Almanac OP The American Orthotic & Prosthetic Association
MARCH 2011
&
WWW.AOPANET.ORG
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
O&P PRACTICES
GO MOBILE
Expert advice for taking your practice on the road
HEALTH-CARE REFORM: What It Means for Your Practice How to File SUCCESSFUL Medicare Appeals
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O&P Almanac MARCH 2011, VOLUME 60, NO. 3
CONTENTS
DEPARTMENTS
COVER STORY
22 Going Mobile
By Jill Culora Providing mobility to patients is the mission of the O&P field, so it makes sense that some facilities may want to bring their services to patients. Practitioners who maintain mobile labs share the successes and challenges of being an O&P professional on the road.
4
AOPA Contact Page How to reach staff
8
At a Glance Statistics and O&P data
10
In the News Research, updates, and company announcements
40
AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
48
AOPA Membership Applications
50 Marketplace
Products and services for O&P
FEATURE
30 Health-Care Reform and O&P
By Deborah Conn The far-reaching Patient Protection and Affordable Care Act will affect Medicare, Medicaid, private insurers, health-care providers, practitioners, suppliers, and patients. But its effects on the O&P profession is still being discussed. AOPA and others offer their expertise.
COLUMNS
16
Reimbursement Page Tips on winning Medicare appeals
38
Ask the Expert Answers to your KX Modifier questions
58 Jobs
Opportunities for O&P professionals
64 Calendar
Upcoming meetings and events
70
Ad Index
72
AOPA Answers
Expert answers to your FAQs
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; e-mail: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, e-mail: dmather@mrvica.com. MARCH 2011 O&P ALMANAC
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OP Almanac
AOPA CONTACT INFORMATION
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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org
EXECUTIVE OFFICES
MEMBERSHIP AND MEETINGS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 ext. 26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com
Tom Wessel, director of business development, 651/724-8753, twessel@AOPAnet.org Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org
Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com
Ann Davis, office, meetings administrator, and associate editor, AOPA in Advance, 571/431-0876, adavis@AOPAnet.org
Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org
AOPA Bookstore: 571/431-0865
Ann Davis, staff writer, 571/431-0876, adavis@AOPAnet.org Teresa Tobat, editorial/production assistant, 703/914-9200 ext. 33, ttobat@strattonpublishing.com
Kathy Dodson, senior director of government affairs, 571/431-0810, kdodson@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org
Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION SERVING THE O&P FIELD FOR OVER 90 YEARS
Renew the Easy Way With AOPA ONLINE PAY Login to pay your dues and update your membership directory information at:
www.aopanetonline.org/profile
Renew Online Today! O&P ALMANAC MARCH 2011
EDITORIAL MANAGEMENT Stratton Publishing & Marketing Inc. ADVERTISING SALES M.J. Mrvica Associates Inc. DESIGN & PRODUCTION Marinoff Design LLC PRINTING United Litho Inc.
BOARD OF DIRECTORS OFFICERS President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, LLC, Houston, TX President-Elect Bert Harman, Otto Bock Health Care, Minneapolis, MN Vice President Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
GOVERNMENT AFFAIRS
Joe McTernan, director of reimbursement services, 571/431-0811, jmcternan@AOPAnet.org
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PUBLISHER Thomas F. Fise, JD
DIRECTORS Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Rick Fleetwood, MPA, Snell Prosthetic & Orthotic Laboratory, Little Rock, AR Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen Levis, Orthologix, LLC, Philadelphia, PA Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI
NEW! UPDATE MEMBERSHIP DIRECTORY INFORMATION ONLINE
Mahesh Mansukhani, MBA Ossur Americas, Aliso Viejo, CA Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2011 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
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At a Glance
Health Insurance Coverage in the United States Coverage decreasing…
Premiums increase…
Uninsured individuals by age group Uninsured at time of interview Children under 18 years
2008
2010
8.9% 7.4%
YEAR
Adults 18 to 64 years
19.4% 21.5%
Uninsured at least part of the year
12.6% 11.7%
Children under 18 years Adults 18 to 64 years Uninsured for more than a year Children under 18 years
Average Annual Premiums for Family Coverage
2000 2005
$6,438
$10,880
23.7% 26.2%
2010
$13,770
5.0% 4.6% 14.3% 16%
Adults 18 to 64 years
Source: Kaiser/HRET Survey of Employer-sponsored Health Benefits, 2005, 2000-2010
Source: Centers for Disease Control and Prevention, 2008, 2010
7.5 million
Number of children under 18 without health insurance in 2009.
58%
Percentage of covered workers enrolled in Preferred Provider Organizations from January through May 2010.
26%
Percentage of women between the ages of 18 to 24 without health insurance in 2009.
$899
Average annual premium paid by workers for single coverage in an employer-sponsored plan in 2010.
$31
Average co-payment for specialty-care services in 2010.
157 million
Number of nonelderly Americans covered under employer-provided health insurance in 2009.
Sources: U.S. Census Bureau’s Income, Poverty, and Health Insurance Coverage in the United States: 2009, Centers for Disease Control and Prevention, The Henry J. Kaiser Family Foundation, Employer Health Benefits 2010 Annual Survey 8
O&P ALMANAC MARCH 2011
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In the News
Global Orthotics Market to Reach $4.7 Billion by 2015 The increasingly aging population and the rising rate of obesity will contribute to a steady long- and shortterm growth in the global orthotics market, according to research by Global Industry Analysts Inc. Bolstered by the changing consumer profile, rising disposable incomes, increased insurance coverage, and public health programs across the world, the global orthotics market is projected to reach $4.7 billion by 2015. The United States orthotic market alone will reach $1.8 billion in the same time period. Other key market trends include: • Increase in device replacement frequency. The average device lasts
one to three years, which guarantees a steady demand for products. • Rise of musculoskeletal disorders. The number of knee, lower back, shoulder, spinal, wrist, and forearm injuries is growing at exponential rates. Rehabilitation, hospitalization, surgical, and post-operative care related to bone and soft-tissue problems cost billions of dollars annually. • Increasing rate of osteoporosis. As the elderly begin to comprise the largest segment of the population, osteoporosis cases will increase, creating a greater demand for external braces and other supportive devices.
Bone Strength Differs Between Ethnicities A new study shows that the bones of pre-menopausal Chinese-American women are far stronger than the bones of Caucasian-American women, according to Columbia Engineering and Columbia University Medical Center researchers. As a result, Chinese-American women have a markedly reduced risk of hip fracture. But the researchers aren’t sure why. “The major differences between Chinese-American women and Caucasian women elucidated in this paper may eventually help us understand the mechanisms by which hormones and other factors control skeletal microstructure,” says researcher John Bilezikian, MD.
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O&P ALMANAC MARCH 2011
Columbia engineering scientists used an Individual Trabeculae Segmentation (ITS), a 3-D imaging analysis technique, to examine the microstructure and strength of the trabecular, or spongy bone. Trabecular bone is the most frequent site of osteoporosis-related fractures. “We found in this research that Chinese-American women do not have the same risk of fracture as Caucasian women due to the plate-like structure of their bone, which offers mechanical advantages over the rod-like structure found in the bones of Caucasian women,” says X. Edward Guo, MD, and lead researcher. “If you look at a building made of walls, you can see
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that it is much stronger than a building made only of columns.” The most important factor when determining bone strength is the ratio of plate to rod in trabecular bone, says Columbia researcher X. Sherry Liu. “We found the plate-to-rod ratio of
TRANSITIONS
Bulow BioTech and Mending Limbs Organization have formed a partnership to assist amputees lacking adequate prosthetic coverage with funding and servicing of devices. Both companies also will raise awareness of the Amputee Coalition. Crutcheze has announced that The Orthopaedic Foot & Ankle Center (OFAC) Remarkable Feet Store, located in the Washington DC metropolitan area, is the newest dealer to join the Crutcheze family. It is the first comprehensive medical and teaching center in the region specializing in foot and ankle disorders. Eastern Michigan University Orthotics and Prosthetics 2011 class began its last semester with a trip to Ohio Willow Wood in Mount Sterling, Ohio. The two-day event included a manufacturing plant tour, seminars on casting and computer-aided design modification techniques, gel liner and elevated-vacuum use, and prosthetic foot selection.
O&P ALMANAC MARCH 2011
individual trabecular plates was significantly larger in the Chinese-American women versus the Caucasian women. Trabecular plates were 9 percent and 4 percent greater in thickness and 11 percent greater in surface area at the distal radius and tibia.”
BUSINESSES IN THE NEWS
Ability Prosthetics and Orthotics acquired BridgePoint Medical, a provider with four patient-care centers in Kentucky and North Carolina. Ability also acquired BPM Fabrication, a North Carolina fabrication facility, as part of the agreement.
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trabecular bone in Chinese-American women was twice that of Caucasian women (0.62 vs. 0.30). We also found the number of trabecular plates was significantly higher in Chinese-American women when compared to Caucasian women,” she explains. “The size of the
Fillauer LLC announces its collaboration with Rizzoli Ortopedia, S.P.A. Rizzoli Ortopedia was founded in the late 1800s in Bologna, Italy, and brings its incorporation of Italian design concepts from the sports car industry to the O&P industry. As part of the new agreement, Fillauer will bring Rizzoli Ortopedia’s REL-K microprocessor knee to market in the United States. The Fundación Prótesis Para la Vida (Prosthetics for Life Foundation) began the new year with a visit from Re:Motion Designs, California, which will field test its Jaipur knee with prototype pyramid component at the Foundation’s clinic in Ecuador. iWalk released preliminary test results conducted on its PowerFoot BiOM by the Center for the Intrepid at Brooke Army Medical Center at Fort Sam in Houston. Northern Prosthetics & Orthopedic, Inc. celebrated its 50th anniversary on March 1. OPAF and The First Clinics, founder of the First Volley Tennis Clinics, received a $10,000 grant from the United States Tennis Association philanthropic arm, USTA Serves.
OPAF also teamed up with the Orthotic Prosthetic Technologies of Austin to host a First Volley Adaptive Tennis Clinic at the Circle C Tennis Club in Austin. Snell Orthotics and Prosthetics celebrated its 100th anniversary serving O&P patients. To commemorate its century of service, Snell hosted a radio program at its Shreveport, Louisiana, facility on February 9. Thompson’s Custom Orthotics and Prosthetics in Spokane, Washington, completed construction of a new facility. The new building, a block from their previous location, more than doubles their space to accommodate the area’s growing service needs. Touch Bionics, has received a $3.8 million funding package from Clydesdale Bank. The deal will provide the Livingston, Scotlandbased company, with a range of banking facilities, including working capital, to support future growth and term loans. Wright & Filippis has reached a partnership agreement with Orthocare Innovations. The agreement grants Wright & Filippis, which manages 37 private clinics in the Midwest, access to Orthocare’s advanced practice technologies.
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In the News BOC Certification Application Process Goes Online
The Board of Certification/ Accreditation, International (BOC) board of directors voted to streamline its certification process— the first step in transitioning to an online application process. As a result of the vote, three major application process changes will be made:
• Certification candidates will no longer be required to create and submit a paper resume. • A checklist of experiential requirements will now be used instead of a narrative. • A system will be implemented to conduct random audits, verifying applicants’ experiential qualifications.
Stem Cells May Prevent Amputation in Diabetics A South Korean man who suffered from diabetes gangrene overcame the foot ulcer using stem cell therapy. This was announced during the International Cellular Muscular Medicine Society’s Annual International Congress on Regenerative and Cell Based Medicine Conference in November. Sun Rae Cho, 72, was diagnosed with diabetes in 1993 and had to
TRANSITIONS
PEOPLE IN THE NEWS
Anna Avakian, CPO and an ABC-accredited prosthetist and orthotist, has joined the SPS’ clinical staff as the director of Clinical and Technical Services. Recently, Avakian served as the lead prosthetist for the Hanger Ivan R. Sabel Foundation Clinic in Dachapelle, Haiti. Naveen Pawar has been hired as Freedom Innovations’ senior product manager.
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O&P ALMANAC MARCH 2011
wear an insulin pump. As a result, he suffered from toe swelling as well as large infected feet wounds. After doctors told Cho his foot had to be amputated, he traveled to China and Japan for infusions of 300 million stem cells into each foot. A mere 10 days after Cho’s infusion, he experienced a 70 to 80 percent improvement in his wounds and saw a 90 percent improvement 20 days later.
Kacy Moran Powers, CO, is now part of Orthologix’s pediatric orthotic team in Philadelphia. Leslie Pitt Schneider has been elected to the Amputee Coalition 2011 board of directors.
