Combined June & July 2020 O&P Almanac by AOPA

EXCLUSIVE OUTSERT! 2020 AOPA VIRTUAL NATIONAL ASSEMBLY PRELIMINARY PROGRAM

The Magazine for the Orthotics & Prosthetics Profession

J U N E / J U LY 2020

Renewed Focus on the Two-Day Rule P.18

O&P Advocates Push To Protect Businesses and Patients P.34

Studying Diabetic Foot Complications

VIRTUAL

VISITS

AS THE COVID-19 PANDEMIC CONTINUES, O&P FACILITIES VENTURE INTO THE WORLD OF TELEHEALTH P.24

P.44

Quiz Me! EARN 2 BUSINESS CE CREDITS

WWW.AOPANET.ORG

P.22

Preview the 2020 AOPA Virtual National Assembly YOUR CONNECTION TO

EVERYTHING O&P

P.40

THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS

UPDATE

Now VIRTUAL

CH TE

SS NE SI

RT DO PE

IC ET TH PR

OT IC

SEPTEMBER 9-12 | 2020

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

CHOOSE FROM

FIVE TRACKS

 Hear from top speakers from around the world  Participate in workshops  Get the latest in 3D Printing and how it will aﬀect the future of O&P care  Obtain useful tips and techniques  Procure CE credits  Choose from ﬁve tracks (orthotic, prosthetic, pedorthic, technical, or business) to customize your learning experience.

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

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

#AOPA2020 FOLLOW US @AmericanOandP

www.AOPAAssembly.org

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contents

J U N E /J U LY 2020 | VOL. 69, NO. 6

COVER STORY

FEATURES

24 | Virtual Visits Many O&P facilities have embraced telehealth as a critical component of their patient-care operations during the COVID-19 pandemic. Early adopters share tips regarding which platforms to use, when a telemedicine appointment is warranted, best practices during virtual appointments, achieving patient and practitioner acceptance, and the future of telehealth in a postpandemic world. By Christine Umbrell

34 |

Advocacy in a Time of Crisis

O&P advocates have stepped up their efforts in recent months, devoting time, energy, and expertise toward ensuring the interests of patients and practitioners are considered as COVID-19-related relief measures are drafted and enacted. While addressing these new concerns, AOPA and key stakeholders have continued to press for legislation that would protect patients and fund masterâ&#x20AC;&#x2122;s level education.

40 |

Easy Access

Prepare for a first-of-its-kind AOPA Virtual National Assembly, coming in September. This year's premier conference event will feature all of the much-anticipated educational offerings, exhibits, and networking opportunities of an in-person eventâ&#x20AC;&#x201D;but you'll enjoy them from the safety and convenience of your home or office. Learn what to expect from the important sessions and activities planned for the online event. By Deborah Conn

JUNE/JULY 2020 | O&P ALMANAC

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contents

PRINCIPAL INVESTIGATOR

DEPARTMENTS

Katia Langton, CPed, CPed(C), DC................................................................... 38 Meet a Canadian pedorthist/chiropractor who studies the differences between diabetic peripheral neuropathy and lumbar spinal stenosis, and explains the treatment plans for each.

Views From AOPA Leadership......... 6 Putting data to work

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

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

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

Research, updates, and industry news

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

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

Staying Up to Speed

CMS policy changes for 2020 CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

P.18

John J. Oâ&#x20AC;&#x2122;Connor, CPO, Inc.

P.13 AOPA News.............................................. 50 AOPA advocacy, announcements, member benefits, and more

ADVOCACY

Careers.........................................................52 Professional opportunities

Marketplace..............................................54 Ad Index......................................................56

RESEARCH EDUCATION

Calendar......................................................58 Upcoming meetings and events

State By State.......................................... 60 P.48 4

JUNE/JULY 2020 | O&P ALMANAC

Re-examining fee schedules

PHOTO: University of Nebraska at Omaha

Member Spotlight................................ 48

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VIEWS FROM AOPA LEADERSHIP

Data—Let AOPA Help You Leverage It

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

ANY OF US SHARE Carly Fiorina’s

goal in our professional lives, but “The goal is to turn data sometimes it is harder to leverage the data into information and than it is to collect it. This is where AOPA comes in; we strive to create initiatives and information into insight.” benefits that allow you—our members— —Carly Fiorina, former chief executive to turn data into insight, and to harness its officer, Hewlett Packard power. I want to share a couple of timely examples with you. We can all use them to strengthen our businesses and improve our patients’ care. In mid-May, AOPA launched the 2020 Operating Performance and Compensation Survey, a proven benchmarking tool that we have been initiating for more than 40 years. By completing the survey, you’ll contribute to the larger data set that helps AOPA develop programs and initiatives. More importantly, you’ll also benefit from the comparison portion of the report you receive. Past participants have found it to be a vital tool toward business planning, allowing them to identify areas of success, potential risk, and improvement. Awareness and preparation are key to the overall success of our businesses, and the data provided in this report will help all of us as we seek continuous improvement. I highly encourage you to take the time to complete the free survey—the more data we have, the more valuable the report becomes to us all. A new initiative AOPA just launched was a result of your feedback. You told us that you needed access to Medicare data. AOPA’s CMS Data Portal allows member access to comprehensive, easy-to-use, easy-to-read Medicare Part B orthotic and prosthetic claims data from the last five years (previous years are available with special request). All you do is log in, set your search parameters, and, in a matter of minutes, get data to: • Understand the current market in terms of size, geographic distribution, and provider specialty • Predict growth and opportunities • Compare historical and projected growth rates in Medicare • Identify new products and services to provide to patients • Identify and compare your market share • See who provides what in your state.

Updated annually, the portal offers the most recent data at your fingertips, and you can download customized reports for your own use. I hope you’ll access it and let us know how you are using the data. The third use I want to mention is how AOPA leverages data to ensure we are meeting your needs—most recently, in the form of a survey regarding COVID-19. The responses were used to develop initiatives and strategies to assist you both during the pandemic and beyond. We used it to determine what topics we needed to address, like telehealth and financial relief. During these times, there is a lot that is unknown, but using the data available through these AOPA initiatives can help address the uncertainty and lead to informed decisions. I hope you are able to take advantage of them. For more on all these initiatives, visit www.AOPAnet.org. Stay safe, kind, and informed. Jeffrey Lutz, CPO, is president of AOPA.

JUNE/JULY 2020 | O&P ALMANAC

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

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AOPA CONTACTS

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

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

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

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

REIMBURSEMENT SERVICES

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

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

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

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

STRATEGIC ALLIANCES

COMMUNICATIONS, MEMBERSHIP & MEETINGS

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

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

O&P ALMANAC

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

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

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

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

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

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

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

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

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

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

JUNE/JULY 2020 | O&P ALMANAC

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

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

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

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NUMBERS

Patients Embrace Telehealth Many Americans appreciate the benefits of virtual appointments

51 Percent

58 Percent

29 Percent

Say they have access to telehealth

Of telehealth users have visited a primary care provider

Have visited a specialist—such as an O&P provider— via telehealth

REACTIONS AFTER VIRTUAL VISITS

78 Percent

Have been satisfied with their experience

43 Percent

Found their visits as effective as an in-person appointment

31 Percent

Found their visits to be better than an in-person appointment

OPINIONS FROM PATIENTS WHO FAVOR TELEHEALTH

65 Percent

63 Percent

44 Percent

Say telehealth visits are more convenient than in-office

Say they don’t have to worry about exposure to other potentially sick patients

Say it’s easier to schedule an appointment via telehealth

38 Percent Say follow-ups/ communications are more streamlined

CONSIDERING TELEHEALTH POST-COVID-19

26 Percent

30 Percent

Of all adults 18 and older say not having to download any special apps or programs would be important to them

Of those 55 and older say not having to download any special apps or programs would be important to them

INSIGHTS FROM HEALTHCARE PROVIDERS

57 Percent

View telehealth more favorably than before COVID-19

64 Percent

Say they have become more comfortable using telehealth

SKYROCKETING CONSUMER ADOPTION

11% Consumers’ Reported Use of Telehealth in 2019

TELEHEALTH VISIT SATISFACTION LEVEL 45%

Extremely satisfied 33%

Somewhat satisfied 19%

Neither satisfied nor dissatisfied Somewhat dissatisfied

Extremely dissatisfied

SOURCE: COVID-19 Black Book Market Research/Sage Growth Partners Survey, May 2020.

JUNE/JULY 2020 | O&P ALMANAC

76%

Consumers Interested in Telehealth Going Forward

SOURCE: McKinsey COVID-19 Surveys, April/May 2020.

SOURCES: Updox Survey/The Harris Poll, June 2020; COVID-19 Black Book Market Research/Sage Growth Partners Survey; May 2020; McKinsey COVID-19 Consumer and Physician Surveys, April/May 2020.

PATIENTS’ PERCEPTIONS

Given the COVID-19 pandemic and the continuing fear of community spread, many Americans are turning to telehealth, or the use of electronic information and telecommunications to support long-distance clinical healthcare. O&P providers can learn valuable lessons regarding consumer participation and preferences from recent surveys of U.S. adults conducted by Updox, McKinsey, and Black Book Market Research/Sage Growth Partners.

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Happenings FAST FACT

O&P Clinicians Saw Significantly Reduced Patient Loads Due to COVID-19 The onset of COVID-19 had a significant negative impact on the number of patients seen by certified orthotic and prosthetic clinicians in April, according to a survey conducted by the American Board of Certification in Orthotics, Prosthetics, and Pedorthics.

56%

39%

MILD: 10-20 Percent Reduction in Patients MODERATE: 25-50 Percent Reduction in Patients HIGH: Greater Than 50 Percent Reduction in Patients

SOURCE: “COVID-19 Impact on ABC Stakeholders,” ABC Clinical Resources, May 1, 2020.

JUNE/JULY 2020 | O&P ALMANAC

Researchers Develop Electronic Skin Powered by Human Sweat A team of researchers at the California Institute of Technology has developed electronic skin, or e-skin, that can be embedded with sensors to monitor information such as heart rate, body temperature, blood sugar levels, metabolic rates, and the nerve signals that control muscles. The e-skin runs on biofuel cells powered by sweat and does not need a battery. The fuel cells built into the e-skin absorb lactate, a chemical found in high quantities in human sweat, generated as a byproduct of normal metabolic processes—especially by muscles during exercise. The lactate combines with oxygen from the atmosphere, generating water and pyruvate, and generating enough electricity to power sensors and a Bluetooth device that allows the e-skin to transmit readings from its sensors wirelessly. The biofuel cells are made from carbon nanotubes impregnated with a platinum/cobalt catalyst and composite mesh holding an enzyme that breaks down lactate. The e-skin, made of soft, flexible rubber, can work as a human-machine interface to control the motion of a robotic arm and a prosthetic leg, according to lead researcher Wei Gao, PhD, assistant professor of medical engineering in the Division of Engineering and Applied Science. “Integrated with strain sensors that

can monitor the muscle contraction, the self-powered e-skin is able to wirelessly transmit gesture data to control a robotic prosthesis,” he said. While near-field communication is a common approach for many batteryfree e-skin systems, it can only be used for power transfer and data readout over a very short distance, explained Gao. “Bluetooth communication consumes higher power but is a more attractive approach, with extended connectivity for practical medical and robotic applications.” The vital signs and molecular information collected using this platform could be used to design and optimize next-generation prostheses, according to Gao. “Such e-skin could bring the human into the loop of prosthesis control to enable real-time user-specific responses to human intent and behavior,” he said. Details of the technology can be found in the April 22 issue of Science Robotics.

