May 2019 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

MAY 2019

Coming Soon: Competitive Bidding of Off-the-Shelf Orthoses P.16

Embracing Sustainable Business Practices P.30

GOT TALENT

HOW TO RECRUIT AND RETAIN TOP PERFORMERS IN A COMPETITIVE JOB MARKET P.22

Orthotic Intervention for Knee Osteoarthritis P.36

Deciphering Prescriptions for Compression Garments P.56

E! QU IZ M EARN

BUSINESS CE

CREDITS

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P.18

This Just In: Leverage Findings From the AOPA Operating Performance Report To Drive ProďŹ ts P.20

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contents

MAY 2019 | VOL. 68, NO. 5

COVER STORY

FEATURES 22 | O&P’s Got Talent A tight U.S. labor market and increasing demand for O&P clinicians combine for a challenging hiring climate in 2019. But successful O&P facility owners and managers have several suggestions for identifying best-fit candidates; encouraging them to join your team; and retaining top performers by offering a competitive salary and benefits, continuing education, and opportunities for advancement. By Christine Umbrell

20 | This Just In

Build a More Proﬁtable O&P Practice

P. 20

Member Spotlight ............................... 40 ■

ST&G USA Corp.

■

Xtreme Prosthetics LLC

DEPARTMENTS Views From AOPA Leadership ........ 4

AOPA Treasurer Jeffrey Brandt, CPO, explains the benefits of AOPA’s benchmarking reports

AOPA Contacts...........................................6

Happenings .............................................. 10

Research, updates, and industry news

P. 13 P. 30

Brian Pietrosimone, PhD ................................................ 36

MAY 2019 | O&P ALMANAC

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

CREDITS

Numbers........................................................ 8

PRINCIPAL INVESTIGATOR | SPECIAL EDITION

From Speculation to Reality

Prepping for competitive bidding of off-the-shelf orthoses

At-a-glance statistics and data

Like many U.S. companies today, O&P facilities are engaging in advanced sustainability initiatives and choosing “greener” business practices. From designing facilities with insulated concrete foam and harnessing solar energy to reducing water usage and leveraging new technologies, O&P businesses are implementing changes both big and small to reduce their environmental footprints. By Meghan Holohan

A new study will examine the efficacy of unloader braces on individuals with medial compartment knee osteoarthritis.

Reimbursement Page ......................... 16

How to reach staff

O&P business owners share their strategies for leveraging the information in AOPA’s annual Operating Performance Report to optimize their business practices. While some use the data to compare their facilities to similar O&P businesses, others examine metrics for strategic planning or share the information to empower staff.

30 | Playing the Long Game

COLUMNS

People & Places ....................................... 14

Transitions in the profession

AOPA News.............................................. 44

AOPA In the News, webinars, meetings, and more

PAC Update .............................................46 AOPA New Members ..........................46 Careers ....................................................... 48

Professional opportunities

Marketplace ............................................ 50 Ad Index..................................................... 5 2 Calendar ..................................................... 54

Upcoming meetings and events

Ask AOPA .................................................. 56 Compression stockings, supply items, and more

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VIEWS FROM AOPA LEADERSHIP

A Powerful Tool for Strategic Planning

Y THE TIME YOU read this column,

spring will have sprung in most of the country. Most of us enjoy this annual ritual of renewal with the return of baseball, gardening, a bike ride, or a walk without gloves and a hat. For our O&P practices, though, many of us now have visibility into what the first half of our fiscal years will look like. Some practices are even nearing the end of Q3 and starting to think about strategic planning exercises for FY2020. It’s a perfect time, if you haven’t already done so, to learn more about the value of the annual AOPA Operating Performance Report and biannual AOPA Compensation and Beneﬁts Report. You will want to set aside the time to complete the 2019 Operating Performance & Compensation Survey—available between May 17 and June 29—and contribute your metrics to the larger data set, for which you’ll benefit from the comparison portion and leverage the final report as a vital tool toward your business planning for next year. As we begin to solicit AOPA members to complete the 2019 survey, we wanted to share what members are saying about the value of completing the survey and accessing the results in the ensuing reports. Participants of the Operating Performance & Compensation Survey have noted that this in-depth undertaking serves as a great benchmarking tool. With the overall data, companies can pinpoint and flag areas of potential risk and improvement. The results are then shared with staff and create necessary dialogue and action items for the improvement of the practice. The report can be used as a transparent real-time check-in or report card on current practices and serves as a great comparison tool as to how your business compares to others in the industry. Awareness and preparation are key to the overall success of any enterprise, and the compilation of this report will help you get where you need to be. While the number of AOPA members who respond to the survey varies annually, about 90 organizations participate. Remember, the more data we have, the more valuable the report becomes. The committee has set a goal of receiving 150 surveys this year. AOPA is standing by to answer questions you may have and to assist you in completing the survey. Don’t delay. Start with yourself and carve out the time today to complete the survey—and share with a colleague that you did so. Avoid starting another year in the quickly changing environment of the O&P profession without this critical operating tool.

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

Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Vice President Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Immediate Past President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS David A. Boone, BSPO, MPH, PhD Orthocare Innovations LLC, Edmonds, WA J. Douglas Call, CP Virginia Prosthetics & Orthotics Inc., Roanoke, VA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Elizabeth Ginzel, MHA, CPO NovaCare P&O, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Spring Lake Park, MN Rick Riley Thuasne USA, Bakersfield, CA

Jeﬀrey Brandt, CPO, is AOPA’s treasurer and a member of AOPA’s Operating Performance & Compensation Survey Committee.

MAY 2019 | O&P ALMANAC

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AOPA CONTACTS

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org GOVERNMENT AFFAIRS Justin Beland, director of government affairs, 571/ 431-0814, jbeland@AOPAnet.org COMMUNICATIONS, MEMBERSHIP & MEETINGS

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

STRATEGIC ALLIANCES

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

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

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

O&P ALMANAC

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 6

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

MAY 2019 | O&P ALMANAC

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

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2019 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac19 for advertising options!

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NUMBERS

Trends Among Veterans With Upper Limb Loss Sixty percent of unilateral and 91 percent of bilateral upper-limb amputees use prostheses

Researchers from the U.S. Department of Veterans Affairs (VA)’s Providence VA Medical Center recently conducted a study of veterans with upperlimb amputation to examine their prosthesis use, satisfaction with devices, health-related quality of life, and care trends. Findings were published in the March 2019 PLoS One article, “A National Study of Veterans With Major Upper-Limb Amputation: Survey Methods, Participants, and Summary Findings.”

CHARACTERISTICS OF SURVEY PARICIPANTS Total survey respondents: 787 male and 21 female.

776

Unilateral amputees; 32 bilateral amputees.

PRIMARY PROSTHESIS TYPE AMONG UNILATERAL AMPUTEES

PERCENT

Average number of years since amputation.

PERCENT

Myoelectric.

Median age.

PROSTHETIC TRAINING

PERCENT

Body-powered.

PERCENT

Cosmetic.

Other.

71 %

71 percent of unilateral amputees received training to use first prosthesis.

HOURS OF WEAR PER DAY

PERCENT

Of unilateral amputees wear their prosthesis eight or more hours.

PERCENT

Of bilateral amputees wear their prostheses eight or more hours.

AMPUTATION CARE Have you ever been to the following type of location for amputation-related care? (Check all that apply.) Unilateral Amputees Bilateral Amputees 82% 84%

VA Medical Center 61%

Local Prosthetist Office 37%

Non-VA Health Center or Hospital Department of Defense Medical Center Someplace Else

MAY 2019 | O&P ALMANAC

20% 13% 16%

31%

53%

72%

59 percent of bilateral amputees received training to use first prosthesis.

59%

“Musculoskeletal problems, phantom limb, and residual limb pain affected the majority, with rates of phantom and residual limb pain higher than previously reported.” —“A National Study of Veterans With Major Upper-Limb Amputation: Survey of Methods, Participants, and Summary Findings”

SOURCE: Resnick, L., et al., “A National Study of Veterans With Major Upper-Limb Amputation: Survey of Methods, Participants, and Summary Findings,” March 2019, PLos One.

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Happenings NATIONAL NEWS

DOJ Indicts 24 Individuals in Medicare Fraud Schemes Involving Orthoses The U.S. Department of Justice (DOJ) has announced multiple indictments against 24 individuals responsible for more than $1.2 billion in losses to the Medicare program through fraudulent schemes involving the use of lead generation marketing to deliver orthoses that were not medically necessary or not wanted by the beneficiary. Simultaneously, CMS announced the immediate suspension of Medicare payments to 130 Medicare-enrolled durable medical equipment suppliers suspected of participating in the scheme and responsible for more than $1.7 billion in Medicare claims and more than $900 million in Medicare reimbursement. The scheme allegedly involved the use of call centers in the Philippines and throughout Latin America, with proceeds laundered through offshore shell companies and used to buy exotic cars, yachts, and luxury real estate, according to Reuters. Charges against various defendants were brought on April 9 in California, Florida, New Jersey, Pennsylvania, South Carolina, and Texas. They were

announced in a joint statement from several U.S. attorneys, the FBI, the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG), and the IRS. “Today, one of the largest health-care fraud schemes in U.S. history came to an end, thanks to close collaboration and coordination between the FBI and partners including HHS-OIG and IRS-CI,” said FBI Assistant Director Robert Johnson. Prior to the indictments, AOPA had expressed concerns about potential fraud and abuse involving off-the-shelf orthoses. “AOPA is highly encouraged by both the DOJ indictments and the administrative action taken by CMS. We are hopeful that this sweeping action will drive this criminally negligent activity out of the orthotic and prosthetic marketplace,” said Eve Lee, executive director of AOPA. AOPA also is pursuing legislation—the Medicare Orthotics and Prosthetics Patient-Centered Care Act—that will ensure that Medicare patients continue to have access to clinically appropriate orthotic care delivered by properly educated, certified and/or licensed professionals.

RESEARCH ROUNDUP

International Researchers Examine Use of Foot Orthoses for Rheumatoid Arthritis

MAY 2019 | O&P ALMANAC

and New Zealand. In Australia, electronic scanning and plaster of Paris were more common. Computer-aided manufacture was used more frequently among respondents in Australia than in the United Kingdom and New Zealand. Respondents in all three countries specified more flexible shell materials for established RA, compared to early stages of the disease. Overall, the researchers saw considerable variation in the self-reported foot orthosis prescription habits of podiatrists for people with RA. Variation between countries and disease stage was seen in types of orthoses, specific brands, manufacturing methods, and materials prescribed. The full study, “Foot Orthoses for People With Rheumatoid Arthritis: A Survey of Prescription Habits Among Podiatrists,” was published in the January 2019 issue of the Journal of Foot and Ankle Research.

PHOTOS: Getty Images

Researchers from the United Kingdom, Australia, and New Zealand conducted a survey of the prescription habits for orthoses among podiatrists for individuals with rheumatoid arthritis (RA). The research team studied the prescription habits of 183 podiatrists and identified differences by geographical location. Podiatrists in the United Kingdom were more likely to prescribe prefabricated orthoses for early RA and custom orthoses for established RA. Australian podiatrists were more likely to prescribe custom orthoses for both early and established RA, and New Zealand podiatrists were more likely to prescribe prefabricated orthoses for both early and established disease. To capture a model for custom orthoses, the use of foam impression boxes was more prevalent in the United Kingdom

HAPPENINGS

RESEARCH ROUNDUP

UPenn Researchers Trial CRISPRBased Sarcoma Treatment

PHOTO: Getty Images

In the first U.S.-based trials involving CRISPR, a genetic engineering tool that uses a sequence of DNA and its associated protein to edit the base pairs of a gene, doctors of the University of Pennsylvania’s (UPenn) Abramson Cancer Center have infused two patients with a CRISPRbased medicine. The patients—one with sarcoma and the other with multiple myeloma—had recently experienced relapses of their cancers. While the CRISPR gene-editing technology has a range of potential applications, it has only recently entered

human testing. The trials are in their early stages, according to a UPenn spokesperson, who confirmed in mid-April that the study had begun. The technology reportedly involves removing immune system cells from patients, genetically modifying them in the lab, and infusing the modified cells back into the body. The intent is that the modified cells will target and destroy cancer cells. It is expected that UPenn will provide an update about the trials later this year, but it will be several years before the CRISPR treatment could become more widely available.

Hanger Completes MAAT Research Studies Hanger has completed and published five separate studies in its Mobility Analysis of Amputees (MAAT) series. These studies were undertaken to clarify the concept of prosthetic mobility as it relates to such considerations as satisfaction, quality of life, comorbid health conditions, and prosthetic component choices. “The MAAT series represents the field’s first attempt at leveraging large convenience samples of patientreported data to better understand the relationships between mobility and such variables as quality of life, satisfaction, comorbid health conditions, and component choices,” said Phil Stevens, MEd, CPO, FAAOP, a director with Hanger Clinic's Department of Clinical and Scientific Affairs. “The series demonstrates the value of implementing outcome measures as a standard of care across multiple clinics and retrospective analyses of those findings.” The five studies include the following: • “Mobility Analysis of Amputees (MAAT I): Quality of Life and

•

Satisfaction Are Strongly Related to Mobility for Patients With a Lower-Limb Prosthesis” “Mobility Analysis of Amputees (MAAT II): The Limited Impact of Comorbid Health Conditions on the Mobility of LowerLimb Prosthesis Users” “Mobility Analysis of Amputees (MAAT III): Matching Individuals Based on Comorbid Health Reveals Improved Function for Above-Knee Prosthesis Users With Microprocessor Knee Technology” “Mobility Analysis of Amputees (MAAT IV): Classification Tree Analysis for Probability of Lower-Limb Prosthesis User Functional Potential” “Mobility Analysis of Amputees (MAAT V): Impact of Five Common Prosthetic Ankle-Foot Categories for Individuals With Diabetic/ Dysvascular Amputation.”

