August 2019 O&P Almanac by AOPA

SPECIAL SECTION: 2019 AOPA NATIONAL ASSEMBLY EXHIBITOR PREVIEW P.40 The Magazine for the Orthotics & Prosthetics Profession

AU G U ST 2019

How To Obtain a Bid Surety Bond P.18

Tips for Helping Young Adults Achieve Independence P.34

Investigations Into Outcomes Measurement Tools P.58

E! QU IZ M EARN

BUSINESS CE

CREDITS P.20

This Just In: Maximus Federal To Take Over Reconsideration Requests P.22

Advances in Osseointegration

WHAT O&P PROFESSIONALS NEED TO KNOW ABOUT PERCUTANEOUS IMPLANTS

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contents

AUG UST 2019 | VOL. 68, NO. 8

FEATURES

AUGUST 2019 | O&P ALMANAC

Who is undergoing osseointegration procedures, and what do prosthetists need to know about caring for this growing U.S. patient population? Recent studies have found improvements in patient-reported outcomes for individuals who undergo surgery and attach their prostheses to implants surgically connected to their residual limbs. Learn what experts are saying about the role prosthetists can play, and find out what to expect as osseointegration advances alongside other technologies, such as neuroprosthetics. By Christine Umbrell

ON THE COVER: Matthew Garibaldi, MS, CPO, working with an osseointegration patient who participated in a clinical study at the University of Californiaâ&#x20AC;&#x201D;San Francisco

22 | This Just In

Reconsideration Requests Maximus Federal has been named as the new Medicare Qualified Independent Contractor (QIC) and will take over the processing of the second level of Medicare appeals by December 31. Many are hopeful that the new QIC will continue the Medicare Telephone Discussion and Reopening Program, which proved highly successful when implemented three years ago.

P. 22

34 | Growth Strategies

P. 34

O&P clinicians who work with teenagers often have a unique opportunity to assist these patients in transitioning into adulthood. As patients prepare to head off to college or live away from home for the first time, prosthetists and orthotists can offer tips on navigating new terrains, caring for O&P devices, and learning to embrace life independently. By Meghan Holohan

COVER PHOTO: Barbara Ries Photography/UCSF

COVER STORY

24 | Advances in Osseointegration

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contents

SPECIAL SECTION

DEPARTMENTS Views From AOPA Leadership......... 6

40 | Oceans of Innovation

J. Douglas Call, CP, on the value of membership

at the Assembly Exhibit Hall

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

44 | Title Sponsors

Numbers...................................................... 10

Meet the title sponsors of this yearâ&#x20AC;&#x2122;s event.

At-a-glance statistics and data

50 | Exhibit Hall Map

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

Research, updates, and industry news

Plan your route on this two-page aerial view of the trade show floor.

People & Places........................................16

50 | Exhibitor Directory

Transitions in the profession

See the full list of companies exhibiting at the 2019 AOPA National Assembly.

PRINCIPAL INVESTIGATOR Sara Morgan, PhD, CPO, LPO............................................................................. 58 Meet a clinician and assistant professor at the University of Washington who studies the efficacy of microprocessor knees, O&P measurement tools, and much more.

P.12

AOPA News.............................................. 66

COLUMNS

AOPA meetings, announcements, member benefits, and more

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

On Your Mark, Get Set, Bid

Welcome New Members................... 67

Tips for navigating Competitive Bidding 2021

Careers........................................................ 68 Professional opportunities

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

Ad Index..................................................... 69 P.18

Member Spotlight................................. 62

P.62

AUGUST 2019 | O&P ALMANAC

P.65

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Marketplace............................................. 70 Calendar...................................................... 74 Upcoming meetings and events

Ask AOPA................................................... 76 Providing care when competitive bidding takes effect

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VIEWS FROM AOPA LEADERSHIP

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

All in the Interest of O&P Businesses

S AN O&P PROFESSIONAL and business owner, I truly value AOPA and

the benefits that accompany membership in this important organization. I regularly share these sentiments with colleagues and encourage them not just to join AOPA but also to become active participants—in part because of the inevitable changes headed our way. Whether the changes come from CMS, the U.S. Department of Veterans Affairs’ medical centers, or affordable care organizations, payment structures will be evolving within the next three to five years, and AOPA is helping us prepare for the inevitable. As a representative of O&P business owners and suppliers throughout the country, AOPA’s leadership, board, and dedicated staff do everything in their power from a legislative standpoint to collaborate with other organizations, including the American Board for Certification in Orthotics, Prosthetics, and Pedorthics; the American Academy of Orthotists and Prosthetists; the National Commission on Orthotic and Prosthetic Education; and others. These partnerships form a strong, invaluable affiliation that enable us to work together to preserve our profession and secure equitable reimbursements for the care we provide our patients. My term as a board member began earlier this year. It’s been an eye-opening experience seeing firsthand just how much AOPA—and other O&P organizations—are doing behind the scenes to facilitate our shared interests as they relate to legislative issues. I’ll admit, I was somewhat unaware of how hard the AOPA directors and staff work to maintain our interests from a business standpoint. Whether your O&P business is big or small, and whether it’s a single- or multi-facility organization, AOPA undoubtedly has your primary business and professional interests in mind. As consolidation continues to occur within our industry, there’s never been a more important time for each of us to become involved in this organization. The more members we can add to our ranks, the better the opportunity we have to maintain our relevance and the excellent track record and performance AOPA has delivered consistently over the years. Virginia Prosthetics & Orthotics has been an active member and strong supporter of AOPA for 40-plus years. We regularly see benefits from the education the organization offers—particularly the AOPA Policy Forum—and believe it is a vitally important platform for providing consistent opportunities to help businesses thrive. To date, it’s been my distinct pleasure to serve with all of the professionals on AOPA’s board and the association staff. These extremely professional, knowledgeable individuals are constantly striving to do the best thing for the profession, its people, and the patients we serve. J. Douglas Call, CP, is a member of AOPA’s board of directors.

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION 6

AUGUST 2019 | O&P ALMANAC

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

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AOPA CONTACTS

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

STRATEGIC ALLIANCES

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

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

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

O&P ALMANAC

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 8

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

AUGUST 2019 | O&P ALMANAC

Eve Lee, MBA, CAE, executive director/publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

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

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

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NUMBERS

Employers Seek To Contain Healthcare Costs Medical costs for individuals covered by private insurance will rise due to increases in medical pricing and costs associated with chronic disease

AVERAGE ANNUAL PER CAPITA SPENDING BY EMPLOYERS ON COVERED INDIVIDUALS

Healthcare pricing, rather than healthcare utilization, is the main force driving up medical costs related to individuals covered by employer-sponsored plans, according to “Medical Cost Trends: Behind the Numbers 2020,” published in July by PwC’s Health Research Institute (HRI). HRI projects a net growth rate of 5 percent in medical costs for individuals covered by private insurance in 2020 due to three “inflators”: a projected growth in retail drug spending of 3-6 percent; prevalence of costly chronic diseases; and increased use of mental health services. Employers are expected to try to contain costs by negotiating contract prices, forging coalitions, setting up their own provider networks, and encouraging telehealth options.

$1,320 Healthy individuals

EMPLOYER COVERAGE OF INDIVIDUALS WITH DIABETES

MEDICAL COST TREND ON THE RISE

28 Percent

Projected percentage increase in the cost to treat patients from one year to the next, assuming that benefits remain the same 5.7

5.5

5.7

6.0

Individuals with complex chronic conditions

“In 2019, 86 percent of employers offered a diabetes management program, up from 70 percent in 2013. And yet the rate of diabetes among

2.2X Cost of healthcare for employees with diabetes compared to nondiabetic employees

Individuals with chronic conditions

$10,830

individuals with coverage through an employer 2017

2018

2019

2020

(Projected)

continues to grow.” —“Medical Cost Trends: Behind the Numbers 2020"

TELEHEALTH GROWS IN POPULARITY

The 49 percent of consumers with employer coverage who are willing to use telehealth instead of an in-person visit say they would use telehealth in the following circumstances: Ongoing assessment of a physical condition or ailment Initial assessment of a physical condition or ailment

62% 43%

Mental/behavioral health services

27%

Emergency situations, such as urgent care

25%

AUGUST 2019 | O&P ALMANAC

SOURCE: “Medical Cost Trends: Behind the Numbers 2020,” PwC’s Health Research Institute, July 2019

Rise in number of individuals with employer coverage with diabetes between 2005 and 2015

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Happenings RESEARCH ROUNDUP

Scientists Develop Advanced Prosthetic Liners Multidisciplinary researchers at the University of Bath in Somerset, United Kingdom, have developed a new approach leveraging 3D-scanning technology to help reduce the number of office visits necessary to replace liners due to fluctuating residual limb volumes. The team is testing an approach that would provide an amputee with a series of personalized liners of different sizes that all fit within the same prosthetic socket. Representatives from the university’s Department of Mechanical Engineering; Department for Health; and Centre for the Analysis of Motion, Entertainment Research, and Applications collaborated on the new approach. The first step involves scanning the 3D shape of an amputee’s

Left to right: Elena Seminati, PhD; John Roberts; Matt Young; and Vimal Dhokia, PhD

residual limb, then leveraging the captured data to create a full digital model of the limb. Researchers use the digital model to design a personalized liner, which is manufactured using a cryogenic machining technique. The approach has been tested on amputee volunteer John Roberts, who underwent amputation in 2017. He currently wears multiple socks and a silicone layer, but with the new approach he wears one specially made and well-fitting liner. To test the liner, the researchers inserted pressure sensors into the socket to check the fit; they also leveraged motion capture technology to monitor the subject’s gait. “We've found this new liner reduces the pressure on the stump significantly, reducing the risk of skin damage and making it more comfortable to walk,” said Elena Seminati, PhD, a lecturer in clinical biomechanics. The researchers believe the new approach will lead to better fitting sockets and will result in more amputees accepting their prostheses. “There’s a window of around 18 months where an amputee decides whether to use [a prosthesis] to learn to walk again or use a wheelchair. Unfortunately, this is a time the residuum changes in size and shape as part of the healing process, making it difficult to get a good fitting,” said Vimal Dhokia, PhD, a lecturer in the Department of Mechanical Engineering. “Our technology will help achieve a comfortable fit for the patient and really make a difference in helping them walk again and improve their quality of life.” The researchers are developing the approach and testing it on new study subjects. Details were published in June in ScienceDaily.

PHOTOS: University of Bath

AUGUST 2019 | O&P ALMANAC

HAPPENINGS

New Technology Has Applications for Artificial Muscles in Prostheses

FAST FACT

Individuals Exhibit Stress Symptoms Following Amputation

The tiny coils in the fiber developed by MIT researchers curl even tighter when warmed up. This causes the fiber to contract, much like a muscle fiber.

In a study of individuals who had recently undergone a lower-limb amputation following a chronic disease such as diabetes, traumatic stress symptoms were prevalent

PHOTO: Felice Frankel, edited by MIT News

Researchers at the Massachusetts Institute of Technology (MIT) have developed a process for coiling contrasting materials together to create a durable fiber that pulls and contracts in a manner similar to human muscles. By coiling a stretchy cyclic copolymer elastomer with a stiffer thermoplastic polyethylene—two materials with different thermal expansion coefficients—the MIT team created a single fiber that contrasts and coils after being stretched. When the new fiber is stretched

out, it naturally forms itself into a tight coil. As the temperature rises, the coil curls up more tightly; as the temperature cools, the fiber returns to its original length. The scientists have performed experiments indicating the fiber is capable of lifting loads up to 650 times its own weight. “The fibers could find uses as actuators in robotic arms, legs, or grippers, and in prosthetic limbs, where their slight weight and fast response times could provide a significant advantage,” according to the MIT News Office.

one month postsurgery, and probable

post-traumatic stress disorder was observed in 14 percent of patients. —“Traumatic Stress Symptoms Following a Lower-Limb Amputation in Diabetic Patients: A Longitudinal Study,” Psychology & Health

Study Compares Orthotic Versus Corticosteriod Treatments for Plantar Heel Pain

Researchers in Australia conducted a study to compare the effectiveness of foot orthoses and corticosteroid injection for plantar foot pain. The scientists, comprised of researchers from La Trobe University and La Trobe Private Hospital in Bundoora, Australia, conducted a study of 103 participants with plantar heel pain in a parallel-group, randomized clinical trial; some participants received prefabricated

arch-contouring foot orthoses while the others received a single ultrasound-guided corticosteroid injection. The researchers found that while the corticosteroid group reported better outcomes at the four-week point after treatment, the orthotic group reported better outcomes at the 12-week point. Details of the study were published in the Journal of Orthopaedic & Sports Physical Therapy.

O&P ALMANAC | AUGUST 2019

HAPPENINGS

STATE O&P

O&P IN THE SPOTLIGHT

Limb Loss and Preservation Registry Featured in Mayo Clinic Publications

Proposed Legislative Initiative Could Affect Provision of O&P in Ohio Ohio State Sen. Rob McColley (R) and Ohio Lieutenant Governor Jon Husted (R) have announced the Common Sense Initiative (CSI), an initiative that includes language that gives flexibility to the board of the Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers (OTPTAT) to give permission to those who research and develop prosthetics using 3D-printing technology. AOPA is working on obtaining the full proposal language to conduct an analysis of the impact it will have on Ohio licensure and O&P practitioners.

The Limb Loss and Preservation Registry (LLPR), in early development, made headlines when the Mayo Clinic’s July 9 Advancing the Science blog and Alumni Magazine spotlighted the registry and interviewed Kenton Kaufman, PhD, PE, program director/principal investigator for the LLPR and director of the Motion Analysis Laboratory at the Mayo Clinic. The Mayo Clinic is the prime contractor leading the registry initiative, with funding provided by the National Institutes of Health and the U.S. Department of Defense, and in collaboration with AOPA and the American Academy of Orthotists and Prosthetists. The initial stages of creating the registry are currently underway, with Kaufman’s team designing and building the registry between now and 2020. “We have begun pilot studies with the American Joint Replacement Registry and two hospitals to assess the feasibility of collecting the data,” using an initial set of data elements to be gathered, Kaufman told O&P Almanac. “This effort will be expanded next year to begin collecting data from prosthetists, other clinical providers, and patients. We will

use the ISPO Scientific Committee recommendation for the minimum dataset to improve how technical and clinical reports are designed and reported to the prosthetic community.” The registry came into fruition after Kaufman and his colleague, Hilal Maradit Kremers, MD, were awarded a $5 million five-year contract by the National Center of Medical Rehabilitation Research. Registry data is expected to come from hospital records, prosthetic facilities, and self-reports by individuals who have lost a limb. “It’s up to us to develop a business model that will sustain the registry,” said Kaufman in the Advancing the Science article. “Our goal is to create a platform that can be used to standardize, measure, and report patient outcomes data, support evidence-based decision-making, enhance healthcare delivery, and establish and disseminate best clinical practices.” More information on the LLPR and the potential involvement of O&P facilities is available in the article “Filling the Data Gap” in the July 2019 O&P Almanac.

FAST FACT

More Than 400 O&P Clinicians Were Certified in 2018 The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) reports that

443 orthotic and/or prosthetic practitioners

were certified last year. There are currently 5,881 ABC-certified clinicians, according to ABC. —“ABC 2018 Annual Report,” American Board for Certification in Orthotics, Prosthetics, and Pedorthics

AUGUST 2019 | O&P ALMANAC

HAPPENINGS

O&P ATHLETICS

West Virginia Facility Hosts First Swing Clinic

PHOTOS: Miller Prosthetics and Orthotics

Miller Prosthetics and Orthotics hosted a First Swing Learn to Golf Training and Clinic in Parkersburg, West Virginia, in June. National Amputee Golf Association First Swing Instructor Don Zommer led the event, which started with a morning session where 17 local therapists, golf teaching pros, and O&P professionals learned more about adapting the game of golf to the physically challenged population. Zommer and John Benway shared their expertise on adaptive equipment, safety instructions, and rules of the game. The group also visited a driving range, where they practiced hitting golf balls from a seated position, using only one arm, and standing on one leg. During the afternoon session, 25 participants and family members visited the driving range to take part in golf activities assisted by the morning attendees.

THE LIGHTER SIDE

FAST FACT

Travel Tips

The Amputee Coalition offers a fact sheet called

â&#x20AC;&#x153;Travel Information: TSA Checkpoint,â&#x20AC;?

which provides need-to-know information for individuals with limb loss or limb difference before stepping through a TSA checkpoint. Visit www.amputeecoalition.org for details.

