August 2020 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

AU G U ST 2020

Should You Pursue Settlement Conference Facilitation? P.22

Trends in Lower-Limb Prosthetics P.36

AOPA Virtual National Assembly Preview: Exhibitor Listing P.44

Research Into MicroprocessorControlled Prostheses and Orthoses

UNDER PRESSURE

AS STRESS LEVELS RISE, O&P COMPANIES FOCUS ON EMPLOYEE MENTAL AND PHYSICAL HEALTH AND SAFETY P.28

P.46

Quiz Me! EARN 2 BUSINESS CE CREDITS

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P.24

This Just In: CMS Resumes Medicare Audits and Prior Authorization of Prostheses P.26

YOUR CONNECTION TO

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

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ADVOCACY | RESEARCH | EDUCATION

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contents

AUG UST 2020 | VOL. 69, NO. 7

COVER STORY

FEATURES

AUGUST 2020 | O&P ALMANAC

28 | Under Pressure Employees at O&P facilities are facing increased stressors due to the coronavirus pandemic. In addition to concerns about possible exposure and their physical health, many are worried about expanded job responsibilities, adherence to new safety protocols, caring for family members, and job insecurity. O&P leaders discuss how they are handling these challenges and share strategies to reduce apprehensions and promote employee mental health. By Michael Coleman

26 | This Just In

CMS Gets Back to Business Find out what’s new in the COVID-19 Reduction of Provider Burden Frequently Asked Questions section of the CMS website. O&P professionals should expect prepayment and postpayment audits to resume this month, and should prepare for the soon-to-be-implemented Medicare prior authorization program for prostheses.

36 |

Lower-Limb Advances

O&P manufacturers continue to innovate and bring new or updated products to the market, while scientists and researchers develop innovative materials and processes. Find out what’s trending in componentry, materials, and techniques, including additive manufacturing and osseointegration. By Christine Umbrell

44 |

2020 AOPA Virtual National Assembly Preview Meet the Assembly Exhibitors Find out which O&P companies will be sharing their products and services at the interactive virtual exhibit hall next month—and plan to drop by the virtual booths or schedule an appointment with an exhibitor.

contents

PRINCIPAL INVESTIGATOR Andreas Kannenberg, MD (Germany/EU), PhD...........................46 Meet the medical director of Ottobockâ&#x20AC;&#x2122;s North American branch, and learn more about the prosthetic and orthotic microprocessor-related studies he is working on.

DEPARTMENTS Views From AOPA Leadership......... 6 Progress on differentiation

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

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

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

Research, updates, and industry news

People & Places...................................... 20 Transitions in the profession

COLUMNS Reimbursement Page..................... 22 Maximizing Revenue in Challenging Times

Should you consider settlement conference facilitation?

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

CREDITS

P.22 P.16 AOPA News...............................................52

Member Spotlight................................ 50 n

AOPA advocacy, announcements, member benefits, and more

Precision Prosthetics & Orthotics

Welcome New Members................... 55 Ad Index...................................................... 55 Careers.........................................................56 Professional opportunities

Marketplace..............................................58 Calendar..................................................... 62 Upcoming meetings and events

State By State.......................................... 64 Minnesota, New York, and Oregon

P.50 4

AUGUST 2020 | O&P ALMANAC

Thanks to my ToeOFF®, I have been able to EMPOWER PEOPLE to challenge their limits and find new heights,

NO MATTER THE OBSTACLE! – Aika, Doctor of Physical Therapy and 2- time Paraclimbing World Champion (RP3) Kristine Paulsen Photography www.kristinepaulsenphotography.com

VIEWS FROM AOPA LEADERSHIP

Progress on the Road to Differentiation

T IS HARD TO BELIEVE that 2020 is more than halfway over. For the majority

of us, our time has been spent dealing with the implications from the coronavirus (COVID-19). This is certainly true for AOPA. AOPA’s efforts have largely been focused on how we can best support our members, the O&P profession, and the patients we serve during this time. We hope you have found what has been done to date helpful. Given the pandemic is far from over, we will continue these efforts. As I have written many times in this column, one of my biggest priorities for my presidency is making strides in the differentiation of O&P from durable medical equipment (DME). I am pleased to report that we have had some exciting news in our legislative work. As you’ll remember, on Nov. 22, 2019, the U.S. House of Representatives introduced the Medicare O&P Patient-Centered Care Act. Reps. Mike Thompson (D-California), GT Thompson (R-Pennsylvania), GK Butterfield (D-North Carolina), and Brett Guthrie (R-Kentucky) were the bill’s original sponsors, and since then Reps. Jeff Van Drew (R-New Jersey), David Roe (R-Tennessee), Joyce Beatty (D-Ohio), Steven Horsford (D-Nevada), Grace Napolitano (D-California), and Ted Deutch (D-Florida) have joined the bill. We have been hard at work to get introduction in the Senate. In late June, Sen. Steve Daines (R-Montana) agreed to be the Republican lead for the Senate version of the bill. The bill was expected to be introduced by mid-August. The plan was that Daines and Sen. Mark Warner (D-Virginia) would introduce and lead the bill, which also would be sponsored by Sens. John Cornyn (R-Texas), Bill Cassidy (R-Louisiana), Tammy Duckworth (D-Illinois), and Tammy Baldwin (D-Wisconsin). So, what is next? We will push hard for this legislation to become law. Stay tuned in the coming weeks to learn how you can help. We will likely request that you reach out to your legislators, asking them to support our bill. Thank you in advance for continuing to advocate for the profession and its patients. Together, we can continue to improve the lives of those we serve. The work thus far on this bill has already spread understanding of the difference between O&P and DME. Given the timing of this column, I would be remiss not to mention the 2020 AOPA Virtual National Assembly. When I addressed the membership for the first time last September in San Diego, I never would have imagined that we would be holding this year’s Assembly virtually. Like you, I was looking forward to seeing each other in person. Rest assured that the virtual conference will have all of the elements you’ve come to expect from AOPA—high-quality education, access to the latest technology through our exhibitors, as well as networking and fun. Word is that you’ll get to experience some of our colleagues’ musical prowess. You’ll get all this—and the ability to earn more than 100 CE credits. If you haven’t registered yet, I encourage you to do so. I look forward to seeing you all online next month. Until then, stay safe and stay kind. Jeffrey Lutz, CPO, is president of AOPA.

