com Email: info@jointactivesystems.com Orthotic Categories: Foot Orthoses, Knee Orthoses, Upper-Extremity Shoulder, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P ALMANAC | MARCH 2020

2020 Directory of Central Fabrication Facilities

LAKESHORE CENTRAL FAB

4605 Detroit Avenue Cleveland, OH 44102 216/651-0110 www.lakeshorecfab.com Email: fab@lakeshorecfab.com Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Upper-Extremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, Other

LIFE-LIKE LABORATORY

1544 Valwood Pkwy., Ste. 104 Carrollton, TX 75006 972/620-0203 www.lifelikelab.com Email: info@likelab.com Prosthetic Categories: Lower-Limb Prostheses, Upper-Limb Prostheses

LIMB SHED

4402 Valley Hwy. Charlotte, MI 48813 517/543-2737 www.limbshed.com Email: limbshed@hotmail.com Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, UpperExtremity Above-Elbow, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal AboveElbow, Other LUIS PROSTHETICS FABRICATION INC.

15247 SW 52nd Street Miramar, FL 33027 305/336-4501 Email: luisprosthetics@yahoo.com

Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Upper-Extremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, Upper Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow

MARAMED ORTHOPEDIC SYSTEMS / BIOSCULPTOR

2480 W. 82nd Street, Ste. 1 Hialeah, FL 33016 305/823-8300 www.biosculptor.com Email: rholland@biosculptor.com

Orthotic Categories: Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Thermoplastics, LowerExtremity Tone Reducing AFOs-Pediatric, Spinal Scoliosis-Milwaukee, UpperExtremity Custom Cranial Helmets, Upper-Extremity Wrist, Hand, Finger, Other—Face Mask Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Upper-Extremity Below-Elbow, UpperExtremity Above-Elbow, Upper-Extremity Shoulder Disarticulation

MEDSUPPLY

33333 Dequindre Troy, MI 48083 248/597-1038 www.med-supply.com Email: drose@med-supply.com Orthotic Categories: Metal and Leather Lower-Extremity, Thermoplastics Lower-Extremity Prosthetic Categories: Lower-Extremity, Partial Foot Lower-Extremity, Syme’s Lower-Extremity, Below-Knee LowerExtremity, Knee Disarticulation Lower-Extremity, Above-Knee LowerExtremity, Below-Knee Endoskeletal, Knee Disarticulation Endoskeletal, Above-Knee Endoskeletal, BelowElbow Upper-Extremity, Above-Elbow Upper-Extremity

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MILE HIGH ORTHOTICS LAB INC.

Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger

Orthotic Categories: Lower-Limb

Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee, Upper-Extremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity BelowElbow, Upper-Extremity Above-Elbow, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow

4970 Monaco Street, Unit A 303/289-1534 www.mholabs.com Email: info@mholabs.com

MOUNTAIN VIEW PROSTHETICS INC.

160 Witter Road Altamont, NY 12009 518/872-0374 www.mountainviewprosthetics.com Email: mvprosthetics@yahoo.com

Orthotic Categories: Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs— Pediatric, Crow Walkers, Knee Orthoses, Upper-Extremity Wrist, Hand, Finger Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other—CAD/CAM Services

NATIONAL LABS

10524 Euclid Avenue, CB 143 Cleveland, OH 44106 216/444-1280 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, LowerExtremity Laminated Carbon Composite,

NORTHERN ARIZONA PROSTHETICS

1726 N. Liana Drive Chino Valley, AZ 86323 928/583-0707 www.nazprosthetics.com Email: nap@nazprosthetics.com

Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

OPTEC USA

975 Progress Circle Lawrenceville, GA 30043 770/513-7380 www.optecusa.com Email: sales@optecusa.com Orthotic Categories: Spinal, Lower-Limb Orthoses, Upper-Limb Orthoses ORTHOMERICA PRODUCTS INC.

6333 N. Orange Blossom Trail Orlando, FL 32810 800/446-6770 www.orthomerica.com Email: custserv@orthomerica.com Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, LowerExtremity Leather Corset and Gauntlet, Lower-Extremity Tone=Reducing AFOs—Pediatric, Lower-Extremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Extremity Custom Cranial Helmets, Upper-Extremity Shoulder, Upper-Extremity Elbow, UpperExtremity Wrist, Hand, Finger Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee

ORTHOPEDIC FABRICATORS INC.

8145 Signal Court, Ste. A Sacramento, CA 95824 916/383-8776 Email: orthofab1@aol.com

Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other—Brace Repairs

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P ALMANAC | MARCH 2020

2020 Directory of Central Fabrication Facilities

ORTHOTICS & PROSTHETICS ONE

527 Park Lane, Ste. 200 Waterloo, IA 50702 800/408-3598 www.oandp1.com Email: sclark@oandp1.com

Orthotic Categories: Foot Orthoses, Lower-Extremity Thermoplastics, Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other—Face Mask Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee, Upper-Extremity Wrist Disarticulation, Upper-Extremity BelowElbow, Upper-Extremity Above-Elbow, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, Other—Laminated KAFO

ÖSSUR AMERICAS INC.

7199 S. Conway Road, Ste. 100 Orlando, FL 32812 888/839-6213 www.ossur.com Prosthetic Categories: Lower-Limb OTTO BOCK HEALTHCARE CANADA

54701 Harvester Road Burlington, Ontario L7L 5N5 Canada 800/665-3327 www.ottobock.ca Email: steve.wall@ottobock.com Orthotic Categories: Spinal Thermoplastics, Lower-Extremity Thermoplastics, Lower-Extremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs—Pediatric, Lower-Extremity Stance Control, Knee Orthoses, UpperExtremity Custom Cranial Helmets,

Upper-Extremity Shoulder, UpperExtremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other PHITS/RS PRINT

44650 Helm Court Plymouth, MI 48170 405/406-1441 www.phitsinsoles.com Email: blake.norquist@rsprint.com Orthotic Categories: Lower-Limb PREMIER O&P LLC

1671 Crane Street, Ste. 5 Schenectady, NY 12303 518/280-4885 Email: premieroandp@yahoo.com Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, LowerExtremity Laminated Carbon Composite, Lower-Extremity Tone-Reducing AFOs— Pediatric, Lower-Extremity Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Extremity Shoulder, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other

22901 Ambassador Blvd. St. Francis, MN 55070 763/242-7583 Email: pridecustom@comcast.net Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

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PROSTHETIC DESIGN INC.

