April 2011 O&P Almanac

Almanac OP The American Orthotic & Prosthetic Association

APRIL 2011

&

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

THE CHALLENGES OF

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O&P Almanac APRIL 2011, VOLUME 60, NO. 4

CONTENTS

DEPARTMENTS

COVER STORY

22 The Weight Factor

By Deborah Conn Childhood obesity has more than tripled in the past 30 years, posing fitting challenges for pediatric orthotists. Experienced clinicians offer tips for treating younger patients, including device selection, socket fitting, and diplomatically dealing with weight management.

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AOPA Contact Page How to reach staff

8

At a Glance Statistics and O&P data

10

In the News Research, updates, and company announcements

40

AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

48

AOPA Membership Applications

FEATURE

50 Marketplace

30 What’s My O&P Practice Worth?

56 Jobs

Products and services for O&P

By Anya Martin Bolstered by a steady stream of patients and health-care investment funds—the market for purchasing and selling O&P practices is strong. Discover the latest market trends, factors that can make or break a deal, and more.

COLUMNS

18

Reimbursement Page A comprehensive look at new enrollment requirements and fees

36

Facility Spotlight Northern Prosthetics and Orthopedic Inc.

Opportunities for O&P professionals

60 Calendar

Upcoming meetings and events

63

Ad Index

64

AOPA Answers

Expert answers to your FAQs

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

APRIL 2011 O&P ALMANAC

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OP Almanac

AOPA CONTACT INFORMATION

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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

EXECUTIVE OFFICES

MEMBERSHIP AND MEETINGS

Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 ext. 26, jrossi@strattonpublishing.com

Tom Wessel, director of business development, 651/724-8753, twessel@AOPAnet.org Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org

PUBLISHER Thomas F. Fise, JD EDITORIAL MANAGEMENT Stratton Publishing & Marketing Inc. ADVERTISING SALES M.J. Mrvica Associates Inc. DESIGN & PRODUCTION Marinoff Design LLC PRINTING United Litho Inc.

BOARD OF DIRECTORS OFFICERS President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthotic and Prosthetics Inc., LLC, Houston, TX

Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org

President-Elect Bert Harman, Otto Bock Health Care, Minneapolis, MN

Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com

Ann Davis, office, meetings administrator, and associate editor, AOPA in Advance, 571/431-0876, adavis@AOPAnet.org

Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO

Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org

AOPA Bookstore: 571/431-0865

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

Ann Davis, staff writer, 571/431-0876, adavis@AOPAnet.org Teresa Tobat, editorial/production assistant, 703/914-9200 ext. 33, ttobat@strattonpublishing.com

GOVERNMENT AFFAIRS Kathy Dodson, senior director of government affairs, 571/431-0810, kdodson@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding & reimbursement services, education & programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a

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O&P ALMANAC APRIL 2011

Vice President Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX

Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

DIRECTORS Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Rick Fleetwood, MPA, Snell Prosthetic & Orthotic Laboratory, Little Rock, AR Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen Levis, Orthologix, LLC, Philadelphia, PA Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI

NEW! UPDATE MEMBERSHIP DIRECTORY INFORMATION ONLINE

Mahesh Mansukhani, MBA Ossur Americas, Aliso Viejo, CA Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2011 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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At a Glance

Birth Defects Snapshot Congenital Defects Are Most Common…

Incidence of birth defects Congenital Malformations

36.5 per 1,000

Hispanics at Greatest Risk for Spina Bifida…

Incidence of spina bifida

4.17 per 10,000

Non-Hispanic Black or African- American

2.64 per 10,000

••

Hispanic

Chromosomal Disorders

3.8 per 1,000

Genetic Risk Factor (Rhesus)

2.6 per 1,000 Non-Hispanic White

Single Gene Disorders

12.3 per 1,000

Source: March of Dimes Global Report on Birth Defects, 2006

30,000

Estimated number children who are fitted for a brace to treat scoliosis.

3%

Percentage of birth defects that occur in live births.

6 million

Estimated number of Americans living with scoliosis.

Source: Centers for Disease Control and Prevention, 2008

10-15

Primary onset ages for scoliosis.

$52,415

Estimated medical costs for a child with spina bifida during the first year of life (2009).

3.3

Sources: Centers for Disease Control and Prevention, National Scoliosis Foundation 8

3.22 per 10,000

O&P ALMANAC APRIL 2011

Number of 8-year-old children per 1,000 who have cerebral palsy.

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In the News Photo: The U.S. Food and Drug Administration

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FDA Pilots Expedited Medical Device Review Process activity and decode neural signals to activate motor neurons that control the prosthesis.

This program is part of the FDA’s Centers for Devices and Radiological Health’s (CDRH) broader effort to speed the review process by identifying appropriate clinical endpoints and key scientific questions, earlier in the review process, and by seeking advice from external experts. Products that qualify for the Innovation Pathway program must meet the following standards and procedures: • products have to be pioneering technologies with the potential of revolutionizing patient care or health-care delivery • selected products would receive an Innovation Pathway memorandum from CDRH containing a proposed roadmap and timeline for device development, clinical assessment, and regulatory review

Brain-controlled prosthetic arm

• products would be assigned a case manager, their important scientific issues would be identified and addressed earlier in the development process, and they potentially could qualify for flexible clinical trial protocols.

Photo: The U.S. Food and Drug Administration

The U.S. Food and Drug Administration (FDA) recently launched the Innovation Pathway program, which will slash the review time for new medical devices nearly in half. The program is designed to encourage development of cuttingedge technologies among medical device manufacturers and help make one to two devices available to the public annually.

The pilot program started in February. Officials hope the new process will cut review time down to 150 days from an average of 225 days. The first device to be used in the program is a brain-controlled, prosthetic arm, which was selected due to its functionality potential.

Developers of the prosthetic arm aim to restore almost-natural arm, hand, and finger function to patients. The device uses a microchip implanted on the brain’s surface to record neural

Above, a brain-controlled prosthetic arm is the first device to be used in the FDA’s new Innovation Pathway program.

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O&P ALMANAC APRIL 2011

Product applications will be reviewed by the Center Science Council, a new CDRH oversight body comprised of senior managers and scientists who will lead the device development and evaluation process.

Enrollment in the Innovation Pathway program will not change the scientific or regulatory standards that CDRH uses to evaluate device submissions and determine their appropriateness.

The Innovation Pathway initiative also has the larger goal of bolstering the nation’s research infrastructure for developing new technologies. Proposed actions include: • establishing a voluntary, third-party certification program for the United States • establishing medical device test centers to promote improvements to new technologies during a product’s development and clinical testing stages • creating a publicly available core curriculum for medical device development and testing to train the next generation of innovators • using more device experience and data collected outside the United States.

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In the News ABC Releases Orthotic Fitter Practice

The American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. (ABC) released the 2010 Practice Analysis of ABC Credentialed Orthotic Fitters to create

TRANSITIONS

Amp1, a team of stand-up amputee basketball players sponsored by Freedom Innovations LLC, kicked off a tour of the Dallas-Fort Worth area with an exhibition during the halftime show at the Dallas Mavericks/ Oklahoma City Thunder game on January 6 in Dallas.

The Amputee Coalition’s 2011 National Assembly will be held June 1-5, 2011, in Kansas City, Missouri.

The Barr Foundation has awarded Project Medishare for Haiti Inc., Phoenix Rising for Haiti, Advantage Program/Open Hands, and Prosthetika $4,000 grants each to provide prosthetic rehabilitation to the victims of the 2010 Haiti earthquake. Donations from the Baltimore City College Choir fundraiser, David Falk of Falk Prosthetics, Pennies for Prosthetics fundraiser and matching funds from the Sovereign Order of St. John made the grants possible.

O&P ALMANAC APRIL 2011

the profession. The results also will be used to identify specific topics for in-service and continuing-education programs and to provide guidance for curriculum review and program selfassessment to education providers.

BUSINESSES IN THE NEWS

The American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. is sponsoring the National Commission on Orthotic and Prosthetic Education’s Futurity Project, an initiative to market and support five new master’s level O&P programs at targeted colleges and universities over the next five years as well as promote the establishment of pre-O&P programs at colleges and universities nationwide that feed into master’s programs.

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and implement a practice analysis of othortic fitters.

ABC will use the results of the practice analysis survey to ensure that its orthotic fitter credentialing exams are relevant for individuals entering

D&J Medical Center for Orthotics and Prosthetics opened a new facility in Wilmington, Delaware, dedicated exclusively to serving veterans. The facility features clinical areas where vets can be seen for compression garments, orthotics, and prosthetics, as well as a sports center with an indoor basketball court, a golf driving net, and exercise equipment.

Essentially Women, a group purchasing organization for women’s health-care products, is holding its 11th annual educational conference and trade show April 4-6, 2011, in Glendale, Arizona.

Freedom Innovations, announced the hiring of five personnel for its new Freedom Innovations Europe, headquartered in Enschede, The Netherlands: • Marcus Walda, clinical trainer • Knut Muhl, area sales manager in Germany • Eduard Schönewolf, area sales manager in Germany • Christophe Simonnot, area sales manager in France • Maartje Gerwers, office manager.

The Orthotic & Prosthetic Assistance Fund (OPAF) & The First Clinics welcome BOC International and Quality Outcomes as new Bronze Level Sponsors for 2011. Bronze level sponsors have donated $2,500 or more to OPAF and The First Clinics.

Additionally, OPAF announced the

launch of First Dance, adaptive social dancing for those with physical challenges at Elegance in Motion Dance Studio in Auburn Hills, Michigan. The inaugural event will be sponsored by Special Opportunities in Advanced Rehabilitation.

Otto Bock has been named a sponsor of the London 2012 Paralympics. They will manage prosthetic, orthotic, and wheelchair services at the Paralympic Villages in Stratford, Weymouth, and Eton Dorney.

Round Rock Orthotics & Prosthetics has hired prosthetists Jim McKean and James Perrone as well as staff orthotist Mike Raney.

The San Antonio Military Medical Center, home to a prosthetic clinic and the military’s only advanced burn unit, was recently featured on National Public Radio.

Tamarack Habilitation Technologies, in collaboration with Becker Orthopedic, presented a new continuing education opportunity for practitioners, assistants, and technicians in the O&P industry, Friction Management for Neuropathic Foot Problems.

Thuasne North America has purchased Townsend Design, a manufacturer of orthoses.

In the News

Photos: Mel Stills

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It’s estimated that 25.5 million people around the world are in need of O&P services, and for the past 10 years, the International Society for Prosthetics and Orthotics (ISPO) has been working to meet that need.

ISPO is a global interdisciplinary organization that improves the quality of life for people who are in need of prosthetic, orthotic, mobility, and assistive devices. Since 1995, ISPO has been supported by the United States Agency for International Development (USAID) through the Leahy War Victims Fund (LWVF). The relationship began with a grant for a conference on appropriate prosthetic technology and continues to evolve.

The organization recently released Appropriate Prosthetic and Orthotic Technologies in Low Income Countries (2000-2010), a report that showcases the work made possible by the USAID/ LWVF donation. The grant has not only allowed ISPO to research developing devices, but it also has had international implications, says report co-author Sandra Sexton. “(This grant) has provided scholarships and has left a legacy of appropriately trained personnel who are

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O&P ALMANAC APRIL 2011

establishing or re-establishing prosthetic and orthotic services in countries that are post-crisis. Our report illustrates both the tremendous unmet need for assistive technology globally and the associated potential for growth of the O&P industry,” she says.

Sexton also notes that while high-income countries have focused on developing highly engineered and complex prosthetic and orthotic components, there is tremendous room for designers to refocus their efforts on developing materials and effective designs that can benefit people everywhere.

Other highlights from the report: • Advancing prosthetic devices globally. An ISPO team tested the quality of a variety of vulcanized rubber prosthetic feet from Cambodia and Vietnam to find the best option for amputees in both those countries, as many of the models broke after use. The study revealed the most durable feet were from Veterans International, Cambodia, and the Prosthetics Outreach Foundation in Hanoi, Cambodia.

The two feet from Veterans

Photo: JS Jensen

ISPO Reports on Activities in Low-Income Countries

International provided a low-cost, durable, and locally manufactured prosthetic foot solution.

• Supporting educational efforts.

ISPO awarded 109 scholarships to professionals trained to meet international standards and promote O&P rehabilitation services in low-income countries.

“We are particularly concerned that graduate clinicians have a network of more experienced colleagues so that they can readily draw upon their wisdom and experience to help them maintain and develop their skills,” Sexton says.

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In the News

Social Status, Access to Care Affect Limb Salvage Disparities in limb amputation rates may be heavily influenced by an individual’s socioeconomic status and access to high-volume hospitals according to researchers from Brigham and Women’s Hospital at Harvard Medical School in Boston.

Their study, published in the February issue of Journal of Vascular Surgery, indicates an increased risk of amputation among minority and patients in poverty as well as those who lack access to higher-volume and higher-quality care hospitals.

“Minority patients tend to have more co-morbidities including diabetes, peripheral artery disease, and renal failure that influence

TRANSITIONS

Mono skier and author Kevin Connolly and his work with OpenProsthetics.org was recently featured on ESPN. Marsha Therese Danzig, yoga instructor and a below-knee amputee, is unveiling “A Primer for Yoga Teachers, Yoga Practitioners, and People Working With Amputees” in the central Massachusetts area.

Mark Edwards has been hired as Otto Bock’s professional and clinical services director.

Jan Paul Miller has joined the Board of Certification/Accreditation

O&P ALMANAC APRIL 2011

• Patients in lower-income quartiles had 11 to 34 percent increased chance of major amputation.

• Those with private insurance and Medicare were less likely to experience major amputation than those with Medicaid.

• Patients at the lowest volume hospital centers had a 15 times higher chance of undergoing major amputation, compared with those at the high-volume facilities.

• Patients in the third quartile of poverty were 77 percent more likely to undergo major amputation compared with patients treated at the highest volume hospital centers.