O&P ALMANAC | AUGUST 2019

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Heather Ferguson, PhD, MBA, has joined WillowWood as the new vice president of operations. Daniel Rubin, currently executive vice president, was appointed chief operating officer (COO). Heather Ferguson Ferguson has extensive experience in manPhD, MBA ufacturing, quality and compliance in medical devices, and nutrition through her prior work at Cardinal Health and Abbott Laboratories. She also has worked internationally on the integration of newly acquired manufacturing facilities. Rubin, as the newly appointed COO, will chamDaniel Rubin pion the principles of operational excellence across all functions of WillowWood while emphasizing the impact team members can have on fulfilling clinical customer needs to ensure better outcomes, according to a press release. “With the recent investment in WillowWood by DW Healthcare Partners, we are entering a new growth phase,” said Rubin. “Our team, especially with the addition of Heather, welcomes new opportunities for development as it means we’ll become a stronger partner for clinicians as they serve the amputee population.”

Dave Robinson

Dave Robinson has joined Allard USA as the Southeast district manager. Robinson comes to Allard USA from Baxter International, where he worked in the Medical Products Division for 18 years and the Renal Division for almost three years. He will serve the O&P community in Virginia, North Carolina, and South Carolina.

Twenty-two para-athletes have been named to Team Össur. “The members of Team Össur are some of the most accomplished and inspirational athletes in the world. Collectively, they have set dozens of World Records, earned countless medals in para-athletic competition, and demonstrated extraordinary acts of athleticism,” said Jon Sigurdsson, resident and chief executive officer of Össur. The 2019-2020 Team Össur roster includes athletes from all over the world: Americas • Mohamed Lahna, triathlete and track cyclist, United States • Rudy Garcia-Tolson, swimmer and triathlete, United States • Sarah Reinertsen, triathlete, United States • Femita Ayanbeku, sprinter, United States • Trenten Merrill, long jumper, United States • Marissa Papaconstantinou, sprinter, Canada Europe • Markus Rehm, long jumper, Germany • Daniel Wagner Jörgensen, long jumper and snowboarder, Denmark 16

AUGUST 2019 | O&P ALMANAC

Helgi Sveinsson, javelin, Iceland Jody Cundy, track cyclist, Great Britain Richard Whitehead, sprinter and marathoner, Great Britain Stefanie Reid, sprinter and long jumper, Great Britain Marlene van Gansewinkel, sprinter and long jumper, Netherlands • Fleur Jong, sprinter, Netherlands • Marie-Amelie Le Fur, sprinter and long jumper, France • Liisa Lilja, triathlete, Finland • Beatrice Vio, wheelchair fencing, Italy Asia • Itani Shunsuke, sprinter, Japan • Maya Nakanishi, sprinter and long jumper, Japan • Liu Meng, table tennis, China Africa • Ntando Mahlangu, sprinter, South Africa • • • • •

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Hanger Inc. has been added as a member of the U.S. small-cap Russell 2000® Index, effective July 1, 2019. Membership in the Russell 2000® Index, which remains in place for one year, is based on membership in the broad-market Russell 3000® Index. The stock also was automatically added to the appropriate growth and value indexes. Russell U.S. Indexes are widely used by investment managers and institutional investors for passive funds and investment products and as benchmarks for active investment strategies. “This is significant as it is a great reflection and celebration of the accomplishments of our nearly 5,000 employees, and the resulting success among our public company peers,” said Hanger President and Chief Executive Officer Vinit Asar. “It also heightens our visibility to investors as we continue demonstrating that we have the optimal long-term strategy in place for our continued growth.” Hanger Inc. also announced it has been named a finalist for the Greater Austin Business Awards in the Innovation category. The awards, presented by the Austin Chamber of Commerce, recognize businesses and organizations for achievements, community contributions, and milestones. The Innovation category recognizes companies that disrupt the market with a new product or service. Hanger has offered inventive peer-to-peer support programs and technologies, including the national Bilateral Above-Knee Amputee Bootcamp and the MiGO virtual reality experience. “We are honored to be named a finalist for this award,” said Asar, “as it recognizes our commitment to enhancing patient care by disrupting the O&P industry with innovative solutions.”

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REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

E! QU IZ M EARN

BUSINESS CE

CREDITS P.20

On Your Mark, Get Set, Bid Navigating the competitive bidding process for off-the-shelf orthoses

2021, including all of the required documents and additional information that must be submitted. Below is information highlighting some of the larger issues that will be part of the bid submission process.

Bid Surety Bonds

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

Key Dates for Competitive Bidding 2021

See the Reimbursement Page article in the July 2019 O&P Almanac for an overview of the Medicare Competitive Bidding 2021 program and a detailed list of the important dates and deadlines that are part of the process.

AUGUST 2019 | O&P ALMANAC

EGISTRATION TO PARTICIPATE

in Competitive Bidding 2021 has been open since June 10, and the bid window opened July 16. With Round 2021 off and running, this month’s Reimbursement Page focuses on the bidding process itself, including mandatory requirements for submitting a bid. If you have successfully registered to participate in the Medicare Competitive Bidding 2021 program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), it is time to begin gathering the information required to prepare and submit your bid. AOPA recommends the use of the Medicare competitive bidding website, www. dmecompetitivebid.com, as a resource for valuable information regarding the competitive bidding program. Once on the competitive bidding website, you can download and review instructions on how to submit a bid. The 55-page bidding instruction document—a downloadable PDF—explains what is needed to submit a bid for Competitive Bidding

PHOTO: Getty Images

Bid surety bonds have been a source of significant confusion among AOPA members who are considering participating in the competitive bidding process. A bid surety bond is an event-specific surety bond that applies only to the competitive bidding program, specifically to the bidding process. The purpose of the bid surety bond is to prevent providers who submit bids at or below the winning bid amount from arbitrarily refusing to accept contracts. CMS uses a complex actuarial process to estimate the number of contracts it must award in a particular competitive bidding area (CBA) based on the expected beneficiary demand in the CBA. Failure of winning bidders to accept contracts may negatively impact the ability to provide adequate service within a CBA. Beneficiary access to care is crucial to the success of the CMS competitive bidding process and therefore must be protected. The requirement for suppliers to obtain a $50,000 bid surety bond per CBA creates a significant deterrent against submitting a bid that cannot be honored upon award of a contract.

REIMBURSEMENT PAGE

Bid surety bonds are independent of traditional Medicare and Medicaid surety bonds and are limited in scope. As long as a provider who is awarded a contract accepts the terms of the contract, the surety bond will be cancelled shortly after the announcement of contract awards, and the surety will be released of all liabilities against the bond. The issuance of a bid surety bond does not replace or change the requirement for suppliers to maintain a general surety bond for Medicare and/ or Medicare enrollment purposes. Providers who wish to submit bids for multiple CBAs must submit a separate surety bond for each of the CBAs where they wish to submit a bid. Bid surety bonds cannot be combined to cover more than one CBA.

Bid Networks

Multiple providers may form a separate legal identity, also known as a network, but only if each of the members of the network certifies that it is unable to provide coverage to the entire CBA. Any network that is formed must,

as an entity, provide coverage to the entire CBA for each product category for which the network is submitting a bid. Each network must have a primary member who will be responsible for registering in DMEPOS Bidding System, DBidS, as well as in Connexion, the program’s secure portal. This individual also will be responsible for uploading all required financial and nonfinancial documents for all network members.

Bona Fide Bids

For a specific bid to be considered valid, it must be shown to be bona fide, according to CMS. This means that the bid must be realistic in nature from a financial and practical manner and must consider operating costs, including overhead, when developing a bid for both lead items and nonlead items within a product category. Bidders may be asked to provide documentation that supports their bid as bona fide. This documentation may include manufacturer invoices, receipts, and signed manufacturer quotes. Bid amounts may be altered while

the bid window is open, but they may not be altered once the bid window closes. Bids that cannot be determined to be bona fide will be disqualified and ineligible for contract award.

Required Financial Documents

All DMEPOS competitive bidding bid submissions must include detailed financial information that establishes the current and expected financial stability of the entity submitting the bid. Required financial documents include tax return excerpts, income statements, balance sheets, cash flow statements, and credit reports. Detailed information regarding the specific financial documents required of bidding entities may be found starting on page 42 of the bidding instruction document. While not mandatory, CMS recommends the use of a financial professional in the preparation and submission of the required financial documents. The complex nature of the documents may require the expertise of a financial expert to ensure proper preparation of the required documents.

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REIMBURSEMENT PAGE

Developing Your Bid

While antitrust regulations prevent AOPA from discussing individual strategies on bid submission, there are several considerations that should help you develop a strategy that best meets your individual needs. • The relationship between the lead item and non-lead items: When submitting a Competitive Bidding 2021 bid, you will only bid on the Healthcare Common Procedure Coding System code that represents the “lead” item within the selected product category. All other items in the product category (non-lead items) will be priced based on the single pricing amount (SPA) for the lead item. When developing your bid strategy for the lead item, consider the potential impact on the non-lead items as you are required to provide all items within the product category if awarded a contract. It is possible that the lead item may not represent a significant revenue source for your company, but it will still impact how much you are reimbursed for non-lead items under competitive bidding.

• Recognition of your limits: To be successful in a competitive bidding environment, you must have a full and complete understanding about what is in the best financial interest of your company. You will need to make a decision regarding whether a particular bid represents the best financial interests of your organization. Knowing your financial limits going into the process will help you to build your bid submission strategy. • Proper preparation: The bid submission process for Competitive Bidding 2021 is not a quick or easy one. Preparation and submission of a bid will take significant time and energy and should not be delayed until it is too late. Make the decision to participate in the process early enough to allow adequate time to complete and submit your bid. In addition to allowing adequate time for bid preparation and submission, ensure that all required licensure and accreditation requirements have

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been met and are current. Expired or lapsed licensure and accreditation can stop a bid dead in its tracks.

Don’t Get Left Behind

Competitive bidding is a complex and detailed process. While it is 17 months away from implementation, the process is well under way and will be completed sooner rather than later. Preparation and understanding are the keys to navigating the process successfully. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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Model A5

Model F5

Model P5

The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

AUGUST 2019 | O&P ALMANAC

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This Just In

Reconsideration Requests CMS names Maximus Federal as new Qualified Independent Contractor

HE CONTRACT TO SERVE as the

entity that processes Medicare reconsideration requests—the Medicare Qualified Independent Contractor (QIC) for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)—will transition from C2C Innovative Solutions Inc. to Maximus Federal by the end of 2019. C2C will hold its last reopening discussion on September 15, and all pending reconsideration requests will be completed by December 31. Information regarding when Maximus will begin accepting Medicare reconsideration requests has not yet been released. The QIC is the Medicare contractor responsible for processing the second level of the Medicare claims appeal process, also known as reconsideration. The name of the contractor is telling as redetermination requires a new review of the claim that does not involve anyone who reviewed the initial claim. This part of the appeals process is designed to allow a truly independent review of the claim based on the documentation in the patient’s medical record.

AUGUST 2019 | O&P ALMANAC

Telephone Reopening Program

During its tenure as QIC, C2C spearheaded a popular telephone program, the Medicare Telephone Discussion and Reopening demonstration project. This program, initiated in 2016, proved to be tremendously successful and drastically reduced the number of reconsideration denials—approximately 80 percent of claims selected for reopening were found in the provider’s favor. The Telephone Discussion and Reopening demonstration project led to a significant reduction in the number of claims that were appealed to administrative law judges (ALJs) and had a positive impact on reducing the backlog of claims awaiting an ALJ decision. While not assured, the success of the program under C2C has led many to believe the program will continue when Maximus takes over as the QIC contractor in 2020.

Transition Planning

Maximus is not new to the Medicare contracting environment as it currently holds multiple contracts serving as the QIC for Medicare Part A and Medicare Part B. Based on its

This Just In

experience in other Medicare appeals operations, minimal disruption is expected with the addition of the DMEPOS QIC contract. Changes to Medicare contractors are regular occurrences. Recent examples of Medicare contractor changes that directly impacted O&P were the transition from NGS to CGS in Jurisdiction B and the transition of Pricing, Data Analysis, and Coding (PDAC) responsibilities from Noridian to Palmetto GBA. While transition is sometimes difficult and not without some hurdles, things usually settle down quickly. Maximus has an impressive record as a Medicare contractor, and it is hoped that it will continue some of the positive programs developed by C2C during its tenure as the QIC. The backlog of cases awaiting adjudication by an ALJ remains between three and five years. While the law states that ALJ hearings must take place within 90 days, this

simply has not been reality for many years due to the increase in claim denials because of Recovery Audit Contractor audits, Comprehensive Error Rate Testing audits, and increased medical review audits by

Medicare contractors. A smooth transition between QIC contractors should allow for the continued reduction in the ALJ backlog and more reasonable treatment of the provider community.

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COVER STORY

Advances in

Osseointegration What O&P clinicians need to know about implant surgery and tips for working with this growing patient population By CHRISTINE UMBRELL

NEED TO KNOW The number of Americans undergoing osseointegration, via a one-stage or two-stage surgical procedure, is growing each year. Most patients who undergo surgery to receive implants do so because traditional socket technology has not worked well for them. As more surgeries are performed, O&P business owners and clinicians should understand the technology, be aware of the latest clinical studies, and understand how to provide prosthetic care for these patients. The osseointegration team at the University of California— San Francisco (UCSF) has conducted a number of implant surgeries and recently published the first U.S. trial for the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA™) Implant System, a prospective study of above-knee amputees with osseointegrated implants. The researchers concluded that one year following osseointegration, there was significant improvement in patient-reported outcomes. Prosthetists who are part of osseointegration teams and who are asked to care for patients who have undergone implant surgery “must play a more prominent role within the clinical decision-making team to ensure successful outcomes,” says Matthew Garibaldi, MS, CPO, a member of UCSF’s osseointegration team.

AUGUST 2019 | O&P ALMANAC

Prosthetic care for patients who have received custom implants may be complicated by the fact there are no official “Instructions for Use” or established rehabilitation protocols for these types of devices. And some patients may have travelled overseas for surgery, and may have received implants that are not regulated by the U.S. Food and Drug Administration. Prosthetists should recognize that alignment needs may change over time for patients with implants, and should understand that these patients may now experience osseoperception—and may feel misalignment more acutely. In the future, osseointegration in combination with regenerative peripheral nerve interfaces, which allow for prostheses to be directly controlled by peripheral nerves, may be a viable option for patients who can’t get a good fit with their prosthetic socket.

COVER STORY

HE NUMBER OF AMERICANS with prosthetic implants

is growing every year; it is estimated that there are more than 100 individuals living in the United States who have undergone osseointegration surgery to receive an implant to which a prosthesis can be attached. While the vast majority of U.S. O&P clinicians have not yet been asked to provide prosthetic care for patients with implants, it won’t be long before more practitioners are expected to be familiar with this technology. As osseointegration becomes a more common solution among amputees for whom sockets are problematic, it’s important for O&P businesses and their clinicians to know what to expect when such a patient visits their facility.

A Growing Patient Population

Osseointegration—direct connection between bone and an implant, to which a prosthesis is attached, via a one-stage or two-stage surgical procedure—has come a long way since the technique was first introduced. While there have been many lower-limb osseointegration procedures performed in the United States, upper-limb surgeries have recently become an option for some individuals who have amputations with documented difficulty using a socket, or where prosthetic use and functionality is limited.

PHOTOS: Barbara Ries Photography/UCSF

Matthew Garibaldi, MS, CPO, works with an osseointegration patient who participated in a clinical study at the University of California—San Francisco (top left); the patient undergoes a gait assessment in the Motion Lab (bottom). O&P ALMANAC | AUGUST 2019

COVER STORY

AUGUST 2019 | O&P ALMANAC

have travelled to have the surgery performed in facilities in foreign countries—such as via the Osseointegration Group of Australia, where 92 visitors from the United States have had osseointegration performed since 2010. (Surgical procedures and implant devices provided outside the United States are not regulated by the FDA.) While the types of surgeries performed and the implants themselves vary, all patients undergo osseointegration with the goal of being able to use an artificial limb that attaches to the implant, forgoing the traditional socket interface. Typically, the prosthesis attaches to an abutment via a “failsafe,” which allows attachment of prosthetic components and is designed to release itself under excessive forces if a fall occurs to prevent fracture of the bone. Regardless of the type of implant or where the surgery was conducted, patients continue to require prosthetic care. Prosthetists who are asked to care for these patients should understand what osseointegration is, what has been learned during the latest

U.S. clinical studies, how to provide optimal care, and what to expect as the science advances and osseointegration integrates more frequently with other technologies, such as neuroprosthetics.

