May 2020 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

MAY 2020

Improving Communications With Payors P.18

Best Practices for Cerebral Palsy P.30

Benefits of the cTUG Measurement Instrument P.38

State-Level Advocacy P.56

FINDING

RELIEF

Grants, Loans, and Creative Cash Flow Solutions Keep O&P Facilities in Business P.22

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P.20

YOUR CONNECTION TO

EVERYTHING O&P

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

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

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

 Obtain useful tips and techniques

 Hear from top speakers from around the world

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

 Participate in hands-on workshops

 Procure CE credits

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

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ADVOCACY | RESEARCH | EDUCATION

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contents

MAY 2020 | VOL. 69, NO. 5

COVER STORY

FEATURES

MAY 2020 | O&P ALMANAC

22 | Finding Relief O&P facilities across the nation are facing hardships as revenues and profits drop, given the current coronavirus pandemic and myriad statewide stay-at-home orders. While most orthotic and prosthetic facilities—deemed essential businesses—are continuing operations, many are experiencing reduced patient loads, resulting in unprecedented financial losses. O&P companies are seeking creative solutions—pursuing grants, loans, tax credits, and more— to keep their businesses afloat until patients return. By Michael Coleman

30 | Collaborative Care for Cerebral Palsy

Orthotists who treat pediatric patients often see children with cerebral palsy (CP)—the most commonly diagnosed childhood motor disability in the United States. Some of the most successful care plans for this patient population involve teaming up with pediatric orthopedic surgeons and other members of the healthcare team, understanding how orthotic care fits into a comprehensive treatment plan that may involve neurotoxins and surgery, and keeping current with the latest CP-related research and developments. By Christine Umbrell

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contents

PRINCIPAL INVESTIGATOR

DEPARTMENTS

Sheila Clemens, PhD, MPT, PT................................................................................. 38 Meet a physical therapist and researcher who specializes in patients with limb loss. Sheila Clemens, PhD, MPT, PT, works as an assistant professor in the Department of Physical Therapy at Florida International University and as a research health scientist at the Bruce W. Carter VA Medical Center.

Views From AOPA Leadership......... 6 Pivoting to meet members' needs

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

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

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

Research, updates, and industry news

People & Places........................................ 17 Transitions in the profession

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

Communication Is Key During COVID-19

Fostering positive relationships with patients, referral sources, and payors CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

P.18 Member Spotlight.................................42 n

Bluewave Technologies

P.14 AOPA News.............................................. 44 AOPA advocacy, announcements, member benefits, and more

Welcome New Members...................45 Careers........................................................ 46 Professional opportunities

Marketplace............................................. 48 Ad Index......................................................52 Calendar......................................................54 Upcoming meetings and events

State By State...........................................56

News from California, Kansas, Massachusetts, New York, and Pennsylvania

P.42

MAY 2020 | O&P ALMANAC

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VIEWS FROM AOPA LEADERSHIP

This Was Not the Plan… Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

HEN I TOOK TO the stage last September at the 2019 National Assembly in San Diego to lay out my plan as AOPA’s president for the coming year, I spoke of a year with a multiple wins for our profession. I didn’t anticipate a pandemic. None of us did. I know every one of you is reeling from the massive impacts from the coronavirus disease (COVID-19). I know all your businesses have been severely impacted. I know your personal lives have been upended. I know because I am experiencing the same impacts. This has been an extremely difficult situation for me to navigate, both professionally and personally. I have had to make decisions that impact others’ lives that I never dreamed I would have to make. I have had to make adjustments to all aspects of my life that are uncomfortable—all while knowing that many others are suffering far more, including grieving the loss of loved ones. These past two months have been extremely humbling and forced me to look inward at how I lead. Upon looking inward, I knew that I had to continue to use my position as the current AOPA president as an opportunity to support the O&P profession to the fullest extent so that patients can continue to receive quality care and all our businesses survive this crisis. AOPA is working all angles to get you the support you need. I hope you have seen and are taking advantage of the resources and guidelines we have been providing. We will continue to provide these as long as needed. If you haven’t already, I encourage you to check out the Member to Member page of the Co-OP. Members are sharing what they are doing to minimize the impacts. If you feel so inclined, share your experiences. We can all learn from one another during times like these. We have undertaken new efforts on the advocacy front, working to get as much relief as possible for O&P included in the bills being passed. As with the resources and guidelines, we will continue these efforts until all impacts have been addressed. We have provided AOPA members and all of their employees the ability to access our learning management system, AOPAversity, for free for the rest of 2020. It is our hope that this benefit will make it easier to stay busy and complete education requirements for no cost during this unprecedented situation. We are reworking O&P Almanac features. On page 22 you’ll find an article entitled, “Finding Relief.” It delves into best practices and ways to help cash flow during this crisis. As appropriate, future issues will continue to include articles to help deal with the pandemic. In mid-April, we sent a survey to the membership asking how you were doing and what else we could be doing to help. We are sharing some of the results in the Numbers department on page 10 as well as the previously mentioned feature on page 22. By the time you read this, I know we also will be working on responding to the feedback. If there is anything else AOPA can do during these uncertain times, let us know. It is still too soon to tell the full extent of the impacts and heartbreak. But, I know that given how strong the O&P community is, that when it is all said and done, we will recover. In the meantime, know AOPA is here. Stay safe and stay kind.

Jeffrey Lutz, CPO, is president of AOPA.

MAY 2020 | O&P ALMANAC

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

Our promise: At Fillauer, we’re inspired by you. You, the practitioners who identify unique needs and collaborate for better. You, patients who have the tenacity to improve your mobility and meet your own goals — be they climbing stairs or competing on a world stage at the Paralympics. Entering a second century of innovation, Fillauer has the experience and expertise to provide the same level of innovation that saw a local, familyowned pharmacy become a global industry leader.

AOPA CONTACTS

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

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

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

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

REIMBURSEMENT SERVICES

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

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

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

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

STRATEGIC ALLIANCES

COMMUNICATIONS, MEMBERSHIP & MEETINGS

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

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

O&P ALMANAC

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

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

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

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

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

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

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

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

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

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

MAY 2020 | O&P ALMANAC

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

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

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

NUMBERS

How Are Your Patients Coping With COVID-19? Patient-care strategies may change as Americans adjust to the pandemic

OVERALL DISRUPTION TO AMERICANS

AMERICANS' HEALTHCARE CONCERNS

INCOME INSIGHTS

34 Percent

Were unable to get medical care unrelated to the coronavirus

92 Percent Reported compliance with social distancing recommendations

82 Percent

Reported they are sheltering in place and not leaving homes except for essential needs such as food and medical care

26.5 Million

Americans were laid off or furloughed in the United States between May 15 and April 18

50 Percent

Surge in use of general telehealth visits in the United States in March 2020

Were unable to get prescription meds

Said that worry or stress related to the coronavirus has had a negative impact on their mental health

Said their lives have been disrupted “a lot” or “some” by the coronavirus outbreak

TELEHEALTH TRACKING

24 Percent

45 Percent

72 Percent

39 Percent

Lost income/lost their job, were laid off, or had work hours reduced

44 Percent

AOPA member patient-care facilities currently using telehealth

IMPACT ON AOPA MEMBER O&P FACILITIES

Current state of O&P businesses, as of April 22 Open for business and fully staffed Open for business with some impacts on staffing and operations Operating at a limited capacity Temporarily closed for business

13% 43% 39% 5%

SOURCE: “AOPA’s COVID-19 Patient-Care Facility Survey,” April 22, 2020.

MAY 2020 | O&P ALMANAC

SOURCES: “The Impact of Coronavirus on Life in America,” Kaiser Family Foundation, April 2020; “AOPA COVID-19 Patient-Care Facility Survey,” April 22, 2020; U.S. Department of Labor.

In addition to losing income and fearing the spread of the coronavirus disease (COVID-19), Americans are worried about accessing healthcare unrelated to COVID-19, according to a new poll from the Kaiser Family Foundation (KFF). Finding from KFF’s “The Impact of Coronavirus on Life in America” and AOPA’s “COVID-19 Patient-Care Facility Survey,” both conducted in April, offer a glimpse at how healthcare consumers and O&P facilities are faring.

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Happenings PANDEMIC RESOURCES

CMS Offers Virtual Toolkit for Changes During Pandemic CMS has released a COVID-19 Partner Toolkit to keep providers informed of the latest CMS materials available relating to the coronavirus disease (COVID-19). The toolkit provides multiple links to information for providers, caregivers, Medicare beneficiaries, and other CMS partners. The resources provide guidance on the disease, handling high-risk groups, coping in rural communities, protecting facilities and individuals from coronavirus scams, expanding telehealth services, and much more. AOPA members may review and utilize the resources at www.cms.gov/ outreach-education/partner-resources/ coronavirus-covid-19-partner-toolkit. Stop the Spread of Germs

Help prevent the spread of respiratory diseases like COVID-19.

Avoid close contact with people who are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces.

Avoid touching your eyes, nose, and mouth.

When in public, wear a cloth face covering over your nose and mouth.

Stay home when you are sick, except to get medical care.

Wash your hands often with soap and water for at least 20 seconds.

cdc.gov/coronavirus

316351-A April 7, 2020 9:58 AM

RESEARCH ROUNDUP

MIT Team Adapts Ewing Amputation for Upper-Limb Clinical Trial A clinical team comprised of surgeons and researchers from Brigham and Women’s Hospital and Massachusetts Institute of Technology’s Center for Extreme Bionics is working on a new version of the Ewing Amputation for upper-limb patients. The Ewing Amputation, first performed on Jim Ewing at Brigham and Women’s Faulkner Hospital in 2016, preserves normal signaling between the muscles and the brain, facilitating proprioception so users feel as if they are controlling their biological limb, according to the research team. MIT researchers Matthew J. Carty, MD, and Tyler Clites, PhD, found that the Ewing procedure improved mobility and offered amputees more control over advanced robotic prostheses, and resulted in decreased muscle loss and less residual limb pain, according to a study published in 2018. As of November 2019, the procedure had

been performed on 20 patients. Carty and his team have begun to apply principles of the Ewing Amputation to individuals requiring above- and below-elbow amputation. The reengineered procedure is designed to provide upper-limb patients with more function and increased use of their prosthesis postamputation. Carty’s team is recruiting and enrolling patients in a three-year, upper-extremity clinical trial. The upper-limb procedure will link muscle pairs to better enable prosthetic control, preserve limb volume, and eliminate neuropathic pain, according to the researchers. “We’ve accrued a lot of data demonstrating that our lower-extremity amputations perform substantially better than standard amputations over a variety of metrics,” said Carty. “If we can show the same benefits to an upper-limb amputation model, it could have huge implications for people who suffer upper-extremity limb loss.”