Details on each of the studies are available at www.hangerclinic.com/research.

Submit a Proposal for an O&P Research Grant By May 31 AOPA, working in conjunction with the Center for Orthotic and Prosthetic Learning and Outcomes/Evidence-Based Practice (COPL) and its board of directors, has announced a Request for Pilot Grant Proposals in 10 potential areas of O&P research, including an open topic. For 2019-2020, the association is seeking proposals at two funding levels for one-time grants: $15,000 for most grants and, for up to two exceptional proposals, $30,000, for one year. AOPA and COPL will give preference to grants that address evidence-based clinical applications in orthotics and prosthetics. Visit www.aopanet.org for details and the complete list of areas of study. The deadline for proposals is May 31, 2019.

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O&P ALMANAC | MAY 2019

HAPPENINGS

VIRTUAL HEALTH

CODING CORNER

Performant Announces New RAC Audit Performant has announced a new approved Recovery Audit Contractor audit issue for review. Performant has begun complex medical reviews for off-the-shelf knee orthoses described by the following codes: L1812, L1820, L1830, L1831, L1833, L1836, L1848, L1850, L1851, and L1852. The reviews will determine if the off-the-shelf knee orthosis is reasonable and necessary for the beneficiary’s condition based on the documentation in the medical record. The review will have a threeyear lookback window and will begin with claims with a date of service on or after Oct. 1, 2015.

Americans Open to Digital Health-Care Options

Fifty-four percent of consumers would be likely to try an FDA-approved app or online tool for treatment of a medical condition. –PwC Health Research Institute Consumer Survey

MAY 2019 | O&P ALMANAC

clinic utilization decreased 28 percent in urban areas, while rural utilization grew 3 percent. Urgent care center utilization increased 15 percent in urban areas while remaining flat in rural areas (0 percent change). Nationally, in 2017, the percentage of all medical claim lines attributed to retail clinics was less than 0.1 percent, that attributed to urgent care centers more than 1 percent, and that attributed to ERs more than 2 percent.

SPINE HEALTH

Celebrate Scoliosis Awareness Month in June National Scoliosis Awareness Month takes place yearly in June with the goal of highlighting the growing need for education, early detection, and awareness to the public about scoliosis and its prevalence within the community. The campaign also seeks to unite scoliosis patients, families, physicians, clinicians, institutions, and related businesses in collaborative partnerships of local activities, events, and grassroots networking

throughout the month, according to the Scoliosis Research Society (SRS). One of the campaign objectives is to use the results from the seminal BrAIST study—the Bracing in Adolescent Idiopathic Scoliosis Trial published in the New England Journal of Medicine—to highlight the importance of early detection and the effectiveness of bracing as early nonoperative care. Details on the campaign are available on the SRS website, www.srs.org.

IMAGE: www.srs.org

54%

A new study on trends in health-care service and medical pricing indicates more practitioners and consumers are embracing telehealth. “FM Healthcare Indicators and FH Medical Price Index 2019,” a whitepaper published by FAIR that examines the rapidly changing health-care environment, studied data from FAIR’s national database of privately insured health-care claims. FAIR focused on alternative places of service—retail clinics, urgent care centers, telehealth, and ambulatory surgery centers (ASCs)—as well as emergency rooms (ERs) to examine changes in utilization, geographic and demographic factors, diagnoses, procedures, and costs. The researchers found that national utilization of telehealth grew 53 percent from 2016 to 2017, which represents a more significant growth than other alternative places of service. By comparison, utilization of urgent care centers increased 14 percent, retail clinics 7 percent, and ASCs 6 percent, while that of ERs decreased 2 percent. During the same time period, retail

PHOTO: Getty Images

FAST FACT

Telehealth Activities on the Rise Across the Nation

HAPPENINGS

AUDIT ANSWERS TARGET

TPE AUDITS

PROBE

EDUCATION

Jurisdiction D Releases Quarterly TPE Results

PHOTO: Getty Images

Noridian, the durable medical equipment administrative contractor (DME MAC) for Jurisdiction D, has published the quarterly results of its Target, Probe, & Educate (TPE) audits. The audits are based on claims reviewed during the October 2018 through December 2018 time frame, with the following results: • Ankle-foot orthoses/knee-anklefoot orthoses (L4360, L4361, L4386, and L4387) had an overall claim potential improper payment rate, based on dollars, of 34 percent. This is the same overall claim potential improper payment rate as the last quarter’s results. • Knee orthoses (L1810, L1812, L1830, L1832, L1833, L1843, L1845, and L1852) had an overall claim potential improper payment rate, based on dollars, of 61 percent. This is the same overall claim potential improper payment rate as the previous quarter’s results.

• Spinal orthoses (L0625, L0626, L0627, L0630, L0631, L0637, L0641, L0642, L0643, L0648, and L0650) had an overall claim potential improper payment rate, based on dollars, of 47 percent. This is a decrease in overall claim potential improper payment rate from the last quarter’s results of 51 percent. • Diabetic shoes (A5500) had an overall claim potential improper payment rate, based on dollars, of 28 percent. This is a decrease in overall claim potential improper payment rate from the last quarter’s results of 36 percent. The top and common denial reasons for all TPE results (in no particular order) are as follows: • Documentation does not support basic coverage criteria. • Documentation was not received in response to the additional documentation request letter. • Claim is the same or similar to another claim on file. • Documentation does not include verification that the equipment was lost, stolen, or irreparably damaged in a specific incident.

MEETING MASHUP

AOPA Members Eligible for Member Pricing at RehabWeek

Hanger Clinic Sponsors First Swim in North Carolina Hanger Clinic recently sponsored a First Swim clinic in Charlotte, North Carolina, at the Harris YMCA. Area therapists, swim coaches, and several DPT students from Elon University took part in morning classroom education, led by Emma Durante, OTR/L.

During the afternoon session, individuals with amputations and spinal cord injuries participated in First Swim. Hanger Clinic’s Kate Hausmann, CO, and Mark Elgart, CPO, as well as Almeta Mallory and Twila Adams, helped facilitate the event. OPAF and the Harris YMCA plan to institute First Friday Swims each month. These events are made possible through grant funding from U.S. Masters Swim and will focus on Adult Learn To Swim skills and drills.

In addition, each conference also organizes its own conference-specific sessions. Attendees can choose which conference to attend at any given time. Members of the International Society for Prosthetics and Orthotics (ISPO) and AOPA are eligible for member rate pricing by indicating their association as “ISPO” in the registration details. Visit www.rehabweek.org.

PHOTOS: Hanger Clinic

IMAGE: www.rehabweek.org

RehabWeek 2019 will bring together different conferences in the field of rehabilitation technology to foster cross-disciplinary communication and the development of relationships. The event, scheduled for June 24-28 in Toronto, Canada, will feature common keynote lectures and other mutually organized sessions, such as panel discussions and poster sessions.

O&P ATHLETICS

O&P ALMANAC | MAY 2019

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Michelle Gleeson has been appointed director of recertification at the American Board of Certification in Orthotics, Prosthetics, and Pedorthics (ABC). Gleeson’s immediate efforts will center on redefining ABC’s Recertification Program as the organization looks to execute its vision for a modern and customer-centered recertification process and platform, according to ABC. Gleeson’s longterm goals for the department include strengthening her team, improving the recertification process, and continuing to provide high-quality customer service. Joy Burwell, MPP, has joined AOPA as the director of communications and marketing, managing the communications and marketing for the organization. Prior to joining AOPA, she was the assistant vice president of communications at the National Council for Behavioral Health. There, she used her experience and expertise in health policy, communication strategies, and traditional and innovative public affairs strategies to help influence decision makers and the public to improve the state of mental health care and addiction services. Burwell spent six years at Amplify Public Affairs, during which time she developed communication and education strategies and media outreach initiatives, and she managed third-party stakeholder outreach and support for a variety of clients. She also has worked at the American Academy of Nursing. Burwell is a graduate of James Madison University and received her master’s degree in public policy from Johns Hopkins University. Justin Beland has joined AOPA as the director of government affairs. Beland is a government relations and grassroots advocacy expert with more than 15 years of experience in public policy, lobbying, and creating innovative engagement strategies. Beland comes to AOPA from a small consulting firm where he represented numerous organizations and companies before Congress and the administration, advising his clients on a broad range of health-care topics including disability policy, Medicare/Medicaid, children’s health, the opioid epidemic, 340B drug pricing, and many others. Beland has degrees in English and communications from the University of Massachusetts, Amherst, and a Master of Fine Arts in creative writing from George Mason University.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

U.K.-based Open Bionics has launched a 3D-printed multigrip bionic arm in the United States, through a partnership with Hanger Clinic. The device is an advanced and lightweight myoelectric prosthesis for children and adults with below-elbow limb differences. Össur, in conjunction with Kinneir Dufort (KD), has been honored with a Red Dot Award: Product Design 2019. The award recognizes Össur’s RHEO KNEE XC, which features a weatherproof cover design that was created by the British design firm KD. “Össur is honored to share this Red Dot Award with KD for our RHEO KNEE XC. For over four decades, we have pursued the development of new technologies to help more people around the world live a life without limitations,” said Jon Sigurdsson, Össur president and chief executive officer. Designers and manufacturers from 55 countries entered more than 5,500 products in the competition. Criteria included the level of innovation, functionality, and formal quality. Representatives from Össur and KD will celebrate the recognition during the Red Dot award ceremony on July 8. Össur also has been named an official partner of DIF, the Danish National Olympic Committee & Sports Confederation. DIF, which coordinates with 9,000 in-country sports organizations and a membership of nearly 2 million people, is dedicated to further developing Danish society by promoting the importance of physical activity as a national priority. “We are pleased to be partnering with DIF, which represents a new and exciting chapter for Össur in Denmark. Our organizations share a common mission: to champion physical activity and help more people live a life without limitations,” said Sigurdsson.

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

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REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

From Speculation to Reality After years of discussion, competitive bidding for some orthoses is scheduled to begin in January 2021

E! QU IZ M EARN

BUSINESS CE

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Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

OR MORE THAN 15 YEARS, the

MAY 2019 | O&P ALMANAC

and spinal orthosis codes (one less than originally proposed) would be included in the next round of competitive bidding, now known as Competitive Bidding 2021, but that the bidding process would begin in June 2019, even though contracts would not be effective until January 2021. CMS indicated that the process of collecting bids, evaluating bids, and awarding contracts can take up to 18 months, and to ensure that contracts are in place by Jan. 1, 2021, the bidding process would begin in June 2019. AOPA has developed a dedicated site on its webpage where AOPA members can find detailed resources regarding the timeline, process, and requirements to participate in the competitive bidding program for OTS orthoses. These member-only resources may be found at https://www.aopanet.org/ coding-reimbursement/round-2021-competitive-bidding-announced/.

him at jmcternan@AOPAnet.org. bursement services at AOPA. Reach Joe McTernan is director of reim-

What Is Competitive Bidding?

Medicare DMEPOS competitive bidding was authorized by the Medicare Modernization Act of 2003. According to CMS, “The intent [of competitive bidding] is to improve the effectiveness of the Medicare methodology for setting DMEPOS payment amounts, which will reduce beneficiary out-of-pocket expenses and save the Medicare program money while ensuring beneficiary access to quality items and services.” Competitive Bidding 2021 will be implemented in 130 competitive bidding areas (CBAs) across the United States. The initiative will involve 16 product categories, including 23 OTS spinal and knee orthosis codes. The knee orthosis codes include L1812, L1830, L1833, L1836,

PHOTO: Getty Images

O&P profession quietly flew under the radar of Medicare competitive bidding. Off-the-shelf (OTS) orthoses were identified as a potential product category at the initial authorization of the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program in 2003—but as each round of competitive bidding was announced, O&P providers breathed a collective sigh of relief as CMS chose to explore competitive bidding through other channels. In 2014, CMS created a “split” code set that identified certain L codes as either custom fitted or OTS. This seemed to set the table for the imminent inclusion of OTS orthoses in the next round of competitive bidding. Once again, for unknown reasons, CMS chose not to include OTS orthoses in that next round of the competitive bidding program. Fast forward to July 2018, when CMS announced that, due to proposed changes to the Medicare DMEPOS competitive bidding program, the program would be suspended from

Dec. 31, 2018, until at least Jan. 1, 2021, to allow CMS to fully regulate changes to the program and to facilitate the bidding process for new contracts. Once again, it appeared that the O&P industry had managed to avoid the issue of competitive bidding—at least for the next several years. That feeling of relief was punctured on Nov. 1, 2018, when CMS indicated that it would be soliciting comments on the potential inclusion of certain OTS knee orthoses and OTS spinal orthoses in the next round of competitive bidding. Specifically, CMS proposed the inclusion of eight knee orthosis codes and 16 spinal orthosis codes. As it had done in the past, AOPA presented a very strong argument regarding why OTS orthoses should not be part of any competitive bidding program. Unfortunately, AOPA’s comments fell on deaf ears at CMS. On March 7, 2019, CMS not only announced that a total of 23 OTS knee

REIMBURSEMENT PAGE

Competitive Bidding 2021 will be implemented in 130 competitive bidding areas across the United States. The initiative will involve 16 product categories, including 23 off-the-shelf spinal and knee orthosis codes. L1850, L1851, and L1852, and the spinal orthosis codes are L0450, L0455, L0457, L0467, L0469, L0621, L0623, L0625, L0628, L0641, L0642, L0643, L0648, L0649, L0650, and L0651. Effective for dates of service on or after Jan. 1, 2021, only DMEPOS suppliers that have been awarded contracts through the competitive bidding program will be able to provide OTS orthoses described by these 27 Health-Care Common Procedure Coding System (HCPCS) codes to

Medicare beneficiaries. Suppliers that have not been awarded contracts will no longer be allowed to provide OTS orthoses described by these codes to Medicare beneficiaries.