700 Harco Drive Clayton, OH 45315 937/836-1464 www.prostheticdesign.com Email: bcarpenter@prostheticdesign.com Prosthetic Categories: Lower-Extremity Below-Knee, Lower-Extremity AboveKnee, Other PROTOSTHETICS

617 4th Street N., Ste. 1 Fargo, ND 58102 701/478-2001 www.protosthetics.com Email: sales@protosthetics.com Orthotic Categories: Spinal, Lower-Limb Orthoses, Upper-Limb Orthoses Prosthetic Categories: Spinal, LowerLimb Prostheses, Upper-Limb Prostheses

PSL FABRICATION

110 W. Industrial Road Fulton, MO 65251 573/642-5554 www.pslab.com Email: pslab5@sbcglobal.net Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Other—CAD/CAM Services PUGET SOUND INNOVATIONS

838 Industry Drive Tukwila, WA 98188 206/575-7500 Email: pugetsoundinnovations@gmail.com Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal

Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Upper-Extremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

SILVERADO FABRICATORS AND MAKER SERVICES

1104 E. Pettigrew Street Durham, NC 22704 984/439-1821 www.silveradofabricators.com Email: ben.silveradofab@gmail.com Orthotic Categories: Lower-Limb Orthoses, Upper-Limb Orthoses, Thermoplastics Foot Orthoses Lower-Extremity, Metal and Leather Lower-Extremity, Thermoplastics LowerExtremity, Gauntlet Lower-Extremity, Laminated Carbon Composite LowerExtremity, Other Prosthetic Categories: Lower-Limb Prostheses, Lower-Extremity, Partial Foot Lower-Extremity, Syme’s LowerExtremity, Below-Knee Lower-Extremity, Below-Knee Endoskeletal, Above-Knee Endoskeletal, Other

SPINAL TECHNOLOGY INC.

191 Mid Tech Drive West Yarmouth, MA 02673 800/253-7868 www.spinaltech.com Email: info@spinaltech.com

Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

SPINAL SOLUTIONS INC.

1971 Old Covington Road Conyers, GA 30013 800/922-5155 Email: spinalsolutions@mindspring.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Crow Walkers, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Extremity Shoulder, Other— Carbon Fiber AFO Prosthetic Categories: LowerExtremity Below-Knee, Lower-Extremity Above-Knee

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P ALMANAC | MARCH 2020

2020 Directory of Central Fabrication Facilities

SPS NATIONAL LABS

10633 Summit Street Lenexa, KS 66215 913/888-4200 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis-Milwaukee, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

SPS NATIONAL LABS

121 23rd Avenue SW Rochester, MN 55902 507/536-6103 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses,

Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices SPS NATIONAL LABS

4155 E. La Palma Avenue, Ste. B-400 Anaheim, CA 92807 714/961-2155 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis-Milwaukee, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation,

Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

SPS NATIONAL LABS

9561 Satellite Blvd., Ste 350 Orlando, FL 32837 678/455-8852 www.cbb.org Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics 48

MARCH 2020 | O&P ALMANAC

2020 Directory of Central Fabrication Facilities

SPS NATIONAL LABS

1119 W. Geneva Drive Tempe, AZ 85282 480/894-1755 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis-Milwaukee, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation, Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

STARTEK ENTERPRISES INC.

4710 Prairie Road Paso Robles, CA 93446 805/239-9567 Email: startekcfab@sbcglobal.net Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Tone Reducing AFOs—Pediatric, Crow Walkers Prosthetic Categories: Lower-Extremity Partial Foot, Lower-Extremity Syme’s, Lower-Extremity Below-Knee, LowerExtremity Knee Disarticulation,

Lower-Extremity Above-Knee, Lower-Extremity Hip Disarticulation, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal AboveKnee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Extremity Partial Hand, UpperExtremity Wrist Disarticulation, Upper-Extremity Below-Elbow, Upper-Extremity Above-Elbow, UpperExtremity Shoulder Disarticulation, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

TITAN O&P FABRICATIONS

600 Lemens Avenue, Ste. 700 Hutto, TX 78634 844/678-4826 www.titanopfab.com Email: andrew@titanopfab.com Prosthetic Categories: Lower-Extremity, Syme’s Lower-Extremity, Below-Knee Lower-Extremity, Knee Disarticulation Lower-Extremity, Above-Knee LowerExtremity, Below Endoskeletal, Knee Disarticulation Endoskeletal, Above-Knee Endoskeletal TOP SHELF ORTHOPEDICS

STAT DIAGNOSTICS INC. /DBA NEWGEN ADVANCED ORTHOTICS LAB

7740 Trinity Road, Ste. 101A Cordova, TN 38018 901/756-0257 www.newgenorthotics.com SURESTEP

17530 Dugdale Drive South Bend, IN 46635 877/462-0711 www.surestep.net Email: info@surestep.net Orthotic Categories: Lower-Limb TIDWELL’S ORTHOTICS AND PROSTHETICS LLC

4450 NW 126th Avenue, Ste. 106 Coral Springs, FL 33065 954/346-5402 www.tidwellsorthotics.com Email: chris.tidwell@tidwellsorthotics. com TILLGES TECHNOLOGIES

1570 Beam Avenue, Ste. 100 Maplewood, MN 55109 651/772-2665 www.tcopinc.com Email: mtil@tcopinc.com

1851 E. Paradise Road, Ste. A Tracy, CA 95304 209/834-1158 www.pacmedical.com Prosthetic Categories: Upper-Limb, Lower-Limb TOUCH BIONICS

35 Hampden Road Mansfield, MA 02048 855/694-5462 www.touchbionics.com Email: wagner@touchbionics.com Prosthetic Categories: Upper-Extremity Partial Hand, Upper-Extremity Wrist Disarticulation, Upper-Extremity BelowElbow, Upper-Extremity Above-Elbow, Other TOWER ORTHOPEDIC DESIGNS INC.