AUGUST 2020 | O&P ALMANAC

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

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

COAPT SIMPLIFIES MY DAILY LIFE

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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

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STRATEGIC ALLIANCES

COMMUNICATIONS, MEMBERSHIP & MEETINGS

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O&P ALMANAC

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

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

AUGUST 2020 | O&P ALMANAC

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

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

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

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NUMBERS

Fewer Americans Covered by Health Insurance Pandemic-related job losses trigger a drop in insured numbers

JOB AND BENEFIT LOSSES

21.9 Million

Lost their jobs or left the labor force between February and May

5.4 Million

Became uninsured as a result of those job losses

HIGHEST INCREASE IN UNINSURED ON RECORD

39 Percent Increase

February-through-May increases in number of uninsured adults are 39 percent higher than any annual increase ever recorded

STATES WITH LARGEST NUMBERS OF NEWLY UNINSURED

689,000 California

659,000 Texas

607,000 Florida

STATES WITH GREATEST INCREASES IN NUMBER OF NEWLY UNINSURED

93 Percent Increase Massachusetts

72 Percent Increase Hawaii

55 Percent Increase Rhode Island

States With Highest Percentages of Uninsured States where 20 percent or more of adults, ages 18-65, are now uninsured Texas Florida Oklahoma Georgia Mississippi Nevada North Carolina South Carolina

AUGUST 2020 | O&P ALMANAC

29% 25% 24% 23% 22% 21% 20% 20%

“Among people who said they or a spouse or partner lost a job or were furloughed because of the pandemic, two of five had health coverage through the affected job. Among those who previously had coverage through an affected job,

one of five said they or a spouse or partner were now uninsured.” SOURCE: “An Early Look at the Potential Implications of the COVID-19 Pandemic for Health Insurance Coverage,” Commonwealth Fund Health Care Poll: COVID-19, May-June 2020.

SOURCE: The COVID-19 Pandemic and Resulting Economic Crash Have Caused the Greatest Health Insurance Losses in American History,” National Center for Coverage Innovation at Families USA; “An Early Look at the Potential Implications of the COVID-19 Pandemic for Health Insurance Coverage,” Commonwealth Fund.

O&P businesses may be seeing an uptick in patients lacking health insurance coverage. Millions of U.S. workers lost their jobs between February and May 2020, the first few months of the COVID-19 pandemic—leading to record numbers of workers losing access to health insurance formerly furnished by their employers. A new study from National Center for Coverage Innovation at Families USA provides details on the growing numbers of uninsured and the states seeing the biggest increases.

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INDICATIONS • Designed to reduce pressure for Wagner 0 and 1 plantar pressure ulcers

FEATURES • Pneumatic ankle bladder to reduce anterior shear motion and friction on the foot • Removable plantar foot sections to allow specific and localized pressure reduction • Neuropathic-friendly foams in the plantar foot section • Off-the-shelf design to allow immediate fit in the clinic • Easy donning and doffing Model #

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Happenings RESEARCH ROUNDUP

Mobility Clinics Improve Outcomes for Patients With Lower Limb Loss Australian researchers studying changes in mobility among lower-limb amputees have found that participation in mobility clinics improves outcomes, according to an article published in Prosthetics and Orthotics International. Led by Sarah Anderson, MPH, PhD, a lecturer in the School of Allied Health at La Trobe University, researchers conducted a pilot study to analyze the effect of participation in targeted mobility training on individuals’ mobility and quality of life. The researchers studied amputees of all ability levels who took part in a two-day clinic to work with prosthetists, physical therapists, allied health personal professionals, and exercise physiologists to learn specific high-level

mobility skills. “These might be how to hop, jump, or sidestep, or perhaps play or participate in sports,” explained Anderson. Clinic attendees took part in sessions focused on physiological skills to strengthen specific muscle groups; introduction to specific sports, including soccer, golf, and running; and talks from a range of people, including others with limb loss. “The participants worked in a group environment and learned from each other as well as from the health professionals in the room,” she said. To measure mobility, participants were asked to complete electronic versions of the PLUS-M and SF-36v2 instrument tools prior to and 12 weeks

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following participation in a mobility clinic. The findings demonstrated that “mobility improved for all participants,” said Anderson, “and these improvements were maintained three months after the clinic.” The researchers concluded that mobility clinics can teach amputees new skills while facilitating interaction with other people with limb loss, resulting in improvements that impact mobility and quality of life in a positive way, said Anderson. “It doesn’t matter if you have never done anything active, or have run marathons—everyone improved their mobility.” Details were published in the June 5 edition of Prosthetics and Orthotics International.

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AUGUST 2020 | O&P ALMANAC

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HAPPENINGS

RESEARCH ROUNDUP

VA Researchers Develop Alternative Socket Liner Material A new three-layer liner system made of advanced hydrated materials is under development by researchers at the Advanced Platform Technology Center at the U.S. Department of Veterans Affairs (VA’s) Louis Stokes Cleveland VA

FAST FACT

COVID-19 Poses High Risk to Patients With Comorbidities People with underlying medical conditions such as heart disease and diabetes were

hospitalized six times as often as otherwise healthy individuals infected with the novel coronavirus during the first four months of the pandemic, and they died 12 times as often. SOURCE: “Coronavirus Disease 2019 Case Surveillance—U.S., Jan. 22-May 30, 2020, U.S. Centers for Disease Control and Prevention

AUGUST 2020 | O&P ALMANAC

“Improving water management in this critical component will fundamentally improve the standard of care for a large population of upper- and lower-limb amputees,” reported Marasco and his team. “A liner material, which keeps this moisture away from the amputee’s skin, would improve comfort and hygiene, but also the critically important fit and thus the overall performance of the prosthesis.” The team plans to test the three-layer system by recruiting 10 able-bodied people to wear a walking boot lined with a sample of the new material in the heel. After comparing the sweaty material with the results of a separate study examining the bacterial content of daily-use socket liners in the Cleveland VA Clinic, the team will finalize the new system and scale materials production to a full-size prosthetic socket liner to test among amputees. They hope to commercialize the system in two to five years, according to Marasco.

THE LIGHTER SIDE

PHOTO: Jennifer Kerbo

Medical Center. Led by neuroscientist and principal investigator Paul Marasco, PhD, the VA team is collaborating with colleagues at the University of Chicago and Case Western Reserve University. The new material is intended to absorb and manage sweat at a faster rate without leaking, changing size, or changing stiffness, to provide a more stable and comfortable separation between the limb and the socket, according to Marasco. The hydrated materials are designed to ease the ability of the moisture to pass through. The system may be used in place of traditional water-impermeable silicone liners, and may be A veteran amputee discusses his prosthetic socket particularly useful for individuals with more than one liner with Courtney Shell, a research associate at amputation, said Marasco. the Advanced Platform Technology Center.