Neural Implants Key to MindControlled Prostheses? Researchers are examining neural implant failure and intend to use their findings to build a mind-controlled prosthetic device that works. Using a three-year, $5.4 million grant from the Defense Advanced Research Projects Agency, the University of Houston, Seattle Children’s Research Institute, the University of Michigan, Rensselaer Polytechnic Institute, and two other companies will collaborate on the project. Typically after neural implants are placed in the brain, the brain treats them like foreign objects and tries to isolate the implants as a way to protect itself. Once an implant has been isolated, usually in six to eight weeks, it stops working. Researchers at the University of Michigan will build specialized neural implants for use in a laboratory and Seattle Institute employees will take 3-D images of brain cells reacting to an implant. Houston researchers will examine the brain images and determine why the implant was rejected. Based on those findings, Michigan researchers will attempt to build a better neural implant. a
Hanger Prosthetics & Orthotics, a division of Hanger Orthopedic Group, has announced the following new employees: Chris Cumsille, BOCPD Aaron Drury, CO Mary Krchelich, CO Michael O’Sullivan, BOCO Robert Scheibmeir, C.Ped Charity Tracey, C.Ped
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Reimbursement Page By Joseph McTernan, AOPA government affairs department
Make the Most of Medicare Appeals Improve your bottom line by efficiently using the appeals process
T
he Medicare appeals process can be a source of frustration and anxiety, but it’s crucial for O&P practitioners to understand how it works and how best to use it. Not using the process efficiently could mean unnecessary loss of revenue and put financial pressure on your business. This month’s Reimbursement Page will provide a general outline of the Medicare appeals process and how you can best utilize it to improve cash flow and profitability. The first step is to understand the parts that make up the process. Technically, there are five levels of appeals available to Medicare providers, but most appeals are completed by the third level, a hearing before an administrative law judge. Let’s take a brief look at each of the appeal levels and what you should expect at each one: 1. REDETERMINATION. The first level of appeal is redetermination, which remains in the jurisdiction of the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) who originally denied the claim. Providers who are dissatisfied with an initial claim decision may file a request for redetermination within 120 days of receiving the initial determination. No minimum dollar amount is required to request a redetermination. The Centers for Medicare and Medicaid Services (CMS) has published a standard form that may be used to file a redetermination request with any of the four DME MACs. The form
16
O&P ALMANAC MARCH 2011
may be found at the following link: www.cms.gov/cmsforms/downloads/ CMS20027.pdf. 2. RECONSIDERATION. The second level of appeal, reconsideration, moves the claim out of the jurisdiction of the DME MAC. CMS has tasked River Trust Solutions Inc., to serve as the qualified independent contractor (QIC) responsible for all DMEPOS reconsideration requests. All such requests must be made within 180 days of receipt of the redetermination decision; the QIC must process all reconsiderations within 60 days of receipt. As with redetermination, no minimum dollar amount is required to request reconsideration. CMS has published a universal reconsideration request form that, like the redetermination request from, may be filed with any
of the four DME MACs. This form may be found at the following link: www.cms.gov/cmsforms/downloads/ CMS20033.pdf. 3. ALJ HEARING. A hearing before an administrative law judge (ALJ) is the third level of appeal. Administrative law judges are under the jurisdiction of the U.S. Department of Health and Human Services and will perform an independent review of the case based only on the information available during the redetermination and/or reconsideration. No new information may be submitted to support your claim once the appeal has reached an ALJ. A request for an ALJ hearing must be made within 60 days of the receipt of the reconsideration decision, and at least $130 must be in dispute.
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Now that you know the basics, let’s get down to strategy for winning appeals.
Strategy: Documentation
The vast majority of Medicare appeals go no further than the ALJ level. A universal form to request an ALJ hearing may be found at the following link: www. cms.gov/cmsforms/downloads/ CMS20034AB.pdf. 4. DAB REVIEW. The fourth level is review by the Departmental Appeals Board (DAB). While there is no minimum dollar amount required to request a DAB review, there must be evidence that the ALJ’s decision is not based within the limits of the laws governing the Medicare program. If the DAB rules that the ALJ properly interpreted applicable law, than the request for review will be denied. A
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O&P ALMANAC MARCH 2011
request for DAB review must be made within 60 days of receipt of the ALJ decision. 5. FEDERAL COURT REVIEW. The final level of appeal involves filing a civil lawsuit against the Medicare program in federal court. Because this is an official court proceeding, providers must be represented by legal counsel. In addition, a minimum of $1,260 must remain in dispute. A useful flowchart that describes all five levels of appeal available to you, as well as the time limits and minimum amount in controversy, may be found above and at the following link: www.cms. gov/OrgMedFFSAppeals/Downloads/ AppealsprocessflowchartAB.pdf.
The secret to a successful appeal begins the minute a patient walks into your facility. Of course, not every claim you submit will be denied, but the actions you take during your initial interaction with the patient may have significant impact should you decide to appeal denial of a claim. Bearing that in mind will instantly increase your chances of a successful appeal. The intake process is your first opportunity to evaluate your patient and begin formulating ideas about the best course of treatment for that patient’s needs. If the patient’s chart begins with a well-organized, relevant assessment of his or her pre-treatment condition, future documentation is more likely to be entered in a similar manner. While it is not the only option for creating documentation, the “SOAP” format is a commonly recognized and widely accepted method of documenting patient interactions. The format consists of four different entries for each patient interaction: Subjective, Objective, Assessment, and Plan: • Subjective information usually entails information reported by the patient, such as symptoms or concerns. • Objective information is usually measurable observations, such as patient weight, physical appearance, and overall condition. • Assessment is the practitioner’s evaluation of the subjective and objective information. • Plan outlines the treatment the practitioner intends to follow to address the patient’s needs. Well-written SOAP notes form the basis of a comprehensive patient chart that may give you the documentation you need to overturn a claim denial during the appeal process.
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Missing pieces of documentation can halt an appeal in its tracks. Medicare payment rules require that certain pieces of documentation must be in the possession of the supplier before a claim may be submitted to Medicare. The primary piece of mandatory documentation is a detailed written order from the referring physician. Without a compliant prescription, Medicare has the right to deny your claim regardless of what other documentation you may provide. Another piece of mandatory information that must be in the supplier’s file is a delivery acknowledgement. Without some form of proof that a completed device has been delivered, your claim and subsequent appeals may be denied. In addition, letters of medical necessity from the referring physician are not required for O&P claims, but they can certainly be useful in the appeals process. No appeal has ever been denied because of too much documentation.
Persistence is probably the best strategy you can use to win your appeal. Strategy: Modifiers In building a strong case for an appeal, make sure your initial claim provides as much information as possible. Correct use of modifiers is very important in order to avoid unnecessary claim denials, but is also very useful when a claim is denied and enters the appeal process. Payment modifiers are used to indicate specific information about the procedure codes submitted on the claim. Commonly used payment
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O&P ALMANAC MARCH 2011
modifiers include KX (indicates that specific required documentation exists in the provider’s records); functional level modifiers (required for prosthetic ankle, foot, and knee codes); and GA (indicates that a signed Advanced Beneficiary Notice is on file). Directional modifiers are used to indicate on which side of the body a device has been provided—LT for left, RT for right, and LTRT for bilateral application.
Additional Strategies Using the resources that you are given is another strategy that can help your appeal. CMS has published the forms to allow providers to organize their appeal in a consistent format and to provide information that is relevant to the claim in question. Failure to use these forms may put you at a disadvantage before the appeal process even begins. While you may submit additional material and information to support your claim along with the appeal form, it is highly recommended that you use the forms CMS has provided to present your appeal in a concise and organized manner. Finally, persistence is probably the best strategy you can use to win your appeal. Each level of appeal requires an independent review of the files that support your claim. Take advantage of the channels that are available to you, and don’t be afraid to take your argument to the next level. The QIC or the ALJ may well have an entirely different—and perhaps more favorable—opinion about the merits of your claim. Appealing claims may sometimes seem like more trouble than it’s worth, but it’s your right as a Medicare provider to disagree with and appeal claims that are denied. Preparing yourself properly for the appeal process should help you win favorable results as often as possible. a Joe McTernan is AOPA’s director of reimbursement services. Reach him at jmcternan@AOPAnet.org.
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O&P ALMANAC MARCH 2011
COVER STORY
Taking your practice on the road? Experts provide a road map for delivering O&P services away from your office
W
hen Tim Mertens, CO, decided to “go mobile” in offering orthotic services from his mobile van in 2008, he did it because he saw clear benefits for his patients. What he didn’t realize was that the unconventional venture would soon become a huge boost to his growing business, Trust Orthotic Technologies based in Omaha. “All of a sudden we were getting referrals from completely different regions,” says Mertens. “We were
reaching the whole surrounding regions of the clinics we were traveling to. We were building relationships with physical therapists and doctors, and this started driving new business for us.” But when Mertens tells people about his mobile orthotic lab, he typically gets one of two very different reactions. Some people see the need for mobility and are excited about it, and others ask, puzzlingly, “You leave your office?” Adding mobility to your practice involves equipping yourself with the
MARCH 2011 O&P ALMANAC
23
GOING MOBILE
Tips from
The Pros
• NEED. What percentage of patients do you currently see out of your office? Do you hope to increase this number? • BACK-UP STAFF. Do you have coverage at your office for days you are working remotely? Will you need coverage? • WORKING STYLE. Will working remotely suit your personality? Do you enjoy driving and seeing patients in different venues? Are you a hard worker? Are you naturally organized?
Photo: Thinkstock
Going mobile is a big undertaking, requiring careful planning. Those who are successful advise taking these factors into consideration:
means to carry the tools and supplies to deliver O&P services remotely, away from your office, in both rural and urban settings. It’s more than just making home, hospital, or clinic calls—it means making evaluations, deliveries, repairs, and adjustments using remote venues as treatment rooms without having to travel back and forth to the office lab for tools and supplies.
Tight Scheduling Mobile services also mean the practitioner, not the client, does the traveling—an aspect that some O&P professionals don’t think would be profitable. “It would look like that initially at a glance,” says Bernie Veldman, CO, Midwest Orthotic & Technology Center in South Bend, Indiana. “But on a good day on the road, I can see and have seen more than 30 patients. It is very possible to get extremely efficient once you get good at scheduling.” Veldman says he sees 60 to 70 percent of his patients outside his office. On a well-scheduled day, he will make two home visits before his first therapy clinic, where he sees eight to 10 patients. That’s followed by two more home visits before spending the afternoon at another therapy clinic, seeing another 10 to 12 patients. His last appointments might be two more home visits on his one- to two-hour drive home. He and his staff work four days a week to make up for their long days.
24
O&P ALMANAC MARCH 2011
“I might only be going to a clinic twice a month, so I try to pack two weeks’ worth of appointments into a single day,” he says. “Everything gets tightened up.” His staff carefully maps his route, so he travels in one direction extending in a 70-mile radius from his office. Most days are efficient but not all of them, says Jason Henry, MSPT, LO, a practice manager at Hope Orthotics in Spring, Texas, who uses a mobile lab. “But it is still something that you are providing as a service that other people aren’t providing,” he says, “so if you’re willing to do that, I think it strengthens your reputation and relationships with referral sources.” Henry sees one third of his patients away from the office, mostly within an hour’s drive north of his practice. “Every once in a while you get a call, and there’s a child who is really, really homebound and the parents can’t get anybody to come see their child, and they can’t get them into a clinic,” he says. “So those are days that you write off a big chunk of your day and just go take care of that child.”
The Good Practitioners who have taken their practice on the road list many advantages: • Access to therapy gyms. In these settings, practitioners work as a team with the therapist and patient. No more miscommunication via e-mails and voicemails means better
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GOING MOBILE
Tools of the Trade
Bernie Veldman, CO, has nine mobile labs in use and is building more.
His ML-5 mobile lab is a GMC Chevy 2500 three-quarter ton cargo van. Here’s a look at the tools he needs to get the job done.
5
4 2
1
3
MOBILE TOOLS (in the van’s cargo space):
7
26
O&P ALMANAC MARCH 2011
8
9
1. 2. 3. 4. 5. 6. 7.
Variable speed router with dust collection
8.
Laptop mount with swivel for laptop computer with wireless broadband
9.
Printer/Scanner/Copier
Bench-mounted vise Modified dust collection system Craftsman tool chest with hand tools Circulation HVAC fan Parts and extras bins GPS mapping software with GPS transceiver
Photos: Midwest Orthotic Services
6
outcomes for the patient. The team brainstorms together, which leads to more problem-solving options. • Better evaluations. “To be able to see patients and evaluate them in their environment, and be able to fit and make adjustments while they are wearing [the orthotic device] during physical therapy” are real pluses, says Mertens, who sees about 30 percent of his patients using his mobile lab. “There might be certain goals that the therapist is working on, and we can see them achieve those goals,” he says. • Fewer mistakes. “Orthotists who see patients at their office use phone calls and e-mails to communicate with physical therapists. Sometimes, when they are explaining something, it’s left to interpretation as to what you’re thinking the physical therapist said or the doctor said. That’s when mistakes are made. You weren’t on the same page,” Mertens says.
“To be able to see patients and evaluate them in their environment, and be able to fit and make adjustments while they are wearing [the orthotic device] during physical therapy” are real pluses. —TIM MERTENS, CO “But when you are together, you can show an example, and very few mistakes are made as far as communication because you are all there together. Everybody gets the orthotic that they would like the first time.” • Faster turnaround time on delivery. Fitting on the spot means no waiting for adjustments. Without a
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mobile lab, patients seen at clinics or hospitals could wait a week or two for an adjustment that might only take 10 minutes to do. • On-the-spot marketing. Show and tell of new and innovative equipment helps the decision process of both the therapist and O&P practitioner. • Expanded coverage area for your practice. With a mobile lab, you can reach more patients without incurring the cost of a satellite office. Plus, you are not locked into one area; you can spread in different directions. “You have the cost of the vehicle, but that’s nothing in comparison to the cost of all the overhead with a second office,” says Henry. “Also, you’re not taking a leap of faith and opening a second office in one place that you haven’t already been and developed some relationships.” • Stronger relationships, which lead to referrals. Veldman says
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27
GOING MOBILE
Busy Out of Office Day With Mobile Lab Round Trips Miles Drive Hours Cost of Gas Cost of Lost Time Total Cost Out of Office Call 1 100 2 20.83 600.00 620.83 # of Evaluations 10 0 0 0 0.00 0.00 0.00 # of Deliveries 8 0 0 0 0.00 0.00 0.00 # of Adjustments 6 0 0 0 0.00 0.00 0.00 TOTAL 1 100 2 20.833 600.00 $620.83
FAST FACTS Difference in $/Day =
$5,176.61 Cost of Mobile Lab =
Without Mobile Lab
$55,000
Round Trips Miles Hours Cost of Gas Cost of Lost Time Total Cost Out of Office Call 1 100 2 20.83 600.00 620.83 # of Evaluations 10 0 0 0 0.00 0.00 0.00 # of Deliveries 8 5.33 533.33 10.67 111.11 3200.00 3311.11 # of Adjustments 6 3 300 6 62.50 1800.00 1862.50 TOTAL 9.33 933.33 18.67 194.44 5600.00 $5794.44
SAVE 16 CLINICIAN HOURS by having a mobile lab. Clinicians can see more patients. This estimate is based on cost of gas and clinician time alone. It does not take into consideration the increased number of referrals and related increased revenue.