How Does the Bidding Process Work?

Competitive Bidding 2021 will not be implemented until Jan. 1, 2021, but the bidding process will begin in June 2019. A new bidding process, called lead item bidding, will be introduced.

In previous rounds of competitive bidding, suppliers were required to place a separate bid for every HCPCS code within a product category. Lead item bidding requires bidders to only submit a single bid for the lead item within a product category. The lead item is defined as the HCPCS code with the highest total allowed Medicare charges for the product category. For Competitive Bidding 2021, the lead item for OTS knee orthoses is L1833 and the lead item for OTS spinal orthoses is L0650. Bidders will only submit bids for these two codes, and the submitted bids will be evaluated based on only these two lead item codes. Bids will be subject to a “bid limit,” which is the highest bid amount that will be considered for a contract award. The bid limit is equal to the full Medicare fee schedule amount for the state in which the CBA is located. Submitted bids that exceed the bid limit will be automatically disqualified.

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REIMBURSEMENT PAGE

Friday, Sept. 27, 2019 10:00 - 11:00 AM Competitive Bidding—Updates and What to Expect? (B5) Elaine Hensley, Chief Liaison, Palmetto GBA DMEPOS Competitive Bidding Implementation Contractor

What is the Competitive Bidding Program? What to Expect if You Bid for the OTS Orthotics? Receive the best information on the DMEPOS Competitive Bidding program, including the time line, what to expect, and how to make the most of the program. Elaine Hensley is the chief liaison for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Implementation Contractor (CBIC). She has 28 years of health care billing and reimbursement experience in the private and public sectors, 26 years are specific DMEPOS, and 10 years as the CBIC chief liaison. Much of Hensley's experience focuses on the development and execution of provider education on Medicare program policies and procedures. Throughout her career, Hensley has demonstrated the ability to partner effectively with CMS, state and national DMEPOS supplier associations, provider groups, beneficiary advocates, and Medicare beneficiaries. Hensley earned a bachelor's in English from Eastern Kentucky University.

MAY 2019 | O&P ALMANAC

CMS will evaluate all of the submitted bids within a CBA and will establish a pivotal bid, which is the lowest bid amount that allows for sufficient beneficiary access to care within a CBA. Bidders whose bids are below the pivotal bid will be awarded contracts, and bidders whose bids are above the pivotal bid will not be awarded contracts. CMS will then establish a single pricing amount (SPA) for the lead item in each product category within a CBA, which will be equal to the highest submitted winning bid for the product category lead item. All providers that are awarded contracts will be reimbursed the SPA for the product category lead item within the same CBA, regardless of their actual bid submission. Non-lead items, which represent all of the other HCPCS codes within a product category, will be reimbursed based on a relative ratio. The relative ratio is determined by dividing the 2015 DMEPOS fee schedule amount for the non-lead item by the 2015 DMEPOS fee schedule amount of the lead item. The year 2015 is used as the base year since it was the last year that the DMEPOS fee schedule was not affected by competitive bidding. Once the relative ratio for each non-lead item in the product category is established, it is multiplied by the SPA for the lead item. The resulting fee is the SPA for the non-lead item. Bidders must submit separate bids for each of the 130 CBAs in which they wish to be considered for a contract award and must meet all CMS enrollment, credentialing, and licensure requirements in order to participate in the competitive bidding process. Additional details regarding these requirements are available on the AOPA website.

Is Competitive Bidding Good for Your Business?

Deciding whether participating in competitive bidding is a business opportunity, rather than a business threat, is a deeply personal decision that must be made individually. There is no single answer to this question. While AOPA is prohibited from discussing individual business decisions with members, the following considerations should be taken into account when making

the best decision for your business: • What percentage of your business’s revenue do the 23 codes that are part of competitive bidding represent? • What is the impact on your business if you can no longer provide Medicare beneficiaries with products included in competitive bidding? • If you choose to submit a bid, what pricing level are you comfortable with? • What is the potential impact on referral relationships should you choose to not submit a bid? • Which CBAs should you submit bids for? • Which product categories should you submit bids for?

Here To Help

Competitive bidding is a new concept to most of the O&P industry. It can be confusing and, frankly, a bit scary. While implementation is nearly two years away, the bidding process for Competitive Bidding 2021 is literally around the corner. AOPA has developed extensive member resources on the competitive bidding program and process and will continue to add information to the AOPA website as it becomes available. AOPA will provide both webinar-based education and on-demand webbased presentations as the opening of the bidding period approaches. While competitive bidding may seem like a foreign concept, it is crucial for O&P providers to understand the program and the processes involved to make informed decisions that best represent the interests of their businesses. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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This Just In

Build a More Profitable O&P Practice O&P business owners share their strategies for leveraging the annual AOPA Operating Performance Report to analyze and optimize their business practices

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MAY 2019 | O&P ALMANAC

the release of the AOPA Operating Performance Report (OPR), a benchmarking report that offers detailed and timely information on company processes and examines how each employee contributes to staff productivity and profitability. The report provides relevant comparisons with industry leaders and allows O&P companies to measure their results against their colleagues and competitors. The information from the report is sourced from AOPA’s annual Operating Performance Survey, and participation is free to AOPA patientcare facility members. The survey is confidential, with data collection managed by third-party company Industry Insights. This year, companies are being asked to complete the survey and return it between May 8 and June 29. Once the data is aggregated and the report is complete, participants will receive a confidential company report, plus the final published report. Andrew Steele, MBA, CPO, LPO, partner/owner at Clark & Associates Prosthetics and Orthotics, takes part in the annual Operating Performance

Survey because he appreciates receiving the OPR as a snapshot of his company’s success. “I look forward to reviewing it each year as a sort of ‘report card’ of where we are as a company,” says Steele. “It is incredibly useful in the fact that it serves as a benchmark for our company. We really would have no other way of determining these industry benchmarks without AOPA’s report. I encourage every business owner, no matter how large or small, to participate.” Steele and other business owners have identified four key reasons to participate in the survey each year:

The OPR provides comparisons to similar facilities.

The OPR “enables us as a business to compare and contrast with other similar facilities across the country within similar populations and demographics,” explains Jose E. Ignacio, CPO, LPO, president and co-owner of the Center for Prosthetics Orthotics Inc. “This is unlike any other marketing tool that is available since it is so specific to our industry, which is quite small in comparison to others.”

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Chris Wallace, MHS, CPO, FAAOP, director of orthotics and prosthetics at Methodist Rehabilitation Center (MRC), says the benchmarking survey “provides the opportunity for me to compare our operational performance to other O&P organizations by market size and geographic location.” In addition, it allows Wallace to see how his organization stacks up compared to other organizations from different settings. “Since we are an institutionally based practice, this information is vital to helping us remain competitive.” AOPA OPC Poscards_8.5x5.5.indd 2

The OPR provides insights into what you’re doing well and what you could do better.

For Tom Padilla, CPO, owner of Brownsfield’s Prosthetics & Orthotics, the OPR “validates some of my assumptions on what I may or may not be doing correctly as an owner,” he says. When he looks at information regarding other O&P facilities, “it forces me to question some of our processes and rethink how I run the company.” Steele says that his management team compares his facility’s year-overyear results and then examines the data from similar companies “to see where we stand with our peers.” This has enabled Clark & Associates “to improve our cost of goods sold percentage to meet or exceed our peer group.” Wallace agrees that the information from the customized benchmarking report has enabled MRC to improve business operations, by comparing

MRC data against data from comparable companies. “These metrics help focus our efforts to minimize wasted resources and time,” says Wallace. “As we are all aware, time has become a most precious commodity in O&P practice management, so information that sheds light on areas of needed improvement is very valuable.”

4/10/19 11:38 AM

The OPR provides metrics for strategic planning and decision making.

According to Steele, the findings from the report regarding cost of goods sold as well as operating costs, such as health insurance and occupancy costs, have been particularly useful at Clark & Associates. “The information regarding revenue per practitioner and practitioner compensation also is useful in our yearly review of salaries,” he says. In addition, he finds value in learning “what product lines companies are adding or dropping and what effect [recovery audit contractor] audits are having on companies.” Ignacio says he finds the “true cost per patient” information most valuable. “This allows us to really determine the actual cost of providing a device for a specific patient in terms of materials, fabrication, overhead, and redos, as well as reimbursement,” he says.

The OPR provides information that can empower staff.

Most employees want to understand their companies’ successes or areas for

improvement, Wallace explains. “Staff that are educated on the overall performance—and how their role impacts the organization—are more engaged in improvement plans,” he says. “I also believe staff are more inclined to suggest and develop their own ideas for improvement if they have a greater understanding of our performance.” Wallace typically shares information from the OPR with location managers. “The report allows me to compare the performance of each location from our own data with the information provided in the survey,” he says. “This allows the managers to have actionable information to help them operate their location more efficiently.” Wallace also reports on the information from the report during his company’s all-staff annual meetings. “I feel strongly that all staff members need to know and understand our current performance and how their role impacts our success.” Reviewing the OPR each year has helped Ignacio fine-tune the purchasing and inventory selection processes at Center for Prosthetics Orthotics. “We are always looking for the best price for certain items as well as deals that we can agree upon with our suppliers,” he says. “We always consider the clinical outcomes in our decision making but are very cognizant of what that item may cost. We share our findings via staff meetings, financial meetings, as well as practitioner meetings.”

An Invaluable Tool

Representatives from AOPA patientcare facility members should plan now to reap the benefits of the 2019 OPR by taking part in this year’s survey before the June 29 deadline. Doing so will enable managers to compare their business practices to those of other facilities—and then make changes to take their facilities to the next level. Says Ignacio, “Accurate reporting is the tool that will allow business owners, who are also practitioners, to grow their practice as if they have achieved an MBA and not just an MPO.” O&P ALMANAC | MAY 2019

COVER STORY

O&Pâ&#x20AC;&#x2122;s GOT

T LENT Ten tips for hiring and retaining top O&P clinicians and office staff By CHRISTINE UMBRELL

MAY 2019 | O&P ALMANAC

COVER STORY

NEED TO KNOW • Given today’s tight labor market and a growing need for O&P clinicians, savvy O&P business owners and managers are taking a closer look at how they recruit, compensate, and retain employees. • Some companies are turning to employee referral programs and recruiters in addition to traditional job boards in seeking out new team members—and several choose to offer permanent positions to their welltrained residents. • Many companies find that advertising attractive and specific benefits— such as health care, coverage of certification and licensure fees, mileage reimbursement, or even student loan repayment—can result in increased interest among job seekers. • A thorough interviewing and onboarding process may involve interaction with multiple staff members, personality testing, and a determination about whether a candidate will be a good fit with the company culture. • Just as important as hiring best-fit candidates is retaining top performers. Offering competitive salaries, continuing education, and opportunities for advancement will be key to preventing top-notch staff from searching for new opportunities.

OOD O&P EMPLOYEES are hard to

come by in today’s tight U.S. labor market. Given a national unemployment rate of 3.6 percent and a projected increase in demand for O&P clinicians, O&P companies seeking high-quality candidates are finding it challenging to fill positions—both entry-level and more experienced positions. “There is a small pool of candidates out there today due to the size of the profession,” explains Steve Mantegani, PT, vice president of operations for NovaCare P&O. “With a small number of O&P schools producing residents, and less residencies available, it becomes challenging to find new candidates in an aging profession.” Hiring clinical staff can be difficult in the current economic climate, agrees Kathleen DeLawrence, chief operating officer of Ability Prosthetics and Orthotics. “Right now, it’s a seller’s market,” and candidates have many options when seeking employment, she says. At Ability P&O specifically, “we’ve got a few openings, and there are not a lot of résumés.”