PHOTOS: Wei Gao, PhD, Division of Engineering & Applied Science, California Institute of Technology

RESEARCH ROUNDUP

HAPPENINGS

Researchers Begin Studying How Prosthesis Use Affects Neural Activity Among Children How does a child’s brain adjust to use of an upper-limb prosthesis? This is the central question in a new investigation at the University of Nebraska at Omaha (UNO), led by Jorge Zuniga, PhD, and Brian Knarr, PhD. In this new study, funded by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health, pediatric participants are being fit with sensor-laden caps, then asked to complete simple activities in the lab that require precise use of a prosthesis, such as picking up or moving blocks. Eight weeks later, after having continued to use their prostheses at home, participants are asked to return to the lab to complete the same activities so the researchers can take note of any changes in neural activity. “Our objective is to determine the influence of using a prosthesis on neuromuscular control parameters in children with unilateral congenital partial hand reductions. We propose that

Rue Gillespie has a cap fitted to her head to study her brain’s activity as she performs tasks with both her right arm and her left 3D-printed prosthetic arm. this new knowledge has the potential to inform the development of rehabilitation programs aimed at reducing prosthesis rejection and abandonment,” said Zuniga. The development of prostheses for children is complex due to their rapid physical growth and

PHOTOS: University of Nebraska at Omaha

Jorge M. Zuniga, PhD, works with Rue Gillespie as a team of researchers at the University of Nebraska at Omaha studies Rue’s use of a prosthesis.

motor development. “Children develop a wide variety of motor repertoires in the sensorimotor cortices of the brain. It has been generally accepted by clinicians that prosthesis use and early age fitting may help a child in their motor development. Additionally, it has been suggested that prosthesis use during daily activities may improve sensory and motor control development in children, thereby enhancing the potential development of motor repertoires. This idea is supported by brain imaging data suggesting that prolonged use of a prosthesis can recruit areas of the motor cortex normally devoted to body representation.” Determining the influence of using a prosthesis on neuromuscular control parameters before and after a period of prosthetic use and comparing these results to a control group “will be important in the development of basic knowledge that can lead to the development of evidence-based rehabilitation programs, such as cross education programs aimed at improving the function and motor development of children,” said Zuniga. O&P ALMANAC | JUNE/JULY 2020

HAPPENINGS

FAST FACT

INSURANCE INSIGHTS

Earlier Prosthesis Fitting Cuts Costs

Medicaid Spending and Enrollment On the Rise

“Earlier receipt of a prosthesis is associated with REDUCED

SPENDING in the 12 months postamputation of approximately $25,000 compared to not

Given the economic downturn and rise in unemployment associated with the COVID-19 pandemic, more Americans are relying on state Medicaid programs. Compared to prepandemic estimates, nearly all states with projections anticipate higher enrollment growth in FY 2020 and continued growth into FY 2021, according to a new brief from Kaiser Family Foundation, “Early Look at Medicaid Spending and Enrollment Trends Amid COVID-19.” Several states have benefitted from a 6.2 percent increase in the federal match rate (FMAP) available to states meeting certain “maintenance of eligibility” requirements. This boost was authorized in the Families First Coronavirus Response Act and intended to help support the states as enrollment in Medicaid grows. The Congressional Budget Office anticipates an unemployment rate of 15

percent during the second and third quarters of 2020, then a decline to approximately 9.5 percent at the end of the year. As individuals lose jobs and income, they typically enroll in Medicaid. Despite the small boost in federal funds, many states are projecting Medicaid budget shortfalls for both 2020 and 2021. Multiple state groups, including the National Governors Association and the National Association of State Medicaid Directors, have called for an increase in FMAP to help cover costs and prevent spending cuts in Medicaid services at a time when demand is growing.

THE LIGHTER SIDE

receiving a prosthesis. … Not providing or delaying the provision of a prosthesis increases costs by about 25 percent.”

SOURCE: “Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation,” T. Miller, R. Paul, M. Forthofer, and S. Wurdeman, American Journal of Physical Medicine & Rehabilitation, Online May 26, 2020.

JUNE/JULY 2020 | O&P ALMANAC

“Duck, duck, goose…deny, deny, cover.”

Spinal Technology Offers an App for Practitioners

With this app, practitioners can take 3D scans, include images to denote anatomical landmarks, then write comments and instructions on the images. Powered by TechMed 3D software, our app combines all images and order form documentation into one secure electronic file.

The SpinalTech3D™ Scan app is designed to work seamlessly with an Apple iPad® and Structure Sensor.

Our SpinalTech3D™ Scan app refines the process of ordering custom spinal orthoses from Spinal Technology by electronically integrating scans, images, and practitioner instructions into our custom spinal and scoliosis orthometry forms. With this app, practitioners can take 3D scans, include images, denote anatomical landmarks, write comments and instructions on the images. Powered by TechMed 3D software, our app combines all images and documentation into one secure electronic file, which is emailed directly to Spinal Technology. When the file is received in-house, we use our proprietary software to modify the scan based on the patient’s information and the brace design selected. The modified 3D model is fine-tuned and uploaded into one of our six carvers to produce a positive mold of the patient’s torso: used to fabricate a precise custom orthosis.

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PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Waldo Esparza, CPO, a Florida licensed prosthetist, has announced his retirement. Esparza was in practice for more than 39 years, with the last 36 in the Tampa Bay area. A graduate of the University of Washington’s Prosthetic and Waldo Esparza, Orthotic Program, Esparza is a former member CPO of Sabolich Prosthetic Clinic and held the position of upper-extremity specialist for Florida NovaCare. Esparza founded Tampa Bay Prosthetics in January 2000. Upon announcing his retirement, Tampa Bay Prosthetics was purchased by Comfort Prosthetics and Orthotics, a Michiganbased company that has expanded to Florida and Louisiana. Esparza’s subspecialty is upper-extremity prosthetics, as demonstrated by his extensive lecturing and publishing on the subject. A transfemoral amputee, Esparza earned a Bronze Medal in sailing at the 1996 Paralympic Games held in Atlanta. Esparza will continue his participation within the O&P community by providing upper-limb consultations and legal expertise in prosthetic knowledge.

O&P Companies Contribute to COVID-19 Response

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

In addition to donating an estimated 20,000 swabs to help healthcare professionals conduct COVID-19 testing in Iceland, Össur was approached by the country’s health authority to help manufacture special mobile patient isolation units to help transport coronavirus-infected patients. Össur conceptualized and built five custom units according to the Icelandic health authority’s specifications, donating all of the labor and components to create these resources to help protect first responders and healthcare professionals involved in moving suspected COVID-19 patients. Paceline Inc., a provider of medical products and solutions, has joined the fight against the coronavirus disease (COVID-19) and is manufacturing ear loop fabric for face masks. “As a medical products manufacturer, we wanted to find a way to help those on the front lines fighting the coronavirus, which is affecting all of us,” said Joe Davant, chief executive officer. Paceline management learned that a large surgical mask manufacturer “had a tremendous need for ear loop fabric, which is the material that holds the surgical mask onto the face. We said we wanted to help be part of the solution,” Davant explained. “With recently purchased machines for this specific project, 100 percent of the fabric made on those machines will be going to surgical mask manufacturers. We are open to expanding our capacity, should additional manufacturers need assistance. It’s extremely gratifying to know that our employees are helping save lives with the ear loop fabric we are making here at Paceline.” Over the course of two days in late May, Ultraflex Systems Inc. handed out 300 masks to residents of Pottstown, Pennsylvania, and surrounding areas. The neoprene masks were fabricated in-house by Ultraflex employees. Small, medium, and large sizes were available on a first-come, first-served basis while supplies lasted.

JUNE/JULY 2020 | O&P ALMANAC

PEOPLE & PLACES

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

College Park’s advanced Espire Elbow Pro has won a Red Dot Award for Product Design 2020. College Park Industries collaborated with Altair Engineering and DornerWorks in this competition. “We’re so honored to receive this Red Dot award for product design,” said William Carver, College Park’s president and chief operating officer. “Our goal was to create usable technology that leverages familiar platforms and functional benefits. This strategy provides patients and prosthetists with a powerful yet intuitive assistive device made for everyday life.” Hanger has launched the Hanger Clinic Virtual Classroom series to provide an online continuing education program. “While the healthcare landscape is rapidly evolving, we remain steadfast in our commitment to providing timely and accessible resources for our peers throughout the O&P community,” said Hanger President and Chief Executive Officer Vinit Asar. The collaborative learning experience is being led by experts, with sessions geared toward O&P professionals, physicians, physical therapists, nurses, and case managers. The courses provide the opportunity to learn from clinical leaders, guest speakers, and patients, with some featuring breakout sessions, small group activities, and case reviews. As part of ongoing virtual learning efforts and complementing its professional education initiatives, Hanger Clinic hosted an industry-wide webinar on May 21, discussing strategies and insights for navigating O&P care through the COVID-19 pandemic. Visit the Hanger Clinic Virtual Classroom on the Hanger Clinic website to learn more about the initiative and to view a list of upcoming virtual classes. OPAF and the First Clinics have announced a decision to dissolve OPAF as of July 31. The OPAF Board of Directors released a statement in May explaining that that the effects of the coronavirus (COVID-19) disease on operations had forced the decision, both due to the need to, at least temporarily, halt the contact-intensive clinics, and because OPAF was dependent on revenues generated from First Clinics to maintain operations. “OPAF has been known as the official philanthropy of the U.S. orthotic and prosthetic community for the past 25 years,” the OPAF Board of Directors noted in a letter dated May 15. “We have been fortunate to operate under the superb leadership of Robin Burton for the past 15 years. … The effects

of COVID-19 on the economy have hit all businesses hard, which has had a devastating effect on OPAF. Therefore, we feel that we have no alternative other than closing. We look back at our many years of operation with pride for what we’ve accomplished. Our clinics have had a positive impact upon thousands of lives. We hope that the legacy we created of hope and empowerment will continue to impact lives.” The Orthotic and Prosthetic Group of America (OPGA) has announced that the nomination period for the O&P Woman of the Year is open. The annual award is open to all women in the profession. Nominators are encouraged to provide examples of how the nominee has made significant contributions throughout her career to serve patients, community, businesses, and the O&P professions. Nominations must be submitted by July 10; instructions are posted on the OPGA website. The 2020 O&P Woman of the Year will be announced during the virtual AOPA National Assembly on Wednesday, September 9. Össur has purchased the rights to proprietary design and visualization software used in the shape capture, design, and manufacture of prosthetics and orthotics from Standard Cyborg Inc. The technology allows O&P professionals to leverage CAD capabilities that use a tablet to capture 3D images and make modifications of their patients’ residual limbs. That socket design can then be sent directly to Össur to create the custom socket in support of the Össur Legs Program. “Because every amputee’s anatomy is unique, their socket requires precise measurement and customization. This technology, which we consider to be the premier CAD design solution for custom sockets, will enable O&P professionals to more easily participate in the Össur Legs Program and deliver solutions to their patients,” said Zach Taylor, Össur vice president of O&P services. According to Taylor, use of Össur Design Studio may translate into benefits for O&P practitioners and their practices, including time savings, flexibility to make modifications anywhere, and scaling existing resources. VGM & Associates is partnering with U.S. Rehab and NCART to raise awareness for the 30th anniversary of the signing of the Americans With Disabilities Act (ADA). The anniversary campaign began in May and will run through July. The three companies have launched communications to raise awareness about the ADA and what it means to stakeholders in the complex rehabilitation technology industry. They also have released a video that features retired Sen. Tom Harkin (D-Iowa), a lifelong champion for people with disabilities and the lead sponsor of the ADA when it originally passed in the Senate.

O&P ALMANAC | JUNE/JULY 2020

REIMBURSEMENT PAGE

By DEVON BERNARD

Staying Up to Speed Keeping up with non-COVID-19-related policy changes and revisions from CMS and the DME MACs

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 22 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

VER THE PAST FEW months,

CMS and the durable medical equipment Medicare administrative contractors (DME MACs) have released a flurry of announcements and changes related to the coronavirus (COVID-19) pandemic—as well as some information and guidance unrelated to COVID-19. This month, we will look at some of the important changes that may have flown under your radar during these challenging times.