HAPPENINGS

MEDICARE MATTERS

DME MACs Publish Reminder for Scoliosis Codes The durable medical equipment Medicare administrative contractors (DME MACs) and the pricing, data analysis, and coding contractor have released a correct coding reminder for five base codes used to describe scoliosis braces: L1000, L1005, L1200, L1300, and L1310. The L1005 (tension-based scoliosis and accessory pads), L1300 (other scoliosis procedure, body jacket molded to patient model), and L1310 (other scoliosis procedure, postoperative body jacket) are considered to be complete devices and all inclusive. The use of any other addition codes will be considered unbundling and incorrect coding. The L1000 (CTLSO, Milwaukee, inclusive of furnishing initial orthosis) is a custom-fabricated scoliosis brace and the following addition codes may be incorporated into the brace and are eligible for separate payment: L1010, L1020, L1025, L1030, L1040, L1050, L1060, L1070, L1080, L1085, L1090, L1100, L1110, and L1120. The listed addition codes also will be denied as not separately payable if billed with a base code other than the L1000. The L1200 (TLSO, inclusive of furnishing initial orthosis only) may have the following addition codes incorporated into the brace and are eligible for separate payment: L1210, L1220, L1230, L1240, L1250, L1260, L1270, L1280, and L1290. The listed addition codes will also be denied as not separately payable if billed with a base code other than the L1200.

AUGUST 2020 | O&P ALMANAC

MEDICARE MATTERS

CMS Releases Revised ABN Form The Advance Beneficiary Notice of Noncoverage (ABN) form is subject to reapproval every three years; the current version of the ABN was approved in 2017 and expired in March 2020. The approval of a new ABN, form CMS-R-131, by the Office of Management and Budget (OMB) was postponed due to COVID-19, and suppliers were temporarily directed to continue using the expired form.

The new ABN, form CMS-R-131, has now been approved and released by OMB and CMS. There were no substantial changes made to the content or directions for use of the ABN. The use of the revised ABN will be mandatory beginning Jan. 1, 2021, and may be downloaded from the CMS website. Suppliers may continue using the ABN form with the expiration date of March 2020, or they may use the newer form.

DME MACs Release AFO/KAFO Policy Article Revisions The four durable medical equipment Medicare administrative contractors (DME MACs) announced a revised version of the Ankle-Foot Orthosis/Knee-Ankle-Foot Orthosis (AFO/KAFO) Local Coverage Determination and Policy Article (PA) in February 2020. Many of the revisions were clerical in nature, such as changing “ordering physician” to “treating practitioner” and updating the policy with the standard written order instructions. However, the PA did update and create coding guidelines for L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1970, L1971, L1980, and L1990. The revised PA with the new coding guidelines was published and effective July 1, 2020.

PDAC Coding Verification Reminder for L3960 Effective for all claims with a date of service on or after Aug. 1, 2020, the only braces that may be billed using code L3960 (shoulder-elbow-wrist-hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment) must have a written coding verification from the pricing, data analysis, and coding (PDAC) contractor and listed on the PDAC Product Classification list.

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HAPPENINGS

COVID-19 COVERAGE

CMS Waives Signature Requirements on Proof of Delivery Documentation In response to the COVID-19 pandemic, CMS previously announced that it would temporarily waive signature requirements on proof of delivery documentation, when a signature cannot be obtained due to COVID-19, for dates of service during the public health emergency. In this situation, suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19. In addition, suppliers should use the CR modifier and include a brief narrative of COVID-19 on the claim.

COVID-19 COVERAGE

Congress Updates Paycheck Protection Program In June, Congress finalized legislation to ensure that businesses that received a forgivable loan through the Paycheck Protection Program (PPP) can have more leeway on how to spend those funds. Under the Paycheck Protection Program Flexibility Act of 2020, small businesses would have to spend just 60 percent of the loan money on payroll instead of 75 percent as outlined in the original law. In addition, current PPP borrowers can choose to extend the eight-week period of the disbursement to 24 weeks, or they can keep the original eight-week period if their business has sufficiently recovered. New PPP borrowers will have a 24-week covered period, but the covered period cannot extend beyond Dec. 31, 2020. Borrowers can use the 24-week period to restore their workforce levels and wages to the prepandemic levels required for full forgiveness. This must be completed

by Dec. 31, 2020, a change from the previous deadline of June 30, 2020. The bill includes two exceptions allowing borrowers to reach full PPP loan forgiveness even if they are not able to fully restore their workforce. Previous guidance already allowed borrowers to exclude from those calculations employees who turned down good faith offers to be rehired at the same hours and wages as before the pandemic. The new bill allows borrowers to adjust because they could not find qualified employees or were unable to restore business operations to Feb. 15, 2020, levels due to COVID19-related operating restrictions. Finally, the bill extends a June 30, 2020, deadline to rehire workers, pushes back the timeline for repaying loans, and allows companies that get loan forgiveness to defer payroll taxes. President Donald Trump signed the bill into law June 5.

CR and KX Modifiers During COVID-19 The DME MACs have indicated that Medicare-approved, physician-based telehealth visits, including those that meet the relaxed telehealth rules in effect during the COVID-19 public health emergency, will be considered compliant for purposes of establishing and documenting the medical necessity of Medicare-covered services. Telehealth-based physician encounters also will meet any face-to-face visit requirements that are incorporated into existing Medicare policies. For claims with a date service on or after March 1, 2020, if a local coverage 18

AUGUST 2020 | O&P ALMANAC

determination (LCD) implied or required that a face to-face encounter was needed, a telehealth visit may be substituted. This would include the Knee Orthosis LCD, the Diabetic Shoe LCD, and the Ankle-Foot Orthosis/ Knee-Ankle-Foot Orthosis LCD. Since telehealth visits are acceptable, be sure to append the KX modifier to your claims, if and only if all other policy criteria have been met. If you are using the telehealth visit in lieu of an actual face-to-face visit, you also must use the CR modifier and indicate â&#x20AC;&#x153;COVID-19â&#x20AC;? in the narrative field.

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Steven M. Filippis has been appointed president of Wright & Filippis. Anthony J. Filippis will continue at the company as chief executive officer and chairman of the Board of Directors and will be phasing out of daily operations. Steven M. Filippis Steven Filippis has been in his current role as executive vice president of sales and business development for more than five years and has been with Wright & Filippis for 36 years. Over the past six years, he has worked with hospitals and insurance carriers to improve relationships and secure preferred provider agreements with hospital systems. He also has been in charge of oversight of the Wright & Filippis partnership with Carolina Prosthetics & Orthotics, the South Carolina division.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Adaptive Prosthetics & Orthotics, headquartered in Glastonbury, Connecticut, has been honored with a Hartford Business Journal 2020 Family Business Award. The award recognizes successful family-owned businesses in the state of Connecticut. Dave Hewett, CP, BOCPO, and his wife, Lisa, started the company in 1997; the business has grown to include 18 employees in six locations throughout New England. Fillauer has joined with Nashville's FabCo Prosthetic Designs to create FabCo Powered by Fillauer, an affiliate of Fillauer Cos. Inc. Fillauer is moving its upper and lower prosthetic central fabrication operations to the Nashville location, while the company's orthotic fabrication team will remain in Chattanooga, Tennessee. “We are thrilled to grow our already strong relationship with the partners at FabCo Prosthetic Designs,” said Traci Dralle, president of Fillauer Cos. “This new business expands our expertise and reflects a shared commitment to work with others in the profession to deliver the best possible results for customers.” Myomo has launched MyoCare, a new program for providing support to first-year users of its MyoPro powered brace. The program offers extended support to current and future clients who receive their MyoPro directly from the company. Individuals who obtain the MyoPro from an authorized orthotics and prosthetics clinic will receive support from the clinic.