300 Alpha Drive Pittsburgh, PA 15238 412/599-1111 Email: judyd@towerortho.com

Orthotic Categories: Lower-Extremity Metal and Leather, Lower-Extremity Thermoplastics, Lower-Extremity Leather Corset and Gauntlet, Lower-Extremity Tone-Reducing AFOs—Pediatric, Crow Walkers

Orthotic Categories: Lower-Limb Prosthetic Categories: Lower-Limb

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P ALMANAC | MARCH 2020

2020 Directory of Central Fabrication Facilities

TOWNSEND DESIGN / THUASNE USA

4615 Shepard Street Bakersfield, CA 93313 661/837-1795 www.townsenddesign.com Email: townsend@townsenddesign.com Orthotic Categories: Lower-Limb UCO INTERNATIONAL

225 Larkin Drive, Unit 3 Wheeling, IL 60090 800/541-4030 www.ucointernational.com Email: uco@ucointernational.com Orthotic Categories: Foot Orthoses VOXELCARE ONLINE CAD/CAM SYSTEMS

Avd. Universidad s/r Ed. Quarum III PCE-UMH Elche 03202 Spain +0034965452517 www.voxelcare.com Email: info@voxelcare.com Orthotic Categories: Lower-Limb WACKER ORTHOPEDIC INC.

2 Flowerfield, Ste. 1B St. James, NY 11780 631/686-6802 www.wackerorthopedic.com Email: wackerorthopedic@gmail.com Orthotic Categories: Lower-Extremity Thermoplastics, Lower-Extremity Tone-Reducing AFOs—Pediatric, LowerExtremity Stance Control, Crow Walkers, Knee Orthoses, Upper-Extremity Elbow, Upper-Extremity Wrist, Hand, Finger, Other—Tibial Transformer

WILLOWWOOD

15441 Scioto Darby Road P.O. Box 130 Mount Sterling, OH 43143 740/869-3377 www.willowwoodco.com Email: chrish@owwco.com Orthotic Categories: Lower-Extremity Thermoplastics, Lower-Extremity Laminated Carbon Composite

WINDY CITY FABRICATORS

3830 W. Irving Park Road Chicago, IL 60618 773/583-4860 www.windycityfabricators.com Email: peter@windycityfabricators.com Orthotic Categories: Lower-Limb Prosthetic Categories: Lower-Limb

Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee, Upper-Extremity BelowElbow, Upper-Extremity Above-Elbow, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow

WILLOWWOOD

1760 W. Redwood Depot Lane, Ste. 6 Salt Lake City, UT 84104 740/869-3377 www.willowwoodco.com Email: lisaw@owwco.com Orthotic Categories: Lower-Extremity Thermoplastics, Lower-Extremity Laminated Carbon Composite Prosthetic Categories: Lower-Extremity Syme’s, Lower-Extremity Below-Knee, Lower-Extremity Knee Disarticulation, Lower-Extremity Above-Knee, Endoskeletal Below-Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above-Knee, Upper-Extremity BelowElbow, Upper-Extremity Above-Elbow, Endoskeletal Below-Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above-Elbow

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics 50

MARCH 2020 | O&P ALMANAC

Trautman Carversâ&#x20AC;&#x2030;: Built for Fab

Trautman Carvers Fillauer offers a full range of carvers to fit every space and budget. Carvers are available in full-sized floor models with lift assist as well as bench models that accomodate smaller spaces, and both models are available with either constant or variable speed motors. Plus, there is a full range of carver accessories and attachments to taylor the Trautman precisely to your fabrication needs.

PRINCIPAL INVESTIGATOR

Questioning the ‘Why?’ Leslie Gray, MEd, CPO, LPO, FAAOP, leads by example— demonstrating the significance of O&P research to students at UT Southwestern

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

MARCH 2020 | O&P ALMANAC

ESLIE GRAY, MEd, CPO, LPO, FAAOP,

may be best known as a long-time professor and curriculum developer in the Prosthetics-Orthotics Program at University of Texas (UT) Southwestern in Dallas, and the program’s current director. But she also contributes to the profession with her research endeavors. Gray recently kicked off a new study—a comprehensive investigation of the properties of carbon fiber and fiberglass in prosthetic feet, in collaboration with David Wilson, MPO, CPO, LPO, FAAOP. The research is in its very early stages, but Gray hopes that the study will provide key information for evidence-based care of lower-limb patients. “We have completed a literature review and published the results as a ‘critically appraised topic’ with the American Academy of Orthotists and Prosthetists,” she says. Next, Gray and Wilson will begin collecting pilot data, which they hope to have in the next three months. “Our interest is in qualitative patient perspectives related to their overall experiences in carbon fiber versus fiberglass prosthetic feet,” she explains. “Additionally, we are

“We are tasked with teaching students how to select the most appropriate feet for patient needs … yet we only have limited information to share. We’d like to back up our assumptions with data for better evidence-based care.” interested in kinematic gait data to see if there are any differences in how patients ambulate in each foot.” While there is not one “best” material for all situations, prosthetists should understand the material properties in order to design the most appropriate device, she says. Gray’s interest in studying the two types of feet was driven by her experiences in the classroom and clinic.