Complicating the O&P hiring process is the fact that many clinicians must relocate for their jobs. If they’re more seasoned professionals, they are likely subject to a noncompete clause from their current employer, and they may not be allowed to provide O&P services within a 25-, 50-, or 100-mile radius of their current worksite, says DeLawrence. Newly certified clinicians, on the other hand, may be on the hunt for a position that gets them closer to home after a few years of school and residency. This quest may limit their geographical preference— or create a concern for the hiring manager that they will not stay long with the company if the position is not where they ultimately want to reside. Given these challenges, it’s important to know where and how to seek out top-notch O&P staff, and how to retain those employees once they’re on board. Savvy O&P business owners and managers are taking a closer look at how they recruit, compensate, and retain employees. Below, Mantegani, DeLawrence, and other hiring professionals offer tips for finding and keeping “right-fit” candidates. O&P ALMANAC | MAY 2019

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referral program, whereby current employees receive bonuses after their referred candidates have been on staff Many companies believe for a predetermined amount of time, the best way to identify according to DeLawrence. potential candidates is by asking At NovaCare P&O, management current staff whether they can recomhas “started to utilize our mend individuals who will younger practitioners to be a good fit—often, they assist in the recruiting will know someone who is efforts as they are better seeking a position or who connected with their may be willing to consider former classmates as well switching jobs. as on websites where Ability P&O has had younger practitioners success in finding both connect and communicate,” clinical and nonclinical Steve Mantegani, PT says Mantegani. staff through its employee

Tips for Young Professionals

Seeking Positions

Recent O&P graduates seeking clinical positions should consider these tips from Chris Robinson, MS, MBA, CPO, ATC, FAAOP(D), clinical resource director at the National Commission on Orthotic and Prosthetic Education: • Recognize that the residency site offers a learning environment that is not often tied to a set schedule. While “class” rarely ran over more than 15 minutes, patients may demand more of your time and energy. • A higher level of agility is needed to thrive in today’s health-care environment, and interpersonal skills are more important than ever. • Don’t settle on a culture that doesn’t align with your beliefs. If you are honest with yourself about your strengths and goals, it will be easier to relay that information to your future employers and find a practice that provides not only a residency opportunity but a longterm career path as well.

MAY 2019 | O&P ALMANAC

Leverage Job Sites and Recruiters

Many O&P companies have found success in using traditional methods to hire, including advertising on the AOPA Job Board as well as more general job-search websites. DeLawrence has had luck filling clinical positions after posting them on Indeed and LinkedIn, as well as by working with recruiters. At NovaCare, “we are fortunate to have a full-time recruiter as part of our team that can source leads through avenues like LinkedIn while also posting our positions on Indeed and our professional websites and magazines,” says Mantegani.

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Ask Current Employees To Spread the Word

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COVER STORY

Advertise Enticing Beneﬁts

A 2018 study found that the more benefits an employee describes in ads, the higher the number of job applications. The study, conducted by Harvard Business School’s Ashley Whillans, found that the “softer” rewards described in advertisements can give candidates the impression that the company cares about its employees and will help workers find a healthy work-life balance. The importance of advertising benefits is supported by a 2018 American Institute of CPAs report, which provided results of a survey of 2,026 employed U.S. adults. When asked to choose between a job with benefits or a job with no benefits but a 30 percent higher salary, 80 percent of respondents chose the job with benefits—not a bigger paycheck. Many companies are offering a wider range of benefits in today’s competitive hiring climate—incorporating nonmedical supplemental benefits such as accident insurance, critical illness insurance, and legal services plans, according to the MetLife “2019 U.S. Employee Benefit Trends Study.” In addition, as paying for education grows more expensive each year, student loan repayments was “the hottest employee benefit” of 2018, according to Forbes.

COVER STORY

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Hire Residents DeLawrence believes O&P When seeking entryowners may need level candidates, to “get a little more the O&P residency creative” with their program can be a great resource— total compensation and many companies ultimately packages, beyond hire the residents who participate Chris Robinson, MS, MBA, just salary and in the program at their facilities. CPO, ATC, FAAOP(D) standard benefits, Residency is considered “the secto better align ond half of a practitioner’s eduwith national benefits trends. “A lot cation,” according to Chris Robinson, of [O&P] companies don’t even pay MS, MBA, CPO, ATC, FAAOP(D), for their employees’ certification and clinical resource director at the licensure fees, or they don’t offer car National Commission on Orthotic and allowance or mileage reimbursement” Prosthetic Education. for clinicians who are on the road to Robinson notes that facilities that see patients in hospitals, rehabs, and participate in the residency program home visits. At Ability, full-time cliniare at an advantage in training young clinicians and instilling positive work cians receive competitive salary and bonuses, car allowances, company-paid habits among these young individindividual health-care benefits as uals—which will likely continue if hired well as dental and eye-care coverage, permanently. “Unlike hiring someone 401(K), licensure and certification who is already certified … a resident costs, and the opportunity for upward is explicitly seeking an opportunity mobility. “Our compensation model is to develop and grow professionally,” packaged to help attract and retain the he says. “Beyond learning the clinical best talent in the profession.” skills essential to practice, residents are

developing their professional identities. Aligning that identity with a residency site’s values not only shapes a competent clinician, but one that is hopefully a good fit for the organization well into the foreseeable future.” At NovaCare, management has hired many of its clinicians after they have completed residencies at the facility. This has been a win-win for the company and the new hires “as we are able to train the residents and slide them into the open positions we have throughout the division,” says Mantegani. “Connecting with the O&P schools is key, as they have great connections to their students and alumni that help to connect employers with new practitioners.” Wright & Filippis, based in Michigan, works closely with Eastern Michigan University and ultimately hires many young clinicians who take part in its residency program, says A.J. Filippis, the company’s chief executive officer. The facility hosts between five and eight residents each year and makes permanent offers to many of them.

O&P ALMANAC | MAY 2019

Seek Candidates Who Fit Company Culture

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process,” says DeLawrence. Ability P&O starts with a Skype interview, then invites candidates into the corpoIt’s not just about finding a job candidate—it’s rate office to meet with the executive about finding the “right” candidate. team and regional managers. Next, O&P owners and managers believe those candidates who are deemed a it’s critical to identify candidates who potential fit are invited to spend one or will be good matches for a company’s two days shadowing staff in a location culture and brand. “The first thing we that has an opening. This multistep look for is fit. Does the clinician fit into hiring approach allows for several our local clinic’s culture as well as the opportunities to ensure the proper overarching culture of the company?” chemistry and a good fit with the explains Mantegani. “We look for peoAbility P&O culture. At Wright & Filippis, ple who will be great team personality testing is part players. We also look for of the hiring process. Job people who are motivated candidates are asked to and passionate about the complete the online Caliper profession. Lastly, we personality analysis test. look at skill level. We have The Caliper test, and some great clinicians we similar personality assesscan use as mentors and provide training should Kathleen DeLawrence ment tools, seek to examine we consider candidates candidates before their that are younger who still hiring to ascertain certain need grooming.” aspects of the candidate’s personality The central goal when hiring should and to assess with greater certainty always be to find someone who is in that the candidate is suitable for the O&P for the right reason, putting the position and the staff that he or she patient first, adds Filippis. He seeks will work with. “The Caliper is just candidates who believe in what they’re one of the tools we use,” says Filippis. doing and want to make a difference. “It looks at empathy for others, their “Hire attitude, then train everything general drive, and dependability,” else,” he says. among other factors, he says. This goes not just for clinical staff, but for all employees at Wright & Filippis. “The traits are still critical—that they have empathy for the patient,” says Filippis. “Often the nonclinical staff is the first person the patient talks to” at an O&P facility, so it’s important that they are effective brand ambassadors when greeting and interacting with patients.

Conduct Thorough Interviews, Consider Personality Testing

Once candidates for open clinical positions are identified, it’s important to learn more about them via both a thorough interview process and their references. It also may be helpful to further assess whether candidates have the appropriate skills and are a “match” with the company. “We have a very intense interview 26

MAY 2019 | O&P ALMANAC

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COVER STORY

Consider Staffing Care Extenders

While it’s important that all facilities have enough certified orthotists and prosthetists on board to meet the needs of the facility’s population, some companies are getting creative in staffing, and hiring more certified assistants and certified technicians. Using these types of care extenders can help fill some of the void, suggests Filippis. The care extender model is a more collaborative approach to patient care because patients may be seen by a team comprised of a certified orthotist or prosthetist, certified O&P assistant, certified orthotic fitter, and/or certified technician. While the certified orthotist or prosthetist must oversee all care and perform some of the higher-level patient-care tasks him- or herself, other aspects of care are carried out by the rest of the team, in accordance with the scopes of practice defined by the certifying bodies. “Care extenders are probably the wave of the future to extend clinical care capacity,” says DeLawrence. And this model parallels other staffing models in the health-care arena—such as physical therapy and medical practice models.

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COVER STORY

Good News for Employers While the O&P hiring climate can be challenging, the numbers of O&P residents is trending upward—meaning increasing numbers of individuals are completing master’s level education then seeking an O&P residency in their pursuit to become certified. Chris Robinson, MS, MBA, CPO, ATC, FAAOP(D), clinical resource director at the National Commission on Orthotic and Prosthetic Education, shares the following numbers of individuals completing O&P residencies over the past four years:

307

RESIDENTS

2015

382

337

RESIDENTS

2016

2017

2018

336

TIP

Looking to the future, this trend is supported by a record number of resident registrations in the 2018 calendar year—409, according to Robinson. These individuals will complete their residency in 2019 or 2020, depending on the program duration.

Establish a Plan To Retain Top Performers

Once an O&P facility is fully staffed, three factors matter most for employee retention: company culture, employee salary, and job stagnation, according to a recent Glassdoor study, “Why Do Workers Quit? The Factors That Predict Employee Turnover.” When workers leave a company, they usually leave for a better company culture, according to the report. And 90 percent of workers in the MetLife study agree that workplace culture is important to employees. Employees who feel a strong sense of purpose are significantly more satisfied with their jobs, feel engaged, and are productive, impactful, and successful, according to MetLife. 28

MAY 2019 | O&P ALMANAC

In addition, money does matter to employees in 2019. Glassdoor found that higher base pay has an important impact on whether employees are more likely to stay or leave for their next role. The residents Robinson interacts with are “conscientious about their finances,” he says. “New graduates recognize that they will have a financial burden associated with loan repayments tied to their education, plus the cost of rent has increased at a much greater rate than salaries have. Most prospective residents will seek out the best learning opportunity, but they also recognize that they will not be able to do their best on the job if they have to share a one-bedroom apartment with three other people while sleeping on the couch in order to get by on a meager salary.”

TIP

More O&P Residents,

DeLawrence notes that offering competitive salaries is important at Ability. “We have a very robust compensation package,” she says. “We believe in investing in our talent” and expect those well-compensated employees to work hard.

Offer Continuing Education, Opportunities for Advancement

Employees who languish in a job too long are likely discouraged about career prospects for advancement in the company, according to Glassdoor. Robinson agrees with that finding, adding, “If a young clinician feels valued and is given the opportunity to grow professionally, I feel that there is rarely a compelling reason to seek other opportunities.” Wright & Filippis offers a variety of opportunities for advancement—made possible by 22 locations. But Filippis points out that not all clinicians are meant to be managers and that advancement can come in different forms. “The skills and traits of a manager are different than those of a clinician,” he says. The company is willing to work with those individuals seeking to advance into management positions—but also provides opportunities for clinicians to work in specialized areas, such as pediatrics, scoliosis, or upper-extremity care, for those orthotists or prosthetists seeking to specialize. Ability P&O has “a very transparent management environment” and strives to equip clinicians with new skills by conducting both internal and external trainings on the latest technologies and clinical strategies. “Every other week, we do a brown bag lunch” featuring a training session, a vendor presentation, or another educational opportunity. Often, these sessions qualify participants for continuing education credits, says DeLawrence. Ability also sends some members of its clinical staff to regional and national O&P meetings. “We try to make sure everyone gets the opportunity to go” at some point within a two-year rotation.

COVER STORY

TIP

Creating career pathways at smaller facilities can be a challenge, but even companies with smaller staffs can offer training opportunities and aid clinicians in pursuing specialized skills.

Communicate Often With Underperforming Employees

Following a structured hiring process and ensuring a good company fit before hiring usually ensures a good match. But what happens when an employee stops meeting expectations? “This is always the most challenging part of the job,” says Mantegani. “Given the challenges of recruiting good practitioners, many times people feel they are held hostage by the underperforming employee. The key is to make sure you address performance early and often. When people are not meeting expectations, you need to sit with them and understand why, then help develop a plan to be more successful. If an employee continues to underperform, then you have to sit

down and do some verbal counseling and, unfortunately, utilize your HR team to begin a corrective action plan.” When employees are not meeting expectations at Wright & Filippis, “we set up coaching plans and try to see if they are willing to make the changes necessary,” says Filippis. “When you get to the point where we have to let someone go, it shouldn’t be a surprise to anyone.” Likewise, at Ability P&O, “we set a performance improvement plan” and work closely with the individual to provide additional training and mentorship as the company’s goal is to retrain them, explains DeLawrence. “I’m very transparent with staff,” she says. “We’ve been successful with this process, but sometimes, it’s just not a good fit—and in those rare occasions, the individual typically knows before we approach them.”