INSURANCE INSIGHTS

EXTENDED

Several States Offer Extended Open Enrollment in Healthcare Exchanges

With the coronavirus disease (COVID-19) affecting hundreds of thousands of Americans, several states offered their uninsured residents a special opportunity to sign up for a health plan via their healthcare exchanges during the off-season. In early 2020, approximately 28 million Americans were uninsured, according to data from the U.S. Census Bureau. The states’ decisions to reopen the exchanges were made to help ease consumers’ concerns about 12

MAY 2020 | O&P ALMANAC

the cost of healthcare so that sick patients would not be deterred from seeking medical attention. Some states also were offering individuals who lost their jobs a chance to enroll in these exchanges. The states of Colorado, Connecticut, Massachusetts, Nevada, New York, Rhode Island, Vermont, and Washington extended their enrollment periods into April. Minnesota has extended its deadline until May 25, Maryland until June 15, and California until June 30. The District of Columbia has left its exchange open indefinitely.

HAPPENINGS

DIABETES DOWNLOAD

UK Team Identifies Five-Year Survival Rate of 40 Percent for Diabetes-Related Amputations A team of researchers from the Lancashire Teaching Hospitals NHS Foundation Trust in the United Kingdom recently completed an investigation of survival rates of individuals who had undergone lower-limb amputations due to diabetic foot disease. Studying the records of patients with amputations between 1997 and 2006, the researchers noted five-year survival rates averaging 40 percent and 10-year survival rates of 24 percent. The researchers studied 233 records and found no difference in survival rates among those individuals with

major amputations (above the ankle) versus minor amputations, and no difference in the rates of male versus 40% female patients. Patients older than 70, however, had slightly lower survival rates. Of the 72 cases who had minor amputations initially, 63 needed a further amputation or contralateral amputation to follow up. Survival rates averaged 64 percent at one year postamputation, and 50 percent at three years postamputation. The study was published in the April 12 issue of Endocrine.

FAST FACT

Patients With Diabetes Experience Greater Complications From COVID-19 Although diabetes has been associated with worse outcomes among patients with the coronavirus disease (COVID-19), the susceptibility to SARS-CoV-2 infection may not be higher in people with diabetes. The inflammatory presentation associated with diabetes may compose the underlying mechanism that leads to a higher propensity to infections, with worse outcomes, among patients with diabetes who contract COVID-19.

AMPUTATION PREVENTION

OSHA Ramps Up Program To Identify Hazards in Manufacturing Facilities

The Occupational Safety and Health Administration (OSHA) issued an updated National Emphasis Program (NEP) in December, designed to focus inspections on identifying amputation hazards in manufacturing industry facilities. The NEP, which was first issued in 2015, targets manufacturing and industrial workplaces where employees may be injured by unguarded or improperly guarded machinery. Approximately 5,920 employees suffered work-related amputation injuries in 2018, according to the Bureau of Labor Statistics. OSHA’s enforcement history indicated that employees performing service or maintenance on equipment are often injured when no machine guarding is present. Given this data, OSHA updated the NEP with changes regarding the coding for OSHA amputation inspections and amputation-related reporting requirements for manufacturers. The updated NEP went into effect Dec. 10, 2019, and OSHA-approved state plans are expected to have enforcement procedures that are at least as effective as outlined in the NEP.

SOURCE: “COVID-19 and Diabetes: Knowledge in Progress,” Diabetes Research and Clinical Practice, April 9, 2020.

O&P ALMANAC | MAY 2020

HAPPENINGS

DME MAC DECISIONS

How Provisions of Emergency-Based Waivers Impact O&P The durable medical equipment Medicare administrative contractors (DME MACs) recently offered a presentation that addresses some of the questions regarding replacement of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) during the COVID-19 pandemic.

Specifically, the DME MACs stated that the 1135 waivers only apply to replacements that are necessary as a direct result of the emergency. For example, the waivers would apply to a patient who is being transported to the hospital with COVID-19 symptoms who loses his brace in the ambulance. However, a beneficiary’s inability to make an appointment or see the referring physician does not qualify under the waiver’s current provisions. In addition, the waivers do not apply to new services such as socket replacements. When providing a replacement item under the waiver, suppliers are reminded to include a narrative description explaining why the item needs to be replaced with their claims and must maintain documentation for the need of the replacement item. Suppliers must also use the CR modifier on their claims.

MAY 2020 | O&P ALMANAC

REGULATORY RELIEF

CMS Pauses Prior Authorization and Eases Regulatory Procedures Due to COVID-19 CMS has announced several temporary regulatory waivers that are intended “to equip the American healthcare system with maximum flexibility to respond to the 2019 novel coronavirus (COVID-19) pandemic.” CMS announced a pause in the prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Implementation of prior authorization for six lower-limb prosthesis codes (L5856, L5857, L5858, L5973, L5980, and L5987) had been scheduled to begin in four states on May 11 and expanded nationwide on October 8. AOPA believes that the pause will allow Medicare providers to continue to focus on providing medically necessary, clinically appropriate O&P care to Medicare beneficiaries without having to dedicate valuable resources to unfamiliar processes and documentation requirements. In addition, CMS announced it would temporarily waive signature and proofof-delivery requirements for Part B drugs and DMEPOS when a signature cannot be obtained due to COVID-19. In this situation, providers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19. CMS announcement also discussed a previously announced relaxation of DMEPOS accreditation requirements to facilitate provider enrollment. The American Board for Certification in Orthotics, Prosthetics, and Pedorthics

and the Board of Certification/ Accreditation have expressed their concern that suspending DMEPOS accreditation requirements may expose the Medicare program to increased fraud and abuse. AOPA and its partners in the O&P Alliance have prepared a letter to CMS asking them to reconsider the suspension of DMEPOS accreditation. CMS additionally indicated increased flexibility in the processing of appeals by both fee-for-service and Medicare managed care contractors. AOPA is examining this provision and will provide additional information regarding these flexibilities in the near future. In a separate announcement, CMS suspended most Medicare fee-forservice medical review activities, or audits. The suspension applies to prepayment reviews under the Target, Probe, and Educate program, as well as postpayment reviews by the DME MACs, the supplemental medical review contractor, and the recovery audit contractor. In cases where fraud and abuse are suspected, however, audits may still be conducted.

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HAPPENINGS

FAST FACT

PARALYMPIC PREVIEW

Tokyo Games Postponed to 2021

Female Veterans Less Likely To Use Upper-Limb Prostheses

In a recently published study of veterans with upper-limb loss, women were less likely than men to have ever used a prosthesis, be current users, and have

THE LIGHTER SIDE

received training for a current prosthesis. In addition, a greater proportion of female veterans used cosmetic prostheses and a smaller proportion used body-powered devices compared to male veterans.

MAY 2020 | O&P ALMANAC

PHOTO: Getty Images

SOURCE: “A National Survey of Prosthesis Use in Veterans With Major Upper Limb Amputation: Comparisons by Gender,” Physical Medicine & Rehabilitation Journal, February 2020.

2020 AOPA Operating Performance Survey for AOPA members Short on time? We’ll do the hard part for you. www.AOPA-survey.com

PHOTO: Getty Images/Atsushi Tomura

The Tokyo Paralympic Games will be postponed one year due to the global COVID-19 pandemic, according to an announcement from the International Paralympic Committee (IPC). Originally scheduled for Aug. 25 to Sept. 6, 2020, the Paralympic Games will now be held Aug. 24 to Sept. 5, 2021. The decision to postpone both the Paralympic and Olympic Games was made The countdown clock of the Tokyo Paralympic by the IPC, International Games was restarted in front of the JR Tokyo Olympic Committee, Tokyo Station on March 31, 2020, in Tokyo, Japan. 2020 Organizing Committee, Tokyo metropolitan government, and government of Japan, and was supported by the International Summer Olympic Sport Federations and National Olympic Committees. The new dates were selected to allow for the maximum time possible to deal with the COVID-19 pandemic, to safeguard the interests of the athletes and Olympic sport, and to coincide with the international sport calendar as best as possible. The events will remain the Games of the XXXII Olympiad and thus continue to have the moniker Olympic Games Tokyo 2020 and Paralympic Games Tokyo 2020, despite the new host year.

PEOPLE & PLACES BUSINESSES COMMUNITY OUTREACH

for NHS staff,” said Nigel Birkett, operations manager. “So far we have made offers of the masks to all the NHS trusts that we currently provide clinical support to and offered support to any other trusts that have reached out to us.”

O&P Companies Alter Production To Make PPE During COVID-19 Pandemic

Knit-Rite has started making washable, reusable face masks. The company’s goal is to make about 10,000 masks a week; for every mask sold, the company donates one.

By the end of April, more than one million total cases of the coronavirus disease (COVID-19) had been reported in the United States. Given the high numbers of patients admitted to hospitals for treatment, personal protective equipment for healthcare workers was hard to find in some areas. Private companies—including some O&P firms, both in the United States and abroad—have stepped in to do their part.

Methodist Orthotics & Prosthetics in Flowood, Mississippi, is making face shields for healthcare workers by modifying an injection-molding process used to make orthoses and prostheses. The first batch of shields went to protect residents and staff at Methodist Specialty Care Center, a long-term care facility. Methodist O&P also has offered face shields to other local entities.

Blatchford in Sheffield, England, has manufactured and delivered more than 1,000 face visors across nine different NHS Trusts, with hundreds more in progress. They also have secured the supply chain, which will enable them to manufacture thousands more in the coming weeks. “We wanted to help in the fight against COVID-19 and thought the best way we could do this is use our materials and expertise to make protective face visors

Össur donated 20,000 testing swabs from its operations so that more people could be tested for the SARS-CoV2 virus in Iceland.

NEW

Data Drives PERFORMANCE with other O&P companies of similar size and location.

A VALUABLE RESOURCE FOR BUSINESSES IN THE O&P INDUSTRY

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Complete the survey to: • Identify where your O&P facility needs to improve.

• Know how your company’s financial performance compares with industry leaders and others in similar markets.

• Help inform business decisions using your company’s benchmarking data. • Help drive AOPA’s advocacy, research, and education initiatives.

AOPA PRODUCTS

COMPANY REPORT

NEW

HARNESS ITS POWER, complete the 2020 Operating Performance Survey. The survey arrives in your mailbox MAY 15, 2020.

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• It’s CONFIDENTIAL. Data collection is managed by Industry Insights. • Participants receive a confidential company report PLUS the final published report valued at $500 each, for FREE. Participation is FREE and limited to AOPA members.

Visit www.aopa-survey.com. O&P ALMANAC | MAY 2020

REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

Communication Is Key During COVID-19

E! QU IZ M EARN

Relationships take on special importance in challenging times

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 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

HE WORLD HAS CHANGED. Over

the past few months, new protocols for going to the grocery store, attending school, going to work, and delivering healthcare services such as orthotics and prosthetics have taught us that we can’t take anything for granted. The future is not the certainty that it was just a short time ago. During these unprecedented times, the value of positive relationships remains a rare constant in an everchanging world. When dealing with patients, referral sources, insurance companies, and federal and state agencies, effective communication and

MAY 2020 | O&P ALMANAC

positive relationships can mean the difference between a successful outcome and a negative one. This month’s Reimbursement Page discusses strategies for building successful relationships through increased communication across the entire O&P spectrum.