SDR Article Revisions

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BUSINESS CE

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PHOTO: Getty Images

The Standard Documentation Requirements (SDR) Article was revised on April 6, 2020. Although the revisions were relatively minor, one revision is worth noting: Statements were added about the prohibition of billing Medicare prior to the beneficiary’s discharge date for a facility. This is more commonly referred to as the two-day rule, or the 48-hour rule. Why is this worth noting? Part of the reason the SDR was created was to address common billing errors identified by the DME MACs. This is reinforced by the SDR’s opening article

text: “Many errors reported in Medicare audits are due to claims submitted with incomplete or missing requisite documentation. Consequently, the DME MACs have created guidance to assist durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers in understanding the information necessary to justify payment.” If the DME MACs felt it was important to include information about the two-day rule, it is safe to assume that they have seen an increase in the improper use of the rule. To quickly review, the two-day rule states that a supplier may deliver an item to a Medicare beneficiary during a Part A hospital (acute, rehab, longterm, etc.) or skilled nursing facility (SNF) stay within 48 hours of that patient’s anticipated discharge, as long as the item is not medically necessary during the remainder of the beneficiary’s inpatient stay and the patient is being discharged to a location that qualifies as his or her home, not to another facility or hospital. Under those conditions, the supplier may bill the DME MAC directly for the device.

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However, the supplier must be delivering the item for the purpose of providing basic instruction on how to use and care for the device. This instruction does not include any therapy or rehab training the beneficiary may receive as part of his or her inpatient care. The intent of the two-day rule is not to circumvent the responsibility of the hospital or SNF to provide its patients with medically necessary services. If an orthosis or prosthesis is needed as part of the patient’s recovery or rehabilitation in the facility, it must be provided by, or paid for by, the facility— regardless of when it was delivered. If an orthosis or prosthesis is delivered to a patient during a Medicare Part A inpatient stay and all of the criteria to bill under the two-day rule have been met, the claim may be submitted to the DME MAC. When submitting a claim under the two-day rule, the date of service is the patient’s discharge date from the inpatient facility—not the actual delivery date. While the two-day rule allows you to use the date of discharge as your date of service, the actual date of delivery should be documented in the patient’s chart in case questions arise in the future. As always, use the two-day rule with caution, as the revised SDR states that the misuse of the two-day rule could be viewed as fraudulent billing.

Lower-Limb Policy Revisions

JUNE/JULY 2020 | O&P ALMANAC

In the Sockets subsection, the policy article now includes specific coding directions for the Infinite Socket; these directions are the same as the ones originally released and revised by the PDAC on Dec. 4, 2019. This section also includes a statement that the following codes should not be billed when providing a replacement socket: L5301, L5540, L5321, and L5590. It also includes a reminder statement that the L5999 should not be used to bill for features already included in the socket and/or socket addition codes.

Several of these headers were included in previous versions of the Policy Article and do not pertain any new revisions. Some of the new headers and revisions also are not entirely new, as they were previously released as joint announcements from the DME MACs and the pricing, data analysis, and coding (PDAC) contractor but have now been officially incorporated into policy. So, what are some of the revisions and new inclusions in the LowerLimb Prosthesis Policy Article Coding Guidelines? First, in the Prosthetic Systems subsection, the policy article breaks down and groups each base prosthetic code into an appropriate category with a definition of what is included in the base—for example: “Exoskeletal prosthetic lower-limb codes L5200, L5250, L5270, [and] L5280 include a molded prosthetic socket, and exoskeletal single-axis knee-shin system, and a SACH foot.”

The Knees subsection now includes information that was originally published as a joint PDAC and DME MAC correct coding announcement in December 2019 to address endoskeletal prosthetic knee-shin systems; however, the revised policy article expanded the guidance to include information on exoskeletal knee-shin systems as well. The policy article now clearly defines what is considered the “base knee code” and what is considered a “knee addition code,” and explains what combination of codes is acceptable. The Ankle subsection has been revised to provide information on which prosthetic feet are eligible to be paired with an ankle code, and to provide clear definitions for the four ankle rotation units: • L5968 describes a device with multiaxial ankle motion, along with an active dorsiflexion motion activated for swing phase only.

PHOTO: Getty Images

The DME MACs released a revised version of the Lower-Limb Prosthesis Policy on March 12, with a retroactive effective date of Jan. 1, 2020. Large portions of the revisions were administrative in nature, such as changing all “physician and physicians” to “treating practitioner and treating practitioners.” They also began to list out all codes individually instead of grouping them into spans; for example, “L5000-L5020” will now be written as “L5000, L5010, and L5020.” In addition, the DME MACs rearranged the Coding Guidelines section in the policy article to include distinct headers for each subsection and provided new coding guidelines. Following are the new headers:

• Repair and Labor Coding • Suspension • Prosthetic Systems • Sockets • Protective Covers • Foot Covers • Knees • Ankles • Feet • Microprocessor Ankle-Foot Systems • Modifiers • Coding Batteries and Charges Concurrently With a Powered Base Item.

REIMBURSEMENT PAGE

structure containing a hinge or joint mechanism. The footplate of the AFO must extend to the metatarsal heads and may extend as far as the toe tips, and the AFO is fastened around the lower leg above the ankle. This AFO can be constructed from thermosetting materials, thermoplastics, or composite-type materials and includes all closure components.

• L5982 describes an exosketetal device that allows an adjustable amount of vertical twisting motion between the foot and pelvis during ambulation. • L5984 describes an endosketetal device that allows an adjustable, or nonadjustable, amount of vertical twisting motion between the foot and pelvis during ambulation. • L5986 describes a device that allows motion in all three planes of motion: sagittal, coronal, and transverse. The Feet subsection clearly outlines which codes are considered base feet codes and which codes are addition codes, as well as which codes may be used together. The Microprocessor Ankle Foot Systems subsection added new information for the L5973. The policy article now defines the L5973 as an endoskeletal device with integrated energy storage-and-release foot and microprocessor (which is programmable along with sensors to optimize plantarand dorsiflexion angles for stance and swing phase) ankle system and includes a foot cover, power source, and charger. The subsections not discussed in detail above did not contain any new or revised information.

AFO/KAFO Policy Revisions

On February 19, the DME MACs released a revised version of the Ankle-Foot Orthosis/Knee-AnkleFoot Orthosis (AFO/KAFO) Policy, with a retroactive effective date of Jan. 1, 2020. While some of the revisions were administrative in nature, the most significant changes came under the Coding Guidelines of the policy article. The policy article went from having direct coding guidance for six codes to having coding guidance for 24 codes. Here are a few examples of the newly revised coding guidelines: PHOTO: Getty Images

• L1932 describes a prefabricated AFO designed to control the dorsiflexion, plantarflexion, inversion, and eversion motions of the anklefoot complex. The construction of the AFO includes a full-length

footplate, rigid front shin shell that extends from lower-shin region to near tibial turbercle, and a rigid strut connects the footplate to shin shell. This AFO is constructed of carbon fiber or equal, and includes all closure components and soft interface material. • L1950 describes a custom-fabricated AFO designed to control inversion, eversion, dorsiflexion, plantarflexion, and horizontal rotation motions of the ankle-foot complex. The construction of the AFO includes, at minimum, a 90-degree spiral-shaped strut joining a rigid footplate (which must extend to the metatarsal heads and may extend as far as the toe tips) and rigid calf cuff. This AFO can be constructed from flexible and strong thermosetting materials, thermoplastics, or composite-type materials and includes all types of closures. The policy article provides similar guidelines for the prefabricated version, L1951. • L1970 describes a custom-fabricated AFO designed to control inversion, eversion, dorsiflexion, plantarflexion, and horizontal rotation motions of the ankle-foot complex. The construction of the AFO includes a rigid shell-like or equal

• L2006 describes a custom-fabricated, single- or double-upright KAFO with an adjustable microprocessor control feature that provides resistance to stance and swing phase knee joint motion. The custom-fabricated KAFO can be constructed from thermosetting materials, thermoplastics, or composite-type materials. The L2006 is considered all-inclusive, so there are no additional add-on codes. The L2006 is a new code for 2020, introduced to describe the C-brace, and effective for claims with dates of service on or after Jan. 1, 2020. The only products that may be billed to Medicare using code L2006 are those for which a written coding verification has been made by the PDAC. These are just a few examples of the changes, so be sure to review the revised AFO/KAFO Policy in full.

Updated ABN Form

The Advanced Beneficiary Notice of Noncoverage (ABN) is subject to approval by the Executive Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (PRA). The ABN must be reapproved every three years; it was last updated and reapproved in 2017. The current version of the ABN, form CMS-R-131, had an expiration date of March 2020. The new/updated ABN form is awaiting final review and approval from OMB. Until the new ABN form is approved and released, the DME MACs and CMS have stated that the current form remains valid and that suppliers should continue to use it until further notice. O&P ALMANAC | JUNE/JULY 2020

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At this time, we do not know what, if any, changes will be made to the ABN form. In 2017, the only significant change was the addition of nondiscrimination language to inform beneficiaries that the ABN is available in alternate formats if needed. As a reminder, ABNs should only be used in one of the two situations: if you have a specific reason why you believe Medicare will deny a claim as not medically necessary or if you are voluntarily notifying a patient that a specific service is simply not a benefit under the Medicare program. The purpose of the ABN in the first instance is to inform the patient, in advance of receiving the service, that you believe that Medicare will deny the claim as not medically necessary for a specific reason. If the patient reviews the ABN and signs and dates it, indicating that he or she has made an informed decision to receive the service, then the patient may be held financially responsible for payment for the service (up to your full usual and customary charge) should Medicare deny the claim as not medically necessary. It is extremely important that the patient sign and date the ABN prior to delivery of the service in order for the ABN to be considered valid. Equally important is the proper explanation of why you believe Medicare will deny the claim as not medically necessary. If the reason documented on the ABN is overly vague, or if Medicare denies the claim as not medically necessary for a different reason, the ABN is invalid and the patient is not responsible for payment.

Airplane Design Abduction Braces

JUNE/JULY 2020 | O&P ALMANAC

Round 2021 Competitive Bidding

As you know, the implementation of prior authorization for six lower-limb prosthetic codes—initially slated to be rolled out in May in four states and in October for the remaining states— has been postponed. Competitive Bidding Round 2021, however, has not been postponed or delayed and is still on track to begin Jan. 1, 2021.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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Over the last few years, the DME MACs have seen a substantial increase in the number of claims submitted for code L3960 (shoulder-elbow-wrist-hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment). The increase was as high as 125 percent in certain years. As a result of these abnormal increases, the DME MACs and the PDAC contractor are taking two steps to address the issue. First, the DME MACs and PDAC released a joint announcement for a new coding verification requirement

for L3960. For all claims with a date of service on or after Aug. 1, 2020, braces billed using L3960 must have a written PDAC coding verification and must be listed on the PDAC Product Classification list, www.dmepdac.com. Second, the joint announcement included coding guidelines for the L3960, indicating the code is only used for abducting the arm away from the body and capable of immobilizing the shoulder, elbow, wrist, and hand. The brace must contain adjustable rigid cuffs and joints/components to optimize the shoulder, elbow, wrist, and hand angles; and the shoulder position is capable of 90 degrees of abduction from torso. The L3960 also contains adjustable rigid chest and pelvic frames, or panel supports for shoulder and arm components. Lastly, any abduction brace meeting the requirements of L3960 is considered all-inclusive, meaning the soft interface and closures/straps are included and cannot be billed separately.