PEOPLE IN THE NEWS

Ryan Ball, a veteran political campaign consultant, has joined the government relations staff of the Orthotic and Prosthetic Group of America.

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treatment options as they are more likely to receive care at low-volume and potentially under-resourced hospitals,” says senior author of the study Louis L. Nguyen, MD. “Addressing social economic status, hospital factors, and the inverse relationship between lower extremity revascularization, procedure volume, and risk of major amputation for critical limb ischemia, highlights potential solutions for disparities related to hospital-level factors. Also increasing state and local funding to facilities that provide care to patients at high risk for major amputation may improve professional resources.”

Key findings:

International as its new certification director.

Touch Bionics patient Johnny Nguyen was profiled in the Washington Post for creating the Bionic Touch Foundation, a nonprofit organization that raises money to purchase bionic upper limbs for low-income amputees and for veterans who have lost arms or hands during their tours of duty.

Steven Reinecke was appointed executive vice president of research and development at Freedom Innovations LLC. Sean Reyngoudt, an amputee and professional kiteboarder as well as waverider, was featured in a new TV action-adventure series, “Catching Air,” premiering on the Discovery Channel’s HD Theater.

Roger Ebert, patient of AOPA member David Rotter, recently wrote about his new chin prosthesis on his blog Roger Ebert’s Journal, published in the Chicago Sun-Times. In the post, “Leading With My Chin” Ebert describes how Rotter helped fit him for a prosthesis.

Sean Scarbrough, CP, will be managing Comprehensive Prosthetics & Orthotics’ Rockford, Ilinois office.

Eric Schwelke has been appointed director of Kessler Orthotic and Prosthetic Services, New Jersey.

John Spillar has joined Technical Orthopedics as a territory sales representative in the South Texas area.

Robert Thompson has joined the Pedorthic Foundation’s board of directors.

Genetic Material May Increase Risk of Diabetic Foot Amputation Small sections of ribonucleic acid, or micro-RNA, may increase the risk of limb amputation in diabetic patients with poor blood flow, according to research published online in Circulation: Journal of the American Heart Association.

Micro-RNA decreases cell growth and prevents the formation of blood vessels. Conditions mimicking diabetes or lack of blood supply to a tissue increased a specific type of micro-RNA—miRNA-503—and reduced the ability of endothelial cells, to pump blood farther throughout the entire body. Slowing down production of miRNA-503, however, improved the ability of endothelial cells to function properly.

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Diabetes Rates Double The number of adults receiving diabetes-related care has increased by almost two-fold during the past 15 years from 9 million in 1996 to 19 million in 2007, according to a report published by the Agency for Healthcare Research and Quality.

Other key findings from the report include: • Nineteen million adults reported seeking treatment in 2007, compared with 9.1 million in 1997.

• Eight million seniors age 65 and older sought treatment in 2007–4 million more than in 1997.

• Total treatment costs for the disease more than doubled, from $18.5 billion in 1997 to $41 billion in 2007. a

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Reimbursement Page

By Kathy Dodson, AOPA government affairs department

CMS Cracks Down on ‘Risky’ Providers New enrollment procedures combat fraud and abuse

I

n its ongoing effort to stop fraud and abuse in the Medicare program, the Centers for Medicare and Medicaid Services (CMS) published in February its final rule covering new enrollment requirements, as well as new powers to suspend payments and put a moratorium on new providers entering Medicare. A draft of similar rules was published last year, and AOPA provided extensive suggestions to CMS on ways to make these less onerous to the field.

Unfortunately, the Office of the Inspector General’s (OIG) pressure on CMS to stop fraudulent billing prevailed, and our suggestions, along with most other specialties, were ignored.

New Enrollment Requirements The basis for the new requirements is a system of classifying providers into one of three “risk groups” based on CMS’s opinion of their likelihood to commit fraud, waste, and abuse.

Each risk group will have its own rules to follow for enrolling in Medicare, and the difficulty of complying will increase as the groups go from limited, through moderate, to high risk.

Limited risk. In the limited-risk category are physicians, non-physician practitioners, and medical groups or clinics, including occupational therapists but excluding physical therapists.

In addition, many Part A facilities that also do some Part B billing—such as ambulatory surgical centers, rural health clinics, and skilled nursing facilities—are included.

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O&P ALMANAC APRIL 2011

Competitive bidding vendors also are limited risk. While in the earlier proposed rule publically traded companies were all assigned as limited risk, this was removed in the final regulations. They will be treated like privately owned providers—with risk levels being assigned by type of provider. In addition, if a physician also has a DMEPOS supplier number, he or she will be treated as moderate or high risk, as appropriate, for that portion of this business.

For this limited-risk group to enroll in Medicare, CMS will verify any provider/supplier specific requirements established by Medicare, conduct license verifications, and do database checks, including verifying Social Security numbers, checking the NPI, looking for OIG exclusions, and verifying tax ID numbers.

Moderate risk. Moderate-risk providers will include physical therapists, ambulance suppliers, hospice organizations, clinical laboratories, community mental health centers, portable x-ray suppliers, and currently enrolled DMEPOS suppliers and home health agencies.

This group will have to meet all of the enrollment requirements for the limited-risk group, plus they will have unscheduled/unannounced site visits.

High risk. Finally, high-risk providers will include all newly enrolling DMEPOS suppliers and home health agencies. For these rules, “newly enrolling” includes both those providers who are not currently enrolled with Medicare as well as new offices of existing, enrolled suppliers.

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Important Note Regarding

EFFECTIVE DATES On March 25, 2011, these new rules went into effect for DMEPOS suppliers not currently enrolled in Medicare; those opening new branches; and those who are currently enrolled but who are due to revalidate their supplier number before March 25, 2012.

However, the new fingerprinting and background check requirements will not go into effect until 60 days after CMS issues more guidance on how this procedure will be carried out. For all other providers, the effective date is March 25, 2012.

So if you are already enrolled with Medicare, but want to open a new branch, your new branch will be considered high risk.

In addition to all of the enrollment requirements for limited- and moderate-risk providers, this group will have to undergo background checks and fingerprinting.

AOPA had requested that state licensed and/or accredited suppliers automatically be considered limited risk; however CMS decided that a license or accreditation was no guarantee against fraudulent behavior.

In addition, it turned down AOPA’s request that O&P be excluded from DME rankings and instead be classified as limited risk for enrolled suppliers and moderate risk for new providers.

Unfortunately, CMS declined to subdivide provider categories.

Requirement Details, New Fees Fingerprinting for high-risk providers will only be required for

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O&P ALMANAC APRIL 2011

those people who own 5 percent or more of the business. Non-owners will not be required to provide fingerprints at this time, although CMS did note that this could be expanded in the future if necessary. Fingerprints will be collected by one of 15 “authorized channelers” already approved by the FBI, so that CMS will not maintain any fingerprints, but will simply receive reports from these “channelers.” Use of electronic media to submit fingerprints is strongly encouraged and significant delays in processing may occur for those submitting hardcopy prints.

If a provider submits claims to both Medicare and Medicaid, the enrollment procedures carried out for Medicare will be accepted by Medicaid. However, if the provider does not enroll in Medicare, then Medicaid will have to carry out the same enrollment steps.

None of the above requirements will apply to Medicare Advantage plans.

It’s important to note that for the first time since Medicare began, CMS will charge a fee to enroll in the Medicare program. When you submit your 855S form for a new enrollment or revalidation of your existing supplier number, you will have to include a $505 fee to cover processing of your application. Your application will not proceed until it is deposited, and if you submit an application without the fee,

it will be returned. However, for simple changes to the 855S, such as a changing phone number, a new billing address, a change in the name of the supplier, or similar updates, an application fee will not be assessed because these changes do not constitute a new enrollment or revalidation.

If your application is denied because you do not meet all of the supplier standards, CMS will not refund your application fee. In addition, a separate fee applies to each of your practice locations, rather than one fee per company. However, the fee will cover both Medicare and Medicaid enrollment. Physicians who have DMEPOS numbers also will have to pay this application fee.

There is a process to request a waiver of the fee, but it will require financial documentation of hardship circumstances. CMS says it will provide more guidance on this process in the future, but for now, there is no standard form to request an exemption.

Enrollment Moratoria The new regulation also gives CMS the right to impose enrollment moratoria in six month increments— either by geography or provider type—if it identifies trends of fraud, waste, or abuse. These moratoria would only apply to newly enrolling providers

or those enrolling new locations.

Some examples of what might cause CMS to invoke a moratorium are a highly disproportionate number of suppliers in a category relative to the number of patients or a rapid increase in enrollment applications within a provider category.

If an application has been submitted at the time a moratorium goes into effect, it will be returned unless it has already been processed and the only step left is to assign a supplier number, in which case it will be allowed to complete processing. Moratoria will not apply to mergers, changes of ownership/consolidations, or changes in an existing practice location or to managed-care organizations.

Payment Suspensions The final new provision of this regulation gives CMS the right to invoke payment suspensions based on a “credible allegation” of fraud. An allegation of fraud may come from any source, including fraud hotline

complaints, data mining of claims, and patterns identified through provider audits, civil false claims cases, and law enforcement investigations.

For the first time since Medicare began, CMS will charge a fee to enroll in the Medicare program.

Suspensions will be limited to 18 months, except when the case has been sent to the OIG or when the Department of Justice asked that it be kept in place due to an ongoing investigation. CMS does recognize the difference between real fraud and billing errors that simply result in an overpayment.

Officials say payment suspensions will be carefully reviewed prior to imposition to ensure they are appropriate.

The only good thing announced in this new regulation is that, at least for now, CMS is not implementing a mandatory compliance program for DMEPOS suppliers, which was proposed in the draft regulations.

Other than that, these new regulations represent yet another example of more regulatory burdens imposed

by CMS on all suppliers, in an attempt to prevent a few from ripping off the system. Good goal…poor implementation.

AOPA has requested further clarification on some of these provisions, and we expect more information will be forthcoming from CMS in a month or two. In the meantime, we will keep you posted as more information becomes available. a Kathy Dodson is AOPA’s senior director of government affairs.

Reach her at kdodson@ AOPAnet.org.

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The

WEIGHT Factor

Accommodating the special needs of young obese patients is an escalating concern among the O&P community

22

O&P ALMANAC APRIL 2011

COVER STORY

BY DEBORAH CONN

T

reating obese children can be a challenge for orthotists and prosthetists, but it is a challenge that most practitioners have to confront at one time or another.

Childhood obesity has more than tripled in the past 30 years, according to the Centers for Disease Control.

Nearly 20 percent of children aged 6 to 11 years were obese in 2008, compared with only 6.5 percent in 1980. The prevalence of obesity among adolescents aged 12 to 19 years increased from 5 percent in 1980 to about 18 percent in 2008. That rise in the general population is at least anecdotally reflected among those receiving O&P care, as many orthotists and prosthetists report increasing numbers of obese children in their own practices.

“We’ve seen a huge change,” says Brian Giavedoni, CP, who has been in pediatric prosthetics for 28 years. Giavedoni works in the Limb Deficiency Program at Children’s Healthcare of Atlanta.

Prosthetists like Giavedoni find that pediatric components, which are lighter and smaller than adult prostheses, cannot accommodate the excess weight. “These components are not designed for a 12-year-old who weighs 200 pounds,” he says. Most pediatric components are rated to bear up to 100 pounds.

“Also, the activity level of a 200-pound 12-year-old is still more than it would be for a 200-pound 40-year-old. This puts a lot of stress on the materials, and our failure rate for components is high for obese children.

We’re using up our warrantees.”

APRIL 2011 O&P ALMANAC

23

COVER STORY

Fitting Challenges Simply moving to adult components is not an easy fix, however. Most amputations on children are done for congenital conditions and occur at the joints, leaving less space for prosthetists to work with. Such space restrictions make it problematic to use larger, adult components.

“We’re already dealing with longer limb lengths,” says Giavedoni, “and then we have to fit something made for a large person.”

“As the weight increases, our choices become more limited.”

—BRIAN GIAVDEDONI, CP

In addition, even obese children are normally shorter than adults, so adult components tend to be too long for pediatric use. Giavedoni cites a recent study about adult prosthetic feet that applies as well to pediatrics.

24

O&P ALMANAC APRIL 2011

“In a healthy adult weight range, you have about 150 foot components at your disposal. As you start to move up in weight, the number decreases, and by the time you reach 300 pounds, you’re down to 10,” he says. “The same thing is happening with children.

As the weight increases, our choices become more limited. And we already have fewer components to choose from because of space restrictions.”

Obesity affects socket fitting, as well. Giavedoni notes that he has many socket options for patients in a healthy weight range, but far fewer for obese users.

Giavedoni has used geriatric devices as a temporary measure until a child can move into adult components.

These tend to be a bit bigger and can withstand higher weights, but, because they are designed for elderly patients, they offer far less functionality.

“They can handle the weight, but not the activity,” he says. This is particularly a problem because obese children need to be as active as possible to control further weight gain.

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COVER STORY The younger children are at the time of amputation, the more active they tend to be, says Giavedoni. Also, unlike many adult amputees, they usually have no co-morbidities, such as diabetes or heart problems, that would slow them down. “They’re your perfect amputee patients,” he says. “Put a prosthesis on them; and they go.”

But obese children are often averse to exercise. Amputation causes the patient to expend more energy simply to get around, and excess weight adds to that burden, says Dan Muñoz, CO, of Shriners Hospitals for Children– Northern California.

“They get hotter more quickly and sweat more, which makes them less inclined to do an activity,” he says of obese children. “It’s a vicious circle.

They’re uncomfortable being active, which makes them put on more weight, which adds to the discomfort.”

Obesity can lead to other health complications as well, even in children.