Benefits and Challenges

Most patients who undergo surgery to receive implants do so because traditional socket technology has not worked well for them. For patients who have experienced high rates of complications, such as decreased tissue compliance and increased incidence of ulcerations, pain, heterotropic ossification, and symptomatic neuromas, implants that eliminate the need for a socket have the potential to increase mobility with a prosthesis. The osseointegration team at the UCSF has conducted a number of implant surgeries and recently published the first U.S. trial for the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA™) Implant System, a prospective study of above-knee amputees with osseointegrated implants.

Schematic diagram of the OPRA system

Postoperative radiograph demonstrating the placement of the OPRA device (left) and clinical photograph of the percutaneous abutment for external prosthesis attachment (right)

Images and photos courtesy of UCSF Department of Orthopaedic Surgery

However, only certain individuals are eligible for the surgery, and a limited number of surgeons and hospitals are authorized to perform osseointegration in the United States. Many of the surgeries being performed are part of clinical trials approved by the U.S. Food and Drug Administration (FDA), through an Investigational Device Exemption, which allows an investigational device to be used in a clinical trial in order to collect safety and effectiveness data. Other surgeries are being performed in humanitarian situations through a Humanitarian Device Exemption (HDE) with the FDA, which allows medical devices that are not otherwise FDA-approved for marketing to be used in limited circumstances without requiring evidence of effectiveness. (An HDE application must contain sufficient information for the FDA to determine that the device does not pose an unreasonable or significant risk of injury or illness, and that the probable benefit to health outweighs the risk of injury or illness from its use.) Currently, only two clinical trials are enrolling in the United States, and both are being led by Jonathan Forsberg, MD, PhD, who is affiliated with Johns Hopkins Hospital and Walter Reed National Military Medical Center. Forsberg also is the principal investigator of a newly developed international registry to track osseointegrated transdermal implants, funded by the U.S. Navy; the registry is designed to capture demographic information, patient-reported outcomes, radiographs, and pictures of skin penetration sites. In the United States, approximately 55 osseointegration surgeries have been performed at the three main institutions where research is being conducted: Walter Reed, Johns Hopkins, and the University of California—San Francisco (UCSF). In addition, some Americans have received custom implants that were manufactured on an “as-needed basis” under the direction of a surgeon. These custom implants are provided through a “custom device” pathway with the FDA. And still other amputees

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COVER STORY

The team is currently in the process of creating a “best practice” patient selection algorithm for osseointegration candidates, according to Matthew Garibaldi, MS, CPO, director at the UCSF O&P Centers and associate clinical professor in the UCSF Department of Orthopaedic Surgery. “This is a complex Matthew Garibaldi, undertaking, given MS, CPO the host of factors

involved with this unique selection process,” he says. “We’ve found the following variables to be present in our most successful cases: stable soft tissue, three-quarters femoral length, healthy bone mass, hygienic home environment, and patient compliance.” The UCSF researchers’ recommendations will be informed by the clinical study they’ve recently completed, the findings of which will be presented at the AOPA National Assembly in September. The UCSF

AUGUST 2019 | O&P ALMANAC

PHOTO: Barbara Ries Photography / UCSF

In the UCSF Human Performance Center, Garibaldi places motion tracking markers to capture kinematic data.

team followed nine patients at a single center; all were transfemoral amputees who experienced difficulty wearing a conventional socket prosthesis and underwent a two-stage osseointegration surgery with six months between stages. After the second surgery, patients advanced to full weightbearing with a short prosthesis before being transitioned to a long prosthesis under the guidance of a physical therapist and prosthetist. Researchers conducted outcome measures testing when patients returned for clinical follow-up at two weeks, three months, six months, and one year after surgery. At the final follow-up, four patients were walking unassisted, one patient used a cane, one patient used one crutch, two patients walked with two crutches, and one patient primarily used a wheelchair. Four patients experienced a total of four infections, with one deep infection necessitating implant removal. In addition, several patients reported having issues with the failsafe connector device between the percutaneous abutment and the external prosthesis. Despite those issues, the researchers concluded that one year following osseointegration, there was significant improvement in patientreported outcomes. “This study has demonstrated that osseointegration using the OPRA device can have a significant positive impact on the quality of life and function in transfemoral amputees and has the potential to revolutionize current treatment strategies and goals for these patients,” according to the researchers. Anecdotally, feedback from the trial participants indicated that “they are extremely pleased with the outcomes, and if the implant were to be damaged, they’d be willing to repeat the entire surgical/rehab process before reverting back to traditional socket technology,” says Garibaldi. The patients identified the benefits of heat reduction, comfort when sitting, ease of donning, and better prosthetic connection to the limb with their implants.

COVER STORY

Of course, the patient experiences were not without their challenges. “Since the majority of patients who consent to this procedure have been largely unsuccessful with traditional socket technology, they come to us fairly deconditioned due to lack of prosthetic use,” explains Garibaldi. “As such, extensive pre- and postsurgical therapy has been required in most cases to optimize functional outcomes.” Patients also experienced hardwarerelated challenges. Early on, many patients involved in the study experienced failures with the implant OPRA connector, which acts as a coupling unit between the prosthesis and the surgically implanted components. “Thankfully, these issues have not persisted following reports to the FDA and subsequent manufacturing changes,” says Garibaldi. The UCSF findings parallel those of a recent Swedish study on longer-term results of osseointegraRickard Brånemark, tion. The Swedish MSc, MD, PhD research team, led by Rickard Brånemark, MSc, MD, PhD, conducted a five-year follow-up of patient-reported outcomes and complications, and found that transfemoral amputees with implants had significant improvement at the five-year mark, but they also experienced increases in infections and mechanical complications at that point in time. The UCSF research team is currently working to align its osseointegration program with the one in place at Walter Reed National Military Medical Center. “We placed our osseointegration recruitment on hold last year while aligning our transfemoral osseointegration research parameters with that of Walter Reed’s in an effort to expand patient trial access and to optimize patient recruitment efforts,” explains Garibaldi. “A largescale clinical trial will allow for more generalizable outcomes as it pertains to the safety and efficacy of osseointegration in the U.S.”

OSSEOINTEGRATION

Outcomes Assessment A research team led by Robert Gailey, PhD, PT, a professor in the Physical Therapy Department at the University of Miami, conducted a study comparing mobility and balance outcomes in amputees with an osseointegrated versus a traditional socket prosthesis. The study compared a small cohort of relatively young healthy people who wear tradiRobert Gailey, PhD, PT tional sockets to a sample who had undergone osseointegration performed by surgeons at the Osseointegration Group of Australia to determine if differences in mobility and balance existed between groups. The findings concluded that people with unilateral transfemoral amputation with an osseointegrated prosthesis demonstrated similar mobility and balance performance compared to a matched-case control traditional socket prosthesis group, but the osseointegration group reported higher perceived balance confidence on self-report measures. “The osseointegration group had better perceived mobility and balance confidence; however, no differences were found with performance-based measures,” says Gailey. Gailey suggests osseointegration is “another option for people with limb loss who cannot wear a socket as an alternative option for mobility equal to that of traditional prosthetic wearers,” he says. “It opens options to a cohort who might not tolerate a socket and could not otherwise use a prosthesis.”

Providing Prosthetic Care

Prosthetists asked to care for patients who have undergone implant surgery Brian Kaluf, BSE, CP, FAAOP “must play a more prominent role within the clinical decision-making team to ensure successful outcomes,” says Garibaldi. “All members of the team—physician, prosthetist, physical therapist, nurse, etc.—must provide equal input from their individual perspective, and the team must be in full agreement regarding a patient’s potential for success with the surgery, given the invasiveness and finality of the procedure.” So, what should a prosthetist know when faced with a patient who has an implant? “This is a new frontier for O&P,” says Brian Kaluf, BSE, CP, FAAOP, clinical outcome and research director at Ability

P&O. His facility was recently faced with finding a way to treat patients who have implants when a longtime patient decided to undergo osseointegration at the University of Pittsburgh under a custom device exemption by the FDA. The patient received a custom Compress® implant—requiring a single-stage surgery—accompanied by a failsafe mechanism. At the O&P facility, it’s generally understood to be within a prosthetist’s scope of practice to attach, align, and maintain the prosthetic components distal to the end of the failsafe mechanism to meet the patient’s ongoing and emerging prosthesis needs, according to Kaluf. “We were able to continue treating the patient after his surgery,” he says, but prosthetic care was complicated by the fact there are no official “Instructions for Use” or established rehabilitation protocols for custom implants. O&P ALMANAC | AUGUST 2019

COVER STORY

Before treating the patient, Ability required that the patient sign a liability waiver—just as he’d been asked to sign liability waivers with the hospital system and the implant manufacturer. Kaluf recommends that any clinician asked to treat a patient with an implant discuss the situation with his or her employer ahead of time and confirm that the employer approves of the facility providing care for such patients. The employer may have concerns related to whether prosthetic care

will be covered under the company’s liability insurance, and the employer also may choose to consult with an attorney about providing a liability waiver form, he says. Kaluf also recommends that clinicians seek out educational opportunities, such as those available at national conferences (see sidebar for information on osseointegration sessions planned for next month's AOPA National Assembly) and a learning module on the Academy’s Online Learning Center titled “Prosthetic Management Following Osseointegration,” or to study any available Instructions for Use or the staged weightbearing protocols associated with the osseointegration surgery and implant. He cautions that clinicians may need to schedule additional appointment time as THURSDAY | SEPTEMBER 26 alignment can be tricky with an implant, and alignment needs Mark your calendar to attend the may change over time. “What Osseointegration Rehabilitation I noticed is that the patient Symposium at the AOPA National has a more direct transmission Assembly meeting in San Diego, schedof muscle power through the uled for September 26, at 3:15 to 5 p.m., prosthesis—a more immediate followed to by a Free Paper Session on reaction of movement, and less Osseointegration Rehabilitation from time delay” than with a socket, 5 to 6 p.m. says Kaluf. “This required a Speakers at the Symposium will include more precise alignment of Dave Beachler, CP; Rickard Brånemark, the prosthetic components MSc, MD, PhD; Matthew Carty, MD; distal to the implant to avoid Jonathan Forsberg, MD, PhD; Matthew gait deviations.” Garibaldi, MS, CPO; Theodore Alexander In addition, the Ability Kung, MD; Richard O’Donnell, MD; Max patient—like many patients Ortiz Catalan, PhD; and Benjamin Kyle with implants—now expePotter, MD. riences osseoperception, During the Free Paper Session, speakers or sensory awareness of his will include Brånemark; Brian Kaluf, BSE, surroundings, because the prosCP, FAAOP; Jeffrey Quelet, CPO; D. Kurt thesis is anchored directly to Collier, CP; and William Lu, PhD. the bone. The phenomenon can Details on all of the osseointegrationmake the prosthesis feel like themed sessions and papers are featured less of a “tool” and more a part in the AOPA 2019 National Assembly of the body for the wearer. Preliminary Program, available on the But prosthetists should be AOPA website. aware that osseoperception, and greater proprioception, means the patient also feels any misalignment more acutely, says Kaluf. Whereas some of the pain associated

Don’t Miss These OSSEOINTEGRATION SESSIONS in San Diego

AUGUST 2019 | O&P ALMANAC

with vertical force or shock can be absorbed through the skin, adipose, and muscle tissues of the residual limb with a traditional socket, it is translated directly to the bone with an implant. “So now our patient experiences some bone pain that he didn’t have before,” says Kaluf. “If his prosthesis gets twisted,” or the patient stumbles across an object, the loads are transferred directly to the bone and the pain can be more intense than before his surgery. In addition, prosthetists should be aware that components—both the failsafes and the prosthetic components—may wear out at a higher rate if a patient has an implant. “Each component undergoes a greater amount of stress and strain” and requires increased attention so replacements can be ordered in a timely manner. Despite some of the new challenges the Ability patient has faced with his implant, “he is glad he had the surgery,” Kaluf says. The patient has not had problems with infection, his surgery closure is healthy, and he can participate in more activities than before.

Neuroprosthetics on the Horizon

As more individuals undergo osseointegration surgery, advanced options are becoming available to promote more intuitive prosthetic control. Studies are currently underway on new robotic prostheses controlled via implanted neuromuscular interfaces. The technology “is under development and currently in an ongoing clinical trial, and as soon as it is CE-marked it will be” offered as an upgrade for people currently using the OPRA implant system, according to Kurt Collier, CP, vice president of prosthetics at Integrum. The new technology has been developed in close collaboration with Chalmers University of Technology and Sahlgrenska University Hospital in Gothenburg, Sweden. The prosthesis is attached to the skeleton, then the human’s biological control system (nerves and muscles) is interfaced via neuromuscular electrodes to the prosthesis via an advanced control system.

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A team led by Max Ortiz Catalan, MD, tested the technology earlier this year, when surgeons performed a pioneering procedure at Sahlgrenska University Hospital; titanium implants were placed in a patient’s forearm bones, from which electrodes to nerves and muscle were extended to extract signals to control a robotic hand and to provide tactile sensations. This surgery resulted in the “first clinically viable, dexterous, and sentient prosthetic hand usable in real life,” according to the researchers. Paul Cederna, MD, FACS, chief of plastic surgery and professor in the Department of Biomedical Engineering at the University of Michigan, helped create some of the technology being leveraged in the advanced control system: regenerative peripheral nerve interfaces (RPNI), which allow for prostheses to be directly controlled by

peripheral nerves. RPNIs are pieces of grafted autologous muscle that regenerate and become reinnervated by an implanted residual peripheral nerve, and are designed to help control myoelectric prostheses. Using this technology, “we are able to amplify the nerve signal 100-fold, drowning out the ‘noise’ so the brain can translate signals,” explains Cederna. In the future, osseointegration in combination with RPNI will be a viable option for patients who can’t get a good fit with their prostheses, Cederna says. The goal is to achieve optimal prosthesis fit via skeletal fixation to the body in combination with RPNI-based control that facilitates signals for individual finger function.

still in the investigation period,” says Garibaldi. “We should approach this treatment option with inquisitive optimism, while investigating it through a critical lens. Our goal is to improve function, but we must always remain focused on patient safety.” The participation of O&P professionals in osseointegration teams and in patient care for individuals with implants will be key to optimal outcomes for this population. “I hope our profession will rise to this challenge and develop best practices for managing care of these patients,” Kaluf says. “Our expertise, training, and skill sets as prosthetists” will be an integral part of the osseointegration evolution.

Only the Beginning

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

While prosthetists are gradually seeing more patients with implants, it’s important to remember that “we’re

Going Overseas for Implants

AUGUST 2019 | O&P ALMANAC

Munjed Al Muderis, MBChB, FRACS, FAOrthA

Amputation Level Breakdown for Procedures Performed By Osseointegration Group of Australia

Figures and photo courtesy of Osseointegration Group of Australia

Ninety-two Americans have travelled to Australia since 2010 to undergo osseointegration surgery conducted by the Osseointegration Group of Australia (OGA), according to OGA. Over the last couple of years, OGA has streamlined the management of patients undergoing the osseointegration procedure. The current standard procedure at OGA involves a single-stage surgery, where the patient undergoes the implantation of a tensile strength titanium device into the residual femur. The latest technique and implant design “have led to dramatically lowering the risk of complications, especially infections, which is now at a rate on par with standard orthopedic surgery,” according to Munjed Al Muderis, MBChB, FRACS, FAOrthA, an orthopedic surgeon and chairman of OGA. The OGA design “has evolved into making the implant inherently stable at the time of implantation by providing key features in the design, including the proximal fins that provide rotational stability and distal flare that provides axial stability allowing us to reduce the rehabilitation time and earlier mobilization, making the patient able to use their prosthetic limb as early as two weeks postsurgery,” Al Muderis says. The technology “transforms the lives of amputees and brings them as close as possible to able body individuals.”

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GROWTH STRATEGIES As students across the nation leave for college, O&P clinicians share best practices for helping pediatric patients transition into adulthood NEED TO KNOW • The number of Americans undergoing osseointegration, via a one-stage or two-stage surgical procedure, is growing each year. Most patients who undergo surgery to receive implants do so because traditional socket technology has not worked well for them. • O&P clinicians can coach patients who are moving out on how to be emotionally prepared to enter a new community where they most likely will look different. • Because many college students walk more often and travel longer distances than they did in high school, some O&P professionals suggest that patients engage in numerous campus visits before deciding on a university; that way, they can examine the terrain and evaluate the institutions’ transportation systems. 34

AUGUST 2019 | O&P ALMANAC

• Some practitioners advocate for thoroughly reviewing a patient’s charts and examining his or her components before the patient leaves for an extended period of time, to ensure devices are still appropriate and in good condition. • Practitioners may suggest that patients find clinicians near their new schools or homes, in case adjustments are needed or an emergency comes up—but young adults also should consider scheduling appointments with their regular O&P providers during school breaks. • O&P professionals may encourage young adults to investigate support groups, adaptive sports activities, or mainstream activities and clubs once they arrive on campus or move to a new neighborhood.