At this stage of the competitive bidding process, most steps have been completed. Next, CMS will announce the final single payment amounts (SPAs), which will replace the standard fee schedule amounts, for each product in each competitive bidding area, and then begin offering and finalizing the contracts for the selected suppliers. This should all take place sometime this summer. As a reminder, the SPA is equal to the highest submitted winning bid for the product category lead item. Non-lead items, which represent all of the other Healthcare Common Procedure Coding System codes within a product category, will be reimbursed based on a relative ratio. The relative ratio is determined by dividing the 2015 DMEPOS fee schedule amount for the non-lead item by the 2015 DMEPOS fee schedule amount of the lead item. The year 2015 is used as the base year since it was the last year the DMEPOS fee schedule was not affected by competitive bidding. Once the relative ratio for each nonlead item in the product category is established, it is multiplied by the SPA for the lead item. The resulting fee is the SPA for the non-lead item. CMS will announce those suppliers who have been awarded the contracts this fall. Even amid the COVID-19 pandemic, it is important to be aware of all of Medicare updates, changes, revisions, and announcements. Be sure to read all of the updates, look for guidance from AOPA, and reach out to AOPA with any additional questions.

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

WE ARE ABC. Let us help you navigate this uncertain time. Visit ABC’s dedicated COVID-19 page today at ABCop.org.

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VIRTUAL

Visits

After adopting telemedicine amid the COVID-19 pandemic, O&P professionals offer tips and consider long-term implications By CHRISTINE UMBRELL

PHOTO: Unsplash

JUNE/JULY 2020 | O&P ALMANAC

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NEED TO KNOW • O&P facilities of many sizes and demographics have adopted telehealth and telemedicine practices to continue providing optimal patient care amid the COVID-19 pandemic. • Practitioners are connecting with patients via a wide variety of virtual meeting platforms. Those facilities seeking long-term solutions should seek out HIPAAcompliant platforms that are secure and user-friendly. • Clinicians should adhere to telehealth-specific guidelines when engaging in telemedicine appointments, geared toward maintaining patient privacy and following documentation guidelines. • O&P facilities also are ramping up their use of telehealth in joint appointments with other rehab professionals, a practice that is particularly helpful when hospitals and skilled nursing facilities limit the number of visitors. • AOPA and other O&P stakeholders are asking CMS to reconsider the telehealth reimbursement policy for O&P during the COVID-19 public health emergency.

TELEHEALTH is the use

PHOTOS: Getty Images

of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration. Technologies include videoconferencing, the internet, storeand-forward imaging, streaming media, and terrestrial and wireless communications. Telehealth refers to a broader scope of remote healthcare services than telemedicine.

ELEHEALTH HAS BECOME A critical

component of O&P patient care this year. Both tech-savvy facilities and those that had never considered the technology have been forced to embrace aspects of telehealth as the pandemic hit and mandates forced patients to stay at home. Forty-four percent of AOPA patient-care facilities reported they were using telehealth in an AOPA survey in late March; that number grew to 62 percent among AOPA members participating in a town hall in May. As we look to the future and a new normal in patient care—with COVID-19 remaining a threat even as states open back up—many facility owners and managers are reconsidering if and how they should continue to practice both telehealth (a more general term defining the use of electronic information and telecommunications technologies to support long-distance clinical health care) and telemedicine (which refers specifically to remote clinical services) as part of their regular operations.

Tel e

s. Tele V h m lt e a e

cin di

• Looking to the future, facilities will need to consider guidance from boards, states, and payors in determining whether and how telemedicine can continue.

TELEMEDICINE

refers specifically to remote clinical services, whereas telehealth can refer to remote nonclinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

SOURCE: U.S. Health Resources Services Administration

O&P ALMANAC | JUNE/JULY 2020

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JUNE/JULY 2020 | O&P ALMANAC

PHOTO: Courtesy of Hanger

by patients with low mobility or compromised immunity, according to DeLawrence. Embracing telehealth and telemedicine has “allowed for a continuity of care during the pandemic,” adds Ksenia Major, BOCO, from the Richmond, Virginia, office of Boston Orthotics & Prosthetics, a facility with a significant pediatric population—for whom more frequent appointments are expected. Since the beginning of the pandemic, Boston O&P has been adhering to guidance from the Federation of State Medical Boards, AOPA, and the American Academy of Orthotists and Prosthetists, which released state-by-state guidance regarding telehealth. Hanger Clinic Vice President of Prosthetics Kevin Carroll, MS, Now that most of the stay-at-home CP, FAAOP (D), leverages telehealth to meet with a patient. orders have been eased, O&P facilities are exploring how to continue to integrate telehealth into their patient-care Fast-Tracking Adoption clinical officer. “Telehealth policies. “We’re through the phase At Hanger, telehealth was interactions can help where you could not go into facili“a small part of normal ensure that O&P patients ties,” says Spencer Doty, CPO, MBA, operations” before 2020, can have some level of president of Active Life Inc. “Now we “but has increased quickly, access to the healthcare know how to follow the guidelines, in part due to lessening services they require. It we have PPE, and we are advancing” restrictions regarding also enables clinical care to provide optimal patient care while Mitchell Dobson, HIPAA platforms,” says providers to address the staying vigilant. CPO, FAAOP Mitchell Dobson, CPO, FAAOP, essential needs of depenDoty believes that, given the beneHanger’s chief compliance officer. dent patient populations while fits of telehealth, it should remain The U.S. Department of Health and ensuring the safety of our employees a complementary part of O&P care Human Services (HHS) announced and patients.” going forward. Telehealth ranges in March that, during the COVID-19 In light of the pandemic, from collecting information and national emergency, covered healthtelemedicine “can limit feedback online, to a phone care providers subject to the HIPAA interaction and exposure call, to telemedicine (a rules may seek to communicate with for both our employees virtual visit), he explains. patients, and provide telehealth and our patients,” agrees With the virus continuing services, through remote communiKathleen DeLawrence, as a threat, “we find out cations technologies, even those that chief operating officer at so much more before a Spencer Doty, may not fully comply with all of the Ability P&O. Telemedicine patient comes in,” he says. CPO, MBA requirements of HIPAA rules. for Medicare patients, “Then when the patient does At Hanger and many O&P facilispecifically, is temporarily come in, it’s purposeful.” By ties, embracing telehealth has been supported via the Medicare waiver having a telehealth phone call before critical for the O&P patient populaof March 6, 2020, allowing for telea patient visit, a facility may find that tion. “People with a disability have medicine appointments to occur in a the visit is not necessary, or that a visit been disproportionately impacted patient’s home. These appointments with a different healthcare provider by the COVID-19 pandemic because may be more efficient than some is needed, says Doty. Or perhaps of serious disruptions to the services office appointments, could benefit follow-up just requires a delivery, he they rely on,” explains Jim Campbell, patients who have difficulty with adds: “Maybe all the patient wants is a PhD, CO, FAAOP, Hanger’s chief transportation, and may be appreciated replacement liner.”

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Choosing the Right Platform

For those facilities looking to implement or revamp telemedicine practices in areas where it is allowed, the first step is deciding which platform to use. With recent advances in virtual meeting technology, setting up a HIPAA-compliant platform “is no longer an undue burden,” says Doty. “The costs are reasonable, and the platforms are secure.” Because the telemedicine requirements have been relaxed, it has been acceptable for facilities to use all sorts of different platforms. But restrictions regarding security measures and minimum requirements may be put into place in the coming months, according to DeLawrence. She suggests that facilities choose a platform that is HIPAA compliant, and she cautions business owners to implement solid business associate agreements with any vendors. When choosing a platform, says Doty, “they all have their pros and cons, but you need to make sure they’re user-friendly,” he says—keeping in mind that the geriatric population appreciates simpler options. Here are just a few telehealth platforms that have been popular among O&P facilities:

explains Eileen Levis, Orthologix president. “As long is information is not recorded or stored, the VA several years ago deemed it acceptable to use FaceTime.”

clinician located in a private room with a closed door to ensure privacy. If the clinician is working remotely, “a separate room with no other individuals inside, similar to a patient encounter room at a clinic office, is the • GoTo Connect: Ability P&O has preferred environment,” says Dobson. chosen to use GoToConnect, a On the other side of the screen, HIPAA-compliant platform for “only the patient, and his or voice and video. authorized guest, can be on a telehealth call,” • EMR-embedded platforms. and should be located At Boston O&P, the facility’s in a private setting, EMR system already had a says Levis. built-in virtual appointment Once the connecKathleen secure platform, so clinicians tion has been made, DeLawrence were able to “jump right in” clinicians should ask to telemedicine appointments patients for their consent when COVID-19 hit. They now use to use any third-party platthat platform regularly—but also forms that have been adopted for use Doxy.me when collaborating telehealth, says DeLawrence. Consent with physicians, according to is required before the appointment Major. may proceed. Dobson also notes that approConducting Virtual priate patient consent is necessary Appointments to have a telehealth encounter, “and After a facility has chosen a platthat involves confirmation of the form, clinicians may need guidance phone number and the patient/careregarding how to carry out telegiver attestation to a short consent medicine appointments. A virtual disclaimer,” he says. appointment can be scheduled just like a regular office visit, says DeLawrence, and should take place with the

• Zoom for Telehealth. Most virtual visits at Active Life are facilitated by the HIPAA-compliant Zoom for Telehealth platform. Doty’s facility created a new domain, activelifeconnect.com, designed to streamline healthcare for patients. Patients can go into the new platform to fill out forms and to connect to virtual appointments on Zoom. “It’s an easy, streamlined tool for patients and clinicians,” explains Doty.

JUNE/JULY 2020 | O&P ALMANAC

PHOTO: Courtesy of Hanger

• FaceTime. When the Pennsylvania governor authorized the use of telehealth for individuals licensed under the Pennsylvania Board of Medicine—including O&P providers—the clinicians at Orthologix adopted the use of FaceTime for telehealth visits. FaceTime acts as a conduit,

Carroll meets online with another Hanger Clinic patient.

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JUNE/JULY 2020 | O&P ALMANAC

PHOTO: Getty IMages

Clinicians may want to advise on-site appointment, and the timing of virtual consult is primarily to follow patients to use a smartphone for their that need. up with patients or their caregivers end of the appointment, as it can be Some facilities have even found and to assist them in determination of easier to maneuver a phone, rather it possible to capture some outcome proper use and care of their device,” than a bulkier iPad, laptop, or desktop, measures via telehealth—Campbell explains Campbell. Telehealth can be to see specific body parts if required says that many of Hanger’s patientused for education, recommendation by the exam, says DeLawrence. If reported outcome measures can be of self-adjustments, cessation of use they take a screen shot of something collected remotely. of the device, and/or determination the patient shows them—such as a At the conclusion of a telehealth of the need to attend an in-person red area on their skin, or a crack in a visit, clinicians make their chart notes appointment at the patient-care clinic, device—they may save it in a HIPAAin the patient’s medical record, as they according to Campbell. compliant EMR system, but then would normally do after any appoint Levis also believes that assessments must delete the image from their ment, says Levis. can work well in the virtual environdevice, according to DeLawrence. “Be sure to mention [in documenment. “You can observe donning and During the appointment, clinicians tation] that this was a telemedicine doffing of the device, the condition of should explore patient needs at appointment,” adds DeLawrence. the device; you can look for redness a similar depth of consideror swelling in the extremities; you can ation and understanding as Deciding What’s use the call to determine next steps— an on-site appointment. Appropriate for does the patient need to go back to “Hanger Clinic clinicians Virtual Medicine the physician, or come in to the O&P follow guidance and Telemedicine can be facility, or in an emergent situation checklists to facilitate a useful “anytime an should a home visit be required?” she comprehensive remote appointment does not says. Certain outcomes measures can Eileen Levis consultation experience and require a physical examinaalso be gathered, including gait, timedto ensure the consult is approtion,” says DeLawrence. The up-and-go, and patient-reported data. priately documented,” Campbell actual delivery of a device, as well Some pediatric appointments may says. “It is important to ensure that as devices needing immediate adjustbe particularly well-suited for telea treatment plan is in place at the ment, generally require an in-person medicine. “Virtual consultation is conclusion of the encounter.” Possible visit. For other appointments, telemed- proving to be very effective with many plans may include documenting a icine can be considered. of our pediatric patients and their resolution of patient needs, the “To determine the nature of any parents,” says Campbell. Clinicians at need to ship necesappointment, it is important to impleboth Hanger Clinic and Boston O&P sary goods, the ment some form of triage—initially to have conducted many appointments to need for an assess the patient’s sense of urgency track and address growth-dependent for the prescribed services, to treatment considerations—for understand any external example, among patients with constraints and considerplagiocephaly or scoliosis. ations, and to determine Some appointments the most appropriate for delivery of off-themode of care delivery, shelf (OTS) devices can be including remote completed via telemedicine, Jim Campbell, consultations,” but should remain a last P PhD, CO, FAAO explains Campbell. resort, says Joe McTernan, “We can efficiently AOPA’s director of coding and collect history and conduct reimbursement services. “For OTS, an initial clinical assessment there has never been a face-to-face and begin the development requirement, but there is a mandate to of a treatment plan remotely ensure a proper fit,” says McTernan. prior to on-site care. It is “For OTS, as long as you follow protoimportant to be aware of any cols and allow patients to express regulatory restrictions,” such questions or concerns,” then sending as appointments that still an OTS device to a patient and leverrequire face-to-face visits. aging telemedicine to assess fit while In many cases, follow-up COVID-19 remains a threat is acceptappointments also work via able as long as it is appropriate for the remote means. “The use of a medical needs of the patient, he says.