Promoting the Profession

All of the strategies mentioned above can be useful in attracting clinicians

to join a facility, and in keeping them there once they come aboard. Forward-thinking companies will use as many of the recruitment and retention tools as possible to identify strong candidates; encourage them to accept a position; and reward them with an attractive salary and benefits, continuing education, and opportunities for advancement. Going forward, it will be important to shine a spotlight on the role of the O&P clinician and attract more great minds to the profession, suggests DeLawrence. “It’s critically important that we educate more students on what we do,” she says. “People don’t know about O&P. … We need to get a message out to the high schools to let more people know about it. It’s a cool field.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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O&P ALMANAC | MAY 2019

ByBy CHRISTINE MEGHAN HOLOHAN UMBRELL

Playing the

LONG GAME O&P professionals share strategies for implementing sustainable business practices and reducing their environmental footprints

NEED TO KNOW • Like other U.S. industries, O&P is embracing more sustainable business practices. Companies are “going green” to reduce their environmental footprint, build their brands as eco-friendly facilities, attract environmentally conscious job seekers, and save money in the long run. • An O&P business owner in Missouri designed his facility with sustainability in mind during a recent rebuilding effort, leveraging insulated concrete form during the building phase and incorporating variable refrigerant flow in the structure’s internal systems. • One New York O&P practice has installed solar panels that provide about 80 percent of its energy. This facility also relies on presence lights as well as recent initiatives to reduce paper and conserve water usage. • An Alaskan O&P company leverages new technologies to reduce its environmental footprint, using CAD to plan and fabricate devices, reducing the number of patient visits, and limiting shipping of parts. The facility also is considering a 3D-printing system that would allow certain parts to be reused. • O&P facilities can start small with their sustainability initiatives. Relying on newer technologies and the three R’s—reduce, reuse, and recycle— can go a long way toward embracing a greener mindset.

MAY 2019 | O&P ALMANAC

“S

USTAINABILITY” WAS THE

goal in building Advanced Orthotics & Prosthetics’ new facility in Joplin, Missouri, a few years ago, after a tornado destroyed the company’s original structure. Owner Frank Ikerd, CPO, sought to construct a facility that could withstand 200-mile-per-hour winds—while employing state-of-theart energy-saving building techniques. “We wanted to build something that was going to be long-standing and enduring,” says Ikerd. So instead of opting for traditional construction, Ikerd’s building team used insulated concrete form. With this method, contractors use Styrofoam molds with the concrete poured into it. It creates durable interlocking walls with tight connections, meaning the building is better insulated as well as easier to heat and cool. And there’s another bonus: less garbage. “That type of construction has much less waste. The forms are reusable—once [the builders] tear them down, they can use [them] again,” he explains. The concrete also has

After a tornado destroyed his practice, Frank Ikerd, CPO, used sustainable building techniques to create an energy-efficient facility.

PHOTOS: Frank Ikerd, CPO

three-inch steel helix coils in it, which strengthens it in a way that steel rebar does not. “It makes it stronger and much less crack-resistant,” Ikerd says. He felt it important to build a physical structure for his practice that would be sustainable as well as resilient during future weather incidents. “You are worried about durability, but you are focused more on conservation and not having as much energy consumption, and not having as much of a footprint,” he says. “So it went hand-in-hand.” At Ikerd’s new facility, the sustainable features extend past its built-for-strength exterior and into the facility’s internal systems. The building relies on variable refrigerant flow, which is energy-efficient and can heat and cool independently. “The motors are varied based on the need,” Ikerd says. “It leads to a lot less energy usage and not as much wear and tear.” Even the toilets at Advanced O&P were selected with sustainability in mind. They’re dual flush, which saves on water. Employees also recycle as much as they can. Changes like these are easy to implement—as well as important first steps in making a practice more sustainable.

Styrofoam forms allow concrete to be poured into them to create a tighter seal between walls, creating a building with less energy loss.

A Greener Mindset

Advanced O&P is just one of several O&P businesses that are intentionally going green—a practice that has been embraced by industries across the nation. Today, many consumers are voicing a preference for doing business with eco-friendly companies, and business leaders are recognizing the value of embracing and promoting more sustainable business practices. In fact, consumers are 58 percent more likely to buy a company’s products or services when they know the organization is mindful of its impact on society and the environment, according to consumer research by The Natural Marketing Institute. The study also found that consumers are willing to spend up to 20 percent more

on environmentally sound products and services. In addition to boosting their brands by demonstrating a commitment to environmental business practices, some companies also are saving money—over time. “It is not something you realize right away,” Ikerd says. “We were thinking long-term, over the life of the building … the savings will pay off.” Ikerd explains that the sustainable building techniques he invested in did not cost much more than traditional construction. “What’s out there is the perception that [sustainable building] is too expensive to do and you are not going to recoup your cost. It wasn’t that much more expensive,” he says. “The cost has actually gone down. As the technology improves, it gets cheaper.” O&P ALMANAC | MAY 2019

PHOTO: Frank Ikerd, CPO

Ikerd sought to design a facility that was both sustainable and strong enough to withstand a natural disaster.

MAY 2019 | O&P ALMANAC

conversations, ideas about reducing waste and protecting clinician health often came up. When Delgado started looking for a permanent clinical position, she kept those thoughts in the back of her mind. She knew she wanted a job that challenged her but also gave her the freedom to explore some of her ideas to improve the efficiency, safety, and sustainability of the O&P workplace. She sought out companies that were not “stagnant,” and that were looking to improve clinical care, promote employee health, and embrace a green mindset to be better stewards of the earth. Fortunately, she secured a position as assistant director of clinical services at Prosthetic & Orthotic

Associates (POA) in the Hudson Valley of New York in 2018. POA had already begun implementing some eco-friendly strategies. Owner Tom Passero, CP, had installed solar panels that provide about 80 percent of the facility’s power. These panels provide plenty of energy for most of the facility’s needs—including powering typical O&P equipment, such as an oven, grinding machines, and vacuums. Over time, the investment in clean energy is expected to pay off for POA: New York, like some other states, offers rebates and tax breaks for solar panels. “It’s a bigger upfront investment, but it absolutely pays off over time,” explains Delgado.

3D illustration of stacked solar battery panels ready for installing and mounting

PHOTO: Getty Images

Cost savings stemming from sustainability can come in many forms: less waste; a reduction in utility costs; access to rebates, federal tax credits, and other financial incentives for environmentally friendly practices; and even a boost in business from positive public relations. These benefits are helping to convince even the most reluctant business owners that sustainable business practices are a good investment. And many companies are noticing an added advantage of attracting strong candidates when hiring. Some job seekers—especially those from younger generations—are more actively pursuing work environments where management is committed to sustainability. In fact, 76 percent of millennials consider a company’s social and environmental commitments when deciding where to work, and 64 percent won’t take a job if a potential employer doesn’t have strong corporate social responsibility practices, according to the Cone Communications Millennial Employee Engagement Study. In O&P, many newly certified clinicians are attracted to workplaces that leverage innovative and eco-friendly business practices. Take Cassandra Delgado, CPO, for example. While she was completing her residency at the University of Michigan, she and her classmates often brainstormed ways to make orthotic and prosthetic fabrication more efficient. During these

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Staff at Alchemy Orthotics & Prosthetics strive to fabricate devices in one visit instead of several, which helps them reduce their environmental impact.

MAY 2019 | O&P ALMANAC

even a local company that takes medicalgrade plastic for recycling—though that did require a call to explain the plastic wasn’t contaminated with biological waste.

Embracing New Technologies

While many thoughts turn to building design and infrastructure as the key to enhancing a practice’s sustainability, using computer software and hardware also reduces waste and can decrease a company’s environmental impact. Wil Sundberg, CPO, owner of Alchemy Orthotics & Prosthetics in Anchorage, Alaska, finds that using CAD to plan and fabricate devices reduces the number of times he needs to see patients because it streamlines the process and eliminates some of the appointments previously needed for fittings and modifications. “It speeds up all the processes that we can speed up,” he says. “Instead of pouring plaster and stripping a cast and modifying it, we have the machine carve out a block out of foam. It saves us a tremendous amount of time” and results in a more sustainable system. What’s more, shipping to Alaska can be challenging and expensive. Being able to fabricate in-house means Sundberg’s team relies less on air and truck transportation for delivery. That reduces

PHOTOS: The Ophira Group

The facility also has presence lights—lights that turn on only when someone is in the room to conserve energy. And two of the clinicians are beekeepers who maintain hives behind the building. The bees not only improve the local environment and pollinate the shrubbery surrounding the office; they also help the business stand out in the community—and the honey they make serves as a nice gift for patients. “A lot of things like this make a difference,” Delgado says. Delgado herself has driven some recent eco-friendly changes at POA. Noticing a heavy reliance on paper when she came on board, she led an effort to laminate clinician intake forms so they can be reused. She also suggested a greater reliance on iPads

for signatures and encouraged increased communication in the facility’s electronic records system to further reduce paper waste. These small changes have had a positive impact on the company’s sustainability—and have streamlined the clinical experience for employees and patients. “The process flows smoother, and it can definitely make everyone’s life easier,” Delgado says. “Choosing the little things to change first will make choosing the bigger things easier,” she explains. “If we can just eliminate a few things, those few things will grow and grow and grow.” She recommends implementing changes “in manageable bites.” Delgado also led an initiative to reduce the amount of water being used at POA. She tries to limit her own water usage by using only one bucket of water to cast. Because the water never touches a patient, there’s no fear of cross contamination. While this might seem like a minor change, it has a big impact: “If I cast six people a day, I would toss six gallons,” Delgado says. With her modification, she instead uses only one gallon. POA also stocks reusable towels and rags instead of paper towels and napkins, keeps no plastic cutlery, and recycles as much as possible. There’s

PHOTOS: The Ophira Group

the company’s carbon footprint while passing on savings to patients. Taking advantage of CAD, laser scanners, CNC machining, and pressure mapping has resulted in a more eco-friendly facility, but Sundberg also emphasizes the part that recycling plays. He is looking into a 3D-printing system that would allow his company to reuse certain parts. “You will be able to recycle a check socket, regrain it, and remill it. It will be slower—going from 30 minutes to 120 minutes—but it will be less man hours, and it will use less materials and have the possibility of being recycled,” Sundberg explains. Joanna Kenton, CPO, a prosthetic faculty member at Century College in Bear Lake, Minnesota, applauds companies like Alchemy, POA, and Advanced O&P for employing new techniques to reduce their environmental footprint. Like Sundberg, she is a big believer in CAD/CAM. “That really takes away two of the steps of casting, getting the mold and the step of modifying,” and reduces the amount of plaster in landfills, she says. Kenton also notes that embracing electronic management systems, such as OPIE and Nymble, can go a long way toward greening an O&P facility. “That greatly reduces the amount of paper and amount of space needed to store those files,” she says. In addition, “It saves on time.” Kenton encourages all O&P professionals to pay close attention to the three R’s: reduce, reuse, and recycle. For reducing, she believes in measuring out supplies exactly to prevent waste. For reusing, she suggests repurposing scrap material. “We try to get as much life out of our equipment [as possible]. Reuse lamination funnels, whatever we can use to get the most life out of a tool,” she says. As for recycling, she urges companies to find ways to recycle almost everything. She says she has even heard of companies that use plastic bottles in their 3D printers. O&P companies should also consider donating used componentry to organizations for use outside of the

Alchemy Orthotics & Prosthetics keeps its business sustainable by using technology that reduces the steps needed for creating orthotic and prosthetic devices.

United States, where resources are scarce. Organizations such as Limbs for Life, the Range of Motion Project, and Prosthetic Hope International may accept used prosthetic limbs to send to third-world countries for use by landmine survivors and others in need. In O&P, as in companies nationwide, business owners and managers are discovering the benefits of building an environmentally friendly business. By making better use of resources, adopting cleaner energy, reducing waste, and recycling, O&P facilities can make a difference in the surrounding

environment while boosting their profile among both patients and potential employees who embrace an eco-friendly lifestyle. The next generations of employees and patients “have grown up with Earth Day and green philosophies,” says Kenton, “and recycling is something they have been doing their whole life.” Building on this momentum can lead to positive change for O&P stakeholders across the nation. Meghan Holohan is a contributing writer to O&P Almanac. O&P ALMANAC | MAY 2019

PRINCIPAL INVESTIGATOR

Easing the Burden of Osteoarthritis

Special Edition

Brian Pietrosimone, PhD, examines the effect of unloader braces on patients with knee osteoarthritis

HERE IS A “lack of evidence”

evaluating the efficacy of unloader braces on individuals with medial compartment knee osteoarthritis (OA), according to Brian Pietrosimone, PhD, an associate professor in the Department of Exercise and Sport Science at the University of North Carolina (UNC) at Chapel Hill. But his new preliminary study—supported by an AOPA research award administered by the Center for Orthotics and Prosthetics Learning and Outcomes/Evidence-based Practice as part of Orthotics 2020—is the first step in adding to the research well regarding knee OA intervention. In January of this year, Pietrosimone enrolled the first subjects in this new study, which is designed to examine the effects of unloader bracing on approximately 30 individuals with knee osteoarthritis. The goal is to collect and report feasibility data for conducting a future randomized clinical trial to evaluate the efficacy of knee unloader braces in patients with knee over an eight-week time period. 1: BoundersOA Free Range

Fulfilling AOPA’s mission to advance research in the profession, O&P Almanac introduces individuals who have undertaken O&P-focused research projects. In this “Special Edition” series of Principal Investigator, we profile participants in the Orthotics 2020 initiative established by AOPA and the Center for O&P Learning/ Evidence-Based Practice. Here, you will learn about some of the research being conducted as part of the Orthotics 2020 initiative, which is a vital enterprise created to evaluate the orthotic services upon which O&P patients depend and to begin populating a stronger research base around issues on the benefit of orthotic services.

