April 2020 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

AP R I L 2020

Two-Stage Rollout for Prior Authorization of Prostheses P.18

Interpreters and Aids for Hard-of-Hearing Patients P.36

Investigating Orthopedic Problems Associated With Limb Loss P.40

Reimbursement for Cranial Orthoses

TODAY'S

EVIDENCE-BASED

PRACTICE

OUTCOME MEASURES 101: A FACILITY PRIMER FOR GETTING STARTED P.24

THE VALUE OF RESIDENTS IN OUTCOMES MEASUREMENT P.30

P.56

Quiz Me! EARN 4 BUSINESS CE CREDITS

WWW.AOPANET.ORG

PP.21 & 38

This Just In: AOPA Launches COVID-19 Resources and Support Center P.22

YOUR CONNECTION TO

EVERYTHING O&P

Save the Date

SEPTEMBER 9-12, 2020 T he p remier meeting for or t h o t ic , p r o st h e t ic , a n d p ed orthic professionals.

MANDALAY BAY RESORT

You won’t want to miss the most anticipated O&P event of the year. You’ll:  Explore an enhanced program that makes the most of your valuable time

 Get the latest in 3D Printing and how it will affect the future of O&P care

 Take part in a new addition, watch patients compete in demonstrations of everyday activities with various devices

 Obtain useful tips and techniques

 Hear from top speakers from around the world

 Choose from five tracks (orthotic, prosthetic, pedorthic, technical, or business) to customize your learning experience.

 Participate in hands-on workshops

 Procure CE credits

Questions about the National Assembly?

Contact AOPA at 571/431-0876.

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

#AOPA2020 FOLLOW US @AmericanOandP

! s a g e V n i u o y ee S www.AOPAnet.org

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contents

APR I L 2020 | VOL. 69, NO. 4

FEATURES

TODAY’S EVIDENCE-BASED PRACTICE Accountability has become critical for successful healthcare facilities—and measuring patient outcomes plays an important role. O&P Almanac delves into the strategies for collecting O&P outcome measures and explores the benefits of including young professionals in outcomes measurement protocols.

24 | Outcome Measures 101 Many forward-focused O&P facilities have implemented strategies for collecting both patient-reported and performance-based measures for some or all of their patients. Learn how to choose the most appropriate measures for your facility, how to ensure those instruments are reliable and valid, and how to share the data with patients, payors, and allied healthcare professionals.

30 | What Residents Can Teach You PHOTO: Barber Prosthetics Clinic

22 | This Just In

Business Is Not Usual The community spread of the coronavirus disease (COVID-19) has put everyone at risk for contracting the disease and interrupted business operations across the nation. AOPA has responded with support in the form of communications with legislators, a new space on the AOPA Co-OP page so facilities can share their experiences and strategies, and a COVID-19 Response and Resources webpage.

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APRIL 2020 | O&P ALMANAC

Some of the youngest O&P professionals can be a source of knowledge for facilities implementing and revamping their outcomes measurement procedures.

While residents spend most of their time learning how to become successful clinicians from more seasoned professionals, they also can share what they studied regarding outcomes measures during their time as O&P master’s students.

By Christine Umbrell

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contents

PRINCIPAL INVESTIGATOR Szu-Ping Lee, PhD, PT................................ 40 Meet an associate professor in the Department of Physical Therapy at the University of Nevada, Las Vegas, who teaches O&P-themed courses, is a local coordinator for the Las Vegas Amputee Support Group, and researches human movement as related to rehabilitation.

DEPARTMENTS Views From AOPA Leadership......... 6 Sending a message with a virtual Policy Forum

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

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

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

Research, updates, and industry news

L5857 L L5980L5973 L5858 7 8 9 L5 5856

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

Know the New Rules for Six Codes

How to submit a prior authorization request for prostheses

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

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

CREDITS

Compliance Corner............................... 36

Interpreting the ADA

When to introduce aids and services for hard-of-hearing patients

P.12

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

AOPA News...............................................47

CREDITS

AOPA advocacy, announcements, member benefits, and more

Member Spotlight................................ 44 n

Michigan Medicine O&P Center

n

TechMed 3D

Careers........................................................ 48 Professional opportunities

Marketplace............................................. 50 P.36

Ad Index...................................................... 53 Calendar......................................................54 Upcoming meetings and events

State By State...........................................56 Updates on cranial orthoses, prior authorization, and more

P.46 P.44 4

APRIL 2020 | O&P ALMANAC

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VIEWS FROM AOPA LEADERSHIP

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

Despite COVID-19, Our Voices Are Louder Together Let’s raise them … virtually

E

VEN AS I WRITE THIS, there will have been further impacts and heartbreak

from the coronavirus disease (COVID-19) by the time you read it. There also will be stories of recovery and victory. COVID-19 has impacted all elements of all our lives, including the operation of our O&P businesses. Sadly, I know we have only begun to feel the impacts … unfortunately, the virus controls the timeline.

Know that AOPA is here for you. I hope you have seen and are taking advantage of the resources and guidelines we have been providing. We will continue to provide these as long as needed. I hope you also have seen the efforts we have undertaken on the advocacy front. As with the resources and guidelines, we will continue these efforts until all impacts have been addressed.

Speaking of advocacy, I have never felt more strongly that advocating for the needs of our profession and the needs of our patients is critical for the future of O&P. It will help us get to a place where O&P clinicians are universally considered part of the healthcare team, where we have an adequate workforce, and where we can be sure patients will get the O&P care they need.

Unfortunately, we cannot meet in-person for our AOPA Policy Forum this year, but we are going to make the most of this very unfortunate situation. Next month, we will still take our issues to Capitol Hill, to reach out to legislators and their staff during our now virtual 2020 Policy Forum. Whether you are a business owner, a practitioner, a resident, an administrator, or an educator, I encourage you to participate. Given that travel is no longer required, we have the opportunity to have even more voices present. I strongly encourage you to invite one or more of your patients to join you, so our elected leaders can see the impact of our care. We need all voices represented, and as big an army of representatives from our field as we can muster.

This year we plan to continue our push to see the Medicare Orthotics and Prosthetics Patient-Centered Care Act (HR 5262) become law. In addition to this pivotal legislation, we will continue pushing for funding for O&P education and research as well as legislation that ensures veterans can choose their O&P provider. We also hope to have the opportunity to discuss COVID-19 reliefrelated legislation.

Participating in the Policy Forum is one of the best opportunities to learn about all of the legislative and regulatory issues facing the profession. It also is a chance to acquire or hone advocacy skills.

I know we all have a lot going on. If there is anything else AOPA can do during these uncertain times, let us know. I do hope you will join me online for the 2020 Policy Forum in May. I promise you will feel invigorated and empowered—and will be doing your part to ensure elected officials understand the needs of our profession and our patients. Together we can raise our voices and continue our work transforming O&P. Stay safe and kind.

Jeffrey Lutz, CPO, is president of AOPA.

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APRIL 2020 | O&P ALMANAC

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

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AOPA CONTACTS

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

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

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide.

These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

STRATEGIC ALLIANCES

COMMUNICATIONS, MEMBERSHIP & MEETINGS

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

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

O&P ALMANAC

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

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

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

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

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

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

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

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

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

8

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

APRIL 2020 | O&P ALMANAC

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

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Copyright © 2020 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac20 for advertising options!

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NUMBERS

Patient Perks

Many O&P facilities adopt patient-focused business practices, including collecting outcome measures

O&P facilities run the spectrum in their decisions to embrace certain strategies that patients appreciate, according to AOPA’s “2019 Operating Performance Report,” based on 2018 data. The report, which captured information from 96 companies representing 1,025 full-time facilities and 200 part-time facilities, offers insights into facilities’ use of Saturday and evening office hours, electronic medical record systems (EMRs), and outcome measure testing.

OFFER EVENING BUSINESS HOURS

OFFER SATURDAY BUSINESS HOURS

USE ELECTRONIC MEDICAL RECORDS

89 Percent

94 Percent

OFFER 24/7 ON-CALL SERVICES

COLLECT PATIENT OUTCOME MEASURES

All respondents

Profit leaders*

77 Percent 13 Percent All respondents

14 Percent Profit leaders

4 Percent All respondents

0 Percent Profit leaders

69 Percent All respondents

All respondents

87 Percent

82 Percent

Profit leaders

Profit leaders

Is Your Practice Collecting Any Kind of Patient Outcome Measures?

Percentages collecting outcome measures, by companies’ net sales/billings Up to $1 Million $1 to $2 Million

64% 75%

$2 to $5 Million

80%

More Than $5 Million

82%

Percentages collecting outcome measures, by companies’ community size Major Metropolitan Area Moderate Size City

72% 78%

Small City Town or

Rural Area

EDITOR’S NOTE: The “2019 AOPA Operating Performance Report” is now available through the AOPA bookstore.

Visit www.AOPAnet.org. Plan now to take part in the 2020 AOPA Operating Performance Survey, coming soon. * “Net profit leaders” were in the top 25 percent in terms of this measurement.

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APRIL 2020 | O&P ALMANAC

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Happenings RESEARCH ROUNDUP

FAST FACT

Researchers Leverage RPNI To Facilitate Mind Control of Prosthetic Fingers

High Rates of Diabetes Among Hispanics Living in United States The percentage of adults living with diagnosed and undiagnosed diabetes in the United States varies significantly by race, particularly among Hispanic and non-Hispanic Asian subgroups. New research from the U.S. Centers for Disease Control and Prevention demonstrates the particularly high rates of diabetes among individuals of Hispanic origin.

HISPANICS LIVING WITH DIABETES IN U.S. Diagnosed and Undiagnosed

Mexicans 25%

Puerto Ricans

22%

Cubans/Dominicans

21%

Central Americans

19%

South Americans

12%

SOURCE: Centers for Disease Control and Prevention

APRIL 2020 | O&P ALMANAC

PHOTO: Evan Dougherty, Michigan Engineering

12

The researchers developed a methodology to separate thick nerve bundles into smaller fibers that enable precise control, and amplify the signals coming from those nerves. This is achieved via regenerative peripheral nerve interface (RPNI), or very small muscle grafts combined with machine learning algorithms.

RPNIs also impede the growth of neuromoas at the severed ends of Joe Hamilton, a participant in the University of nerves, reducing residual Michigan RPNI study, naturally uses his mind to limb pain, according control a DEKA prosthetic hand to pinch a small to the researchers. zipper on a hand development testing platform.

Because the learning Researchers at the University of happens in the algorithms Michigan (UM) have developed a instead of by prosthetic users, study biological interface that relies on the subjects have been able to complete nerves in a patient’s residual limb tasks using the new technology on the to enable individual finger control first try without thinking about it, says of prosthetic devices. A team led by Chestek. The researchers worked with Paul Cederna, MD, a professor in the four subjects using the new biological department of biomedical engineering, interface coupled with the Mobius and Cindy Chestek, PhD, an associate Bionics LUKE Arm. In the lab, the professor of biomedical engineering, participants were able to pick up blocks developed a technique to tap faint, with a pincer grasp; move their thumb latent signals from arm nerves and in a continuous motion; lift spherically amplify them to enable real-time, shaped objects; and play a modified finger-level control of a prosthesis. version of rock-paper-scissors. “It’s like “This is the biggest advance in you have a hand again,” said particmotor control for people with ampuipant Joe Hamilton. “You can pretty tations in many years,” said Cederna, much do anything you can do with who also serves as the Robert Oneal a real hand with that hand. It brings Collegiate Professor of Plastic Surgery you back to a sense of normalcy.” at the UM Medical School. “We Next steps will involve implanting 12 have been able to provide some indwelling electrodes in each of 10 parof the most advanced prosthetic ticipants. The research was published control that the world has seen.”

March 4 in Science Translational Medicine.

HAPPENINGS

RESEARCH ROUNDUP

Prototype Prosthetic Control System Leverages Low-Power Portable Imaging Sensors

PHOTO: Siddhartha Sikdar, PhD

Researchers at Volgenau School of Engineering at George Mason University (GMU) are developing and evaluating a prosthetic control system that integrates wearable ultrasound imaging sensors, rather than electromyography, to sense residual muscle activity. The new approach distinguishes between different functional compartments in the forearm muscles and provides robust control signals that are proportional to muscle activity.