COVER STORY

Madonna Ibrahim, CPO, conducts a telehealth prosthetic consult using her iPad at an Active Life Inc. facility.

PHOTO: Active Life Inc.

O&P facilities also are ramping up arrangements allow for continued their use of telehealth in joint appointcollaboration with the entire healthments with other rehab professionals. care team. Many in-patient facilities, such as hospitals and skilled nursing facilities, Reimbursement Concerns have been on tight lockdown, limiting Of course, one of the biggest roadthe number of visitors—including blocks to telemedicine implementation healthcare providers. Telemedicine is reimbursement. “There’s no way has been leveraged in a variety of ways to bill for telehealth,” says Ashlie to ensure the O&P needs of patients in White, AOPA’s director of strategic these facilities are still being met, alliances. O&P billing is reliant on the says Prateek Grover, MD, Healthcare Common Procedure medical director at The Coding System (HCPCS), and Rehabilitation Institute billing is directly associated of St. Louis. Some with the provision of a device, prosthetists have been rather than care appointunable to visit patients ments. But, given the extra in-person, but have been workload associated with , or aj M ia Ksen able to get on telemeditelemedicine in the current BOCO cine visits with physicians pandemic, AOPA is working in patients’ room to asses closely with the O&P Alliance in an them, Grover explains. effort to request guidance on how O&P In other cases, patients have gone providers could receive reimburseto orthotists’ facilities and have had ment for specific services provided exams conducted there, with physithrough telemedicine, says White. cians attending via videoconference. On May 21, AOPA sent a letter to This has happened frequently at members, noting that key members Boston O&P, where clinicians have of Congress were circulating a letter seen AFO patients for a fitting, with to be sent to Secretary of HHS Alex physicians and therapists in virtual Azar and CMS Administrator Seema attendance, says Major. These Verma urging them to reconsider the

telehealth reimbursement policy for O&P during the COVID-19 public health emergency. Subsequently, the O&P Alliance sent a letter to Azar and Verma on June 11, asking CMS to authorize appropriately credentialed orthotists and prosthetists to submit claims for certain Medicare services furnished virtually during the COVID-19 pandemic. For now, Active Life's Doty views a virtual visit in much the same way as a traditional in-person visit, with billing associated with the device delivery and not the actual appointment. “If it comes to light that there is a way to have an additional billing code when we’re using telehealth, that would be great,” he adds. “Currently, O&P providers are reimbursed for evaluation, measurement, provision of device, and follow-up under the HCPCS system,” adds Levis. “The HCPCS system would need to be totally revamped, to allow for encounter fees,” both telehealth and in-person. For now, she views telehealth as a “cost-saving tool.” Telehealth “cannot generate revenue, but it could save money, if you’re using the tool effectively.”

Wider Adoption Ahead?

In the coming months, as regulatory agencies re-examine how businesses have been carrying out operations during the pandemic, it is possible that the waivers easing restrictions for telehealth may be dropped, and facilities will need to look closely at guidance from boards, states, and payors in determining whether and how telemedicine can continue. White advises AOPA members to visit the AOPA Co-OP for state-specific guidance and restrictions. Telehealth is “an invaluable tool that has come to the forefront as a result of the pandemic,” explains Levis. “Now it’s on a fast track and is being utilized more often as part of the overall healthcare delivery system. Very specific platforms are available to enable us to expand beyond simply FaceTime. Those are options we should all be looking at.” As states’ regulations differ, Levis encourages O&P clinicians to understand the O&P ALMANAC | JUNE/JULY 2020

COVER STORY

parameters within their states. “Take the steps necessary to move your practice forward within those regulations, and keep pace with the everchanging healthcare landscape.” Campbell notes that, while HIPAA constraints will need to be considered, “we have demonstrated that remote consultations can replace, and in some cases, shorten, many on-site appointments.” He expects to see Hanger Clinic conducting more virtual appointments in the future, “in part because patients and their families find it to be both effective and convenient.” In the short term, as the virus remains a threat, “we still need to recognize that COVID-19 exacerbates pre-existing health conditions, respiratory function, immune system

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function, heart disease, or diabetes, placing many O&P patients at increased risk,” Campbell says. “By deploying, where appropriate, telehealth solutions and programs, many people with comorbid health conditions can receive care from home, minimizing their risk of contracting the virus.” Major agrees that telemedicine will remain critical as long as COVID-19 remains a threat, particularly among pediatric patients who are immunocompromised, “so we can minimize their risk.” In the longer term, O&P facilities will need to consider the financial benefits once waivers regarding telehealth are lifted, says Dobson. “It will be important to re-evaluate the cost versus value that it brings, as a HIPAA-compliant platform is not an inconsequential cost.” Of course, the need for in-person O&P care remains paramount—with new safety measures in place to

protect both patients and clinicians from the spread of coronavirus or other diseases. “There will never be a replacement for the physical form of care that’s required” in O&P, says Doty. Using an integrated approach to patient care that involves both telehealth and in-person visits is likely the future of healthcare. “For the greater good of the O&P community, practices need to continue to integrate.” And even if a facility chooses not to incorporate telehealth as a regular part of general O&P patient care, it will be important to have telehealth capabilities for future emergencies. “There will likely be future flare-ups of COVID-19, and we’ll need to be ready and have the ability to serve the modern culture,” says Doty. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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ADVOCACY IN A TIME OF CRISIS AOPA staff and members promote O&P interests and push for key legislation—during the pandemic and into the future NEED TO KNOW • O&P advocates have been working diligently on behalf of practitioners and patients this year, adding to their preplanned agendas when the COVID-19 pandemic hit and stay-at-home measures went into effect. • Since March, AOPA and key stakeholders have been pushing to ensure relief measures include consideration for O&P businesses and to educate members on how to access funds and adapt patient-care operations. • In addition, AOPA has remained steady in its work to advance the Medicare O&P PatientCentered Care Act, which would improve access to, and quality of, O&P care received by Medicare beneficiaries while simultaneously combatting fraud and abuse. • Advocates also are focusing on legislation that would fund grants to help universities establish master’s degree programs in O&P, or to grow existing institutions’ master’s programs. • On the state and local level, AOPA has been hands-on in recent months, aggregating statespecific updates and sharing that information on the AOPA Co-OP.

JUNE/JULY 2020 | O&P ALMANAC

&P ADVOCACY EFFORTS IN the

year 2020 have taken a turn no one could have expected in January. Given the spread of the coronavirus disease (COVID-19) in the United States and the subsequent state stay-athome orders beginning in March, O&P stakeholders pivoted their advocacy efforts to ensure relief measures included consideration for O&P businesses and to educate members on how to access funds and continue patient-care operations during unprecedented times. But just as important are the continuing efforts to advocate for legislation to benefit O&P patients and providers as facilities resume operations. AOPA made a swift decision to host a virtual, rather than in-person, Policy Forum in May, assembling a record number of O&P stakeholders in a condensed, online format to share strategies for advancing both the O&P Patient-Centered Care Act and provisions within the Wounded Warrior Workforce Enhancement Act (WWWEA). Participants heard from Sen. Tammy Duckworth (D-Illinois), and “came together as a community, even within a virtual world, and shared a sense of connectedness,” says Teri Kuffel, JD, vice president at Arise Orthotics & Prosthetics in Minnesota, an AOPA board member, and leader of AOPA’s legislative arm. “We also had the opportunity to reach out to our respective legislators virtually and through the AOPA Votes letterwriting platform. Hundreds of letters went out from O&P constituents all across the country.” These united efforts are indicative of the dedication of the O&P community in advancing the profession for the long term and ensuring that legislators understand the work of clinicians to provide a higher quality of life for orthotic and prosthetic patients.

Pandemic Priorities

When the COVID-19 pandemic became a national crisis—forcing most Americans to stay in their homes and many businesses to shut down—AOPA’s government affairs team jumped

Sen. Tammy Duckworth (D-Illinois)

into action to advocate on behalf of O&P professionals everywhere. AOPA’s team conducted state-by-state research, finding that O&P businesses were indeed considered “essential businesses” and therefore allowed to operate in at least some capacity during stay-at-home orders. AOPA’s Executive Director Eve Lee, MBA, CAE, and Director of Government Affairs Justin Beland led efforts to ensure member companies could keep their doors open, had access to personal protective equipment, and understood how to access funds available via grants and loans. Staff aggressively advocated on behalf of members to ensure the unique needs of the O&P community, including clinicians, suppliers, and patients, were taken into consideration when drafting relief legislation. AOPA held Zoom meetings, town halls, and webinars to help educate

members on federal government SBA grants and loans such as Economic Disaster Relief and the Paycheck Protection Program (PPP), and CMS offerings such as the temporary Medicare Advanced Payments program, says Kuffel. Launching a COVID-19 Response and Resources webpage in March, AOPA published actions, information, and analyses of significance to O&P stakeholders. The webpage features links to guidance on topics such as how the stimulus package applies to O&P businesses; documentation and telehealth waivers; operation of businesses during state or local restrictions related to COVID-19; and enrollment procedures that had been waived for COVID-19. Throughout the spring, Beland and AOPA Director of Coding and Reimbursement Services Joe McTernan took hundreds of member calls to assist O&P business owners in accessing funds available through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and PPP. Of particular importance, AOPA spearheaded efforts to have language included in CARES Act to ensure veterans could receive care from their choice of practitioner throughout the crisis. Specifically, the bill says, “The Secretary of Veterans Affairs shall ensure that, to the extent practicable, veterans who are receiving or are eligible to receive a prosthetic appliance … are able to receive such an appliance that the Secretary determines is needed from a nonDepartment of Veterans Affairs (VA) provider under a contract with the Department during a public health emergency.” This verbiage was important as the VA had recently announced it would discontinue offering nonurgent community care referrals to veterans during the coronavirus pandemic. Beland and his team continue to work behind the scenes to push for this temporary provision to become permanent, so veterans may continue to receive O&P care from their chosen provider long after the pandemic is over. O&P ALMANAC | JUNE/JULY 2020

When the COVID-19 pandemic became a national crisis—forcing most Americans to stay in their homes and many businesses to shut down—AOPA’s government affairs team jumped into action to advocate on behalf of O&P professionals everywhere.

After the relief legislation was passed, Beland “explained the intricacies of the CARES Act” to members so they could take advantage of some of its provisions while continuing to run their businesses in a difficult time, says Kuffel. “In reaction to the COVID-19 pandemic, AOPA’s advocacy team continues to advocate for its members,” says Kuffel, “by always being available to answer questions and help guide O&P business owners and manufacturers through unchartered territories.”