Natural Progression

• Providers can easily adjust at any time -no tools required.

Brian Pietrosimone, PhD, leverages an ultrasound imaging technique to measure whether braces are unloading tissues of the joint. 36

MAY 2019 | O&P ALMANAC

Much of Pietrosimone’s early research focused on individuals who had suffered a knee injury and, as a result, were at higher risk of developing arthritis, and learning about how their movements evolve over time. “Even small changes

PHOTO: Brian Pietrosimone, PhD

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PRINCIPAL INVESTIGATOR

MAY 2019 | O&P ALMANAC

Pietrosimone and his team study how subjects walk with and without unloader braces in the lab at the MOTION Science Institute at the University of North Carolina.

force plates,” Pietrosimone explains. “We can see how they change the way they put force through their extremities or through the joint.” The team also will examine how patients’ cartilage compresses before and after patients take a set number of steps. “We have an ultrasound technique where we’re able to measure the cartilage on the end of the femur, before and after they walk. We do what we consider a ‘stress test’ to stress the cartilage. We have people walk 3,000 standardized steps at their normal self-selected walking speed, and we’re able to measure how much that cartilage compresses over that amount of steps,” he says. His team can make these measurements with and without the brace, to determine whether the brace is able to change the amount of compression of the cartilage. “A lot of people have thought that these braces are really unloading the tissues of the joint, but no one’s really been able to measure that. Now, with this ultrasound imaging technique, we’re able to do it.” In addition to the in-lab measurement and imaging analysis, Pietrosimone’s team will instruct study subjects to take their braces home for eight weeks. Then, they will measure subjects’ self-reported pain and abilities

using the brace at home. “We’re going to look at [whether wearing the brace] changes their performance on specific tasks of daily living—getting up out of a chair, going up and down stairs, and walking speed,” he explains. “We’re also going to monitor, before and after they’ve worn the brace, how many steps they take throughout the day,” using an accelerometer. “We’re going to see if they end up improving the amount of physical activity” they engage in. Aggregating this information is critical, Pietrosimone says, because it might show that orthotic intervention can help prevent additional health problems. This is because walking is painful for individuals with arthritis, so they choose not to engage in as much activity as is generally recommended. “And if you can’t do as much activity, you develop all these other comorbidities—cardiovascular disease, obesity, diabetes—that have all these other major health concerns. So, if we can improve their ability to move around with this brace, will they actually go out and do it?”

First Steps

Due to time limitations, the current project is a preliminary study and will provide a base from which further research will grow. “The goal of this

PHOTOS: Brian Pietrosimone, PhD

in a repetitive movement like walking gait can have huge effects over the course of a day, or a month, or a year, or a decade of walking differently on that limb,” he says. He has spent years studying how those small changes might change the biochemistry or the tissue at the joint. He also has studied the movements of people who already have arthritis—“how they may move differently after they’ve actually developed the condition, which may actually progress their arthritis faster or progress their symptoms,” he explains. “So, we’re looking at ways we can change how people move to decrease the progression or just improve their function and ability in activities of daily living.” With this newest, AOPA-supported study, Pietrosimone and his team of doctoral students are delving into the topic of whether unloader braces can improve quality of life for knee OA patients—in particular, patients who have developed medial compartment osteoarthritis. “We’ve been looking at, when people are walking, how the movement may put strain on the cartilage of their joint,” he says. “Bracing could be a way to oﬄoad different areas of the joint and maybe affect how the cartilage is strained during walking.” For the new study, Pietrosimone and his team have developed a protocol to test whether bracing results in positive outcomes. He will provide unloader braces—specifically, Össur and Townsend Design orthoses—“to try to unload the medial portion of the joint—to actually take the femur and the tibia and separate them as you walk, so these two bones basically aren’t compressing every time you walk and putting more pressure on the tissues in that joint,” explains Pietrosimone. He is recruiting subjects who have knee OA, but who are not yet ready for knee replacement surgery, from the UNC medical system and carrying out preliminary analysis of subjects in the MOTION Science Institute at UNC. In the lab, the research team will leverage 3D biomechanical analyses. “We have people walk in our lab [which is equipped with cameras], and we put markers on different areas of their body, and we have them walk across

PRINCIPAL INVESTIGATOR

project is to provide us with some type of idea of how effective these braces may be in improving … self-reported function, biomechanics, and changes in cartilage,” says Pietrosimone. He hopes to have the project completed and data for 30 subjects compiled by the end of 2019, and plans to write up results in early 2020. “Our working hypothesis is that braces would decrease the strain on the cartilage over those 3,000 steps, and that, when we look at the biomechanical analyses, they would decrease the forces that are associated with increased medial compartment loading,” predicts Pietrosimone. “We are hypothesizing that the group would actually do more physical activity now that they have a brace that potentially makes them less painful when they move, and that they would be able to do more physical activity at the end of that eight weeks. And that they would perform better with activities that are generally difficult for people with knee OA, like getting up from a chair, and going up and down stairs.” If they find that unloader braces offer these benefits, as Pietrosimone anticipates, he plans to develop a larger randomized controlled study that can determine efficacy of the orthotic intervention.

Putting a Background in Sports Science to Good Use

Pietrosimone has many interests outside of his current O&P research. He earned his master’s in education and PhD degrees from the University of Virginia’s Curry School of Education, with a focus on athletic training and sports medicine. He spent a few years as an assistant professor at the University of Toledo, where he also served as director of the university’s Joint Injury and Muscle Activation Laboratory, before joining UNC in 2013. In addition to his professorial duties in the Department of Exercise and Sport Science, he also serves as director of UNC’s MOTION Science Institute. “I was always interested in acute injury and returning people back to their function after they had an acute joint injury,” says Pietrosimone. He was

drawn to joint research after noticing how childhood injuries can develop into much greater problems in adulthood. “You’re most at risk of having an injury to your joint very early in life—that’s when you’re most active, that’s when you’re going to be potentially putting forces on that joint that might cause massive ligament or cartilage types of injuries,” he says. When you have an injury as a child or teenager, it may have long-lasting implications on function. “Often times, there’s a period of time where you can get back and do the activities that you want to do, to some extent. But then, what we see is that people who have suffered or sustained a knee injury early in life, they develop this arthritis very quickly. So, they may have a decreased quality of life very early on, in their 30s or 40s, which may set them up for long-term disability and really affect how athletic they can be and how physically active they can be,” Pietrosimone says. With his research, he hopes to “find a way that having an injury when you’re younger doesn’t necessarily mean that you are

going to be disabled when you’re older.” Some of his other research projects have included studying the effectiveness of prophylactic bracing in football players in limiting knee injuries and studying the effect of unloader braces on people who have a varus knee deformity but have not yet developed knee OA. He and his team also have written a paper, currently under review, examining the ability of the ultrasound technique to determine if there’s a difference in cartilage strain. “Most of our work, though, is not necessarily in braces—it’s in looking at changes that happen at the joint that would increase the risk of developing arthritis,” he says. Looking ahead, he hopes to build on the current AOPA-sponsored study to ensure improved outcomes for future OA patients. “There’s no cure for osteoarthritis at this point,” he says, “so trying to find interventions early that can decrease [patients’] risk of developing this condition is important. But then once they develop this condition, how can we make sure it doesn’t get any worse?”

Notable Works Brian Pietrosimone, PhD, has been involved in the publication and presentation of dozens of important articles and papers over the course of his education and career. Some of his most impactful works include the following: • Pietrosimone, B., Loeser, R.F., Blackburn, J.T., Padua, D.A., Harkey, M.H., Stanley, L.E., Luc-Harkey, M.S., Ulici, V., Marshall, S.W., Jordan, J.M., Spang, J.T. “Biochemical Markers of Cartilage Metabolism Are Associated With Walking Biomechanics SixMonths Following Anterior Cruciate Ligament Reconstruction.” Journal of Orthopaedic Research 2017; 35(10): 2288-2297. • Pietrosimone, B., Blackburn, J.T., Harkey, M.S., Luc, B.A., Hackney, A.C., Padua, D.A., Driban, J.B., Spang, J.T., Jordan, J.M. “Greater Mechanical Loading During Walking Is Associated With Less Collagen Turnover in Individuals With Anterior Cruciate Ligament Reconstruction.” American Journal of Sports Medicine 2016; 44(2): 425-32. • Luc, B., Gribble, P.A., Pietrosimone, B.G. “Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers Needed to Treat Analysis.” Journal of Athletic Training 2014; 49(6): 806-819. • Pietrosimone, B.G., Grindstaff, T.L., Linens, S.W., Uczekaj, E., Hertel, J. “Efficacy of Prophylactic Braces in Prevention of Knee Ligament Injuries: A Numbers Needed to Treat Analysis.” Journal of Athletic Training 2008; 43(4): 409-415.

O&P ALMANAC | MAY 2019

MEMBER SPOTLIGHT

ST&G USA Corp.

By DEBORAH CONN

Global Manufacturing Team Southern California company offers O&P componentry in the United States, South Korea, and beyond

N 2005, GLENN CHOI,

MAY 2019 | O&P ALMANAC

ST&G staff members at a recent trade show

FACILITY: ST&G USA Corp. LOCATION: Brea, California, and Seoul, Korea OWNER: Glenn Choi HISTORY: 12 years

Glenn Choi

Testing Lab

with engineers and designers, the company employs prosthetists to support its research and educational activities. Choi notes that ST&G maintains a strong partnership with a government research group in Korea. “Because of my engineering background,” he says, “I drive a lot of product development ideas to the research group, [which] in turn works with us to develop the ideas into products. … Although we are a small company, we sell worldwide,” Choi says. “We initially did a lot of international business in South Korea, then focused on the U.S. market. As other companies have begun to seek us out, we’re continuing to grow domestically and internationally.” Among ST&G’s innovative products is the Maglock, a magnetic suspension device that can eliminate the need for a pin-lock liner. Choi says it is the “ultimate product for patients who have dexterity issues, have issues with pin alignment, or require a caregiver.” One of its newest products, Toe Flex, provides the functional movement of an anatomical ankle

ST&G manufacturing facility Balancing research and development with sales and marketing can be difficult for such a small company, Choi acknowledges. ST&G initially focused heavily on product development but has now shifted more resources toward marketing. The company participates in trade shows and conducts frequent seminars and workshops. It has expanded its advertising efforts and started using social media as well. “As a small company, we have to find ways to grow and compete,” Choi says. “Always, our goal is to develop new products and materials that truly benefit our customers.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: ST&G USA Corp.

formerly director of engineering at a large U.S. prosthetics manufacturing firm and then an engineering consultant, decided to establish his own company. He and a partner launched ST&G in South Korea, his native home, and just two years later, Choi established a division in Brea, California. Today he is sole owner and president of ST&G. Choi calls ST&G “a hip-to-foot company,” which evolved from making basic components to manufacturing a wide range of more complex and sophisticated products. The company offers several innovative prosthetic devices, including knees, feet, running blades, and pediatric prostheses. Its inventory of prosthetic components—adapters, connectors, liners, valves, suspension systems, and more—is extensive. ST&G also carries a more limited number of orthotic devices. When developing prosthetic sockets, Choi became dissatisfied with carbon fiber. “It’s brittle and when you grind it, it breaks up into carbon dust, which is itchy when it penetrates the skin, and over time it’s bad for the health,” he says. Choi developed a new, proprietary material, NSP fiber, which he says is ecofriendly, nonhazardous, and lighter and stronger than carbon fiber. ST&G uses NSP fiber, which is composed of polyvinyl alcohol and other blends, in its own products and markets the material to other industries. The company, with 21 employees, bases its manufacturing facility in Seoul and has an office in Taiwan to manage regional sales in Asia. Along

and foot. The product employs a split carbon heel, multiaxial ankle, and independent split toe features. “It has combined foot and ankle movement and can bend at the metatarsal,” Choi says. “The ability to have the toe bend at the late stance phase of gait means a more natural walking pattern.” The product is a good example of how a small business like ST&G can find ways to grow and compete, according to Choi. “We have a great group of scientific engineers to help us to innovate products that no one else has” and that are patient-focused, he says.

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MEMBER SPOTLIGHT

Xtreme Prosthetics LLC

By DEBORAH CONN

Patient Care in the Bluegrass State Solo practitioner offers prosthetic solutions designed for comfort and long wear times

N 1984, THREE DAYS before his 25th birthday, William Bray— known to many as “Junior”—lost his left leg below the knee in a motorcycle accident. Bray went back to work as a truck driver, but when his company relocated, he pursued a position at the facility that had made his prosthetic leg. “I started as a tech and kept moving forward,” says Bray, who has been a certified prosthetist since 1994. He worked for a facility that experienced repeated buyouts by larger and larger O&P companies, eventually serving as a facility manager.

William (Junior) Bray, CP, makes adjustments to a prosthesis.