AUGUST 2020 | O&P ALMANAC

Oklahoma State University (OSU) has announced that the OSU Institute of Technology has suspended admission to its associate in applied science in orthotic and prosthetic technologies program and will not be enrolling new students in the program for fall of 2020 while the program is in review. The program is one of only six two-year O&P technician programs in the country. OPAF and the First Clinics has reversed its July decision to dissolve the organization, a decision initially made given challenges related to the COVID-19 pandemic. Instead, the organization will go into a state of dormancy. This allows OPAF and the First Clinics to maintain its name, programming, and structure while substantially decreasing operating costs. The hope is that OPAF can reorganize after the pandemic wanes. Moving forward, OPAF’s Board of Directors will be conducting the daily business of the organization. Össur has announced that a new, streamlined version of its Empower program is now available via smartphone app. The program provides comprehensive practice management solutions for durable medical equipment, prosthetic, and orthotic suppliers and O&P practices.

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REIMBURSEMENT PAGE

By JOE MCTERNAN

Maximizing Revenue in Challenging Times Consider settlement conference facilitation to receive a negotiated settlement of Medicare claims that are awaiting adjudication

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 24 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

E! QU IZ M EARN

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CREDITS P.24

INCE THE DECLARATION of the

COVID-19 public health emergency in March, AOPA has worked diligently to ensure members understand the options that are available to maximize opportunities to maintain sufficient operating revenue to support their business needs. The uncertainty that surrounds this unprecedented time in our history is a source of trepidation and stress as small businesses continue to take the necessary steps to support continued operations. This month’s Reimbursement Page reviews some of the opportunities to maintain revenue sources that AOPA has already communicated to its members and explains an additional option, known as settlement conference facilitation, that may be attractive to O&P businesses with unpaid claims that have been stuck in the appeals process for months or even years.

Early Relief Measures

AUGUST 2020 | O&P ALMANAC

PHOTO: Getty Images

When the COVID-19 public health emergency was initially declared, many businesses, including healthcare operations, came to a grinding halt. There were immediate concerns about the continued viability of small healthcare businesses that had most of their sources of revenue severely reduced or eliminated, literally overnight. Recognizing the danger that

a sudden and drastic reduction of available healthcare providers during a state of emergency would represent, Congress passed what has become known as the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This legislation contained two provisions that distributed immediate cash to healthcare providers facing unexpected revenue shortfalls. These programs have become known as the CARES Act Provider Relief Fund and the Paycheck Protection Program. The CARES Act Provider Relief Fund represents a total distribution of $175 billion in grant payments to Medicare Part A and Part B providers and Medicaid providers, including an initial distribution of $30 billion that was automatically sent to all Medicare fee-for-service providers. An individual provider’s share of the initial $30 billion was calculated based on the provider’s total Medicare billing in 2018. An additional $20 billion in provider relief funds was made available to Medicare fee-for-service providers through an application process. Grant payments made through the Provider Relief Fund do not have to be repaid if providers are able to meet the requirements of the program. Additional information on the Provider Relief Fund may be found on the “CARES Act” section of the www.hhs.gov website.

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REIMBURSEMENT PAGE

• The appellant may be excluded from participation if he or she has or has had False Claims Act litigation or investigations pending against them, or other program integrity concerns, including pending civil, criminal, or administrative investigations. In addition to the qualifying conditions for the appellant, the claim itself must meet specific conditions, spelled out on the OMHA settlement conference facilitation website. This site also details the individual steps that make up the settlement conference facilitation process.

More Options on the Horizon? The Paycheck Protection Program, administered by the Small Business Administration (SBA), has, to date, provided more than $520 billion in low-interest, forgivable loans to companies that qualify as small businesses. These loans are entirely forgivable if certain conditions are met, including the retention of all staff. Additional information on the Paycheck Protection Program is available on the SBA’s website, www.sba.gov.

Settlement Conference Facilitation

AUGUST 2020 | O&P ALMANAC

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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For many AOPA members, funds available through either the Provider Relief Fund or the Paycheck Protection Program have meant the difference between keeping the doors of their business open or closing them altogether. As the public health emergency continues, businesses continue to look for ways to free up revenue from nontraditional sources. One solution that may free up muchneeded revenue involves a negotiated settlement of Medicare claims that are

awaiting adjudication by an administrative law judge (ALJ), a process called settlement conference facilitation. This process, coordinated through the Office of Medicare Hearings and Appeals (OMHA), is potentially advantageous to both the provider and the Medicare program. The provider may free up revenue by accepting a smaller percentage of the potential value of the claim, and the Medicare program may reduce the significant backlog of claim appeals that are awaiting adjudication by an ALJ. A settlement conference facilitation is an individual process between a single provider and OMHA in which the two parties utilize mediation principles to reach a mutually acceptable resolution of claims that are awaiting a hearing before an ALJ or the Medicare Appeals Council, which represent the highest levels of Medicare appeals. If an agreement is reached, the claims in question are dismissed without a final decision regarding coverage but are paid at a percentage of the full value of the claim. In order to participate in a settlement conference agreement, the following conditions must be met: • The appellant must be a Medicare provider or supplier that has been assigned a National Provider Identifier and Provider Transaction Access Number; • The appellant cannot have filed for bankruptcy and/or expect to file for bankruptcy; and

In addition to the potential resolution of pending appeals on an individual provider basis through settlement conference facilitation, AOPA has engaged both CMS and OMHA in discussions regarding the potential for a settlement agreement that would be offered to O&P providers collectively. This would be a separate process from the OMHA settlement conference facilitation; while any settlement amount could not actually be negotiated by AOPA, the association will continue to facilitate the discussion with CMS and OMHA. AOPA understands the challenges its members will continue to face as they navigate the new reality precipitated by the COVID-19 public health emergency, and remains committed to providing valuable resources to AOPA members to help clinicians and business owners adjust to the new reality of effective delivery of O&P care.

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This Just In

CMS Gets Back to Business Even with the COVID-19 public health emergency continuing, CMS resumes Medicare audits and prior authorization of prostheses

MS HAS UPDATED its COVID-19

Reduction of Provider Burden Frequently Asked Questions (FAQ) document to provide updates on the resumption of Medicare audit activity and revised implementation dates for Medicare prior authorization of six lower-limb prosthesis codes.