“I’m seeing things in kids I never used to see, like children who are prediabetic,” says Giavedoni. “I’ve started to see issues with skin that should not be happening with a 12-year-old. You tend to see skin issues more in diabetic adult patients.” He uses silicone liners with these children in an attempt to protect their skin.

change alignment,” he says. “It is harder to fit devices, fabricate them, and keep them fitting.”

Obesity also has a negative impact on gait, even before an orthotist is involved. As result, says Gavin, outcomes with overweight children may not be as good as with children who are not overweight.

One contraindication to scoliosis bracing is morbid obesity, according to Muñoz. The frequent fluctuation in the distribution of body mass makes fitting difficult, and patients experience more pressure issues.

“Obesity complicates the process mechanically. It is harder to fit devices, fabricate them, and keep them fitting.”

—TOM GAVIN, CO

Mechanical Challenges Obesity is definitely a complicating factor for pediatric orthotists, says Tom Gavin, CO, founder, president, and director of clinical services at BioConcepts Inc., based in Burr Ridge, Illinois.

“Obesity complicates the process mechanically, as we have to transmit forces through the tissue to try to

26

O&P ALMANAC APRIL 2011

“It’s hard to keep a TLSO [thoracolumbosacral orthosis] still on the patient,” explains Greg Aaron, CO, also at the Northern California Shriners Hospital in Sacramento. “The extra tissue pushes up the orthosis when patients sit down, so when they stand up, they have to wiggle and twist around to push it back in the right position.”

Gavin modifies spinal orthoses to address this issue. “I begin by making an orthosis that contains the tissue and controls where it goes before I actually try to move it,” he says. Muñoz takes a similar approach, sometimes adding elastic components underneath a brace to try to contain adipose tissue.

“We build in more padding and use bigger components,” he says.

“Sometimes we have to compromise.

We may have to lower the amount of force we apply or modify the trim lines so the patient can tolerate the device, even though it may not be biomechanically optimal.”

Obesity also can cause KAFOs (knee-ankle-foot orthoses) to dig into a patient’s groin area when he or she bends over. Aaron flares out the plastic on the front edge of the device to prevent the hard material from causing skin problems. “We could put a flare in the back too, if we had to,” he says, “but if it’s too big, the child would have trouble sitting down.”

Another problem arises with bilateral KAFOs on children so heavy that their knees meet. “When we add medial knee joints, these children will really have to widen their stance to accommodate the KAFO,” he says.

“And there’s not much we can do about this, because the medial upright is necessary to handle the load.”

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Self-Image One of the most difficult issues to address has to do with the patient’s self image. “Most of these children have a lousy body image to begin with,” says Aaron. “And then you put a scoliosis brace or post-operative TLSO on them, and it makes them look even bigger.”

Giavedoni refers obese patients and their families to nutritional counseling. Muñoz can call on a complement of staff nutritionists, psychologists, social workers, and school reentry specialists at the Shriners Hospital to work with his obese patients.

“I never say ‘do not.’ I make suggestions, give them choices and options.”

—KELLY MONROE, RD Addressing a patient’s self-esteem and weight issues can be difficult, and many practitioners feel it is outside their scope of practice to deal with these problems head on. “As orthotists, we shouldn’t be managing issues we’re not qualified to manage,” says Gavin. “But it is our duty to consult the physician to see if they can help patients manage their weight.”

[ 28

Kelly Monroe, RD, is a dietician at Shriners who works with all in-patients and out-patients on referral. She assesses children’s ideal body weight, which depends on the injury, and encourages them to eat more healthfully.

Education plays a big role in her work, and she develops handouts with sample menus and healthful alternatives to high-calorie foods.

SAVE THE DATE SEPTEMBER 19-22, 2011

O&P ALMANAC APRIL 2011

]

“I never say ‘do not.’ I make suggestions, give them choices and options,” she says. Often obese children have obese parents, says Monroe, “so I am very diplomatic with my choice of words, because these families are already sensitive.”

Gavin, who has personally battled weight issues in the past, understands that sensitivity. “The biggest problem I see is when practitioners turn their frustration into blaming the patient for a less-than-desirable outcome,” he says.

“It may take more on our part to get the same result as with a non-obese person,” Gavin adds. “It’s probably not a good idea to put a rookie practitioner on a difficult case. But it is not impossible, and the challenge shouldn’t lead us to categorize these people as not manageable.” a Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@ cox.net.

For more information, visit our Web site at www.AOPAnet.org.

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Background: Bachelor’s degree from The University of California, Santa Cruz. Master’s degree from The University of Hawaii. More than 20 years as a healthcare executive.

Achievements: Holds seven U.S. patents for orthotic devices that have benefited ten of thousands of patients.

Impact: In 2010, more than 1,000 practitioners attended John’s educational courses on contracture management and rehabilitating knee braces.

Service: Past Chairman of the Region D Medicare Advisory Committee; member of the BOC Board of Directors.

“

I would not be a practicing clinician and Vice President of Ongoing Care Solutions/NeuroFlex if it were not for BOC. The next few years will be critical for O&P, and I am excited about BOC’s expanding role in the O&P community.

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How to score the best deal and avoid some common sellers’ mistakes

What’s My O&P Practice WORTH?

BY Anya

30

Martin

O&P ALMANAC APRIL 2011

N

ow that the economy is picking up again, some O&P practitioners are considering buying another O&P business or selling their own, especially those who are approaching retirement age. Either way, it’s a complex matter.

The good news is that the current market is one of the strongest to date, with lots of deals being closed, says Barry Smith, Esq., owner of Los Angeles-based Lloyds Capital Inc. Smith has brokered sales for 110 O&P practices in 41 states over the past 20 years, totaling more than $200 million in revenues.

Why the interest now? The big reason is general investor enthusiasm for health care, which remained attractive as a needs-based sector while other industries floundered in an unstable economy, says Brian Gustin, CP, owner of Green Bay, Wisconsin-based Forensic Prosthetic and Orthotic Consulting, who has both bought and sold practices. One private equity investment firm told him that $400 billion in cash is waiting

on the sidelines for investment in the health sector.

O&P specifically is well positioned to take a piece of the health-care investment pie because margins remain decent, says Smith. In addition, he says, the industry has a steady pipeline of patients, due in part to the rise in diabetes, a precursor to amputation, in Southern states in particular. A favorable tax climate is helping the market right now, Smith adds, with federal capital gains tax rates remaining at just 15 percent through 2012.

Those combined strengths are attracting a diverse range of buyers, from traditional ones to new players. Of the former, the biggest continues to be Hanger, which is also the only public company currently buying in O&P. Other contenders include practitioners who have reached a certain size and are ready to expand, and employees who want to leave their current positions and start their own business or buy out the boss. Smith also is brokering deals for physician groups who want to expand their offerings, the occasional hospital

that wants to acquire what would otherwise be a referral, and venture capital investors.

“Venture capital is the new kid on the block,” Smith says. “Right now there are only two venture capital companies out there [interested in O&P], and they are very localized, but I think more will be entering the space.”

Some Caveats Despite this seemingly rosy picture, however, sellers need to recognize that they may not always get their ideal asking price, Smith notes. In general, prices are declining due to apprehension about reimbursements from cash-strapped state Medicaid programs.

Medicare and insurers are tightening their belts as well in anticipation of adding more sick people to their rolls, Smith says.

“Uncertainty is the nemesis of Wall Street, and health-care providers don’t want to provide services without knowing if they are going to get paid or how much they will be paid,” he explains.

APRIL 2011 O&P ALMANAC

31

Five Sales, Five Prices SALES COMPANY A

VOLUME

SALES PRICE

$1,200,000 $1,100,000

B

1,000,000 600,000

C

1,150,000 1,400,000

D

900,000 900,000

E

950,000 850,000

AVERAGE $1,040,000 $970,000 AVERAGE MULTIPLE OF SALES

.93 x sales volume

Question:

What makes Company C sell at a multiple of 1.22 of sales volume, but Company B only sells at a 0.6 multiple?

Answer:

Profitability. Company C was mainly prosthetics and management and ran a very tight ship. It was also located in a relatively inexpensive area of the country in which to do business. Company B had a mixture of orthotics, prosthetics, and mastectomy; was in a major metropolitan area; and was overstaffed.

Source: Barry Smith, Esq., Lloyds Capital Inc., 2011

On the macro level, recent court rulings and Congressional threats to repeal all or part of the Patient Protection and Affordable Care Act are slowing investment across the whole health-care spectrum, Gustin says.

Political leanings aside, investors just don’t like the idea that there is no clear roadmap to control costs and guide reimbursements.

“Congress’s dithering on health care is a real problem,” he says. “Given that health care is almost 20 percent of gross domestic product, having some kind of playbook—any kind at all— would help restart the economy.”

Company Worth While the market may have its ups and downs, Smith says the first step for sellers won’t change: determining

32

O&P ALMANAC APRIL 2011

their practice’s worth. Unfortunately, many sellers trip up at this seemingly straightforward task because they are emotionally attached to what has been their life’s work and cannot accept the hard numbers.

“Nobody cares how much sweat and sleepless nights you spent building your company,” says Gustin. “What they care about is the likelihood you can continue your cash flow going forward.”

Put another way, a huge reason for the disconnect between buyers and sellers is that many owners equate revenues with profitability, while it’s profitability that drives the price, Smith says.

“The myth I hear almost weekly is that, on average, an O&P business sells for about one times its revenue,” he

explains. “Incorrect. You may get 50 cents on the dollar, or 100 cents on the dollar, or 150 cents on the dollar, but it depends on how profitable you are.”

Smith cites the example of his last five deals for companies with sales volumes of around $1 million (see sidebar and chart for more details).

One practice sold for $600,000 while another sold for $1.4 million.

As a rule of thumb, valuation for O&P equals three to five times cash flow for most businesses, Smith says, but where exactly that figure falls depends on profits and a variety of other factors, including, but not limited to: • balance sheet • personnel • whether the owner is staying or leaving • types of insurance contracts • whether the business is orthotics, prosthetics, or both • number of offices • competition in geographic area • reputation • number of referral sources • sales trend over last three years— up, down, or flat • number of interested buyers.

After the initial valuation, potential buyers will do their own due diligence to confirm your figures and ensure that your business does not have any liabilities that could affect its profitability down the line, says Smith.

“That’s where the real hard work begins, because you’re going to have to produce a whole bunch of documents,” he adds. “And after going through all that hard work, the buyer may say, ‘No thanks,’ or revise to a lower offer.”

At the end of the day, the definition of “fair market value” of your business is what a buyer is ready to pay, says Frank Bostock, CO, southwest region vice president for Hanger. Bostock’s responsibilities at Hanger include identifying potential O&P business acquisitions, but he also has been on the seller’s side. He sold his own practice to Novacare Orthotics & Prosthetics, which was subsequently acquired by Hanger.

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A Tale of Two Deals Case Study 1:

Case Study 2:

Ability Prosthetics & Orthotics Acquires BridgePoint Medical LLC

Hanger Passes on Stubborn Owner

One recent deal was so amicable that in many ways it could be called a merger. Officially, Gettysburg, Pennsylvania-based Ability Prosthetics & Orthotics, which owns five patient-care centers in Pennsylvania and Maryland, acquired Lexington, Kentucky-based BridgePoint Medical LLC’s four centers, two in Kentucky and two in North Carolina, and BPM Fabrication, its central fabrication facility in Asheville, North Carolina.

While the deal took effect January 14, both Jeffrey M. Brandt, CPO, now president and COO of Ability, and Clint McKinley, BridgePoint’s CEO and now CEO of Ability, say the seed was planted four years ago, when the two met and discovered that they shared similar visions for growth and a patient-centric care model. So when Brandt started exploring ways to expand Ability in the summer of 2010, McKinley was the first person he called.

Conversely, McKinley had been looking to sell, not to leave the business but to strengthen its clinical management piece.

Although he spoke to several other companies, he sealed the deal with Ability because of its culture and care delivery system.

Current economic conditions didn’t play a part in the transaction, but the fact that both companies had performed well in adverse conditions in 2009 and 2010 was another plus, Brandt says. “We certainly had been tested to a degree, and anybody that can survive that and consolidate in a down market, you’d like to believe will be perfectly poised when the market does turn,” he adds.

Both Brandt and McKinley see the acquisition as the first step in an aggressive but targeted growth strategy that will include opening new practices and additional acquisitions. “There’s a lot of older ownership in this industry that is heading toward retirement that needs to do estate-planning with their practices,” McKinley says. “They’re starting to think about an exit strategy, and a logical one is to sell their practice and pull out the equity.”

Other potential sources for acquisitions include owners who prefer to concentrate on the clinical side, rather than keeping up with regulatory changes and practice management, as well as the practitioner who runs a good practice but wants to be part of a bigger organization.

While Ability will be targeting underserved or poorly served markets and also looking at return on investment, the key deal clincher will be whether the practice shares the patient-centric model or can easily be adapted to it, McKinley says. “The culture can’t be so different that it takes a monumental effort to get [staff] to embrace the vision we have,” he adds. “It’s not going to be just a pure financial decision.”

34

O&P ALMANAC APRIL 2011

When deals don’t happen, it’s often because an owner is too fixated on immediate financial return, rather than looking at the broad picture, says Frank Bostock, CO, southwest regional vice president for Hanger Prosthetics & Orthotics. When identifying practices for purchase, Bostock considers a combination of attributes, including looking for locations where market conditions appear ripe for growth. He then may consult the directory of the American Board for Certification in Orthotics, Prosthetics, & Pedorthics for accredited facilities in specific geographic areas. He researches further to estimate business size and how many and what type of certified practitioners are in the office.

If a practice looks like a possible match, Bostock will contact the owner to discuss a potential sale. The price that Hanger, like any buyer, will offer comes down to current earnings, as well as potential for growth, presence of highly skilled practitioners on staff, and leadership in new technology. “The buying decision today is really based on, ‘Is it a good strategic fit?’”

Bostock says.