The new sensing strategy has the potential to significantly improve functionality of upper-extremity prosResearchers at George Mason University, Infinite Biomedical theses and provide dexterous intuitive Technologies, MedStar National Rehabilitation Hospital, and Hanger control, according to Siddhartha Sikdar, Clinic are developing a sonomyographic prosthetic system that integrates PhD, professor of bioengineering and low-powered ultrasound imaging system into a prosthetic socket. director of the Center for Adaptive Systems of Brain-Body Interactions at also will assess performance of sonDEADLINE EXTENDED GMU. The university is partnering with omyographic control compared to Infinite Biomedical Technologies as myoelectric direct control and myowell as clinicians at MedStar National electric pattern recognition control.

O&P Research Rehabilitation Hospital “In our preliminary Proposals Due and Hanger Clinic in work, we have demonMay 21 carrying out this study. strated that individuals The team predicts that with transradial limb loss the new approach will be can utilize sonomyography AOPA and the Center more intuitive than myoto achieve excellent offline for Orthotic and electric direct control and classification accuracy Prosthetic Learning and Outcomes/ pattern recognition control for decoding multiple Evidence-Based Practice (COPL) and enable users to condegrees of freedom with are seeking proposals at two funding trol terminal devices with minimal training,” said levels for one-time grants: $15,000 more dexterity. The team’s Sikdar. “We have also and up to two exceptional proposals Siddhartha Sikdar, PhD compact, research-grade sonomyoshown that sonomyography can for $30,000 for one year. Preference graphic prosthetic system integrates be used to achieve precise proporwill be given to grants that address a miniaturized low-power ultrasound tional control of a target position.” evidence-based clinical applicaimaging system into a prosthetic socket By the end of the project, the team tion in orthotics and prosthetics. and leverages algorithms for real-time will have a standalone prototype of Visit www.AOPAnet.org to view classification and control with multiple a sonomyographic upper-extremity the RFP topics and guidelines or degrees of freedom. They will place prosthesis that has been tested in to apply online. The deadline for ultrasound imaging transducers within laboratory settings. “The next step all proposals is May 21, 2020. test prosthetic sockets to complete would be to refine and develop the system integration, then test the system prototype for take-home clinical trials with transradial study participants and in a future follow-on project,” said evaluate the sonomyographic signal Sikdar. “We will work with our industry quality with changes in arm position partners to develop a prototype that and socket loading. The researchers would be ready for commercialization.”

O&P ALMANAC | APRIL 2020

13

HAPPENINGS

VETERANS’ VIEWS

Researchers Study Satisfaction Among Upper-Limb Prosthesis Users Most veterans with unilateral upper-limb loss rank satisfaction with their prosthesis at just shy of “satisfied,” regardless of the type of device, according to a study of 449 veterans. Users of myoelectric, body-powered, and cosmetic prostheses felt similarly about their componentry.

Linda Resnik, PT, PhD, FAPTA, a research career scientist at the Providence VA Medical Center, led the study. Participants were asked to describe their prosthesis, prosthetic training, device repairs, and visits to a prosthetist. They also rated their device satisfaction using two standardized measures, the Trinity Amputation and Prosthetic Experience Satisfaction Scale and OPUS Client Satisfaction With Devices Scale.

Resnik and her team expected to see greater satisfaction among myoelectric prosthesis users, but ultimately found “no differences in satisfaction by prosthesis type or terminal device.” Factors that could negatively impact satisfaction among technologically advanced prosthesis users include device fragility and unrealistic expectations, Resnik suggested.

The researchers also identified lower satisfaction scores among individuals with more proximal amputation levels, younger users, and African-American users, regardless of device type.

The research team sought to identify factors linked to prosthesis satisfaction and found that initial prosthetic

training is associated with greater happiness, and noted that occupational or physical therapy can play a critical role in the early stages of prosthetic care. “Data shows that some people don’t receive training to use their device,” said Resnik. “When that happens, patients don’t incorporate their device into their daily lives … . They become frustrated and are set up for a bad experience.”

The full results were published online in January in Prosthetics and Orthotics International.

CODING CORNER

DME MACs Make Revisions to AFO/KAFO Policy

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APRIL 2020 | O&P ALMANAC

The LCD and PA also updated the code descriptor of L2006 based on a recent quarterly update from the Healthcare Common Procedure Coding System. The new code descriptor for L2006 is: “Knee, ankle, foot device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, included all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated.” The previous code descriptor read, “Swing and/or stance phase microprocessor control.” Visit the CMS website for details.

AOPA’s Coding & Reimbursement Committee is reviewing the new and revised AFO coding guidelines and will provide the DME MACs with appropriate recommendations if necessary.

PHOTOS: Getty Images

The four durable medical equipment Medicare administrative contractors (DME MACs) released a revised version of the Ankle-Foot Orthosis/ Knee-Ankle-Foot Orthosis (AFO/ KAFO) Local Coverage Determination (LCD) and Policy Article (PA). Many of the revisions were clerical in nature, such as changing “ordering physician” to “treating practitioner” and updating the policy with the standard written order instructions.

However, the PA did contain some significant revisions, including updating its coding guidelines for the L1906 and introducing new coding guidelines for 16 AFOs: L1900, L1902, L1904, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1970, L1971, L1980, and L1990.

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Craig Higgins has been named chief financial officer (CFO) at WillowWood, where his responsibilities will include financial planning, operating budgets, and decision support analysis to guide the leadership team with investments and capital expenditures. “Expertise and experience are obviously critical when selecting a CFO, but culture and fit were equally key determinants in our choice for this role,” said Mahesh Mansukhani, WillowWood’s chief executive officer. “Craig [is] not only the best fit, but he’s a treasure trove of experience and will further our initiatives to drive performance, growth, and overall success.”

Victoria (Vikki) Ledbetter has been appointed director of marketing at Fillauer. She will oversee marketing operations, sales enablement, digital communications, and overall content and brand strategy. Ledbetter comes from Victoria (Vikki) employee benefits and Fortune 500 company Ledbetter Unum, where she most recently served as an interim director and manager in corporate communications.

“Vikki brings deep experience and fresh energy to the industry,” said Traci Dralle, president, Fillauer Companies. “She has a passion for data, research, and creative problem solving that will help us tell our story and better serve our clients and customers.”

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) has partnered with the Amputee Coalition to better support, educate, and serve the limb loss community. The organizations will collaborate to provide patient education materials to all ABC-accredited facilities, provide access to the Amputee Coalition’s Prosthetist Finder online tool to all ABC-certified prosthetists, and launch a well-being program for ABC-accredited facility owners that promote patient-centered care.

“We are excited about this partnership because it allows us to better serve the two million Americans living with limb loss and limb difference,” said Mary Richards, Amputee Coalition chief executive officer. “More than 28 million Americans are at risk for amputation, and working with an organization like ABC allows us to educate providers, patients, and families in a whole new way.”

16

APRIL 2020 | O&P ALMANAC

Healthcare startup BLUEWAVE Technologies has released new lab results indicating that its BLUEWAVE device can effectively kill the non-enveloped virus, MS2 Bacteriophage, and Methicillin-Resistant Staphylococcus Aureus (MRSA).

The technology uses room-temperature ozone gas, enhanced by a proprietary vacuum infusion process, to effectively kill bacteria and viruses without the use of water, detergents, or added chemicals, according to the company.

Recent test results have demonstrated that the device is more than 99 percent effective at killing non-enveloped MS2-Bacteriophage on two-ply polyester fabric and stainless steel surfaces. The company notes that there may be possible applications in the current COVID-19 pandemic because non-enveloped viruses are typically more difficult to kill than enveloped viruses, such as coronaviruses. The company plans to generate additional data demonstrating efficacy of the device against other viruses.

The Board of Certification/Accreditation (BOC) has been honored with a Gold Stevie www.bocusa.org Award for sales and customer service in the “Best Use of Technology in Customer Service” category. The award recognizes BOC’s focus on improving customer service by creating a better website experience.

In April 2019, BOC debuted a modern, mobile-friendly website. Analytics reveal increased mobile access and the ability to access information more quickly, according to BOC. Coyote Prosthetics announced a cease in operations in effect between March 19 and April 6 to allow patients and staff to quarantine during the COVID-19 outbreak in the United States. The company apologized for any inconvenience but noted the decision was made in consideration of the long-term health and safety of the company’s staff, families, patients, customers, neighbors, and fellow Americans.

Orthomerica has launched the AllSTAR team of cranial clinicians.

This network of clinicians is dedicated to the care of infants with deformational plagiocephaly and postoperative craniosynostosis using the STAR® family of cranial remolding orthoses manufactured by Orthomerica Products Inc. The AllSTAR network was developed to recognize and promote the clinical expertise of orthotic clinicians who specialize in the management of infants with skull deformities. Össur has donated 20,000 testing swabs from its operations so that more people could be tested for the SARS-CoV2 virus in Iceland.

Steeper USA relocated to a new office on March 21. The company’s new address is 8666 Huebner Road, Suite 112, San Antonio, Texas.

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REIMBURSEMENT PAGE

By DEVON BERNARD

Know the New Rules for Six Codes

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.21

CMS is planning a two-stage rollout of the new requirements regarding prior authorization of six prosthetic codes Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 21 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

6 L585 L5858

L5857

L5980 L5973

7 8 9 L5

C

MS HAS RELEASED THE first set

of Healthcare Common Procedure Coding System (HCPCS) prosthetic codes to be subject to prior authorization.

The six codes, announced in February, include three microprocessor-based prosthetic knee codes, a microprocessorbased prosthetic foot code, and two K3-level prosthetic foot codes, as described below: • L5856—Addition to lower-extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type.

• L5857—Addition to lower-extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type.

• L5858—Addition to lower-extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type.

• L5973—Endoskeletal ankle-foot system, microprocessor-controlled feature, dorsiflexion and/or plantar flexion control, includes power source.

• L5980—All lower-extremity prostheses, flex foot system.

• L5987—All lower-extremity prostheses, shank foot system with vertical loading pylon.

This month’s Reimbursement Page reviews how we got here, what we know, and what can be expected with the prior authorization process.

History Lessons

In 2012, CMS launched a prior authorization process for certain power mobility devices in seven demonstration 18

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Update From CMS After this article was written, CMS announced several temporary regulatory waivers intended “to equip the American healthcare system with maximum flexibility to respond to the 2019 novel coronavirus (COVID-19) pandemic.”

Included in the announcement was a notice that CMS will pause the national prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies. Visit the AOPA website for an update on the rollout. states—California, Florida, Illinois, Michigan, New York, North Carolina, and Texas. CMS subsequently reported a decrease in expenditures in those select areas and decided to expand prior authorization.

In May 2014, CMS released a proposed rule on prior authorization, and then on Dec. 30, 2015, released the final rule that set the groundwork for Medicare prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items, including most lower-limb prosthetic HCPCS codes. The final rule established a master list of HCPCS codes that are eligible for inclusion in prior authorization; the list consisted of 135 HCPCS codes, 84 of which described lower-limb prostheses; none of the codes described orthoses.

How were these codes selected and placed on the master list? To be considered eligible for inclusion, HCPCS codes were required to be part of the

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DMEPOS fee schedule, to have an average purchase price of $1,000 or higher or an average monthly rental rate of $100 or higher, and to meet one of the following qualifying criteria: • The item is identified in a report from the U.S. Government Accountability Office or the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) as having a high rate of fraud or unnecessary utilization; or • The item is listed in the Comprehensive Error Rate Testing (CERT) program’s annual “Medicare Fee-for-Service Improper Payment Rate Report.”

The final rule also announced that CMS would not include all 135 HCPCS codes in the initial implementation of the prior authorization program.

Instead, CMS would publish a subset of the 135 HCPCS codes to be subject to prior authorization initially; CMS referred to this list as the “requires

prior authorization” list. The final rule explained that following any announcement on the requires prior authorization list, there would be a 60-day notice period prior to implementation. Finally, the final rule stated that implementation of the Medicare prior authorization program could occur on a local or regional level instead of nationally.