Medicare Audits Resuming

The FAQ was updated to indicate that CMS has authorized Medicare

DME MACs Announce Verification Requirement for Six Lower-Limb Prosthesis Codes The durable medical equipment Medicare administrative contractors (DME MACs) and the pricing, data analysis, and coding (PDAC) contractor have announced a new coding verification requirement for the six lower-limb prosthetic codes that will be subject to Medicare prior authorization. For claims with dates of service on or after Jan. 1, 2021, the only products that may be billed using codes L5856, L5857, L5858, L5973, L5980, and L5987 are those for which a writing coding verification review has been made by the PDAC and is listed on the PDAC Product Classification List. The DME MACs also released a revised version of the Lower-Limb Prosthesis Policy Article with an effective date of Aug. 1, 2020. The revised version includes new coding guidelines for codes L5856, L5857, L5858, L59973, L5980, and L5987.

AUGUST 2020 | O&P ALMANAC

contractorsâ&#x20AC;&#x201D;including the durable medical equipment Medicare administrative contractors, the recovery audit contractors, and supplemental medical review contractorsâ&#x20AC;&#x201D;to once again perform prepayment and postpayment audits as part of their medical review responsibilities. CMS had suspended most audits as of March 30, 2020, due to the COVID-19 public health emergency.

This Just In

July 2020 Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs) Q. Is CMS suspending most Medicare Fee-For-Service (FFS) medical review during the Public Health Emergency (PHE) for the COVID-19 pandemic?

Q. Is CMS enforcing signature requirements on proof of delivery slips in response to the COVID-19 pandemic, for Dates of Service (DOS) within the PHE for the COVID- 19 pandemic? A. Given the nature of the pandemic and the inability to collect signatures during this time, CMS will not be enforcing the signature requirement. Typically, Part B drugs and certain Durable Medical Equipment (DME) covered by Medicare require proof of delivery and/or a beneficiary’s signature. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.

Q. For ambulance services that require a physician or certain non-physician personnel to sign and certify that a non-emergency ambulance transport is medically necessary, are these signature requirements not required during the COVID-19 PHE? A. We understand that in certain situations during the COVID-19 PHE it may not be feasible to obtain the practitioner signature. Therefore, for claims with dates of service during the COVID19 PHE (January 27, 2020, until expiration), CMS will not review for compliance with appropriate signature requirements for non-emergency ambulance transports during medical review, absent indication of fraud or abuse. Ambulance providers and suppliers should indicate in the documentation that a signature was not able to be obtained because of the ongoing COVID-19 pandemic. However, we note that Medicare Part B covers ambulance transport 1

communicating its concern to CMS about the burdens that renewed audit activity will place on providers that are already operating under challenging circumstances.

Revised Implementation Dates for Prior Authorization of Prostheses

The updated FAQ also included new implementation dates for the Medicare prior authorization program for the six lower-limb prosthesis codes that had their original implementation delayed due to the

COVID-19 public health emergency. These codes include L5856, L5857, L5858, L5973, L5980, and L5987. CMS announced that Medicare prior authorization for the six codes will begin in the four states previously selected for the initial rollout— Pennsylvania, Michigan, Texas, and California—on Sept. 1, 2020, and will be implemented nationally on Dec. 1, 2020. AOPA has developed resources to assist members in understanding how the prior authorization process will work and what to expect from it. These resources, including live and on-demand education opportunities, will be made available to AOPA members soon. CMS has posted the CMS FAQ document on its website; search for “Coronavirus Disease 2019 (COVID-19) Provider Burden Relief FAQs.”

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FAQs

In the updated FAQ, CMS indicates that due to the “importance of medical review activities to CMS’s program integrity efforts, CMS expects to discontinue exercising enforcement discretion beginning on Aug. 3, 2020, regardless of the status of the public health emergency.” CMS indicates that if individual providers that are selected for medical review believe that responding to a request for documentation will create a hardship situation, they should discuss response options with the contractor performing the review. It is important to note that CMS authorized the reinstatement of all Medicare audits, not just audits of orthotic and prosthetic claims. The timing of the resumption of audit activity is surprising considering that the public health emergency remains in effect. AOPA will be

A. On March 30 CMS suspended most Medicare Fee-For-Service (FFS) medical review because of the COVID-19 pandemic. This included pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and postpayment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC). As states reopen, and given the importance of medical review activities to CMS’ program integrity efforts, CMS expects to discontinue exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency. If selected for review, providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness. CMS notes that all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will also be applied.

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COVER STORY

UNDER

PRESSURE O&P business leaders discuss stressors and strategies to promote employee mental health amid the COVID-19 pandemic By MICHAEL COLEMAN

NEED TO KNOW • Staff at O&P workplaces across the country are facing additional stress this year due to the spread of the coronavirus (COVID-19) and related concerns of job insecurity, expanded job responsibilities, adherence to new safety protocols, and fear of exposure. • Many O&P owners and managers are taking an active approach to leading through the crisis and are employing strategies to boost employees' mental health and safety. • Some O&P clinic leaders advocate for including employees in crisis-related decision-making, as regular and transparent communication can soothe worries. • Many O&P companies have enhanced their alreadystringent facility cleaning protocols and are limiting the number of practitioners and patients in the facility to boost employees' confidence in their safety in the workplace. • Allowing staff members to telework, or to take personal time off, gives employees choices when they have young children or at-risk family members at home. • Employers and office managers can look to the website of the American Psychological Association for additional recommendations on managing a workforce during a pandemic.

AUGUST 2020 | O&P ALMANAC

COVER STORY

RONTLINE MEDICAL WORKERS stressed by a

PHOTO: Getty Images

“We are experiencing the collision of three national grueling onslaught of COVID-19 cases are comcrises—the COVID-19 pandemic, economic turmoil, and manding much of the media coverage in America. But recent, traumatic events related to systemic racism,” says O&P professionals also are dealing with depression, Arthur C. Evans Jr., PhD, APA’s chief executive officer. burnout, worry, and fatigue as the pandemic enters its “The collective mental health of the American public has sixth month—with cases increasing in many states and endured one devastating blow after another, the long-term months to go before a vaccine is publicly available. effects of which many people will struggle with for years The pandemic has forced dramatic changes in the way to come. We don’t have to be passive players in mitigating much of the industry does its job. While facility owners, the rapidly increasing stress Americans are facing and its managers, and suppliers are weathering the storm both consequences on our health.” financially and operationally, they say the Instead of passivity, O&P leaders are coronavirus upheaval has taken a toll on mental taking an active approach to the crisis and the health for everyone at their workplace. Fear mental health of workers. Industry veteran of contracting the virus, pay cuts, furloughs, Joyce Perrone, who is director of De La Torre longer hours, additional cleaning and adminisOrthotics & Prosthetics and a partner with trative duties, skittish patients, and other new PROMISE Consulting, says the primary action challenges all add up to mental and physical O&P leaders can take to help alleviate stress exhaustion. among workers is to, well, lead. “Leaders and Joyce Perrone It’s not just healthcare workers suffering companies have a responsibility to keep the COVID-related burnout, either. More than course straight,” says Perrone, who is based 80 percent of all Americans polled by the American in the Pittsburgh area. “I don’t care what your beliefs are Psychological Association (APA) in late May and early [about COVID-19 protocols or the nature of the virus itself ], June say the nation’s future is a significant source of your No. 1 goal has to be to keep your employees safe and to stress in the era of coronavirus. keep your patients safe. O&P ALMANAC | AUGUST 2020