HEN NICK ACKERMAN, CP, LP,

left home to attend Simpson College in 1997, he knew that, like other incoming freshmen, he would face many changes. But some of the challenges he encountered would be unique to him—because he wore prosthetic legs. At home, everyone knew Ackerman, and few were shocked to see him running on his knees or donning prostheses. But at college, he was meeting entirely new people—many of whom had never met a person who used a prosthetic device. Ackerman decided to approach the situation in the same manner he did at home: He would not make a big deal about it.

Preparing Patients for Independence

As Ackerman has both lived and learned, O&P clinicians working with a pediatric population frequently assume a responsibility for helping their longtime patients prepare to go off to college or live independently after growing up in their parents’ homes. For many of these young adults, moving on after high school is the first time they’re on their own, with no one to assist them when it comes to showering or navigating rough terrain, for example. Emma Dahl, a patient of Ackerman’s whose right leg was amputated below the knee to remove a cancerous tumor intertwined in the muscle and bone,

just finished her first year of college at the University of Northern Iowa. While she made it through freshman year without experiencing any significant damage to her prosthetic leg or an emergency requiring her to seek adjustments, she noticed that some of the emotional aspects of having a prosthetic device differed from what she was used to at home—just as Ackerman discovered more than two decades ago. “It’s definitely an adjustment,” says Dahl, “because I grew up in a small town and [lost my leg] during my senior year when I had cancer.” At home, her community rallied around her—but, as Dahl explains, when she went to college, nobody knew her history or why she wears a prosthesis.

Nick Ackerman, CP, LP

PHOTO: Getty Images

“My mom had always been a proponent of, ‘If it is not a big deal, don’t make it one,’” explains Ackerman, director of prosthetics at American Prosthetics and Orthotics in Clive, Iowa. “It is a very small physical characteristic, and it doesn’t define my personality or outlook.” When he started at Simpson, Ackerman joined a fraternity and wrestled until he graduated in 2001. Through his involvement with those communities, he made great friends. While seeing someone wrestle without legs might have initially startled some, most didn’t think of him as “the guy with prosthetic legs.” “I could accurately say not having legs is the fourth or fifth thing that people I went to college with would describe me as. It revolves more around my personality and work ethic and that I happened to wrestle,” he explains. “Maintaining the confidence in who you are and letting your personality show is the most important thing” when integrating into a new community, says Ackerman.

O&P ALMANAC | AUGUST 2019

“They just saw this girl who has a weird leg. It was kind of an adjustment—and you notice people who notice your leg, and they don’t want you to notice,” says the 19-year-old sophomore studying education. Although Dahl never broaches the subject unless someone asks, she does not mind discussing her prosthesis. “I love talking about it,” she explains. “I wish there were more people with prosthetic legs in books because having robot legs is kind of cool … . Asking questions is not a bad thing.”

AUGUST 2019 | O&P ALMANAC

Calling on Backups

To help their patients prepare to live on their own for the first time, O&P clinicians can coach them on how to be emotionally prepared to enter a new community where they most likely will look different and have to answer questions about their devices or limb difference. But there also are logistical issues to consider. Ackerman went to college only 45 minutes from home and could return when he needed an adjustment. However, Dahl attends a university that is much further from home, so Ackerman recommended a clinician close to her school. While a lot of prosthetists and orthotists feel hesitant to work on other people’s patients—they often can’t bill for it—people who are too far from their regular clinician need to have someone to visit in case of emergency. “It can be important to establish a connection with a clinician nearby … to make the small adjustments if needed,” he says. “I’ll use the AOPA directory and give [my patients] a list of providers closest to their school, just so they have a contact person,” agrees Brigid Driscoll, PT, CO, a clinician at Ann & Robert Lurie Children’s Hospital in Chicago. “If I know someone in the general area, I will get in touch with them and connect [patients] with a good provider.”

Brigid Driscoll, PT, CO

While ensuring students have access to a local clinician in case of an emergency is important, experts agree that they should schedule appointments with their regular O&P practitioners when they are home for the holidays or on summer break to help with continuity of care. “They do tend to remain with us and see us on breaks,” Driscoll says. During her first year of college, Dahl made sure to follow this advice. She scheduled appointments with Ackerman during her breaks. And although she’s only had her prosthetic device since she was 17, Dahl knows the value of returning to her regular clinician for any needs she has. “We still go back to [Ackerman] every once in a while because I need an adjustment or [something] is not quite working with my leg,” she explains.

Stocking Up

Before young adults head off to college or make other moves, some orthotists and prosthetists may choose to provide their patients with extra components so they can make minor adjustments themselves. But this approach should be taken on a case-by-case basis. Driscoll doesn’t usually give her patients extra equipment or replacement parts due to “the risk of them not doing it properly,” she says. Others take a different approach. “If they are going to college, they have reached an aptitude where they can probably manage a few things,” says Brian Emling, CPO, LPO, a clinician at Children’s Healthcare of Atlanta. Before a patient leaves to attend a university, Emling suggests conducting a chart review to see what they’ve had issues with in the past. “I think, ‘What can I equip them with that can make these little tweaks?’” For example, he might send them with pads or straps that could help them deal with minor problems, with instructions to call him if needed. “It’s nice to be able to talk to them,” Emling says. “If a pad or something falls out, you tell them this is what you can do to adhere something.”

PHOTO: Getty Images

Ackerman admits he was hard on his devices during school, but he was lucky that every time he called his regular prosthetist, he could get an appointment. “I did beat [my prostheses] up quite a bit,” he says. “I would call [my prosthetist], and he would meet me for an appointment.” Learning to manage your own O&P care is part of the transition of growing up, Ackerman adds. Just as you have to learn to do your own laundry and manage your meals, “you have to take

care of your own prosthetic needs,” he says. “Mom and dad aren’t there to take care of your prosthesis.”

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Other clinicians agree that exhaustively reviewing the charts and examining a student’s device before he or she leaves can help prepare patients for being away from home and their regular clinician. Part of Driscoll’s strategy to help her patients successfully be independent includes examining the device and how it is wearing on their bodies to help prevent any problems when they’re on their own. But she says her office keeps the lines of communication open, too, so they can connect with students who need more oversight or who might have loads of questions. “We always coordinate things for the kids who need more regular management,” Driscoll explains. “We are able to communicate with them, and they let us know their needs.”

Summer Camps Offer a Taste of Independence to Children and Teens

AUGUST 2019 | O&P ALMANAC

Test-Driving the Campus

Clinicians may suggest that pediatric patients preparing for college participate in numerous campus visits before deciding on a university—and even after accepting an offer of admission. Students should study the school’s terrain, determine how accessible it is, and figure out how they will be able to navigate the campus. Only through personal inspection will students with prosthetics truly feel informed about and prepared for any mobility challenges they might encounter in their new environment. Emling encourages patients to share details of their campus visits. “I tell them to take advantage of early visits … and have them navigate campus like they would if they were a resident there,” he says. “What’s coming in terms of any barriers? Or any ramps— where are they going to be? So they’ve got it in their mind about how to navigate the day-to-day.”

PHOTO: Getty Images

Many O&P professionals encourage pediatric patients to test-run life without their parents by attending summer camp. Camps geared toward patients with limb loss or limb difference, or camps for children with cerebral palsy, can help young people learn to interact with others and become a little more independent. “You draw a little bit of something from everybody you surround yourself with,” says Nick Ackerman, CP, LP. “Having some sort of dry run or practice run in a camp environment and seeing other kids … might be helpful.” The Paddy Rossbach Youth Camp, run by the Amputee Coalition, is one example of a camp open to children with limb loss and limb difference. Offered for one week each summer and funded by various sponsors and donors, the camp offers an environment where campers ages 10 to 17 convene and enjoy the outdoors. “They get to talk to other kids and counselors who share their similar experiences. They can learn and challenge themselves, and have a great time doing it,” according to the camp website. Campers are challenged to test their independence and test themselves while making friends and taking part in activities. Camp No Limits provides another summer camp opportunity; the organization offers camps for children with limb loss and limb difference at various locations. Activities at Camp No Limits incorporate family members as well.

Brian Emling, CPO, LPO

Driscoll chats with her patients about walking because she’s found that college students walk more often and travel longer distances than they would have in high school. “I talk to them about proper shoe wear to make sure they are using a good base and maintaining their [ankle-foot orthosis],” she says. “Some of our kids who go from ambulation to a wheelchair, we talk to them about balancing out their mobility to protect their joints.” She also encourages patients to try maneuvering through their city and using public transportation alone, for example. “We are preparing patients for life,” she says. “We are trying to get them functional long term. We are trying to get them to build strength in their school setting, social setting … . Early education is a huge component.” Dahl admits she struggled to walk through the University of Northern Iowa campus during the winter when the snow and ice weren’t cleared off properly. She often worried that she would slip and fall, but she has since acclimated to the area.

Encouraging Students To Embrace Campus Life

Once students arrive on campus, they might be drawn to joining support groups or clubs that include people with limb differences. Dahl did not find any groups on her campus, but she wishes that she had. When Ackerman was in school, he declined joining groups specifically for people with disabilities and instead sought out more mainstream activities; he appreciated that his friends normalized his differences to others. “The net expands much larger” when you join a group like the wrestling team or a fraternity, he says. “It probably was beneficial that I had 40 guys that had my back and defended me.” And while Ackerman did not seek out other students with limb differences when he was in school, he now recommends that some patients seek this type of support if they want it. Driscoll says that she informs patients of various groups catering to people using prosthetics and orthotics,

Sharing Protected Health Information When Patients Turn 18

The parents of pediatric patients may not be aware that all protected health information (PHI) must be shared directly with the patient—and not his or her parents—beginning on the patient’s 18th birthday. As patients approach this milestone, you may need to educate parents—and patients—on patient privacy rules stipulated by the Health Insurance Portability and Accountability Act (HIPAA). Even though many young adults remain on their parents’ health insurance plans until they reach the age of 25, medical information must be kept private as soon as an individual turns 18, according to HIPAA. This means that facilities must follow certain HIPAA stipulations when handling the PHI of patients once they reach adulthood, and they may only disclose PHI directly to patients. If patients who have turned 18 wish to continue sharing medical information with their parents, patients may sign a HIPAA Privacy Authorization Form authorizing a healthcare facility to use and disclose their PHI to a designated individual—such as a parent—for a stated period of time. They may choose to disclose all, or just parts, of their health information to the designated third party. Many universities have additional forms for parents to sign if students agree to share their health information with their parents while on campus. And some laws associated with PHI disclosure and informing patients of the regulations may vary by state, so be sure to check local laws. but she doesn’t push the issue. “I try to make them aware of [groups],” but she encourages patients to gather more information since joining organizations is such a personal choice. In some cases, “they may not want to be siloed into that group.” Emling recommends that patients seek out adaptive sports, which enable patients to interact with people who look like them and understand their differences—but in a fun environment. He recommends they start these types of activities in high school and use connections from that group to find similar activities on campus. “I have them at least try it out first here and encourage them to make connections,” he says.

O&P clinicians who work with pediatric patients have a unique opportunity to help children learn to embrace their individuality and prepare for adult life—whether they choose to attend college or simply move out on their own. “Encouraging that independence … from a very young age goes a long way to motivate these kids to try a different environment to take more independent risks,” says Driscoll. “We have such an advantage of working with these kids, sometimes from infancy, that we can really establish a relationship.” Meghan Holohan is a contributing writer to O&P Almanac. O&P ALMANAC | AUGUST 2019

Oceans of Innovation AT THE ASSEMBLY EXHIBIT HALL

Preview the exhibitors, sponsors, and special events planned for the trade show floor during the 2019 AOPA National Assembly

Title Sponsors......................... Meet the exhibitors that have signed on as title sponsors for the 2019 AOPA National Assembly Exhibit Hall Map..................... Navigate the show floor using this handy floor plan Exhibitor Directory................ Access a complete, alphabetical listing of the exhibitors and their booth numbers

AUGUST 2019 | O&P ALMANAC

50 50

AOPA 2019 NATIONAL ASSEMBLY

HE EXHIBIT HALL AT the San

Diego Convention Center will serve as the headquarters for O&P professionals seeking to “drive the waves of change” during the 2019 AOPA National Assembly next month. Plan to spend plenty of time on the trade show floor September 25-28, where you will browse the hundreds of exhibits, demonstrations, and special events scheduled to take place. By traveling to the West Coast to celebrate this year’s Assembly, you will be rewarded with many opportunities to preview the latest O&P products and services; network with business owners, managers, clinicians, researchers, and other O&P stakeholders; and immerse yourself in cutting-edge educational sessions, award presentations, and keynote speeches. You may choose to arrive early to take advantage of the special opportunities preceding the Assembly on Tuesday, September 24—such as AOPA Night at the Ballpark for a Padres/Dodgers game or the Preshow Hands-On Workshop. Or you can kick off your on-site experience with this year’s captivating Opening General Session on September 25, featuring Captain Lanny Boswell, USN (Retired), followed by the Welcome to San Diego Grand Opening Reception on the trade show floor. At this special event, you will get your first introduction to the latest and greatest in O&P innovation from top O&P companies. See cutting-edge technologies and talk with representatives from exhibiting companies to find out how you can leverage the newest products to provide optimal patient care.

O&P EXPO DAY Saturday, September 28 9 a.m. – Noon

AOPA and its exhibitor partners will open the Exhibit Hall to the O&P community to facilitate sharing, learning, and camaraderie among the many facets of the patient population and rehabilitation community. In addition to interacting with 150 exhibitors showcasing every component, service, and device imaginable, Expo Day will feature several fun activities: • Photo opportunities and autographs with nine-time Paralympian Gold Medalist Jeremy Campbell • Headshot photo lounge (free professional headshots) • Complimentary massage station • Popcorn stand • Door prizes and giveaways

Paralymp Jeremy C ic Gold Medalist ampbell

EXHIBIT HALL HOURS Wednesday, September 25, 5:30 – 7:30 p.m. Thursday, September 26, 11 a.m. – 5 p.m. Friday, September 27, 11 a.m. – 6 p.m. Saturday, September 28, 9 a.m. – Noon

O&P ALMANAC | AUGUST 2019

AOPA 2019 NATIONAL ASSEMBLY

DON’T MISS THESE

Special Events

IN THE EXHIBIT HALL

Welcome to San Diego Grand Opening Reception Wednesday, September 25 5:30 – 7:30 p.m.

Exhibitor-Sponsored Happy Hour in Exhibit Hall Friday, September 27 5 – 6 p.m.

Lunch Break in Exhibit Hall Thursday and Friday, September 26 and 27 11 a.m. – 1 p.m.

Expo Day Community Outreach Saturday, September 28 9 a.m. – Noon

HEADSHOT PHOTO LOUNGE

Time to update your LinkedIn photo? Take advantage of this opportunity to receive a free professional portrait. You will receive both a digital and paper copy. The headshot photo lounge is located at Booth 445 in the Exhibit Hall and will be open all days of the show. See the lounge for specific times. Sponsored by Alps South LLC.

STEP IT UP CHALLENGE Participate in a three-day Step It Up Challenge! Each day attendees can track their steps via phone, separate app, fitness tracker, pedometer, etc. Participants must post a picture of their daily steps by 7 p.m. each day in the Activity Feed of the AOPA 365 app or present their data to the Step It Up race headquarters, located right outside the Exhibit Hall. Sign up for your chance to win daily cash prizes! *Exhibitors can participate but do not qualify for prizes. Sponsored by MD Orthopaedics.

TECHNICAL FABRICATION CONTEST

Win cash prizes and bragging rights by being the fastest to properly assemble an articulating ankle-foot orthosis or simple below-knee prosthesis. More than $4,000 in cash prizes will be awarded.

Need a Few Minutes To Rejuvenate? Get a seated massage in the Exhibit Hall. In less than 10 minutes, you can reduce stress, increase concentration, and relax! A professional masseuse will massage your neck, back, and shoulders. The massage station is located at Booth 333. Sponsored by Cailor Fleming Insurance.