Recently, Bostock contacted a seasoned practitioner of 25 years who had lost market share and seen revenues plummet due to fewer insurer contracts and physician referrals. The owner had even slashed his own salary by 65 percent because he didn’t want to cut earnings for his loyal employees.

At first glance, that practice might not seem like an attractive purchase, but with the practitioner’s experience and location, an acquisition would be less expensive than opening a new facility. So Hanger made an offer that, while lower than the owner had expected, included the opportunity for him to continue to practice at his original salary and also earn rental income from the building, which he owned. Other potential benefits included a more flexible schedule, an exit strategy, and more vacation time, since the owner would now be able to leave the office knowing he had someone to cover for him.

However, the owner turned down Hanger’s price.

“He was fixated on a purchase price that was based on emotion rather than market conditions,” Bostock says.

“The offer, if accepted, would have provided the owner with an opportunity to sell his assets at market value and share in the success of the business going forward.”

Given the scenario, Bostock adds, the offer probably will be the best and quite possibly the only offer the practice is likely to receive.

Preparation and Timing Never go with a gut feeling, Gustin says. An initial valuation may be done in consultation with your company’s accountant and attorney, but then it’s highly advisable to hire a broker who knows market conditions and can assess your company’s books and tax returns dispassionately from a buyer’s perspective.

Before Gustin sold his original practice, which had grown to five Wisconsin locations, to Benchmark Medical Inc., he engaged Smith.

“I used my own attorney and accountant for some local representation,” Gustin says, “but neither of those individuals knew the O&P marketplace.”

A good broker can insulate the seller from the process, which, Smith says, “can get a little bit bloody at times.” The broker also can ensure that the seller, who typically only does this once, gets a fair price from a buyer, who often makes a living at negotiating deals.

“It’s like making your first leg,” Smith says. “It’s not going to fit very well. People may hop or have a bad gait. It might fall apart. You don’t want to screw up [your sale] because you’re only going to do it once.”

Sellers also need to factor in time.

On the surface, the time to sell might seem to be when retirement is looming or when economic conditions are good, but consider that Gustin’s first sale took about a year from first phone call to ink on a contract.

Owners should further calculate that the buyer is likely to expect them to stay with the business for some time, typically three years, Smith says.

Bostock remained with Novacare and still works for its current owner, Hanger. Gustin stayed with Benchmark for a year and a half before moving on to BridgePoint Group, where he helped with expansion. He left that position when private equity started to dry up, stalling acquisitions, and founded his own business, Forensic Prosthetic and

Orthotic Consulting, which consults with law enforcement, manufacturers, and private practices on policy and documentation, work-flow efficiencies, and product positioning relative to current coverage criteria.

Sometimes a valuation can even be a wake-up call to delay a sale and fix the business first, Smith says.

For example, repairs could include looking for ways to reduce expenses to improve a profit margin, he adds, noting that rough target thresholds are 25 to 30 percent of revenues for labor and 20 to 25 percent for supply costs.

Another possible fix is patient visit and billing documentation, which directly relates to potential liability issues down the road.

Buyers sometimes will require an escrow account simply for potential recoupment claims, Gustin says. Often the problem is that documentation doesn’t justify why a patient required a particular device, he adds, citing reports so brief that they read simply: “The patient came in for a fitting today and they were very pleased.” While working for BridgePoint Group, he recalls withdrawing from one particular acquisition because of shoddy and incomplete patient visit reports.

“Unfortunately there’s nothing you can do to correct documentation in the past because you can’t go in and alter previous documentation,” Gustin says.

“The only way you can improve it is on a going-forward basis.”

The Decision Always think like an investor, says Gustin, and remember that what you see as a strength may be viewed differently by a buyer. For example, the owner of a large pediatric practice recently bragged to him that the majority of his patients were on Medicaid, saying, “That’s like a 15-year annuity because the kids come back year after year.” A buyer is likely to think the opposite, however. With so much business dependant on coststrapped state Medicaid programs, the entire practice could be at risk.

So when’s the best time to sell?

Bostock recalls a colleague asking him why he sold his own business, which, at the time, had more than 100 employees, multiple locations, a central fabrication lab, and was in profit. However, it had reached a size where to grow beyond its current geography, Bostock felt it made sense to align itself with a national firm with more resources. “‘You guys were doing really well,’ [my colleague] said,” Bostock recalls.

“My response is, ‘That’s when you should sell.’” a Anya Martin is a contributing writer to O&P Almanac. Reach her at anya99@ mindspring.com.

APRIL 2011 O&P ALMANAC

35

n

Facility Spotlight

By Deborah Conn

50 Years and Counting Adaptability and focus on patient care keeps Northern Prosthetics and Orthopedic Inc. in business for half a century

FACILITY: Northern Prosthetics and Orthopedic Inc.

LOCATION:

Rockville, Illinois, and Janesville, Wisconsin

OWNER:

The Schulze Family

HISTORY:

50 years in business

Erich Schulze, CPO, C.Ped

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O&P ALMANAC APRIL 2011

N

orthern Prosthetics and Orthopedic Inc. marked its 50th anniversary on March 1 of this year. The family-owned facility, founded by Herbert Schulze, CP, and Lothar Grade, CO, opened its doors in Rockford, Illinois, in 1961. Today, under the direction of Schulze’s son, Erich, who is certified in prosthetics, orthotics, and pedorthics, Northern Prosthetics and Orthopedic continues to serve the northern Illinois area as well as southern Wisconsin through its satellite office in Janesville.

Although it has grown in 50 years, the company remains small.

Practitioners include Erich and Herbert Schulze (still in good health and still working); Ed Roman, CP, LPO; Roy Martin, C.Ped, RTO; and Michael Carzoli, CP, as well as a certified prosthetic technician and three administrative staff members who handle appointments and billing.

Clinicians see a variety of patients, including pediatric, adult, and geriatric cases. The facility treats many

military veterans as well as civilians, and although most patients come for prosthetic care, NPO is trying to raise community awareness of its orthotic services as well.

“When my father began the company, it had two partners and one employee. Although we are still relative small, we are a much better rounded facility now, with practitioners who specialize in many different aspects of O&P,” says Erich Schulze. “There is someone here who can take care of just about any patient.”

Competition and Adaptation Rockford has a population of about 150,000, and until recently, Northern Prosthetics and Orthopedic was one of only two O&P facilities in town.

“A couple of new prosthetic shops have opened up in the area, and we’re fighting for the same patients,” says Schulze. Nevertheless, he welcomes the challenge. “We feel that competition is a good thing,” he says. “It keeps us on our toes and aware of making our

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Top photo: Erich Schulze, CPO, C.Ped, prepares to cast a bilateral trans-tibial patient. Lower photo: Roy Martin, C.Ped, CTO, fabricating a custom foot orthotic.

38

O&P ALMANAC APRIL 2011

best effort every day.

Competition can make us stronger and better at what we do.”

That competition and the struggling economy have motivated Schulze to cut costs.

NPO has reduced inventory, ordering whenever possible on as as-needed basis. The company also has absorbed some functions, such as cleaning services, rather than using outside contractors. The company does nearly all fabrication in house.

“We continually review what we are paying for things and try to get discounts from our suppliers,” says Schulze. The office is careful to obtain preauthorization for services to ensure payment.

“In a small office like ours, everyone wears many hats,” he says.

Schulze and his office manager, Tina Hoel, are responsible for compliance and accreditation issues. The practice holds monthly staff meetings to review procedures as well as monthly practitioner meetings in which participants review patient charts, one another’s notes, and coding. “We discuss how to improve documentation, recordkeeping, and policies and procedures,” he says. “These are ongoing concerns for all of us.”

Fifty years is an impressive milestone, and Schulze is proud of NPO’s history as a family business.

Although he preferred a low-key commemoration—cake and coffee for the staff, and maybe dinner out later this anniversary year—Schulze is celebrating in his own way: “We focus on patient care, just as we have for the past half-century.” a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net.

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AOPA Headlines AOPA WORKING FOR YOU

Keeping Those Dollars at Home Count the ways AOPA saves money for you—and the entire O&P community

S

ome of the least visible activity by AOPA creates terrific payback benefits for AOPA members. Take the rates that are in place at the Mirage Hotel for the 94th National Assembly in Las Vegas, Sept. 19-22, 2011.

Any change in hotel rates can have a significant impact on your pocketbook, so AOPA always monitors rates in hotels booked for AOPA events to make sure our members are getting the best deal. When a promotional offer from the Mirage showed up at a much lower rate than the one for our 2011 event, we reopened negotiations, even though the contract was signed in 2007.

As a result of this negotiation, the Mirage lowered AOPA’s rate from $219 to $135, which more accurately reflects current marketplace conditions in Las Vegas. This translates into a savings of close to $350 for a four-night stay. Projecting that savings for 2,000 attendees adds up to nearly $700,000.

More Hotel Savings The hard line AOPA has taken in negotiating future National Assembly contracts with hotels results in other savings as well. All of the contracts negotiated before 2007 included attrition clauses and stiff food and beverage minimums. This meant that if we committed to book a certain number of rooms in a hotel and actual bookings fell short, AOPA had to swallow the shortfall and write a check to the hotel. The same with food and beverage minimums— any shortfalls meant AOPA wrote a check. Sadly, checks have indeed been written to honor such obligations.

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O&P ALMANAC APRIL 2011

Since 2007, AOPA has signed no hotel contacts that contain attrition clauses or excessive food and beverage minimums. It’s hard to project what this means in dollars and cents, but there’s no question it protects AOPA from exposure to some very serious financial obligations.

For example, a cost analysis of our contract for San Antonio in 2015 compared concessions received by AOPA with other contracts for that same year. The analysis showed savings of $329,644—more than a quarter of a million dollars.

AOPA is booked through 2020 (except for 2018) under similar contracts with similar concessions. It may be a stretch, but projecting the San Antonio savings over the 10 years means $3,296,440 stays in the O&P community.

Rent, Mailing, and Media About the same time negotiations were underway with the Mirage Hotel, we were in intense negotiations with our current landlord. As a result of these negotiations, AOPA entered into a Letter of Intent with the landlord to extend our lease for another 11 years. Office rent accounts for about 4 percent of AOPA’s budget.

Again, market conditions provided leverage to negotiate a new lease at $33 per square foot versus the nearly $38 we would have paid in 2011 under the old lease. This resulted in a very substantial savings over what would have been paid from your AOPA dues dollars.

Just recently we entered into a co-mailing arrangement with our O&P Almanac printing partners that bundles our magazine with other magazines as they go to postal distribution sites across the country. The

Almanac is individually mailed from that point, but the co-mailing postage savings amounts to $1,300 per issue.

That means AOPA should see another $15,600 staying in the O&P community this year rather than going to the U.S. Postal Service.

Another big savings comes from the unique and creative approach to media advocacy AOPA undertook in partnership with Plowshare Group Inc. Plowshare is AOPA’s media consultant specializing in public service announcements for nonprofit organizations. Perhaps you’ve seen one of the full-page advocacy ads that appeared in regional issues of Newsweek, Sports Illustrated, The Week, Time, and U.S. News and World Report in November and December.

Part of this was paid advertising, but the bonus was the inclusion of public service (unpaid) ads in certain markets that yielded the equivalent of $613,950 in paid advertising—and reached a circulation of 2,117,100. Among the magazines carrying AOPA’s public service ads were Town & Country, Cooking Light, Travel + Leisure, and Food & Wine. We can’t afford to shell out big bucks for paid advertising, but these public service ads amounted to $613,950 of value for the O&P community.

The Bottom Line AOPA members have had to trim their sails and tighten expenses to survive in this challenging economy.

AOPA has done the same to make sure your needs can be met, even as the legislative and regulatory challenges grow larger. There’s no question that reimbursement issues will demand substantial resources, as will the regulation-writing processes arising from the new Patient Protection and Affordable Care Act and other elements of the new health-care reform law.

AOPA’s “working for you” savings can be allocated to advocacy and public relations initiatives or to increase the war chest in the form of AOPA reserves that may be needed to fight the truly serious battles ahead.

As former Sen. Everett Dirksen said about federal spending, “A billion here, a billion there, and soon it adds up to real money!” Savings add up, too. We haven’t racked up Dirksen-level numbers, but every dollar counts. Every dollar helps put a smile on AOPA Treasurer Jim Weber’s face—and forge a stronger voice for the O&P community. a

OP Almanac &

Correction: February 2011 In “Best Practices for Geriatric Spine Care” featured in February issue O&P Almanac, we incorrectly labeled the photo on page 20 as Thomas M. Gavin, CO. This photo is of Andrew J. Mills, managing director of the SpineCorporation Limited in Chesterfield, United Kingdom. We regret this error.

Clarification: December 2010 Reimbursement Page The December 2010 O&P Almanac’s Reimbursement Page addressed Medicare coverage and recent policy changes regarding diabetic shoes. One of the recent changes was the need for an in-person visit between the prescribing physician and patient within six months of delivery of the shoes.

It should be noted that the in-person visit must occur within the six months prior to delivery of the shoes. There is currently no follow up visit required for diabetic shoes covered by Medicare.

Questions? Contact Devon Bernard at dbernard@AOPAnet. org or 571/431-0854, or Joe McTernan at jmcternan@AOPAnet. org or 571/431-0811.

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AOPA Headlines

AOPA President Responds to New York Times Article

AOPA Responds to Excise Tax

AOPA President Tom DiBello, CO, FAAOP, issued a letter to editor of the New York Times regarding Gina Kolata’s article, “Close Look at Orthotics Raises a Welter of Doubts,” published on Jan. 17, 2011. The story consisted of interviews and speculation about foot orthoses and questioned their effectiveness.

DiBello’s reply to this article expressed concerns over Kolata’s over-generalizations and imprecise terminology and explained that the O&P field is not devoid of rigorous scientific outcomes studies. The criticism that studies do not include controls, i.e. “groups...that did not receive orthotics” is simplistic, since there are no placebos in bracing—the patient always knows if they are wearing a brace.