None of the possible 84 prosthetic codes were included on any of the subsequent requires prior authorization lists between 2015 and 2019. The lists released during this time period

primarily included DME items, such as power wheelchairs and pressurereducing support surfaces.

In July 2019, CMS released a proposed rule that suggested lowering the $1,000 average purchase price requirement for prior authorization consideration; this minor change opened the door to greatly expanding the number of HCPCS codes on the list of codes eligible for preauthorization. On Oct. 31, 2019, CMS released a final rule, effective Jan. 1, 2020, lowering the average purchase price requirement from $1,000 to $500. This reduced threshold for inclusion means that 226 O&P HCPCS codes are eligible to be included on the prior authorization master list if they meet all of the other criteria: have a high rate of fraud/ unnecessary utilization or appear on a CERT improper payment rate report.

With the expansion of the HCPCS master list, it was assumed that a new requires prior authorization list would be released; this list was released Feb. 11, 2020.

O&P ALMANAC | APRIL 2020

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What We Know Now

Six HCPCS prosthetic codes were added to the requires prior authorization list in February because they meet all of the established criteria: They are listed on the current DMEPOS fee schedule, and they have an average purchase price reimbursement of more than $500. In addition, lower-limb prosthesis codes have been discussed in OIG reports (August 2011); plus, the “2018 Medicare Fee-for-Service Supplemental Improper Payment Data,” or the CERT report, noted that lower-limb prostheses accounted for $46 million in improper payments.

The February 2020 announcement included a timeline. The prior authorization process for the six prosthetic codes will be rolled out in two phases, to allow CMS “to identify and resolve any unforeseen issues.”

Initial implementation of the prior authorization program for these six codes will occur on a local/regional level instead of nationally. Phase I will begin for claims with a date of service on or after May 11, 2020, and will occur on a very limited basis in one state in each of the four DME Medicare administrative contractor (DME MAC) jurisdictions: Pennsylvania for DME MAC Jurisdiction A, Michigan for DME MAC Jurisdiction B, Texas for DME MAC Jurisdiction C, and California for DME MAC Jurisdiction D. However, the DME MACs will begin accepting prior authorization requests (PAR) for claims in these four states on April 27, 2020.

Phase II, the rollout to all remaining states and territories in the four DME MAC jurisdictions, will begin Oct. 8, 2020, and the DME MACs will begin accepting PARs for these states on Sept. 24, 2020.

Anticipating Change

CMS and the DME MACs recently provided some subregulatory updates and guidance, but some minor details of the prior authorization process are still being worked out and have not been released.

In addition, it is unknown whether the final process will change after Phase I is completed. But based on the new information as well as information in the final 20

APRIL 2020 | O&P ALMANAC

rules, and considering how prior authorization is currently being conducted for other providers and suppliers, we have an idea of how the process will work.

Based on the final regulations, a PAR must be completed prior to both delivery to the beneficiary and claim submission, so the final prosthesis cannot be delivered until a prior authorization decision has been made for devices being provided to patients with one or more of the six designated prosthetic codes.

The prior authorization process for the six prosthetic codes will be rolled out in

TWO PHASES, to allow CMS “to identify and resolve any unforeseen issues.”

If you determine that you will be providing one or more of the six codes, the first step is to submit a PAR and seek a positive affirmation indicating that your PAR has been approved.

You may submit a PAR using one of three options: fax, mail, or the DME MAC’s web portal. We are still unclear on how each method will work—the dedicated fax numbers and specific addresses for submission have not yet been published—but you should review each option and choose wisely. The DME MACs will use the same method you use to submit a PAR to respond to the prior authorization request.

You must include certain documentation with each PAR. First, you will have to complete a PAR coversheet from your DME MAC (these have not been published) to indicate patient information (Medicare Beneficiary Identifier number, name, etc.); your information (National Provider Identifier, Provider Transaction Access Number, address, etc.); and the HCPCS code(s) in question. You also must submit all supporting documentation from the medical record and documentation required by Medicare policy to demonstrate that medical necessity and Medicare coverage criteria have been met. This documentation would include an order (standard written order), relevant information

from the beneficiary’s medical record (physician documentation), and relevant supplier-produced documentation.

Once the PAR and supporting documentation have been submitted, the DME MAC will review the information and make a determination.

For your initial PAR, the DME MAC must make its decision in 10 business days, according to the final rule.

Currently, PARs for pressure-reducing support surfaces are handled within five days, and PARs for power mobility devices are handled within 10 days.

After the PAR is reviewed, the DME MAC will send you a letter informing you of the results, either affirmative or nonaffirmative, and a detailed explanation for the decision. The letter also will include a unique tracking number (UTN).

If you receive an affirmative decision, meaning the documentation you submitted supported medical necessity and coverage criteria, you may submit the claim for payment. Be sure to include the UTN to prove that you completed a PAR because any claims that are submitted without first completing a PAR will be automatically denied.

If the PAR was denied and you received a nonaffirmation, meaning your documentation did not support medical necessity and/or coverage criteria, you have a few options. First, you may review the decision letter to address and resolve the nonaffirmative reasons provided and resubmit a new PAR. However, with the resubmission of a PAR, the decision time to receive a decision could take up to 20 days, according to the final rule. Currently, power mobility devices have a 20-day window and pressure-reducing support services have a five-day window. CMS and the DME MACs have stated that for lower-limb prostheses, PAR resubmissions will have a timeframe of 10 days. A PAR may be resubmitted an unlimited number of times until all problems are resolved and a positive affirmation is received.

Another option upon receiving a nonaffirmation PAR is to bypass the PAR resubmission process and submit the claim. The claim will be denied and you will be financially liable, but appeal rights

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will be available to you. Just remember that claims for items requiring prior authorization that are submitted without a PAR determination and corresponding UTN will be automatically denied.

A third option when receiving a denial is to inform the beneficiary of the nonaffirmative decision and have that beneficiary sign an Advanced Beneficiary Notice of Noncoverage (ABN), then submit the claim. The code subject to the PAR will still be denied and appealable, but the beneficiary will be financially liable.

Keep in mind that you may not use an ABN to bypass the PAR process.

Details, Details

Since the introduction of prior authorization five years ago, AOPA has expressed two primary concerns about the program, both via formal submitted comments and during in-person meetings with CMS officials.

First, AOPA believes that the process should not cause unnecessary delays in care. Second, AOPA believes that

a positive affirmation should provide protection from further audit activity.

Prior to the release of 2020 final rule, AOPA was pleased to receive a direct communication from a highranking CMS official that addressed these concerns. Specifically, the communication stated that CMS does not intend to significantly expand the number of lower-limb prostheses subject to prior authorization in the future, and that CMS understands the need for timeliness in making prior authorization decisions. This also has been reinforced by the DME MACs’ track record of completing PARs well before the 10-day deadline. The CMS official also clarified that a positive PAR affirmation will guarantee payment and reduce the likelihood of future audits.

AOPA’s discussions with other providers and suppliers who have had exposure to the Medicare PAR process have indicated that the system and process have been an overwhelming success, and they are happy with the program. We hope that O&P suppliers

will have the same experience.

Visit the AOPA website and the O&P Co-OP for up-to-date information on the prior authorization process; these platforms will be updated as the DME MACs release new information. We also will be tracking and monitoring the program as it is rolled out in Phase I and Phase II, and we will provide the DME MACs with appropriate feedback and concerns.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming.

Reach him at dbernard@AOPAnet.org.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz.

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21

This Just In

Business Is Not Usual AOPA launches a COVID-19 Response and Resources webpage and other forms of support during the pandemic

T

HE PAST FEW WEEKS have

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APRIL 2020 | O&P ALMANAC

PHOTO: Adobe Stock

brought monumental challenges and changes in every aspect of life. As the coronavirus disease (COVID-19) has spread across the globe and throughout the United States, O&P professionals have been forced to make unprecedented decisions in their personal and professional lives. As essential businesses, some O&P facilities have remained open, while others have temporarily shut their doors or limited their patient care hours.

AOPA has responded with support in many ways. The association is contacting legislators to explain how they can best support the O&P profession and is providing guidance on regulations like documentation, telehealth, and stay-at-home orders. AOPA also has created a new space on the Co-OP page so O&P companies can share their experiences and strategies with each other.

Most importantly, AOPA has debuted a COVID-19 Response and Resources webpage, https://AOPAnet. org/resources/covid-19/.

“With COVID-19, we are in uncertain times, with apprehension about providing current and future O&P care at unprecedented levels,” said AOPA Executive Director Eve Lee, MBA, CAE, when the site launched. “In addition, we know managing the needs of your staff is difficult. AOPA is here to help our members navigate this rapidly evolving situation.” AOPA staff will update the site frequently with actions, guidance, and resources that could be beneficial to O&P business owners, managers, clinicians, suppliers, and stakeholders.

This Just In

The webpage features links to guidance on topics such as the how the recently passed $2 trillion stimulus package applies to O&P businesses; documentation and telehealth waivers; operation of businesses during state or local restrictions related to COVID-19; and enrollment procedures waived for COVID-19. Another link offers an analysis from McGuireWoods on how the Revised Family First Coronavirus Response Act could impact businesses.

The site also links to more general guidance regarding the pandemic from the Centers for Disease Control and Prevention, the World Health Organization, the Occupational Safety and Health Administration, the Small Business Administration, and several additional agencies.

Members also can turn to the webpage for updates on upcoming AOPA events. For example, the

Most importantly, AOPA has debuted a COVID-19 Response and Resources webpage,

https://AOPAnet.org/resources/covid-19/.

Medicare 101 seminar originally scheduled for March 30 in Rosemont, Illinois, was revamped as a virtual event to take place April 22-23 from 11 a.m. to 1:30 p.m. EST. And the Coding and Billing Seminar scheduled for April 27-28 in Charlotte, North Carolina, has been rescheduled to July 20-21, 2020.

The May Policy Forum also has been redesigned as a virtual event.

Visit the webpage to see all of

these resources, a discussion of the actions AOPA has taken to advocate on behalf of AOPA members, and additional information. Visit the AOPA Co-OP for state-specific guidance, including state government orders and feedback from local O&P facilities. And know that AOPA staff is available to answer questions or listen to your concerns—reach out to staff at info@AOPAnet.org.

O&P ALMANAC | APRIL 2020

23

FEATURE

Outcome Measures Take the first step at your facility with this primer on when, why, and how to implement outcomes measurement protocols

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APRIL 2020 | O&P ALMANAC

FEATURE

A

S O&P FACILITIES ADOPT

, CP PO

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CP

where we start and where we are planning, monitoring progress, and evidence-based practices, going” with a new patient is important. predicting recovery.” measuring outcomes has become an “We want to improve not only the essential part of patient care. Outcome patient themselves—their status Determining Appropriate Tools measurement tools—standardized and their outcome—but the quality Outcome measurement tools should instruments to evaluate a change in of our very intervention. And some help capture a holistic patient portrait, health status—come in many shapes of the factors that are incorporated and may measure mobility, balance, and forms, so clinicians are using into that are understanding comfort, cognition, and quality of life. different measures, in different ways, performance, and speed—mostly with Outcome measures can include at different facilities. Understanding relationship to walking speed, but also patient-reported measures, such as the variety of outcome measurement speed of recovery—and then satisfaction questionnaires that capture patients’ tools, and why each is useful, can help as well.” perceived functional status, quality a facility implement procedures of life, and satisfaction with O&P can, Ph to capture important outcome When and How intervention. Or, they may be perforn u D D, information and aggregate To Measure mance-based measures, which assess ad that data appropriately.