Partnering With Patients

Effective communication with patients is crucial to achieving successful outcomes. The patient is the individual who will be most impacted by the service you provide. Maintaining frequent and open lines of communication with patients— as well as their family members and caregivers—will help to build trust, garner important feedback, and involve the patient in treatment decisions. Patients are a vital part of the reimbursement team and should be included in any conversation that requires a decision on taking a specific direction in their plan of care. In addition to serving as their own advocates, patients also may serve as your advocates when negotiating with insurance companies or communicating with outside providers and healthcare facilities. The value of a

BUSINESS CE

CREDITS P.20

strong relationship with your patients is virtually immeasurable.

Building Relationships With Referral Sources

Referral sources are a valuable ally to O&P providers—these relationships require important information sharing among all parties. Your relationship with each referral source must be a partnership, with communication flowing freely between the O&P provider and the referral source— and also flowing among others involved in the patient’s treatment plan. These include patients, insurance companies, other healthcare facilities, and individual members of the rehab team such as therapists, nurses, and technicians. Most insurance companies view the referral source as the “quarterback” of the rehab team, responsible for driving the treatment plan and organizing the activities of the various team members. Establishing strong ties with referral sources will help to build trust and open lines of communication that are necessary to achieve successful outcomes for your patients.

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Communicating With Insurance Companies

At the end of the day, O&P is a business. The efficient delivery of medically necessary care to all of your patients should remain a priority—but to achieve that goal, you must continue to be reimbursed for the services you provide. Creating effective lines of communication with insurance companies and other payors is crucial to consistent claim payment and cash flow. No system is perfect, and that includes insurance payment processes. Since insurance companies typically process very high claim volumes, they must rely on automated systems to process and pay most claims. When a claim is identified as an anomaly in the automated system, it is removed from the system and must be reviewed by a human being before a payment decision is made. This can be time consuming and may result in unnecessary delays and claim denials. Building the right relationships with the right people may mean the difference between a claim being paid and a claim being denied. In addition, it’s important to encourage positive communications between your patients and their insurance companies, as they can often serve as their own best advocates.

Working With Federal and State Agencies

Combined, Medicare, Medicaid, and the U.S. Department of Veterans Affairs (VA) account for a significant percentage of O&P claims on an annual basis in the United States. They also represent three large bureaucracies with multiple layers of management, 20

MAY 2020 | O&P ALMANAC

Creating effective lines of communication with insurance companies and other payors is crucial to consistent claim payment and cash flow. including political appointees, career employees, and contractors. Building effective relationships with the correct decision makers can help increase your knowledge regarding how these larger systems work—and offer insights into how you can influence decisions so that they are in the best interest of delivery of highquality, medically necessary care. AOPA has worked diligently to improve its relationships with CMS, its Medicare and Medicaid contractors, and the VA. For the past several years, AOPA has participated in the durable medical equipment Medicare administrative contractor (DME MAC) advisory councils for all four DME MAC jurisdictions. These councils are comprised of provider groups that advise the DME MACs on policy issues and work with the DME MACs to address claims processing, audit, and coverage issues. AOPA’s participation on these councils has helped to facilitate strong lines of communication between AOPA and the DME MACs.

The recent collaboration between AOPA and the DME MACs to publicly condemn the predatory behavior of unscrupulous providers fraudulently providing medically unnecessary knee and back braces is a prime example of the mutual benefits of the relationship between AOPA and the DME MACs. Shortly after AOPA’s public announcement regarding the predatory nature of the late-night television ads that were promoting the delivery of knee and back braces “at little or no cost to you,” the U.S. Department of Justice announced multiple indictments via Operation Brace Yourself. In addition to building stronger relationships with CMS and its contractors, AOPA also has worked hard to develop and maintain strong relationships with the VA. As one of the largest healthcare delivery systems in the country, the VA is influential both internally and externally. An inherently decentralized system, the VA healthcare system is divided into 23 Veteran Integrated Service Networks (VISNs). There is tremendous value to fostering relationships with both national VA representatives and local VISN management. These partnerships show their value when negotiating payment terms or access to veterans in local clinics. As we approach a new normal as a result of the COVID-19 public health emergency, one of the things that remains unchanged is the value of relationships and communication between O&P providers and patients, referral sources, and payors, as well as federal, state, and local agencies. Building strong relationships today will inevitably pay dividends in the future. 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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COVER STORY

MAY 2020 | O&P ALMANAC

COVER STORY

Finding

RELIEF U.S. O&P facilities leverage grants, loans, and creative cash flow solutions to keep their businesses afloat during the COVID-19 pandemic

By MICHAEL COLEMAN

NEED TO KNOW

• As the O&P profession navigates the fallout of the coronavirus pandemic, state-wide stay-at-home orders, and reduced patient loads, many facilities are pursuing grants and loans to keep their practices solvent. • Some business owners received payments as part of the CARES Act, and some took advantage of advanced payments from CMS that were temporarily offered in April in an expansion of the Medicare Accelerated and Advanced Payment Program. • Grants and advanced payments have not gone far enough in meeting shortfalls for most companies, so some are pursuing private loans or loans made available via the Paycheck Protection Program. • Still other companies are taking advantage of tax credits or tapping into retirement funds. • As companies re-evaluate their income and expenses and make hard decisions about managing their workforces, they also are looking to the future—preparing to ramp back up operations to meet patients’ needs and return to generating a more steady stream of income.

S THE CORONAVIRUS (COVID-19) crisis inflicts

massive damage to the U.S. economy, many O&P companies are finding creative ways to continue serving patients and keep revenue flowing—albeit at a slower scale and pace. The federal government’s massive, two-part economic rescue package—the Coronavirus Aid, Relief, and Economic Securities (CARES) Act—included billions of dollars intended for small businesses and medical providers, and some O&P clinics are already seeing relief money in their accounts. At the same time, creative staffing, adherence to social distancing recommendations, and widespread government acknowledgment of O&P clinics as “essential businesses” have enabled most clinics to keep their doors open. A few O&P facilities have closed temporarily, and some have scaled back operations, but the majority are continuing their operations in some capacity. When AOPA surveyed member patient-care facilities in mid-April, 13 percent were open for business and fully staffed, and another 43 percent were open with “some impacts” on staffing and operations. Thirty-nine percent were operating at limited capacity, while 5 percent had temporarily closed for business. But with COVID-19 related hospital admission rates steadily declining in late April and some governors signaling at least a cautious return to normal for many businesses, the O&P profession appears poised for a steady rebound as the economy recovers. “Probably by the end of June, we’ll start to be okay,” says Barry Smith, a lawyer and longtime broker of O&P business sales who stays in close touch with clinic owners across the country. “If owners can stick it out until then, I think the patients will start to return. But it’s going to be a difficult 60 days.” O&P ALMANAC | MAY 2020

COVER STORY

PATIENT CARE in a Pandemic

Accessing Grants and Loans

As O&P facilities grapple with the consequences of fewer patients and reduced revenues and profits, most firms are turning to grants and loans to keep their operations afloat. Fifty-eight percent of O&P patient-care facilities surveyed by AOPA in April said they had received a relief payment from the U.S. Department of Health and Human Services (HHS). HHS began releasing $30 billion of the $100 billion Public Health and Social Services Emergency Fund that is part of the CARES Act in late April. The payments, deposited directly in providers’ business accounts, are not loans and do not need to be repaid, but they did come with certain terms and conditions for acceptance and retention. 24

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PHOTO: Getty Images/Tom Pennington

When the coronavirus pandemic began to wreak havoc on lives and businesses across the United States in March, AOPA found “very consistent language that clearly considers the continued operation of healthcare facilities as ‘essential’ services that are exempt.” The exemption “applies to both patients, who may continue to receive care from healthcare facilities, and employees, who may continue to work at these facilities,” the organization wrote in a statement on its website. But while O&P clinics have been deemed essential services in virtually all states where such decrees were issued, that doesn’t mean they’ve been employing standard operating procedures, says Barry Smith, a lawyer and longtime broker of O&P business sales. Social distancing—keeping everyone six feet apart and using appropriate protective gear—is the guiding principle. O&P facilities have adopted “what seems to be a universal policy—only one person can come [into the facility with] the patient at the most, and it’s better if the patient can come by themselves,” Smith explains. “Some clinics are rotating clinicians so that all clinicians are not there all days, so that if one clinician gets sick, maybe not all clinicians need to go into quarantine.” Many facilities have removed some chairs in their waiting rooms, “and they’re spaced six feet apart.”

CMS offered an additional source of relief in early April, expanding the Medicare Accelerated and Advanced Payment Program to increase cash flow for impacted providers. CMS temporarily revamped the program to include a larger number of Part A and Part B Medicare providers and to reduce the time frames for issuing payments from several weeks to approximately seven days. The updated program allowed eligible providers, such as those that had billed Medicare within the past 180 days and met other requirements, to request up to three months of expected Medicare payments to be made if their business operations had been impacted by COVID-19. While several O&P companies were able to take

advantage of these advanced payments, CMS announced in late April it was suspending the program for Medicare Part B providers, including O&P providers, and would no longer accept new applications for advanced payments for these providers. CMS announced in late April that another $20 billion allocated to Medicare providers in the CARES Act was set to be distributed in two ways—as an automatic distribution to Medicare providers who previously submitted cost reports, and in subsequent waves of distribution based on applications in a General Distribution Portal. Medicare providers that have already received a payment from the Provider Relief Fund are eligible to apply for additional funds by submitting data about their annual revenues and estimated COVID-19 related losses via the portal, accessible at https:// covid19.linkhealth.com/docusign/#/ step/1. While the relief payments and Medicare advanced payments were helpful to those able to access them, these funds did not go far enough in meeting shortfalls for most companies, so many are securing loans, says Tim Stoltz, CPA, CFP, MTAX, a partner at Bestgate Tax and Accounting Advisors in Frederick, Maryland. Stoltz, whose firm advises many O&P and medical practitioners, says his colleagues pivoted to a near-total focus on informing clients about federal assistance options and smart tax strategies in response to the pandemic’s devastating toll on business revenues. He and his colleagues encouraged all small businesses to apply for Paycheck Protection Program (PPP) loans, which he calls “the centerpiece” of the federal economic relief package for small businesses. Congress approved the PPP program in March, authorizing $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. The money ran out fast, as businesses flooded the government with requests for assistance. Congress added another $310 billion to the program in late April.

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COVER STORY

Under PPP, the terms are the same for everyone. The loan will be forgiven if proceeds are used to cover payroll costs, as well as most mortgage interest, rent, and utility costs over the eight-week period after the loan is made. Employee and compensation levels also must be maintained. Payroll costs are capped at $100,000 on an annualized basis for each employee. Due to likely high subscription, it is anticipated that not more than 25 percent of the forgiven amount may be for non-payroll costs. Loan payments will be deferred for six months.

$ 26

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day before the funding ran out, and we saw them approve and fund loans in the same day—which we did not see happen from banks,” he says. “You may just have to get a little creative and get outside your normal channels.” Still, questions continue about access to the loans, as well as their terms of forgiveness. The federal government offered additional information on April 27 but did not issue any guidance on forgiveness terms, according to Stoltz. “Significant open questions” remain, he says.