PHOTO: Leslie Gray, MEd, CPO, LPO, FAAOP

PRINCIPAL INVESTIGATOR

“We are tasked with teaching students how to select the most appropriate feet for patient needs and assisting our prosthetic patients through this process, yet we only have limited information to share,” she explains. “We’d like to back up our assumptions with data for better evidence-based care. The pilot data will likely give us insight into additional questions and data to be collected.” Ultimately, the information will be shared with prosthetists to assist them in clinical decision making and educating patients on their prosthetic options. PHOTO: Leslie Gray, MEd, CPO, LPO, FAAOP

Entrenched in the Community

UT Southwestern has been Gray’s professional home since the beginning of her O&P education. “I have served in a variety of roles—from student, to resident, then clinician, to instructor, and now assistant professor and director of the Prosthetics-Orthotics Program,” she says. She currently oversees both the academic and clinical operations of the program, in addition to having

Gray, center, with two University of Texas Southwestern MPO students, Morgan Gizzi and Lindsay Pauline, at the Texas Chapter of the American Academy of Orthotists and Prosthetists Annual Meeting in 2019. instructional and clinical duties. Gray’s early clinical and teaching experiences influenced her decision to take part in O&P research efforts. “I find it hard to teach and explain to students and patients why certain clinical decisions are made when there is no

IntRoduCIng nEW REStECH

research to support some prosthetic and orthotic practices,” she explains. “I never like giving the answer, ‘Just trust me,’ or, ‘Because it works.’” Working in an academic medical center, Gray says she is surrounded by “brilliant and curious minds who are always questioning ‘why’

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PRINCIPAL INVESTIGATOR

and working to answer these questions for their respective disciplines.” Being in this environment stimulates collaboration, “and after finding this collaboration, I realized that it is possible to contribute to research in a meaningful way without having a full-time career in research— and still fulfill my passion for patient care and teaching.” Today, Gray teaches, practices, and researches both prosthetics and orthotics “across a variety of patient populations and diagnoses.” In addition to the current prosthetic foot investigation, Gray is part of a team that is investigating the effects of Sutti Bounders modular pediatric dynamic elastomers on pediatric gait. “The initial results, showing a potential for ankle power generation by the Bounder, are exciting,” she says. “We are actively working to expand this study and hope to share full results with the profession.”

At School and at Home

In her role as instructor and program director, Gray likes to demonstrate the importance of research and how it can improve the care her students will eventually provide future patients. She also shares her own research experiences and encourages students to contribute their clinical expertise to collaborative research projects. “The faculty at UT Southwestern assist students by guiding them through research projects that align with their both clinic and research interests,” says Gray.

“The faculty at UT Southwestern assist students by guiding research projects that align with both their clinic and research interests.”

MARCH 2020 | O&P ALMANAC

Leslie Gray, MEd, CPO, LPO, FAAOP, is the author or presenter of dozens of peer-reviewed articles and conference presentations. Some of her most impactful contributions include the following:

Leslie Gray, MEd, CPO, LPO, FAAOP, leads a presentation at the University of Texas Southwestern Medical Center in November 2019. Additionally, the School of Health Professions at UT Southwestern has a doctorate program in applied clinical research that is designed to provide research training in patient-oriented research and clinically relevant basic/ translational research for graduate-level healthcare professionals who hold a minimum of a master’s degree. While her academic, clinical, and research duties keep Gray busy, she enjoys exploring the great outdoors with her family during her off-hours. “My husband and I enjoy off-road biking with our 12-year-old daughter—we can’t call it mountain biking [given the terrain] in Dallas—and any activity that allows us to be outdoors,” she says. “Evening walks with my daughter are my most cherished times. I relax by cooking on Sundays, and I’m a three-time chili cookoff champion at my work.” Gray’s O&P clinical hand skills also come in handy at home. “I’m proud to say that I’m handy enough to work with my husband on our classic truck and tackle any home repair or remodeling project that comes our way,” she says. As she embarks on new research projects and works to better inform the profession and push for evidence-based care, Gray is coming much closer to answering the “Why?” in O&P.

• Rezazadeh, S., Quintero, D., Divekar, N., Reznick, E., Gray, L., Gregg, R. “A Phase Variable Approach for Improved Rhythmic and Nonrhythmic Control of a Powered Knee-Ankle Prosthesis,” IEEE Access, Vol. 7, pp. 109840-109855, 2019. DOI: 10.1109/access.2019.2933614. • Hurst, M. Gray, L. “Critically Appraised Topic (CAT): Clinical Considerations for 3D Printing Lower-Limb Sockets,” American Academy of Orthotists and Prosthetists, September 2019. • Hatler, K., Gray, L., Wilson, D. “Critically Appraised Topic (CAT): The Clinical Differences Between Carbon Fiber and Fiberglass Composite Prosthetic Feet,” American Academy of Orthotists and Prosthetists, 2018. • Quintero, D., Reznick, E., Lambert, D.J., Rezazadeh, S., Gray, L., Gregg, R. “Intuitive Clinician Control Interface for a Powered Knee-Ankle Prosthesis: A Case Study,” IEEE Journal of Translational Engineering in Health and Medicine, Vol. 6, pp. 1-9, 2018, Article No. 2600209. DOI: 10.1109/JTEHM.2018.2880199.

PHOTO: Leslie Gray, MEd, CPO, LPO, FAAOP

them through

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MEMBER SPOTLIGHT

College Park Industries

By DEBORAH CONN

Prosthetic Solutions Michigan manufacturer has refined and expanded its offerings over three decades

OLLEGE PARK INDUSTRIES

MARCH 2020 | O&P ALMANAC

James custom builds a Soleus foot to match a patient’s unique specifications.