Outcome measurea patient’s physical ability to perform “We take measurements ment tests should be tasks. Condition-specific measures are to capture basic, specific administered prior geared toward a specific population data based on what we’re to and after the O&P or condition. trying to achieve and our intervention, and then In O&P specifically, many facilities goals. So, outcome measureat regular intervals or at are embracing both patient-reported ments are more than just follow-up appointments. and performance-based measures. measurements,” explains J. Chad Evaluating patients and Major notes that some of the most Duncan, PhD, CPO, associate professor establishing a baseline by adminispopular measurement tools being used of physical medicine rehabilitation tering outcomes testing at the initial for lower-limb prosthetic patients and the director of Northwestern visit is critical. “We have to understand include the following: the Amputee University’s Prosthetics and Orthotics the ‘input’ before we can evaluate the Mobility Predictor; Patient Assessment Center. Measurements can offer an outcome,” explains Carnahan. “Patient Validation Evaluation Test (PAVET); understanding of where patients are A may have a different potential than Prosthesis Evaluation Questionnaire ability-wise, where they want to be, patient B. So, if patient A’s outcome is (PEQ); Timed Up and Go (TUG); timed where they are headed, and the change different than patient B’s outcome, we walk tests (for example, 10-meter they’ve experienced when they return need to look at the factors that affect walk tests); distance walk tests (for for a later visit. “They provide us with that.” When two patients with similar example, two-minute walk tests); and a baseline, which is very important in diagnoses have different the Activities Balance Confidence arnahan, M today’s managed care environment.” outcomes, it doesn’t (ABC) Scale. These tools and C S tin “We have a responsibility and an necessarily mean one others like them “provide opportunity to prove what we do of those outcomes is a means to accurately and before we then move on to improving unsuccessful because reliably quantify both what we do,” says Kristin Carnahan, the patients may have psychological and physical MSPO, CPO, FAAOP, an instructor had different starting function,” says Major. at Northwestern’s Feinberg School points. “The change When it comes time of Medicine. She acknowledges that in that outcome could to decide which specific proving “quality” O&P intervention is be significant for that outcome measures to use at a difficult, but suggests that “knowing person, or they’re reaching facility, it’s important to consider the maximum potential that they can, the practice itself and its patient popubased on their particular presentation,” lation. Major recommends using a Carnahan explains.

“DEEP”—define, explore, evaluate, and Documenting patient health status plan—approach when choosing which is an important component of initial measures to implement: testing. “It allows us to establish the • Define what is needed by asking presence and severity of conditions,” these questions: Which health says Matthew “Matty” Major, PhD, an status domain am I interested in assistant professor at Feinberg and a assessing? Which patient group or research health scientist at the Jesse condition? At which stages during Brown VA Medical Center. “It also the rehabilitation process will helps us in recommending a treatment, the assessment take place? Is the

O, FAA OP

O&P ALMANAC | APRIL 2020

25

FEATURE

Ma t

or, aj

assessment going to be self-reported be included in the medical record; and or performance-based? How is the ensuring that outcome measures will information going to be used? How satisfy the intended purposes after will that information help me and they’ve been collected. my patient arrive at the desired rehabilitation outcomes?

Psychometric Properties • Explore by searching the literature When implementing outcome related to your defining questions measures protocols it is important to to narrow down which measures consider their psychometric propermay be the most appropriate. ties. “Psychometric properties describe • Evaluate whether the measure is how accurately—that’s validity—and valid according to its psychometric precisely—that’s reliability—outcome properties. Is the measure valid, measures quantify clinically relevant is it reliable, is it feasible for my constructs,” says Major. They are patient group, can they perform this dependent on what is being measured, measure? Is it even feasible for me, how it’s being measured, and on whom given the resources that I have in it is being measured. my own clinic?

Along these lines, it’s important to • Plan how and when to administer ensure that the selected instruments the measure and then how produce measurements that are “Matty” and when to record, use, consistent and without error, w M e th interpret, and report says Major. “If an instruthese results. ment is reliable, then if no change has occurred in When defining and your patient’s status, the exploring, Major recominstrument measurement mends deciding what is the same. So, a reliable information you wish to instrument is stable, and collect, and making sure the it measures a variable with information will be clinically consistency.” Even when tools useful by providing baseline data are reliable, there can be systematic and allowing comparison between error—for example, a consistent overinterventions or assessing rehabilitation or under-estimation of a true score, as progress to justify those intervenwhen a weight scale consistently adds tions. Also determine when tests will three pounds. This type of error is easy be administered, and how they will to address by subtracting three pounds be integrated into a pool of data for after weighing, says Major. There also research purposes. For additional may be random error, or factors that information, Major recommends influence the observed score in unprereviewing how-to videos available dictable directions. “They may vary in on the Online Learning Center of magnitude from one measurement to the American Academy of Orthotists the next.” and Prosthetists and reading the To ensure reliability and reduce information summarized on the errors, facilities should take note of an Shirley Ryan AbilityLab’s rehabilitaoutcome measure’s test-retest relition measurement database, available at ability, intra-rater reliability (a level www.sralab.org/rehabilitation-measures. of agreement of results when admin For the planning and evaluating stages, istered on the same subject by the Major suggests determining which same rater), and inter-rater reliability measures should be self-reported (a level of agreement when adminisrather than performance-based; tered on the same subjects by different determining whether you have the raters). “The form of reliability resources—equipment, space, time, assessment really depends on the and personnel—to implement the source of error being measured,” says measures you’ve identified; deciding Major. “Without sufficient reliability, whether data collection forms should the instrument is not dependable.

Ph D

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APRIL 2020 | O&P ALMANAC

Unreliable measures do not truly reflect change and progress in patient status or allow comparison between clinicians. So, the reliability of these outcome measures that you use is absolutely critical.”

Just as important as reliability is validity—ensuring the instrument measures the characteristic it is intended to measure. “Validity level indicates how representative the measurements are of a particular construct and provides information on how the test results can be used and interpreted,” says Major. “It allows us to answer these questions: Can we discriminate among individuals with and without certain traits? Can we evaluate change in the magnitude or the quality of a variable from one time to another?”

Different types of validity include face validity, meaning the instrument superficially appears to measure what it is intended to measure and the method is plausible; content validity, which is how much the instrument actually captures of the various dimensions of a particular construct; criterion validity, which includes concurrent and predictive validity; and construct validity, which is how well the instrument measures what it is intended to measure over a particular construct.

Sharing the Data

Once a facility adopts outcome measurement protocols and begins aggregating data in a standardized manner, that facility can then organize the data and make it accessible to clinicians and their patients in a HIPAA-compliant manner.

Collecting outcome measurement data is important for internal usage within a facility—but other parties are interested in this information as well. “Because outcome measures are standardized measures, with consistent protocols and consistent outcome metrics, that allows us to communicate these outcomes with patients, clinicians, and importantly, third parties,” says Major. “So, across institutions, across clinics, across clinicians, it’s all very important.”

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FEATURE

Typical Outcome Measures At Sabolich Prosthetics & Research, led by Scott Sabolich, CP, a medical assistant administers several outcome measures tests for all lower-limb patients during specific patient visits: during the initial visit, one month postdelivery, and then every six months until the patient needs a new prosthesis. The data is input into the facility’s software management system and is being used to demonstrate efficacy of intervention and as part of research studies, in a HIPAA-compliant manner. These same tests also are administered at several other facilities—Ottobock clinical partners—so data can be aggregated and analyzed across facilities, in a HIPAA-compliant manner.

The following tests are administered by an experienced, trained medical assistant at Sabolich: Physical Tests • Amp-No Pro, for unilateral patients with no prosthesis (no other physical tests) • Amp-Pro, for everyone first • K2: Timed Up and Go, 10-meter walk test, and two-minute walk test • K3: Four-square step test, 10-meter walk test, and two-minute walk test

Written Tests • PLUS-M • EQ-5D-5L • Activities of Daily Living Questionnaire

“The first time someone tries to do this whole set, it takes 45 minutes, and it sometimes gets frustrating,” explains Russell Lundstrom, director of field clinical services at Ottobock, who assisted Sabolich in the process of standardizing outcome measures for his facility. “But with time and streamlining the practice and some training, [it only takes] 20 minutes for performance measurements and then maybe 10 minutes for data entry. And then you can have the patients fill out these forms either while they’re waiting before they meet with a prosthetist or at some other time, so you don’t take away from the follow-up visit itself.”

Ru

s

Sharing performance-based data to build a different level of trust with with patients helps them understand your patients as you’re really focused on how well an O&P intervention objective ways of measuring their is working. Patients new to improvement.” d s n t r u om ll L outcome measurement “The outcome measures se testing may be a little offer means to set and confused, says Russell monitor goals, not only Lundstrom, director of for you to monitor the field clinical services at rehabilitation progress, Ottobock, but they evenbut for patients to be tually appreciate learning able to see how well how far they are advancing they’ve done,” adds Major. as they navigate rehabilitation.

And if patients have a compet“Then they start saying, ‘I want to itive mindset and the ability to see how I’m doing on my two-minute progress further, these measures allow walk test,’ or, ‘I think I can go much them to work toward the use of more farther this time,’” says Lundstrom. advanced componentry.

“You can use those assessments to set Sharing outcome measures data goals with your patients and to get them with other members of patients’ excited about anticipating the kind of healthcare teams—including general improvements that you hope to see in practitioners, physiatrists, physical them,” he says. “There’s also a potential therapists, and occupational 28

APRIL 2020 | O&P ALMANAC

therapists—also is beneficial. For example, says Lundstrom, this data can enable “the ability to communicate that a patient’s TUG time decreased from above a threshold that would indicate a higher risk of falling to below that threshold, or that his walking speed improved in a meaningful way since O&P intervention.”

Sharing outcomes data with payors is key to demonstrating the value of O&P intervention for reimbursement purposes. “It adds value to prosthetists and orthotists in terms of justifying your medical necessity, getting that preauthorization approval, and overturning a denial,” says Lundstrom. In addition, once there are established outcome measures recognized by payors, facilities can share positive outcomes to build trust with payors and differentiate their brands. “You can establish your clinic as one that routinely collects outcomes and is able to justify your decisions and your component selections.”

“At the end of the day, we’re trying to provide a case for medical necessity,” says Major, “so it really comes down to patient status documentation, allowing us to capture a holistic patient portrait.”

One Piece of the Treatment Puzzle

There is no one perfect plan for implementing and optimizing an outcomes measurement protocol at an O&P facility. But starting off slowly by adopting a few measures consistently and systematically can aid a facility in providing more standard and valuable patient care.

While outcomes are being used in many settings as a metric to assess quality and performance, Duncan emphasizes that they remain just one piece of the larger patient care puzzle.

“Just one measurement doesn’t do it all for us; there’s all these pieces that we have to put together,” he says. “We’re sort of like a Sherlock Holmes—determining what’s the best approach, the best intervention, the best management of that patient—and the best way to communicate with our other allied healthcare providers.”

COAPT RECOGNIZES MY POTENTIAL

GEN 2

W FEATURE

You

hat Residents Can Teach

Many of today’s young professionals enter their residencies well-prepared to assist with outcome measurement strategies

Malena Rapaport, MSc, CP(c), administers the Berg Balance Test with a patient at Barber Prosthetics Clinic.

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NEED TO KNOW: • At O&P facilities across the nation, owners and managers are ramping up their outcome measurement strategies in an effort to provide optimal care and demonstrate the value of O&P intervention.

• O&P residents usually arrive at their residencies with a good understanding of outcome measurement protocols, having studied both patient-reported and performance-based instruments during their O&P master’s coursework.

• While young clinicians spend most of their residencies learning clinical care from experienced practitioners at their residency sites, they also may contribute to the general knowledge base by sharing what they learned as students in their O&P classes and in clinical settings.

• Residents who are willing to show initiative in this area can be both learners and teachers—and add value to O&P businesses that are capturing, recording, and interpreting patient outcomes data.

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HEN BARBER PROSTHETICS CLINIC developed its standardized

outcome measurement protocol a few years ago, one of the key contributors was then-25-year-old Malena Rapaport.

Rapaport had just graduated from the O&P program at the British Columbia Institute of Technology (BCIT) and was completing her residency at Barber. But she hit the ground running, joining owner Dave Moe, CP(c), and head of research Brittany Pousett, MSc, CP(c), to improve the clinic’s ability to be evidence-based.