Creative Cash Flow Solutions

Another program that dovetails with the Paycheck Protection Program is a business relief provision known as the Employee Retention Credit. This refundable payroll tax credit for “qualified wages” is paid to employees who remain on the payroll between March 13 and Dec. 31, 2020. The credit offers a refundable $5,000 for each full-time employee retained during that time period. Employers qualify if their business was fully or partially shut down, or if their gross receipts fell below 50 percent of the same quarter in 2019. They can secure the credit immediately by reducing payroll taxes they submit to the IRS. If a business has 100 or fewer employees, any compensation paid during the period when the operations were impacted by one of the two scenarios is eligible for the credit, even if it’s paid to an employee who is still on the job. “The Employee Retention Credit clearly can be a better option if you have a lot of low-paid employees,” Stoltz says. He believes this credit can serve as a good “backup” for companies unable to secure a PPP loan. What if an O&P clinic doesn’t qualify for the federal assistance in the CARES Act or a PPP loan? Then what? O&P facilities can pursue other options to generate emergency cash, including borrowing from retirement funds or researching nonfederal grants. The CARES Act loosened borrowing requirements on retirement plans to give small business owners more options for staying afloat. For example, while there has long been a general limit of $50,000 for borrowing from 401(k)s without tax penalties, the CARES Act raised that ceiling to $100,000. “That’s significant,” Stoltz says. “You can access some of your 401(k) money if you need some cash flow. The downside of that is while the market prices are down, you must sell your securities in order to generate cash—and it’s not a good time to sell.”

PHOTO: Getty Images/valentinrussanov

The problem with the PPP program is that it’s unclear if a business’s application will be approved, or when. “If you haven’t applied yet, you’re at the bottom of a very tall stack,” Stoltz says. “If you apply now, you’re going to be waiting to potentially get funding.” With the second infusion of $310 billion into the PPP, many businesses were anxious to know if they would be able to access the funds, especially since the first round of relief was snapped up so quickly. The second round also earmarks $60 billion for

community bank lending, according to Stoltz. “Many large banks are not accepting any additional applications. At this point, the best chance of getting a PPP loan approved will be by going through a local bank.” Nontraditional financial institutions, such as fintechs, also have been doing a good job with small business loans, says Stoltz. Companies such as PayPal, Kabbage, and Lending Tree are stepping into the breach and, in many cases, processing loans more quickly than traditional banks. “PayPal got approved to process these loans one

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COVER STORY

The CARES Act loosened borrowing requirements

on retirement plans to give small business owners more options

MAY 2020 | O&P ALMANAC

still owe taxes on that for staying afloat. money if it comes from a tax-deferred account. You can make several separate withdrawals, encourages O&P clinic owners to look but together, they may not exceed to economic development entities, $100,000. “It helps with cash flow, but private charitable institutions, state ultimately, you have to come up with Department of Labor websites, and the money,” and reimburse yourself to local chambers of commerce for avoid paying taxes on the withdrawal, possible relief options. adds Stoltz. Getting a little deeper into the What About Insurance? weeds, since Congress enacted tax One major source of relief funding reform in 2017, net operating losses that traditionally steps up to provide (NOLs) generated in tax years beginaid during a major national crisis—the ning in 2018 cannot be carried back insurance industry—has denied most and can only offset up to 80 percent of claims related to COVID-19. taxable income in carryover years. But Don Foley, principal at Cailor the CARES Act permits NOLs from Fleming, an Ohio-based company that the 2018-2020 tax years to be carried insures more than 1,000 O&P pracback to the previous five tax years, tices, says that business losses from beginning with the earliest year first. It pandemics simply are not covered, also suspends the 80 percent of taxable and that the decision was made by income limitation through the 2020 both the insurance industry and the tax year. The NOL carryback can result federal government in 2003, after the in an immediate refund of taxes paid in September 11 terrorist attacks raised prior years. similar questions. “You can carry this back five years “After 9/11, we [the industry] talked and claim a refund and theoretito the Bush administration and made it cally get some money,” Stoltz says. clear that we can’t cover pandemics,” “I encourage people to consider Foley says, “and every [insurance reguthat” if they think they may meet the latory agency] in all 50 states agreed program’s requirements. that that was too much for the insurBeyond federal assistance, Stoltz ance industry to be able to handle.”

PHOTO: Getty Images/Andersen Ross

Tapping individual retirement account (IRA) funds is another option. During normal times, federal law requires a 10 percent early withdrawal penalty for those who take money from retirement accounts before age 59 1/2, unless they qualify for certain exceptions, like a first-home purchase or a qualifying educational expense. Now, the CARES Act adds additional exceptions for those who have been significantly affected by COVID-19. Among them is an exception for business owners who had to close their doors or cut back hours due to the pandemic. “If you take an IRA distribution right now, the 10 percent tax will be suspended,” Stoltz says. “And then on top of that, you don’t have to pick up all the income immediately. It can be taken over three years. And you also can put your money back into the IRA, so that you end up not paying tax on it. So that’s another benefit. But similar to the 401(k), it could cause you to sell low and buy high, and should be avoided if you can. But if you’re in a crisis and you need cash, it’s an option.” If you meet the criteria, you can take up to $100,000 from your retirement savings without penalty, regardless of age, though you may

COVER STORY

Foley says he understands his clients’ immense frustration, and he’s trying to give as much guidance as possible to help them find assistance, but it must come from banks and other resources, rather than the insurance industry. However, he is advising clients to file claims anyway so he can review them with a “fine-toothed comb” in preparation for what he expects will be a tidal wave of lawsuits for denials. “You want the insurance company to just verify that there’s not a hint of coverage anywhere … and insurance companies don’t ever want to be accused of bad faith,” he says.

describes reality. If you do expect to bring employees back, then using the term furlough is probably a bit better on their psyche.” Stoltz also advises any employer considering workforce reductions to check the applicable laws in their state, as they relate to employment law and insurance.

collaboration with local and state public health leaders.” As O&P facilities begin to see more patients to meet their immediate orthotic and prosthetic needs, practitioners will prepare to treat patients under more restrictive conditions, using personal protective equipment and adhering to recommendations

Cause for Hope

from the Centers for Disease Control and Prevention for healthcare providers during the pandemic. While some O&P clinics whose financials were bleak before the pandemic hit may end up going out of business, according to Smith, most are coping by laying low, minimizing costs, and eagerly anticipating a return to normal. Says Smith, “Everyone’s kind of waiting for the green light.”

Cutting Costs

PHOTO: Getty Images/Justin Heiman

In addition to applying for grants, loans, and additional funding, some O&P companies are taking a hard look at their overhead—and are wrestling with how to manage their workforce at a time of dramatically reduced revenues. The question of whether to furlough employees or lay them off, or just reduce hours, is weighing on many in the profession. Whereas a furlough is a mandatory, temporary, unpaid leave, a layoff is a full separation from the company. Furloughs are sometimes seen as advantageous because they allow a business owner to reduce labor costs without adding new expenses such as severance packages and outplacement services. When business returns, employees can return to work and pick up where they left off. When a furlough lasts for one or more full workweeks, federal law does not require the company to pay the furloughed employee’s salary. When a furlough lasts for less than one full workweek and an employee works at any given point during that week, the employer must pay the exempt employee’s full weekly salary. “The main difference in furloughing an employee, rather than laying them off, is that you are setting an expectation for in the near term they will get their job back,” Stoltz explains. “If the employee is laid off, then it’s typically a permanent separation. I think it’s best to use the term that best

Healthcare facilities in some states were beginning to see renewed signs of activity in late April, with some states easing stay-at-home restrictions—and some facilities planning to ramp back up patient visits while adhering to health and safety precautions. CMS and the American College of Surgeons rolled out recommendations in late April on how hospitals in certain parts of the United States could begin considering how to safely restore elective procedure caseloads. The American Hospital Association indicated its support for such an approach, noting, “This CMS guidance is clearly focused on addressing important healthcare needs for non-COVID-19 patients, with decisions being made by providers in

Michael Coleman is a contributing writer to O&P Almanac. EDITOR’S NOTE: This material is not intended, and should not be relied on, as legal advice. AOPA members should consult with their own counsel and financial advisors as needed.

O&P ALMANAC | MAY 2020

By CHRISTINE UMBRELL

Collaborative Care for Cerebral Palsy Orthotists play critical roles in integrated approaches to care and future breakthroughs

NEED TO KNOW • Orthotists play a key role in the treatment of cerebral palsy (CP)—the most commonly diagnosed childhood motor disability—and can benefit from working in collaboration with orthopedic surgeons, nurse practitioners, and therapists. • Bracing is typically the first intervention for children diagnosed with CP, and orthotists frequently fit these patients with ankle-foot orthoses, supramalleolar orthoses, or other types of braces, depending on their unique presentation. • Orthotists working with CP patients should be aware of any neurotoxin injections their patients are receiving for spasticity management, as well as upcoming surgeries, as bracing continues to play an important role between injections and postsurgery.

MAY 2020 | O&P ALMANAC

PHOTO: Getty Images/Ezra Bailey

• Research teams at several universities are studying cerebral palsy and looking at new ways to treat the disorder, investigating methodologies to prevent contractures and improve muscle strength.

HAT DO ORTHOTISTS NEED to

know about cerebral palsy (CP)? Quite a lot, according to the specialists who treat this pediatric population. The disorder is the most commonly diagnosed childhood motor disability in the United States, and approximately 10,000 babies are born with CP each year. About two-thirds of CP patients have the ability to walk and ambulate, but the vast majority of these patients require orthoses to provide a stable base for movement and establish a gait that is meaningful. Orthotists play an essential role in treating this significant patient population, as orthoses help build stability while increasing strength, comfort, and independence. Orthoses can be used to relieve several conditions, including knee or hip subluxation or dislocation, spastic movement, low-tone pronation, high-tone pronation, swing-phase inconsistency, drop foot, eversion, and more. Treatment protocols are evolving, with many patients prescribed orthoses in combination with medications, neurotoxins, and surgery. Understanding the latest treatment protocols and the benefits of interdisciplinary approaches can help orthotists optimize their roles in the care of CP patients.

Collaborative Care

Over the past three years, Natalie Wilson, MSOP, CPO, clinic manager at Active Life Inc. in Southern California, has fit hundreds of CP patients with orthoses. She has treated these patients as part of a collaborative team that includes Rachel Thompson, MD, a pediatric orthopedic surgery specialist, and Jill Yastishak, CPNC, a pediatric nurse practitioner, both of whom are affiliated with the University of California—Los Angeles (UCLA) and the Orthopaedic Institute for Children (OIC).