College Park headquarters in Warren, Michigan

COMPANY: College Park Industries OWNERS: Privately held LOCATION: Warren, Michigan, with facilities in Mt. Clemens, Michigan, and Boston HISTORY: 32 years

Karen wears an Accent foot, featuring adjustable heel height.

is based in Boston,” explains Simpson. “Now all of our research efforts are conducted in that location.” Government grants are funding high-risk, high-reward technology research into such disparate areas as advanced prosthetics, moisture-wicking liners, and MEGI, a myoelectric gaming interface that trains patients to use upper-limb, powered prostheses. “Patients put a band on their residual limb and flex their muscles to control the game,” Simpson says. “They can play Team Sonic Racing and use different muscles to move the car in different ways. It’s a great tool for perfecting myoelectric control, and they can train before they even receive the powered limb.” Seven specialists are charged with the company’s marketing efforts, which include an active presence on Facebook, Twitter, LinkedIn, YouTube, and Instagram. “We aim our messages to both patients and prosthetists,” Simpson says. The College Park team will soon launch an end-user website called “I Am Rebuilt” that will

offer resources for the limb loss community. The company is expanding its outreach efforts, in part by working with Cosi Belloso, PT, a physical therapist who specializes in amputee care. Her CosiTalks, an online educational video series, discuss devices, including those from College Park, and other issues important to those with limb loss. College Park prioritizes education, offering training classes and continuing education credits for prosthetists, both online and in person. The company also sponsors several activities and organizations serving the amputee community, including the Range of Motion Project, which offers services to those without access to O&P care, and OPAF and the First Clinics. College Park has grown rapidly, says Simpson, drastically expanding product lines, sales, and its international presence in the last decade. She expects further growth fueled by the company’s commitment to innovation and continuous improvement. “Even products that have been around for a long time are continually improved, based on patient feedback and our engineers’ own ideas,” she says. “We plan to keep up the pace.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: College Park Industries

was established in 1988 on the foundation of its flagship product, the Trustep foot. “It was one of the first prosthetic feet to allow movement on all planes,” explains Laura Simpson, communications specialist at the company. “It provides nearly the same vertical motion, rotation, and stability as an anatomical foot, so it’s one of the most natural feeling prostheses.” Today, the Trustep—refined and improved over the past three decades—is among College Park’s product line of 14 prosthetic feet that range from the low-impact Celsus foot to the high-impact Soleus foot and innovative hydraulic feet, Odyssey K2 and Odyssey K3. The company also offers a prosthetic shoulder, a pneumatic and a friction-brake knee, and most recently, the Espire Elbow series, which consists of both mechanical and powered models. Although the company does not offer a blade-type foot, “we have Paralympic athletes training on our feet,” says Simpson. College Park is based in Warren, Michigan, where most of its 117 employees are located. All devices are manufactured there to meet customers’ specifications. An engineering facility in Mt. Clemens, Michigan, holds machining and office space, with about 15 engineers working to improve existing products and explore new ones. “In 2015, we acquired Liberating Technologies, which

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MEMBER SPOTLIGHT

Orthotic & Prosthetic Labs

Full-Service Facilities Five-location company features a dedicated prosthetics facility and in-house fabrication

LAINE DRYSDALE, CP, WAS

already familiar with the Orthotic & Prosthetic Labs (OP Labs) facility in Springfield, Massachusetts, when he and Jim Haas, CO, acquired it in 2008. Drysdale had been a patient there after losing his left leg below the knee in a motorcycle accident when he was a teenager. Drysdale trained first as a physical therapist, and after several years of practice, he realized he needed to continue his education in the field by getting his doctorate—or pursue a new path. He opted for the latter, attending the O&P program at nearby Newington, Connecticut, and becoming a certified prosthetist. Drysdale worked at OP Labs for a time and then, when the owner was ready to sell, he and Haas bought the business.

Blaine Drysdale, CP, with a patient

FACILITY: Orthotic & Prosthetic Labs OWNERS: Blaine Drysdale, CP, and Jim Haas, CO LOCATION: Springfield, Massachusetts, and surrounding areas HISTORY: 35 years

Drysdale works on a prosthesis at the Prosthetics Center in Springfield, Massachusetts.

MARCH 2020 | O&P ALMANAC

One of Drysdale’s lower-limb patients

and orthotics—in its second Springfield office. The practice has 20 employees across its five offices. The company recently hired a marketing specialist who will call on referral sources and manage OP Labs’ social media presence, including an active Facebook page. “We involve ourselves in the community by doing things like sponsoring golf tournaments, hosting a support group at the hospital, and donating shoes to homeless shelters,” says Drysdale. “I always felt like we could do more, but we are really busy working for our patients. That’s why we’ve added someone on staff to focus on these activities.” Being an amputee himself can be an advantage in his work, Drysdale says. “It’s easier to identify problems because I’ve experienced many of them. I can trial new devices and suspension systems before recommending them to patients,” he says. However, he sometimes waits to tell new patients about his own limb loss. “After we’ve been working together for a while, I’ll show them my leg and they realize how normal it is. Everyone has to grieve the loss, but when you see someone doing normal things with a prosthesis, it’s inspirational.” Drysdale’s goals for the future include increased use of advanced technology, including 3D printing, and faster deliveries. He is pleased with the success of OP Labs, and with his choice to become a prosthetist. “I love connecting with patients, and I love the combination of using technology and working with my hands. It’s great being there when someone takes a few steps and you know you helped make that happen.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Orthotic & Prosthetic Labs

OP Labs has five offices in Massachusetts: two in Springfield, and one each in Pittsfield and Northampton, and most recently, Worcester. Drysdale’s pride and joy, the Prosthetic Center, opened in 2018 in Springfield as a space dedicated entirely to prosthetics. The building had once housed a trolley manufacturing plant, offering plenty of room to renovate to the owners’ specifications.

“We have lots of windows and wide hallways, which are great for observing gait, and the main office is a communal space for prosthetists,” says Drysdale. Each of the facility’s prosthetists decorated his or her own treatment room, “which makes for a homey and welcoming atmosphere.” The Prosthetic Center includes a small museum of older prosthetic devices and trolley memorabilia, as well as a library. The waiting room features a large TV playing recorded testimonials and stories from patients. “We’re talking about having a movie night,” says Drysdale. “It could serve as an introduction to prosthetics for people who are facing that prospect.” Because of his background in physical therapy, Drysdale recognizes the value of home visits, and OP Labs owns a van equipped with power tools so that modifications can be made on site. “Losing a limb is overwhelming,” he says, “and our patients find it much more comfortable to be in their own homes for the first few visits.” OP Labs does all its own fabrication—both prosthetics