FACILITY: Xtreme Prosthetics LLC OWNER: William (Junior) Bray, CP LOCATIONS: Somerset and Glasgow, Kentucky HISTORY: Nine years

A patient walks in parralel bars with her new prosthesis.

MAY 2019 | O&P ALMANAC

Bray fits a patient with a new prosthesis.

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

1 year HISTORY: LP, CPO(SA) John Hattingh, CP, OWNER: Leesburg, Virginia LOCATION: FACILITY:

PHOTOS: Xtreme Prosthetics LLC

In 2010, Bray opened his own practice in Somerset, Kentucky, about 90 minutes from his home in Scottsville. In 2016 he opened a second location in Glasgow, Kentucky. The company’s central fabrication lab is located in Scottsville, with a full-time technician. Bray is the sole practitioner, dividing his time

between both offices, which are administratively staffed full time. Each patient-care location has two fitting rooms, a machinery room, a work area, and a gait analysis room with steps and parallel bars. The Glasgow location is about 1,500 square feet, and Somerset is about twice as big. Bray’s mission as a facility owner is to improve the comfort of amputees. He fits 90 percent of patients with suction and vacuumassisted suspension. “I know it is the most comfortable,” he says. “I experience it every day.” Being an amputee himself gives Bray credibility with patients, along with a drive to find the most appropriate solution for each one. “It doesn’t matter what kind of foot or knee a patient has if the socket is not comfortable. As an amputee, I understand that there is a comfort level that will enable someone to wear a device 12, 14, or even 16 hours a day,” he says. “I know by experience that this outcome is achievable, and I want to give an amputee every opportunity, use every tool in my toolbox, to get a good outcome.”

Most of Bray’s patients became amputees as the result of diabetes or vascular issues, although he also sees trauma patients. He treats both young and older patients, many of whom travel quite a distance to be seen at Xtreme Prosthetics. The practice is part of an O&P group that works on strategies to achieve best practices. “Especially as a small provider, we focus on outcomes,” says Bray. “That’s how 99 percent of providers will be paid, based on outcomes. If you don’t document outcomes and show some history, I don’t think you’ll be a provider for very long.” Xtreme Prosthetics markets directly to patients, rather than to physicians and physical therapists. In addition to word of mouth, the company advertises frequently on local television stations, yielding an average growth rate of about 18 percent. Bray also plans to revamp the company’s online presence to better engage the public. “When people need to look for something now, they go online,” he says. “We get 99 percent of our information from search engines. So, we need to optimize our website to take advantage of that.” Bray has seen a lot of changes in O&P over the years. His first prosthesis was the SACH foot, an ankle block, and a laminated socket. “I had to make my own liner in those days,” he recalls. “I remember when Fillauer developed the pin-locking system. The serial number on my pin system was 0046!” Today, Bray takes advantage of more advanced suspension systems and won’t settle for less with his patients. “At the end of the day, the patient still has to do the walking,” he says. “But I know we’ve done everything in our power to give them the tools to do it.”

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1 year HISTORY: LP, CPO(SA) John Hattingh, CP, OWNER: Leesburg, Virginia LOCATION: FACILITY:

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Call Cailor Fleming today and we’ll gladly customize a specific plan for you. We’ve been a trusted insurance company for years, let our experience and lasting service speak for itself.

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PROFESSIONAL LIABILITY | GENERAL LIABILITY | PROPERTY

| AUTO | UMBRELLA | WORKERS COMP & MORE

AOPA NEWS

AOPA IN THE NEWS

, AOPA s McTernan Quoted in HME News AOPA Director of Coding and Reimbursement Services Joseph McTernan was quoted in April in HME News regarding the recent indictments by the U.S. Department of Justice against 24 individuals responsible for more than $1.2 billion in losses to the Medicare program through fraudulent schemes involving the use of lead generation marketing to deliver orthoses (more information on page 10).

“They deliver braces without ever actually interacting with the patient,” said McTernan in the article, “O&P Stakeholders Take Next Steps To Preserve Access.” “The patients didn’t need or want the braces, but were pulled in by some slick advertising, where they dial a number and the next thing, five braces are on their doorstep, all billed to Medicare.” See the April 26 edition of HME News to read the full article.

AOPAversity: Webinar Series Subscription During the one-hour monthly webinars, AOPA experts provide the most up-to-date information on a specific topic. Webinars are held the second Wednesday of each month at 1 p.m. EST. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits, so you can still take advantage of the series discount and the valuable learning opportunities.

AOPA Members Nonmembers

Price Per Seminar

$99.00* $199.00*

Price for Full Year

$990.00 $1,990.00

* Includes an unlimited number of participants per telephone line. AOPA members may use code “member” when registering for the $99 price.

Earn 1.5 Business CEs each by returning the provided quiz within 30 days and scoring at least 80 percent. All webinars begin at 1 p.m. EST. Webinar registration fees are nonrefundable. AOPA can provide the webinar recording if registrants cannot make the scheduled webinar.

JUNE 12

JULY 10

Documentation— Understanding Your Role

Target, Probe, & Educate—Get To Know the Program & What the Results Are Telling You

The rules have changed regarding orthotists’ and prosthetists’ documentation. This webinar will explore the O&P clinician’s role in documenting medical necessity. Reimbursement experts answer these questions: • • • •

What needs to be documented? What must the physician document? Are there any special rules for O&P notes? What has changed with the new “Dear Physician” letter?

MAY 2019 | O&P ALMANAC

AOPA experts will offer a review of the most recent Target, Probe, & Educate (TPE) audit results released by the durable medical equipment Medicare administrative contractors. Hear answers to some of your most pressing questions:

TARGET

TPE

Program PROBE

EDUCATION

• What claims are being denied? • What are the common denial reasons in the TPE program? • What steps you can take to avoid future denials?

THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS

Experience all the AOPA National Assembly has to offer while visiting San Diego.

SEPTEMBER 25-28 / 2019 SAN DIEGO CONVENTION CENTER

Driving the Waves of Change

#AOPA2019

Join AOPA this fall in San Diego, known for incredible panoramic views. Located in the downtown Marina district, the San Diego Convention Centre has many top attractions within walking distance.

SOUTHERN CALIFORNIA San Diegoâ&#x20AC;&#x2122;s unbeatable location makes it the perfect gateway providing you with outstanding opportunities for pre- and post-conference travel.

AOPAnet.org

O&P PAC

HE O&P PAC UPDATE provides

information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC would like to thank the following AOPA member for his contribution to the O&P PAC*: • Christopher Berdhal, CP • George Breece • Michael Fenner, CP, BOCPO • John Hays, CP, LP • William Leimkuehler, CPO • Frank Snell, CPO, FAAOP • Jason Tanner, CPO • James Young Jr., CP

To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/pacauth. *Due to publishing deadlines this list was created on April 19, 2019, and includes only donations/contributions made or received between Jan. 1, 2019, and April 19, 2019. Any donations/contributions made or received on or after April 19, 2019, will be published in the next issue of O&P Almanac.

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

NEW MEMBERS

HE OFFICERS AND DIRECTORS of

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

MAY 2019 | O&P ALMANAC

Covvi USA Inc. 2102 N. Loop 1604 West San Antonio, TX 78248 210/748-7721 Member Type: Supplier Create O&P 1 Mustang Drive Cohoes, NY 12047 518/302-9198 Member Type: Supplier

Open Bionics Future Space, Fulton Road UWE North Gate Bristol, UK BS34 8RB +44 11 742 85752 Member Type: Supplier Membership has its benefits:

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

AOPA Coding Experts ARE COMING TO

Indianopolis

June 3-4, 2019

ATLANTA

FEB. 26-27 | 2018

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA June 3-4 2019, in Indianapolis to advance 14 CEs your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics.

EARN

AOPA experts provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group.

Book your hotel room by

MAY 10

for the discounted rate!

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more at bit.ly/2019billing.

The Indianapolis Marriott Downtown 350 West Maryland Street Indianapolis, Indiana 46225 Book your hotel by May 10 for the $189/night rate by calling (877) 640-7666 and asking for the AOPA room rate.

Top 10 reasons to attend: 1.

Get your claims paid.

Increase your company’s bottom line.

Stay up-to-date on billing Medicare.

Code complex devices.

Earn 14 CE credits.

Learn about audit updates.

Overturn denials.

Submit your specific questions ahead of time.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience. Find the best practices to help you manage your business.

Participate in the 2019 Coding & Billing Seminar!

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific

CPO

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned

Southern California A well-established, privately owned, multioffice, ABCaccredited corporation is seeking experienced CPOs who will support the company’s vision, mission, and values and provide premier prosthetic and orthotic patient care to join our team. Candidates must be energetic, self-driven, motivated, and knowledgeable individuals who possess strong clinical, technical, and interpersonal interaction skills. They must be patient oriented and innovative, and desire a long-term career with a growing company. We offer competitive salaries, benefits, and a rewarding place to take the next step in establishing a great career and make a difference. Salaries are commensurate with experience. Local ABC-accredited practitioners are preferred. Apply by email to: Email: Box100@AOPAnet.org Reference Job ID: 45402723

by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received

one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

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

Member Nonmember $85 $150

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

North Central CP, CPO

Missouri A well-established, privately owned, multioffice, ABCaccredited corporation is seeking a new prosthetic director. Candidates should have a minimum of five years of experience and enjoy teaching and training residents. Candidates must be compassionate and dedicated to quality patient care and work well in a team environment. We offer a competitive salary and excellent health benefits (medical, dental, vision, and 401K plan). The position offers relocation assistance, car allowance, and onsite central fabrication facility. To hear more details about this job, send your résumé to the email address listed below. Apply by email to: Email: Box101@AOPAnet.org Reference Job ID: 101

North Central Prosthetic Residency Director

St. Louis, Missouri Looking for a CP or CPO who loves to teach others. Must have a minimum of five years of prosthetic experience. This would be an ideal position for an older practitioner who just wants to teach and not have to worry about meeting sales quotas or the pressure of bringing in new referral sources. We have an extensive existing patient base and the focus would be on teaching new residents. We offer a competitive salary and excellent health-care benefits including medical, dental, vision, and 401K. If this sounds like it would be right for you, send your résumé or CV to: Apply by email to: Email: Box102@AOPAnet.org Reference Job ID: 102

MAY 2019 | O&P ALMANAC

CAREERS

WANTED!

OWNERS WANTED!

A few good businesses for sale.

DOTHAN, ALABAMA LUBBOCK, TEXAS

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

LONG ISLAND, NY

If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com SUBSCRIBE

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

INCREDIBLE BUSINESS OPPORTUNITY! NATIONAL BRACE is looking to put clinicians into practice with three offices that are BOC accredited along with many private insurances. PLEASE ONLY LICENSED AND HIGHLY MOTIVATED INDIVIDUALS APPLY. So if you have ever dreamed of owning a practice will little or no money down, Brightree, back office support, vertically integrated purchasing, and completely turnkey: NATIONAL BRACE™ Email in confidence to nationalbraceinc@gmail.com.

AOPA’s O&P Career Center

Connecting highly qualified O&P talent with career opportunities

EMPLOYEE

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EMPLOYER

• Post your job in front of the most qualified group of O&P professionals • Search anonymous résumé database to find qualified candidates • Manage your posted jobs and applicant activity easily on this user-friendly site.

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https://jobs.aopanet.org O&P ALMANAC | MAY 2019

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac19 for advertising options.

ALPS Smart Seal Liner

Need Carbon Tapes

Smart Seal Liner features raised bands that grip to the socket wall to form a secure interface. The bands are coated to ensure longer life and extra security for a smarter seal. The Smart Seal Liner has a new seamless knitted construction with a modern look and is available in locking and cushion suspension. The locking version features a new distal construction to control distal distraction with no matrix. The Smart Seal Liner is just what you need to achieve great suspension! Call us or visit www.easyliner.com for more details.

Mt. Emey Oﬀ-the-Shelf Diabetic Inserts Mt. Emey newly designed off-the-shelf diabetic inserts are fabricated using top quality materials and with new arch design for unsurpassed support where needed, nicely packaged for retail customers. Our goal is to increase your bottom line while providing the highest quality products to your patients. For free display samples, call our toll-free line at 888/937-2747.

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

MAY 2019 | O&P ALMANAC

We offer the best prices on lightweight 3K carbon tapes in a finished edge (DW) and nonfinished edge (FR) configuration. Our carbon tapes are highly formable, wet out quickly, and should be used with all your composite layups. • Sizes: 1-inch, 2-inch, 3-inch, 4-inch, and 6-inch. • Sold in 10-foot cut sections and 50-yard rolls.

For more information, call 800/FABTECH or visit www.fabtechsystems.com.

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

Arizona AFO’s Moore Balance Brace Check out the latest peer-reviewed, published study substantiating the efficacy of Arizona AFO’s Moore Balance Brace. This randomized controlled trial investigated the long-term impact of a balance ankle-foot orthosis, the Moore Balance Brace, on balance, fear of falling, and physical activity in older adults. Researchers reported not only a decrease in fall risk, but a meaningful reduction in fear of falling, leading to an increase in physical activity. Check out the full study at arizonaafo.com/baylor.