What Is Cerebral Palsy? Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. The most common motor

disability in childhood, CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles. The symptoms of CP vary from person to person, according to the U.S. Centers for Disease Control and Prevention. A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person’s lifetime. CP patients “can have different presentations depending on where damage to the brain occurs,” explains Natalie Wilson, MSOP, CPO, clinic manager at Active Life Inc. in Southern California. “Spasticity can manifest with velocity-dependent movements with involvement from the cerebral cortex, whereas low tone can appear with cerebellar legions.” While some patients present with just high or low tone, other patients present with dyskinetic or athetoid cerebral palsy, which is a mixture of high and low tone, stemming from the basal ganglion. “With this abnormal tone, we often have weaknesses, and impaired motor control with each patient,” leading to impaired speed, precision, and timing during the activities of daily living, explains Wilson. And with weakness and impaired motor control, “we have the possibility of contracture through muscle imbalances,” and bone growth leading to abnormal movement.

O&P ALMANAC | MAY 2020

Rachel Thompson, MD, evaluates a young patient who has cerebral palsy.

MAY 2020 | O&P ALMANAC

PHOTO: Rachel Thompson, MD

Wilson typically visits the base, and she appreciates the close OIC/UCLA clinic once a week relationships she has fostered with and sees about 20 to 30 kids each Wilson and other orthotists in treating time. “Probably half of them utilize CP patients. bracing … and utilize supports [such Although surgery can be an as handheld devices, standing frames, important part of treatment, “it’s or wheelchairs] either before or after not the surgeon who will make the surgery in simultagreatest difference,” says neous conjunction Thompson, who studied with neurotoxins,” gait analysis in residency she says. and fellowship and Wilson typically completed an orthotic is called in to see CP tuning course while in patients soon after orthopedic residency at their initial consult Northwestern. “With with Thompson. At a good orthosis, and that point, Thompson with a good orthotist and Yastishak will [skilled at tuning], you have completed an Natalie Wilson, MSOP, CPO can sometimes avoid initial clinical gait surgery—or at least analysis, measured range of motion, supplement the necessary surgery to and identified the patient’s gross gain the greatest functional benefits,” motor functional classification system Thompson adds. “The right orthosis (GMFCS) level on a scale of I to V. For can change everything.” patients who require orthoses, Wilson works closely with the team to select Beneficial Bracing the most appropriate device. For CP patients, bracing is typically the “We brainstorm to determine how first intervention. Patients are usually to make patients’ gaits as efficient as fit with orthoses as soon as they show possible,” says Thompson. As an ortho- an interest in weight bearing, says pedic surgeon specializing in CP, she Yastishak. realizes that “orthotists really underOrthoses help a child maintain stand the biomechanics” in this patient his or her level of mobility or correct

physical issues that are preventing the child from being fully ambulatory. “Our goal is to avoid surgery if we can,” says Thompson. “We know surgeries work, but they have a very high recurrence rate and a risk for overcorrection when they are done too young or in the wrong patient,” says Thompson. “So, we try not to operate before the age of 6, and we try to use bracing as much as possible.” Wilson and the team select a device after assessing patients’ balance and gait, tone, spasticity, and R1 versus R2 range of motion, and they choose a brace based on physical range of function, and what the patients’ joints are doing. “For our brace design, our main goals are to correct and prevent deformity,” Wilson says. “We want to protect the joints, decrease pain, facilitate upright posture … and just allow the child to be functional and to be a kid. …. We want to make sure they’re stable, they can clear the limb, and be as independent as possible, given their GMFCS level.” Patients can be fit with a range of braces—from foot orthoses up to kneeankle-foot orthoses (KAFOs). “AFOs and supramalleolar orthoses (SMOs) are definitely our most common,” says Wilson, “with AFOs being the most common.” Wilson often fits SMOs for hindfoot control for patients on the mild end of the CP spectrum, depending on their spasticity and range of motion. But she more frequently fits CP patients with either solid or articulated AFOs, depending on the physical presentation. In many cases, Wilson chooses custom-fabricated articulated AFOs that have inner liners and can control excess pronation or supination, or orthoses designed to control hyperextension. “We do like to use the inner boot when appropriate to provide more triplanar control as necessary,” she says, preferring the soft inner liner “because of the often-increased tone, and the high incidence of skin breakdown” among CP patients. “I try to utilize that or PPT foam inside of a polyethylene liner if they really need more of that triplanar control.”

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Thompson notes that most kids benefit more from AFOs compared to SMOs, and her team tends to avoid KAFOs. Even though CP patients don’t appear to be weak, their spasticity actually masks weakness. Thus, walking can be a challenge for CP

patients wearing heavy KAFOs—and they may choose not to walk at all if it becomes difficult. Rather than moving to a KAFO, Wilson will set in more dorsiflexion than is usual in an AFO, “to avoid [knee hyperextension and] the heaviness and bulkiness of

the KAFO,” says Thompson. Wilson recommends that orthotists keep an open mind when it comes to brace design because it is hard to know exactly which device will be the optimal choice for the individual patient. “You don’t always know what’s going to work for the patient,” or what will end up being too stiff, or too flexible. “We’re often … hoping something will work, and then it isn’t quite functionally [working] as well [as we had hoped], so we just switch to a different design.” Some companies offer a 90-day warranty for this purpose, which can be advantageous to orthotic practices that treat CP patients. In addition, “as kids are growing, Comprehensive care for cerebral palsy (CP) patients requires both hip walking, and going to a physical thersurveillance and spine surveillance, according to Rachel Thompson, MD, apist, their prescriptions can change, a pediatric orthopedic surgery specialist affiliated with the University of California— even though CP is not progressive,” Los Angeles (UCLA) and the Orthopaedic Institute for Children. says Wilson. “Even if an AFO worked when you delivered “Every child with cerebral palsy is at risk for hip dislocation or subluxit, with a dystonic ation,” says Thompson. Risk is tied directly to the patient’s gross motor patient, you may functional classification system (GMFCS) level. For children with lower need to switch GMFCS levels, or the less independently mobile patients, the risk of designs as the need having a hip dislocation is upwards of 80 percent. changes.” Because the risk is so high, Thompson and her team members In general, Wilson and Thompson take X-rays of CP patients every six to 12 months. “It seems like a prefer the “less is lot of radiation, but if we miss a hip that’s dislocated, it will be painful more approach” and debilitating and can cause a lot of … downstream effects like when it comes to all scoliosis, pelvic obliquity, difficulty with sitting, and difficulty with aspects of treatment Rachel Thompson, MD standing. It’s really important that these children do get monitored for CP patients. “We for these dislocations.” like to provide as minimal support or low-profile support as possible to also Monitoring patients’ spines also is critical. “We don’t have to get X-ray surveillance keep their max function available,” says because you can see the spine in these children,” Thompson says. Treating scoliWilson. When patients are able to stay osis early is important because scoliosis can lead to limitations in sitting tolerance, upright, “we can increase their bone compression of the trachea, swallowing difficulty, and aspiration, she explains. density and stretch those muscles” Scoliosis treatment plans vary according to ability level. For children who are while keeping patients at eye level primarily using a wheelchair, “we use the wheelchair modifications,” says Thompson. with their peers, she adds. “Leg length discrepancies are not uncommon, “We don’t necessarily like a thoracolumbosacral brace on top of a wheelchair” so we want to monitor those as well because these patients often present with respiratory or gastrointestinal difficulties, because we want to make sure the hips “so we don’t want to put something constrictive on top of them.” and spine are balanced.” But TLSOs are an effective treatment for patients at the

Hip and Spine Surveillance: Part of the CP Treatment Plan

lower GMFCS levels. “Children with cerebral palsy who are ambulatory and have scoliosis can be managed similar to adolescent idiopathic scoliosis,” Thompson says. “Treat them with a well-fitting TLSO worn, depending on how old they are, for 12 to 23 hours a day.” Patients with curves that are too stiff, or too large for nonoperative management, typically require surgery.

MAY 2020 | O&P ALMANAC

Role of Neurotoxins and Surgery

Orthotists working with CP patients should be aware of any neurotoxin injections their patients are receiving for spasticity management. Neurotoxins derived from Botulinum toxin A do not affect the orthotic treatment plan or how an orthotist makes a device,

A 3-year-old boy with spastic diplegic cerebral palsy undergoes bilateral gastrocnemius and soleus Dysport injections.

New Treatments on the Horizon

PHOTO: Jill Yastishak, CPNP

“but they do help reduce spasticity, so patients can get a more increased range,” Wilson says. “So, it’s important to know the timing of the injections.” At the UCLA/OIC clinic, many of the patients are treated with either Botox or Dysport, often administered by Yastishak. Prescribed to reduce energy output, retain muscle length, and prevent development of worsening contractures, these neurotoxins are commonly injected into the gastrocnemius or soleus muscle, but can be used for other muscle groups showing excessive, function-limiting, spasticity. This procedure can help delay the need for surgery until after a child has turned 6. In the past, the clinic administered neurotoxins several times a year, but the frequency has been reduced in accordance with new research findings. “We used to give neurotoxins every three to four months if we were seeing a benefit, beginning with patients who were showing an interest in walking” but who could not get their heels on the ground or into braces to weight bear or achieve mobility, says Yastishak. After a July 2019 study demonstrated that neurotoxins can achieve the same benefits, with fewer side effects, if injected annually instead of quarterly, Thompson and Yastishak began following the one-year guideline, when possible. “One injection

Research teams at several universities are studying cerebral palsy and looking at new ways to treat the per year has the same disorder. Thompson is involved in positive benefits but prevents some of these efforts at UCLA. Her against excessive muscle atrophy current research initiative involves and reduces scarring of the muscle,” defining the timeline for muscular explains Yastishak. changes. “There’s a time between age For patients who require surgery, 1 and age 10 where these contractures Thompson chooses from four types [in CP patients] are getting worse,” she of procedures, depending on the explains. “If we can figure out when patient’s presenaffected muscle begins tation: muscle or to lose satellite cells and tendon lengthening; become fibrotic, perhaps a tendon transfer; we can intervene. guided growth; or “If we can figure out osseous reconstructhe molecular pathway tion. Regardless of the that starts these chilprocedure, bracing dren on a road to having continues to play fibrosis and contractures, an important role maybe we can develop an postsurgery. “Patients injectable biologic agent usually have the [to] keep those muscles Jill Yastishak, CPNP same tone and spashealthy and without ticity even though surgery helps with the fibrosis, so that we can maintain the range” of motion, says Wilson. “So, their ability to grow normal, healthy they usually stay in the same type of muscle,” preventing the need for orthotic device” after surgery. surgery, she says.

Jill Yastishak, CPNP, spoke about cerebral palsy during the 2019 AOPA National Assembly as part of a panel of speakers that included Spencer Doty, MBA, CPO; Rachel Thompson, MD; and Natalie Wilson, MSOP, CPO. O&P ALMANAC | MAY 2020

Treating CP Patients During a Pandemic Natalie Wilson, MSOP, CPO, was able to continue seeing some of her patients for essential visits, including patients with cerebral palsy (CP),

during the COVID-19 pandemic—thanks to

careful planning and stepped-up safety practices.

During the stay-at-home mandate in California, Active Life Inc. was open

and operating, and staff saw patients whose visits could not be delayed, explains Wilson. “We did a lot of telehealth, and were open on an emergency basis,” she explains.