Money saved if 5 Days/Month =
$26,868.00/ Month Months until Cost of Van is Covered =
2 Months
Source: The AOPA Different Business Models Workgroup, Jim Kaiser, CP, LP, chairman.
90 percent of his referrals come from physical therapists, not from doctors. In addition, says Henry, “The therapists love [mobile lab visits] because they feel like they are more involved in the orthotic decisions.” Patients and parents see the teamwork and have more confidence in the system, which also leads to new referrals.
The Bad Despite these advantages, the approach is by no means perfect. Practitioners list these drawbacks to going mobile: • Communication challenges with staff. Just as communicating with physical therapists and doctors via phone and e-mail can be a challenge, communication with staff back at the office can be a struggle at times when working remotely because the practitioner is not physically there to show or point to something that’s being discussed. “It takes a little bit
28
O&P ALMANAC MARCH 2011
more effort to make sure things aren’t getting lost in the shuffle,” says Veldman. • Need for efficient scheduling. Working remotely makes efficient scheduling crucial. Practitioners suggest blocking certain days out for mobile lab work and having staff cluster appointments by geographical area. Time-saving measures include seeing several patients on the same day at the same site for follow-up fitting and evaluations. “Line them up just as you would do in the office,” says Mertens. • Need for organization. “It can be very difficult to keep it all organized,” says Henry. “Make sure that all the fabrication you need for a mobile clinic is ready and done before you go out. You need to coordinate with someone at the clinic really well about which children will be seen that day so that you have all the equipment you
need for that day. You really need to have all your ducks in a row.” • Possibility of missing walk-ins. At small practices, you might be the only practitioner, meaning that when you are away from the office there is no one to cover you for unscheduled patient visits. • No capacity for fabrication. Making the necessary device can’t be done from a mobile lab.
The Bottom Line The orthotic and prosthetic profession focuses on giving people mobility, yet going mobile in providing that service has yet to take off. “I don’t know if it’s a reluctance to do the remote practice because it is much harder work, or if it’s because they don’t want to spend the money on a mobile lab,” says Veldman. “I’ve got nine mobile labs, and I’m building three more.” Veldman is a strong advocate of mobile labs because he not only
uses them; he also makes and sells them. At a cost of about $50,000 fully equipped, a mobile lab is much less expensive than making out-of-office calls without a mobile lab or setting up satellite offices. With a mobile lab, there’s no monthly rent or utility and phone bills like you would pay for a satellite office you’ll only use part time. The mobile lab gives you a one-stop shop, proponents say, and will reduce the back-and-forth trips needed make adjustments and deliveries—a cost savings that can add up to thousands of dollars once you calculate the lost time spent making multiple trips without a mobile lab. “I cover an area that goes 60 miles in all directions,” says Veldman. “I would have to have four offices to cover those areas, which means four leases, and I will only be there part time in each office. But with the mobile lab, I buy one lab and I take it with me to the therapy clinics.” Mertens says implementing his mobile lab was expensive, but adds:
“It’s like buying anything else: You have to look at it for its lifetime, and that’s how I looked at it. I know that my business has picked up as a result of it.” Veldman developed the mobile lab concept in 2001 and built his first one using a towable trailer, which he soon realized wasn’t necessary because he could work just as well in the back of a van sitting down instead of standing. “I knew of other people who were doing exactly what I was doing, which was working out of the back of my car,” says Veldman. “I had a big hockey gear bag with all my tools in it, and I had a router I could clamp on a table somewhere in a therapy gym. Just working out of my trunk wasn’t a very professional way of doing it.” While suitable for both orthotics and prosthetic work, mobile labs are more commonly used by orthotists, and especially those treating children. “Working with children, physical therapists are really our eyes and ears, and I think it takes more teamwork between the therapist and orthotist to
achieve the goals that they’ve set out for the child,” says Mertens. “Adults can articulate their needs and goals. Children can’t. Plus children change so fast that you need the eyes and ears of the therapist.” Mobile labs have a lot to offer patients, physical therapists, and business owners, and for Henry, at least, his mobile lab has given a boost to his work life. “If I drive in the morning, it’s like a commute to the clinic, and if I’m parked there all day and see a lot of children throughout the day, and then drive home again, then that’s not any different than driving to your office,” he says. “I love my office, my staff, and working there, but I also love getting out and going to someone’s clinic and working with different therapists and meeting new people. I like being out and about.” a Jill Culora is a contributing writer to O&P Almanac. Reach her at jillculora@ gmail.com.
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29
Health-Care
R eform and O&P
Predicting the effects of new legislation on the profession is an educated guessing game BY DEBORAH CONN
30
O&P ALMANAC MARCH 2011
W
ith passage of the 900-page Patient Protection and Affordable Care Act (PPACA) in 2010, O&P practitioners want to know how the bill’s numerous provisions— many of which will be phased in over the next seven years—will impact their businesses. PPACA is far-reaching legislation that affects Medicare, Medicaid, private insurers, health-care providers, practitioners, suppliers, and patients—and nearly all employers and U.S. legal residents. It calls for an expanded federal role and fundamental changes to health insurance markets and regulatory structures. One of the most obvious changes is the expansion of coverage, according to a presentation by John Markus, JD, former vice president for compliance for HealthSouth and an expert on regulations impacting health-care delivery. In his talk “Healthcare Reform: The Big Picture” at the 2010 AOPA National Assembly in Orlando, he estimates that by 2019, an additional 31 million
people will be covered under commercial insurance plans and Medicaid. But whether that coverage will extend to O&P services and devices is still unknown. (AOPA members can watch the Markus presentation online at www.AOPAnetonline. org/education.)
Essential Benefits The language of the bill is intentionally broad, naming 10 categories—including “rehabilitative and habilitative services and devices”—that must be included in the package of essential benefits to be covered under the law. But it leaves the precise definition of those categories to the Department of Health and Human Services (HHS). What does “rehabilitative and habilitative services and devices” mean? That question is why AOPA is so engaged in assuring that the HHS includes O&P in regulations it is writing on defining the “essential health benefits.” Key questions are how prevalent O&P coverage is in typical employer plans and the cost of coverage.
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Key Effects
of Health-Care Reform Law on O&P • All U.S. citizens and legal residents required to have health insurance coverage by 2014. • All employers with an average of 50 or more full-time employees must provide health insurance coverage by 2014. • In 2010, 13 tax credits of up to 35% of cost of health care were available to small employers that cover at least 50% of premium costs for 25 or fewer full-time employees with average annual wages of $50,000 or less. The credit bumps up to 50% in 2014, with stipulations. • Benefits that took effect September 2010: No lifetime or annual limits on benefits although plans may place “restricted annual limits” on essential health benefits until Jan. 1, 2014; plans may impose limits on specific non-essential health benefits; no exclusions for pre-existing conditions for children under 19 and coverage must continue for children through age 25. • A 2.3% Medical Device Excise tax will be levied on medical devices sold in the United States after Dec. 31, 2012. Potential exemptions for O&P are being explored.
SOURCE: John Markus, JD, presentation “Healthcare Reform: The Big Picture” at the 2010 AOPA National Assembly in Orlando. AOPA members can watch the full presentation online at www.AOPAnetonline.org/education.
Where Are the Uninsured? HEALTH INSURANCE COVERAGE ESTIMATES Percent Uninsured, 2007
All Races, Under Age 65
Uninsured by County U.S. percent 17.1
State
MODEL-BASED ESTIMATES The data provided are indirect estimates produced by statistical model-based methods using sample survey, decennial census, and administrative data sources. The estimates contain error stemming from model error, sampling error, and nonsampling error.
29.2 to 49.5 22.6 to 29.1 17.1 to 22.5 13.7 to 17.0 6.6 to 13.6
Source: U.S. Census Bureau, Small Area Health Insurance Estimates (SAHIE) Program, July 2010
U.S. DEPARTMENT OF COMMERCE Economic and Statistics Administration U.S. Census Bureau
Source: U.S. Census Bureau, Small Area Health Insurance Estimates (SAHIE) Program, July 2010 32
O&P ALMANAC MARCH 2011
SAHIE07-1.3
At the request of HHS Secretary Kathleen Sebelius, the Institute of Medicine recently convened a committee to recommend processes and methods for the agency to define and update the essential benefits package. Peter W. Thomas, JD, general counsel of the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) and counsel to the O&P Alliance testified before the committee as to the meaning of rehabilitation. The committee is expected to deliver a report later this year, and then HHS will release proposed regulations defining the essential benefits package. The proposed regulations are subject to public comment, after which HHS will issue the final set of regulations.
Paying for Health-Care Bill Markus reported that the total price tag for the law includes $455 billion in cuts over 10 years in Medicare, Medicaid, and CHIP (the Children’s Health Insurance Program). Notably, $196 billion is to come from reductions in annual updates to Medicare fee-forservice rates, including payment freezes and productivity adjustments. “This is a huge price tag, and there is no doubt that it will almost certainly extract a significant toll in terms of decreasing our reimbursement over these years and as a result could jeopardize the ability of many practices to stay in business and to offer care to our patients,” says Tom Kirk, CEO of Hanger Orthopedic Group. According to Markus’ talk to AOPA, Congress significantly did not include a freeze or limitation in the Medicare consumer price index inflation update. But it did implement a new policy called the “productivity adjustment” that will likely have a negative impact on reimbursement. The theory is that increasing fee schedules by the amount of inflation will lead to continually rising prices, without recognizing that providers can become more efficient through better technology and economies of scale. The productivity adjustment will combine with the consumer price index for an overall increase or decrease. A CPI of 3 percent combined with a
productivity adjustment of -1 percent would result in a 2 percent increase in the fee schedule. With little or no inflation, as has recently been the case, the productivity adjustment could result in decreases in the fee schedule.
Tax Concerns Another provision of special interest to O&P is an excise tax of 2.3 percent on manufacturers of medical devices sold in the United States after Dec. 31, 2012. “Eyeglasses, contact lenses, and hearing aids are specifically listed as exempt from the device tax in Code section 4191(b),” notes Stephanie Kennan who is part of the AOPA lobbying team at Alston & Bird. “In addition, the Secretary is directed to exclude from the tax ‘any other medical device…of a type which is generally purchased by the general public at retail for individual use’. Code sec. 4191(b)(2)(D), the technical explanation of the device tax, provides further that devices qualify for the exception if the device is ‘generally designed and sold for individual use’.”
AOPA representatives, including both a manufacturer and patient-care facility member, met with IRS and Treasury Department officials February 10, 2011, to educate them about O&P and to explore possibilities to qualify for exemption from the tax. PPACA also calls for a tax on so-called “Cadillac” plans, or health insurance plans with particularly generous benefits, according to Markus. Effective in 2018, the legislation levies a 40 percent tax on the “excess amount” of plans with benefits above the threshold of $10,200 for single coverage and $27,200 for family coverage. The purpose of the tax is to rein in healthcare spending; typically, people with better benefits packages incur higher health expenses. The possible danger to the O&P field is that such plans could reduce or eliminate orthotics and prosthetics coverage in an effort to contain costs.
Settings for Care The new law calls for the Centers for Medicare and Medicaid Services (CMS)
The Pros and Cons of Health-Care Reform Law
+
Pros
✚✚ 30+ million more American will have health coverage in 2019. ✚✚ Insurance reforms reduce coverage and cost obstacles for people with disabilities. ✚✚ Further benefits if O&P expressly included in “essential health benefits.” ✚✚ Emphasis on outcomes improvement and “patientcentered” care.
–
Cons
Medicare reimbursement pressure caused by annual productivity adjustments. Medical device tax. “Pay or play” obligations for large employers. Some coverage reforms will not apply to large group or self-funded plans.
Source: John Markus, JD, presentation “Healthcare Reform: The Big Picture” at the 2010 AOPA National Assembly in Orlando. AOPA members can watch the full presentation online at www.AOPAnetonline.org/education. Markus is an attorney who specializes in regulatory compliance. If your company would like to explore engaging his assistance, he may be reached at 205/226-3402. 34
O&P ALMANAC MARCH 2011
to design a system of post-acute care bundling, a five-year pilot program set to begin in 2013. According to Markus, the system would bundle payments for inpatient hospitalization, physician services, outpatient hospital services, hospital readmissions, postacute services, and “other services the Secretary deems appropriate.” Episodes of care would start three days prior to a hospital admission and end 30 days following patient discharge. If an acute care hospital receives a lump sum payment to cover costs during the initial hospital stay and subsequent rehabilitation of O&P patients, Thomas suggests that bundling may delay “patient access to O&P care, until the 30-day payment bundle lapses and the practitioner is able to bill Medicare Part B directly for O&P services. This, of course, may occur unless the bundling program expressly prohibits this from occurring.” The impact on O&P of accountable care organizations (ACOs), which will be implemented Jan. 1, 2012, also is uncertain. The model calls for integrated systems of providers in which physician groups work more closely and in greater alignment with hospitals and other providers. Those that meet quality targets and reduce costs will share in Medicare savings. As with post-acute care bundling, the practical impact of ACOs is an offshoot of the old maxim “he who has the gold, rules.” According to Thomas, “In a partially capitated ACO, this same incentive will be counter-balanced by the ACOs interest in reducing reimbursement rates for providers within the ACO, resulting in lower margins for individual providers and perhaps lesser quality. Partially capitated ACOs hold much more concern for O&P providers than fee-for-service ACOs.” HHS has not yet issued proposed regulations for ACOs, so, as with many other provisions of the new law, O&P providers will have to wait and see. a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net.