MARKETPLACE Discover PROTEOR USA

Rheo Knee® The perfect combination of stability and dynamics—combining both stability and a dynamic walking experience, Rheo Knee utilizes magnetorheological fluid and a state-of-the-art microprocessor to automatically adapt with every step. Now featuring: upgraded Össur Logic App, enhanced stability control, and weatherproofing. Visit ossur.com/rheo-knee to learn more.

New 6Y110 Skeo Sealing Liner From Ottobock All in one. Sealed. Done. In combination with one-way valves or the electronic Harmony system, the new Skeo Sealing liner can give your transfemoral patients a secure hold and a high level of comfort. Its especially sturdy sealing ring securely maintains the vacuum in the prosthetic socket. With this new liner, we have designed all of our key liner features into one product: • Smooth outer coating for easy cleaning and donning • Skinguard antibacterial for reduced odors • Full-length no-stretch matrix for reduced movement. Ask your sales representative for more details. For more information, call 800-328-4058 or visit professionals.ottobockus.com.

WalkOn® Carbon-Fiber AFO WalkOn ankle-foot orthoses (AFOs) are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally. WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return. WalkOn offers a full range of AFO sizes and designs, including the WalkOn Reaction junior pediatric sizes. Fast and easy to fit, the WalkOn footplate is trimmable and can be shaped with scissors, often requiring only one office visit.

Delivering an extensive, progressive product line that includes everything today’s active amputees need to live the life they love. Offering an innovative portfolio that includes everything from the virtually indestructible RUSH Foot collection to the world’s first microprocessor-controlled hydraulic four-bar knee with both stance and swing functionality, the ALLUX. The EASY RIDE, multiuse extreme sports knee, to the KEASY, renowned prefabricated cones. The K2 GERY foot to the flexible, all-terrain, DynaTrek foot. Discover the exciting PROTEOR USA product line today! A whole new look. A whole new vibe. A whole new world. #HumanFirst. Visit us at proteorUSA.com.

Spinal Technology Inc. Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis. For information, contact 800/253-7868 or visit www.spinaltech.com.

For more information, call 800-328-4058 or visit professionals.ottobockus.com for details. O&P ALMANAC | MAY 2019

MARKETPLACE JAWS Prehensor

Expanded Sizing for Alpha® Liners

JAWS is an innovative, versatile, heavy-duty, voluntary opening prehensor that can be used with and without a cable-harness system. Powerful and adjustable with four grip settings, easily “shift-controlled” by wearer. Perfect for yard, ranch, and farm tools with special capability at handling handlebars for ATVs, snowmobiles, and watercraft. Truly a “cross-over” terminal device with multiple functions and capabilities. Crafted at 5 inches long with aircraft aluminum, stainless steel, and highperformance gripping polymer rubbers. L code 6721. Order now for delivery in May/June 2019. Technical description and video on the website. JAWS IS THE ANSWER For more information, email trsprosthetics.com or call 800/279-1865.

Several Alpha Liners are now available in small sizes, allowing even more amputees to experience Alpha’s well-known comfort. Now available in size small: • Alpha Duo® Liners, with a symmetrical, 4.5-mm profile • Alpha Silicone® Liners with a progressive profile • Alpha SmartTemp® Liners in both progressive and 6-mm uniform profiles. Amputees with smaller residual limbs who prefer either fabricless liners or silicone liners are candidates for these new options. The small liner sizes are intended for amputees with a distal residual limb circumference less than 8 inches. For information or to see size charts, visit www.willowwoodco.com.

AD INDEX

Advertisers Index Company

Website

ALPS South LLC

800/574-5426

American Board for Certification in Orthotics, Prosthetics, and Pedorthics

703/836-7114

www.abcop.org

Amfit

15 800/356-3668

www.amfit.com

Apis Footwear Co.

888/937-2747

www.apisfootwear.com

Cailor Fleming

800/796-8495

www.cailorfleming.com

888/WEAR-ESP

www.wearesp.com

17, 37

800/FABTECH

www.fabtechsystems.com

ESP LLC Fabtech Systems LLC

Page Phone

www.easyliner.com

Hersco

1 800/301-8275

www.hersco.com

Naked Prosthetics

www.npdevices.com

OHI

27 877/780-8382

www.ohi.net

Össur Americas Inc.

www.ossur.com

888/977-6693 800/233-6263

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

Proteor USA

855/450-7300

www.proteorusa.com

Spinal Technology Inc.

800/253-7868

www.spinaltech.com

TRS Prosthetics

800/279-1865

www.trsprosthetics.com

WillowWood

33 800/848-4930

MAY 2019 | O&P ALMANAC

www.willowwoodco.com

www.bocusa.org

EARN CE CREDITS AT YOUR OWN PACE www.AOPAnetonline.org/aopaversity

100+ TOP-QUALITY ORTHOTIC, PROSTHETIC, AND PEDORTHIC EDUCATION COURSES.

EARN SCIENTIFIC, BUSINESS, AND PEDORTHIC CE CREDITS BY STUDYING THE COURSE MATERIAL AND PASSING THE QUIZ.

ACCESS YOUR PERSONAL ACCOUNT, VIEW VIDEOS, PRINT CERTIFICATES, OR REVIEW CE CREDIT HISTORY 24/7.

Learn & Earn TOP QUALITY

orthotic, prosthetic and pedorthic education and CE credits from the organization that knows O&P.

Itâ&#x20AC;&#x2122;s as easy as 1-2-3 1. Set up your free personal online account 2. Choose your education and study 3. Take the quiz and print your certificate Membership has its benefits:

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Better BUSINESS WITH AOPA

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Start earning your credits today!

Visit www.aopanetonline.org/aopaversity.

CALENDAR

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

Cascade Dafo Institute

Eight free ABC-approved online continuing education courses for pediatric practitioners. Take anytime, anywhere, and earn up to 11.75 CE credits. Visit cascadedafo.com or call 800/848-7332.

2019 May 2–4

State Association Meeting: Tennessee Society of O&P. Sheraton Music City, Nashville, TN. For more information, email tsopstaff@gmail.com or visit www.tennsop.org.

May 17–18

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certiﬁcation@abcop.org, or visit www.abcop.org/certiﬁcation.

June 1

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

June 1

ABC: Application Deadline for Fall CPM Exams. Applications must be received by June 1 for individuals seeking to take the August and September CPM exams. Contact 703/836-7114, email certiﬁcation@ abcop.org, or visit www.abcop.org/certiﬁcation.

June 3–4

Coding & Billing Seminar. Indianapolis. Book your hotel by May 10 for the $189/ night rate. For more information, email Ryan Gleeson at rgleeson@ AOPAnet.org. SEMINAR

June 3–8

May 3–4

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certiﬁcation@abcop.org, or visit www.abcop.org/certiﬁcation.

May 7–8

AOPA 2019 Policy Forum. Register online at bit.ly/policyforum2019. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

May 8

Are You Compliant? Know the Supplier Standards. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

May 15–17

State Association Meeting: New York Chapter AAOP. Rivers Casino & Resort, Schenectady, NY. For more information, email nysaaop.meeting@gmail.com or visit www.nysaaop.org.

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 300 locations nationwide. Contact 703/836-7114, email certiﬁcation@abcop.org, or visit www.abcop.org/certiﬁcation.

June 12

Documentation—Understanding Your Role. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

July 1

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

July 10

Target, Probe, Educate—Get To Know the Program & What the Results Are Telling You. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

MAY 2019 | O&P ALMANAC

CALENDAR July 12–13

Primefare East Regional Scientific Symposium. Renaissance Hotel and Convention Center, Downtown Nashville. For more information, visit www.primecareop. com, call 888/388-5243, or email Cathie Pruitt at primecarepruitt@ gmail.com or Jane Edwards at jledwards88@att.net.

September 25–28

AOPA National Assembly. San Diego Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

October 9

June 14

State Association Meeting: Kentucky O&P Association. Hyatt Regency Lexington, Lexington, KY. For more information, email kopa.editor@gmail.com or visit www.kyopa.net.

Performance Reviews: How Is Your Staff Doing? Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

November 3–9

July 11–13

State Association Meeting: Alabama Prosthetic & Orthotic Association. Embassy Suites Birmingham/Hoover, Birmingham, AL. For more information, email info@ alabamapoa.org or visit www.alabamapoa.org.

August 14

Are You Ready for the Worst? Contingency Planning. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

August 23–24

Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Baylor College of Medicine McNair Campus in Houston. Contact Ben Guenther at 903/884-6681 or visit www.txaaop.org.

September 11

Veterans Affairs Updates: Contracting, Special Reports, and Other News. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

September 12–14

State Association Meeting: Midwest Chapter AAOP. Grand Geneva Resort & Spa, Lake Geneva, WI. For more information, email mwcaaop@gmail.com or visit www.mwcaaop.org.

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

Health-Care Compliance & Ethics Week. AOPA is celebrating Health-Care Compliance & Ethics Week and is providing resources to help members celebrate. Learn more at bit.ly/aopaethics.

November 6–8

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

November 13

The Holiday Season—How To Provide Compliant Gifts. Register online at bit.ly/ 2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

December 11

New Codes for 2020, Other Updates, and Yearly Roundup. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

2020 September 9–12

AOPA National Assembly. Mandalay Bay, Las Vegas. For general inquiries, contact Ryan Gleeson at 571/4310836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

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

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O&P ALMANAC | MAY 2019

ASK AOPA CALENDAR

Prescription Particulars Tips for providing compression stockings, supply items, and more

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@contentcommunicators.com.

When a doctor prescribes one pair of compression stockings with two reﬁlls, can we dispense two pairs right away—using the reﬁlls?

If you are providing all of the items at once, you must be sure you are able to demonstrate that there is a medical need and necessity for all items to be provided at once. In addition, you must be sure you have provided proper wear-and-care instructions and guidance regarding when the items should be rotated.

quantity provided) and an estimated frequency of replacement. For example, with prosthetic socks, you could indicate that eight socks were provided and they will be replaced every three months. If supply items are covered under the original detailed written order, and the order indicates when and how many items are to be delivered, do I still need to obtain a proof of delivery document?

If the ordering physician prescribes “compression stockings” but does not specify the type, may we determine the best option for the patient?

The initial order does not have to be specific; it could simply state “compression garments” or “anklefoot orthosis” or “back brace.” However, you must keep two things in mind. First, if the initial order specifies the type of garment or the brand, then you must provide that style or brand—unless you are able to confer with the physician and determine if a different style or brand may be used. Second, any item you are providing must be supported by the documentation in the medical record, in your notes, and in the physician’s notes.

MAY 2019 | O&P ALMANAC

Yes. A proof of delivery document is required for any items and services you provide and intend to bill. In addition, all of the normal rules and requirements of a proof of delivery still apply.

If we are replacing supply items, is a new prescription/ order required?

No. A new prescription is not required because supply items, just like repairs and adjustments, are covered under the original prescription for the lifetime of the item. If you are delivering and providing supply items that will be replaced on a routine basis, you will want to indicate this on the detailed written order. Be sure to list all of the supplies that are separately billable/payable (including the original

What quantity of supply items are we allowed to provide at any given time?

The quantity depends on directions found in the Medicare medical policies, as well as whether there is an established medically unlikely edit in place for the item you are providing.

Answer Question 1

CALL FOR VOLUNTEERS

AOPA Wants YOU!

Build your network. Advance your career. Give back to the profession. Volunteer for a Workgroup and/or Committee.

Together we will drive the waves of change. The American Orthotic & Prosthetic Association

AOPA VOLUNTEER COMMITTEES | WORKGROUPS

(AOPA) has opened its annual call for volunteers

•

Assembly Planning Committee

•

Coding and Reimbursement Committee

•

Government Relations Committee

•

Government Relations Contributions/Fundraising

planning the National Assembly to driving the O&P

•

Member Services Committee

research agenda to developing our legislative

•

Mobility Saves Committee

strategy, there is something for everyone. Find a

•

Operating Performance and Compensation Workgroup

Committee and/or Workgroup that interests you,

•

Research Committee

•

State Representatives

•

Veterans Affairs Committee

and we need your talent. Employees of all AOPA member companies are invited to serve on one of AOPA’s Committees and/or Workgroups. From

and submit an online application on the Call for Volunteers webpage today!

Don’t miss this exciting opportunity to become

involved in the O&P profession by supporting AOPA and your fellow colleagues! Terms of service are two-years and will begin December 1, 2019. Most workgroups or committees meet face-to-face at least once per year with monthly conference calls lasting approximately one-hour. Additional time commitments include reviewing materials and work to accomplish the goals of each workgroup or committee. For details about the goals and responsibilities of each workgroup or committee and information on the nomination process, refer to the Nominations Policy.

APPLICATION DEADLINE: JUNE 30, 2019

Submit your application at www.AOPAnet.org/volunteer.

QUESTIONS? Contact Betty Leppin at bleppin@AOPAnet.org or 571-431-0810.

The new C-Brace® Step into the future.™

Meet the world’s first mechatronic stance and swing phase control orthosis system (SSCO®), which controls both the stance and swing phase with microprocessor sensor technology. For patients with neurological conditions affecting their legs, C-Brace supports the user during the entire gait cycle and adapts to everyday situations in real-time. It’s time to step into the future.

• Request a C-Brace Trial at

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