Malena Rapaport, MSc, CP(c)

PHOTOS: Barber Prosthetics Clinic

From her BCIT coursework, Rapaport had learned about an array of outcome measurement tools and worked with patients in clinical settings in applying those tools. And, as is encouraged in the Canadian O&P educational process, she had concurrently studied and earned a master’s degree in rehabilitation science at McMaster University. From that experience, she had learned broader theories and psychometric factors behind outcome measures in general. “We learned how to identify what we are trying to affect, then learned the skills and appropriate outcome measures” to achieve those goals, recalls Rapaport.

Rapaport discusses progress with a patient while referring to outcome measure reports.

For her BCIT capstone project, she worked with clinicians at Barber to study the various outcome measures available for O&P patient care. This project segued into her role as a resident at the facility and propelled her into the perfect position to aid the team in establishing a set protocol for outcome data collection.

“We identified a core set of outcome measurements we wanted to use with patients, then we took into account the physical space available, when we would collect the measures, who would do it, and how we would record the data in our EMR system,” says Rapaport, now a certified prosthetist. Today, clinicians at Barber conduct a comprehensive set of outcome measurements.

Several years into the new protocol, the facility has seen success in using the measures to improve patient care.

O&P ALMANAC | APRIL 2020

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FEATURE

During an in-service at GF Strong Rehabilitation Center, Rapaport teaches a physiotherapist how to interpret outcome measures data for patients with limb loss.

Learning Outcome Measures Early In the O&P educational experience, residencies are a time of great learning and advancement. In most placements, recent O&P school grads have a lot to learn from the experienced clinicians at the facilities where they are placed. But in some cases, residents are finding that they can be teachers themselves, sharing their knowledge on outcome measures with the more seasoned professionals.

Brian Hafner, PhD

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Rapaport completes a walking test with a patient at Lions Gate Hospital in North Vancouver, Canada.

PHOTOS: Barber Prosthetics Clinic

“As a resident, there’s so much to learn—so it’s great when you’re encouraged to share the 10 percent that you do know!” says Rapaport.

“Every grad coming out of O&P schools has these skills, so it’s beneficial when a facility allows residents to implement their way of thinking.”

Today’s O&P schools have transitioned their programs to devote a great deal of curriculum time to the topic of outcome measurements. At the University of Washington (UW), for example, students in their third quarter are required to take “Outcome Measures for the Prosthetics and Orthotics Clinic,” taught by Brian Hafner, PhD. Students first learn how outcome measures are developed and

tested, and they are given opportunities to try using different types of instruments. Each student is then required to take a deep dive into one instrument of their choosing—studying that instrument using knowledge from the course, then creating a poster describing the history of its development, its psychometric properties, and information about how to administer, score, and interpret the measure.

Students share their unique findings with their classmates and faculty through presentation of their poster in class and during their second-year capstone presentation event. They leverage that information as a base for

the rest of their clinical coursework in school and as they begin to work with patients in the clinical setting.

“Applying outcome measures is a skill set, not a toolkit,” says Hafner.

“You have to know which ones to use, how to score them, what those scores mean,” and how to record that information and refer back to it, he explains. Because it’s not easy to determine which outcome measure should be implemented at a particular O&P facility, it’s important to understand a wide variety of them. “Each one is targeted to the needs of the patient and the capabilities of the facility, so our students have to be able to adapt,” he says. UW students are exposed to both self-reported measures and performance-based measures, including the Prosthetic Mobility Performance Test (PROMPT)—a new tool under development by Hafner’s team.

UW is not the only school teaching these concepts; all of the O&P schools integrate outcome measurement coursework, to some extent. At the University of Hartford (UH), O&P students taking the “Scientific Inquiry I” class, which focuses on evidencebased practice, study the proper interpretation and use of outcome measures, says Kristamarie Pratt, PhD, MEng, who teaches the class. “We discuss psychometric properties of outcome measures—more specifically,

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reliability, validity, and clinical meaningfulness,” she says. In addition, UH students review sensitivity, specificity, and likelihood ratios of diagnostic tools and screening tests.

By having studied these tools and the concepts behind them in their O&P coursework, “our students are ready to bring that information to clinical practices” once they reach their residencies, says Hafner. “This is a way for our students to give back to their mentors.”

NCOPE Standards Mandate Outcomes Education for O&P Students and Residents

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Two-Way Teaching

PHOTO: Barber Prosthetics Clinic

Several standards from the National Commission on Orthotic and Prosthetic Education (NCOPE) address education relating to outcomes.

J. Chad Duncan, PhD, CPO, director of Northwestern University’s Prosthetics and Orthotics Center, shared these standards during a symposium at AOPA’s National Assembly last September.

“NCOPE Standard C.1.8, Rehabilitation Sciences, talks about prosthetic care and orthotic care, appreciating the implications of the stakeholders’ perspectives J. Chad Duncan, on clinical decision making, analyzing, PhD, CPO synthesizing clinical and functional outcomes, and identifying efficacy of provision of orthotic and prosthetic services,” Duncan said. “These are very, very important.” In addition, NCOPE Standard C.2.4.3, under the Patient Assessment area, says, “Outcome assessment, use and interpret appropriate patient-reported and performance-based outcomes measures, to assess achievement of patient-specific orthotic and prosthetic outcomes as compared to their baseline measures.”

In addition, Duncan explained that the Outcomes Assessment area under C.2.4.3 discusses assessment of healthcare and biomechanical needs over time: “Alteration of treatment plans indicated to increase or maintain optimal quality of life throughout the patient's lifespan, and the interpretation of findings—we start instilling that at a very basic level for the students that are currently in the programs.” Duncan explained that of all the universities with O&P master’s programs must take these standards into account and incorporate these requirements into their curricula.

Duncan also reminded attendees that NCOPE has standards for residency programs that relate to outcome measurements. “Just because they graduate, doesn’t mean they stop learning; they have to evolve and use the information that you guide them with as residency directors.

And part of that is under Standard 1.3.4, Follow-Up,” he said. “Under this standard, the resident must demonstrate the ability to develop and implement an effective follow-up plan to assure optimal fit and function of the orthosis or prosthesis and monitor the outcome of that treatment plan.” In addition, 1.3.4.6 states that residents should “assess the function and raw ability of the device using validated outcomes measures and as appropriate.”

Looking to the NCOPE standards in developing curricula and overseeing an O&P residency is a great way to ensure today’s young clinicians are prepared to participate in outcomes measurements in an O&P facility.

At O&P facilities across the nation, owners and managers are ramping up their outcome measurement protocols in an effort to provide optimal care and demonstrate the value of O&P intervention. “You need good information to make good decisions,” says Hafner. “Whether you’re evaluating a patient for the first time or taking measurements after providing an intervention, insurers are requiring better documentation, which means using standardized measures. Plus, most clinicians want to understand the effectiveness of the devices they provide—it’s part of good practice to know what works, how well it works, and for whom it works best.”

As recent O&P grads begin their residencies, they come armed with the knowledge of outcome measurement tools—and, often, they have experience in taking outcome measurements during their clinical courses. Facilities that hire these young clinicians are responsible for teaching them more about measurement protocols at their facilities (see sidebar, “NCOPE Standards Mandate Outcomes Education for O&P Students and Residents”). But they also stand to learn a lot from these well-educated millennials and Gen Zers—if they are willing to listen.

At Scheck & Siress, residents come from a variety of O&P programs and with differing exposures to outcome measures. Once they arrive as residents, they take part in a series of rotations— with some rotations involving the capture of more outcome measures

FEATURE

than others, says Jason Wening, MS, CPO, FAAOP, residency director.

Clinicians-in-training who are in heavy prosthetic rotations, and those who rotate through a neurological orthotic clinic, have the most exposure to outcome measures, he notes.

Some residents learn a lot just by helping patients who are filling out PLUS-M questionnaires, particularly older patients who may have trouble navigating iPads. “That can be a powerful learning opportunity for the resident; it can help residents learn how to ask questions and get information,” says Wening. “The questions can lead to better information than an open-ended question like, ‘What are your goals?’”

Residents also learn about patient safety while capturing outcome measurements, says Wening. “You want to give patients the best components so you want them to get high scores” on tests that determine K levels, “but if a patient doesn’t feel safe doing an outcome measure, it’s time to stop,” he says, so you don’t push a patient to do something they are not able to do and risk having them fall.

The clinical team at Barber Prosthetics Clinic: Tessa Richardson, CP(c); Rapaport; Jesse Spellen, CP(c), Brittany Pousett, MSc, CP(c); and David Moe, CP(c) who are willing to show initiative and keep doing a best practice they learned with a previous mentor are bringing a lot of value to the company,” he says.

“They’re showing they’re being a contributor, not just a learner.” These residents will be more successful when they are hired as clinicians and are expected to be more independent.

True Teamwork Jason Wening , MS, CPO, FAAOP

PHOTO: Barber Prosthetics Clinic

Residents also may benefit from working with assistants and technicians at O&P facilities, particularly at a company like Scheck & Siress, where assistants conduct most of the outcome measure testing. “When they graduate from their residency, they may end up at a smaller facility where they have to do more,” Wening explains. “The bottom line is that the clinician is responsible for the care of the patient.”

When the recent grads are assigned to a mentor who is less inclined to take outcome measures, “that’s where residents can be proactive and differentiate themselves by sharing what they’ve learned” during previous mentoring opportunities and at their O&P schools, says Wening. “Residents

Like Wening, Rapaport believes residents should be proactive in sharing their knowledge. “It’s the responsibility of the resident to identify what skills they may be able to contribute” and communicate that information to managers. She recalls that she was encouraged to provide value to the Barber team and has done so by conducting short workshops about specific outcome measures in response to clinicians’ questions; researching how to use a recently purchased G-WALK movement analysis tool and creating a presentation and resource regarding the tool; and assisting other clinicians as needed in using outcome measurement instruments or interpreting the results.

Rapaport also has found a novel way to educate others outside the facility on Barber’s outcome measurement procedures. She has taken the lead in creating modules explaining

the theory of outcome measures and Barber’s prescribed protocols, and she has shared those videos in an online educational platform created with the help of PnO Data Solutions.

Employees at Winnipeg Prosthetics and Orthotics, an unaffiliated O&P facility in Manitoba, recently completed that online education, and the facility has implemented the same outcome measures protocols as Barber. The facilities have begun sharing data, Rapaport explains. “It’s an exciting step. We can start to make some overarching statements and learn more about what we do for our patients.”

If residents are proactive and facilities are receptive, more O&P companies can increase their capabilities and implement thorough outcome measurement protocols. Partnering with young clinicians can help facilities in their quests to “create a culture of outcomes measurement in the clinic” where taking and recording patient outcomes is part of businessas-usual, says Hafner. “It has great potential to inform clinical practice, and make the facility better.”

Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

O&P ALMANAC | APRIL 2020

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COMPLIANCE CORNER

By DEVON BERNARD

Interpreting the ADA Know when and how to leverage aids and services to communicate with hard-of-hearing patients

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At its core, the ADA is divided into five sections, or titles, designed to address or relate to different Equal Employment aspects of everyday public life.

Opportunity for Individuals Title I, Equal Employment With Disabilities Opportunity for Individuals With Disabilities, addresses TITLE I employment. This title requires employers to provide reasonable accommodations to qualified applicants and employees. A reasonable accommodation is any TIT III LE modification or adjustthe LE IV on ublic n TIT Te o P ment to a job or work n i i t lec y na b nd om mi bility ns a ties environment that will enable i r mu i isc sa tio il nic nd of Di oda l Fac an applicant or employee o ati N is ia on s mm rc with a disability to participate s Ba cco me A om C in the application process or to perform essential job functions.

Title II, Nondiscrimination on the Basis of Disability in State and Local Government Services, prohibits discrimination in all programs, activities, and services of public entities.

APRIL 2020 | O&P ALMANAC

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HIS YEAR MARKS THE 30th anniversary of the Americans With Disabilities Act (ADA). Signed into law on July 26, 1990, by President George H.W. Bush, the ADA has gone through some changes, and amendments have been added over the past three decades. But at its core, it remains a law designed to prohibit discrimination against individuals with disabilities in all areas of life and to ensure that people with disabilities have the same rights and opportunities as everyone else.