AUGUST 2019 | O&P ALMANAC

Meet up with old friends and forge new partnerships during the special events scheduled to take place on the Exhibit Hall floor throughout the Assembly—including lunches on Thursday and Friday. Don’t miss the ever-popular Exhibitor-Sponsored Happy Hour, scheduled for 5 p.m. on Friday, September 27. Attendees will enjoy refreshments, door prizes, and even complimentary show shirts, while supplies last. And be sure to take part in Expo Day for community outreach activities on Saturday, September 28, where you’ll share the Exhibit Hall with the greater San Diego community and have the opportunity to take a photo with Paralympian Jeremy Campbell, visit the Headshot Photo Lounge for a free professional headshot, get a complimentary massage, and more. In between visits to the trade show floor, you’ll be able to participate in top-notch education and learn about cutting-edge research in O&P—and really think about the future of the profession. Attend the keynote presentations on Wednesday and Saturday. Listen in during the Thranhardt Lecture series, to hear the latest clinical breakthroughs, and the Hamontree Business Education sessions, to soak in practical tips to run your business in a more efficient and patient-friendly manner. With so many special events scheduled for the San Diego Convention Center, you will want to plan your itinerary now. Set aside several hours to browse the Exhibit Hall aisles, meet with representatives from exhibiting companies, and interact with likeminded O&P professionals from across the world. Keep these O&P Almanac pages handy to help guide your trip.

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Title Sponsors Sponsors preview their exhibits and share their visions for the future of O&P

Allard USA BOOTH 535

www.allardusa.com Area of Specialty: Orthotic and Prosthetic Devices

What can attendees expect to see at your booth?

Allard is proud to expand into the prosthetics market with an exclusive distributorship with iFIT Prosthetics, the only immediate-fit, transtibial preparatory device on the market giving prosthetists the ability to respond quickly to patient needs. We also have listened to our customers and now offer Allard ankle-foot orthoses (AFOs) with a lower heel height, Ypsilon Flow 1/2 and ToeOFF Flow 2 1/2, with half the heel height of our original model Allard AFOs.

What are you looking forward to at this year’s Assembly?

Expanding our relationships with our O&P customers and understanding the challenges facing the market and the profession today in North and South America.

What types of technology will be driving the waves of change?

Millennials driving changes to 3D printing. In addition, there will be more outcome tools available to ensure product selection, and patients will demand maximum results. There may be a shortage of clinicians to meet patient demand. 44

AUGUST 2019 | O&P ALMANAC

Alps South LLC BOOTH 819

www.easyliner.com Area of Specialty: Sleeves, Liners, Locks, and Skin Care Products

What can attendees expect to see at your booth?

We will be showcasing our new Silicone Pro Liner and VIP (Vacuum Integrated Pump) as well as presenting our innovative knitting technology featured in our Smart Seal and ECO Liners.

What are you looking forward to at this year’s Assembly?

This year we are looking forward to sharing our new products with all those attending the AOPA National Assembly and seeing what is new in the industry.

NATIONAL ASSEMBLY SPONSORS

Cailor Fleming Insurance BOOTH 333

American Board for Certification in Orthotics, Prosthetics, and Pedorthics

www.cailorfleming.com Area of Specialty: Insurance

What can attendees expect to see at your booth?

BOOTH 949

ABCop.org Area of Specialty: Professional and Business Credentialing

What can attendees expect to see at your booth?

Information on certification pathways for individuals and accreditation resources for business owners.

What are you looking forward to at this year’s Assembly?

Meeting with future O&P professionals and hearing from our credential holders on how we can help them be more successful in the future.

What types of technology will be driving the waves of change?

It appears that for us, virtual technology has the potential to be a driving force in the future. It is unclear at the moment what direction that might take, but it is something that ABC is exploring.

Board of Certification/ Accreditation BOOTH 1446

www.bocusa.org Area of Specialty: CMS-deemed accreditation; DMEPOS certification

What can attendees expect to see at your booth?

Board of Certification/Accreditation (BOC) staff and executives will be available to discuss the importance of

accreditation and explain the process for obtaining this valued credential for your business. BOC currently provides accreditation for O&P facilities and certification for orthotic and mastectomy fitters. We also are committed to our current O&P certificants in need of guidance or support as they continue meeting education and other annual requirements.

What are you looking forward to at this year’s Assembly?

AOPA always provides a wonderful opportunity for individuals in the O&P field to come together and share experiences, new technology, and a wealth of industry knowledge. BOC is highly engaged in this forum as a place to learn and to lead. We look forward to connecting with our certificants and accredited facilities as well as other professionals in the O&P field.

What types of technology will be driving the waves of change?

The O&P profession continues to adopt new technologies, but technology alone will not drive us into the future. A focus on evidence-based care and outcomes relevant to the communities we serve will take the O&P profession into 2020 and beyond.

Top-quality massages! Cailor Fleming sponsors a massage station for all attendees and exhibitors, too. It’s a really cool way to show the O&P industry how Cailor Fleming wants to make sure people are feeling comfortable and relaxed—and it’s a nice break after walking around the Exhibit Hall all day long. But we also are focusing on coverage for sexual harassment, discrimination, and other forms of management liability, and are presenting new options for cyber liability insurance.

What are you looking forward to at this year’s Assembly?

As always, getting to see our clients face to face, since we don’t often get to do this, other than at state, regional, or chapter meetings. Also looking forward to seeing the Pacific Ocean!

What types of technology will be driving the waves of change?

Artificial intelligence (AI)! From self-driving cars to robotic surgery, it will be interesting to see how AI is incorporated into prosthetic devices. And this is all the more reason to make certain companies have all the cyber risks insured, because with hacking and breaches, there is no way for anyone to stop it from happening—so your best bet is to insure your company. And nowadays, an insulin pump, pacemaker, or implanted defibrillator can be hacked, so C-legs and myoelectric prosthetics also are vulnerable—another reason for cyber liability insurance.

O&P ALMANAC | AUGUST 2019

NATIONAL ASSEMBLY SPONSORS

California Orthotic & Prosthetic Association

Endolite

https://californiaoandp.com/ Area of Specialty: O&P State Association

www.endolite.com Area of Specialty: Lower-Extremity Prosthetics

BOOTH 1245

What can attendees expect to see at your booth?

California Orthotic & Prosthetic Association (COPA) is pleased to have been invited to assist with the development and organization of the 2019 National Symposium. At our booth, we’ll have information about membership; the COPA annual educational event; the webinar schedule; legislative matters, such as Medi-Cal fee schedule reform efforts; Hill Day in Sacramento; and the lead advocacy training program in California.

What are you looking forward to at this year’s Assembly?

We’re looking forward to taking in the broad array of business education opportunities that AOPA has to offer. Additionally, we’re excited to connect with COPA members and other state representatives across the nation.

BOOTH 717

What can attendees expect to see at your booth?

Endolite will be showcasing our latest prosthetic advancements and company developments with the O&P community.

What are you looking forward to at this year’s Assembly?

We are looking forward to sharing updates, introducing our latest innovations, and networking with partners and customers. Join us for the Grand Opening Reception to hear more, and visit us at Booth 717 to see our latest advancements.

What types of technology will be driving the waves of change?

In the future, we will see advancements in technology that are driven and supported by strong clinical evidence and outcome measurements. This, in combination with advancements in materials, processes, and biomimetic design principles, will bring us the next generation of orthotic and prosthetic solutions.

OPIE Software BOOTH 727

https://opiesoftware.com/ Area of Specialty: O&P Technology and Business Needs

What can attendees expect to see at your booth? 46

AUGUST 2019 | O&P ALMANAC

OPIE Software will be demonstrating how your practice can benefit from products and services that go beyond the software, through new trainings, tools, and business support. From data analytics, to revenue cycle management training and tools, to brand new features and functionality in OPIE Billing and Purchasing & Inventory, we have a lot to offer this year. We’ll also highlight advances in our browser-based solution, OPIE Anywhere, that provide mobility, freedom, and efficiency to clinicians.

What are you looking forward to at this year’s Assembly?

This year, we’re looking forward to connecting with colleagues, customers, and partners to help evolve our products and services to meet their needs and help navigate their ongoing challenges. We can’t wait to attend seminars that provide insight into current trends surrounding reimbursement and other professional challenges. Plus, interaction with AOPA leadership helps us stay current with industry trends and organizational strategy, providing value to our AOPA membership as well as our customers.

What types of technology will be driving the waves of change?

How do you go back and fill in gaps in education at every level of your practice? Improve your practice with comprehensive training! Data-informed decision making will become essential for continuous quality improvement in practice management software, and reporting tools will enable businesses to remain profitable in a hypercompetitive market. Our workshop will teach you about data-informed decision making to improve clinical and financial outcomes by identifying opportunities that exist for every individual within your practice, at any level in your organization.

WHEN PATIENTS ASK MORE OF YOU, YOU CAN ASK MORE OF US. As you have more to do and less time to do it in, WillowWood Custom Solutions is a partner you can rely on without sacrificing quality and workmanship.

An extension of your clinic’s facility We’re a partner, not a vendor. We understand the ins and outs of what your clinic needs and how we can help.

Spend less time on fabrication Freeing you up to do everything else that’s on your plate.

High-quality custom prosthetics Designed to help your patients regain functionality, mobility, and the ability to get back to the lives they love.

Quick turnaround times Our dedicated fabrication team provides fast turnaround so clinicians can stay on schedule.

NEED A PARTNER YOU CAN DEPEND ON?

GIVE US A CALL. 800.848.4930 www.willowwoodco.com

NATIONAL ASSEMBLY SPONSORS

Össur Americas Inc. BOOTH 935

patient outcomes and continuously strive to improve our products through innovation. We are looking forward to helping practitioners provide cutting-edge technology to help their patients live life without limitations.

www.ossur.com Area of Specialty: Orthopedic, Prosthetic, and Orthotic Solutions

What can attendees expect to see at your booth?

Össur® will be showcasing our line of noninvasive orthopedics at AOPA. Our innovative prosthetic technologies that we plan on highlighting include the new PROPRIO FOOT®, Pro-Flex® Pivot, the Pro-Flex® Align, the weatherproof RHEO KNEE® and RHEO KNEE XC, and our full line of Low Activity Solutions, as well as the i-Limb™ and our world’s first i-Digits Quantum. Other highlights include our Bracing and Supports line. The Unloader® line of osteoarthritis bracing features the clinically proven Unloader One® knee brace and the Unloader® Hip brace. Our growing line of Rebound® products features the lightweight Rebound® DUAL ST ligament knee brace and the Rebound® Post-Op Knee. In addition, the Formfit® Pro range will be on display, with breathable support technology and precision-engineered 3D knit.

What are you looking forward to at this year’s Assembly?

With Össur® being a leading global manufacturer of noninvasive orthopedics, it’s important to sponsor and participate in the AOPA National Assembly to showcase our innovative products and connect with key leaders in the O&P industry.

What types of technology will be driving the waves of change?

Össur is a forward-thinking, innovative company that will advance noninvasive orthopedic products in 2020 and beyond. From mind-controlled prosthetics to the future of advancing bracing designs in bracing and supports, our goal is to provide the best 48

AUGUST 2019 | O&P ALMANAC

industry is unparalleled in our history with the increased use of advanced electronics and hydraulics, active-powered systems, neural control, smart materials, and 3D printing. These technologies are driving the industry to move into a new realm of fabrication, product development, and patient care.

Ottobock

BOOTH 1117

professionals.ottobockus.com Area of Specialty: Prosthetic and Orthotic Devices

What can attendees expect to see at your booth?

This year, Ottobock will be showcasing new technology from across our extensive portfolio. Some of the products we’re excited to demonstrate are the new C-Brace and carbon-fiber Taleo foot, the latest updates from our iFab digital fabrication team, as well as a preview of Myo Plus, our new pattern recognition system. In addition, we’ll feature systems from across our orthotics and prosthetics portfolios, highlighted by patient need.

What are you looking forward to at this year’s Assembly?

2019 is Ottobock’s 100-year anniversary, so this is a special year for us as a company. We are proud to be a part of the AOPA National Assembly and are excited for another successful Assembly where we can interact with our fellow exhibitors and attendees. Ottobock, as always, is looking forward to the opportunity to demonstrate our technology, new and existing, that can help clinicians drive successful outcomes with their patients. This ultimately drives us all forward in achieving our goal of helping people maintain or regain their freedom of movement.

What types of technology will be driving the waves of change?

The rapid and continuous development of new technologies in the O&P

PROTEOR USA BOOTH 1327

proteorusa.com Area of Specialty: Prosthetic Feet and Knees

What can attendees expect to see at your booth?

PROTEOR USA will be featuring our expansion of the hugely popular RUSH Foot collection. The newest RUSH Foot, the RAMPAGE, along with the EVAQ8 integrated elevated vacuum systems, are products that offer superior patient outcomes. We will also feature the world’s only polycentric microprocessor knee, the Allux, and mechanical knee options Symphony and Hytrek.

What are you looking forward to at this year’s Assembly?

We look forward to strengthening our relationships with our valued customers and helping them achieve superior patient outcomes.

What types of technology will be driving the waves of change?

Innovative materials and designs that are lighter in weight and more conducive to everyday life and activities for the amputee. The focus should always be on ways to improve quality of life for the individuals wearing the products.

NATIONAL ASSEMBLY SPONSORS

What are you looking forward to at this year’s Assembly?

Spinal Technology Inc. BOOTH 841

WillowWood BOOTH 517

www.spinaltech.com Area of Specialty: Spinal Orthotics

www.willowwood.com Area of Specialty: Orthotic and Prosthetic Components and Liners

What can attendees expect to see at your booth?

At Booth 841, we will be showcasing the new SpinalTech3D Scan App, ST Spinal Trim, and ST Tension Tape.

What are you looking forward to at this year’s Assembly?

Spinal Technology is looking forward to educating attendees on the wide variety of custom scoliosis braces that we offer, as well as how we can help them achieve better results with their scoliosis patients.

What types of technology will be driving the waves of change? While Spinal Technology has been using CAD/CAM technology since 1995, the use of CAD/CAM technology is advancing the ways that we approach and treat scoliosis.

WillowWood will be featuring the full Alpha Liner family as well as our custom fabrication services and LimbLogic elevated vacuum offerings. We’re very excited about previewing our newest liner technology, which is compatible with Coapt’s Complete Control technology. Our new, offthe-shelf Alpha Liner enhances myoelectric prostheses by offering superior comfort, better control through consistent electrode-skin contact, improved suspension, and expanded socket design options. We have a couple of workshops at which we’ll focus on this new liner, and we’ll be showcasing the technology at our booth in the Exhibit Hall. In addition, WillowWood is the 2019 Prosthetic Education Sponsor.

Of most interest is the new innovation that the industry will be showcasing at the Assembly. These days, launching new products comes with the additional responsibility of demonstrating outcomes, so it will be interesting to see which manufacturers can step up to this obligation. Beyond microprocessor technology, which continues to evolve, we have seen tremendous recent progress in areas such as hydraulic ankles and fiberglass feet, so I expect to see more of these types of products come to market at the show.

What types of technology will be driving the waves of change?

At a minimum, “smart technologies” that track patient compliance will become more and more the norm. Beyond this, technology that not only treats the indication it was prescribed for, but lowers the incidence of co-morbidities, will be necessary for sustained reimbursement. The ultimate will be technologies that do all of the above and enable improved activities of daily living. This is what we should all be striving for if we want amputees to not only survive, but also thrive in society.

2019 TITLE SPONSORS Double Diamond Sponsor

Platinum Sponsors

Diamond Sponsors

Gold Sponsors

Silver Sponsors

O&P ALMANAC | AUGUST 2019

American Orthotic &

AOPA NATIONAL ASSEMBLYSAN DIEGO CONVENTION

Exhibitor Directory

FDV HF1 FE

HX2

N THE FOLLOWING PAGES is an advance

indicates new exhibitor for 2019. Exhibitors as of Aug. 2, 2019.

RIU ITO 2 34 0 34 33 8

435

534

538

FREEEMAN

Massage Lounge

TECH FAB CONTEST

333 SPONSORED BY

CAILOR FLEMING INSURANCE

DAW INDUSTRIES INC. 429

8 6 32

425

524

421

520

32 2

American Central Fabrication.....1146 American Orthotic & Prosthetic Association (AOPA) ........................611 www.aopanet.org

0 32

Allard USA Inc............................ 535 www.allardusa.com

439

ACRM/American Congress of Rehabilitation Medicine.................. 1540 www.acrm.org Adapttech........................................1049 www.adapttech.eu

SPONSORED BY

ALPS SOUTH LLC

indicates the exhibitor is a Supplier Plus Partner with AOPA.

Alternative Prosthetic Services Inc.......................................750 www.alternativeprosthetics.com

Headshot Lounge

AU D

HF2

Bold listings indicate the exhibitor is a member with the American Orthotic & Prosthetic Association (AOPA).

ST AG E

look at the companies that will be exhibiting at the 2019 AOPA National Assembly. Youâ&#x20AC;&#x2122;ll find website information and booth numbers for each exhibitor. Use this guide and floor plan to organize your visit to the Exhibit Hall. Better yet, check out their websites now and plan ahead!