By DEBORAH CONN

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

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

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www.AOPAnet.org

AOPA NEWS

O&P Advocacy in the Trenches AOPA joins Amputee Coalition in supporting O&P patient-friendly legislation in Virginia At the request of the Virginia Orthotic & Prosthetic Association, AOPA staff joined the Amputee Coalition in late January to testify in front of the Labor and Commerce Subcommittee of the Virginia House of Delegates in support of HB 503. This bill, first introduced in 2019, would mandate health insurance coverage for mechanical, bionic prostheses that have a Medicare code under all Virginia state-regulated health plans. During the subcommittee meeting, AOPA testified that “the existing insurance fairness law has made it possible for Virginians living with limb loss and limb difference to receive care that would have otherwise been arbitrarily denied or capped, but it does not extend this guarantee of coverage to the most vulnerable individuals in our community. It also fails to secure access for patients to the most medically appropriate prosthetic devices for the restoration of mobility. Passage of this bill will rectify these shortcomings.” The AOPA representatives cited state studies, including those conducted in California, Colorado, and Maine, that demonstrate the addition of prosthetic coverage has a minimal impact on individual premiums but a tremendous impact on patients in need of prosthetic care. They also noted that many of the states with insurance fairness laws include coverage of prostheses with microprocessor and myoelectric technology. In addition, they referenced the RAND Corp. study “Economic Value of Advanced Transfemoral Prosthetics,” commissioned by AOPA, that confirms that microprocessor-controlled knees are associated with substantial improvements in physical function and reductions in incidences of falls and osteoarthritis compared to nonmicroprocessor-controlled knees. Following the hearing, the legislation was recommended to be continued to the next session, upon the recommendation that the Health Insurance Reform Commission continue to review the impacts of the bill, per its mandate. The Senate companion bill, SB 382, passed out of subcommittee and is now on the docket in the Senate Finance Committee. AOPA’s visit to the Virginia House of Delegates is just one example of the association’s extensive advocacy efforts on behalf of activities at the state and local level. 60

MARCH 2020 | O&P ALMANAC

Evaluating Contractor Operational Performance AOPA takes part in CMS listening session In late January, representatives from AOPA participated in a CMS listening session that was designed to receive provider feedback on the operational performance of Medicare administrative contractors (MACs). CMS Administrator Seema Verma introduced the session, which was moderated by Larry Young, director of the CMS Medicare Contractor Management Group. The 60-minute session provided a brief background on the roles and responsibilities of the MACs and a discussion of general MAC performance based on CMS metrics. The session then was opened to allow participants to provide feedback on opportunities for the MACs to improve their performance and enhance their interaction with providers. AOPA submitted written comments in advance of the listening session that encouraged CMS to fully implement the qualified provider provisions outlined in Section 427 of the Benefits Improvement and Protection Act of 2000 and allow the durable medical equipment (DME) MACs to incorporate those provisions into their claims processing activities. AOPA’s comments also encouraged CMS to provide clear instructions to the DME MACs regarding the inclusion of orthotists’ and prosthetists’ clinical notes as part of the patient’s medical record for medical review purposes. AOPA continues to support open dialogue with CMS and the DME MACs, with the goal of achieving fair and equitable treatment of O&P providers and ensuring that Medicare beneficiaries continue to have access to highquality, clinically appropriate orthotic and prosthetic care. Questions regarding this issue may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

AOPA NEWS

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

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

Webinars UPCOMING WEBINAR // UPCOMING WEBINAR // UPCOMING WEBINAR

WEDNESDAY

A Policy Review: LSO/TLSO

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

APR. 8

UPCOMING WEBINAR // UPCOMING WEBINAR // UPCOMING WEBINAR

WEDNESDAY

Social Media Mayday: Increase Your Footprint

Are you getting the best return from social media? The May 13 webinar, presented by Joy Burwell, AOPA’s director of communications and marketing, will provide you with tips and resources regarding which properties are best for your business and how you can better use them to reach your patients, your payors, your referral sources, and your community. Take part in this webinar—and make sure you are putting your best digital foot forward!

MAY 13

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

AOPA Co-OP

Co-OP

A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. This searchable database provides up-to-date information on developments in Medicare policy, state-specific legislation, private-payor updates, and more. Members can access detailed information on everything from modifiers to product-specific L codes and associated policies. Register for the next Co-OP Live Tutorial hosted by AOPA Director of Strategic Initiatives Ashlie White, who will demonstrate how to use the Co-OP and answer all of your questions. Any employee of an AOPA member firm is welcomed to join this free tutorial. Co-OP Live Tutorial Webinar • March 13 • April 17 Registration at bit.ly/Co-Op2020.

O&P ALMANAC | MARCH 2020

O&P PAC UPDATE

HE O&P PAC UPDATE provides information

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

SAVE THE DATE

• Steven Ehretsman • Don Foley • Martin McNab, CPO

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/aopapac. *Due to publishing deadlines this list was created on Feb. 3, 2020, and includes only donations and contributions made or received between Jan. 15 and Feb. 3, 2020. Any donations or contributions made or received on or after Feb. 3, 2020, will be published in a future issue of O&P Almanac.

MAY 5–6

WASHINGTON, DC HOST HOTEL:

RENAISSANCE ARLINGTON CAPITAL VIEW HOTEL 2800 S POTOMAC AVE ARLINGTON, VA 22202

YOUR CONNECTION TO EVERYTHING O&P

WWW.AOPANET.ORG

NEW MEMBERS

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of the American

Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

MARCH 2020 | O&P ALMANAC

Pacific Medical P&O 3120 Squalicum Parkway, No. 1 Bellingham, WA 98225 360/738-6032 Affiliate

Precision Prosthetics & Orthotics 12361 E. 17th Avenue Casper, WY 82609 307/237-3271 Patient-Care Facility

EMPOWERING HUMAN POTENTIAL Their lives are our purpose. Each year we help more than one million people regain their confidence, independence and quality of life. And we’ve been doing it for more than 155 years. All across the country, our team of unsurpassed clinical talent is growing. We’re looking for people who want to make a difference and help lead the future of orthotic and prosthetic care. Experienced clinicians who understand the power of combining clinical practice with scientific research. Experts in our field determined to mentor the next generation of O&P caregivers. Leaders committed to changing lives. Empower your career. Apply today and make a difference.