Several of Wilson’s patients underwent CP-related surgeries right before

the stay-at-home orders were mandated, so she saw these patients during

their cast changes postsurgery to fit them with proper orthoses. She also saw

new patients at Active Life who had been seen by physicians via telemedicine appointments and had been referred to Wilson for orthoses.

Active Life implemented several key measures to

keep patients safe during essential visits. Clinicians were asked to practice at only one of the company’s 10 loca-

tions instead of traveling among facilities. Each clinician

treated patients in one assigned patient room, rather than switching rooms throughout the day, says Wilson. Staff

followed the guidelines for healthcare providers published

by the U.S. Centers for Disease Control and Prevention, including disinfecting all areas and instruments, maintaining six feet of distance among patients in the waiting area, and requiring the use of personal protective equipment for

clinicians—including gloves and N95 masks. Staff also asked all visitors a set of screening questions to identify any patients who could have COVID-19.

“We know that the abnormal neurologic input is clearly causing downstream changes. There is certainly a known decrease in satellite cells that prohibits normal muscle growth and results in weakness, but there is also something happening with the non-contractile portion of the muscle that we’ve been thus far ignoring, and that’s what’s really causing the fibrosis,” Thompson adds. Her team is currently studying muscle samples from children and comparing the muscles of CP versus non-CP children, seeking a way to perhaps intervene and stop the fibrosis and muscle atrophy before they start, to prevent contractures and 36

MAY 2020 | O&P ALMANAC

improve muscle strength. In addition, Thompson’s team is developing a mouse model to study how CP muscles are affected by neurotoxins as well as other questions—such as, “What does selective dorsal rhizotomy do? What does orthopedic surgery do? What if we create a biologic where we use collagenase, and we try to just kill all of the collagen? Does that work? “Hopefully, we’ll have some better ways to treat CP in five to 10 years,” Thompson says. “But that doesn’t negate from the fact that we have a lot of work to do as orthopedic surgeons and orthotists in the meantime.”

Team Building

Relationships are key when working with CP patients, who have very different needs than pediatric patients who wear braces for shorter periods of time. “You get to follow patients long-term and form relationships,” says Thompson. “You get to help ensure that every patient has as much independence and human dignity as possible.” Orthotists play an instrumental role in treating this patient base and should consider building more collaborative relationships with orthopedic surgeons and rehab teams to optimize treatment. “I would encourage orthotists to have more of a one-on-one relationship with referring doctors so you can get a better understanding of the whole treatment,” says Wilson. Both healthcare providers and the patients themselves benefit from a collaborative approach, such as the relationships established at the UCLA/ OIC clinic. “Everything is all in one location,” says Wilson. “We can talk immediately about patient care. And it’s easier for parents to keep track” of patient information and appointments. “Cerebral palsy specifically is one of those diagnoses that you shouldn’t be practicing in a vacuum,” Thompson adds. “I appreciate everything that [orthotists] bring to the table to really help out our children, and make it easier for me to do my surgical job.” By working across disciplines, CP patients have the best chance of maintaining stability and mobility. “No matter what orthosis we put you in, no matter what orthopedic surgery we do, you’re still going to have poor motor control and differences in tone,” says Thompson. “We can’t expect to fully change the way that this child walks, but we can at least give them aids to help put them in the best, most effective position, knowing that we’re fighting against a neurological disease that we don’t yet have a treatment for.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

As social distancing keeps us apart, we all stand strong in our mission to serve — making us more united than ever.

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PRINCIPAL INVESTIGATOR

Turning Point Sheila Clemens, PhD, MPT, PT, investigates the separate tasks involved in Timed-Up-and-Go tests

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

MAY 2020 | O&P ALMANAC

FEW YEARS AGO, Sheila Clemens,

MPT, PT, decided to take her 25 years of experience in physical therapy to the next level. After spending more than two decades as a physical therapist (PT), she sought a PhD in physical therapy from the University of Miami, eventually becoming both an educator and a researcher at Florida International University (FIU). During her doctorial studies, Clemens completed a dissertation under the advisement of Bob Gailey, PhD, PT. Funded jointly by the U.S. Department of Defense and the Department of Veterans Affairs (VA), the project that served as the source of Clemens’ dissertation data has resulted in three publications so far. “My research colleagues and I worked to collect data on a modified administration of the Timed-Up-and-Go (TUG) test,” she says. Called the Component Timed-Upand-Go (cTUG), the new test is performed the same as the traditional TUG from the patient’s perspective, but the clinician times the test in a way that provides separate times for each of the functional tasks of the TUG: 1. Sit-to-stand and gait initiation 2. Walk to the turn 3. 180-degree turn 4. Walk back to the chair 5. Turn to sit.

In addition to timing the individual tasks, the clinician administering a cTUG also records a total time. “This provides the clinician with more information about how the patient is performing basic prosthetic mobility tasks commonly performed throughout the day,” Clemens explains. As a follow-up to this work, she spoke about the modifiable rehabilitation variables that can affect cTUG performance times during a free paper session at the annual meeting of the American Academy of Orthotists and Prosthetists (AAOP) earlier this year.

Growing Interest in Limb Loss Patients

Clemens, who completed her undergraduate and master’s studies at Michigan State University and the University of Michigan, began to focus more closely on limb loss patients after about 10 years in PT practice. “I always enjoyed treating more complex patients, with my outpatient practice consisting of both a neurological and orthopedic population,” she explains. “I decided that people with limb loss seemed to be a combination of complexity, along with the potential for high functionality. I was very lucky that a few prosthetists noticed my interest and talent for dealing with prosthetic patients.” These prosthetists

PHOTO: Sheila Clemens, PhD, MPT, PT

PRINCIPAL INVESTIGATOR

PHOTO: Sheila Clemens, PhD, MPT, PT

encouraged her to specialize in working with patients with amputations. A few years ago, Clemens returned to academia to pursue a PhD in physical therapy, with a goal of “working on research projects that can translate to clinical practice” and becoming more effective at treating patients with amputations. “I know what is important to clinicians and want to help them to improve how they rehabilitate amputees,” she says. “Because I have been fortunate enough to work with engineers in my research, I am able to bring a clinical physical therapist’s perspective to the laboratory to things that otherwise may not have clinical practicality.” Clemens was awarded her PhD from University of Miami in 2017. Today, she embraces two key roles: as an assistant professor in the Department of Physical Therapy at FIU and as a research health scientist at the Bruce W. Carter VA Medical Center in Miami. “As a tenure-earning assistant professor, my responsibilities are primarily

Sheila Clemens, PhD, MPT, PT, fourth from left, with her DPT students at their research poster at a physical therapy national conference in February in research and teaching activities,” she explains. She leads several PT students in research projects each year and teaches in an interdisciplinary classroom of both PT and O&P graduate students. “FIU has re-established its orthotics and prosthetics program through the Department of Biomedical

Engineering and has partnered with the PT program in instructing the O&P students for a portion of their graduate curriculum,” she explains. This partnership educates students from two different professions and enables them to learn important aspects of each other’s respective occupations.

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PRINCIPAL INVESTIGATOR

Optimizing Treatment Plans

Clemens supplements her instructional duties with various research projects. In addition to her cTUG work, she has investigated using mobile technologies— such as portable instrumented walkways and wearable sensors—to collect gait data on people with unilateral lower-limb amputation. Clemens also is interested in developing new gait parameters to examine segmental symmetry and repeatability, and in investigating health disparities in people with dysvascular amputation. She spoke on the topic of sensor-based segmental gait symmetry and repeatability measures during the AAOP meeting in March, and she plans to continue to pursue funding for both topics. “Ideally, my research will lead to better understanding about what affects gait symmetry measures and turning ability in all amputees,” she says. “However, this research will be focused on our veteran population, both male and female.” She also plans to study the effect of social, environmental, and financial barriers on mobility and self-efficacy in people with lower-limb amputation. She hopes these studies will provide service to a potentially underserved population of minorities,

specifically blacks and Hispanics. Clemens believes this type of research may advance the needs of O&P patients where reimbursement is an issue. “All research, if done well, can contribute to strengthening arguments by practitioners when addressing thirdparty payor issues,” she says.

Call for Collaboration

Clemens hopes to see more O&P, PT, and related healthcare professionals conduct studies that will help patients achieve more optimal gait. “There are few to no randomized control trials in the limb loss literature,” she says, “and to answer many questions, we need to put effort into running those types of experiments.” While it is difficult to recruit large samples of subjects for amputee research, Clemens believes that addressing the topic of symmetry/ asymmetry in prosthetic gait “will give us a better understanding of what our expectations should be for

Notable Works Sheila Clemens, PhD, MPT, PT, is the author or presenter of dozens of peer-reviewed articles and conference presentations. Some of her most impactful contributions include the following: • Clemens, S., Kim, K.J., Gailey, R., Kirk-Sanchez, N., Kristal, A., Gaunaurd, I. “Inertial Sensor-Based Measures of Gait Symmetry and Repeatability in People With Unilateral Lower Limb Amputation.” Clinical Biomechanics, 72: 102-107, 2020. Epub ahead of print.

• Clemens, S.M., Gailey, R.S., Bennett, C.L., Kirk-Sanchez, N.J., Pasquina, P.F., Gaunaurd, I.A. “The Component Timed-Up-and-Go Test: The Utility and Psychometric Properties of Using a Mobile Application To Determine Prosthetic Mobility in People With Lower-Limb Amputations.” Clinical Rehabilitation, 32(3):388-397, March 2018.

MAY 2020 | O&P ALMANAC

PHOTO: Sheila Clemens, PhD, MPT, PT

• Clemens, S.M., Klute, G.K., Kirk-Sanchez, N., Raya, M., Kim, K.J., Gaunaurd, I.A., Gailey, R.S. “Temporal-Spatial Values During a 180-Degree Step Turn in People With Unilateral Lower Limb Amputation.” Gait & Posture, 63: 276-281, June 2018.

our patients,” she explains. “Is symmetry achievable—and if it is, is it the most functional gait for a prosthetic wearer? What are the primary causes of asymmetry? Are there potential biomarkers for recovery in our amputee patients related to symmetry? So many questions!” Working with students allows Clemens to ignite a spark—one that may lead to more research endeavors among the youngest healthcare professionals. “Exposing PT and O&P students to gait biomechanics and amputee rehabilitation and research in my graduate courses is preparing the next generation of students in a unique way that may not be found in other programs,” she says. “I am able to get the students hands-on practice of techniques by bringing in former patients and study participants to the classroom, providing valuable experience” before they head out to clinics. Her affinity for students extends into her personal life, as well— Clemens has three college-age sons, two of whom are identical twins. And while she loves FIU, she remains incredibly passionate about her alma mater—Michigan State University. She follows the school’s basketball and football teams, and “it ruins my day if they don’t win!” she says. “I literally check the sports schedules during their seasons before I commit to any personal or professional events.” She also enjoys traveling with her family and doing yoga. As she continues to inform, educate, and investigate, Clemens plans to keep her focus on studying gait and improving quality of life for amputee patients.