The guidelines set by the New York Times stipulated that letters to the editor could not exceed 150 words. Accordingly, DiBello abided by this constraint to enhance the likelihood of the letter being published:

On January 4, AOPA sent a letter in response to the U.S. Treasury Department and Internal Revenue Service’s requests for comments outlining concerns about the effects of the excise tax on the O&P field. The letter addresses the excise tax that affect the practitioners’ customization of devices, the U.S. Food and Drug Administration’s treatment of O&P patient-care facilities, and the use of other component parts when building a customized device for a patient.

The letter requested a meeting with Treasury and IRS officials that occurred February 10, 2011, where AOPA was able to present compelling evidence on how components and devices meet the law’s exemption criteria. Hopes are high for achieving the exemption, based on this meeting. The entire letter and comments subsequently submitted can be read online at www.AOPAnet. org/2011_Treasury_letter.pdf Questions? Contact Steven Rybicki at srybicki@AOPAnet.org or 571/431-0835.

Dear Editor:

ter of s Raises a Wel ok at Orthotic Lo , while se es lo os “C th s out foot or ab Gina Kolata’ n tio es qu c terminology. a scientifi via imprecise n Doubts” raises io at s iz al er over-gen thotics extend prompting an discipline of or e ent th rr at cu th In . ed es itt foot orthos of The article om et bs su tood to latively narrow monly unders beyond the re thotics is com or ufactured y, an og m s ol as in vices from m medical term de g in sis ac br nge of ing for scolio describe the ra ed spinal brac at ic s with br nt fa tie pa om r cust mobility fo n ai s. st knee braces to su at th ing condition acing items ronic, debilitat ch or s; and custom br aj ie m ud r st he tcomes sis and ot us scientific ou multiple sclero void of rigoro ctiveness de t fe ef no e is tiv ld ra The fie and compa ed et pl e are no m co Th en derway. er research has be promise are un t ea ls difficult. gr ro r nt fe co of ble, making si studies which vi e ar test es ac acing. Br ts-all. The grea placebos in br as one-size-fi k led or tia w t en n’ ed es ing do ned and cr Effective brac ated by a trai ic br fa e y. on is g anatom value in bracin ecific patient’s nform to a sp co to t, lis ia ec sp urs,

Very truly yo

O, FAAOP lo, PharmD, C Thomas DiBel tion President thetic Associa hotic and Pros rt O an ic er m A 200 le Street, Suite 330 John Carly 4 31 22 a irgini Alexandria, V 1-0814 43 1/ 57 e: Phon

Questions? Contact Steven Rybicki at srybicki@AOPAnet.org or 571/431-0835.

42

O&P ALMANAC APRIL 2011

2011 AOPA National Assembly: Poster Presentations Present your research findings or a particular case presentation at the 2011 AOPA National Assembly.

Presentations should be graphical displays in a poster format using photographs, diagrams, flowcharts, graphs, and any sample educational materials.

Applications can be submitted via www.AOPAnet.org and will be accepted through July 1.

Questions? Contact Tina Moran at tmoran@AOPAnet.org or 571/431-0808.

n

AOPA Headlines

Advanced Coding and Billing Seminars 2011 Dates Announced The first AOPA Advanced Coding and Billing Seminar of 2011 will be held at the Mirage Resort and Casino in Las Vegas on May 19-20, 2011.

The Advanced Coding and Billing Seminars include breakout sessions for practitioners and administrators that will focus on each group’s specific interests and educational needs.

Don’t miss the opportunity to experience two days of valuable O&P coding and billing information from AOPA experts. Attendees who register prior to April 20 will You will learn: • medical policies • hints on better documentation • how to create a compliance plan • how to audit charts.

EARN

14 DCITES CRESEMINAR PER

receive a $25 discount off the regular tuition price. AOPA has secured a room rate of $125 per night at the Mirage.

To register for the May 19-20 AOPA Advanced Coding and Billing Seminar, visit https://aopa.wufoo.com/ forms/2011-mastering-medicare-las-vegas/.

AOPA also will be hosting this seminar June 15-16 in San Antonio and October 24-25 in Baltimore.

Questions? Contact Ann Davis at adavis@AOPAnet.org or 571/431-0876.

Practitioners will cover: • coding principles • coding for complex devices • coding for repairs and adjustments • Medicare ‘99 codes • mutually exclusive codes.

Administrators will cover: • the Quality and Supplier Standards • strategies for handling appeals and denials • strategies for handling unique billing situations • documentation requirements • Medicare as secondary payer.

Sound Win for Nevada O&P Patients to develop letters to legislators. They also In November, Nevada’s helped O&P patients reach out to their state Medicaid patients over the age of 21 representatives and recruited the support of who are O&P users were told those the Amputee Coalition. services might be slashed to compensate Advocacy efforts did not go unnoticed. for the state’s annual budget deficit. Former Following his January 24 inauguration, Nevada Governor, James Gibbons’ state adminisGovernor Brian Sandoval announced in trators recommended cuts to the state’s Medicaid his “State of the State” address that he program for low income individuals, including the was making several “add backs” to the elimination of payments for O&P services to any proposed policy to Medicaid cuts, including Medicaid beneficiary over the age of 21. his decision to re-instate Nevada Medicaid Shortly after, AOPA and Nevada O&P practicoverage for orthotics and prosthetics users tioners began to fight back. AOPA started working regardless of age. with Melinda Lisle, of the Nevada firm, Orthopro, Nevada State Capitol While the outlook has improved, the in convening conference calls with many Nevada battle isn’t over. And it won’t be until the final state budget O&P firms—including mostly AOPA members— interested in is approved. AOPA, Nevada practitioners, lobbyists, and taking a stand. patients will continue working until we know that O&P AOPA also started public relations initiatives—a billboard services to Medicaid beneficiaries have not been cut. displayed in Carson City, advertisements in the state’s major Working together, swiftly, wisely and in conjunction with newspapers, and article pitches to raise awareness of O&P AOPA’s expertise, practitioners can continue to make an fairness to Nevada’s health-care media writers. impact and deliver quality care for less-advantaged patients.

O&P practitioners’ meetings also made headway.

Questions? Contact Steven Rybicki at srybicki@AOPAnet.

Clinicians solicited help from Nevada DME providers, and org or 571/431-0835.

Nevada practitioners hired a lobbyist and worked with AOPA 44

O&P ALMANAC APRIL 2011

PROTECT YOUR BUSINESS PROTECT YOUR PATIENTS

PROTECT YOUR FUTURE

YOU MAKE

ThE dIFFERENCE

2011 AOPA POLICY FORUM April 11-12, 2011 • l’EnfAnt plAzA HotEl WAsHington, DC

The most effective O&P messenger is YOU! the annual AopA policy forum is your once a year opportunity for the orthotics and prosthetics community to tell the wonderful story of restoring our patients’ lives and hopes to legislators and their staffs.

We need your participation in the 2011 AOPA Policy Forum!

Health Care Reform is law and it is more important than ever to educate members of Congress on how orthotics and prosthetics restore lives. In addition to on the spot training on AOPA’s federal policy objectives, there will be briefings and training on critical state O&P issues, including parity, licensure, and Medicaid issues. This year’s Policy Forum subjects— •

What healthcare reform means to your business;

•

Federal parity and the Medicare O&P Improvements Act;

•

State licensure/parity initiatives;

2011 AOPA POLICY FORUM TENTATIVE SChEdULE: MonDAy, April 11 11:00 a.m. – 3:00 p.m. registration open 11:00 a.m.– Noon state reps Meeting 1:00 p.m. – 5:30 p.m. policy forum general sessions

•

Combating Medicaid reductions; and

5:30 p.m. fundraiser/reception

•

How to jumpstart state-level initiatives.

6:30 p.m. – 7:00 p.m.

Attendee reception

7:00 p.m. – 9:00 p.m.

Dinner tuEsDAy, April 12 7:30 a.m.

Attendee Breakfast and general session 8:00 a.m. – 9:00 a.m. fundraiser Breakfast 8:30 a.m. – 5:00 p.m.

Congressional Appointments

NEW LOCATION! NEW AGENDA! NEW EXPERIENCE! Experience Washington as you’ve never experienced it before – at the L’Enfant Plaza Hotel, 480 L’Enfant Plaza SW, Washington, DC 20024. A five-minute Metro ride from the Capitol Dome, Senate and House Office buildings and all the magnificence of our nation’s capital.

register online: www.AOPAnet.org or call 571/431-0876 for details.

n

AOPA Headlines

2011 AOPA Assembly

ANNOUNCEMENT

AOPA has secured a room rate of $135 per night for the 2011 National Assembly. Believe it, a room for just $135.

It’s the Mirage room rate for this year’s assembly. Don’t miss this opportunity to enjoy AAA Four Diamond luxury.

Need more reasons to attend?

• unprecedented business education featuring experts in health-care reform, documentation, O&P business management, ethics, different business models, and more new multi-discipline panels on cerebral palsy, stroke management, and wound care

E TH CE A PLTO BE!

• country’s largest orthotics, prosthetics, and pedorthics trade show • ability to earn more than 34 continuing education credits • premier learning experience with the best speakers from around the world • extensive symposium on treating spinal trauma featuring live demonstrations • best practices for assistants and administration staff • new roundtable discussions • programs preparing you for the future of O&P including topics such as osseointegration, robotics, and material science.

Attending also means taking in the robust offerings of the Las Vegas strip: shopping, entertainment, championship golf, and more.

Questions? Contact Ann Davis at adavis@AOPAnet.org or 571/431-0876.

Documentation Pointers

Promote the Business with a Free Poster from AOPA

Is there really such a thing as too much documentation?

The simple answer is no, but just as important as what you document is how you document.

Join AOPA for the April 13, 2011, AOPAversity Audio Conference, “Improving Your Clinical Documentation.”

An AOPA expert will guide you through the ins and outs of proper O&P clinical documentation. Topics for discussion will include: • different documentation methods and their advantages • when to document patient encounters • how to properly write addenda to your documentation • how to work with other members of the rehab team to achieve consistent documentation.

Don’t miss this valuable educational opportunity.

As audit activity increases, proper documentation techniques become increasingly important in ensuring the success of your business.

Looking for a way to enhance your office space and promote O&P causes? Then look no further than www.AOPAnet.org.

AOPA members can order complimentary posters, which are replicas of ads which appeared in a variety of print publications throughout October and November 2010, as long as supplies last. Some O&P professionals who have decorated their offices with the posters agree they are more than just aesthetically pleasing.

“They are great and add a wonderful reminder of what we’re all about,” said Claudia Zacharias, president and CEO of the Board of Certification/Accreditation, International.

46

O&P ALMANAC APRIL 2011

O&P PAC Update The O&P PAC would like to acknowledge and thank AOPA member Kevin Gilg, CP, for his recent contribution* and support.

The O&P PAC recently made a donation* to the following members of Congress: • Senator Orrin Hatch (R-Utah), Senior Member of Senate Committee on Finance; Member of Health, Education, Labor and Pensions Committee, Committee on the Judiciary, the Joint Committee on Taxation; Member of the Special Committee on Aging • Representative Joseph Pitts (R-Pennsylvania), Chairman: Health Subcommittee • Senator Debbie Stabenow (D-Michigan), Chairwoman: Committee on Agriculture, Nutrition & Forestry; Member of the Budget Committee, the Energy & Natural Resources Committee, and the Finance Committee • Senator Ben Nelson (D-Nebraska), Member: Agriculture, Nutrition & Forestry; Appropriations; Armed Services; Rules and Administration Committees.

IN MEMORIAM

Harry J. Lawall Jr., CPO Harry J., “Bud”, Lawall Jr., CPO, of Newtown, Pennsylvania, died on Dec. 20, 2010, at St. Mary Medical Center, Langhorne, Pennsylvania. He was 55.

Born in Philadelphia, he was the son of Rosemary Malone Lawall and the late Harry Lawall, Sr. Father and son would go on to become co-founders of Harry J. Lawall & Son. Lawall was a resident of Newtown for 20 years and formerly lived in Holland, Pennsylvania. He graduated from Holy Ghost Preparatory School in 1972 and received his bachelor degree from New York University in 1976. In 1977, he and his father founded Harry J. Lawall & Son, in Philadelphia.

In his leisure time, he enjoyed boating and golfing.

He is survived by his wife of 33 years Donna M. Schneider Lawall.

PDAC verified L1971

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level, which have an impact on the orthotic and prosthetic community. The PAC achieves this goal by working closely with members of the House and Senate to educate them about the issues and help elect those individuals who support the orthotic and prosthetic community.

To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@ AOPAnet.org. *Due to publishing deadlines this list was created on February 18, 2011. Any donations received or made after that date will be published in a subsequent issue of O&P Almanac.

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AOPA Applications

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

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million

Owens Carolina Orthotic & Prosthetic 8123 Charlotte Hwy Ft. Mill, SC 29707 803/746-4260 Fax: 704/332-6128 Category: Affiliate Parent Company: Owens Carolina Orthotic & Prosthetic Network Inc., Charlotte, NC

Florida O&P Services, Inc. 3636 University Blvd S., Ste. B-10 Jacksonville, FL 32216 904/737-7755 Fax: 904/737-7962 Category: Affiliate Parent Company: Florida O & P Services, Inc., Orange Park, FL

Florida O&P Services, Inc.