This issue’s Compliance Corner focuses on one provision of the ADA that continues to cause some confusion among medical professionals: the rules regarding communicating with patients who may have hearing, vision, or speech impairments—or understanding when an interpreter is required.

Protecting Individuals With Disabilities

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ADA

E! QU IZ M

This section also may be viewed as the transportation title, as it applies to public transportation provided by public entities. It establishes detailed standards for the operation of public transit systems, including commuter and intercity rail. This section requires local public transit systems to offer paratransit services or similar options.

Title III, Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities, prohibits private places of public accommodation—such as hotels, restaurants, or healthcare facilities—from discriminating against individuals with disabilities and sets the building standards for accessibility. This title directs businesses to make reasonable modifications to their normal daily operations when serving people with disabilities, and requires that these businesses take the required and necessary steps to communicate effectively with customers with vision, hearing, and speech disabilities.

Title IV, Telecommunications, requires that all telephone and Internet companies provide a system that allows

COMPLIANCE CORNER

individuals with hearing and speech disabilities to communicate over the telephone. This section also requires closed captioning of federally funded public service announcements.

Finally, Title V, or the Miscellaneous Provisions, lays out the ADA’s relationship with other existing laws and prohibits any retaliation or coercion.

As would be expected, answers to questions about the requirements regarding interpreters are found in Title III. Specifically, Section C, Part 360.303, Auxiliary Aids and Services, covers this topic. This section states that you have a duty to make available or offer appropriate aids or services when they are needed to provide effective communication with people who are deaf or hard of hearing.

Meeting the Needs of the Hard of Hearing

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However, if the patient is there for a first fitting or the appointment requires a full exam and testing, then notes may not be adequate to explain the situation or allow the patient to ask complex questions. In this case, an interpreter may be required, or you may be asked to use a different method, if requested by the patient.

Be sure to consider the patient’s normal means of communication or preferences. Understand that there are different types of sign language, so you would need to determine the method preferred by your patient—if the patient even uses sign language.

In addition, the patient may have experiences with all of the auxiliary aids and services you offer but may prefer one method over another.

Remember that you are not always required to provide the method of interpretation that the patient chooses or prefers. You should ask the patient’s preference and try to accommodate that choice to ensure lines of effective communication, but the final decision rests with you—as long as the method chosen results in effective communication.

In addition, the ADA states that you are not required to provide a particular auxiliary aid or service if it causes an undue burden to your business.

An undue burden can be something that involves significant difficulty, such as hiring an interpreter on short notice, or expense. An undue expense doesn’t solely mean the interpreter is more expensive than the item/ service you are providing; an undue expense considers your overall financial resources and overall expenses.

Note that the business is required to pay for whichever interpreter, auxiliary aid, or service you and your patient elect to use, as this is considered part of doing business. If you are a small business and are required to pay for one or more auxiliary aids or services, you may want to consider speaking with an accountant as tax breaks may be available.

This Compliance Corner looked at only one component of the ADA, and it did so with a broad lens. If you have specific questions or are looking for an interpretation of the ADA, consider speaking with an attorney or visiting the ADA website, www.ada.gov.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming.

Reach him at dbernard@AOPAnet.org.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz.

Earn CE credits accepted by certifying boards:

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PHOTO: Getty Images

So, what are considered appropriate aids and services, and what is effective communication?

Several aids and services are considered appropriate, and each one has its own merits, faults, and complexities; the one you choose to use may be based on your situation.

Here are some examples of appropriate aids and services: written materials/exchange of written notes, computeraided transcription services, and video remote interpreting services.

Then there is the option of qualified interpreters. A qualified interpreter is defined as someone “who is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary.” An individual does not need to be certified in order to meet this definition, unless your state requires the use of certified individuals.

In most cases, family members, friends, and companions would not be considered qualified interpreters because they could be emotionally involved or could have interests that conflict with the patient’s—thus, they would not be able to interpret “effectively, accurately, and impartially.”

In addition, using family members,

friends, or companions as interpreters can cause problems when it comes to maintaining patient confidentiality.

However, even though a family member, friend, or companion is not a qualified interpreter, one of these individuals may be acceptable in certain scenarios—for example, in an emergency.

So how do you know which method of interpretation to use? That depends on the effectiveness of the communication required. The key to communicating effectively is to consider the nature, length, complexity, and context of the communication and the patient’s normal and preferred methods of communication. For example, if the patient is in the office to set up an appointment, ask some general questions, or meet briefly for a quick follow-up appointment, you may be able to rely on notes, brochures, or a similar method of communication.

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PRINCIPAL INVESTIGATOR

Studying the Senior Population Szu-Ping Lee, PhD, PT, investigates human movement as it relates to rehabilitation

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

APRIL 2020 | O&P ALMANAC

ZU-PING LEE, PhD, PT, a clinically

trained physical therapist, plays a critical role as a rehabilitation researcher deeply embedded in the O&P community. An associate professor in the Department of Physical Therapy at the University of Nevada, Las Vegas (UNLV), he teaches several O&Pthemed courses to the doctor of physical therapy (DPT) students. He also is the local coordinator for the Las Vegas Amputee Support Group, affiliated with the Amputee Coalition.

Approximately 150 students are currently seeking DPT degrees at UNLV where Lee teaches the Prosthetics & Orthotics Lecture and Laboratory course. He also conducts amputee rehabilitation research in collaboration with local O&P clinics, rehabilitation hospitals, and the U.S. Department of Veterans Affairs Southern Nevada Healthcare System.

Born and raised in Taiwan, Lee completed his undergraduate studies in physical therapy at the National Yang-Ming University in Taipei before moving to the United States at age 26.

He earned his master’s degree in human performance and biomechanics from the University of Florida, followed by his doctorate in biokinesiology from

University of Southern California, Los Angeles, in 2012.

“I am trained as a physical therapist and biomechanics researcher interested in human movement as related to rehabilitation,” Lee explains. He was introduced to O&P by a former professor, the late Edward Neumann, CP, who taught in UNLV’s Department of Civil and Environmental Engineering Department for years before becoming a certified prosthetist at age 55. “He made me realize that O&P has a lot of engineering and technical developments,” Lee explains, “so perhaps someone should also look at the human factor that is equally important in rehabilitation after amputation.”

Seeing the Patient Behind the Device

Lee focuses his career on investigating the learning of motor skills after limb loss. “While I appreciate the advancements in prosthetic technology, it is important not to forget the human factor,” he says. “After all, a prosthetic device is a tool still controlled by a person to accomplish what he or she wants to do. Just like mastering any tool or skill, there is a learning process,” which may be complicated by factors such as

PHOTO: Szu-Ping Lee, PhD, PT

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PRINCIPAL INVESTIGATOR

disparities associated with limb loss. In this arena, he has studied how socioeconomic status affects access to physical therapy, capacity to perform physical activity, and fear of falling among the limb loss population. He is particularly proud of the work currently under review

by Prosthetics & Orthotics International.

In this study, his team showed that financial difficulty can negatively impact long-term high-level functioning after amputation. (“High-level functioning” means being a mother or going to work, not just something simple like moving one’s leg or walking, according to Lee.) He hopes that payors and health policy makers will consider these factors when determining reimbursement.

Finally, Lee studies motor skill learning among limb loss patients. He is part of an ongoing five-year investigation, funded by the National Institutes of Health, assessing how limb loss and chronic diabetes affect learning of motor skills such as balance and fall arrest. “Hopefully we will have some interesting results soon,” he says.

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Szu-Ping Lee, PhD, PT, assists Bree, a Certified Peer Visitor who has hip disarticulation, in trying rock climbing.

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PHOTO: Szu-Ping Lee, PhD, PT

age, level of amputation, complexity of the device, psychosocial factors, and presence of other medical conditions.

“If physical therapists and prosthetists can understand how best to facilitate learning,” says Lee, “it will definitely lead to faster recovery and better function.”

Lee keeps the patients in mind as he investigates three different lines of O&P-related research. First, he studies orthopedic problems associated with limb loss—for example, knee pain and back pain. He has published several papers on this topic, including one studying patellar tendon morphology in transtibial amputees using a prosthesis with a patellar tendon-bearing feature.

He found the results of this study to be especially intriguing. “People with below-the-knee amputations still have their knees, and these joints can still hurt,” he explains. “We showed that wearing a prosthesis that puts pressure around the knee can alter the structure of the knee tendon, when compared to nonamputees.”

Second, Lee focuses on health

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O&P ALMANAC | APRIL 2020

41

PRINCIPAL INVESTIGATOR

Lee, far left, during an Amputee Coalition Certified Peer Visitor training session in 2019 Much of Lee’s work is designed to improve the quality of life among older amputees. “Younger people or children always figure things out. It is much harder for someone who is older,” he explains. “However, 70 percent of amputations are due to diabetes or other vascular problems typically seen in older folks. I think the challenges that are unique to them should be studied.”

Lee plans to dedicate his research career to focusing on this population.

He is optimistic that his work will help highlight factors related to improving patient function, and that it will help justify specific care services or devices. He also is working on developing assessment tools for secondary conditions, such as back pain, that will one day be useful in early identification and treatment of low back pain in people with limb loss.

Lee expects to see more researchers studying the human aspect of rehabilitation in the coming years. He has noticed an uptick in studies related less directly to the prosthetic devices, and focusing more broadly on issues such as rehabilitation, health disparity, and secondary medical problems.

Lee spends much of his instructional time at UNLV teaching students about the benefits of mutual understanding between healthcare fields such O&P and PT. “Our DPT students are training to become physical therapists.

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APRIL 2020 | O&P ALMANAC

Notable Works

Szu-Ping Lee, PhD, PT, is the author or presenter of dozens of peer-reviewed articles and conference presentations. Some of his most impactful contributions include the following: • Ciccotelli, J., Damele, M., Gross, R., Robina, R., Lee S.P. “Lumbopelvic Muscle Performance and Cross-Sectional Area in Individuals With Unilateral Above-the-Knee Amputation: Implications for Low Back Pain.” Proceedings of the American Physical Therapy Association Combined Sections Meeting, Washington D.C., 2019.

• Ho, K.Y., Evers, M., Kellogg, J., Teter, K., Lee, S.P., Chang, Y.J., Bashford, G. “Patellar Tendon Morphology in Transtibial Amputees Utilizing a Prosthesis with a Patellar-Tendon-Bearing Feature.” Nature Scientific Reports, 9(1): 1-7, 2019.

• Lee, S.P., Chien, L.C., Chin, T., Fox, H., Gutierrez, J. “Financial Difficulty After Amputation Is Associated With Perceived Health and Well-Being in Community-Dwelling Persons With Lower Limb Loss.” Prosthetics & Orthotics International (in review).

• Shih, H.T., Lee, S.P. “Effect of Age and Body Mass Index on Mobility in Middle to Older Age Adults With and Without Lower Limb Amputation.”

Proceedings of Annual Meeting of American Society of Biomechanics, Rochester, MN, 2018.

PHOTO: Szu-Ping Lee, PhD, PT

Promoting Collaborative Healthcare

For them, the emphasis of my teaching is interdisciplinary collaboration and communication with O&P professionals.

If they learn only one thing in my class, I hope that is how to effectively communicate with O&P professionals so we work together to help patients,” he says. The DPT students also have an opportunity to become involved in clinical research relating to amputees.

Lee also works with PhD students.

“They receive rigorous training in study design, biomechanical methods, and

findings dissemination. Currently two of my PhD students and a postdoctoral scholar are doing very exciting research related to the limb loss population,” he says.

Beyond teaching responsibilities, Lee enjoys his community organizational role at the Las Vegas Amputee Support Group. “Seeing the people in the community gives meaning to my teaching and research. My friends often give me new research ideas,” he explains.

In that capacity, he regularly plans and participates in workshops such as Amputee Coalition’s Certified Peer Visitor training and adaptive activities for limb loss patients. Lee himself enjoys hiking and rock climbing— endeavors he usually undertakes with his wife, who also is a physical therapist. “The area around Las Vegas is an amazing outdoor playground,” he says.