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MEMBER SPOTLIGHT

Bluewave Technologies

By DEBORAH CONN

Healthier O&P Company’s product leverages ozone to kill bacteria

HE FIVE FOUNDERS OF

MAY 2020 | O&P ALMANAC

Bluewave Technologies team, from left, Justin Zhou, PhD, Ken Cherisol, Miles Clark, and two technicians

COMPANY: Bluewave Technologies OWNERS: Privately held LOCATION: Orange City, Florida, and New York City HISTORY: Five years

Bluewave device

Technicians solder parts of the Bluewave device.

between five and seven minutes to deodorize an object and about 25 minutes to reduce bacteria. Clark says the Bluewave can kill MRSA bacteria—Methicillin-resistant Staphylococcus aureus—and is currently being tested on viruses. “We developed a great product with so many applications, but we needed to find the right market for it,” says Clark, who is chief strategy officer of the company. “We considered marketing to healthcare workers who wanted to clean and deodorize their clothing after shifts, and we also thought about cleaning sports equipment.” Fortunately, Zhou, the company president, met Paul Prusakowski, CPO, owner of Gainesville Prosthetics and Orthotics in Florida and founder of OPIE Software, at a Christmas party. It was Prusakowski who persuaded the Bluewave team to make the device available to O&P practitioners. Within five days of hearing about it, Zhou and his co-founders were at the 2018 annual meeting of the American Academy of Orthotists and Prosthetists in New Orleans. “We demonstrated the units and got a great response,” Clark says. “We realized this was a good market for us, both because it served an important need and because it could lead to future healthcare applications.”

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

PHOTOS: Bluewave Technologies

Bluewave Technologies met more than a decade ago, working in research and development for a startup company that made electrochemical devices. Eventually they left that company and pursued different directions: Miles Clark attended law school, Ken Cherisol studied advanced electrical engineering, and Justin Zhou sought a PhD in material science. Meanwhile, Julius Regalado was playing with an idea for deodorizing his girlfriend’s old, moldy boots. “Julius came up with a prototype in a kitty litter box that worked,” says Clark. “It wasn’t at all suitable for commercial purposes,” but Regalado took that idea and worked with Cherisol and Zhou to develop it. Since Clark was studying intellectual property law at the time, he came on board to write the patent application, then became involved in the invention and product development as well. “Ken and I spent a lot of time in his garage making the first units we sold,” he recalls. The result was the Bluewave device, a machine that can deodorize objects and kill the bacteria causing odors using infusions of ozone. An operator places the item to be cleaned in a special bag that is attached to the Bluewave machine. The device extracts the air in the bag and replaces it with highly concentrated ozone, repeating the vacuuming-and-inflating process multiple times. “The ozone creates oxidation reactions that kill bacteria and viruses,” explains Clark. “But ozone isn’t good to breathe, so we made it a closed-loop system that is safe to use inside.” The process takes

Today, Bluewave has five employees: Clark; Cherisol, chief technology officer; Zhou, president; and two techs who help manufacture the devices. Regalado and Lester Hammond II, another early co-founder, continue to hold stakes in the business but no longer work for the company. Bluewave’s manufacturing site is in Orange City, Florida, and Zhou handles investor relations and some healthcare business development from an office in New York City. At this point, the Bluewave is classified as a pesticidal device that kills bacteria. But, given the recent pandemic related to the coronavirus disease (COVID-19), the company would like to expand its scope. “Some of the literature we’ve read discusses the effect of ozone on all kinds of microbes. We’ve tested it on one virus, the MS2 bacteriophage, and it killed the virus in about 10 minutes.” Because guidelines from the U.S. Food and Drug Administration (FDA) indicate that nonenveloped or “small” viruses, like MS2, are typically harder to kill than enveloped or “lipid” viruses, like coronaviruses, the company is optimistic about being able to apply the Bluewave in the current crisis. Clark is reaching out to the FDA and other regulatory bodies to start and perhaps speed the process of conducting trials and gaining approval. “We have both a moral and a business obligation to help mitigate the human and economic damage caused by the pandemic,” he says. Eventually, Bluewave would like to expand to such areas as physical therapy, podiatry, and sports medicine while maintaining a commitment to its core O&P market. “In the meantime,” Clark says, “we are trying to help out as best we can.”

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AOPA NEWS

AOPA Offers COVID-19 Responses, Guidance, and Resources AOPA leadership has continued to closely follow the spread of the coronavirus disease (COVID-19) and its widespread impacts. We also have been taking your calls and emails and hearing firsthand how extremely difficult and uncertain things are for you, your businesses, and your patients.

To that end, we are responding with support. We are responding with outreach to legislators about how they can best support the O&P profession. We are responding by providing guidance on regulations like documentation, telehealth, and stay-at-home orders. We are responding by pulling together resources. We are responding by creating a space on the Co-OP to share your experiences and strategies with one another. All of this information can be found on the newly developed COVID-19 Response and Resources webpage, www.AOPAnet.org/resources/covid-19/. We will be updating this webpage frequently with actions, guidance, and resources, and will be pushing out updates via email, Smartbrief, and AOPA’s social media channels. As the situation evolves daily, we encourage you to also follow the guidance being issued from the Centers for Disease Control and Prevention (CDC), the World Health Organization, and your local, state, and federal government. The CDC website features resources and guidance for healthcare facilities; visit www.cdc. gov/coronavirus/2019-ncov/healthcare-facilities/. Thank you for all you continue to do for your patients and the O&P profession. The AOPA Board of Directors and staff are here to support you. If you have questions, concerns, or needs, do not hesitate to reach out to any of the staff at info@AOPAnet.org.

MAY 2020 | O&P ALMANAC

COPL RFP Deadline Extended to May 21 To accommodate the disruptions caused by COVID-19, AOPA has extended the deadline for the Center for Orthotic and Prosthetic Learning and Outcomes/ Evidence-Based Practice’s (COPL’s) 2020 Request for Pilot Grant Proposals to May 21, 2020. COPL is seeking proposals in 10 potential areas of orthotic and prosthetic research, including an open topic at two funding levels for one-time grants, $15,000 and up to two exceptional proposals for $30,000 for one year. Preference will be given to grants that address evidence-based clinical application in orthotics and prosthetics. View the RFP topics, guidelines, and application on AOPA’s website. Contact AOPA’s director of strategic alliances, Ashlie White, with any questions at awhite@AOPAnet.org or 571/431-0812.

AOPA Offers Members Free Access to AOPAversity AOPA knows you and your employees are being tremendously impacted by COVID19. To help, we are offering you, our AOPA ACCESS members, the ability to access our online learning management system, AOPAversity, for free for the rest of 2020. It is our hope that this will make it easier to navigate the current unprecedented situation. What does this mean? You and your employees can now access all 72 online offerings, which are prerecorded videos available on demand. That’s 33 business offerings worth 34.5 Business Credits and 39 clinical offerings worth 60.5 Scientific Credits—all for free. If you do not currently have an AOPAversity account, visit www.AOPAnetonline.org/aopaversity/register to create a profile. You will need your AOPA member ID and the Zip code affiliated with your membership when you create your profile to access the free offering. Already have a profile? Log in at www.AOPAnetonline.org/aopaversity. Your username is the email used to create your profile. This offer is valid through Dec. 31, 2020, and excludes any refunds to purchases made prior to the start of this offer. We hope this benefit offers you additional support during this uncertain time. Contact Ryan Gleeson at rgleeson@AOPAnet.org with any questions.

FREE

AOPA NEWS

Co-OP

Webinars U P C O M I N G W E B I N A R / / U P C O M I N G W E B I N A R / / NU E WP C O M I N G W E B I N A R

WEDNESDAY

Clinician’s Corner: Prosthetics

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

JUNE 10

SCIEN

TIFIC C

REDITS

UPCOMING WEBINAR // UPCOMING WEBINAR // UPCOMING WEBINAR

WEDNESDAY

JULY 8

The ABCs of Appeals: Know the Players and Get the Tips

DME MAC … QIC … ALJ … and so many more! Learn the ins and outs of the five levels of the Medicare appeals process, including what type of claims can and cannot be appealed. You’ll find out the best way to craft an agreement to ensure success in your appeal. Log on July 8 to decipher the acronyms and hear what the experts have to say.

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

Don’t Sleep on the Latest AOPA Member Resource

RE YOU UTILIZING YOUR AOPA MEMBERSHIP? Attend

the upcoming live tutorial to learn about one of the best resources available for O&P practices, the AOPA Co-OP. A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. This searchable database provides up-to-date information on developments in Medicare policy, state-specific legislation, private-payor updates, and more. Members can access detailed information on everything from modifiers to product-specific L codes and associated policies. Register for the next Co-OP Live Tutorial hosted by AOPA Director of Strategic Initiatives Ashlie White, who will demonstrate how to use the Co-OP and answer all of your questions. Any employee of an AOPA member firm is welcomed to join this free tutorial. Co-OP Live Tutorial Webinar • Friday, May 15 • Friday, June 19 Registration at bit.ly/Co-Op2020.

NEW MEMBERS

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of the American

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

Phoenix Molded Shoes, Inserts, & Braces 3743 Kenilworth Avenue Sebring, FL 33870 863/658-2621 Supplier

SOLA Prosthetics Inc. 4541 N. Josey Lane, Ste. 240 Carrollton, TX 75010 972/ 492-7652 Affiliate

O&P ALMANAC | MAY 2020

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific Certified Orthotist/Prosthetist

Job location key:

Alaska Work and Play in Alaska

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

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

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

O&P Almanac Careers Rates

Website: www.northo.com

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.

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.

MAY 2020 | O&P ALMANAC

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

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

Website: www.northo.com

CAREERS

WANTED!

Pacific CO/CFo

Pleasant Hill, Oakland, East Bay Area, California Collier O&P is a full-service orthotic and prosthetic patientcare facility with on-site fabrication. We are searching for a CO/CFo. The appropriate candidate will operate in a multioffice environment, so some travel is required. We offer a competitive salary/benefit structure commensurate with experience; it includes health, vacation, continuing education, and 401(k). Email your résumé to:

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

Email: john@collieroandp.com Website: www.Collieroandp.com

Ca reer Opportunities... California

CPO-Modesto CPO-Salinas

Washington

CO or CPO–Wenatchee CO or CPO-Richland Oregon CPO - Portland To apply, submit resume to:

ca reers@pa cmedica l.com

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services. The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others. A competitive salary, benefits and profit sharing are offered based on position/experience.

Ou r C u l t u re & C om m i t m e n t “ We w i l l s e rve a n d h e l p oth e rs g row p e rs on a l l y , p rofe s s i on a l l y , a n d s tri ve to p u t oth e rs n e e d s fi rs t a n d fore m os t a s d e m on s tra te d b y ou r p os i ti ve a tti tu d e , te a m w ork a n d p rofe s s i on a l i s m . ”

O&P ALMANAC | MAY 2020

MARKETPLACE

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

Kleenaire Charcoal Filtered Air Purification System

Affordable alternative to purify the air. • Designed for easy installation. » Mount the Kleenaire on a wall and plug it in. • Pre-Filter—Aeropleat filter will remove many contaminants. • Charcoal Filter—The activated carbon absorbs odors and irritants. Remove unpleasant and perhaps unhealthy contaminants from the environment. For more information, contact Coyote Prosthetics and Orthotics at 208/429-0026 or visit www.coyotedesign.com.