Hanger.com/Empower

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

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Certified Orthotist/Prosthetist

Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates

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

Pacific CPO Practice Manager

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

Member $482 $634

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

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

Nonmember $678 $830

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

North Central

Member Nonmember $85 $150

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

Northern California Spectrum Orthotics and Prosthetics is looking for a certified practitioner to manage facilities in Northern California. Previous management experience is preferred; however, all applicants will be considered. We are looking for an individual who is ready for an ownership opportunity. As a partner, you will not be compensated proportional to your experience. For perhaps the first time you will compensated based on your productivity. Your success could be limitless. If you believe in your ability to succeed in growing an already successful practice, I encourage you to respond to this ad. Spectrum is a multifacility O&P provider and has been in operation since 1994. Spectrum has offices located throughout Oregon and California. The offices are long standing in the communities with a good physician and patient following. Certification is required, with minimum of five to seven years of experience.

A large number of O&P Almanac readers view the digital issueâ&#x20AC;&#x201D; If youâ&#x20AC;&#x2122;re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

MARCH 2020 | O&P ALMANAC

Visit website: www.spectrumoandp.com For more information, contact: Forest Sexton by email at Forest@spectrumoandp.com.

CAREERS Pacific

Pacific

Certified Orthotist/Prosthetist

Certified Prosthetist Orthotist (CPO)

Alaska Work and Play in Alaska

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

Website: www.northo.com

Pacific Certified Orthotic/Prosthetic Technicians Alaska Work and Play in the Last Frontier

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

Website: www.northo.com

Idaho Brownfield’s Prosthetics & Orthotics is the premier provider of pediatric and adult prosthetics and orthotics in western-Idaho and eastern-Oregon. We are seeking a dynamic, detail-oriented, and highly motivated certified prosthetist orthotist (CPO) with a passion for helping the pediatric population to join our team. If you enjoy helping patients, and have a team-player mentality, we are interested in visiting with you about the practice opportunity. Benefits of working with Brownfield’s: • Work-Life Balance • In-House Fabrication • Competitive Salary • Opportunity for Growth • Full Range of Benefits Boise is consistently ranked one of the best small cities in America. Boise is at the crossroads of many activities, including skiing, biking, hiking, fishing, and camping. With the beautiful Boise River running through the heart of the city, a peaceful walk along the greenbelt may be all you need to unwind after a day at the office. If you are looking for an active community that values family life, then Boise may be the place for you. All interested candidates are encouraged to apply by submitting their resume to Nick Russell, Director of Operations of Brownfield’s Prosthetics & Orthotics. All inquiries will be held in strict confidence.

Contact: Email: nrussell@brownfieldstech.com

WANTED! A few good businesses for sale. Lloyds Capital Inc. has sold over 150 practices in the last 26 years. If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com O&P ALMANAC | MARCH 2020

MARKETPLACE

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

ALPS Silicone Pro Liner

The Original Preflexed Suspension Sleeve

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

Boston Brace 3D® The Boston Brace 3D® is our next innovation in the nonoperative treatment of idiopathic scoliosis. Our clinical experts, working with pediatric orthopedic surgeons, have combined their knowledge of the three-dimensional scoliosis curvature with the latest in shape capture and CAD/CAM technologies to develop a brace that provides higher in-brace correction without reducing adherence. Outstanding Outcomes The combination of in-brace curve reduction and adherence to wear schedules has shown in multiple studies to reduce the curve progression, and in some cases, actually improve the curve. To get these results for your patients, contact Jamie Benelli at 508/638-1175 or visit BostonOandP.com

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

Sutti Bounders Store & Return Energy— Mimicking Normal Muscle Function New “Sutti Bounders” modular pediatric dynamic elastomers are a patent pending elastomer technology that offer two progressive solutions. Sutti Bounders store and return energy - mimicking normal muscle function to produce both eccentric and concentric contractions and if needed, a ground reaction force. Smart and simple modular design, standardized sizes and three levels of performance to choose from add up to an easy to use expandable dynamic system to treat your pediatric and young adult patient base. For more information, visit www.fabtechsystems.com/ bounders or call 800/322-8324.

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

MARCH 2020 | O&P ALMANAC

MARKETPLACE Trautman Expansion Arbors from Fillauer Fillauer’s Trautman Expansion Arbors are designed to prevent the sanding cone from flying away. When the expansion arbor spins, it expands and applies pressure to the inside of the sanding sleeve—holding the sleeve on the arbor.

Features and benefits: • Provides a smoother grinding surface for straighter lines and higher quality finish • Eliminates grinding chatter that hard grinding surface gives • Available in three sizes and as a kit of three • Available in 1/2-13, 5/8-11 and M16 threads to fit most O&P machinery. For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com.

Fillauer’s Coneiak Mini Polishing Arbors

Fillauer’s Coneiak Mini Polishing Arbors are perfect for your pediatric fabrication needs. Use these with your Dremel or Trautman Carver to reach tight spaces and small edges. To order your 5-piece kit or individual arbor, contact Fillauer or your preferred O&P distributor today. For more information, contact Fillauer at 800/251-6398, 423/624-0946, or visit www.fillauer.com.