Lee hopes to inspire more individuals in a variety of disciplines to more closely study rehabilitation among amputees—particularly older patients. Says Lee, “I think it is very exciting that so many good researchers are passionate about helping persons with limb loss.”

#LLAM #LimbLossAwareness

Be STRONG April is Limb Loss and Limb Difference Awareness Month!

Find out how you can participate in this month-long event to help celebrate, motivate, educate, and bring awareness to the community.

HERE ARE JUST A FEW WAYS TO GET INVOLVED!

M

LA

Hill Day from Home: learn more about our plans for taking this year’s Advocacy Forum online, and how you can participate at amputee-coalition.org/advocacyawareness/advocacy-forum

#L

Participate in one of the Amputee Coalition Flagship Events

50 Governor Challenge Be Strong Daily “Dares” Fundraising Kit Wear Orange on Wednesdays Order Free Awareness Ribbons from Amputee Coalition store

Visit us at amputee-coalition.org/events-programs/limbloss-awareness-month to learn more about what you can do to raise awareness with impact.

MEMBER SPOTLIGHT

Michigan Medicine O&P Center

Collaborative Care in the Great Lakes State Orthotists and prosthetists work closely with other specialists at the University of Michigan’s O&P facility

T

HE UNIVERSITY of Michigan

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APRIL 2020 | O&P ALMANAC

A patient tries out a new blade prosthesis.

FACILITY: Michigan Medicine O&P Center LOCATION: Ann Arbor, Michigan OWNER: University of Michigan HISTORY: 108 years

Brian Kelly, DO

face masks, and upper- and lower-limb orthoses. Prosthetic care is comprehensive, including upper- and lower-extremity devices fabricated by highly trained technicians who work side-byside with practitioners at the O&P Center. This care is further enhanced by strong relationships with university researchers who collaborate with the O&P Center to measure outcomes and develop new devices and treatments.

Michigan Medicine O&P recently completed a renovation of its fabrication area, including technician work areas, storage, and a state-of-the-art dust collection system. “Our offsite facilities have the necessary tools and equipment to do all manner of fittings, repairs, and adjustments,” says Wensman.

The center’s marketing efforts focus primarily on the university’s own medical system. “One of our marketing goals is to make sure everyone who works for Michigan Medicine knows how to work with us,” says Kelly.

As part of a university, the center has robust educational and

training programs, including O&P educational courses for physical medicine and rehabilitation, orthopedic, and neurosurgery residents; clinical rotations for O&P students in technician and practitioner programs; and shadowing opportunities for interested high school and college students.

The center conducts extensive outreach activities through the University of Michigan Community Amputee Network, or UCAN. A six-week class called Amputees Creating a New Tomorrow delivers information on such topics as phantom pain, driving, body image, and physical therapy. Another UCAN program features a monthly support group, a monthly newsletter, and a website with links to services and activities such as ballroom dance, sporting activities, and social outings for individuals with limb loss. Patients also may choose to take part in peer mentoring and online support groups.

Beyond its vast range of offerings, what makes the O&P Center unique is its teamwork and coordination of care between its physicians and practitioners, says Kelly. “A patient might have trouble fitting into their socket because of an undiagnosed medical condition, such as congestive heart failure leading to swelling in the limbs. Another patient may be experiencing more frequent falls from advanced diabetes and not related to the alignment of the prosthetic device,” he explains.

“We see each person as a whole, in all of their medical aspects, and we have access to physician specialists for every situation.”

“Michigan’s mantra is ‘the team, the team, the team,’” adds Wensman. “We have to work together to make this work.”

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

PHOTOS: Michigan Medicine O&P Center

Medicine’s O&P Center is one of the largest single-site providers in the country—and one of the oldest, tracing its origins back to 1912. In the 1930s, the program was incorporated into the school’s Appliance Shop; a few decades later, orthotics and prosthetics were transferred from the university’s surgery department to the new Department of Physical Medicine and Rehabilitation.

Michigan Medicine O&P sees more than 35,000 patients annually at its primary location and offsite clinics. The O&P Center and University Hospital Clinic are located in Ann Arbor. The Northville Health Center is a large multidisciplinary facility that offers orthotic, prosthetic, and pedorthic care, as is the Brighton Center for Specialty Care. In addition, the O&P Center offers multidisciplinary clinics for amputees and specialty clinics for brachial plexus, postpolio, and cancer care, enabling patients to see their physician as well as their O&P clinician in a collaborative environment.

Seventy-three employees staff the O&P Center, including Medical Director Brian Kelly, DO, who oversees the entire program; Director of O&P Services Jeffrey Wensman, CPO; 33 clinical staff members; 10 technical staff; and 28 administrative/support personnel.

The center provides customfabricated O&P services for all ages.

Clinicians meet patients’ orthotic needs with cranial remolding helmets for babies, protective

By DEBORAH CONN

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MEMBER SPOTLIGHT

TechMed 3D

By DEBORAH CONN

Scanning Solutions Canadian company offers human body measurement software to assist in fabricating O&P devices

T

RUE TO THE STARTUP

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APRIL 2020 | O&P ALMANAC

The TechMed 3D team

COMPANY: TechMed 3D OWNER: Michel Babin LOCATION: Quebec City, Quebec HISTORY: 11 years

The company’s app, 3DsizeME

is designed to scan the human body,” says Babin, “and it tolerates micromovements, which makes it possible to scan babies’ heads for orthotic helmets even if they move and to scan a torso even while the subject is breathing.”

The Structure Sensor Mark II, produced by Occipital, is an economical option that turns an iPhone or iPad into a 3D scanner.

The product is small and lightweight, so it is helpful for situations that require a portable scanner. It works with TechMed’s 3DsizeME app for Apple devices, which controls and optimizes the scanner.

In 2012, TechMed entered a partnership with Rodin 4D, a major presence in the O&P industry, which integrated MSoft into its system. In 2019, the company developed MSoft+, which automates certain MSoft with measure- algorithms and is ments obtained from able to generate a scanned foot a complete 3D file, recommend products, and provide measurements within 30 seconds.

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

PHOTOS: TechMed 3D

mythos, Michel Babin developed the software at the heart of his company in his basement.

In 2007, Babin was working at Creaform 3D, a company that produces 3D scanners for a variety of industries. He realized that the scanners were not very user-friendly and required a high learning curve, leading to often inconsistent results.

His solution was to develop software designed to simplify the process and to produce more usable information. Targeting the O&P industry, Babin created MSoft to more easily integrate scans of the human body with computeraided tools to fabricate devices.

Babin founded TechMed 3D in 2009 and made his first sale a few months later. In 2010, he hired his first employee.

Today, the company has 20 employees, plus customers in more than 50 countries, including orthotists, prosthetists, and central fabrication facilities.

“The scanner produces raw data,” he explains. “It doesn’t address alignment, and it’s not that easy to turn that data into useful information for fabricating devices. Our software provides alignment, reduces noise around the file, fills in the holes, and produces a representative file of the body part that is compatible with construction and modification.”

According to Babin, the software is “scanner agnostic,” so the choice of scanner is left to each facility, but TechMed 3D does offer two types of scanners for purchase. The BodyScan scanner is produced by Creaform 3D. “It

The company also has developed a new business model, called Pay per Scan, in which the software, support, and updates are free, with fees incurred only when the file is used. Using this model, “customers do not have to finance the purchase of the software,” explains Babin, “which is a big help for their cash flow management.”

TechMed is unique, says Babin.

“A few scanner companies can provide software for day-to-day O&P work, but it’s expensive and not that intuitive. Our real competitors are traditional methods of fabrication, like plaster casts and foam boxes.” The software is intuitive enough that clinicians can master it by watching brief videos, according to Babin. “We offer a lot of one- and two-minute videos, which can be very helpful when people decide to move from plaster to digital.” TechMed markets its products through trade shows, its website, and in-person customer visits. The company blog both introduces new products and highlights other technologies and developments in the O&P industry.

As it establishes itself, TechMed is exploring ways to give back to the community at large; Babin has been in discussions with Doctors Without Borders to donate software.

Babin expects more companies to move from plaster to digitization, both for environmental reasons and for improved efficiency and accuracy. “Clinicians will outsource production or do their own in-house, adopting whatever business model best serves them,” he says. “Our goal is to continue to provide a cheaper, faster, and easier solution to that process.”

AOPA NEWS

Co-OP

Don’t Sleep on the Latest AOPA Member Resource

A

RE YOU UTILIZING YOUR AOPA MEMBERSHIP?

Attend the upcoming live tutorial to learn about one of the best resources available for O&P practices, the AOPA Co-OP. A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. This searchable database provides up-to-date information on developments in Medicare policy, state-specific legislation, private-payor updates, and more. Members can access detailed information on everything from modifiers to product-specific L codes and associated policies.

Register for the next Co-OP Live Tutorial hosted by AOPA Director of Strategic Initiatives Ashlie White, who will demonstrate how to use the Co-OP and answer all of your questions. Any employee of an AOPA member firm is welcomed to join this free tutorial.

Co-OP Live Tutorial Webinar • Friday, May 15 • Friday, June 19 Registration at bit.ly/Co-Op2020.

Webinars UPCOMING WEBINAR // UPCOMING WEBINAR // UPCOMING WEBINAR

WEDNESDAY

Social Media Mayday: Increase Your Footprint

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

MAY 13

MAY 5–6

WASHINGTON, DC

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

WEDNESDAY

Clinician’s Corner: Prosthetics

SCIEN

TIFIC C

Check AOPAnet.org for updates.

REDITS

Take part in the second installment of AOPA’s new Clinician’s Corner webinar, and learn about the newest techniques in prosthetics. Get tips on how to best treat your patients while earning scientific credits. Clinician’s Corner will be presented by one of AOPA’s many honored National Assembly presenters.

JUNE 10

During these one-hour sessions, AOPA experts provide up-to-date information on a specific topic. Webinars are perfect for the entire staff—they’re a great team-building, money-saving, and educational experience! Sign up for the entire series and get two conferences free.

Entire Series ($990 Members/$1,990 Nonmembers). Register at bit.ly/2020webinars.

YOUR CONNECTION TO EVERYTHING O&P

O&P ALMANAC | APRIL 2020

47

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Certified Prosthetist Orthotist (CPO)

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

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

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

Nonmember $678 $830

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

Job Board

Member Nonmember $85 $150

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

SUBSCRIBE

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

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Inter-Mountain

APRIL 2020 | O&P ALMANAC

New Mexico A well-established, privately owned ABC-accredited facility is seeking an experienced CPO who will support the company’s mission, and provide premier prosthetic and orthotic patient care.

Candidates must be energetic, self-motivated, and knowledgeable with strong clinical, technical, and interpersonal interaction skills. They must be patient-oriented and innovative, and desire a long-term career with a growing company.

We offer competitive salaries, benefits, and a rewarding place to take the next step in establishing a great career and making a difference. Salaries are commensurate with experience. Local ABC-certified practitioners are preferred.

Apply by email to: Email: WeisbergPros@gmail.com

WANTED! A few good businesses for sale.

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

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

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

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

CL MB The path to the top isn’t always easy.

But at Hanger, no one has to do it alone.

And there’s no limit to how high any of our team members can climb.

Hanger is the clinical leader in orthotic and prosthetic care because we hire the best and the brightest. We provide vast resources, opportunities for career advancement, and the most innovative technology in our field to help them do what they do best: care for our patients.

We’re passionate about the life-changing, fulfilling work we do to empower our patients to take on life’s challenges with increased mobility, independence and self-confidence. We know this important work starts by supporting our employees.

Empower your career. Apply today and climb higher at Hanger.

Hanger.com/Climb

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

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac20 for advertising options.

ALPS Valve Integrated Pump ALPS Valve Integrated Pump (VIP) is just what you need for elevated vacuum systems.

Designed with the practitioner in mind, the VIP is easy to install and easy to use. Once the amputee dons the prosthesis and places a seal sleeve over the socket, the pump is activated from the user’s weight during heel strike, and draws elevated vacuum after toe-off during swing phase. Engineered out of a medical-grade silicone and two valves to control the airflow, the VIP is available with two different levels of vacuum to accommodate most users’ activity levels and skin types.