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

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

MAY 2020 | O&P ALMANAC

Pediatric Formula The Formula foot is the ideal balance of flexibility and power. A first of its kind, the Pediatric Formula is a highperformance, customizable, pediatric foot that grows with the child. The long, lightweight carbon pylon provides critical energy return through the posterior attachment, while the compact shape of the ankle simplifies cosmetic finishing without hindering performance. The Standard and Custom Pediatric Formula feet are transforming pediatric prosthetics for kids who require exceptional performance and flexibility. Let them be little. Let them play big! For more information including product manual and order form, visit Fillauer.com/products/pediatric-formula .

Adjustable Alignment Bracket The Adjustable Alignment Bracket is designed to make it easier to fit and align posteriorly mounted feet like the Formula or Allpro. The bracket is for in-clinic fitting only—it is not a permanent mounting solution, but rather a fitting tool. The bracket is compatible with the Formula and AllPro Posterior Mount feet. Order yours at Fillauer.com.

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

MARKETPLACE Agilium® Vantage Knee OA Brace from Ottobock

Announcing the Newest Unloader One® Brace From Össur

Meet the Agilium Vantage, a low-profile, wraparound knee brace designed to provide lasting pain relief for patients with mild to moderate unicompartmental osteoarthritis. Key features: • Dynamic Y force strap system unloads the knee with a single pull • Adjustable, numbered closure straps for patient compliance • Trimmable sleeves reduce inventory to only three sizes.

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

Give your patients less pain and more life with the Agilium Vantage. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

DynamicArm Myoelectric Elbow From Ottobock Give your patients the natural movement and power they need in a myoelectric transhumeral prosthesis! The DynamicArm Elbow combines a sophisticated microprocessor technology with a powerful electric motor to help users precisely position their elbow, all while lifting up to 11 lbs. Additional benefits: • Infinite locking positions • Natural and nearly silent free swing • Minimal operating noise • Ability to shorten forearm to minimum length of 187 mm • Speed of up to 268 degrees/second to mimic physiologic movement • Up to six simultaneous digital inputs. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

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

Spinal Technology Inc. Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis. For information, contact 800/253-7868 or visit www.spinaltech.com. O&P ALMANAC | MAY 2020

MARKETPLACE

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

MAKING LIVES BETTER

Tel: 727.528.8566 Tel: 800.574.5426 www.easyliner.com info@easyliner.com

Play like a pro.

Support for Better Life! allardusa.com

Meet the AllPro: the most naturally active, flexible, energy-returning foot from Fillauer.

info@allardusa.com P: 888-678-6548 F: 800-289-0809 50 MAY 2020 | O&P ALMANAC AD_AOPA_Product_Directory_FEB2019.indd 1

2019-02-11 08:05:32 AllPro Quarter.indd 1

3/25/20 9:02 AM

MARKETPLACE

PERSONAL. INTUITIVE. COMPLETE CONTROL. Our Gen2 System is the industry best in pattern recognition technology

DISTRIBUTION REIMAGINED Product Selection • Customized Solutions • Excellent Service

www.cascade-usa.com | 800-888-0865

coaptengineering.com

INNOVATION IMPLEMENTATION TRAINING Offering the most advanced Ponseti Method clubfoot braces in the industry. Providing unsurpassed customer service and support throughout the entire clubfoot journey. Developing hands-on training tools to better equip practitioners around the globe. Enabling children with clubfoot to take the Next Steps 2 New Feet — that’s the MD Orthopaedics way!

orthopaedics

w w w. m d o r t h o p a e d i c s . c o m O&P ALMANAC | MAY 2020 AOPA directory.indd 2

3/24/2020 2:02:53 PM

MARKETPLACE

Working Together for Better Outcomes WillowWood is committed to partnering with clinicians to drive innovation and improve the quality of care for amputees.

Watch Video. Pass Test. Earn CEUs. SPS is here to make your job easier, which means having continuing education available at your fingertips. Expand your skills at your own pace by enrolling in SPS Online CEU Courses today. To get started, visit

info.spsco.com/ceu 800.848.4930 www.willowwood.com

800.767.7776 | SPSCO.COM

2020_ 3.5x4.5'' Corporate Ad.indd 1

AD INDEX

3/30/2020 9:58:43 AM

Advertisers Index Company Allard USA

Page Phone 19

American Board for Certification in Orthotics, Prosthetics, & Pedorthics 37

866/678-6548

www.allardusa.com

703/886-7114

www.abcop.org

Amfit

5 800/356-3668

www.amfit.com

Cascade Dafo Inc.

www.cascadedafo.com

Coyote Design

800/819-5980

www.coyotedesign.com

ESP LLC

888-WEAR-ESP

www.wearesp.com

Fillauer Companies Inc.

Website

7, 27

800/848-7332

800/251-6398

www.fillauer.com

Hersco

1 800/301-8275

www.hersco.com

Naked Prosthetics

888/977-6693

www.npdevices.com

Ă&#x2013;ssur Americas Inc.

800/233-6263

www.ossur.com

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

11 855/450-7300

www.proteorusa.com

Surestep

39 877/462-0711

www.surestep.net

Spinal Technology Inc.

www.spinaltech.com

MAY 2020 | O&P ALMANAC

800/253-7868

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

and we need your talent. Employees of all AOPA member companies are invited to serve on one

•

Government Relations Contributions/Fundraising

of AOPA’s Committees and/or Workgroups. From

•

Government Relations Committee

planning the National Assembly to driving the O&P

•

Member Services Committee

research agenda to developing our legislative

•

Operating Performance and Compensation Workgroup

strategy, there is something for everyone. Find a

•

Research Committee

Committee and/or Workgroup that interests you,

•

State Representatives

and submit an online application on the Call for

•

Veterans Affairs Committee

IP H A S I T S B E

ADVOCACY

R BE

Volunteers webpage today!

Don’t miss this exciting opportunity to become

involved in the O&P profession

RESEARCH EDUCATION

by supporting AOPA and your fellow colleagues! Terms of service are two-years and will begin December 1, 2020. 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, 2020

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

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

CALENDAR

technicians in 350 locations nationwide. Contact 703/8367114, email certification@ABCop.org, or visit ABCop.org/ individual-certification.

June 10

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

June 12

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

Cascade Dafo Institute

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

2020

Kentucky Orthotic & Prosthetic Association (KOPA). The 2020 conference will be held online. For more information, visit www.kyopa.net/education.html.

June 19 WEBINAR

July 1

ABC: Application Deadline for Fall CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/ individual-certification.

July 1

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

May 13 WEBINAR

visit www.AOPAnet.org.

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

July 8 WEBINAR

visit www.AOPAnet.org.

May 13–15

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

June 1

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

June 8–13

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and 54

MAY 2020 | O&P ALMANAC

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

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

July 20-21 SEMINAR

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

July 23–25

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

July 30–August 1

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

CALENDAR

July 31–August 1

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

September 24-26 (New rescheduled date)

Texas Society of Orthotic & Prosthetic Professionals (TXSOP) Meeting (formerly TAOP and TXAAOP). Rescheduled from June. Richardson, TX. For more information, visit www.txsop.org/annual-meeting.html.

October 3

August 1

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

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

October 8-10

August 1

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

South Carolina Society of Orthotists and Prosthetists (SCSOP) NC/SC Combined Meeting. SCSOP hosting. Greenville, SC. For more information, visit https://scsop.org.

October 14

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

August 1

Application Deadline for ABC/OPERF Resident Travel Award. Four residents will be selected to present their Directed Study Research project at the 2020 Academy Annual Meeting and receive $2,500 plus complimentary meeting registration. For more info or to apply, go to operf.org.

October 15-17 (New rescheduled date)

Tennessee Society of Orthotists and Prosthetists (TSOP) Annual Meeting. Rescheduled from April. Embassy Suites Nashville Airport, Nashville, TN. For more information, visit www.tennsop.org.

August 12 WEBINAR

www.AOPAnet.org.

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

November 4–6

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

September 2

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

November 9-10

WEBINAR

SEMINAR

November 11

September 9–12

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

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

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

WEBINAR

visit www.AOPAnet.org.

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

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

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

O&P ALMANAC | MAY 2020

STATE BY STATE

State-Level Advocacy News from California, Kansas, Massachusetts, New York, and Pennsylvania

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.aopanet.org/resources/co-op.

California The California Orthotic and Prosthetic Association (COPA) has been pursuing an initiative to address the Medi-Cal reimbursement rates that have remained unacceptably low and unchanged for several years. In a recent letter to members, COPA President Maynard Carkhuff wrote, “Our goal is to increase all Medi-Cal Healthcare Common Procedure Coding System reimbursement levels from 51 percent to the national state average of 75 percent of the prevailing Medicare allowable fee schedule. We believe this is essential to restoring incentives that ensure O&P care for these socially vulnerable patients. We know that a united industry voice matters, and we hope you will join in supporting this effort by your direct participation in these activities.” 56

MAY 2020 | O&P ALMANAC

Kansas

AOPA has submitted a policy review request to BlueCross BlueShield (BCBS) Kansas regarding the policy titled Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses, due to contradictions in the policy language that are resulting in the inconsistent processing of claims and subsequent denials, which are unsupported by the scientific references cited in the policy.

Massachusetts

Members in Massachusetts are working with AOPA to research restrictive policies related to microprocessor-controlled prosthetic feet. Several policies, including BCBS Massachusetts and Tufts Health Plan, include experimental or investigational language associated with these types of prostheses. AOPA and Massachusetts members will be submitting policy reviews in the coming weeks.

New York

AOPA is working with members in New York to develop a letter-writing campaign to request that policy makers in the state adjust the Medicaid fee schedule. Members report that there have been no increases to the O&P fee schedule in 33 years, and beginning Jan. 1, 2020, an across-the-board Medicaid payment reduction of 1 percent was applied to all fee-for-service payments.

COVID-19 Updates AOPA is maintaining statespecific updates related to the coronavirus disease (COVID-19) on all state pages of the Co-OP. Please visit your state’s page for additional information. This campaign will take significant support from members on the ground in the state. Please comment on the Co-OP or email jbeland@AOPAnet.org and awhite@AOPAnet.org to share feedback regarding this effort or to get involved.

Pennsylvania

Eileen Levis provided the following update on telehealth in Pennsylvania: “On March 18, 2020, the governor’s office issued directives with regard to telemedicine. Among the boards listed approved for telemedicine was the Pennsylvania Board of Medicine. As orthotists and prosthetists are licensed under this board, we believe telehealth services to be appropriate use for those licensees.”

Submit Your State News

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

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