VGM Financial

1797 Old Moultrie Rd., Ste. 110 Saint Augustine, FL 32084 904/826-0027 Fax: 904/805-9973 Category: Affiliate Parent Company: Florida O & P Services, Inc., Orange Park, FL

1111 W. San Marnan Drive Waterloo, IA 50701 319/274-6661 Fax: 319/236-6903 Category: Supplier Affiliate Parent Company: Orthotic & Prosthetic Group of America, Waterloo, IA

ATLAS International

VGM Insurance

11389 Trade Center Drive Rancho Cordova, CA 95742 916/858-3322 Fax: 916/858-3320 Category: Supplier Level 1

1111 W. San Marnan Drive Waterloo, IA 50701 866/497-0836 Fax: 319/235-6656 Category: Supplier Affiliate Parent Company: Orthotic & Prosthetic Group of America, Waterloo, IA

Peripheral Vascular Associates 6800 Park Ten Blvd, Ste. 154-E San Antonio, TX 78213 210/828-2503 Fax: 210/828-0590 Category: Patient Care Facility Richard Bolware, CP, Sarah Unland

Forbin

The Orthopedic & Sports Medicine Center 2000 Medical Pkwy, Ste. 101 Annapolis, MD 21401 410/267-5579 Fax: 410/268-0986 Category: Patient Care Facility Joseph Porter, CO, PTA

1111 W. San Marnan Drive Waterloo, IA 50701 866/999-9469 Fax: 877/389-8420 Category: Supplier Affiliate Parent Company: Orthotic & Prosthetic Group of America, Waterloo, IA

www.AOPAnet.org 48

O&P ALMANAC APRIL 2011

For over 50 years, PEL has offered practitioners outstanding

Roni Menefee • “My job is to supply my customer’s needs, in a timely matter, at a competitive price.”

• A.A. degree, working on B.A. • Sings in her church choir • Likes walking and reading (but not at the same time!)

Value

on the most popular products available from the O&P industry’s leading manufacturers.

Phone, fax or email a knowledgeable Customer Service Rep, like Roni, for up-to-date information on the newest and most innovative products available – representing outstanding value. Over 98% of popular products ship from PEL the same day they are ordered.

Hosmer Entegra SV

Fillauer

Ibex Foot System • Innovative micro-slice pylon • Multi-axis heel/toe for terrain conformance • Energy optimized pylon/heel plate design • Designed for patients up to 330 lbs • Only 16.2 oz. (459g)/ Build Height 6.75" (17cm) • Ibex XD designed for patients up to 440 lbs • Ibex XD 21.2 oz. (602g)/ Build Height 7.63" (19cm) • Durable; passed ISO-22675 test standard

Knit-Rite Soft Sock®

• Independently adjustable hydraulic knee • Rugged thru-bolt design • Lightweight aluminum alloy frame • 135° range of motion • Integrated kneeling pad • ISO tested and rated for 220 lb (100 kg) • Maintenance-free Oilite® sleeve bearings

New 3-De! p Toe Sha

The original Soft Sock® improved with a patented hemispherically knit threedimensional distal shape.

• 3D distal end shape provides improved fit qualities and comfort over traditional flat knit “envelope” shape of prosthetic socks • Moisture wicking fibers move moisture away from skin and inhibit odor in sock • Lycra® provides stretch and excellent fitting qualities • Available in X-Static® – the Silver Fiber® or original CoolMax® • Soft Socks feel soft and cuddly worn next to the skin

PEL Supply Co. Orthotic & Prosthetic Components

®

pelsupply.com

4666 Manufacturing Road Cleveland, OH 44135-2672 USA

Ph 800-321-1264 Fx 800-222-6176

®

Experience the Power of One.

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Marketplace

MT. EMEY MEDICAL COLLECTION SHOES

This category of shoes is designed for hard-to-fit feet with larger orthotics needs. It offers a variety of closure for ease of fit adjustability.

These shoes will accommodate mild or severe foot deformities, such as edema, charcot, bunion, and RA, and are in stock for on-time delivery.

Whether you need to order the custom orthotics only or from a wide selection of Apis shoes, we offer great package deals.

For more details, call our friendly CSRs at 888/937-2747.

COLLEGE PARK INTRODUCES THE VELOCITY™ FOOT College Park Industries (CPI) is pleased to introduce their newest prosthetic foot, the Velocity. This innovative foot complements CPI’s line of low maintenance, multi-spring feet, including the highly successful Soleus®. The Velocity delivers a lower profile along with coupled toe springs that work together to provide a progressively smooth roll-over. The design also includes a responsive composite heel for dynamic function. CPI’s signature gait matching process and same day 50

O&P ALMANAC APRIL 2011

custom build allow each Velocity spring to be ergonomically tuned, providing an appropriate amount of dynamic response. The foot provides high functionality and low maintenance, with easy heel adjustments for fine-tuning. The versatile Velocity has smooth, controlled action and is appropriate for middle to high impact level users.

College Park Industries has been a lower limb prosthetics industry leader for more than 20 years. CPI designs and manufactures high-quality, anatomically correct foot/ankle systems with a superior range of motion as well as the iPecs, a wireless prosthetic gait lab. Emulating human anatomy and highly customizable, CPI products enrich the lives of tens of thousands of satisfied users throughout the world.

With state-of-the-art design and precise engineering, College Park remains committed to the research and development of the finest prosthetic products.

For more information, call 800/7287950 or visit www.college-park.com.

MINIMAC KNEE FROM FILLAUER LLC The MiniMac knee is a lightweight, single axis knee incorporating a mechanical lock during the stance phase of gait, along with a stance flexion feature, utilizing mechanical flexion to control the prosthesis swing rate.

• Automatic knee locks at full extension • Rated for up to 132 lbs • Adjustable stance flexion • Low-profile proximal adapter • Free swing design • Friction swing control adjustment.

For more information, contact customer service at 800/251-6398 or visit www.fillauer.com.

MASTERFLEX COLOR

Euro International’s newest program addition is the Masterflex Color, a permanent elastic deep drawing sheeting material with high elasticity and dimensional stability which is available in different thicknesses. But also in 15 different color variations which makes this material a novelty because as far as we know, Euro International is the first company with such a broad and vibrant color palette.

• Masterflex Transparent and Masterflex Color applications • Inner shoe material • Waterproof splints • Metacarpus/forearm splints • Arm/foot prostheses • Peroneal/ankle/foot caps • Trial shoes • Trial prostheses for thigh amputations.

For more information, call 800/3782480 or visit www.eurointl.com.

INTRODUCING KISS REPLACEMENT KITS! AVAILABLE IN BEIGE OR BLACK These kits are designed to replace key components, without the need to purchase a distal base!

CMP32/A: Includes a velcro sewn placard, proximal nut and screw, proximal strap, and distal strap.

CMP31/A: Includes an adhesive-ready placard, proximal nut and screw, proximal strap, and distal strap.

For more information, contact KISS Technologies LLC at 410/663-KISS or visit www.kiss-suspension.com.

OPTEC USA SPECIAL APRIL 1 THRU MAY 31: $59 OASIS REHAB™ LSO The bivalve Oasis Rehab with rigid anterior and posterior polymer panels provides compression and stabilization from L1 to L5 vertebrae. The Rehab anterior is available in neutral or pendulous abdomen; the posterior is

available in three different degrees of lordosis resulting in an intimate fit that provides support, comfort, control, and increased patient compliance.

These promotions apply to standard pricing and cannot be combined with any other discounts or promotions.

Find out more about these and other products: call us at 888/982-8181 or visit us at www.optecusa.com.

NEW FROM MOTION CONTROL: NEW TRIAD PREAMP

• Three mounting options • Water-resistant case • High interference rejection • Gain adjustments on preamp • Compatible for use with: ✔✔ Utah Arm 3 & 3+ (kit: p/n 4050214) ✔✔ Utah Hybrid Arm (kit: p/n 4050214) ✔✔ ProControl Systems (kit: p/n 4050216) ✔✔ Otto Bock electrode cables.

For more information call 888/6962767, email info@UtahArm.com, or visit www.UtahArm.com.

Provel offers cost effective, fast, easy to use, and reliable O&P automation. The D2 digitizer, C7 carver, and T7 thermoformer are appropriate for small clinics as well as large central fab's.

AOP file compatible and backed by a two year warranty. The D2 digitizer allows automated shape capture of prosthetic casts with unmatched accuracy. The C7 carver is not only fast and precise, its self contained dust collection system is extremely quiet. The T7 thermoformer consistently produces high quality thermoplastic sockets from industry standard preforms.

For more information visit www.provel.us or call 509.857.2009.

APRIL 2011 O&P ALMANAC

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OPTEC USA SPECIAL APRIL 1 THRU MAY 31: 20% OFF STOCK MODULAR BRACES LSO AND TLSO Optec USA’s Stock modular braces are designed to restrict unwanted movement and control the spine in single or multiple planes of motion.

Prefabricated stock sizes can be trimmed, molded, or modified to provide your patients with an intimate custom fit. OPTEC USA’s rigid spinal system provides superior stabilization and support that your patients need with the ultimate comfort they deserve.

SALO not included in sale. These promotions apply to standard pricing and cannot be combined with any other discounts or promotions.

Find out more about these and other products: call us at 888/982-8181 or visit us at www.optecusa.com.

FOR UNMATCHED VERTICAL SHOCK AND ROTATION TRY ÖSSUR’S NEW RE-FLEX ROTATE™ TODAY!

provides smooth, progressive rotation with no abrupt stops. The EVO feature promotes a smoother, more comfortable rollover while increasing stability in stance. This unmatched combination makes Re-Flex Rotate the ideal solution for low to high impact patients who can benefit from vertical shock and rotation.

For more information, please call 800/233-6263 or visit www.ossur.com.

structure that creates an impression of depth. The PVC-based material provides robust features for the gloves, showing high durability compared to other materials. Skin Natural is appropriate for patients wearing myoelectric, body powered, and passive arm prostheses.

To find out how to get your patients into Skin Natural today, call 800/3284058 or visit www.ottobockus.com.

OTTO BOCK’S NEW PROSEAL SYSTEM FOR TF SUCTION SOCKETS

PEDIATRIC SEAMLESS AFO SOCKS FROM PEL SUPPLY

The new ProSeal System creates a proximal seal between the socket and liner, suitable for suction sockets for transfemoral amputees. The system consists of the 452A1 ProSeal Ring, an uncovered Liner, and the 21Y14 PushValve auto-expulsion valve. The ProSeal Ring maximizes the surface area and enhances the vacuum effect on the entire residual limb—not just the distal end. Users benefit from increased suspension in the socket plus easy donning and doffing.

To learn more, contact your sales representative at 800/328-4058 or visit www.ottobockus.com.

TRY THE NEW SKIN NATURAL GLOVE BY OTTO BOCK: A MORE REALISTIC APPEARANCE, NATURALLY!

Re-Flex Rotate with EVO boasts the most vertical travel of any vertical shock and rotation foot on the market today. A titanium spring provides more than half an inch of vertical travel and gives the foot a lightweight, responsive feel. Torsion cell technology

52

O&P ALMANAC APRIL 2011

Durable and easy-to-clean, Skin Natural gloves provide more realistic characteristics due to a multilayered

The new SmartKnit® seamless AFO socks from Knit-Rite offer form fitting foot and ankle interface specifically sized and designed for pediatric AFO and KAFO wearers. Plus: • Moisture wicking fibers wick moisture away from the skin and help inhibit odor in the socks • Core-Spun, high-stretch fibers hug the child’s feet like a protective second skin • Seamless design helps prevent skin irritations and pressure over the toes • Heel-less design ensures a perfect fit every time • Non-binding Halo Top™ fits comfortably to minimize indentations.

For more information about the new Pediatric AFO/KAFO socks— or any other SmartKnit products from Knit-Rite, call your friendly PEL Supply customer service rep at 800/321-1264, fax 800/222-6176, or email customerservice@pelsupply.com.

Registered customers may order online at www.pelsupply.com.

Medicare Approved Diabetic Shoes (A5500) & Inserts (A5512)

Lady’s

Toll Free:1-888-937-2747 Men’s 1 pair shoes+3 Pairs of inserts

1 pair shoes+3 Pairs of inserts

9205

9213

9206

9214

9207

TM

708-L

9605

888-V

9605-Tan

505

9606

9215

9208 9601 A5512 A5512

9209

9210

9211

Each pair is packed with 3 pairs of diabetic inserts, (PDAC A5512), these shoes are made with high-grade genuine leather with fabic lining and solid EVA outsole.

Extremely light weight, come in 3 widths & added depth.

9602

9602-BRN

Sizes & Widths: B/D(M/W):5.5.5-11 3E(WW):5,5.5-11 5E(XW):5,5.5-11

9701-1L

Package Includes: (Same as Men’s)

Each pair is packed with 3 pairs of diabetic inserts, (PDAC A5512), these shoes are made with high-grade genuine leather with Leather lining and solid EVA outsole.

Extremely light weight, come in 3 widths & added depth.

Sizes & Widths: D/2E(M/W): 7,7.5-11.5,12-15 4E(XW): 7,7.5-11.5,12-15 6E(XXW): 7,7.5-11.5, 12-15

Diabetic Socks

9212 9701-3V

Colors:Black,White, Brown, Navy, Ruby Red, Beige, Taupe. Refer to catalog for more details & call us to get free sample kit for 28 styles Apis Footwear Company

2239 Tyler Ave. South El Monte, CA 91733

Tel: 1-888-937-2747 Fax: 1-888-990-2245

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Marketplace

SPINAL TECHNOLOGY Spinal Technology Inc. is a leading central fabricator of Spinal orthotics, upper and lower limb orthotics and prosthetics. Our ABC certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products, 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 Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses.

For information call 800/253-7868, fax 888/775-0588, or email Info@spinal tech.com or visit www.spinaltech.com.

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O&P ALMANAC APRIL 2011

SPS HAS NEW WALKAIDE 3.0 SOFTWARE

G-LOCK: DUAL SUSPENSION FROM A SMALL DESIGN

SPS is pleased to launch the new WalkAide 3.0 Software designed to ease programming while availing practitioners a full range of customization options.

WalkAide 3.0 Rapid Programming Option • Easy three step programming— 75 percent fewer steps • Detailed gait analysis/ programming available for fine tuning • Upgrade free of charge—download via www.walkaide.com/WalkAnalyst WalkAide’s new Bi-Flex cuff is designed to provide a secure fit and optimal electrode positioning to enhance reproducibility of outcomes both inside and outside clinical settings.