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2011 AOPA POLICY FORUM April 11-12, 2011 • l’EnfAnt plAzA HotEl WAsHington, DC
The most effective O&P messenger is YOU! the annual AopA policy forum is your once a year opportunity for the orthotics and prosthetics community to tell the wonderful story of restoring our patients’ lives and hopes to legislators and their staffs. We need your participation in the 2011 AOPA Policy Forum! Health Care Reform is law and it is more important than ever to educate members of Congress on how orthotics and prosthetics restore lives. In addition to on the spot training on AOPA’s federal policy objectives, there will be briefings and training on critical state O&P issues, including parity, licensure, and Medicaid issues. This year’s Policy Forum subjects— •
What healthcare reform means to your business;
•
Federal parity and the Medicare O&P Improvements Act;
•
State licensure/parity initiatives;
•
Combating Medicaid reductions; and
•
How to jumpstart state-level initiatives.
2011 AOPA POLICY FORUM TENTATIVE SChEdULE: MonDAy, April 11
7:00 p.m. – 9:00 p.m. Dinner
11:00 AM – 3:00 p.m. registration open
tuEsDAy, April 12
1:00 p.m. – 5:30 p.m. policy forum general sessions
7:30 a.m. Attendee Breakfast and general session
5:30 p.m. fundraiser/reception
8:00 a.m. – 9:00 a.m. fundraiser Breakfast
6:30 p.m. – 7:00 p.m. Attendee reception
8:30 AM – 5:00 p.m. Congressional Appointments
NEW LOCATION! NEW AGENDA! NEW EXPERIENCE! Experience Washington as you’ve never experienced it before – at the L’Enfant Plaza Hotel, 480 L’Enfant Plaza SW, Washington, DC 20024. A five-minute Metro ride from the Capitol Dome, Senate and House Office buildings and all the magnificence of our nation’s capital.
register online: www.AOPAnet.org or call 571/431-0876 for details.
2011 AopA poliCy foruM The 2011 AopA policy forum will be held Monday, April 11 and tuesday, April 12 at the L’Enfant Plaza Hotel in Washington, DC—a five-minute Metro ride from the U.S. Capitol and the Senate and House office buildings. Beginning at 1:00 p.m. Monday, April 11th, this event will provide attendees with up-to-date briefings from key congressional lawmakers, the AOPA lobbying team, and other experts about critical issues confronting the O&P profession. Further information on how to use this information effectively in lobbying members of Congress will conclude the first day. the Monday evening reception and dinner will offer terrific networking and a further learning experience. The meeting will culminate on tuesday, April 12th, with advocacy visits with your elected representatives and their staffs on Capitol Hill. AOPA’s staff and lobbyists will schedule these meetings for you. In addition to intensive briefings on AOPA’s federal policy objectives, there will be extensive briefings and training on critical state O&P issues, including parity, licensure, and state Medicaid cuts.
registration fee The registration fee for the AOPA Policy Forum is $125 per person. Hotel reservations AOPA has reserved accommodations at the L’Enfant Plaza Hotel for your convenience. All hotel reservations must be made by attendees directly through the hotel by calling either 800/635-5065 or 202/484-1000. You must also indicate that you would like the AOPA room block to receive our preferred group rate of $249 per night for single/double occupancy. RESERVE EARLY, AS THE HOTEL WILL LIKELY SELL OUT OVER THE DATES OF THE POLICY FORUM. Please be sure your hotel reservation request reaches the L’Enfant Plaza Hotel prior to Monday, March 21, when any remaining rooms will be released. Since rates quoted here are on a space-available basis only, once the Policy Forum block of rooms is sold out, which may be earlier than March 21, 2011, there is no guarantee that rooms will be available or that they will be available at the preferred rate.
2011 AOPA POLICY FORUM L’ENFANT PLAzA hOTEL, WAShINgTON, dC APRIL 11-12, 2011
Registration Form (Please use one form for each attendee.) LAST NAME
FIRST NAME
TITLE / CREDENTIALS
CITY
STATE
ZIP
TELEPHONE
FAx
COMPANY
STREET ADDRESS
E-MAIL (FOR CONFIRMATION PURPOSES)
Home zip Code: (needed to locate your Congressional District) ____________________________________ registration fee:
Attendees are responsible for making their own hotel reservations. Call the L’Enfant Plaza Hotel at 800/635-5065 or 202/484-1000 and ask for the AOPA room block.
o Per Person: $125
payment options: o VISA o MasterCard
o AmEx
CREDIT CARD NUMBER
please check one: o I will be staying at the L’Enfant Plaza Hotel. o I will not be staying at the L’Enfant Plaza Hotel. (I will be staying at __________________________________________)
o Check ExP. DATE
fax registration form and payment information to: 571/431-0899 Or mail form with payment to AOPA Policy Forum, Dept. 34711, Alexandria, VA 22334.
NAME ON CARD (PLEASE PRINT)
SIgNATURE
special Accommodations required: o Yes o No (If Yes): ________________________________________________________
Questions? Registration, travel and/or hotel accommodations questions, contact us at 571/431-0876 or adavis@AOPAnet.org.
Have you attended the o&p policy forum or a legislative Conference in the past?
Policy Forum content or legislative questions, contact us at 571/431-0810 or kdodson@AOPAnet.org.
o Yes. If yes, how many? m 1 m 2 m 3 o No. This is my first Policy Forum.
Convenient online registration is available at
m 4
m 5+
www.AOPAnet.org
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Ask the Expert By Devon Bernard, AOPA government affairs department
Solving the KX Mystery Answers to your questions on this commonly misconstrued modifier One of the most overused and most misunderstood modifiers used with Medicare claims is the KX modifier, which should only be used for certain O&P claims. This installment of Ask the Expert will try to clear up some of the misconceptions about the KX modifier and help you understand when it should be used.
Q: A:
What is the KX modifier?
Briefly, KX means that all the proper documentation is on file to support the level of service you are providing. The KX indicates that the service being provided is medically necessary and is eligible as a Medicare benefit. The KX modifier also allows the DME MACs to perform automatic medical reviews of claims.
Q:
If the KX indicates that the proper documentation is on file, why don’t I include it on all claims?
A:
You should have all documentation on file to support the level of services you are providing, but the KX is not required for all claims. The answer is found in the full Medicare definition of the KX modifier: “The requirements specified in the medical policy have been met.” This means that if a medical policy has set forth special documentation criteria for billing, you must meet all the criteria in order to bill—that’s when you use the KX. Four O&P medical policies currently require the use of a KX modifier: AFO/ KAFO, KO, Orthopedic Shoes, and Therapeutic Shoes for Persons with Diabetes.
Q:
Must all the supporting documentation be physically in my files before I can add the KX modifier to the claim? 38
O&P ALMANAC MARCH 2011
A:
The answer is yes and no. It all depends on how the policies are written. Under the “Documentation Requirements” heading of the Local Coverage Determination (LCD) portion of the policy, there will typically be a statement that tells you when and how the KX modifier must be used. For example, in the KO policy under “Documentation Requirements,” you will find this sentence: “Suppliers must add a KX modifier … if all of the coverage criteria … have been met and evidence of such is retained in the supplier’s files.” This indicates that you must physically have the documentation supporting the use of the KX modifier in your files; if you don’t have this documentation, you may not attach the KX modifier. However, if you review the same section of the Therapeutic Shoes for Persons with Diabetes policy, you will not see such a statement. Instead, the policy specifies, “Suppliers must add a KX modifier … only if criteria in the Non-Medical Necessity Coverage and Payment Rules section of the related Policy Article have been met. This documentation must be available upon request.” This indicates that you don’t have to have all the supporting documentation in your files, but you must be able to provide it if it is requested. Bottom line: Even though a policy may state that you don’t have to have the supporting documentation in your files, it is still a wise idea to obtain
physical copies of any supporting documentation and place the copies in your files. This way you ensure that the documentation does exist and can be easily located if it is requested.
Q: A:
How do I appeal a claim that is missing the KX modifier?
If you realize a claim was rejected or denied due to medical necessity because you didn’t include the KX modifier, you do not need to go through the whole appeal process. In the past, the claim could be reopened over the phone or via fax to your local DME MAC. Reopening the claim allowed you to fix minor clerical errors, such as forgetting a modifier, and saved the time it would take to resubmit your claim. This is no longer the case. Since the DME MACs have enacted front-end edits to conduct medical reviews for claims that require the use of the KX modifier, your claim will most likely be rejected for missing information if
you didn’t include the modifier. This is especially true when the policy requires the presence of one of the following modifiers: KX, GA, or GY. Since the claim was rejected and not processed, you cannot reopen it; instead you must resubmit the claim with the KX modifier added.
Q:
How do I submit a claim when the item or service I am providing doesn’t meet the KX requirements?
A:
If the device you are providing doesn’t meet the policy guidelines for a KX modifier, the item may be denied as not medically necessary. Since the item is not medically necessary, you may have the patient sign an Advance Beneficiary Notice (ABN), and submit the claim with a GA modifier, if you issued a proper ABN. However, some policies indicate that if the item or service doesn’t meet the coverage criteria, it will be considered non-covered. If an item or service
is deemed non-covered, you should submit the claim with the GY modifier. Don’t simply add the KX modifier to your claims because you know or believe it will get your claim paid. This practice can be viewed as abuse and could eventually lead to fraudulent billing. Before using the KX modifier, make sure to review current medical policies to ensure that the specific policy criteria have been met and that the use of a KX modifier is required. If you still have questions about the proper use of the KX modifier, or any of the other modifiers used for Medicare claims, you may contact us at AOPA. You might also consider signing up for the March 9, 2011, AOPAversity audio conference, “Modifiers: Enhance Your Claim Two Letters at a Time.” a Devon Bernard is reimbursements manager for AOPA. Reach him at dbernard@aopanet.org.
W NE IGN S E D
MARCH 2011 O&P ALMANAC
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AOPA Headlines AOPA WORKING FOR YOU
Save the Date— Save Your Future Don’t miss the AOPA Policy Forum, April 11-12, 2011
S
ay hello to the new team in town. The 112th Congress welcomed 110 new players this year, and many different people are now in key decision-making roles affecting the O&P community. Those two facts add up to a convincing argument for putting aside your day-to-day business cares and investing a little time in preserving the long-term health and survival of high-quality O&P patient care—not to mention the future of your business. Your best chance of advancing that cause is by participating in the AOPA 2011 Policy Forum, April 11-12 at the L’Enfant Plaza Hotel in downtown Washington. A nearly 20 percent turnover in this Congress means a lot of opportunities to educate legislators about O&P. And the only effective way to do that is through the annual face-to-face meetings AOPA can arrange for members. Last year’s Policy Forum generated 230 opportunities to tell the O&P story to staff and members of Congress. It’s the O&P community’s once-a-year chance to put a face with a cause—the face of AOPA members.
What’s at Stake Issues of paramount importance at the federal level include legislation known as the Orthotic and Prosthetic Medicare Improvements Act. The bill was introduced in the last Congress by Shelley Berkley (D-Nevada) and will be reintroduced in the new Congress. By curbing fraud and abuse, the bill is projected to save a solid $250 million—and potentially much more. That’s good news to a savings-hungry Congress. Securing Republican backers for this legislation in the current Congress will be vital. Be part of the O&P Parity legislation that was introduced in the Senate during the last Congress by Sen. Tom Harkin (D-Iowa) and Sen. Olympia Snowe (R-Maine) and in the House by Rep. Rob Andrews (D-New Jersey). Efforts to reintroduce and reenergize this legislation in the new Congress are one of the key objectives of this year’s Policy Forum. Visits by AOPA members will pave the way. Be part of AOPA’s fight to have O&P exempted from the
40
O&P ALMANAC MARCH 2011
Medical Device Tax, as well as helping ensure that O&P is covered as part of the essential health benefits package. The forum kicks off Monday afternoon, April 11, 2011, at 1 p.m. (EST) with briefings on the legislative outlook for the new Congress, a review of tools that will help educate legislators and staff, and specific suggestions on making the face-to-face meeting more productive. Monday’s 6:30 p.m. reception and dinner will offer wonderful networking opportunities and a chance to exchange experiences in pursuing state and federal policy objectives. Then on Tuesday, April 12, a 7:30 a.m. breakfast will include a final briefing in preparation for the visits to Capitol Hill, which will begin at 8:30 a.m. Expanded time will be allotted to state issues, particularly the threats of Medicaid cuts now looming in several states. Former California Gov. Arnold Schwarzenegger was among the first to propose O&P Medicaid cuts. The threat has been turned back for the present in California, but there are no guarantees about the future. Arizona has actually passed a law limiting orthotic services to those 21 and under and denying funds for microprocessor prosthetics. Nevada’s former governor proposed O&P Medicaid cuts for those over 21, but the new governor reversed course. So, for the time being, Nevada may be off the hook. Medicaid cuts could pose threats in every state as budget deficits grow larger and larger. You’ll find out how to frame the message, hire a lobbyist, and mobilize the local O&P community. And you’ll learn how to use the array of advocacy tools AOPA has developed. These tools include talking point “leave behinds” for legislative visits, suggested letters to legislators, billboards, print ads, and editorial placements that can be customized to the specifics of your state. These cut proposals and other state issues are receiving intense focus by AOPA, including trying to identify key O&P leaders in each state who can be the eyes and ears for alerting AOPA to issues in their state harmful to O&P and help mobilize actions in the state by the O&P community.