Call us or visit www.easyliner.com for more information.

Apis

2nd Generation Coapt Control Gen2 is the all-new and reimagined myoelectric pattern recognition control system from Coapt. Compatible as an add-on system to virtually every powered upper-limb prosthetic configuration, Gen2 unleashes an unprecedented level of personal, intuitive control for its wearers.

Coapt’s Gen2 has enhanced the performance of the COMPLETE CONTROL pattern recognition core and introduces unrivaled new features, changing the field once again: • CONTROL COACHTM—An onboard A.I. companion guiding the wearer through accelerated learning and adoption of their prosthesis control • ADAPTIVE ADVANCETM—An extra machine learning layer capable of continuously improving Gen2’s harmony with its wearer.

For more information, visit www.coaptengineering.com.

A Perfect Fit for You and Your Patients Apis custom program offers practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words.

Call us at 1-888/937-2747.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls.

The LEAP is a short, semirigid anklefoot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue.

For more information, call 800/301-8275 or visit www.hersco.com.

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APRIL 2020 | O&P ALMANAC

Consistently capture true anatomy under weight-bearing conditions with the Symphonie® Aqua System, available through Cypress Adaptive. This innovative, hydrostatic technology replicates the exact forces one would experience while standing in a prosthetic socket. The accuracy of the weight-bearing impression eliminates the need for cast modifications and enables the practitioner to achieve consistent outcomes and efficiently provide the patient with a comfortable, well-fitting socket.

For more information, contact Cypress Adaptive at 888/715-8003 or visit our website, www.cypressadaptive.com.

MARKETPLACE The Original Preflexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement.

For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com.

New! Bondtek Adhesive Introducing Bondtek Urethane Adhesives: Great for any situation when you need something glued quickly and easily.

Bondtek is the costeffective go-to adhesive for all your fab needs.

Sets fast, holds shape, and no sag, with 30- and 60-second set times.

Standard 50- and 220-ml sizes. Prop 65 free material.

Learn more at 800/322-8324 or visit www.fabtechsystems.com/bondtek.

Naked Prosthetics Naked Prosthetics designs and manufactures high-quality prosthetic devices specifically for finger loss. Our mission is to assist people with digit amputation(s) and positively impact their lives with fully articulating, custom finger prostheses.

Our product aims to restore the ability to perform most tasks, supporting job retention and an active lifestyle. Our customers have lost fingers to power tools, equipment malfunctions, injury in the line of military service, random accidents, and infections; in some cases, multiple digits have been lost. NP provides a viable functional prosthesis, as opposed to a passive cosmetic solution. Our design mimics finger motion and utilizes the remainder of an amputee’s digit to power the device.

For more information, visit www.npdevices.com.

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

Learn more at https://go.ossur.com/ unloader-one-x-opa.

Spinal Technology Inc. Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses.

Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry.

Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis.

For information, contact 800/253-7868 or visit www.spinaltech.com.

O&P ALMANAC | APRIL 2020

51

MARKETPLACE Ottobock Unique Liners Now with custom silicone material and scanning app.

Unique Liners from Ottobock are highly customized to achieve innovative fitting results.

This now includes the new Skeo Unique silicone liners in addition to the Uneo Unique urethane liners.

There are many options for these customized solutions, including textile covers, suspension options including DVS Dynamic Vacuum, and fresh scent or Skinguard antibacterial for our Uneo liners.

Plus, we offer the free Custom4U iPad app for easy scanning with a Structure scanner to reduce mess and save on shipping costs.

Contact your sales representative at 800/328-4058 or visit https://shop.ottobock.us for details.

WalkOnÂŽ Carbon Fiber AFO WalkOn AFOs are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally. WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return. WalkOn offers a full range of AFO sizes and designs including the WalkOn Reaction junior pediatric sizes.

Fast and easy to fit, the WalkOn footplate is trimable and can be shaped with scissors, often requiring only one office visit.

Contact us at 800/328-4058 or visit professionals.ottobockus.com.

52

APRIL 2020 | O&P ALMANAC

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

Discover the exciting PROTEOR USA product line today at proteorusa.com. #humanfirst

The Xtern Foot Drop AFO From TurboMed Orthotics This unique ankle-foot orthosis (AFO) was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe.

The Xtern is HCPCS code L1951 validated.

Turbomed innovative products are now available through distributor partnerships in more than 26 countries.

Its unique design and material composition give another meaning to walking and running. There is no limitation with the Xtern for the customers—not even a weight limit! For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the Xtern in less than five minutes. Available in USA from Cascade Supply, SPS, Lakes Medical Innovations, Kevin Orthopedic, and Physio Tech.

For more information, visit www.turbomedorthotics.com.

MARKETPLACE Vasyli + Armstrong II Sheer Reducing Diabetic Orthotic

2020 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HealthCare Common Procedure Coding System (HCPCS) code changes with an array of 2020 AOPA coding products.

Ensure each member of your staff has a 2020 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• 2020 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers

Clinically proven and patented diabetic orthotic addressing the two most important factors in preventing callousing and ulcerations—sheer and pressure. The Armstrong II combines a dual-density medicalgrade plastizote/EVA and a unique Glidesoft forefoot sheer reducing forefoot for bestin-class outcomes. SADMERC A5512 approved For more information, visit www.vasylimedical.com.

• 2020 Quick Coders: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

AD INDEX

Advertisers Index Company

Page Phone 800/574-5426

Website

ALPS South LLC

9

Amfit

15 800/356-3668

www.easyliner.com

Amputee Coalition

43

888/267-5669

www.amputee-coalition.org

Apis Footwear Company

21

888/937-2747

www.apisfootwear.com

Cailor Fleming Insurance

45

800/796-8495

www.cailorfleming.com

Coapt

29 844/262-7800

www.coaptengineering.com

ComfortFit Orthotic Labs Inc.

19

888/523-1600

www.comfortlabs.com

Cypress Adaptive LLC

27

888/715-8003

www.cypressadaptive.com

ESP LLC

5

888/WEAR-ESP

www.wearesp.com

Fabtech Systems LLC

17

800/FABTECH

www.fabtechsystems.com

Ferrier Coupler Inc.

23

810/688-4292

www.ferrier.coupler.com

Hanger

49 512/777-3814

www.amfit.com

www.hanger.com

Hersco

1 800/301-8275

www.hersco.com

Naked Prosthetics

11

www.npdevices.com

Össur Americas Inc. Ottobock

888/977-6693

3 800/233-6263 C4 800/328-4058

www.ossur.com www.professionals.ottobockus.com

PROTEOR USA

7 855/450-7300

www.proteorusa.com

Spinal Technology Inc.

33

www.spinaltech.com

800/253-7868

TurboMed Orthotics

37

888/778-8726

www.turbomedorthotics.com

Vasyli Medical

39

888/882-7954

www.vasylimedical.com O&P ALMANAC | APRIL 2020

53

CALENDAR

May 1

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

May 5–6

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

May 13 APPLY ANYTIME! BOC Certification. Apply anytime and www.bocusa.org test when ready for the orthotic fitter, mastectomy fitter, and DME specialist certifications. To learn more about BOC’s nationally recognized, in-demand credentials and to apply today, visit www.bocusa.org.

Cascade Dafo Institute

Nine free ABC-approved online continuing education courses for pediatric practitioners.

Take anytime, anywhere, and earn up to 14.25 CE credits.

Visit cascadedafo.com or call 800/848-7332.

2020 April 6–11

April 8

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

April 17 WEBINAR

visit www.AOPAnet.org.

May 13–15

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

May 15–16

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

May 29–30

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

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

ABC: Application Deadline for August Written & Simulation Exams. Applications must be received

by June 1 for individuals seeking to take the August Written and Simulation certification exams. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

June 8–13

ABC: Written and Simulation Certification Exams.

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

June 10

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

WEBINAR

April 22-23 WEBINAR

54

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

June 1

ABC: Written and Simulation Certification Exams.

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

WEBINAR

WEBINAR

Medicare 101. For more information, visit www.AOPAnet.org.

APRIL 2020 | O&P ALMANAC

June 19 WEBINAR

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

CALENDAR

September 9–12

July 8 WEBINAR

visit www.AOPAnet.org.

AOPA National Assembly. Mandalay Bay, Las Vegas.

For more information, visit www.AOPAnet.org.

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

October 3

July 31–August 1

PrimeFare East Regional Scientific Symposium.

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

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

July 1

ABC: Application Deadline for Fall CPM Exams.

All practitioner candidates have an additional 30 days after the application deadline to complete their residency.

Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

July 1

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

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

August 12 WEBINAR

www.AOPAnet.org.

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

September 2

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

Calendar Rates CE For information on continuing education credits, contact the sponsor.

Questions? Email ymazur@AOPAnet.org.

CREDITS

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

WEBINAR

November 4–6

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

November 11

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

WEBINAR

visit www.AOPAnet.org.

July 20-21 SEMINAR

October 14

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

WEBINAR

www.AOPAnet.org.

2021 September 9–12

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

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email ymazur@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Words/Rate

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Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

O&P ALMANAC | APRIL 2020

55

STATE BY STATE

Updates on Cranial Orthoses, Prior Authorization, and More

P Co-O e h t t i Vis test the la e e s to nd OPA a A m o fr ers memb r e h t o 9.

VID-1 O C n o Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more.

Update on Reimbursement for Cranial Orthoses

In a clear policy win for O&P, BlueCross BlueShield has issued a revised policy, DME 103.007, “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses,” effective March 1, 2020, in five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. The updated policy addresses many of the concerns AOPA expressed in its policy review request submitted following the Nov. 1, 2019, published policy. Visit the AOPA Co-OP for additional information.

Prior Authorization for Prostheses

Initial implementation of prior authorization for six prosthetic codes is scheduled for May 2020 in Pennsylvania, Michigan, Texas, and California, with nationwide implementation scheduled for late 2020. The six codes that will require Medicare prior authorization are L5856, L5857, L5858, L5973, L5980, and 5987.

The selected codes represent three microprocessor-controlled prosthetic knees, a microprocessor-controlled prosthetic foot, and two functional Level 3 prosthetic feet. (See Reimbursement Page on page 18 for details on the planned rollout of prior authorization.)

56

APRIL 2020 | O&P ALMANAC

Minnesota

In Minnesota, Senate counsel and MN Medicaid/DHS are working on a bill to broaden the scope of prescribers of O&P to Medicaid recipients to match Medicare standards.

Specifically, the bill will seek to include physician assistants, nurse practitioners, and clinical nurse specialists.

Ohio

The Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board is seeking comments and feedback on rules implementing recently enacted changes to Ohio law that allow the Occupational Therapy, Physical Therapy, and Athletic Trainers Board to grant the authority to an individual who is not licensed to practice prosthetics to engage in the 3D printing of open-source prosthetic kits. Visit the Ohio page on the AOPA Co-OP for details.

Submit Your State News

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

For up-to-date information about what’s happening in O&P in your state, visit the AOPA website.

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

CALLING ALL

EXHIBITORS MANDALAY BAY RESORT

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

WHY EXHIBIT?

EXHIBITOR BENEFITS

• Build your customer base and increase

• Two exhibitor full conference badges

sales by meeting with decision-makers.

• Get face-to-face time with existing customers

to answer questions and build new relationships.

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

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

• Speak to AOPA reimbursement experts who can

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

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

• Additional discounted full conference badges.

• Ability to receive CE credits.

• FREE breakfast and lunch during show hours.

• Private lounge exclusive to exhibitors.

• Much more!

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

FOLLOW US @AmericanOandP

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

www.AOPAnet.org

YOUR GOAL

Successful patient outcomes OUR COMMITMENT

3/20 Š2020 Ottobock HealthCare, LP, All rights reserved.

To advance the standard of care. To provide you with leading medical technology backed by 100 years of experience. To create better access for prosthetic and orthotic devices that change lives. And provide the education and training needed to ensure your successful outcomes. Because when your patients succeed, we have all reached our goals.

We all move forward, together.

ottobockus.com/forward-together