• Consistent, accurate placement for clinician and patient • Patient can place and operate cuff with one hand • Disposable liner.

For more information, contact SPS customer service at 800/767-7776 x 3 or your SPS sales manager.

For use in laminated or thermoplastic sockets, the G-Lock provides suction suspension, through a one-way expulsion valve, and a standard pin lock. Amputees receive the security of a pin while minimizing pistoning through the use of suction. The G-Lock has a CAD-friendly, drop-in design yet remains easy to work with in traditional fabrication processes. The G-Lock comes with a 38 mm pin and has a four-hole pattern for attachment to the socket. The lock’s weight limit is 250 lbs and has a 12-month warranty.

For more information, contact WillowWood at 800/848-4930 or www.willowwoodco.com.

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION

Business OpTimizATiOn AnAlysis TOOl (BOAT) AOPA’s largest and most successful members use the BOAT and you should also.

The BOAT will help you:

This AmAzing Profit Booster is FREE for AoPA MeMbers.

You will have access to your own secure and confidential account on the BOAT which will contain your company’s reported data and is specifically tailored to help O&P business owners manage their business for

•

Create budgets

•

Track your finances

•

Participate in the annual Operating Performance and Compensation survey (OPC)—which provides you with a personal benchmark comparison study

•

OPC data you submit will automatically populate your BOAT site providing valuable historical information

•

Provide access to the new AOPA Patient Satisfaction Survey (required by certifying bodies)

•

Examine the financial fitness of your business

•

Help you identify and understand your competition, market conditions and referral sources

•

Much more!

3

Enroll Today!

greATer prOfiT And quAliTy pATienT cAre.

If you do not already have a BOAT account, contact AOPA’s BOAT partner, Michael Becher, Industry Insights, (614)389-2100 x 114 or mbecher@industryinsights.com, to enroll today.

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Jobs

INCREASE EXPOSURE AND SAVE!

Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.

North Central Certified Prosthetist/Orthotist, Certified Orthotist, Board Certified Prosthetist Privately owned practice with a 50-year track record has an immediate opening in our large, Midwest facility. We’re looking for an orthotist or prosthetist who is good with patients, familiar with the latest technology, aggressive with patient care, and motivated to help us market our facility. We offer a competitive salary and health benefits.

Send resume to:

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific Use our map to find which region you fit into!

CLASSIFIED RATES Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email and Web addresses are counted as single words.) AOPA member companies receive the member rate.

Member Non-member Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color

1/2 page, color

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org.

No orders or cancellations are taken by phone.

Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org., along with a VISA or MasterCard number, the name on the card and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711.

Note: AOPA reserves the right to edit Job listings for space and style considerations.

Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

JOB BOARD RATES Visit the only online job Member Non-member board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140 Save 5 percent on O&P Almanac classified rates by placing your ad in both the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.

56

O&P ALMANAC APRIL 2011

Email: mhcbl@aol.com Fax: 317/858-3146

Certified Prosthetists, Board Eligible Orthotists, Board Eligible Prosthetists, Certified Pedorthists, Residents Illinois Immediate openings and excellent opportunities for independent, motivated, and ABC-certified practitioners for a well-established, multiple location O&P practice in Illinois.

The ideal candidate will be ABC-certified and must be eligible for Illinois state licensure. We would also like to speak with candidates seeking residency in orthotics and prosthetics.

Our fast-paced, energetic atmosphere is a rewarding place to establish a great career. We offer a very competitive salary and benefits package commensurate with experience.

If you have what it takes to be a part of a successful and well-organized team then we would love to speak with you. Management experience is a plus! Multiple locations available. Forward your resume, in confidence, to:

Recruitment Manager Comprehensive Prosthetics & Orthotics, Inc. 741 W. Main Street Peoria, IL, 61606 Fax: 309/676-2279 Email: jim@cpousa.com

Northeast

Mid-Atlantic Certified Prosthetist/Orthotist

Certified Prosthetist

Philadelphia Culture, arts, history and architecture…not to mention cuisine! Philly has it all! It is the country’s fifth-largest city comprised of art museums and galleries, serious shopping, all four major sports, University of Pennsylvania. And, you can’t forget the Philly Cheese Steak! If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign on bonus potential…plus much more. If interested, please contact, in confidence:

Vermont Yankee Medical, providing orthotic and prosthetic services for more than 64 years, is looking for a certified prosthetist ready to relocate to Vermont.

With five locations in some of the most scenic areas of the country, Yankee Medical offers a lifestyle that attracts professionals. Send resume to:

Attn: President Yankee Medical 276 North Avenue Burlington, VT 05401 Email: jnf@yankeemedical.com

Sharon King Hanger Prosthetics & Orthotics, Inc. Phone: 512/777-3814 Email: Sking@hanger.com www.hanger.com/careers

AVAILABLE POSITIONS Orthotist

Why do I work for Hanger?

“

I like working for a company that cares for its employees as much as they care for their patients. That’s why I’ve been with Hanger for the past 28 years.

When Hurricane Katrina hit my hometown of New Orleans, Hanger was there for me. They gave me as much time as I needed—with pay—and helped me relocate to Atlanta.

By working at the largest prosthetic and orthotic company in the nation, I have more than just career opportunities.

I have an employer that treats me like family.

”

Tony Thaxton Jr., CPO, LPO, Certified Practitioner, Orthotist-Prosthetist

American Canyon, CA Pensacola, FL Iowa City, IA Mt. Vernon, IL Urbana, IL Evansville, IN Michigan City, IN Paducah, KY Methuen, MA

Geneva, NY New York City, NY Tahlequah, OK York, PA Alliance / Akron, Oh Spartanburg / Union, SC Longview, WA Milwaukee, WI

Orthotist/Prosthetist Houston, TX

Prosthetist Port St. Lucie/Melbourne, FL Jackson, MS Clearwater/New Port Richey, Enid, OK FL Austin, TX Hays/Salina, KS

Prosthetist/Orthotist Little Rock, AR American Canyon, CA Long Beach, CA Denver, CO Thornton, CO Pensacola, FL Des Moines, IA Dubuque, IA Michigan City, IN Louisville, KY Downey, CA Mt. Vernon, IL Woburn, MA Waterville, ME

Baltimore, MD Meridian, MS Springfield, MO Albany, NY Akron, OH Bend, OR Lancaster, PA Philadelphia, PA Olympia / Vancouver, WA

Certified Pedorthist

Willoughby, OH Tahlequah, OK Tacoma / Renton, WA Parkersburg, WV

Orthotic Fitter Willoughby, OH

To apply for any of these positions, visit www.hanger.com/careers

Olympia / Vancouver, WA

Entry Level Hanger Orthopedic Group, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any

other basis prohibited by federal, state or local law. Residency Program or Certificate Primary Education Program Info, contact: Robert S. Lin, CPO/Dir. of Academic Programs. Hanger P&O/ Newington O&P Systems, Ph. 860.667.5304; Fax 860.667.1719

Torrance, CA

APRIL 2011 O&P ALMANAC

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Jobs Northeast

Certified Orthotist, Certified Prosthetist/ Othotist New York City The city of New York is “The Crossroads of the World” with the Broadway theater district, Wall Street, the New York Stock Exchange, Chinatown, Columbia University, Rockefeller University, New York University and so much more! We have an opportunity with management potential for an individual possessing excellent patient care, organizational and communication skills. We offer very competitive compensation and benefit packages accompanied by the security of the oldest O&P patient care company in the world, the latest technology, a family of practitioners and relocation assistance and signing bonus. If you are ready for a change, let’s talk! Contact, in confidence:

Certified Orthotist/Certified Prosthetist Orthotist Charlotte, North Carolina Welcome to Charlotte, North Carolina, the largest metropolitan area in North Carolina. Charlotte is rich in history, culture and southern hospitality. If you are looking for city life or country living we have it here. Advanced Prosthetics and Orthotics, LLC is committed to providing intelligent and compassionate care; utilizing our role as an effective member of the rehabilitation team. We are a well-established ABC accredited facility seeking experienced CO/CPO for the Charlotte, North Carolina area. Candidates must be self-motivated, comfortable in a variety of clinical settings, and have excellent communication and organizational skills.

Please submit resume via fax or email:

Fax: 704/510-1311 Email: apocharlotte@birch.net Visit: www.advancedpros.com

Pacific Sharon King Hanger Prosthetics & Orthotics, Inc. Phone: 512/777-3814 Email: Sking@hanger.com www.hanger.com/careers

Southeast CPO Birmingham, Alabama We have an immediate opening for a certified orthotist/prosthetist to join our well-established practice in Birmingham, Alabama. The ideal candidate must have or be eligible for Alabama State licensure. The ideal candidate also should possess at least three years of broad experience in orthotics/prosthetics. Fabrication skills are desired. We offer a competitive salary based on experience, and benefits including health insurance, vacation, personal time, and 401(k). Forward your resume, in confidence, to:

Eric S. Eisenberg, MS, CPO BioTech Limb & Brace, LLC 2421 4th Avenue South Birmingham, AL 35233 Phone: 205/324-7897 Fax: 205/324-7899 Email: eseisenberg@msn.com

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O&P ALMANAC APRIL 2011

Certified Prosthetist-Orthotist or Certified Prosthetist-Facility Manager Southern California Exceptional opportunity for a CPO/CP to manage our satellite office in California’s beautiful Santa Clarita Valley.

Are you looking to grow your career and take on more responsibility? We are a well-established, multi-facility company with an immediate opening for an experienced practitioner (CPO or CP with orthotics experience) to run and grow our practice in Santa Clarita. This ABC-certified practitioner must be self-motivated, patient-oriented, and possess sound clinical, organizational, and interpersonal skills. Familiarity with OPIE software and chartless environment is a huge plus. A minimum of five years’ clinical experience is preferred. We offer a highly competitive salary, incentive program, and outstanding benefits package.

If you are ready to take the next step in your career and relocate to one of the safest and most desirable places to live in the nation, please send your resume with cover letter to:

Valley Institute of Prosthetics and Orthotics Siri Khalsa, Administrator Email: skhalsa@vipoinc.com www.vipoinc.com

Pacific

Inter-Mountain

Certified Orthotist

CPOs, COs

Northern California Do you dream of earning six figures? Receiving a significant sign-on bonus and to work for the oldest and one of the most respected orthotic and prosthetic patient care companies in the world? Are you looking for security? In addition to the above, we offer competitive benefits, world-class education fair, latest technology and a family of more than 1,000 practitioners in addition to the support of HR, sales/marketing, accounting, etc. Our core values are: • Integrity • Clinical and operational excellence • Unsurpassed customer satisfaction • Flexible and entrepreneurial operations • Creativity and innovation • Shared success.

• If you have the skills, drive, and ambition…let’s talk!

Contact, in confidence:

San Antonio Do you want to work for an established, growing company in an environment that values autonomy, clinical excellence, and work/ life balance? Do you want to live in an area where hill country, brush country, historic homes, and exciting metropolitan living are all within minutes of each other? If so, MK Prosthetic and Orthotic Services in San Antonio is the place for you.

We are seeking experienced, self-motivated practitioners to join our dynamic private practice. Our ideal candidates will have at least three years of experience; pediatric experience is a major plus. Practitioners must be eligible for Texas licensure and be ABC certified. Come and build a rewarding, successful career with us. With multiple locations in San Antonio, we’re sure to have a facility that will suit your lifestyle. We offer a competitive salary, full benefits, and an excellent bonus structure.

All inquiries will be kept in confidence.

Sharon King Hanger Prosthetics & Orthotics, Inc. Phone: 512/777-3814 Email: Sking@hanger.com www.hanger.com/careers

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION SERVING THE O&P FIELD FOR MORE THAN 90 YEARS

Renew the Easy Way with AOPA ONLINE PAY NEW! UPDATE MEMBERSHIP DIRECTORY INFORMATION ONLINE

Login to pay your dues and update your membership directory information at:

www.aopanetonline.org/profile

Fax: 210/614-9333 Email: hr@mkprosthetics.com

Orthotic/Prosthetic Technician Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations.

Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care.

We prefer candidates who have completed Discover an Orthotic/Prosthetic Technician program Marshfield, and are ABC registered. Additionally Wisconsin & enjoy: on-the-job training combined with work • Low cost of living experience that includes all aspects • Clean, safe environment of fabrication and component assembly • Short commutes with of orthotic and prosthetic devices is low traffic volume • Excellent educational also preferred. opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package

Join us and see how your career can shine.

To apply, please visit:

www.marshfieldclinic.jobs Reference Job Number MC110034 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

Renew Online Today!

APRIL 2011 O&P ALMANAC

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Calendar

2011 ■■

PROMOTE EVENTS IN THE O&P ALMANAC

CALENDAR RATES Telephone and fax numbers, email addresses and Web sites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Member Non-member Words Rate Rate 25 or less $40 $50 26-50 $50 $60 51+ $2.25 $3.00

per word per word Color Ad Special: 1/4 page Ad $482 1/2 page Ad $634

$678 $830

BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org.

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

For information on continuing education credits, contact the sponsor.

Questions?

Email srybicki@AOPAnet.org.

AOPA-sponsored activities appear in red.

60

O&P ALMANAC APRIL 2011

■■ APRIL 5 WillowWood: Discover LimbLogic® VS via WebEx, 10:30 am ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/2.5 BOC. To register online, visit www.willowwoodco.com.

■■ APRIL 5 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use.

Credits: 2.5 ABC/2.5 BOC. www.willowwoodco.com.

■■ APRIL 6 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8:00 – 9:00 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com.

APRIL 7-9 Rehabilitation Institute of Chicago: Advances in Rehabilitation for the Patient with a Lower Extremity Amputation. Chicago.

Approved for 17.50 ABC CEUs. Contact Melissa Kolski, 312/238-7731; www.ric.org/ education.