COVER STORY

too. “People look to leaders to be calm and deliberate in their decisions and actions,” the APA says. “Leaders who react to stressful events in highly emotional ways can add to people’s stress and anxiety. Leaders can start by slowing down, taking stock of their stress, and understanding what is causing an emotional reaction. Even when facing the demands of a high-profile crisis, leaders must take breaks to reset and refocus.” Among the other suggestions the association recommends are to share information with empathy and optimism, use credibility to build trust, be honest and transparent, provide regular communications, and offer a forum for feedback. To get a better sense of how the O&P profession is handling the mental stress and challenges the pandemic has created, we spoke to leaders at several AOPA member organizations. Each is dealing with its unique situation, but all have been coping with the additional pressures and offer insights on managing them. Here’s what they had to say.

AUGUST 2020 | O&P ALMANAC

PHOTO: Getty Images

“You need to walk the the disease, but also about talk,” Perrone continues. bringing it home to their fami“You need to be sure that lies, she says. workspaces are getting The worries don’t stop cleaned and that people there. Job security is another are wearing their masks. concern, says Wright. “If You don’t want a patient you’re one of the healthcare Ability Prosthetics & Orthotics, to come walking in and workers who maybe isn’t on Exton, Pennsylvania Vaile Wright see senior employees the front line, but you’re in When patient visits and revenues standing around talking to each other elective areas, then there have been fell off a cliff in the early days of without masks. They’re not going furloughs and real budget cutbacks. the pandemic, Ability Prosthetics & to feel safe in that environment. There is also a lot of grief and Orthotics, which owns Leadership has to be highly engaged trauma related to that,” she and operates 11 clinics in at this time.” adds. “So, there’s a variety Maryland, Pennsylvania, But Perrone also acknowledges of issues, depending a bit and North Carolina, that it’s not easy to make employees on your specialty and your furloughed much of its feel comfortable when the nation setting and what you’re being administrative staff to is battling the worst public health confronted with.” keep the lights on. crisis in 100 years. “When you look Clear and consistent “Our practitioners are Kathleen at it from a mental health issue, you messaging from leadership is now doing a lot of the DeLawrence have to constantly be on guard,” she one tactic to mitigate stress. shipping and receiving, says. “There’s a sort of Grim Reaper “That’s being proactive on how to unpacking boxes, and inventory over our shoulders at all times. Does employ safety protocols, but [it’s] also and cleaning,” in addition to seeing that add pressure to the system? assurances that it’s OK to stay at home patients, says Kathleen DeLawrence, Absolutely.” if you’re sick and that it’s encouraged Ability’s chief operating officer. “Some Healthcare workers are battling that you take time off for self-care,” days they might be in a room with stress “on multiple fronts,” according Wright explains. a patient and they’re getting phone to Vaile Wright, the senior director of On its website, APA offers guidcalls that another patient is out in healthcare innovation in the practice ance to employers trying to manage the parking lot waiting. So, they are directorate at the APA. One of the a workforce during the pandemic. also doing all this coordination. … leading stressors for these individuals Among the suggestions is making sure It’s definitely wearing on people. It’s is concern not only about catching leaders are managing their own stress, becoming a grind on the clinicians.”

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COVER STORY

In addition to administrative furloughs, Ability’s senior leadership and clinical team took a temporary 20 percent pay cut. Other employees kept their normal salaries, but their workloads shot up. “We did it all with the expectation that we would preserve the business and there would be jobs for people to come back to,” DeLawrence explains. “That was our No. 1 goal. And, we’re seeing the business coming back.” Regular communication across the workplace—even though many interactions are now remote—has helped to soothe worries. At Ability, managers bring employees into the loop on crisis-related decision-making, and it helps tamp down anxiety. “We spend a lot of time communicating to the staff—what we know, they know,” DeLawrence says. “And we’re having all-hands meetings almost every Friday to say, ‘Here’s the new protocol, here are the new things you need to do.’” While DeLawrence and others in the O&P industry can’t control the COVID-related precautions patients and employees take in their private lives, she is not concerned about Ability staffers. “We are not monitoring their social lives because they know how critical it is to stay safe,” she explains. “What we are monitoring is any sort of travel out of their home

AUGUST 2020 | O&P ALMANAC

PHOTO: Getty Images

territory—basically any out-of-state a big concern because most of Ability’s travel. We are following the State of clinicians don’t have small children. Pennsylvania guidelines for quaranMany of the company’s administrative tine.” If employees travel to any state staffers who do have young children on Pennsylvania’s quarantine list, the are working from home. “We were company is asking them to get a COVID able to work it out in the spring, and test within three days of their return. we’ll work it out in the fall,” says “As soon as they get a negative reading, DeLawrence. “We are very fortunate.” they can return to work,” she adds. No one at Ability has raised any Amputee Prosthetic Clinic vocal objections about being required Co., Albany, Georgia to wear a mask on the job. But after a According to the Centers for Disease scare early in the pandemic due to an Control (CDC), Americans most intern falsely believing that she had vulnerable to COVID-19 are often the virus, DeLawrence opted the same individuals who to suspend the intern shadhave need for O&P care. owing program to give her That includes patients with staff greater peace of mind. diabetes, obesity, weakened DeLawrence says commuimmune systems, and other nicating to Ability’s staff of ailments. 47 and letting them know “We are all dealing with that they can take time off people that have comproJim Young, CP, to deal with kids or nurture mised immune systems. LP, FAAOP their mental health has We have patients who have been crucial to avoiding everything from AIDS staff burnout. About 17 or 18 of those to hepatitis C,” says Jim Young, CP, staffers are practitioners. “I’ve been LP, FAAOP, president of Amputee encouraging people to take their PTO Prosthetic Clinic Co., which has oper[personal time off ],” she says. “We’ve ations in Macon, Tifton, and Albany, got enough people that we can cover Georgia. One way Young is helping our office.” to reduce exposure—and stress—for Managing the workload when his staff and patients is to try to do as school resumes in the fall—likely in much as possible within the typical a patchwork fashion depending on O&P exam and fitting process in a where clinics are located—shouldn’t be single visit. He’ll often ask patients who may need to be fitted with new devices to plan on staying at the clinic for the business day. “Instead of traveling 60 or 70 miles each way to see me several times, they do it once,” says Young, who treats many patients from rural areas. “It reduces everyone’s exposure.” The vulnerability of some patients’ immune systems demands constant cleaning in the clinic even in normal times, says Young who also is an aboveknee amputee. But now he’s making sure his patients are aware of Amputee Prosthetic Clinic’s typically rigorous disinfecting regimen. “We have always just assumed everybody coming in has something we don’t want, and the next person who comes in doesn’t want it either,” Young reasons. “[Patients] always notice