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AOPA Headlines
These state reps will be invited to meet during the Policy Forum to exchange information and strategies. AOPA recently assisted Nevada members in pulling together an ad hoc coalition to raise money to hire a lobbyist and to develop a strategy to make sure O&P Medicaid cuts limiting services to those under 21 proposed by the state’s previous governor and rolled back by the new governor do not reappear.
Regulations to Watch But legislation isn’t the only game in town at the 2011 Policy Forum. Several threats on the regulatory front also may create problems for the O&P community. A recent FDA investigation attempted to characterize “central fabrication” at a patient care facility as a manufacturing activity covered by a multitude of differing Federal Food & Drug Administration (FDA) regulations. These regulations, if imposed, create a vastly expanded compliance burden. AOPA has developed a publication titled What To Do When the Investigator Calls which contains a roadmap for appropriate actions by patient-care facilities and manufacturers alike.
Regulations implementing the new health-care law will be written over the coming months and years, and public comment will provide a chance for input on proposed rules and regulations that will control who gets paid and how much. Learn how you and your colleagues can play a role in influencing how the regulations are written and applied. The L’Enfant Plaza Hotel, just a five-minute subway ride from the House Office Buildings, offers a $249 rate, which is extremely favorable for April in Washington. AOPA secured this rate for three nights in advance and one day following the Policy Forum. April is a wonderful time to enjoy Washington, so consider some family relaxation time as well. Register for the 2011 AOPA Policy Forum by going to www.AOPAnet.org and clicking on the Policy Forum tab on the left hand side of your screen. To reserve your rooms at the L’Enfant Plaza’s special $249 AOPA rate, call 800/6355065 and say you’re with the American Orthotic and Prosthetic Association’s Policy Forum. Don’t miss this opportunity to advocate for O&P care— and for your profession. a
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AOPA Headlines
AOPA Challenges State Reimbursement Policies On November 16, 2010, AOPA submitted comments to the Washington State Health Technology Assessment Program regarding the benefits of reimbursing claims for microprocessor-controlled prosthetics-lower limb and myoelectric (with processor) controlled prosthetics-upper limb. AOPA was alerted that the state was reviewing whether to alter reimbursements for those devices, quickly authored its response, and made itself available for further comment. AOPA argued that refusing to reimburse the devices
would be a disproportionately harmful action affecting a very small amputee population in the state. Paying for these devices is fiscally responsible because these devices give patients mobility and allow them to resume working. AOPA also made the case the benefits outweigh the costs because reimbursing O&P services means investing in a device, but the consequence of that treatment will be a gain in patient productivity (getting back to work, paying taxes, etc.) and the overall result will be a net positive when compared to the cost of paying for the device/treatment. This Washington state project was the latest in a series of ongoing AOPA initiatives to preserve O&P reimbursement by state governments. AOPA is currently working with O&P facilities in Arizona and Nevada on O&P Medicaid cuts prohibiting reimbursement for patients over age 21 in those states. Visit www.AOPAnet.org to read the entire document. If you have questions, please contact Kathy Dodson at kdodson@ AOPAnet.org or 571/431-0810.
AOPA Lobbies Against CMS Anti-Fraud Provisions The Centers for Medicare and Medicaid Services issued proposed regulations to implement anti-fraud provisions of the Patient Protection and Affordable Care Act. AOPA was dismayed by the proposed regulations because of their potential impact on O&P providers. The regulations would assign all DMEPOS providers to one of three risk categories. These categories include: 1. DMEPOS providers/companies that are publicly traded on the NYSE or NASDAQ would be considered limited risk. 2. Currently enrolled (revalidating) DMEPOS Medicare providers would be recognized as moderate risk. (The applicable date for these regulations for most currently enrolled providers would be March 23, 2012, although an earlier date of March 23, 2011, would apply for currently enrolled providers whose revalidation cycle results in revalidation between March 23, 2011, and March 23, 2012). 3. Recently enrolling suppliers and providers of DMEPOS and those opening new locations will be assigned to the high risk category. (Applicable date would be March 23, 2011.) All AOPA patient care facility members would be subject to assignment to one of these three risk categories, and the most extensive aspects of the rules would initially apply to all newly enrolling O&P patient care facility providers and those currently enrolled facilities opening new locations. 44
O&P ALMANAC MARCH 2011
AOPA’s legislative counsel, Alston & Bird, prepared a comprehensive summary of these regulations. AOPA has highlighted the portions that are of greatest significance to O&P care providers. CMS offered a period of time where people, businesses, and institutions could comment on the proposed regulations. AOPA sent its response to CMS prior to the November 16 deadline. AOPA argued several points including that the regulations should consider and recognize O&P licensure and/or accrediting bodies referenced in BIPA 2000 Section 427; that O&P suppliers who meet licensure/accrediting standards not be subject to the restrictions and burdens placed on “moderate risk” and “high risk” providers; that restrictions applied to O&P providers not impede O&P providers from being able to conduct business; and requesting that implementation be pushed to March 23, 2011, for new O&P facilities and March 23, 2012, for existing O&P facilities. AOPA also opposed the $500 application fee and requested further due process considerations for payments suspensions and compliance standards. AOPA will continue to keep members informed about the regulation-writing process and the rules that are ultimately adopted by CMS. Questions? Contact Kathy Dodson at kdodson@AOPAnet. org or 571/431-0810.
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networking and a further learning e culminate on tuesday, April 12th, w elected representatives and their staff and lobbyists will schedule these me intensive briefings on AOPA’s federa be extensive briefings and training including parity, licensure, and state M
AOPA Headlines
SAVE THE DATE! 2011 AOPA Policy Forum Scheduled The 112th Congress is in session and with a new Republican majority in the House comprised of many freshman legislators, ensuring patient care providers support O&P is critical. The 2011 AOPA Policy Forum will be from Monday, April 11 to Tuesday, April 12, 2011, in Washington DC. Members will be briefed on state and national legislative activities and prepped for in-person meetings with their congressional representatives. In 2010, AOPA secured more than 230 scheduled events, including constituent coffees, meetings with the healthcare staff of their House and Senate legislators, and meetings with representatives and senators. The cost of registration is $125 per person and AOPA has secured a room rate of $249 per night at the L’Enfant Plaza Hotel, a five-minute subway ride to Capitol Hill.
Re
The tentative schedule for the Policy Forum is as follows:
MONDAY, APRIL 11 11:00 am - 3:00 pm Registration Open (Please use one form for each attendee.) 1:00 - 5:00 pm Policy Forum General Sessions 5:30 pm Fundraiser/Reception NAME 6:30 pm ReceptionLAST and Dinner TUESDAY, APRIL 12 COMPANY 7:30 am Breakfast and General Session 8:00 am Fundraiser Breakfast STREET ADDRESS 8:30 am to 5:00 pm Hill Visits CITY
TELEPHONE
E-MAIL (FOR CONFIRMATION PURPOSES)
Home zip Code: (needed to locate your Co
____________________________________ registration fee: o Per Person: $125
AOPAudioversity: Making the Most of Medicare Modifiers Just two letters can make the difference between a claim payment or denial. Modifiers provide valuable information to Medicare and other payers that may help them make claim payment decisions. Join AOPA on Wednesday, March 9, 2011, at 1 pm ET for this valuable Audio Conference on Modifiers and how and when to use them. Discussion topics include: • using modifiers to communicate with payers • the difference between informational and payment modifiers
46
O&P ALMANAC MARCH 2011
•
potential issues caused by incorrect or omitted modifiers • Using modifiers to bill for upgrades. The cost of participating is always just $99 for members per line for AOPA members ($199 for non-members) and any number of employees may listen in on a given line. Listeners can earn 1.5 credits as long as they return the quiz within 30 days and receive a score of at least 80 percent correct. Register at www.AOPAnet.org. Contact Ann Davis at adavis@AOPAnet. org or 571/431-0876 with questions.
payment options: o VISA o MasterCard
o AmEx
CREDIT CARD NUMBER
ExP
NAME ON CARD (PLEASE PRINT)
SIgNATURE
special Accommodations required: o (If Yes): _____________________________
Have you attended the o&p policy for Conference in the past? o Yes. If yes, how many? m 1 m 2 m 3 o No. This is my first Policy Forum.
m
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AOPA Applications
The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million
Bio-Mechanical Composites Inc.
L.I.C. Prosthetics & Orthotics
1300 Keo Way Des Moines, IA 50309 515/720-6985 Fax: 515/244-5455 Category: Supplier Level 1
321 E. Center Street Anaheim, CA 92805 714/563-0056 Fax: 714/563-0074 Category: Patient Care Facility Frederick Randjbar, BOCPO
Bulow BioTech Prosthetics 3227 Sunset Blvd., Ste. 103 West Columbia, SC 29169 866/520-0244 Fax: 615/712-7264 Category: Affiliate Parent Company: Bulow BioTech Prosthetics, Nashville, TN
Bulow BioTech Prosthetics 100 Kenner Avenue Nashville, TN 37205 615/712-7261 Fax: 615/712-7264 Category: Patient Care Facility Mat Bulow, CP
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O&P ALMANAC MARCH 2011
Orthofeet 152A Veterans Drive Northvale, NJ 07647 201/767-6224 Fax: 201/767-6748 Category: Supplier Level 1
Pacific Medical P&O 6085 N. First Street, Ste. 102 Fresno, CA 93710 559/438-2745 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
1170 Olive Avenue Merced, CA 95348 209/722-2440 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
3001 L Street Sacramento, CA 95816 916/706-1520 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
609 E. Orangeburg, Ste. 102 Modesto, CA 95355 209/526-1721 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
95 Quinta Court Sacramento, CA 95823 916/689-7528 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
1335 Coffee Road, Ste. 210 Modesto, CA 95355 209/524-3113 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
1128 N.E. Second Street Corvallis, OR 97330 541/752-9034 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
4626 Willow Road, Ste. 102 Pleasanton, CA 94588 925/227-1306 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
87 Centennial Loop, Ste. 306 Eugene, OR 97401 541/743-0670 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
1760 Gold Street, Ste. 400 Redding, CA 96001 530/229-0351 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
2780 E. Barnett Road, Ste. 110 Medford, OR 97504 541/608-2478 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
1301 Secret Ravine, Ste. 100 Roseville, CA 95661 916/778-0530 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
2675 N.W. Thurman Street Portland, OR 97210 503/227-1636 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
Pacific Medical P&O
1523 N. Canal Blvd. Remond, OR 97756-1340 541/548-9980 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
969 Stevens Drive, Ste. 2B Richland, WA 99352 509/371-9660 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
317 S. 11th Avenue Yakima, WA 98902 509/469-9995 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Pacific Medical P&O
Pacific Medical P&O
600 N.W. Gilman Blvd. Issaquah, WA 98027 425/427-8900 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
601 Broadway, Dm #140 Seattle, WA 98122 206/386-2040 Category: Affiliate Parent Company: Pacific Medical Prosthetics & Orthotics, Tukwila, WA
Sunny Hills Prosthetic Services Inc. 332 E. Commonwealth Avenue Fullerton, CA 92832 714/738-4769 Fax: 714/871-4816 Category: Patient Care Facility Randy McFarland, CPO
Yale Surgical Company/ Yale Comfort Shoe Center 276 Mill Hill Road Bridgeport, CT 06604 203/372-7112 Fax: 203/338-8437 Category: Supplier Affiliate Parent Company: Yale Surgical-Yale Comfort Shoe, New Haven, CT a
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CUT-4-CUSTOM TLSO Allard USA incorporates their versatile 3D-Lite low temperature thermoplastic into a line of pre-cut TLSOs and LSOs, called Cut-4Custom (C4C). Front and back sections have straps pre-attached. Both sections are ready to be heated and custom molded to patients. Four heights to accommodate prescription and patient anatomy. 3D-Lite becomes soft and is ready to mold to patient contours in less than 10 minutes. This innovative material may be re-heated, flattened, and re-molded. It is aerated for breathability, lightweight, non-toxic and may be worn in the shower. For more information, call 888/6786548, email info@allardusa.com, or visit www.allardusa.com.
MT. EMEY MEDICAL COLLECTION SHOES This category of shoes is designed for hard-to-fit foot or one with larger orthotics needs. It offers a variety of closure for ease of fit adjustability. These shoes will accommodate mild or severe foot deformities, such as edema, charcot, bunion and RA, and are in stock for on-time delivery. Whether you need to order the custom orthotics only or with the great selections of Apis shoes, we offer great package deals. For more details, call our friendly CSRs at 888/937-2747.