HG5

Alps South LLC........................... 819 www.easyliner.com

American Prosthetic Components LLC............................1334 www.apcomponents.com AMFIT INC....................................... 641 www.amfit.com

AUGUST 2019 | O&P ALMANAC

HG4

HG3

Prosthetic Association - National Assem EXHIBITOR HALL MAP 2019

SEPTEMBER 26 - 28, 2019

SAN DIEGO CONVENTION CENTER

N CENTER - EXHIBITHALL HALLSFLOOR G & H - SAN DIEGO, CALIFORNIA 2019 EXHIBIT PLAN indicates the exhibitor is a Title Sponsor

FDV FE

GX1

FF1

indicates new exhibitor for 2019

CONCESSIONS

ER IS R PO

549

650

651

750

648

649

748

ST&G USA CORP. 545

644

645

848

849

747

846

847

745

844 842

541

640

ALLARD USA INC. 535

641

741

VORUM 635

ADAPTTECH

951

751

840

KNIT-RITE 735

949

1048

946

1049

1149

1047 1146

1147 1246

SPINAL TECHNOLOGY

1348

1143 1242

Ã&#x2013;SSUR AMERICAS INC.

CASCADE ORTHOPEDIC 835

1450

1045 1144

945

841

BROAD BAY

1041 1140 1138

OPGA

SURESTEP

OPIE SOFTWARE 727

ORTHOMERICA PRODUCTS INC.

523

FILLAUER

ENDOLITE

O&P PAC Info Counter

1345 1444

1243 1342

935

1035 1134

1135

1235 1334

FREEDOM INNOVATIONS

831

ALPS SOUTH LLC

1031 1130 1029 1128

TOWNSEND DESIGN

(THUASNE USA)

1129

PEL 1229

819 617

EPICA

MARTIN BIONICS

1545

1443

1543

1441 1540

1541

1339

1539

1435

1335

925

OTTOBOCK

1025 1124

1535

1530

1531

1429 1528

1529

1526 1425 1524

COLLEGE PARK INDUSTRIES

1520 1519

1117 815

1525

1423 1522

919

717

1317

1417 1516

1517

914 1014 1015 1114

AOPA 611

PROTEOR USA 1327

SPS

WILLOWWOOD

517

1245 1344

Hall G

529 627

54'

PPT

1537

Hall H BECKER

1347 1446

1239 1338

1349 1448

1247

1241 1340

1113 1213

Entrance

1214 1314 1413 1414 1513

Emergency Exit

Entrance

PRIVATE MEETING ROOMS

Registration ePosters & Posters Lounge G1

FDV & FE

O&P ALMANAC | AUGUST 2019 HG2

WF HP

61' X 10' USABLE SPACE

FDV & FE FS

EXHIBITOR DIRECTORY 2019

Amputee Coalition........................ 1423 www.amputee-coalition.org Anjon Holdings............................. 1531 www.anjonholdings.com Anodyne.............................................741 www.anodyneshoes.com AON................................................. 1342 www.insurance4op.com Apis Footwear Co......................1338 www.apisfootwear.com Artec 3D........................................ 1214 www.artec3d.com Aspen Medical Products...............1417 www.aspenmp.com Becker Orthopedic Appliance Co....................................529 www.beckerorthopedic.com

Cailor Fleming Insurance............... 333 www.cailorfleming.com

BioStep.......................................... 1541 www.biosteportho.com Bluewave............................................ 322 www.bluewave.tech

California State University Dominguez Hills O&P Program...... 1529 www.csudh.edu/oandp California Orthotic & Prosthetic Association (COPA)...................... 1245 www.californiaoandp.com

Board of Certification/ Accreditation (BOC)....................1446 www.bocusa.org

Boston Orthotics & Prosthetics...1126 www.bostonoandp.com Brightree LLC................................. 1243 www.brightree.com

Cascade Orthopedic Supply Inc......................................... 835 www.cascade-usa.com CBS Medical Billing & Consulting LLC.................................751 www.cbsmedicalbilling.com

BroadBay LLC..................................1149 www.broad-bay.com

Challenged Athletes Foundation....................................... 1524 www.challengedathletes.org

Bulldog Tools Inc............................. 421 www.bulldogtools.com

Click Medical.................................... 951 clickmedical.co Coapt............................................520 www.coaptengineering.com

AUGUST 2019 | O&P ALMANAC

Coyote Prosthetics & Orthotics.. 1239 www.coyoteprosthetics.com CPO Services.............................. 1545 www.cpousa.com Create O&P..................................... 1448 www.createoandp.com Curbell Plastics Inc.......................... 1444 www.curbellplastics.com/oandp

Cascade Dafo............................. 1143 www.cascadedafo.com Bort-Swiss Orthopedic Supply.....844 www.bort-swissortho.com

Comfort Products Inc.................... 1134 www.comfortoandp.com Cornerstone Prosthetics & Orthotics......................................1144 www.cornerstonepo.com

BioSculptor Corporation.............. 1340 www.biosculptor.com Bioskin/Cropper Medical Inc...... 1526 www.bioskin.com

College Park Industries................. 1317 www.college-park.com

Cypress Adaptive LLC.................. 1247 www.cypressadaptive.com DAW Industries Inc.........................429 www.daw-usa.com DJO.................................................. 1520 www.djoglobal.com DME MAC MEDICARE...................1031 www.cgsmedicare.com DOD-VA Extremity Trauma and Amputation Center of Excellence (EACE)....................... 1314 https://health.mil/about-MHS/OASDHA/ HSPO/EACE

Orthotic OrthoticTherapy TherapyShouldn’t Shouldn’t End Endat atthe theFront FrontDoor. Door.

Extend ExtendYour YourPatient’s Patient’sIndoor IndoorAFO AFOWear WearTime Timebybyupuptoto 30% 30%with withthe theApex ApexFour-Way Four-WayStretchable StretchableBasis BasisSlip-On. Slip-On.

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Unisex Unisex Sizing Sizing

Men’s Men’s Sizes: Sizes: 4-14 4-14 Women’s Women’s Sizes: Sizes: 5-15 5-15

* * For Foraalimited limitedtime, time,bundle bundlethe theApex ApexBasis BasisSlip-On Slip-Onwith withany anyeligible eligible AFO AFOfrom fromArizona ArizonaAFO AFOand andsave save30% 30%on onthe theBasis: Basis:just just$18.50! $18.50! *

* Not Not available available with with ECEC Neurowalker, Neurowalker, Partial Partial Foot Foot AFO, AFO, Partial Partial Foot Foot Walker, Walker, Closed Closed Toe Toe Walker, Walker, Open Open Toe Toe Walker Walker or or thethe AZAZ Crow Crow Walker. Walker.

Patient PatientCompliance ComplianceMade MadeEasy! Easy! The The innovative, innovative, four-way four-way stretchable stretchable Basis Basis Slip-On, Slip-On, allows allows forfor a supportive a supportive ﬁt ﬁwhich t which can can bebe worn worn with with most most AFOs AFOs and and foot foot orthotics. orthotics. Patients Patients can can remove remove their their shoes shoes at at home, home, keep keep their their AFO AFO on,on, slip slip into into thethe Basis Basis and and enjoy enjoy additional additional hours hours ofof supplementary supplementary therapy. therapy. Lightweight Lightweight and and attractive, attractive, thethe Basis Basis is is sturdy sturdy enough enough forfor use use in in and and around around the the home home resulting resulting in in better better patient patient outcomes. outcomes.

Compliance Compliance* Comfort * Comfort* Protection * Protection* Style * Style

Beneﬁ Beneﬁ tsts&&Features: Features: • Washable • Washable (Do (Do Not Not Put Put In In Dryer) Dryer) • Unisex • Unisex sizing sizing • Simple • Simple design design and and over-sized over-sized pull pull tabs tabs allow allow forfor easy easy donning donning • Slip-resistant • Slip-resistant sole sole • No • No additional additional widths widths • ½” • ½” Removable Removable heel heel liftlift • Removable • Removable foot foot bed bed • Toe • Toe box box • Heel • Heel counter counter • Highly • Highly breathable breathable

844.245.4361 844.245.4361••www.arizonaafo.com www.arizonaafo.com TM

O&P ALMANAC | AUGUST 2019

EXHIBITOR DIRECTORY 2019

Invent Medical USA LLC.......... 1025 www.inventmedical.com Kevin Orthopedic..........................748 www.kevinorthopedic.com Kinetic Research Inc.......................549 www.KineticResearch.com KISS Technologies LLC.................. 840 www.kiss-suspension.com KLM Laboratories.......................... 1213 klmlabs.com Knit-Rite Inc..................................... 735 www.knitrite.com LaunchPad O&P..............................1014 www.launchpad-op.com LegWorks..........................................945 www.LegWorks.com LIM Innovations..............................1113 www.liminnovations.com Drew Shoe Corp................................1441 www.drewshoe.com

Forrest Stump...............................1414 www.forreststump.org

Endolite..............................................717 www.endolite.com

Freedom Innovations LLC..............925 www.freedom-innovations.com Friddle’s Orthopedic Appliances Inc..................................................... 1242 www.friddles.com

Engineered Silicone Products LLC...................................1140 www.wearesp.com

Grace Prosthetic Fabrication Inc.... 425 www.gpfinc.com Hi-Tech........................................ 1539 www.humanitechnology.com

Epica Applied Technologies........ 1339 www.epicatech.com

Hope To Walk............................... 1513 www.hopetowalk.org

Fabtech Systems LLC.....................1516 www.fabtechsystems.com

HP................................................. 1344 www8.hp.com/us/en/printers/3d-printers. html

Fillauer.......................................... 617 www.fillauer.com FIOR & GENTZ GmbH................... 538 www.fior-gentz.us FIT360.......................................... 1530 FLO-TECH® Orthotic & Prosthetic Systems Inc................... 435 www.1800flo-tech.com

AUGUST 2019 | O&P ALMANAC

Infinite Biomedical Technologies..................................... 1528 www.i-biomed.com

Limb Loss and Preservation Registry............................................... 342 www.mayo.edu/research/labs/ motion-analysis/research/limb-losspreservation-registry LimbTex Ltd. .................................320 www.limbtex.com Martin Bionics Innovations......... 1443 www.martinbionics.com MD Orthopaedics Inc.....................439 www.mdorthopaedics.com Medex International Inc..............1048 medexinternational.com Medi Lazer.....................................326 www.rxloupes.com Mile High Orthotics Lab Inc..........545 www.mholabs.com Monetek LLC.................................. 1345 www.monetek.com

Integrum Inc..................................... 534 www.integrum.se

Motion Unlimited.........................1537 www.motion-unlimited.com

International Institute of Orthotics and Prosthetics............... 1035 www.iiofoandp.org

Myomo............................................... 541 www.myomo.com

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EXHIBITOR DIRECTORY 2019

Naked Prosthetics......................... 1045 www.npdevices.com National Commission on Orthotic & Prosthetic Education (NCOPE) .... 648 www.ncope.org nora systems Inc.............................. 651 www.nora-shoe.com NovaCare P&O............................ 1138 www.novacare.com Nymbl Systems...............................1235 www.Nymbl.Healthcare O&P Almanac....................................611 www.aopanet.org

O&P EDGE/Western Media LLC.... 846 www.opedge.com OHI....................................................1335 ohi.net OP Solutions Inc............................ 1047 OPSolutions.us

Ã&#x2013;ssur Americas Inc......................... 935 www.ossur.com

PROTEOR USA...............................1327 www.proteorusa.com

Ottobock...........................................1117 professionals.ottobockus.com

PSYONIC.................................... 1347 www.psyonic.co

OPAF & The First Clinics..............1525 Www.opafonline.org Open Bionics...............................1535 www.openbionics.com OPIE Software.................................. 727 www.opiesoftware.com

OPTEC USA Inc................................831 www.optecusa.com Orfit Industries America...............1041 www.orfit.com Orthofeet.................................... 1543 www.orthofeet.com Orthomerica Products Inc............. 523 www.orthomerica.com Orthotic & Prosthetic Group of America (OPGA)............................ 1135 www.opga.com Osseointegration Group of Australia............................................350 www.osseointegration.org 56

AUGUST 2019 | O&P ALMANAC

Range of Motion Project (ROMP).............................................1522 www.rompglobal.org Paceline........................................... 1429 www.paceline.com Pedorthic Foundation........................ 324 www.pedorthicfoundation.org Pedorthic Services........................1015 www.pedserv.com PEL................................................... 1229 www.pelsupply.com PLS - Pedorthic Lab Specialties....... 1413 pedorthiclab.com Powerstep..................................... 1132 www.powerstep.com

Renia GmbH.................................... 649 www.renia.com Restorative Care of America Inc..... 1029 www.rcai.com Rodin 4D............................... 848 & 849 www.rodin4d.com Royal Knit Inc...................................847 www.royalknit.com RS Print.............................................. 644 rsprint.com Silipos..................................................842 www.silipos.com Sole Mates......................................815

EXHIBITOR DIRECTORY 2019

Soletech Inc.....................................1147 www.soletech.com

TechMed 3D Inc............................... 747 www.techmed3d.com

Spinal Technology Inc..................... 841 www.spinaltech.com

Thermo-Ply Inc.............................. 1425 www.thermoplygel.com Tillges Technologies LLC.............. 640 www.tillgestechnologies.com

Springer Aktiv AG......................... 1114 www.springer-berlin.de SPS................................................ 919 www.spsco.com ST&G USA Corp...............................645 www.stngco.com SteeperUSA.................................... 1349 www.steeperusa.com Surestep............................................627 www.surestep.net Tamarack Habilitation Technologies Inc..............................524 www.tamarackhti.com

Top Shelf Orthopedics................. 1348 www.topshelforthopedics.com Townsend Design (Thuasne USA)...............................1129 www.thuasneusa.com Trend Medical...............................1130 www.trend-med.com TSM Smart Materials Co. Ltd.........1246 www.tsm-smart.com

University of Hartford MSPO Program..................................356 www.hartford.edu/tmspo VA Office of Research & Development....................................1519 www.research.va.gov VitalFitsr....................................... 914 www.VitalFitsr.com Vorum................................................635 www.vorum.com VQ Orthocare................................... 1517 www.vqorthocare.com WillowWood................................517 www.willowwoodco.com

Turbomed Orthotics Inc............... 946 turbomedorthotics.com Ultraflex Systems Inc................... 1450 www.ultraflexsystems.com

2019 Prosthetic Education Sponsor

O&P ALMANAC | AUGUST 2019

PRINCIPAL INVESTIGATOR

An Inquisitive Nature Sara Morgan, PhD, CPO, LPO, studies the efficacy of microprocessor knees, crossover feet, O&P measurement tools, and much more

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.

AUGUST 2019 | O&P ALMANAC

ARA MORGAN, PHD, CPO, LPO,

began her O&P career in a typical fashion—by earning a bachelor’s degree in orthotics and prosthetics from the University of Washington (UW) in 2004, working as a resident for Hanger Clinic, earning her certifications, then securing a clinical position at Gillette Children’s Specialty Healthcare in St. Paul, Minnesota, where she worked from 2006 to 2009. But after a few years as a practitioner, Morgan realized she wanted more. “As a clinician, I had an interest in ongoing research, but I did not have the training or mentorship to pursue my own research interests,” Morgan explains. That realization led her to return to UW to pursue a doctoral degree in rehabilitation science. There, she says, she “had the opportunity to study with accomplished researchers like Valerie Kelly, PhD, PT, and Brian Hafner, PhD, who trained me to conduct research in areas that were important to me.” In 2014, Morgan earned her PhD from UW, where she now works as an assistant professor. “My role at UW is split between a variety of research projects and teaching in the Master of Prosthetics and Orthotics (MPO) program,” she explains.