COVER STORY

when they come and we’re wiping everything down with Clorox wipes and Lysol. But now, we’re putting items in our newsletter about it.” Another challenge: Some patients chafe at being asked to wear a mask, a key CDC recommendation for reducing spread of coronavirus. In those situations, Young, who is the company’s only clinician, relents and sees the patient while he alone wears a mask. “Cleaning has always been a part of our protocol from Day One when I opened 15 years ago, but now the whole mask thing—that’s different,” Young says. “We’re basically in a place where I suppose at least one of us should be wearing a mask, so people are pretty protected. But we are getting some patients who just say, ‘I’m not doing it.’ To some people, it’s a conspiracy.” Young says he tapped into the Paycheck Protection Program to keep all five of his employees on the payroll when business fell away due to some patients’ fears about the virus. “We

and Henderson, North Carolina, says she’s had to strike a “a fine balance” to ensure adequate care and attention for patients, staff, and her business’s bottom line. When the COVID-19 crisis hit, LimBionics quickly implemented a streamlined schedule that reduced interactions among staffers, as well as patients. In the early weeks of the crisis, she decided to alternate practitioners, with a different practitioner had to make sure that everybody treating patients each day. The clinics was still getting paid,” Young says. also saw only patients with emer“Because even though we’re gencies, prostheses, and up and operating like normal, wounds and fractures that the rest of the world is not. were urgent. People are afraid to come out. “Many patients wanted They’re afraid to be in a situato wait to come in anyway, tion where they’ll be around a so this schedule worked lot of folks.” well for us and made us feel safer,” Stresing Brittany Stresing, LimBionics, explains. “The staff and I CPO, FAAOP North Carolina were always in constant Brittany Stresing, CPO, FAAOP, and communication and worked from owner of the LimBionics, with locahome on documents and projects when tions in Durham, Raleigh, New Bern, we weren’t in the office.”

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O&P ALMANAC | AUGUST 2020

COVER STORY

Patient POV Stella Sieber, a scientist at the National Institute of Environmental Health in Durham, North Carolina, lost both of her legs above the knee in a traffic accident in 2002, and she’s been living as a bilateral amputee ever since. Like other amputees, Sieber is trying to balance concerns about receiving O&P treatment with worries Stella Sieber about COVID-19 and healthcare environments. She had a few tips for O&P clinics from the patient’s perspective as both patients and practitioners navigate the virus. Go easy on the appointment reminders for care that is not critical. Sieber says she’s purposefully delayed her own care, including having new sockets made, out of respect for federal and state health guidelines regarding nonurgent care. If applicable, continue convening support groups or other outlets for O&P patients to gather (even virtually) and discuss their challenges, breakthroughs, hopes, and fears. Many patients are doing without this much-needed resource during the pandemic. When it comes to cleanliness, sanitation, and best practices for managing and slowing the spread of COVID-19, be the example. Make sure patients see clinicians and others in the office are wearing masks. Be sure the waiting areas provide ample space for distancing. Ask patients to do their part, too. Require masks and politely request that they wash their hands upon entry to the clinic. It reinforces to patients the company’s commitment to safety and compliance to standards. Strongly consider utilizing telehealth opportunities to conduct appointments that don’t require hands-on treatment. Not only does it reduce the risk of exposure, it saves travel time (and maybe time off work) for the patient, says Sieber.

AUGUST 2020 | O&P ALMANAC

PHOTO: Getty Images

Stresing says that while coronavirus has been challenging for everyone, she hasn’t noticed any members of staff who are seriously struggling. “We have not had anyone quit due to the stress,” Stresing says. “We are all in constant communication, and I request everyone be open with how they are feeling. With how our schedule was and is, we are able to keep excess stress to a minimum. I feel respect goes both ways, so I have great respect and care for my staff, and I try to let that be known to them whenever possible.” As a business owner, Stresing says that her primary concerns or sources of stress during the pandemic are multifold. “How do you keep the business functioning and bills paid, stay within guidelines for care, be worried about patient and staff safety while not knowing for how long this will be going on?” asks Stresing, who also gave birth to a baby this summer. “The hardest part of dealing with COVID is there are just so many unknowns. We don’t have any idea how long this will last. The best protocol continues to change, and that is stressful. We also have to be a support system for the staff to ensure they are not worried about their jobs and paying their bills. So, we take on that stress as well.” Stresing says she’s assured employees that their jobs are safe but also emphasizes that everyone must band together and help pull the weight. “I have made it clear to my staff that if we are all doing our part as a team and know we are all giving our all, then they can know I will not do anything to negatively impact their pay unless it becomes absolutely necessary,” she says. “Thankfully, it has not. That being said, there is the stress of paying the same bills but yet having reduced patient volume.” While the situation is “very difficult to manage,” Stresing says she’s found comfort by staying in contact with physicians who refer patients. “They know we are working and what our protocol is.”

Orthomerica Products Inc. Patient-care clinics aren’t the only facet of the O&P industry coping with pandemic-related stress. Orthomerica, a global device manufacturer, managed to retain its entire 250-person workforce throughout the first five months of 2020 and beyond. But the workload has shifted dramatically. “The first thing we had to deal with was casts coming in,” says Vince Decataldo, the company’s Floridabased prosthetic products manager. “We have cast impressions coming into our facility from all over the world every day, and we have to keep our people safe. How do you disinfect them?” All incoming shipments were quarantined for 24 and up to 48 hours, which slowed production, he explains. “Then those casts or [other devices] go through a disinfecting protocol to make sure that, again, our employees stayed safe.”

Decataldo says Orthomerica—like all of the clinic and industry leaders interviewed by O&P Almanac—has not offered extended paid COVIDrelated leave, but it has “definitely been encouraging working from home.” That has dual benefits: Employees don’t have to encounter anxiety about working in confined spaces, and it allows for better social distancing among those who must work on site. “Any of our teams that have that ability to work from home can really decrease the amount of people in the

building,” Decataldo says. “Technicians can’t fabricate from their home, so it’s opened up a lot of personal space for manufacturing.” That management approach to the crisis seems to have worked. “We’re just happy to have jobs,” Decataldo says. “We’re all just very happy that we’re able to work. The morale here is that we are doing well and able to support the O&P community during a difficult time.” Michael Coleman is a contributing writer to O&P Almanac.