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INTRODUCING THE VELOCITY FOOT FROM COLLEGE PARK Brand new for 2011! Delivering a lower profile, the Velocity’s coupled toe springs work together to provide a progressively smooth roll-over. It combines high functionality and no maintenance, with easy heel adjustment capabilities for fine-tuning. Special introductory price now through June 30, 2011. Key features include: • Smooth control from heel strike to toe off, throughout stance phase • Highly sophisticated dynamic response • Maintenance free design • Precision gait matched for out-ofthe-box performance • Weight limit up to 125 kg (275 lbs), three-year warranty • Same-day, custom built to order. For more information, call 800/7287950 or visit www.college-park.com
NEW FROM COMFORT PRODUCTS: SILVER LINER SHEATH™! Consistent with being the industry’s innovation leader, we are the first company to incorporate silver yarn into a sheath product. Embedded with X-Static® silver yarn, Comfort’s Silver Liner Sheath™ helps eliminate skin problems common to many liner wearers, including dermatitis, rashes, and odor. All without compromising suspension. The Silver Liner Sheath™ is compatible with all liners, as well as standard prosthetic socks. Prosthetic practitioners are advised to consider the Silver Liner Sheath™ for their patients. Comfort Products: the innovation leader in knitted orthotic and prosthetic products. For a FREE SAMPLE, please call 800/822-7500.
FILLAUER LLC ANNOUNCES THE U.S. LAUNCH OF THE RIZZOLI ORTOPEDIA REL-K® MICROPROCESSOR KNEE SYSTEM The REL-K® (Rizzoli Electronic Knee) is the latest generation of microprocessor knees that promises amputees the ability and freedom to navigate their environment simply and easily. With its innovative sensor system that samples angular position, velocity, and knee loads at 1,000 times per second, the REL-K® instantly works in concert with the patient and adjusts itself for optimum performance. Since the control system is located entirely in the knee, most foot and pylon combinations can be used. Unlike other systems that restrict ankle and foot combinations, the REL-K® is adaptable to a variety of systems. The knee’s composite frame was developed by Italian sports car designers for high-strength and cosmetic appeal. The hydraulic unit evolved from a design used in F1 racing for speed and accuracy of control. The REL-K® is rated for patients up to 220lbs/100kg. For more information contact Fillauer LLC at 800/251-6398 or visit www.fillauer.com.
NEW PROSTHETICS CATALOG FROM PEL SUPPLY PEL Supply Company, one of the nation’s largest independent wholesale distributors of O&P products, has released their comprehensive new Prosthetic Catalog. The catalog showcases more than 400 pages of prosthetic products, components, tools and accessories, including new products from hundreds of quality manufacturers, shown in clear, close-up photographs. Detailed product descriptions include specifications, options, measuring instructions, warranty and weight limit information and easy-to-follow ordering instructions and examples. And—in response to customer requests—this new catalog includes all of the items from the Tools and Fabrication catalog as well. Enclosed in a three-ring binder, the loose-leaf catalog is divided into 18 sections. There is an all-inclusive master index for quick reference, making it even easier for the busy practitioner to find the exact product needed. New PEL Helps Tab features PEL’s Focus Programs. These are products typically in stock in standard sizes. Also included are L-Code Reference Guides and a Conversion Chart. For those who prefer, the catalog is also available on CD, as well as online at www.pelsupply.com. To request your copy, contact your friendly PEL Supply Customer Service representative. Phone PEL at 800/321-1264, fax 800/222-6176 or e-mail customerservice@pelsupply.com. Registered users can order online at www.pelsupply.com.
MASTERFLEX COLOR
available in different thicknesses. But also in 15 different color variations which makes this material a novelty because as far as we know, Euro International is the first company with such a broad and vibrant color palette. • Masterflex Transparent and Masterflex Color applications • Inner shoe material • Waterproof splints • Metacarpus/forearm splints • Arm/foot prostheses • Peroneal/ankle/foot caps • Trial shoes • Trial prostheses for thigh amputations. For more information, call 800/3782480 or visit www.eurointl.com.
Euro International’s newest program addition is the Masterflex Color, a permanent elastic deep drawing sheeting material with high elasticity and dimensional stability which is
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NEW SPL2 CLINICAL TRIAL ORTHOSIS FROM FILLAUER LLC Fillauer is pleased to introduce the SPL2 Clinical Trial Orthosis. This innovative product allows the user the opportunity to wear and see the benefits of the Fillauer SPL2 Orthotic Knee Joint prior to purchase. The CTO is easily adjustable for a wide variety of body types and knee centers. Features of the SPL2 Clinical Trial Orthosis: • Four modes of operation • Easily adjustable knee center height parameters • Available in left and right • Ability for the clinician and patient candidate to “Try Before You Purchase” to achieve the best possible outcome for your patient. For more information, please contact Fillauer LLC customer service at 800/251-6398 or www.fillauer.com.
INTRODUCING KISS REPLACEMENT KITS! AVAILABLE IN BEIGE OR BLACK These kits are designed to replace key components, without the need to purchase a distal base! CMP32/A: Includes a velcro sewn placard, proximal nut and screw, proximal strap, and distal strap. CMP31/A: Includes an adhesive-ready placard, proximal nut and screw, proximal strap, and distal strap. For more information, contact KISS Technologies LLC at 410/663-KISS or visit www.kiss-suspension.com.
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NEW FROM MOTION CONTROL: NEW TRIAD PREAMP
Foot features a lightweight, durable composite keel with interchangeable anterior and posterior bumpers. The foot is offered in both endoskeletal and exoskeletal versions. For information, contact Ohio Willow Wood at 800/848-4930 or www.owwco. com.
MARCH PROMOTIONS—$100 OFF EZ STEP AND $50 OFF STEALTH TLSOs
• Three mounting options • Water-resistant case • High interference rejection • Gain adjustments on preamp • Compatible for use with: ✔✔ Utah Arm 3 & 3+ (kit: p/n 4050214) ✔✔ Utah Hybrid Arm (kit: p/n 4050214) ✔✔ ProControl Systems (kit: p/n 4050216) ✔✔ Otto Bock electrode cables. For more information call 888/6962767, e-mail info@UtahArm.com, or visit www.UtahArm.com.
LOW-ACTIVITY FOOT SOLUTIONS FROM OHIO WILLOW WOOD
For amputees requiring low-activity feet, Ohio Willow Wood offers its SACH foot with titanium pyramid and its Single Axis feet. The feet have lifelike, unisex cosmeses and patient weight limits of 250 lbs. The SACH foot with titanium pyramid is a durable foot suitable for endoskeletal or exoskeletal applications. By incorporating the titanium pyramid no additional foot bolt is required, saving time, money and weight. The Single-Axis
EZ Step discounted $100 until March 31. EZ Step Leather Ankle Gauntlet continues the pattern of innovation and excellence catered to your needs. The EZ Step’s custom fabrication combines incomparable comfort with unparalleled control, helping to make each step easier than the last. Stealth TLSO’s are discounted $50 through March 31. The Stealth TLSO provides motion restriction for the thoracic and lumbar regions. The posterior extends from the sacrococcygeal junction to the inferior of the scapular spine, wrapping around the trunk to provide lateral strength. These promotions apply to standard pricing and cannot be combined with any other discounts or promotions. Find out more about these and other products: call us at 888/982-8181 or visit us at www.optecusa.com.
IDENTIFY | INNOVATE | INDIVIDUALIZE CPIdeal is our pursuit of the ideal form, fit and function for each individual. We begin by identifying the critical needs of our customers, then create innovative designs to provide an ideal performance. Finally, each foot is custom built and shipped the same day to provide individualized solutions from thousands of possibilities. Delivering a lower profile, the Velocity’s coupled toe springs work together to provide a progressively smooth roll-over. Experience high functionality and no maintenance, with easy heel adjustment capabilities for fine-tuning.* You can trust College Park to create your patient’s CPIdeal.
individualized solutions. thousands of possibilities.
800.728.7950
I
www.college-park.com
*INTRODUCTORY OFFER. Call us today for more details and price savings. Mention Promo Code: ALMANAC-VL
NEW
FO R 2 0
VELOCI11 TY PROGR ES SIV SMOOT ELY H
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OPTEC USA AND OPGA PARTNER OPTEC USA has become an official supplier partner of the Orthotic R e a d y W h e n Yo u A r e . . . and Prosthetic Group of America (OPGA), Waterloo, Iowa. All OPGA members will receive a membership discount off of our full range of products. OPTEC offers a wide variety of spinal braces, as well as both custom and prefabricated orthotic and lower limb braces. We look forward to working with you as well as building our partnership with OPGA. Call us at 888/982-8181 or visit us at www.optecusa.com.
THE NEW PROPRIO FOOT® WITH EVO™ BY ÖSSUR: STABLE, SMOOTH, AND COMFORTABLE The newly redesigned PROPRIO FOOT with EVO utilizes intelligent ankle flexion to help users walk confidently and naturally without watching the ground, alleviating having to think about every step for fear of tripping and falling. It also features the exclusive EVO (Energy Vector Optimization) technology for improved dynamic response, enhanced comfort, and excellent stability throughout the gait cycle. The life-like ankle movement enables this foot to adjust for normal sitting and standing, and automatic alignment for adapting to various types of footwear. Suggested Medicare assigned billing code is L-5973. For more information call 800/2336263 or visit Össur at www.ossur.com.
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ÖSSUR’S ICEROSS DERMO® LOCKING LINER, NOW AVAILABLE IN A CONICAL PROFILE!
Transtibial patients with conicalshaped thighs can now enjoy an improved and more comfortable fit with Össur’s new Iceross Dermo Conical locking liner. This liner is perfect for low to moderate activity patients with vascular problems or sensitive skin, and is retrofitable with all Iceross 3 mm liners. Iceross Dermo Conical liner features vertical waves, which reduce proximal pressure, as well as horizontal waves at the knee for easier flexion. For more information, please call 800/233-6263 or visit our Web site at www.ossur.com.
THE LATEST INNOVATION IN FLEXIBLE SOCKET MATERIAL POLYTOL®—BACKED BY EXPERT FABRICATION A flexible socket made with Otto Bock’s breakthrough PolyTol® material contours to the body with exceptional, long-lasting elasticity. PolyTol is easy on your patient’s skin, with no irritating or allergenic components. The material offers good moisture absorption and skin adhesion for an intimate and comfortable fit. As the clinician, you also have the advantage of Otto Bock’s fabrication staff, experts who work with PolyTol every day and can give you just what you ordered, right when you need it, and at a cost with no surprises. To learn more, contact your sales representative at 800/328-4058 or visit us online at www.ottobockus.com.
Provel offers cost effective, fast, easy to use, and reliable O&P automation. The D2 digitizer, C7 carver, and T7 thermoformer are appropriate for small clinics as well as large central fab's. AOP file compatible and backed by a two year warranty. The D2 digitizer allows automated shape capture of prosthetic casts with unmatched accuracy. The C7 carver is not only fast and precise, its self contained dust collection system is extremely quiet. The T7 thermoformer consistently produces high quality thermoplastic sockets from industry standard preforms.
For more information visit www.provel.us or call 509.857.2009.
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HELIX3D: THE SHAPE OF THINGS TO COME The Helix3D Hip Joint takes advantage of a groundbreaking design to create a more natural, three-dimensional hip movement. Its polycentric design improves toe clearance and provides threedimensional movement that mimics the movement of the human pelvis. And the hydraulic provides greater stability every step of the way. The results for your patient are dramatic— greater stability and less compensatory movements to make every step more stable and confident. To find out more about how you can get your patients into Helix3D today, call 800/328-4058 or visit www.ottobockus.com.
PEL SUPPLY OFFERS FREE ALPHA® FLEX SLEEVE Purchase one Ohio Willow Wood Alpha Flex Sleeve and one Alpha Select Liner will receive a second Alpha Flex sleeve FREE from PEL Supply with order code PC-FLEX3 until July 1, 2011. Featuring a highly flexible fabric for greater comfort, flexibility and increased range of motion, the Alpha Flex Sleeve may be used with locking suspension, suction suspension or with LimbLogic™ VS for creating an airtight seal. It features a contoured polyurethane pad on the interior fabric cuff which covers the typical socket brim and helps reduce damage to the seal due to impacts in the brim area. Alpha Select Liner’s hybrid gel combines durability with comfort.
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Its flexible front panel allows for easy flexion without pulling or tightening at the knee. Progressive gel style provides extra distal cushioning and 2.5 mm gel behind knee and proximally. And, the locking version controls pistoning without a rigid distal matrix. For more information, contact the PEL Supply Company at 800/321-1264, fax 800/222-6176, or e-mail customer service@pelsupply.com. Order online at www.pelsupply.com
NEW ONE YEAR WARRANTY FOR DYNAMIC WALK SINGLE SIDE BY CENTRI® The Dynamic Walk Single Side Orthosis is a new AFO made of a lightweight moldable carbon fiber composite material. The open heel construction allows for optimal fit and comfort with various shoe types. The Dynamic Walk Single Side provides dorsi-assist with subtalar inversion and eversion control. This high activity design enables freedom of motion and allows for walking, running, and climbing stairs. Features include: • Easy donning and doffing • High strength • Fits easily into regular and narrow shoes • Flexible for multi-plane action • Enables athletic activity such as moderate running • Choose between PEEK rods on medial or lateral side. All Dynamic Walk models purchased in 2011 have a one-year warranty. For more information, contact Fillauer LLC at 800/251-6398 or Hosmer at 800/827-0070.
SPINAL TECHNOLOGY’S EXPERTISE IN LOWER LIMB TECHNOLOGY & PROSTHETICS Spinal Technology, Inc. takes its excellence in product quality and service and brings them to lower limb orthotics and prosthetics. With our unparalleled customer service, experienced technicians and certified orthotists, we offer custom-made lower extremity orthotics and prosthetics with emphasis on highquality craftsmanship. For more information on our lower limb products and prosthetics, call 800/253-7868, or e-mail us at info@ spinaltech.com.