Pushing for PatientCentered Legislation

Beyond working on pandemicrelated advocacy initiatives, AOPA has remained steady in its work to advance the Medicare O&P PatientCentered Care Act. The bipartisan legislation, introduced in the House of Representatives as H.R. 5262 last fall after much hard work on the part of AOPA’s advocacy team, would improve access to, and quality of, orthotic and prosthetic care received by Medicare beneficiaries while simultaneously combatting fraud and abuse. Specifically, this bill would: • Restore congressional intent by revising the overly expansive regulatory interpretation of the meaning of “off-the-shelf” (OTS) orthotics 36

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to clarify that competitive bidding may only apply to orthoses that require minimal self-adjustment by patients themselves, not the patient’s caregiver or a supplier. • Distinguish the clinical, serviceoriented nature in which O&P is provided from the commoditybased nature of the durable medical equipment (DME) benefit. • Reduce the likelihood of waste, fraud, and abuse in the Medicare program by prohibiting the practice of “drop shipping” of orthotic braces that are not truly “off the shelf” (i.e., subject to minimal self-adjustment by the patient him- or herself ). At this time, the most important provision in the bill is the separation of O&P from DME, according to Beland. While Congress and CMS already treat O&P differently from DME, further separation is needed, and O&P PatientCentered Care Act seeks to ensure safe and effective patient care by distinguishing orthotists and prosthetists from suppliers of DME and by differentiating the clinical, service-oriented manner in which O&P devices are provided. Beland is optimistic about the future of the legislation as the argument for separation has been resonating among lawmakers in recent months. During

the COVID-19 pandemic, “we’ve been explaining to legislators that we’re continuing to care for patients [via telehealth], but we can’t bill for our services” because of the way the Healthcare Common Procedure Coding System (HCPCS) system is set up. These discussions have helped educate several members of Congress regarding the need to distance O&P from DME, according to Beland.

Investing in O&P Education

O&P stakeholders are cautiously optimistic about new efforts to expand the number of students able to enroll in master’s-level O&P programs. For nearly 10 years, AOPA has been advocating for grants to help universities establish master’s degree programs in O&P or to grow existing institutions’ masters’ programs. The goal is to “expand the pipeline of clinicians with master’s degrees” to care for wounded warriors and veterans as well as the aging civilian population, says Catriona Macdonald, president of Linchpin Strategies and an AOPA lobbyist. “The field is facing a serious shortage of highly trained clinicians,” Macdonald explains. “Currently, only 12 schools in the country offer master’s degrees in O&P, graduating a total—nationwide—of fewer than 250 students per year.”

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Several versions of the WWWEA have been introduced since 2013, but the legislation has failed to become law. This year, provisions from the WWWEA have been pulled out of the proposed bill and updated, with the hope that provisions will be included in the National Defense Authorization Act (NDAA). With this approach, AOPA is requesting that the Department of Defense award a total of $45 million to provide limited, one-time competitive grants to qualified universities to create or expand accredited advanced education programs in O&P and develop best practices in effective O&P education. Sens. Duckworth and Dick Durbin (D-Illinois) have requested that the $45 million in funding for O&P master’s level education be included in the NDAA when it is written by the committee chair, Sen. Jim Inhofe (R-Oklahoma). Macdonald and AOPA also have been talking to members of the Senate Armed Services Committee about military readiness and the implications of not having enough clinicians, and they are hopeful that this year’s NDAA will ultimately include funding to expand clinician education. The funding would be instrumental in ensuring enough prosthetists and orthotists in 2025 and beyond. A predicted lack of qualified O&P clinicians remains a problem, says Macdonald, even in the context of the COVID-19 pandemic. “At a time when O&P clinics are suffering financially, and we are seeing furloughs and layoffs, it’s hard to talk about needing more clinicians,” she says. “But when we get to the other side of the crisis,” a significant need for O&P patient care will remain. In addition, prosthetists may be in even greater demand, given the population of COVID-19 survivors who require amputations due to coronavirus-induced sepsis, says Macdonald. “Right now, the field is in contraction,” she says. “But we won’t see the end of diabetes and cardiac issues, and we may see more COVID-19 patients, so the need for clinicians will go up.” If the legislation passes as currently 38

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AOPA has been advocating for grants to expand the pipeline of clinicians with master’s degrees to care for wounded warriors and veterans as well as the aging civilian population.

written, universities could apply for up to $3 million in funding to expand, or to start up, O&P master’s programs. This funding could be critical to smaller O&P programs, particularly given the equipment and lab expenses associated with such programs, as well as to any universities considering adding O&P master’s programs, according to Macdonald. In addition to Durbin and Duckworth, several other members of the Senate’s Armed Services Committee represent states that have schools with O&P master’s programs, including Sens. Rick Scott (R-Florida), Gary Peters (D-Michigan), and David Perdue (R-Georgia), says Macdonald.

She and Beland are hopeful the provisions will be included in the final version of the NDAA and will be signed into law this fall—but there are many unknowns, so AOPA will continue to monitor activities and advocate for the funding in the coming months.

Advancing State and Local Efforts

AOPA also has been highly engaged in more localized initiatives in recent months, aggregating state-specific updates and sharing that information on the AOPA Co-OP, facilitated by Ashlie White, MA, director of strategic alliances. “We found that states need support associated with their individual advocacy efforts,” explains White. She meets quarterly with members of the States’ Reps Committee to identify areas where AOPA could be helpful at advancing state initiatives. “Our impact can be significant in helping groups organize their efforts,” White says. AOPA has lent a hand in several state advocacy efforts, by participating in state advocacy events, organizing calls, and meeting with state representatives to push local movements forward. For example, Beland provided critical support and in-person attendance in the push for insurance fairness in Virginia, and has helped other states in their licensure, legislative, and insurance fairness initiatives.

Looking to the Future

As O&P professionals continue to navigate the COVID-19 pandemic and adjust business practices to ensure the health and safety of patients and employees, AOPA’s advocacy team “will remain committed to educating and guiding its members and the extended O&P community through whatever this pandemic brings our way,” says Kuffel. “As we get back to business, AOPA will continue to make daily contributions on what that ‘new normal’ looks like—concerning office protocols, legislative initiatives, and educational resources.”

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Easy Access Plan now to take part in AOPA's first Virtual National Assembly, with something for everyone

HIS YEAR, O&P PROFESSIONALS

can’t travel to AOPA’s annual National Assembly—so AOPA is bringing the industry’s premier conference event directly to E S U TOmembers and stakeholders. EASYOriginally planned to take place in Las Vegas September 9-12, the event will be delivered virtually on the same dates, complete with education, networking opportunities, and an exhibit hall. Participants in the 2020 AOPA Virtual National Assembly will benefit from all of the same content and networking opportunities of an in-person event—while sitting in the safety and comfort of their offices or homes and saving on travel and lodging expenses.

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JUNE/JULY 2020 | O&P ALMANAC

Virtual Value

Not-so tech savvy? Not to worry. AOPA’s first-ever virtual National AOPA staff vetted more than a dozen Assembly takes a challenge—how to virtual meeting providers, ultimately hold meetings, educational sessions, selecting a platform for its robust and a trade show safely during the features and ease of use. AOPA COVID-19 pandemic—and turns it has sent a video demonstration to into a unique opportunity for all members and will offer pre-Assembly participants. The lack of in-person training on using the platform. In addicontact gives way to solutions that tion, attendees will be able to access offer more participants new ways of one-on-one tech support before and getting involved. throughout the event. “We are channeling the Assembly Planning Can’t-Miss Content Committee’s energy into While a lot will be creating an engaging event different for this year’s with continuing education event, attendees can still credits for the highest level count on familiar content of O&P clinical, business, and planning, including daily technical education,” says Teri General Sessions, clinical, Michael Lovdal, PhD technical, and business Kuffel, JD, vice president of Arise Orthotics & Prosthetics, education, in-depth panel and co-chair of the Assembly Planning discussions, manufacturers’ workCommittee. Kuffel and co-chair Rick shops, free paper sessions, and more. Riley, vice president of sales and Each day, events will start no earlier marketing with Span Link International, than 11 a.m. ET to accommodate are working closely with the rest of the participants in different time zones. committee and AOPA staff to reimagine As in the past, AOPA will offer two the conference experience. pre-show workshops on Tuesday, The virtual setting enables more September 8: an orthotics workshop members of the O&P community to on “Muscle Tone and Hypertonous participate, Kuffel notes. Going online Assessment and Relevance to Orthotic opens the Assembly to everyone with a computer, tablet, or mobile device. Now, practitioners who may have missed past Assemblies because of time pressure or financial constraints can easily attend. AOPA is offering discounted group rates for the virtual experience, enabling more participants from each facility to reap the benefits of this year’s conference. “People who may not usually travel to the National Assembly can participate from the comfort of their home or office,” Kuffel says. “And unlike in-person events, registrants won’t have to juggle which session to see and which they have to miss because they are scheduled at the same time. Now registrants don’t have to choose, because every session will be recorded and available to view for 30 days after AOPA President Jeffrey Lutz, CPO the Assembly.”

Management,” and a prosthetics workshop on “Prosthetic Management and Rehabilitation.” Four General Sessions—one for each day of the Assembly—focus on the important topics of 2020 and the future of the profession: • The Opening General Session, scheduled for Wednesday, September 9, at 6 p.m. ET, tackles a top-of-mind issue presented by leading healthcare analyst Michael Lovdal, PhD: “What Has Changed in American Healthcare and How Will the Pandemic Affect the Future?” This event will be followed by the Virtual Welcome Reception. • Thursday’s General Session, at 11 a.m. ET, features of the award-winning Thranhardt Lectures. These presentations have been named the year’s best research studies in orthotics and prosthetics and will focus on “Systematic Procedure in Lower-Limb Amputation—The Scandinavian Approach” and “High-Intensity Gait Training for Stroke Patients.”

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O&P ALMANAC | JUNE/JULY 2020

Mark Your Calendars for These Engaging Events VIRTUAL HAPPY HOUR

OPENING GENERAL SESSION

Wednesday, September 9 6 p.m. ET Take part in the keynote address from Michael Lovdal, PhD, a leading healthcare analyst, who will share his insights on the impacts of COVID-19 during his presentation, “What Has Changed in American Healthcare, and How Will the Pandemic Affect the Future?”

GENERAL SESSION 2 Thursday, September 10 11 a.m. ET Kick-start the day with the Thranhardt Lecture Series, with award-winning presentations in both prosthetics and orthotics.

GRAND OPENING VIRTUAL WELCOME RECEPTION

Wednesday, September 9 7 p.m. ET Kick off the virtual show with opportunities to network with colleagues, win door prizes, and get a first look at the exhibit hall.

O&P PAC APPRECIATION RECEPTION

GENERAL SESSION 3 Friday, September 11 11 a.m. ET Don’t miss this year’s AOPA Annual Membership Meeting to learn what’s happening in the O&P profession and the association.

EXHIBIT HOURS The interactive Exhibit Hall will be open for several hours each day, including “unopposed exhibit time” from 1:30 to 3 p.m. ET on Thursday and Friday.

JUNE/JULY 2020 | O&P ALMANAC

Thursday, September 10 5 p.m. ET Join your colleagues to celebrate and network. Bring your favorite beverage and join the session for door prizes, entertainment, and chat rooms.

Friday, September 11 4 p.m. ET Contributors to the O&P PAC are invited to a private reception with one or more O&P congressional champion.

CLOSING GENERAL SESSION

Saturday, September 12 11 a.m. ET Make sure your facility is following all of the rules by taking part in this important session on “Workplace Sexual Harassment Tools and Guidance.”