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

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

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

O&P ALMANAC | MARCH 2020

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

Agilium® Vantage Knee OA Brace From Ottobock Meet the Agilium Vantage, a low-profile, wraparound knee brace designed to provide lasting pain relief for patients with mild to moderate unicompartmental osteoarthritis. Key features: • Dynamic Y force strap system unloads the knee with a single pull • Adjustable, numbered closure straps for patient compliance • Trimmable sleeves reduce inventory to only three sizes. Give your patients less pain and more life with the Agilium Vantage. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

MARCH 2020 | O&P ALMANAC

PROTEOR USA Rush Rampage LP With an ongoing mission to improve the lives of amputees through innovation and product improvement, PROTEOR USA is proud to introduce the all-new RUSH RAMPAGE LP, RAMPAGE LP EVAQ8, and RAMPAGE LP H2O. The RUSH RAMPAGE LP features a similar, medium build-height profile as the RUSH LoPro and offers increased dynamic response and a higher patient weight limit, all while achieving an overall reduction in product weight. Discover the exciting PROTEOR USA product line today at proteorusa.com. #humanfirst

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

MARKETPLACE 2020 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HealthCare Common Procedure Coding System (HCPCS) code changes with an array of 2020 AOPA coding products. Ensure each member of your staff has a 2020 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

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

COMPLETE CONTROL

• 2020 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • 2020 Quick Coders: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

AD INDEX

Advertisers Index Company

Page Phone

Website

Allard USA

866/678-6548

www.allardusa.com

ALPS South LLC

800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics, & Pedorthics

703/886-7114

www.abcop.org

Amfit

31 800/356-3668

www.amfit.com

Boston Orthotics & Prosthetics

800/262-2235

www.bostonoandp.com

Cascade Dafo Inc.

800/848-7332

www.cascadedafo.com

ESP LLC

888/WEAR-ESP

www.wearesp.com

Fabtech Systems LLC

7, 53

800/FABTECH

www.fabtechsystems.com

Fillauer Companies Inc.

23, 51

800/251-6398

www.fillauer.com

Hanger Hersco

63 512/777-3814 1 800/301-8275

www.hanger.com www.hersco.com

Naked Prosthetics

888/977-6693

www.npdevices.com

Össur Americas Inc.

800/233-6263

www.ossur.com

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

27 855/450-7300

www.proteorusa.com

Surestep

19 877/462-0711

www.surestep.net

TurboMed Orthotics

www.turbomedorthotics.com

888/778-8726

O&P ALMANAC | MARCH 2020

CALENDAR additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

April 1

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

April 6–11

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

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

April 8

Cascade Dafo Institute

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

WEBINAR

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

April 17 WEBINAR

Co-OP Tutorial. For more information, visit www.AOPAnet.org.

April 23–25

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

2020

April 27–28

March 11 WEBINAR

visit www.AOPAnet.org.

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

Co-OP Tutorial. For more information, visit www.AOPAnet.org.

March 19–21

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

March 30 SEMINAR

www.AOPAnet.org.

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

May 5–6

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

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

April 1

ABC: Practitioner Residency Completion Deadline for Spring CPM Exams. All practitioner candidates have an 70

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

May 1

March 13 WEBINAR

SEMINAR

MARCH 2020 | O&P ALMANAC

May 13 WEBINAR

visit www.AOPAnet.org.

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

CALENDAR May 13–15

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

May 15–16

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

May 29–30

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

June 1

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

July 31–August 1

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

August 12

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

WEBINAR

www.AOPAnet.org.

September 2

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

September 9–12

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

October 3

June 8–13

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and technicians in 350 locations nationwide. Contact 703.836.7114; certification@abcop.org; www.abcop.org/certification.

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

June 19

Co-OP Tutorial. For more information, visit www.AOPAnet.org.

July 8 WEBINAR

visit www.AOPAnet.org.

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

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

November 4–6

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

November 11

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

Calendar Rates

October 14

WEBINAR

June 10

WEBINAR

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

WEBINAR

visit www.AOPAnet.org.

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

Let us share your next event! Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email ymazur@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

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Color Ad Special 1/4 page Ad

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O&P ALMANAC | MARCH 2020

STATE BY STATE

Several States Experience Reimbursement Issues for Cranial Orthoses Alabama, Illinois, Kansas, Montana, New Jersey, New Mexico, Oklahoma, and Texas report denial issues

In the February State by State, reimbursement-related issues related to cranial orthoses were reported as affecting five states associated with BlueCross BlueShield (BCBS) Health Care Service Corp. (HCSC), which incorporates BCBS organizations. Since then, the issues have expanded to include policies in additional states.

NEW FOR

2020!

EVERAL STATES ARE experiencing

issues with denials due to restrictive language in recently published policy updates for adjustable cranial orthoses for positional plagiocephaly and craniosynostoses. AOPA is aware of restrictive policy language in the following states: Alabama, Illinois, Kansas, Montana, New Jersey, New Mexico, Oklahoma, and Texas. Contradictions in the policy language are resulting in the inconsistent processing of claims and subsequent denials, which are unsupported by the scientific references cited in the policy.

MARCH 2020 | O&P ALMANAC

Major concerns include, but are not limited to, the following: • Absence of separate coverage criteria for both plagiocephaly (documented by asymmetry measurements) and brachycephaly (as documented by. the Cephalic Index). For plagiocephaly, a cranial orthosis is indicated as an appropriate intervention where asymmetry is substantiated by 12 mm or more in measurement of the cranial vault, skull base, or orbitotragial depth. We believe the wording of this policy inadvertently excludes access for patients with deformational plagiocephaly. • Inclusion of the requirement for physical therapy where the intervention is not indicated. Most policies reference physical therapy as an “example” of a conservative intervention, but, as worded, this policy requires it. However, physical therapy is only required (and is an added expense) if congenital muscular torticollis has been diagnosed as the etiology of the condition. AOPA has contacted each of these entities to formally request peer-to-peer discussions regarding

these policies with the appropriate individuals and AOPA medical directors. AOPA also has submitted a policy review request with HCSC. Additional advocacy efforts are underway. To learn more about these issues or to comment, email Ashlie White at awhite@AOPAnet.org.

Submit Your State News

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

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

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

We are looking for:

Submit your proposal for the American Orthotic and

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

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

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

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

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

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

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

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

www.AOPAnet.org

OUR COMMITMENT

We are committed to helping you foster better outcomes with unparalleled clinical support and prosthetic devices that change lives. Ottobock is a leader in innovation with products like bebionic®. Provide your patients with coordinated, worry-free control with up to 14 grip patterns. Because when your patients succeed, we have all reached our goals. We all move forward, together.

Advanced technology and precision control for your patients

YOUR GOAL

professionals.ottobockus.com Lina wearing bebionic with Myo Plus Pattern Recognition