Research Goals

Morgan categorizes her research endeavors into two distinct areas: clinically meaningful assessment of prosthetic and rehabilitation interventions, and measurement of important health outcomes in people who use prostheses and orthoses. “Comparative assessment of interventions will inform clinical care decisions and prosthetic prescriptions for practitioners in the field,” says Morgan. She has contributed to several interesting studies in this category, over the past five years. For example, Morgan is part of a research team, led by Hafner, which has extensively studied the crossover foot design in people with transtibial amputation. “In this line of investigation, we used a mixed-methods approach to assess performance-based and selfreported outcomes between crossover feet and traditional energy-storing feet,” she explains. “Our results largely found that people with transtibial amputation performed as well, or better, in the crossover feet compared to energy-storing feet, and reported improvements in high-level activities.” In addition, Morgan has served as principal investigator on a multidisciplinary collaboration to assess the

PHOTO: Sara Morgan, PhD, CPO, LPO

PRINCIPAL INVESTIGATOR

PHOTO: Sara Morgan, PhD, CPO, LPO

controlled study to assess effects of a communityfunctional performance, gait based seated exercise parameters, self-reported program on health and health outcomes, and quality of life for people prosthetic use between knee with diabetic foot conditions,” she explains. ulcers. This population “Results from this study will often experiences be used to inform prosthetic deconditioning during prescription in the early the healing process, phases of rehabilitation, which can result in including guidance for design worse functional and of initial prostheses.” health outcomes over time, according to She also is working with Morgan. “Our goal a team of researchers from was to conduct pilot UW and the University of research to assess Miami to develop a whether engagement performance-based measure in safe, seated exercise of mobility for people who would mitigate deconuse prosthetic limbs. “We ditioning and promote are traveling to numerous health,” she says. “We sites around the United also aimed to examine States, and collaborating with the feasibility of the clinicians, researchers, and study design and to faculty at each site, to collect assess if people with performance data on 500 diabetic foot ulcers people who use lower-limb would participate in prostheses,” she says. The group exercise.” goal is to make available Morgan and Geoff Balkman, CPO, LPO, collect data for the Morgan’s work in the the resultant measurement development of a performance-based measure of mobility. second category—measure tool to clinicians who development and assessment—is examined other commonly used work with prosthetic limb users. designed to help clinicians incorporate measurement tools in prosthetics “to In addition, Morgan is a member assessment into routine clinical evaluate their psychometric propof a research team tasked with practice, track their patients’ health erties and improve clinical utility of developing and testing a measure outcomes, and evaluate the effecvarious instruments,” including the of mobility for orthosis users. “The tiveness of various rehabilitation Socket Comfort Score (SCC). “Our result of this work will be a brief interventions, according to Morgan. team expanded the SCC measure to measure that is easy to use in clinOne such project was a collabinclude additional assessment strateical and research environments.” oration with a team of researchers gies for prosthetic socket comfort.” in developing the Prosthetic Limb These investigations into O&P Paving the Way for Users Survey of Mobility (PLUS-M), measurement tools will ultimately Future Researchers an outcome measure that has been facilitate collection and interpretation In addition to Morgan’s research adopted in clinics that treat people with of important health outcomes in a responsibilities, she invests a lot of limb amputation throughout the nation. clinical setting, according to Morgan. time in teaching within UW’s MPO In developing the PLUS-M, Morgan “This information can be shared program. Her main focus is critical and the rest of the team carried out with payors to provide evidence evaluation of scientific literature and secondary data analyses—examining of the effectiveness of prosthetic application of evidence to O&P pracdata from more than 1,500 people with and orthotic interventions.” tice. “I mentor students to translate limb loss—to help better understand research evidence into practice, design how health-related quality of life Ongoing Investigations capstone projects that incorporate differs in people with limb amputation Morgan is currently serving as principal research methods, and, in some cases, compared to the general U.S. populainvestigator for an ongoing comparative involve them in research during their tion. Her team ultimately documented effectiveness study on use of microcourse of study,” she says. “I also work trends in meaningful health outprocessor and nonmicroprocessor closely with doctoral students on our comes for people with amputation. knees in early rehabilitation. “We are various research projects and serve Morgan’s research team also has conducting a longitudinal randomized on doctoral committees at the UW.” O&P ALMANAC | AUGUST 2019

PRINCIPAL INVESTIGATOR

In both her teaching and research responsibilities, Morgan remains focused on the future. “I believe that next-generation O&P research will benefit from investment in research studies that incorporate challenging designs, including longitudinal studies with long-term follow-up, multisite studies with large and diverse samples, and translational studies to assess novel interventions in clinical environments,” she says. “Research that incorporates designs like these will be difficult to conduct given our small field, customized interventions, and limited funding opportunities. However, such research is much needed and will strengthen our overall Morgan collects data to assess biomechanical properties of the crossover foot. body of evidence, contribute to the development of clinical practice guidelines, and inspire confidence from clinicians and payors.” Morgan is active within the O&P community. She is on the board of directors for the American Academy Sara Morgan, PhD, CPO, LPO, has been involved in the publication and of Orthotists and Prosthetists, serves presentation of dozens of important articles and papers over the course of her on the editorial board for the Journal education and career. Some of her most impactful works include the following: of Prosthetics and Orthotics, and is a member of multiple committees related to research in the field. She has • Morgan, S.J., McDonald, C.L., Halsne, E.G., Cheever, S.M., Salem, R., contributed to dozens of published Kramer, P.A., Hafner, B.J. “Laboratory- and Community-Based Health studies and has presented at industry Outcomes in People With Transtibial Amputation Using Crossover and meetings on numerous occasions. Energy-Storing Prosthetic Feet: A Randomized Crossover Trial.” PLOS When not working, Morgan likes ONE 2018; 13(2): e0189652. PMID: 29414988. to spend time with her children, • Hafner, B.J., Gaunaurd, I.A., Morgan, S.J., Amtmann, D., Salem, R., ages 3 and 6, and her husband, who Gailey, R.S. “Construct Validity of the Prosthetic Limb Users Survey of also is a clinician in the field. Her Mobility (PLUS-M).” Arch Phys Med Rehabil 2017; 98(2):277-285. PMID: kids “bring quite a bit of fun into my 27590443. home life,” Morgan says. “Together, my family likes to enjoy all that • Morgan, S.J., Kelly, V.E., Amtmann, D., Salem, R., Hafner, B.J. “Selfthe Pacific Northwest has to offer, Reported Cognitive Concerns in People With Lower Limb Loss.” Arch including hiking, camping, and visPhys Med Rehabil 2016; 97(6):912-918. PMID: 26836953. iting beautiful parks and beaches.” As she watches her children • Morgan, S.J., Friedly, J.L., Amtmann, D., Salem, R., Hafner, B.J. “A Crossgrow, she will remain committed Sectional Assessment of Factors Related to Pain Intensity and Pain to advanced O&P investigations as Interference in Lower-Limb Prosthesis Users.” Arch Phys Med Rehabil part of the research team at UW— 2017; 98(1):105-113. PMID: 27742450. identifying and testing improved prosthetic and orthotic designs and developing clinically accessible O&P measurement tools.

Notable Works

AUGUST 2019 | O&P ALMANAC

PHOTO: Sara Morgan, PhD, CPO, LPO

Silicone Prosthetics to Restore the Original Appearance Custom fitted for the ultimate patient comfort. Custom sculpted, in great detail, to the mirror image of the sound extremity.

Traditional prostheses have been fabricated primarily to restore function with little emphasis on the aesthetic appearance. ARTech's natural looking restorations are virtually undetectable. ARTech silicone prostheses can improve gait and posture, ease lower back pain, relieve pressure on bone spurs and other sensitive areas, protect the tissue from further injury, improve the operation of myoelectric hands, etc. When a restoration has a natural appearance, sculpted and painted to match the opposite limb, as opposed to the robotic or mannequin look of traditional prostheses, utilization by the patient is maximized.

Office: (888) 775-5501 Fax: (972) 775-2000 www.artechlab-prosthetics.com

MEMBER SPOTLIGHT

Click Medical

By DEBORAH CONN

All About Adjustability

Company offers prosthetic sockets, orthotic solutions, and casting options

LICK MEDICAL OWES ITS

AUGUST 2019 | O&P ALMANAC

Click Medical has designed devices that allow patients to adjust their prostheses “on the go.”

COMPANY: Click Medical OWNERS: Jimmy Capra and Joe Mahon, CP LOCATION: Steamboat Springs, Colorado HISTORY: Six years

Jimmy Capra

Joe Mahon, CP

education, and customer support. Its products include prosthetic and orthotic applications of Click’s adjustable technology, including kits for traditional and suspension prosthetic sockets, straps and buckles for a range of orthoses, and lacers for therapeutic and athletic shoes. “Our system allows amputees to make their own adjustments as often as they like, and through clothing,” explains Mahon. “Some patients adjust their sockets five to 10 times in a day; others might adjust them 20 to 30 times, depending on the changing volume of the residual limb and what they are doing.” Empowering device wearers to make their own adjustments benefits both patients and practitioners, Mahon says. Patients don’t have to make an appointment and wait to see a practitioner—by which time the fit issue may have changed. And clinicians save time and cut back on work that may be nonreimbursable. Click’s technology has been used with about 45,000 prosthetic

Joe Mahon, CP, works with a patient.

“We value innovation in how we deliver education as well as in our products,” Capra explains. “Clinicians and technicians can access educational courses through our online portal at any time, and we can provide them with kits to practice on while they watch.” Capra and Mahon are well aware of the importance of outcomes research in O&P, and their company is eight months into a study measuring outcomes among a wide range of patients, in addition to other studies on adjustability by practitioners and academics. Looking ahead, Capra wants to continue to improve and refine the company’s offerings. “We want our products to be easier to use and easier to fabricate. It should be a no-brainer that people will be using our sockets as a standard of care,” he says. “Changing lives and helping people: That’s our daily goal.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Click Medical

start to the proverbial “aha” moment, which transpired in 2009 when Joe Mahon, CP, a clinician at a Salt Lake City facility, noticed something. “I had a patient who needed the fit adjusted on her prosthetic socket. I was not in the office that day, but I met her there and made the adjustment,” recalls Mahon. “It struck me that if she could adjust the socket herself, it would save a lot of time for both of us. “Soon after that, I was skiing with my wife, and I noticed that as she got off the lift, she bent down to adjust the dial on her snowboarding boots. Aha! What if we could use that technology to adjust socket fit?” Mahon went home and dissected his wife’s boots. He experimented with the mechanism on a prosthetic socket and saw that it could be used to adjust the fit at any time. Over the next few years, Mahon refined the technology and in 2013 began using the device in his Salt Lake City facility. In 2015, Mahon joined forces with Jimmy Capra, former director of the medical business unit at Boa Technology, which produced the closing system incorporated into Mahon’s design. The two launched Click Medical, with Capra as chief executive officer and Mahon as chief clinical officer. Today, Click’s 2,600-squarefoot facility in Steamboat Springs, Colorado, houses all assembly, warehousing, and business activities. The company has 12 employees in several departments, including marketing, sales, operations, clinical and technical

patients since 2015, and about 20 percent of O&P clinics in the United States have tried the system. The company’s primary form of marketing is through education. “We educate patients who would like to manage their own care, and clinicians looking for a better solution to managing a rigid socket,” says Capra. Click leverages advertising, social media campaigns, industry meetings, and email blasts to existing customers, as well as sales efforts by its worldwide distributors.

AT Brace Training October 17-18, 2019 Align Technologies, LLC of San Mateo, California is offering Certified Orthotists a limited number of openings for a two-day theoretical and practical training course on the consultation, evaluation, scanning, fitting and follow up of our Align Technologies (AT) scoliosis brace. The AT brace is a semi-asymmetrical scoliosis brace with pressures and expansions built into the positive mold. It is an anterior opening 5/32 finished polypropylene brace with no liner. The AT brace is an upgrade from the standard U.S. manufactured â&#x20AC;&#x153;3-Dâ&#x20AC;? scoliosis braces currently on offer. It is a billable TLSO scoliosis brace that provides correction of the Cobb angles while also providing some rotational and sagittal plane correction. This semi-asymmetrical TLSO scoliosis brace provides the highest level of quality and function for the currently available and billable L-codes with the support of experienced team members who are available for the training and guidance of the orthotist. The Certified Orthotists will learn a completely new approach to the treatment of patients with Idiopathic Scoliosis (IS), including the most advanced approaches for the treatment of early onset scoliosis (EOS), Neuromuscular Scoliosis, and Adult scoliosis cases. Upon completion of this intensive and complete semi-asymmetrical TLSO training course, the orthotist will be approved to purchase the AT brace and will have access to the support of our national and international team. Please email Grant Wood at gwood@align-cliinic.com for more details and a course application. Align Technologies Brace Training Course Thursday and Friday, October 17-18, 2019 San Mateo, California | E-mail: gwood@align-clinic.com

Vegas Is About

Risk Taking Learn to mitigate your business risks, register for the Mastering Medicare: Essential Coding and Billing Techniques in Las Vegas, November 4-5. But don’t take our word for it. Attendees from the last seminar said:

Great takeaways and clarifications of topics that we are actively working on in the office. I wish all staff could attend!

This was my third time at this course.

Every time it gets better.

For more than 20 years, our faculty have helped thousands of attendees get claims paid, survive audits, collect interest from Medicare, file successful appeals and code miscellaneous items.

Speakers did a great job. Thoroughly covered topics, were engaging and entertaining.

Anyone who does billing and coding, even

clinicians,

would benefit from this information.

When asked if they would recommend to others, “I’m

working on the billboard now.”

Want even less risk? Register before October 4 to take advantage of the early bird rate.

Each Seminar is updated based on the latest developments, feedback from previous attendees, and needs of the profession. It is two days full of valuable instruction on topics O&P providers face daily, like prior authorization, competitive bidding, Medicare documentation requirements, and new codes. Additionally, 14 CE credits can be earned.

Attendees are responsible for making their own hotel reservations. Book by October 7 for the $135/ night rate by calling 800/374-9000 and asking for the AOPA Coding and Billing Seminar rate.

NOVEMBER 4-5, 2019

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

www.AOPAnet.org

MEMBER SPOTLIGHT

Rimrock Prosthetics

By DEBORAH CONN

Responsive O&P

Montana clinician emphasizes listening skills and attention to detail

ARLY ON, JIM MIDDLETON,

PHOTOS: Rimrock Prosthetics

CP, realized how much he enjoyed working with disabled athletes. As a young man, he volunteered with the National Sports Center for the Disabled in Winter Park, Colorado, where he grew up. He eventually helped set up a program in Miami for disabled sailing, waterskiing, and scuba. “I couldn’t get enough of it,” he recalls. He earned his bachelor’s degree in prosthetics at the University of Minnesota and served his residency at the University of Michigan Orthotic and Prosthetic Center. Afterward, he worked at a hospital in Montana, but his goal was to be independent. “I wasn’t interested in doing cosmetic work—I wanted to focus on the functional,” he recalls. “I remember sitting in a ski lift in Winter Park with five amputees. They seemed to have really cool prostheses, but a couple of them were [dissatisfied with] their devices because they were uncomfortable—they were getting poked,” he says. “I started doing informal surveys, and whenever there was something amputees didn’t like about their leg, it was because the prosthetist didn’t listen to them. I realized that if I could be a good listener, I could be a good prosthetist.” One way Middleton could show patients he was listening was by designing laminations that reflected their interests

Jim Middleton, CP, and one of his patients, Addison

FACILITY: Rimrock Prosthetics OWNER: Jim Middleton, CP LOCATION: Billings, Montana HISTORY: 15 years

and personalities. “I spend at least an hour or two with each patient,” he says, “and the more we talk, the more we figure out what each one wants.” Middleton launched Rimrock Prosthetics in Billings, Montana, in 2004. In addition to reception employees, a billing specialist, and a technician, Rimrock also employs clinician Bryant Guide, CPO—a recent addition, according to Middleton. “I was recovering from leukemia and I decided I wanted to run a full-service facility, and I needed help. Now we provide upper- and lower-extremity prosthetics and orthotics, and we can be on call at local hospitals.”

Rimrock’s patients are all ages and ability levels, including some Iraq and Afghanistan veterans and elite athletes. Favorite patients include high school student R.J. Lowdog, a bilateral, belowknee amputee with Paralympic aspirations, as well as 11-year-old Addison Benson, a bilateral below-knee patient who plays softball on a championship team. Rimrock is in the midst of an extensive renovation, requiring the facility to occupy temporary quarters for a few months. The old facility was gutted and will be twice the size of the original. “It’s very modern and designed specifically for prosthetics,” explains Middleton. “We have a large gait area with cameras, a laptop, and an 82-inch monitor instead of mirrors.” The new facility features two patient rooms with gait bars and a large fabrication lab where all devices are made. Middleton relies on word of mouth to market his services, and he’s not able to keep up, he says. “I’m making stuff that people are proud of, and they’re showing it off.” Middleton also devotes time to volunteering with the One World Unity Project, which provides prosthetic services as well as stoves and filters to address air and water problems in Guatemala. While it can be challenging to leave his facility for two-week stretches, Middleton hopes to commit to more mission trips now that a new CPO is on board. Once the remodel is finished, Middleton will have Rimrock just where he wants it. “I love doing this,” he says. “I have these relationships. Everyone who comes to see me is a friend at this point.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net. O&P ALMANAC | AUGUST 2019

AOPA NEWS

Don’t Sleep on the Latest AOPA Member Resource: AOPA Co-OP Are you utilizing your AOPA membership to its fullest? Be sure to visit the AOPA Co-OP at www.aopanet.org/resources/co-op/. A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. It is a searchable database that 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. Additionally, members can share information and insights on developments impacting the entire O&P profession. If you haven't signed up for the Co-OP yet, take part in a live tutorial on one of the following dates:

Friday, August 9 Friday, September 6 Friday, October 18 Friday, November 8 Friday, December 6 All tutorials take place at noon EST.