• Friday’s General Session, AOPA’s Membership Meeting and Awards Program, will be held at 11 a.m. ET. Attendees will hear election results, the treasurer’s report, and AOPA’s latest achievements in advocacy, research, and education. • The Closing General Session on Saturday at 11 a.m. ET will focus on workplace sexual harassment, with tools and guidance to help create dialogue and a respectful environment for all staff members. The concurrent educational programs, which follow each day’s General Session, provide an opportunity for participants to pursue education in five separate tracks: orthotics, prosthetics, business, technical, and pedorthics. Content will be advanced and highly relevant, says Kuffel. Participants have the chance to earn more than 100 CE credits. Highlights in the orthotic track include two symposiums: “Orthotic Spine Management” and “The Teamwork of ACPOC: Promoting Collaboration and Comprehensive Care of Children With Musculoskeletal Differences.” Standouts in the prosthetic track include “Getting a Grip on Mechanical and External Powered Partial Hand Prostheses,” “Impact of Prosthetic Interventions on Musculoskeletal Pain in Individuals With Lower-Limb Amputations,” and “Challenges of a Modern AK Socket Design” symposiums. The pedorthic track will focus on treating the geriatric patient, and a wound-care program brings in Naz Wahab, MD, a physician with expertise in evidence-based advanced wound healing modalities. Participants won’t want to miss this year’s business-focused Hamontree presentations, in addition to timely presentations on “COVID-19: Protecting Your Business and Making Sure the Work Gets Done,” and “Navigating O&P Education and Practice as a Minority Individual or Workplace.”

The online experience has been optimized to enable interaction with presenters, with opportunities for Q&As, says Tina Carlson, CMP, AOPA senior director, membership, education, and meetings. “Some presentations will be handled differently from others,” she explains. “Some will be pre-recorded but will still offer an opportunity for chat with the moderator and speakers.” Planners continue to finalize details, and AOPA will share more information before the September event.

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of booth staff, an unlimited number of documents, and how-to videos or commercials. Exhibitors will be able to leverage a polling feature to gain specific information about attendees or to hold a variety of quizzes to encourage attendee participation. The platform keeps track of who visits an exhibitor’s booth and how many times they do so, in addition to identifying attendees who have requested additional information.

Continuing Connections

Interactive Exhibits

This year’s virtual exhibit hall will be one of the most exciting elements of the Assembly, according to Kuffel. Both exhibitors and attendees will find features of the online conference designed to tailor the experience to their interests and needs. Similar to the in-person event, exhibitors will have virtual booths open during certain hours for attendees to “drop by” and engage in video chats. Using tags attached to exhibitors’ profiles, registrants will be able to find the companies best suited to their needs, while exhibitors can use registrants’ tags to identify the attendees who would most likely be interested their products and services. “Exhibitors will be able to search attendee tags and job functions and then set up meetings during dedicated exhibit times,” says Kuffel. The platform features a calendar that shows open appointment times for everyone involved, simplifying scheduling. Each exhibitor can customize its landing page to feature photos and profiles

Attendees at this year’s Assembly may not have physical interactions—but they will have plenty of opportunities to connect with peers virtually. In addition to the Wednesday evening Welcome Reception and the Friday O&P PAC Appreciation Reception at 4 p.m. ET, Thursday’s Virtual Happy Hour at 5 p.m. ET will be filled with entertainment, giveaways, and chat rooms. AOPA will be providing members with more information on these networking events in the weeks to come. All in all, “This will be an Assembly to remember, that’s for sure!” says Kuffel. “For many years to come, we will remember the effects COVID had on our nation, companies, patients, families, and friends. We will remember how we survived these times and worked together to make the best of an unprecedented situation that was far beyond even our collective control. “We will remember that coming together in a time of need is what we strive to do every day, for every patient that crosses our path.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net. O&P ALMANAC | JUNE/JULY 2020

PRINCIPAL INVESTIGATOR

Early Detection Katia Langton, CPed, CPed(C), DC, investigates lumbar spinal stenosis and complications from diabetes

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.

during her early career as a chiropractor in deciding to launch a second career as a pedorthist. Langton, who grew up in Vancouver, British Columbia, studied at Simon Fraser University and Canadian Memorial Chiropractic College, and then she practiced in the chiropractic field for 20 years. During that time, she noticed that many of her patients were troubled by painful foot conditions, pronation problems, and alignment issues that caused back problems. This prompted her to study pedorthics at the International School of Pedorthics and the Western States Pedorthic Program. Once she earned her CPed credential, Langton returned to Vancouver and opened Island Pedorthic Foot Care. Now owner of OceanWalk Pedorthic Footcare Clinic, she concentrates her efforts on catching Charcot foot early and preventing diabetic foot complications. “Our focus is preventative off-loading with diabetic orthoses, which will reduce the number of ulcerations and foot complications we will see in the future,” she says.

PHOTO: Adobe Stock

JUNE/JULY 2020 | O&P ALMANAC

ATIA LANGTON, CPED, CPED(C), DC, drew from lessons learned

Early Intervention

“I became a pedorthist because I had two main goals: to prevent diabetic foot ulcers and amputations, on a global

level, … and to practice and teach other healthcare practitioners how to differentiate lumbar spinal stenosis (LSS) patients from the diabetic neuropathy patients,” she says. LSS, a degenerative condition of the low back, is a disabling, chronic medical condition with serious irreversible consequences that limit seniors’ mobility, walking, and independence as they age. OceanWalk offers both in-clinic consultations and a mobile foot clinic component serving multiple locations, including many remote First Nations communities needing pedorthic services. “The goal of these clinics is to prevent diabetic foot ulcers and amputations and to keep patients active, walking, and mobile,” says Langton. She stays true to her chiropractic roots by continuing to treat patients as owner of Nanaimo Chiropractic Inc. “We focus on a nonsurgical treatment approach based on the LSS program at Mt. Sinai Hospital in Toronto,” she explains. The goal is to improve standing and walking using manual therapy, specific exercises, and a custom table that helps to align the spine to increase openings for the spinal nerves. This six-week program involves exercises to strengthen weak back and leg muscles and mobilizations and stretches to reduce pressure on spinal nerves when standing and walking.

PRINCIPAL INVESTIGATOR

Helping Others Through Research

PHOTO: Katia Langton, CPed, CPed(C), DC

Research plays a prominent role in Langton’s career. She partnered with Ed Jude, MD, an endocrinologist in the United Kingdom, in a research study on “Peripheral Neuropathy and Lumbar Spinal Stenosis in Patients With Diabetes.” They conducted an initial investigation in 2017, Katia Langton, CPed, CPed(C), DC studying 84 patients who were referred to a diabetic foot clinic for assessment Study Group in Portugal in 2017. and treatment for diabetic peripheral LSS is “underrecognized, underdiagneuropathy and its symptoms. Langton nosed, misdiagnosed, and thus largely and her team found that 13 out of the untreated,” Langton explains. LSS 84, or 15 percent, actually had LSS causes neuropathy—but in a top-down symptoms causing neuropathy, but manner that can be treated. Left alone, the symptoms were mimicking diait progresses and limits mobility, which betic peripheral neuropathy. Langton predisposes patients to chronic disand Jude shared these results during eases—the most common one being a presentation of the Diabetic Foot diabetes. “Our research continues, and

we are now partnering in a larger study to look at the effects of this in different countries based on the aging population globally.” The study is in its early stages; Langton and Jude are compiling data and plan to include patients who have been confirmed for LSS via MRI imaging.

Creating Guidelines That Benefit Patients

Langton plays another important role, serving as secretary of the Diabetic Foot Stream Committee of the International Diabetes Federation. In this capacity, she assisted the committee in creating Diabetic Foot Guidelines published in 2017 (www.idf.org/ component/attachments/?task=download&id=1152), as well as a Pocket Chart (www.idf.org/component/ attachments/?task=download&id=1177). Built into the guidelines are defined risk categories as well as information to aid in recognition of LSS. “It is important that healthcare practitioners understand LSS and that as soon as the spinal nerve exits the spinal cord,

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O&P ALMANAC | JUNE/JULY 2020

PRINCIPAL INVESTIGATOR

Understanding Lumbar Spinal Stenosis What Causes LSS?

• Degenerative disc thinning/bulging • Hypertrophic facets • Thickening/infolding of the ligamentum flavum.

How Does LSS Cause Symptoms?

• Narrowing of the spinal canals inhibits venous return that leads to congestion within the canal, which results in blockage of the cerebro spinal fluid (CSF) and leads to further congestion • Congestion compresses the arterial blood flow to spinal nerves that leads to ischemia and lower-extremity symptoms causing neuropathy.

What Are the Symptoms? • • • • • •

Unilateral or bilateral buttock pain Hip and leg pain and weakness Low back pain (occasionally) Numbing and tingling in lower extremities and feet Bowel and bladder weakness Weakness in lower extremities mimicking diabetic peripheral neuropathy.

What Is the Presentation?

• Decreasing ability to walk upright • Relief with forward flexion or sitting immediately (this differentiates from mechanical low back pain) • Increased ability to walk upright with forward flexion as this opens up the spinal canals and relieves congestion, which decreases compression on arterial blood flow to decrease ischemia on the spinal nerves • Positive for shopping cart sign (ability to walk upright bent forward over a shopping cart) • Numbing, tingling pain in feet and lower legs mimicking diabetic peripheral neuropathy.

JUNE/JULY 2020 | O&P ALMANAC

PHOTO: Katia Langton, CPed, CPed(C), DC

and there is stenosis present, Comprehensive diabetic foot then it can cause neuropathy. assessments and foot care, Neuropathy is nerve damage, based on prevention, education, no matter what the source and a multidisciplinary team is—diabetes or neuroischemia approach, will reduce foot from stenosis,” she explains. complications and amputations “Any damage, compression, up to 85 percent. We need to inflammation, or neuroischfront-end load our resources emia along the course of the and shift into treating diabetic nerve from the nerve root foot disease earlier in the to the tips of the extremities risk category and away from can cause neuropathy.” reactionary ulcer care. And Senior patients will benefit this means catching patients if healthcare practitioners with neuropathy from LSS Langton speaks at a meeting of the International learn to differentiate LSS, and protecting them early.” Diabetes Federation in 2017. which is treatable, from She urges new clinicians to diabetic peripheral neuoropathy, costs are associated with the highest learn to identify these two different which is not treatable but is managerisk category, according to Langton. conditions so that they are best able able, says Langton. “Clinicians need “We need to focus on treating these to assess, treat, and refer accordingly. to understand that LSS is a ticking patients earlier, and with a focus on “Don’t assume anyone else is doing it,” time bomb in these seniors, waiting preventing ulcers and progression she says. “When you are a pedorthist to rob them of their mobility. And it is into Risk Category 3,” she says. “Each looking at [a patient’s] feet, you are imperative with our aging population country’s healthcare budget will not be in a perfect position to solve these globally that this is well understood.” able to sustain the demand necessary confusing problems for the patient Comprehending the LSS-versusto treat diabetic foot complications, and give them some answers, direcdiabetes distinction is particularly critical such as ulcers leading to amputations, tion, and protection with a focus because 80 percent of the diabetic foot as this disease progresses incessantly. on returning their mobility.”

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MEMBER SPOTLIGHT

John J. O’Connor, CPO, Inc.