SPS PROVIDES ICEROSS COMFORT® LINERS A classic solution for a multitude of patient conditions, the Iceross Comfort Liner is an exceptional liner for a host of amputees. It is particularly effective for those with residual limbs with bony prominences prone to pressure peaks and/or conical residual limbs. Iceross Comfort is designed with a stabilizing matrix, sizespecific distal attachment, and a nylon outer cover. The soft silicone relieves pressure and discomfort in sensitive areas, bony prominences, and/or scarred skin tissue. Iceross Comfort is available in a cushion, locking, and Wave option for the locking liner. For more information, please stop by SPS Tables Nos. 19-24 at the 2011 Academy Annual Meeting & Scientific Symposium or call SPS Customer Service at 800/767-7776, ext. 3. a
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INCREASE EXPOSURE AND SAVE!
Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.
Northeast Certified Prosthetist/Certified Prothetist/ Orthotist – Board Eligible We are an accredited, privately owned O&P facility with offices in Philadelphia and South Jersey and have an excellent reputation. We are seeking a self-motivated, skilled, and experienced practitioner with a strong clinical background who is patient oriented. Competitive salary and benefits package offered. Send resume to:
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific Use our map to find which region you fit into!
CLASSIFIED RATES Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, e-mail and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Non-member Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or e-mailed to srybicki@ AOPAnet.org., along with a VISA or MasterCard number, the name on the card and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. JOB BOARD RATES Visit the only online job Member Non-member board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140 Save 5 percent on O&P Almanac classified rates by placing your ad in both the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.
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Bill Penney Philadelphia Orthotics & Prosthetics Inc. 709 Somerdale Road Voorhees, NJ 08043 Phone: 856/428-4201 Fax: 856/428-4204
Certified Prosthetist Vermont Yankee Medical, providing orthotic and prosthetic services for over 64 years, is looking for a certified prosthetist ready to locate to Vermont. With five locations in some of the most scenic areas of the country, Yankee Medical offers a lifestyle that attracts professionals. Send resume to:
Attn: President Yankee Medical 276 North Avenue Burlington, VT 05401 E-mail: jnf@yankeemedical.com
Southeast
North Central
CPO Georgia An experienced CPO is needed for a well-established, ABC-accredited facility in Georgia. The individual must be licensed (or eligible) by the state of Georgia. This position is for three of our central-Georgia locations, and has opportunities for advancement. Benefits include full health insurance (including dental), life insurance, and a company-sponsored retirement plan. Send resume to:
C. H. Martin Company, est. 1912 Fax: 404/525-9819 www.chmartinco.com
Certified Prosthetist/Orthotist, Certified Orthotist, Board Certified Prosthetist Privately owned practice with a 50-year track record has an immediate opening in our large, Midwest facility. We’re looking for an orthotist or prosthetist who is good with patients, familiar with the latest technology, aggressive with patient care, and motivated to help us market our facility. We offer a competitive salary and health benefits. Send resume to:
E-mail: mhcbl@aol.com Fax: 317/858-3146
AVAILABLE POSITIONS Orthotist
Why do I work for Hanger?
“
I like working for a company that cares for its employees as much as they care for their patients. That’s why I’ve been with Hanger for the past 28 years. When Hurricane Katrina hit my hometown of New Orleans, Hanger was there for me. They gave me as much time as I needed—with pay—and helped me relocate to Atlanta. By working at the largest prosthetic and orthotic company in the nation, I have more than just career opportunities. I have an employer that treats me like family.
”
Tony Thaxton Jr., CPO, LPO, Certified Practitioner, Orthotist-Prosthetist
Torrance, CA Pensacola, FL Mt. Vernon, IL Urbana, IL Evansville, IN Michigan City, IN Paducah, KY
Duluth, MN Methuen, MA Milwaukee, WI Geneva, NY York, PA Spartanburg, SC Longview, WA
Orthotist/Prosthetist Albany, NY
Prosthetist Clearwater, FL Jackson, MS Port St. Lucie/Melbourne, FL Enid, OK Hays / Salina, KS Austin, TX
Prosthetist/Orthotist
Springfield, MO New York City, NY Akron, OH Bend, OR Lancaster, PA Houston, TX Paris, TX Olympia/Vancouver, WA
Little Rock, AR Lodi, CA Salinas, CA Denver, CO Thornton, CO Louisville, KY Baltimore, MD Meridian, MS
Certified Pedorthist
Stratford, CT Willoughby, OH Tahlequah, OK
To apply for any of these positions, visit www.hanger.com/careers
Tacoma/Renton, WA Parkersburg, WV
Orthotic Fitter Olympia/Vancouver, WA
Hanger Orthopedic Group, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any
other basis prohibited by federal, state or local law. Residency Program or Certificate Primary Education Program Info, contact: Robert S. Lin, CPO/Dir. of Academic Programs. Hanger P&O/ Newington O&P Systems, Ph. 860.667.5304; Fax 860.667.1719 MARCH 2011 O&P ALMANAC
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Certified Prosthetists, Board Eligible Orthotists, Board Eligible Prosthetists, Certified Pedorthists, Residents Illinois Immediate openings and excellent opportunities for independent, motivated, and ABC-certified practitioners for a well-established, multiple location O&P practice in Illinois. The ideal candidate will be ABC-certified and must be eligible for Illinois state licensure. We would also like to speak with candidates seeking residency in orthotics and prosthetics. Our fast paced, energetic atmosphere is a rewarding place to establish a great career. We offer a very competitive salary and benefits package commensurate with experience. If you have what it takes to be a part of a successful and well organized team then we would love to speak with you. Management experience is a plus! Multiple locations available. Forward your resume, in confidence, to:
Recruitment Manager Comprehensive Prosthetics & Orthotics, Inc. 741 W. Main Street Peoria, IL, 61606 Fax: 309/676-2279 E-mail: jim@cpousa.com
Pacific Certified Orthotist/Certified Prosthetist Orthotist California Do you want to work for an established, growing company in an environment that values clinical excellence, and work/life balance? Do you want to live in one of the most desired and diverse areas in the country, beautiful Southern California? SCOPe has a career opportunity for you. We are a leading orthotics and prosthetics company looking for an energetic and motivated CO and/or CPO to provide comprehensive assessment, treatment, and follow-up for our patients. SCOPe offers competitive salaries as well as an excellent benefits package for full-time employees. Salary is commensurate with experience. All communications will be held in the strictest confidence. Interested parties can send resumes via e-mail to:
Fax: 858/292-5496 E-mail: jobs@scop.net www.scop.net
Certified Orthotist
Michigan City, Indiana We invite you to join the family of the oldest orthotic and prosthetic patient care company in the world. If you are seeking a new start and want security, support and the benefits of the lastest technology, we need to talk! We offer a very competitive compensation and benefit package accompanied by Hanger’s famous Ed Fair, opportunities for growth, support of more than 1,000 practitioners and sales and marketing, a corporate office to support your HR, accounting, and real estate needs. If you possess excellent communication and patient care skills and are ready to make a change, we would love to discuss our needs in Michigan City! To apply for this position, please visit:
Northern California Do you dream of earning six figures? Receiving a significant sign-on bonus and working for the oldest and one of the most respected orthotic and prosthetic patient care companies in the world? Are you looking for security? In addition to the above, we offer competitive benefits, worldclass education fair, latest technology and a family of more than 1,000 practitioners in addition to the support of HR, sales/marketing, accounting, etc. Our core values are: • Integrity • Clinical and operational excellence • Unsurpassed customer satisfaction • Flexible and entrepreneurial operations • Creativity and innovation • Shared success. If you have the skills, drive, and ambition…let’s talk! Contact, in confidence:
www.hanger.com/careers
Sharon King E-mail: Sking@hanger.com
Certified Orthotist
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Jobs Pacific
Orthotic/Prosthetic Technician
Certified Prosthetist-Orthotist or Certified Prosthetist-Facility Manager
Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations. Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care. We prefer candidates who have completed Discover an Orthotic/Prosthetic Technician program Marshfield, and are ABC registered. Additionally Wisconsin & enjoy: on-the-job training combined with work • Low cost of living experience that includes all aspects • Clean, safe environment of fabrication and component assembly • Short commutes with of orthotic and prosthetic devices is low traffic volume • Excellent educational also preferred. opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package
Southern California Exceptional opportunity for a CPO/CP to manage our satellite office in California’s beautiful Santa Clarita Valley. Are you looking to grow your career and take on more responsibility? We are a well-established, multi-facility company with an immediate opening for an experienced practitioner (CPO or CP with orthotics experience) to run and grow our practice in Santa Clarita. This ABC-certified practitioner must be self-motivated, patient-oriented, and possess sound clinical, organizational, and interpersonal skills. Familiarity with OPIE software and chartless environment is a huge plus. A minimum of five years’ clinical experience is preferred. We offer a highly competitive salary, incentive program, and outstanding benefits package. If you are ready to take the next step in your career and relocate to one of the safest and most desirable places to live in the nation, please send your resume with cover letter to:
Join us and see how your career can shine. To apply, please visit:
www.marshfieldclinic.jobs Reference Job Number MC110034 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.
Valley Institute of Prosthetics and Orthotics Siri Khalsa, Administrator E-mail: skhalsa@vipoinc.com www.vipoinc.com
TO: FROM: DATE: RE: &
Renae Wesolowski & Barb Burr Cori Maki 1/18/2011 O&P Almanac
MFC011820-OPAlmanac.OPT O&P Almanac Published by the American Orthotic & Prosthetic Association
OP Almanac Online Ae Dt Zc
Bonus Circulation to the American Academy of Orthotists and Prosthetics (AAOP) Annual Meeting
Reading the O&P Almanac has never been easier!
March 2011
• Access advertiser Web sites by simply clicking on the hotlinks Inc. • Access content with the click of a mouse or the touch of a smart phone1/4 page (3.5” x 4.5”) • P h oEasily n e : 2 6e-mail 2 . 5 0 2 .your 0 5 0 7favorite F a x : 2articles 6 2 . 5 0 2 .to 0 5colleagues 08 • Save articles as PDFs! Space: $482.00 Go to www.AOPAnet.org, click on ‘O&P Almanac Online’ today!
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For more information, contact Steven Rybicki at 571/431-0835 or srybicki@AOPAnet.org. For advertising information, contact Dean Mather at 856/768-9360 or dmather@mrvica.com. Deadline
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62
O&P ALMANAC MARCH 2011
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Calendar
2011 ■■ MARCH 9 AOPA Audio Conference: “Enhance Your Claims Success, Two Letters at a Time.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org. ■■
PROMOTE EVENTS IN THE O&P ALMANAC
CALENDAR RATES Telephone and fax numbers, e-mail addresses and Web sites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Member Non-member Words Rate Rate 25 or less $40 $50 26-50 $50 $60 51+ $2.25 $3.00 per word per word Color Ad Special: 1/4 page Ad $482 1/2 page Ad $634
$678 $830
BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or e-mail srybicki@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor. Questions? E-mail srybicki@AOPAnet.org.
AOPA-sponsored activities appear in red.
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O&P ALMANAC MARCH 2011
■■ MARCH 9 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5:00 pm – 6:00 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ technology. Presenter Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ MARCH 16 Ohio Willow Wood: Alpha Liner Family: Selecting and Evaluating for Successful Patient Outcomes Manufacturer Workshop, 1:30 pm ET at 2011 Academy Annual Meeting. Orlando. Workshop curriculum includes case studies, features and benefits, and evaluation criteria to help choose the optimum liner for patients. ■■ MARCH 16–19 37th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663 ext. 208 or dragusa@oandp.org.
MARCH 22 Ultraflex: Adult UltraSafeStep™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ knee and ankle technology. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■
■■ MARCH 24 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ MARCH 28–APRIL 2 Association of Children’s Prosthetic-Orthotic Clinics 2011 Annual Meeting. Park City, UT. The Canyons. For more information, call 847/6981637, e-mail acpoc@aaos.org, or visit www.acpoc.org.
■■ APRIL 4-8 Applied Technology Institute (ATi) Orthotic Fitter School. Atlanta Galleria Doubletree Suites. Independent comprehensive course to prepare for certification exam. Approved entry level school by NCOPE (ABC), and BOC; and for continuing education by BOC and NATA. Contact Lois Meier at 888/265-6077 or lois@kasseledu.com or visit www.kasseledu.com. ■■ APRIL 5 Ohio Willow Wood: Discover LimbLogic® VS via WebEx, 10:30 am ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/ 2.0 BOC. To register online, visit www.owwco.com/webinar.php.
■■ APRIL 5 Ohio Willow Wood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use. Credits: 2.5 ABC/2.0 BOC. www.owwco.com/webinar.php. ■■ APRIL 6 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8:00 – 9:00 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, FAAOP, Call 800/2206670 or register at www. ultraflexsystems.com. ■■ APRIL 7 Ohio Willow Wood: LimbLogic® VS Applications Practitioner Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.0 BOC. Registration deadline: 3/17/2011. Contact: 877/665-5443. ■■ APRIL 7-9 Rehabilitation Institute of Chicago: Advances in Rehabilitation for the Patient with a Lower Extremity Amputation. Chicago. Approved for 17.50 ABC CEUs. Contact Melissa Kolski, 312/238-7731; www.ric.org/ education.