■■

■■ APRIL 11-12 2011 AOPA Policy Forum.

Washington DC, L’Enfant Plaza Hotel. To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.

■■ APRIL 13 AOPA Audio Conference: “Improving Clinical Documentation.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.

■■ APRIL 13 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5:00 pm – 6:00 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ technology. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ APRIL 15 Ohio Orthotics and Prosthetics Association Annual Spring Meeting.

Columbus, OH. Hilton Columbus. Contact Dianne Farabi at 614/659-0197 or dfarabi@columbus.rr.com.

■■ APRIL 15–16 Ohio Chapter, American Academy of Orthotists and Prosthetists (AAOP) Annual Spring Technical Meeting.

Columbus, OH. Hilton Columbus. Exhibits included.

Contact Richard W. Butchko 614/659-0197 or butchko1@ columbus.rr.com. See Web site at www.ohiochapteraaop.com.

■■ APRIL 21 Ultraflex: Adult UltraSafeStep™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ knee and ankle technology. Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ APRIL 26 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Register at www. ultraflexsystems.com, 800/2206670 ■■ APRIL 27–29 New York State Chapter of AAOP Educational Program.

Albany, NY. Albany Marriott Hotel. Contact Joann Marx, CPO at Marx4nysaaop@aol. com.

■■ MAY 6-7 The Northwest Chapter of the American Academy of Orthotists & Prosthetists.

Seattle. The Bellevue Courtyard by Marriott Hotel.

For information contact Tim Shride, CPO, LPO, at 612/2030936 or nwaaop@gmail.com or visit www.regonline.com/ nwaaop_2011.

■■ MAY 10 WillowWood: Discover LimbLogic® VS via WebEx, 10:30 am ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/2.5 BOC. To register online, visit www.willowwoodco.com.

■■ MAY 11 AOPA Audio Conference: “Which Box to Check?

The Negative Effect of the 855S on Reimbursement.”

To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

MAY 11-14 PA Academy of Orthotic & Prosthetics Spring Conference. Pittsburgh.

Sheraton Station Square.

Contact Beth Cornelius or Joseph Carter at 814/455-5383.

■■

MAY 12-13 Advanced Orthotic Design Workshop, OTS Corp., Asheville, NC. Course includes: solutions and techniques that optimize gait. Addresses the new orthotic components that emphasize dynamic motion guidance. Presentation of case studies containing unique challenges and subsequent clinical solutions. To register, contact Tracy Ledford at 800/221-4769 or tracy@otscorp.com.

■■

■■ MAY 12-13 WillowWood: Alpha Seminar. Mt. Sterling, OH. Course breakdowns the Alpha family of products, identifies best clinical applications of liners, discussion of liners for vacuum suspension, and the latest in suspension systems. Includes brief review of TPE liner benefits and fitting assessment.

Credits: TBD. Registration deadline: 4/21/2011. Contact: 877/665-5443 or visit www. willowwoodco.com.

■■ MAY 12–14 Western and Midwestern Orthotic Prosthetic Association/California Orthotic and Prosthetic Association Annual Meeting.

Reno, NV. Peppermill Hotel.

Contact Steve Colwell at 206/440-1811 or Sharon Gomez at 530/521-4541 or visit www.wamopa.com.

JUNE 3–4 PrimeFare East Regional Scientific Symposium 2011. Nashville. Nashville Convention Center. Contact Jane Edwards at 888/388-5243.

■■

■■ JUNE 6-7 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Little Rock, AR. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending.

Contact 888/678-6548 or email info@allardusa.com.

■■ JUNE 8 AOPA Audio Conference: “Preventing Audit Disasters.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

JUNE 9 Hosmer Upper Extremity Seminar. Los Gatos, CA. Comprehensive seminar on upper extremity prosthetics.

Areas the seminar will focus on are alternative upper extremity componentry, impression techniques and harnessing. Learning objectives will include familiarization with work sources, biomechanics, componentry adjustment, and prosthetic optimization. To register, please contact Jackie Bradford at 800/827-0070 or jbradford@hosmer.com.

■■

■■ JUNE 9-10 Michigan Orthotics & Prosthetics Association (MOPA) Continuing Education Meeting. Soaring Eagle Casino & Resort, Mt. Pleasant, MI. Contact Mary Ellen Kitzman, 248/615-0600, MOPA_meeting@mopa.info or visit www.mopa.info.

■■ JUNE 10 Advanced Lower Extremity Design Seminar. Los Gatos, CA. The seminar will examine the development of current composite dynamic foot and microprocessor knee systems with respect to biomechanics, physiologic function, and functional design classification.

Attendees will receive handson demonstrations that allow them to experience the new feet and knee designs first

hand. Please contact Jackie Bradford at 800/827-0070 or jbradford@hosmer.com.

■■ JUNE 13-17 Applied Technology Institute (ATi) Orthotic Fitter School, CSUDH Center for Orthotics and Prosthetics. Long Beach, CA. Independent comprehensive course to prepare for certification exam. Approved entry level school by NCOPE (ABC), and BOC; and for continuing education by ABC, BOC and NATA. Contact: Lois Meier at 888/265-6077 or lois@ kasseledu.com or visit www. kasseledu.com.

2011 Advanced Lower Extremity Prosthetic Design Seminars APRIL 11-12

JUNE 13

APRIL 15

AUGUST 3

MAY 18

AUGUST 19

Chattanooga, TN Charlotte, NC Houston, TX

Santa Ana, CA Baltimore, MD St. Louis, MO

JUNE 10

Los Gatos, CA For more information regarding the seminars listed or to register, please contact Nicki Cantrell at 800-251-6398 or ncantrell@fillauer.com

AD309 02-25-11

APRIL 2011 O&P ALMANAC

61

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Calendar

■■ JUNE 16 WillowWood: LimbLogic® VS Applications Practitioner Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.75 BOC. Registration deadline: 5/26/2011. Contact: 877/665-5443 or visit www. willowwoodco.com.

JUNE 17-18 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting.

Fabricate sockets following recommended techniques for airtight socket designs.

Credits: TBD. Registration deadline: 5/26/2011. Contact: 877/665-5443 or visit www. willowwoodco.com.

■■

■■ JUNE 20-21 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Louisville, KY. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending.

Contact 888/678-6548 or email: info@allardusa.com.

■■ JUNE 27-28 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Denver. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEU’s Pending.

Contact 888/678-6548 or email: info@allardusa.com.

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O&P ALMANAC APRIL 2011

■■ JULY 13 AOPA Audio Conference: “Don’t Rile the OSHA Police.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

■■ SEPTEMBER 14 AOPA Audio Conference: “Don’t Run Afoul of the KO Rules.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

■■ JULY 21-22 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Springfield, MA. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending.

Contact 888-678-6548 or email: info@allardusa.com.

■■ SEPTEMBER 19–22 AOPA National Assembly.

Las Vegas. Mirage Hotel. Exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/431-0852, or koneill@ AOPAnet.org.

■■ JULY 28-29 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

San Antonio. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs pending.

Contact 888-678-6548 or email: info@allardusa.com.

■■ AUGUST 5-6 Texas Chapter of the American Academy of Orthotist and Prosthetist (TCAAOP) Annual Meeting and Scientific Symposium.

Sheraton Austin Hotel at the Capitol, Austin. For more information go to www. txaaop.org or contact Suzanne O’Connor at 972/953-0860 or

suzanne.occonnor@cpocare. com.

■■ AUGUST 10 AOPA Audio Conference: “How to Get Paid for Miscellaneous and Repair Codes.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

■■ OCTOBER 12 AOPA Audio Conference: “Developing Your Medicare Billing Compliance Plan.”

To register contact Ann Davis at 571/431-0876 or adavis@ AOPAnet.org.

■■ OCTOBER 12-16 Skills for Life 3: Bilateral Upper Limb Loss Workshop, Denver Renaissance Hotel.

US Member Society-ISPO, Amputee Services of America and the Amputee Coalition.

For more information visit www.usispo.org/skills_for_ life.asp.

■■ NOVEMBER 9 AOPA Audio Conference: “Happy Holidays: Kickbacks and Gifts in O&P.” To register contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.

■■ DECEMBER 14 AOPA Audio Conference: “Are You Ready for the New Year? 2012 New Codes and Policies.” To register contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

2012 ■■ MARCH 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, ext. 208 or dragusa@oandp.org.

2013 ■■ FEBRUARY 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/3803663, ext. 208 or dragusa@ oandp.org. a

n

Ad Index

COMPANY

PAGE

PHONE

WEB SITE OR EMAIL

ALPS

25

(800) 574-5426

www.easyliner.com

Orthotics, Prosthetics & Pedorthics

19

(703) 836-7114

www.abcop.org

Anatomical Concepts Inc.

47

(800) 837-3888

www.prafo.com

Apis Footwear

53

(888) 937-2747

www.bigwideshoes.com

BOC International

29

(877) 776-2200

www.bocinternational.org

Cailor Fleming Insurance

43

(800) 796-8495

www.cailorfleming.com

Cascade Dafo

17

(800) 848-7332

www.cascadedafo.com

College Park Industries Inc.

39

(800) 728-7950

www.college-park.com

DAW Industries

1

(800) 252-2828

www.daw-usa.com

Dr. Comfort

5, C3

(800) 556-5572

www.drcomfortdpm.com

DYCOR

21

800/794-6099

www.dycormfg.com

Euro International

11

(800) 378-2480

www.eurointl.com

Fillauer Companies Inc.

27

(800) 251-6398

www.fillauercompanies.com

KISS Technologies LLC

37

(410) 663-5477

www.kiss-suspension.com

KNIT-RITE

2

(800) 821-3094

www.knitrite.com

Motion Control

13

(888) 696-2767

www.utaharm.com

OPTEC

6, 7

(888) 982-8181

www.optecusa.com

Orthomerica Products

33

(800) 446-6770

www.orthomerica.com

and Review Guide

41

www.oandpstudyguide.com

Ossur Americas Inc.

C4

(800) 233-6263

www.ossur.com

Otto Bock HealthCare

C2

(800) 328-4058

www.ottobockus.com

PEL Supply Company

49

(800) 321-1264

www.pelsupply.com

Spinal Technology Inc.

9

(800) 253-7868

www.spinaltech.com

SPS AOPA PRESENTS

15

(800) 767-7776 Ext. 3

www.spsco.com

American Board for Certification in

Orthotic and Prosthetic Study ®

Expert Coding Advice 24/7 at www.LCodeSearch.com

> > >

The O&P coding expertise you’ve come to rely on is now available whenver you need it.

Match products to L codes and manufacturers— anywhere you connect to the Internet.

This exclusive service is available only for AOPA members.

Log onto LCodeSearch.com and get started today.

Not an AOPA member?

GET CONNECTED Contact Michael Chapman at (571) 431-0876, ext. 293 or mchapman@AOPAnet.org.

Manufacturers: Get your products in front of AOPA members!

Contact Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0876, ext. 211.

APRIL 2011 O&P ALMANAC

63

n

AOPA Answers

Rules for Sharing Members ask questions about physician co-locations, reimbursement criteria, and device life spans AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.

Q: A:

Based upon the new Medicare Supplier Standards, can I still share space with a physician?

It depends. AOPA has recently convinced CMS not to ban all co-locations with a physician. If the physician does not bill Medicare for DMEPOS services, then yes, you can share a location. However, if he or she bills for these types of services (such as canes, crutches, walkers, etc.), then you cannot share a location.

Q:

A physician who bills Medicare for DMEPOS services wants to rent space to my O&P facility.

Is this correct?

A:

If you want to actually share the same location as this physician, Medicare will not approve a supplier number for you because the physician already has a DMEPOS supplier number. However, if you can rent a separate suite (recognized by the United States Postal Service), then it is acceptable, and Medicare should approve your new supplier number.

Q: A:

How do I determine if an item or service is covered by Medicare?

The LCDs and PAs, aka policy, address coverage criteria for most of the frequently ordered O&P items and services, but not all of them. Currently, there are no Medicare policies for upper extremity orthoses and prostheses, hip orthoses, or cranial helmets. If a coverage criterion for an item is not defined in a policy, then it means that only general coverage criteria must be met for the item or service to be covered by Medicare.

What are the general coverage criteria? First, the item or service must fall within a benefit category established

by Medicare. Second, it must be reasonable and necessary

64

O&P ALMANAC APRIL 2011

for the diagnosis or treatment of the illness or injury or to improve the functioning of a malformed body member. Last, the item or service must meet all other applicable Medicare statutory and regulatory requirements.

Q: A:

What is Medicare’s reasonable useful lifetime for orthotics and prosthetics?

The reasonable useful lifetime (RUL) for orthotics and prosthetics is determined by program instructions from Medicare. When there are no program instructions, the DME MACs may establish RULs for orthotics and prosthetics, but in no case can it be more than five years. In other words, if Medicare doesn’t establish a RUL for an item, the DME MACs may then create a RUL through policy. But if they don’t create a policy, the RUL for an item is set at five years.

Prosthetics have a RUL that is less than five years.

Medicare through the Benefits Improvement and Protection Act (BIPA) 2000 has provided program instructions for the RUL for prosthetics. In BIPA Medicare has stated that “prosthetic devices which are artificial limbs” may be replaced at anytime regardless of useful lifetime, as long as the replacement is reasonable and necessary. In the External Breast Prostheses policy, the DME MACs have also established a RUL, which is less than five years. A silicone breast prosthesis has a RUL of two years and a foam, fiber, or fabric breast prosthesis has a RUL of six months.

No direct program instructions from Medicare exist for orthotics, so the RUL for orthotics is set at five years. The exceptions to this are knee orthoses. In the Knee Orthoses policy the DME MACs have established a RUL ranging between one and three years, depending on the type of knee orthosis. KOs described by codes L1810–L1830 have a RUL of one year, and L1831, L1832, and L185 have a RUL of two years. All other KOs have a RUL of three years. a

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