This is your opportunity to learn about O&P's most comprehensive resource for coding, billing, and reimbursement. Ashlie White, AOPA’s director of strategic initiatives, will demonstrate how to use the Co-OP and answer all of your questions. Contact Betty Leppin, bleppin@aopanet.org, for details.

SEPTEMBER 11

AOPAversity Webinars During the one-hour monthly webinars, AOPA experts provide the most up-to-date information on a specific topic. Webinars are held the second Wednesday of each month at 1 p.m. EST. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits, so you can still take advantage of the series discount and the valuable learning opportunities. Sign Up for the 2019 Half-Year Series & Save! Registration Fee

AOPA Members Nonmembers

Price Per Seminar

$99.00* $199.00*

Price for Half-Year

$495.00 $995.00

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

Earn 1.5 Business CEs each by returning the provided quiz within 30 days and scoring at least 80 percent. All webinars begin at 1 p.m. EST. Webinar registration fees are nonrefundable. AOPA can provide the webinar recording if registrants cannot make the scheduled webinar. 66

AUGUST 2019 | O&P ALMANAC

Co-OP

UPCOMING WEBINAR

Veterans Affairs Updates: Contracting, Special Reports, and Other News Receive an update on the current and proposed rules at the U.S. Department of Veterans Affairs (VA) that may have an impact on the O&P field: • The 2017 proposed rule for Prosthetic & Rehabilitative Items & Services • The VA Office of Inspector General report on miscellaneous codes • VA contracts and contracting • And more.

OCTOBER 9

UPCOMING WEBINAR

Performance Reviews: How Is Your Staff Doing? Given the current competitive job market, it’s important to ensure your current employees are fulfilling their responsibilities and that they understand what they need to do to meet their goals. Take part in the October webinar to find out how your performance reviews can facilitate a stronger staffing team. AOPA experts will address the following questions: • How can you identify top players? • What are the best metrics to use in your reviews? • When is the best time to give reviews? • And more.

AOPA NEWS

Attend the Las Vegas Coding & Billing Seminar November 4-5 The Mirage 3400 S. Las Vegas Blvd. | Las Vegas, Nevada AOPA experts provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, colleagues, and more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. For more information and to register, visit www.aopanet.org/education/ coding-billing-seminar/. At this seminar, you will: • Receive up-to-date information on prior authorization and other hot topics. • Ensure your proof of delivery meets Medicare requirements. • Learn how to assess risk areas in your practice. • Learn successful appeal strategies and hints to avoid claim denials. • Practice coding complex devices, including repairs and adjustments. • Attend breakout sessions for practitioners and office staff. • Earn 14 continuing education credits.

NEW MEMBERS

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of the American

Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or statelicensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Alcam Medical Orthotics & Prosthetics 1760 Chicago Avenue, Ste. L-21 Riverside, CA 92507 951/782-7000 Member Type: PatientCare Facility

Quest Medical Services Inc. 418 Security Square Gulfport, MS 39507 228/339-0034 Member Type: PatientCare Facility Membership has its benefits:

Creative Prosthetics and Orthotics LLC 3305 16th Avenue SE, Ste. 101 Conover, NC 28613 828/994-4808 Member Type: PatientCare Facility

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

O&P ALMANAC | AUGUST 2019

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

CPO

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

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

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

Nonmember $678 $830

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

Member Nonmember $85 $150

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

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.

Inter-Mountain

AUGUST 2019 | O&P ALMANAC

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

Inter-Mountain Owner Wanted

Lubbock, Texas INCREDIBLE BUSINESS OPPORTUNITY! National Brace is looking to put a clinician into practice. Please only licensed and highly motivated individuals apply. If you have ever dreamed of owning a practice that is totally affordable with no money down, Medicare, Texas Medicaid, Brightree, vertically integrated purchasing, great lease, and completely turnkey in downtown Lubbock:

National Brace™ Email in confidence to: Email: nationalbraceinc@gmail.com

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

CAREERS Pacific

Mid-Atlantic

Certiﬁed Prosthetist Orthotist (CPO)

O&P Technician

San Diego, CA Full-time position available for CPO in a multi-office, ABC-certified, well-established company in sunny San Diego. Applicants should be experienced in all aspects of the O&P profession with excellent O&P skills, patient care, and carry-through. Good time management and organizational skills a must, as well as being a multitasker and demonstrate exceptional design and problem-solving skills. We offer competitive salaries and benefits.

Northeast Ohio Wanted: O&P technician with experience modifying AFOs and KAFOs, pulling plastic, and laminating prosthetics. Must be professional, knowledgeable, and self-motivated. Excellent pay, IRAs, and medical insurance. Send résumé to:

Send résumés to: Email: bionicsop@gmail.com Website: www.bionicsoandp.com

Western Reserve Orthotics Prosthetics Centre Inc. Email: kgrope@wrop.net and nbrown@wrop.net Website: www.wropcenter.com 6431 Mahoning Avenue, Austintown, OH 44515 Phone: 330/792-6826 Fax: 330/792-8493

AD INDEX

Advertisers Index Company

Page Phone

Website

Align Technologies, LLC Allard USA Alps South LLC Amfit ARTech Laboratory Inc. College Park Industries ComfortFit Orthotic Labs Inc. Coyote Design ESP LLC Fabtech Systems LLC Ferrier Coupler Inc. Fillauer Companies Inc. Hanger Hersco Naked Prosthetics Nebraska Spine + Pain Center OHI Össur Americas Inc. Ottobock PROTEOR USA Spinal Technology Inc. WillowWood

63 650/375-2231 11 866/678-6548 31 800/574-5426 17 800/356-3668 61 888/775-5501 7 800/728-7950 57 888/523-1600 33 800/819-5980 5 888-WEAR-ESP 19, 43 800-FABTECH 20 810/688-4292 37 800/251-6398 21 512/777-3814 1 800/301-8275 27 888/977-6693 23 402/496-5535 53 877/780-8382 3 800/233-6263 C4 800/328-4058 C2 855/450-7300 9 800/253-7868 47 800/848-4930

www.align-clinic.com www.allardusa.com www.easyliner.com www.amfit.com www.artechlab-prosthetics.com www.college-park.com www.comfortlabs.com www.coyotedesign.com www.wearesp.com www.fabtechsystems.com www.ferrier.coupler.com www.fillauer.com www.hanger.com www.hersco.com www.npdevices.com www.nebraskaspineandpain.com www.ohi.net www.ossur.com www.professionals.ottobockus.com www.proteorusa.com www.spinaltech.com www.willowwoodco.com O&P ALMANAC | AUGUST 2019

MARKETPLACE

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

CROSS Knee Hyperextension Orthosis CROSS™ is intended for mild to moderate knee hyperextension due to neuromuscular diseases or other injuries. The orthosis can be used together with an Allard ankle-foot orthosis when knee hyperextension is present with foot drop. • Easy-to-grasp wide cuff for single-handed donning • Unique “donning aid” included for users with limited hand dexterity • YouTube video fitting: www.youtube.com/watch?v=9jj6V2Dfbuc Available in sizes small, medium, large, and extra large. For more information, contact customer service at 888/678-6548 or email info@allardusa.com.

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

Amfit’s New Precise AT Insole Amfit’s new OTC insole, Precise AT, offers a range of sizes to fit most anyone. Designed with the H-1-5 Stability Triangle, it provides flat, planed areas under the heel, and first through fifth metatarsal heads. This promotes proper heel strike and better toe-off, for increased performance. Our COOLMAX top cover is moisture controlled, keeping your foot cool and dry. The bottom layer, made up of Ultralon Performance Foam, is perforated with a closed cell structure that supports, cushions, and adds strength. Available in low, medium, and high arch heights. For more information, please give us a call at 800/356-3668 or send us an email at orders@amfit.com. 70

AUGUST 2019 | O&P ALMANAC

ComfortFit Labs’ SmartScan Powered by FusiForm and iTOM-CAT Combining Technology, Accuracy, and Craftsmanship. Now our customers can scan for custom orthotics, Richie braces, ComfortFit stabilizer braces, and Medicareapproved diabetic insoles with the ComfortFit SmartScan System. Cast and order more efficiently and save time. Our SmartScan System features a choice between our FusiForm and our iTOM-CAT system. Both include: simple startup, no fees, HIPAA compliant, ComfortFit prescription forms, order status notification, uses iPad and Structure Sensor, free next-day hardware exchange for one year. For more information, call us at 1-888/523-1600.

Quik Glue Available in 30- and 60-second set times. • 50 cc or 220 cc • Great for attaching componentry • Multiple repair uses • Very quick set with no sag. They ship nonhazardous and are safe with no odor. For more information, contact Coyote Prosthetics and Orthotics at 208/429-0026 or visit www.coyotedesign.com.

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

MARKETPLACE Fabtech Epoxy Meter Mixer Making your fabrication life easier! Our Epoxy Meter Mixer offers a faster, cleaner, and accurate way for you to meter your RESTECH+ Epoxy resin ratio every time! • Our resin pump meter mixing system has onegallon resin reservoirs for the A & B sides for a total of two gallons. • Keeps your mixing station clean and organized! • Accurately dispenses up to three quarts of unmixed two-part RESTECH+ epoxy resin per minute. • All you have to do is mix the resin. • No more gram scale! Call for more details! Contact us at 800/322-8324 or visit www.fabtechsystems.com.

Need Carbon Tapes! We offer the best prices on lightweight 3K carbon tapes in a finished edge (DW) and nonfinished edge (FR) configuration. Our carbon tapes are highly formable, wet out quickly, and should be used with all your composite layups. • Sizes: one-inch, two-inch, three-inch, four-inch, and six-inch. • Sold in 10-foot cut sections and 50-yard rolls. Contact 800/FABTECH or visit www.fabtechsystems.com.

5XA Aluminum Hook From Fillauer • Lightweight aluminum body • Canted “fingers” allow visual feedback • Canted shape allows the user to pick up paper, coins, and other small fine objects from the side with ease • Available in 1/2-20 inch or M12x1.5-mm thread • Variety of anodized colors available: black, blue (pictured), gold, or red (pictured).

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

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

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

For more information, visit www.Fillauer.com. O&P ALMANAC | AUGUST 2019

MARKETPLACE Proprio Foot®

Discover PROTEOR USA Proprio Foot® debuted in 2006 with a simple goal: to reduce trips and falls. This latest-generation microprocessor ankle, built upon a Pro-Flex® LP foot module, provides 44 percent more toe-off power—taking us one step closer to our goal. Visit ossur.com/proprio-foot to learn more.

Ottobock ErgoArm Family Update The lightweight and versatile ErgoArm Family just got an update—it is now available in jet black. As well as this additional color, we’ve also made some improvements to enhance functionality and appearance: • AFB finger wheel now matches the color of the forearm shell for improved cosmesis • A new membrane cover protects internal components and provides a seamless appearance. Visit professionals.ottobockus.com or call 800/328-4058 to order.

Ottobock’s CCAFO Provides Robust Stability and Support Crafted from carbon prepreg, this lightweight and low-profile ankle-foot orthosis (AFO) provides a solution for individuals with or needing: • Plantarflexion weakness • 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 (heel-off). This latest addition to the Ottobock line of AFOs is custom-made to match your patient’s specific height, weight, and activity level. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

AUGUST 2019 | O&P ALMANAC

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

Custom Alpha DESIGN® Liners for Improved Patient Outcomes Ill-fitting off-the-shelf liners can be uncomfortable for a user but could also compromise residual limb health. Custom Alpha DESIGN® Liners may yield the greatest benefit for these users—an improved fit. Having custom liners in a clinic’s toolkit can yield improved patient outcomes. To learn more about Alpha DESIGN Liners, call 800/848-4930, visit www.willowwoodco.com, or stop by our booth, 517, at the AOPA National Assembly.

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CALENDAR

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

September 11

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

September 12–14

Midwest Chapter AAOP. Lake Geneva, WI. Visit www.mwcaaop.org.

Cascade Dafo Institute

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

September 25–28

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

October 1

2019 August 14

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

August 23–24

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

August 23–24

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

September 1

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/certification.

September 6–7

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

AUGUST 2019 | O&P ALMANAC

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

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 7–12

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

October 9

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

October 10–12

NC Chapter of the AAOP Scientific Meeting. The Hotel Ballast, Wilmington, NC. For more information, visit www.ncaaop.com or email ncaaop@gmail.com.

CALENDAR

October 19

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. Aloft Hotel New York LaGuardia Airport, 100-15 Ditmars Blvd., East Elmhurst, NY 11369. For more information, contact Drew Shreter at 800/946-9170, ext. 101, or email dshreter@pomac.com.

November 13

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

December 11

November 1

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

November 1

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

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

2020 January 17–23

US ISPO Pac Rim Meeting. Sheraton Maui Resort & Spa Lahaina, Maui, Hawaii. Visit www.usispo.org.

March 19–21

November 3–9

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

November 4–5

Coding & Billing Seminar. Las Vegas. Book your hotel by October 7 for the $135/night rate. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org or register online at bit.ly/2019billing. SEMINAR

Georgia Society of O&P. Alpharetta, GA. Visit www.georgiasop.com.

May 13–15 NYSAAOP Meeting. Schenectady, NY. Visit www.nysaaop.org/meeting. September 9–12

AOPA National Assembly. Mandalay Bay, Las Vegas. For general inquiries, contact Ryan Gleeson at 571/431-0836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

November 6–8

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

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

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 | AUGUST 2019

ASK AOPA CALENDAR

Helpful Hints for Round 2021

2021

Clarifying rules and expectations for competitive bidding of off-the-shelf orthoses Q

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P profession. Each month, we’ll share several of these questions and answers from AOPA’s expert staﬀ with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

If we are awarded a contract under the Round 2021 Competitive Bidding Program, are we still required to follow the Medicare documentation requirements?

Yes. If you win a contract, you must meet all Medicare documentation requirements. This would include obtaining all of the appropriate documentation from the physician and ensuring you have valid orders and proof of delivery forms on file.

If we are awarded a contract under the Round 2021 Competitive Bidding Program and are nonparticipating providers with Medicare, could we choose to not accept assignment on an item in a product category?

No. If you are awarded and accept a contract for a specific product category, you are agreeing to accept assignment on all claims in that product category. By accepting assignment, you are agreeing to accept Medicare’s payment as payment in full.

If I am not awarded a contract under the Round 2021 Competitive Bidding Program and a patient comes to me with a prescription for an item in one of the selected product categories, must I turn the patient away? Or can I still provide the item?

If the patient resides in one of the competitive bidding areas, you must inform the individual that you do not have a contract for the item in question and that if he or she receives the item from you, Medicare will not pay for it. You also must explain that there are providers in the area with a contract. If the patient still wishes to receive the item from you, make sure he or she signs an Advanced Beneficiary Notice to document that you informed the patient that you are not a contracted provider.

If I am not awarded a contract under the Round 2021 Competitive Bidding Program, may I use subcontractors to help me provide the items in a select product category?

AUGUST 2019 | O&P ALMANAC

Yes, it is possible for you to use subcontractors, but you must keep a few key rules in mind. First, the subcontractor may be responsible for only the following services: purchase of inventory, maintenance/repair of rented equipment, and delivery and instruction on the use of a Medicare-covered item. Second, the subcontractor must meet all licensure and accreditation requirements, when appropriate. Third, you must notify Medicare of all of the subcontractors you will be using. Finally, since you are the contract supplier of record, it is your duty to ensure that all subcontractors are obtaining all of the required documents—prescriptions, medical records, delivery slips, etc.

If I am considered a small supplier (generating gross revenue of $3.5 million or less in annual receipts, including Medicare and non-Medicare revenue), must I still submit a bid in order to be awarded a contract and/or provide covered items in a product category?

Yes, you must still submit a valid bid and meet all other bidding requirements, such as being accredited and having a bid surety bond. However, the Social Security Act mandates that small suppliers have opportunities to obtain contracts and, as such, the competitive bidding program attempts to make sure at least 30 percent of contracted suppliers are small suppliers.

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SEPTEMBER 25-28 / 2019 SAN DIEGO CONVENTION CENTER

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

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

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

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

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Request a C-Brace Trial at professionals.ottobockus.com/c-brace