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Calendar
■■ APRIL 8 Ohio Willow Wood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting. Fabricate sockets following recommended techniques for airtight socket designs. Credits: 12.25 ABC/12.0 BOC. Registration deadline: 3/17/2011. Contact: 877/6655443. ■■ APRIL 11-12 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Garden Grove, CA. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending. Contact 888-678-6548; e-mail: info@allardusa.com.
APRIL 11-12 2011 AOPA Policy Forum. Washington DC, L’Enfant Plaza Hotel. To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org. ■■
■■ APRIL 13 AOPA Audio Conference: “Improving Clinical Documentation.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.
■■ APRIL 13 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5:00 pm – 6:00 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ technology. Presenter: Keith
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O&P ALMANAC MARCH 2011
Smith, CO, LO, FAAOP Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ APRIL 15 Ohio Orthotics and Prosthetics Association Annual Spring Meeting. Columbus, OH. Hilton Columbus. Contact Dianne Farabi at 614/659-0197 or dfarabi@columbus.rr.com.
APRIL 15–16 Ohio Chapter, American Academy of Orthotists and Prosthetists (AAOP) Annual Spring Technical Meeting. Columbus, OH. Hilton Columbus. Exhibits included. Contact Richard W. Butchko 614/659-0197 or butchko1@ columbus.rr.com. See Web site at www.ohiochapteraaop.com. ■■
■■ APRIL 21 Ultraflex: Adult UltraSafeStep™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ knee and ankle technology. Call 800/220-6670 or register at www.ultraflexsystems.com. ■■ APRIL 26 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Register at www. ultraflexsystems.com, 800/2206670. ■■ APRIL 27–29 New York State Chapter of AAOP Educational Program. Albany, NY. Albany Marriott Hotel. Contact Joann Marx, CPO at Marx4nysaaop@aol.com.
■■ MAY 6-7 The Northwest Chapter of the American Academy of Orthotists & Prosthetists. Seattle. The Bellevue Courtyard by Marriott Hotel. For information contact Tim Shride, CPO, LPO at 612/2030936 or nwaaop@gmail.com or visit www.regonline.com/ nwaaop_2011. ■■ MAY 11 AOPA Audio Conference: “Which Box to Check? The Negative Effect of the 855S on Reimbursement.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
■■ MAY 11-14 PA Academy of Orthotic & Prosthetics Spring Conference. Pittsburgh. Sheraton Station Square. Contact: Beth Cornelius or Joseph Carter at 814/455-5383. ■■ MAY 12-13 Ohio Willow Wood: Alpha Seminar. Mt. Sterling, OH. Course break-down the Alpha family of products, identifies best clinical applications of liners, discusses liners for vacuum suspension, and the latest in suspension systems. Includes brief review of TPE liner benefits and fitting assessment. Credits: TBD. Registration deadline: 4/21/2011. Contact: 877/6655443. ■■ MAY 12–14 Western and Midwestern Orthotic Prosthetic Association/California Orthotic and Prosthetic Association Annual Meeting. Reno, NV. (New) Peppermill Hotel. Contact Steve Colwell at 206/440-1811 or Sharon Gomez at 530/521-4541 or visit www.wamopa.com.
■■ JUNE 3–4 PrimeFare East Regional Scientific Symposium 2011. Nashville. Nashville Convention Center. Contact Jane Edwards at 888/388-5243. ■■ JUNE 6-7 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Little Rock, AR. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending. Contact 888/678-6548 or e-mail: info@allardusa.com. ■■ JUNE 8 AOPA Audio Conference: “Preventing Audit Disasters.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
■■ JUNE 9-10 Michigan Orthotics & Prosthetics Association (MOPA) Continuing Education Meeting. Mt. Pleasant, MI. Soaring Eagle Casino & Resort. Contact Mary Ellen Kitzman, 248/6150600, MOPA_meeting@mopa. info or visit www.mopa.info. ■■ JUNE 20-21 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Louisville, KY. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending. Contact 888/678-6548 or e-mail: info@allardusa.com.
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Calendar
2011 Advanced Lower Extremity Prosthetic Design Seminars APRIL 11-12
JUNE 13
APRIL 15
AUGUST 3
MAY 18
AUGUST 19
Chattanooga, TN Charlotte, NC
■■ SEPTEMBER 19–22 AOPA National Assembly. Las Vegas. Mirage Hotel. Exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/431-0852, or koneill@ AOPAnet.org.
Los Angeles, CA Baltimore, MD
Houston, TX
St. Louis, MO
JUNE 10
OCTOBER 12 AOPA Audio Conference: “Developing Your Medicare Billing Compliance Plan.” To register contact Ann Davis at 571/431-0876 or adavis@ AOPAnet.org. ■■
Campbell, CA
For more information regarding the seminars listed or to register, please contact Nicki Cantrell at 800-251-6398 or ncantrell@fillauer.com
■■ NOVEMBER 9 AOPA Audio Conference: “Happy Holidays: Kickbacks and Gifts in O&P.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org. AD309 02-02-11
JUNE 27-28 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Denver. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending. Contact 888/678-6548 or e-mail: info@allardusa.com. ■■
■■ JULY 13 AOPA Audio Conference: “Don’t Rile the OSHA Police.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
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O&P ALMANAC MARCH 2011
AUGUST 10 AOPA Audio Conference: “How to Get Paid for Miscellaneous and Repair Codes.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org. ■■
■■ SEPTEMBER 14 AOPA Audio Conference: “Don’t Run Afoul of the KO Rules.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
■■ DECEMBER 14 AOPA Audio Conference: “Are You Ready for the New Year? 2012 New Codes and Policies.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.
2012 ■■ MARCH 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, x 208 or dragusa@oandp.org.
2013 ■■ FEBRUARY 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x 208 or dragusa@oandp.org. a
We were with John. Every step of his way. JOHN KENNEY, BOCO John is one of the many BOC-certified practitioners making a difference to their patients and their profession every day.
Background: Bachelor’s degree from The University of California, Santa Cruz. Master’s degree from The University of Hawaii. More than 20 years as a healthcare executive. Achievements: Holds seven U.S. patents for orthotic devices that have benefited ten of thousands of patients. Impact: In 2010, more than 1,000 practitioners attended John’s educational courses on contracture management and rehabilitating knee braces. Service: Past Chairman of the Region D Medicare Advisory Committee; member of the BOC Board of Directors.
“
I would not be a practicing clinician and Vice President of Ongoing Care Solutions/NeuroFlex if it were not for BOC. The next few years will be critical for O&P, and I am excited about BOC’s expanding role in the O&P community.
”
BOC is proud to have walked alongside John in his career. We are here to support you in your journey, too.
BOCinternational.org/profiles
O&P Certification
877.776.2200 | 410.581.6222
DMEPOS Accreditation
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Ad Index
COMPANY
PAGE
PHONE
WEB SITE OR E-MAIL
Advanced O&P Solutions Allard USA Inc. ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics Apis Footwear Arizona AFO The Bremer Group BOC International Cascade Dafo College Park Industries Inc. DAW Industries Dr. Comfort Dycor Euro International Ferrier Coupler Inc. Fillauer Companies Inc. KISS Technologies LLC KNIT-RITE Med Spec Motion Control Ohio Willow Wood OPTEC Orthomerica Products Ossur® Americas Inc. Otto Bock HealthCare PEL Supply Company Spinal Technology Inc. SPS Texas Assistive Devices LLC AOPA PRESENTS
29, 51 55 19, 71
866/914-AOPS 888/678-6548 800/574-5426
www.aopsolutions.com www.allardusa.com www.easyliner.com
33 703/836-7114 25, 63 888/937-2747 45 877/780-8382 9 800/428-2304 69 877/776-2200 27 800/848-7332 53 800/728-7950 1, 57 800/252-2828 5, C3 800/556-5572 29 800/794-6099 15 800/378-2480 49 800/437-8597 21, 65 800/251-6398 35, 67 410/663-5477 2, 31 800/821-3094 39 800/582-4040 61 888/696-2767 Insert 800/848-4930 6, 7 888/982-8181 47 800/446-6770 41, C4 800/233-6263 C2 800/328-4058 43 800/321-1264 11 800/253-7868 17 800/767-7776 Ext. 3 13 800/532-6840
www.abcop.org www.bigwideshoes.com www.arizonaafo.com www.bremergroup.com www.bocinternational.org www.cascadedafo.com www.college-park.com www.daw-usa.com www.drcomfortdpm.com www.dycormfg.com www.eurointl.com www.ferrier.coupler.com www.fillauercompanies.com www.kiss-suspension.com www.knitrite.com www.medspec.com www.utaharm.com www.owwco.com www.optecusa.com www.orthomerica.com www.ossur.com www.ottobockus.com www.pelsupply.com www.spinaltech.com www.spsco.com www.n-abler.org
Expert Coding Advice 24/7 at www.LCodeSearch.com
> > >
The O&P coding expertise you’ve come to rely on is now available whenver you need it. Match products to L codes and manufacturers— anywhere you connect to the Internet. This exclusive service is available only for AOPA members.
Log onto LCodeSearch.com and get started today.
Not an AOPA member?
GET CONNECTED 70
Contact Michael Chapman at (571) 431-0876, ext. 293 or mchapman@AOPAnet.org.
O&P ALMANAC MARCH 2011
Manufacturers: Get your products in front of AOPA members!
E FlexCLushion iner EZ xtreme
Liner & Sleeve
Providing Practical more Magic of what you Hardly just a pretty face,the EZ Flex Liner want and need!
delivers unequaled function without sacrificing anything.
Extreme Advantage-Indicated for Transfemoral Unified Flexible Front OR
ACTIVE Transtibial amputees; The unique fabric on the Reduce on-hand anterior surface inventory provides cost and space stretch requirements through unlimited over the application on either TT or TF patella for greater elasticity amputees. while reducing pressure on the knee and the amount of energy required to flex the knee
Extreme Contact-- 80% Less Vertical Stretch 80% Less Vertical Stretch As compared to other Alps Posteriorly gel liners, resulting in As compared to other Alps gel demonstratively increased liners, virtually eliminating contact while stabilizing pistoning minimizing movementwhile of redundant tissue. bunching behind the knee during flexion
Medial view of the knee in flexion demonstrates the greater elasticity of the anterior fabric to extend over the front of the knee. Paring it with the limited vertical stretch posterior fabric reduces the overall effort expended by the amputee to bend the knee and increases comfort. Alps New Extreme Cushion Liner has limited vertical stretch to reduce movement of redundant tissue. Use appropriate for TT or TF Alps New EZ Flex Liner applications. (anterior view shown above) is available in 3mm or 6mm Uniform thicknesses. Eight sizes fit circumferences of 16 cm to 44 cm.
support the residual limb and Antioxidants in EZ Gel help sensitivethe tissues. protect skin from damage caused by free radicals.
ALPS EZGel is perfect for those Extreme Versatility--
with poor skin characteristics Cushion linertissues. available in 3 mm or sensitive or 6mm Uniform profile to fit circumferences ranging from 1653 cm. Sleeve available in 3mm Budget Friendly-or 6mm sizeson20the - 70 cm. No otherinliner market Alps New Extreme Sleeve seals against the skin without restricting circulation or causing shear forces. ALPS GripGel helps prevent the sleeve from rolling down the patient’s limb.
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AOPA Answers
Lower Limb Amputee Care Members ask questions about reimbursements and functional classification rules AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, e-mail Editor Josephine Rossi at jrossi@strattonpublishing.com.
Q:
We just completed the fabrication of a lower limb prosthesis, but when we called the patient to schedule delivery, we were informed that the patient passed away. Are we able to bill Medicare for the prosthesis?
A:
Chapter 15, section 20.3, of the Medicare Benefit Policy Manual addresses the billing of custom artificial limbs and braces that are fabricated but cannot be delivered due to patient death, a change in patient condition that no longer warrants the need for the item, or cancellation of the order by the beneficiary. In this situation, because the patient passed away, you may bill Medicare for the prosthesis using the date of death as your date of service. Since the prosthesis was not delivered to the patient, you should not bill for any components that were not customized for the individual needs of the patient. These components may be returned to stock and considered new because they were never delivered.
[ 72
SAVE THE DATE SEPTEMBER 19-22, 2011
O&P ALMANAC MARCH 2011
]
Q:
I have heard that functional level restrictions do not apply to bilateral amputees. Is it true that a bilateral amputee can have any prosthetic componentry they want?
A:
The Medicare Lower Limb Prosthetic Policy states the following: “It is recognized, within the functional classification hierarchy, that bilateral amputees often cannot be strictly bound by functional level classifications.” While this statement recognizes that there may be individual circumstances where a bilateral amputee may have a clinical need for componentry that exceeds his or her functional level assessment, bilateral amputees still have limits on the type of prosthesis Medicare will pay for. Bilateral amputees must undergo a functional level assessment and in most cases, will only qualify for prosthetic components within their functional level classification. If there is a specific clinical need for prosthetic components that exceed the patient’s functional level classification, the need must be well documented and supported by information in the patient’s medical records. a
For more information, visit our Web site at www.AOPAnet.org.
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A Family of Comfort.
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Over ½” of total vertical travel
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EVO™ promotes smoother rollover and a more fluid gait Improves stability when walking or standing
“As a prosthetic technician and amputee, I’ve tried a lot of different feet. Re-Flex Rotate is the lightest-feeling foot with shock absorption and rotation that I have ever worn. It’s smooth and comfortable, whatever the activity.” — Kenny Buford, 41
CALL (800) 233-6263 OR VISIT OSSUR.COM TO LEARN MORE.
©2010 Ossur. All rights reserved. Össur is a registered trademarks of Össur. Re-Flex Rotate and EVO are trademarks of Össur.