By DEBORAH CONN

Decades of Service Long-time facility owner expresses gratitude to mentors and patients

FTER MORE THAN A half

JUNE/JULY 2020 | O&P ALMANAC

FACILITY: John J. O’Connor, CPO, Inc. OWNERS: Jack O’Connor, CPO, FAAOP, and Patricia O’Connor LOCATION: Winston-Salem, North Carolina HISTORY: 46 years

Jack O’Connor, CPO, FAAOP, and Patricia O’Connor

head of the O&P department. “Ronnie kicked me out of the nest and told me I had to take that position,” he recalls. Within six months, Bowman Gray refocused its mission as a teaching hospital and closed the department. “The dean gave me the opportunity to buy all the tools and equipment, as well as to perform warranty work on former patients,” says O’Connor. He opened his own facility and has been seeing patients ever since. On Snell’s advice, O’Connor kept his practice small. “Ronnie had five or six facilities and lots of headaches,” he says. O’Connor maintained a three-person staff—himself, Patricia, and an assistant named Sam Fogg. “Things got pretty frantic sometimes, but it would have been worse if we had been bigger.” Since 1980, the O’Connors have lived literally 13 stair-steps from their work, in a home that contains the office. “We’ve never had a snow day,” says Pat O’Connor. “We’re always here. That made it easier for us and much better for our patients. We could see them on holidays, if they couldn’t

leave work. And we had one patient who had trouble with her locking liner show up at 11 p.m.!” Both O’Connors have relied on AOPA throughout their careers. “We have gone to every AOPA meeting east of the Mississippi River,” says O’Connor. “When I had a billing problem with Medicare, Joe [McTernan] and Devon [Bernard] were the first two people I called,” says Patricia. “They stayed with me every step of the way.” O’Connor’s long tenure in O&P has given him a special perspective on the industry. “I’ve seen the progression from exoskeletal wooden legs to endoskeletal limbs made of titanium and carbon fiber,” he says. “I love the new hardware and different adaptors. I’m a tool guy, and these modern components are so much easier and better for the patient.” O’Connor is transitioning longtime patients to the Hanger Clinic where he is employed, where he can continue to serve them. “They will get used to a really good crew at Hanger, young and very bright. It’s also a great opportunity to pass on what I know,” he says. “I’m passing on things I learned from Ronnie— like selecting the most appropriate components, not necessarily the most expensive. It’s more important to think about what’s best for the person, and not just the bottom line. “I have been most blessed and fortunate to do the work I have loved all my life,” concludes O’Connor. “I am extremely grateful to the patients who entrusted me with their care.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: John J. O’Connor, CPO, Inc.

century of O&P service, Jack O’Connor, CPO, is closing shop— but gradually. O’Connor and his wife, Patricia, who manages all things administrative, will continue to see patients at the John J. O’Connor, CPO, Inc. facility in Winston-Salem, North Carolina, on Mondays and Fridays for the time being, and work Tuesdays through Thursdays at the local Hanger Clinic. “At some point, we will close the office, but I will continue to work at Hanger as long as I am physically able,” he says. O’Connor, 75, got into the O&P industry “accidentally,” he says. “I was an electrician in the Navy in 1966 when I got called to interview as an orthopedic mechanic at the Philadelphia Naval Hospital,” he explains. “I showed up at the limb shop in an old World War II barracks, where I was interviewed and tested. I loved it—and I’ve been at it ever since.” O’Connor eventually became certified in orthotics and prosthetics, attending both New York University and Northwestern University. A major influence on O’Connor’s career was Ronnie Snell, CPO, one of the founders of the American Academy of Orthotists and Prosthetists. “I was lucky enough to work for Ronnie in Memphis,” says O’Connor. “He taught me his philosophy of treating patients, which was always to go above and beyond.” In 1974, a former colleague alerted O’Connor to a position in the Orthopedics Department of North Carolina Baptist Hospital/ Bowman Gray School of Medicine (now Wake Forest University/ Baptist Health). O’Connor became

An ENDORSED MEMBER of AOPA

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

AOPA Offers Members Free Access to AOPAversity AOPA knows you and your employees are being tremendously impacted by COVID-19. To help, we are offering you, our AOPA 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 50

JUNE/JULY 2020 | O&P ALMANAC

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.

FREE ACCESS

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.

AOPA NEWS

Webinars

Co-OP

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.

UPCOMING WEBINAR // UPCOMING WEBINAR // UPCOMING WEBINAR

WEDNESDAY

AUG. 12

Contracting 101: Understanding the Basics

What can you do to make sure that a contract is beneficial to you? During the August 12 webinar, learn the basic steps in identifying opportunities, negotiating contracts with payors, and maintaining positive relationships with all parties involved.

UPCOMING WEBINAR // UPCOMING WEBINAR // UPCOMING WEBINAR

WEDNESDAY

SEPT. 2

Outside the Norms: Outliers and Situations Where the Rules Are Different

Everyone assumes they know the rules, but what about those special instances when the common rules don’t apply? When is your date of service different from the date of delivery? When is your place of service not the home? Get the answers to these questions and more. 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 • July 24 Each held at • Aug 14 Noon ET • Sept 18 To register, visit AOPA’s Education Calendar. O&P ALMANAC | JUNE/JULY 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

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Member $482 $634

Nonmember $678 $830

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

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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.

JUNE/JULY 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! 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

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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.

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremost as demonstrated by our positive attitude, teamwork and professionalism.”

O&P ALMANAC | JUNE/JULY 2020

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CCAFO From Ottobock Ottobock’s expertise in custom orthotic fabrication and carbon composites come together to produce custom AFOs. Crafted from carbon prepreg, this lightweight and low-profile AFO provides a solution for individuals with plantarflexion weakness and those needing triplanar support for the foot and ankle. The design stores and returns energy for propulsion while providing function of the soleus muscle and third rocker mechanics. This CCAFO is custom-made for your patient’s specific height, weight, and activity level. Benefits include: • Lightweight, low-profile design • Energy dynamics of carbon prepreg for improved gait and energy return • Custom design for greater stability and the ability to control deformities. For more information, visit www.professionals.ottobockus.com or talk to your sales rep.

O&P ALMANAC | JUNE/JULY 2020

MARKETPLACE Pectus Carinatum Treatment The P4CO line of Pectus Carinatum Orthoses applies corrective force where it belongs—at the pectus deformity. Eliminating ratchet straps greatly reduces the risk of over-tightening and rib deformity. The P4CO is individually crafted from a cast of the patient. We provide complete fitting and wearing instructions for a superior outcome. • No ratchet straps • Carbon fiber design • Modular, easily adjusted by orthotist • Low profile and comfortable to sleep in • Can be fixed tension or patient adjustable • Patented.

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.

Visit carbonbasedllc.com for complete information, videos, and more.

AD INDEX

Advertisers Index Company

Page Phone

American Board for Certification in Orthotics, Prosthetics, & Pedorthics 23 Amfit Apis Footwear Company Cailor Fleming Insurance College Park Industries ComfortFit Orthotic Labs Inc. Cypress Adaptive LLC ESP LLC Fillauer Companies Inc. Hersco Naked Prosthetics Ottobock Phoenix Molded Shoes, Inserts, & Braces PROTEOR USA Spinal Technology Inc.

JUNE/JULY 2020 | O&P ALMANAC

703/836-7114 37 800/356-3668 45 888/937-2747 49 800/796-8495 3 800/728-7950 32 888/523-1600 27 888/715-8003 11 888/WEAR-ESP 5, 33 800/251-6398 1 800/301-8275 9, 29 888/977-6693 C4 800/328-4058 19 863/658-2616 7 855/450-7300 15 800/253-7868

Website www.abcop.org www.amfit.com www.apisfootwear.com www.cailorfleming.com www.college-park.com www.comfortlabs.com www.cypressadaptive.com www.wearesp.com www.fillauer.com www.hersco.com www.npdevices.com www.professionals.ottobockus.com www.phoenixmolded.com www.proteorusa.com www.spinaltech.com

Co-OP

AOPA’s Co-OP The O&P Compendium

An online reimbursement, coding, and policy resource, the site includes a collection of detailed information with links to supporting documentation for the topics most important to AOPA Members. O&P’s best kept secret, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of the membership.

Resources include:

We ARE AOPA

•

State-specific insurance policy updates,

•

L-code search capability,

•

Data and evidence resources,

•

And so much more!

Learn more and sign up at www.AOPAnet.org/co-op.

ADVOCACY | RESEARCH | EDUCATION

The Co-OP is a FREE member benefit.

CALENDAR

July 30–August 1 (Dates subject to change due to COVID-19)

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.

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. 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.

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.

August 1

Cascade Dafo Institute

Nine free ABC-approved online education courses to enhance your clinical practice. Take anytime, anywhere, and earn up to 14.5 CE credits. Visit cascadedafo.com or call 800/848-7332.

2020 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.

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.

August 3–8

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

August 12 WEBINAR

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

July 16

www.AOPAnet.org.

July 23–25 (Dates subject to change due to COVID-19)

ABC: Practitioner Residency Completion Deadline for October 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.

Digitally Enabling Modern Approaches to O&P. Sponsored by HP. Details can be found here: https:// hp.zoom.com/webinar/register/WN_gGXxqefgTPCURZeryZmkQw.

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. 58

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.

JUNE/JULY 2020 | O&P ALMANAC

September 1

CALENDAR

September 2

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

September 9–12

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

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.

September 25–26 (Dates subject to change due to COVID-19)

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.

October 3

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

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

October 12–17

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

October 14

October 1

ABC: Application Deadline for ABC/OPERF Student Award for Academic Achievement. Ten exceptional students will be selected to win $1,000 to cover educational expenses. For more info or to apply, go to operf.org.

October 9–10 (Dates subject to change due to COVID-19)

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

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

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.

November 4–6

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

November 9-10

Mastering Medicare: Essential Coding and Billing Techniques Seminar. Philadelphia, PA. For more information, contact info@AOPAnet.org or visit www.AOPAnet.org. SEMINAR

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

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O&P ALMANAC | JUNE/JULY 2020

STATE BY STATE

Re-Examining Fee Schedules Updates from California, Indiana, Kentucky, New York, and Oregon

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 efforts by the California Orthotic and Prosthetic Association (COPA) to work a MediCal fee schedule increase into the state budget have been tabled as a “status quo budget” is expected to pass due to the unfortunate circumstances surrounding the coronavirus (COVID19) crisis. COPA’s planned State Hill Day, scheduled for March 18, was cancelled as it was to fall on the same day the State Capitol building closed as part of California’s stay-at-home order. COPA is exploring next steps.

Indiana

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.

JUNE/JULY 2020 | O&P ALMANAC

Members in Indiana are exploring the formation of a state association or society. Members have expressed an interest in organizing around several common goals that would require state-wide consensus.

Kentucky

Insurance fairness legislation has been introduced in Kentucky. House Bill 532, An Act Relating to Coverage for Prosthetics and Orthotics, was introduced on Feb. 28, 2020, by Rep. Al Gentry (D) and referred to the state’s House Subcommittee on Banking and Insurance on March 2, 2020.

New York

AOPA is working with members in New York to develop a letter-writing campaign to request that policymakers 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. This effort will take significant support from members on the ground in the state. Please comment on the AOPA Co-OP or email jbeland@AOPAnet.org and awhite@AOPAnet.org to share feedback regarding this effort or to get involved.

Oregon

Members in Oregon are preparing to request a Medicaid fee schedule increase for cranial remolding orthoses. The current reimbursement for S1040 in Oregon is $476.19, much lower than the national median of $1,836.94.

Submit Your State News

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

W SU

COMPARE YOUR

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

RVE

Y N EW S

Data Drives

URV

NEW

SUR

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

YOUR REPORT CARD Complete the survey to:

Performance Area:

• Identify where your O&P facility needs to improve.

Gross Margin

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

Sales Generated Per Employee

• Help inform business decisions using your company’s benchmarking data.

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Good

Fair

Needs Work

Cost of Goods Sold

• Help drive AOPA’s advocacy, research, and education initiatives. AOPA PRODUCTS

COMPANY REPORT A VALUABLE RESOURCE FOR BUSINESSES IN THE O&P INDUSTRY

A ME R I CA N O RT H OT I C & PR O ST H E T I C AS S O CI ATION (AO PA)

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

Participation is FREE and limited to AOPA members.

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ADVOCACY | RESEARCH | EDUCATION

Visit www.aopa-survey.com. www.AOPAnet.org

WalkOn Carbon Fiber AFOs Lightweight, durable stabilization

The WalkOn family of AFOs provide options for patients with dorsiflexion weakness who require support for moderate to severe drop foot. These orthoses are lightweight, low-profile, and extremely tough. Their dynamic design provides a more physiological and symmetrical gait, offering fluid roll over and excellent energy return.

professionals.ottobockus.com