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Orthomerica was tuned in to the mental health component of its workforce early in the pandemic, and managers tried to remain cognizant of distress. “All of the executive leaders and managers were aware of this and looking for certain signs of depression and anxiety due to the current pandemic situation,” Decataldo says. “OPI has made our employees feel very comfortable. If you were not comfortable being here during this pandemic, or if you weren’t comfortable coming in, you were allowed to go home, to take PTO with no repercussions whatsoever. We only want them here if they’re comfortable.”

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O&P ALMANAC | AUGUST 2020

By CHRISTINE UMBRELL

LOWER-LIMB

ADVANCES

New materials, techniques, and devices offer more options for clinicians and consumers

NEED TO KNOW

■ Developments in materials science, microprocessor technology, additive manufacturing, osseointegration, and other areas are influencing which devices are selected and how those components are fit on patients for optimal function. ■ More functional and durable materials have given way to advanced prosthetic feet and ankle componentry. ■ Microprocessor technology is assisting patients in achieving greater mobility and fewer falls, and a few payors are beginning to adjust their coverage benefits for lower-functioning patients.

AUGUST 2020 | O&P ALMANAC

■ Some O&P facilities are venturing into additive manufacturing for prosthetic sockets—both check sockets and final versions. ■ As increasing numbers of Americans consider osseointegration surgery, more prosthetists are becoming educated about treating patients who have implants. ■ Facilities of all sizes and geographic locations are capturing outcome measures data to form recommendations when deciding which prosthesis to fit on a particular patient.

Advances in materials science lead to lighter and more functional prostheses.

HE STEADY ADVANCE of new

PHOTO: Getty Images

technologies has led to expanded choices when it comes to lower-limb prostheses. Each year, manufacturers continue to innovate and bring new or updated products to the market, while scientists and researchers develop new materials and processes, presenting clinicians and consumers with many options. As we maneuver through the 2020s, advances in microprocessor technology, 3D-printed sockets, osseointegrated implants, and more will have an impact on which devices are selected and how those components are fit on patients for optimal function. Here’s a look at some of the most significant trends affecting lower-limb prosthetics, according to several clinicians with expertise in this area.

Manufacturers are making the most of new materials as technology advances, says Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics for Hanger Clinic. More functional and durable materials, some of which are proprietary, have given way to more advanced prosthetic feet. “A person’s human foot is very dynamic, and to mimic that with a prosthesis is challenging,” says Carroll, noting that new materials have helped manufacturers come much closer to a natural foot. “Patients are responding well to these newer technologies. Hydraulic ankle systems designed with state-of-the-art materials enable patients to achieve more optimal results and fluid-like movement, says Carroll. Early iterations of these prostheses have had some challenges, but recent versions offer “very fluid-like ankle motion that allows for greater plantarflexion and dorsiflexion,” he says. “Patients have been asking for more natural movement in their ankle and foot—now we can achieve that. We are seeing them achieve a more natural gait and enjoy very active lifestyles.”

Kevin Carroll, MS, CP, FAAOP

Carroll also notes that many of the new materials allow for much lighter prostheses that are “very discreet and can look natural.”

Microprocessor technology continues to advance—and payors are taking note.

Compared to five years ago, microprocessor options have proliferated, leveraging the latest technologies, says Ryan Filippis, CP, clinical manager, Wright & Filippis. “The knees today have much more functionality and better gait.” Ryan Filippis, CP

Microprocessor ankles are a good choice for patients who are unlimited in the community and who can vary cadence, and perhaps even play golf. But they may not be appropriate for patients who engage in high-impact running, jumping, or weightlifting, says Filippis. “Microprocessor ankles can’t keep up with that type of activity level.” While microprocessor technology has been deemed appropriate by many insurance companies for patients with K3 and K4 functional levels, several studies have demonstrated that some amputees at the K2 level also stand to benefit from the technology. Filippis notes that microprocessor knees have been demonstrated to limit falls, improve stance stability, and reduce the chance of injuries. “Insurance companies are scared of the dollar amount, but it could save money” to allow some individuals with K2 functional level to acquire MPKs, because they can save on costs associated with hip surgery or fall-related medical expenses, says Filippis. O&P ALMANAC | AUGUST 2020

Microprocessor ankles “keep some K2 patients safe,” agrees Jason Kunec, CPO, a clinician at Ability Prosthetics & Orthotics. “And they may be able to take a K2 to a K3 level.” Kunec previously worked for the U.S. Department of Veterans Affairs, where he witnessed microprocessor knees providing tremendous stability and safety for patients designated as K3 patients with lower ability. “Insurance companies need to realize there are safety and health benefits” to microprocessor technology.

Jason Kunec, CPO

Fortunately, a few private payors have begun offering coverage for mircroprocessor technology for some patients with a K2 functional level, says Ashlie White, AOPA’s director of strategic alliances. She points to Health Care Service Corporation and fivestate Blue Cross Blue Shield (in New Mexico, Montana, Oklahoma, Texas, and Illinois) as examples of insurers that have covered microprocessor technology for patients assigned a K2 level. In these policies, coverage for

patients with a K2 functional level is dependent on documentation that the patient is a limited community ambulator, but coverage is only appropriate if improved stability in stance permits increased independence, less risk of falls, and the potential to advance to a less restrictive walking device. The microprocessor knee in these cases would enable fine-tuning and adjustment of the hydraulic mechanism to accommodate the unique motor skills and demands of the functional level K2 ambulator. “Inclusion in the medical necessity criteria and recognition of the specific benefits of MPK technology for limited community ambulators indicate a definitive shift in medical policy—expanding access to patients not previously eligible for microprocessor-controlled prostheses,” White explains. “We believe this issue is trending in the right direction.”

Some clinicians adopt additive manufacturing for socket design. Over the past few years, some clinicians have begun to embrace additive manufacturing—not only for orthoses, but also for prosthetic sockets. As additive manufacturing has matured,

AUGUST 2020 | O&P ALMANAC

PHOTOS: Macy O&P

Paul Macy, CPO, leverages 3D printing to create check sockets in-house using fused deposition modeling, then partners with vendors that house Multi-Jet Fusion 3D printers to create the final socket.

stronger materials have emerged, allowing for the creation of parts that are both lightweight and flexible. Paul Macy, MS, CPO, has been leveraging 3D printing at Macy O&P since he opened the facility two-and-a-half years ago. “The practice is entirely CAD-based,” he says. “We scan patients and complete the entire process digitally.” For lower-limb patients, that means Macy 3D-prints check sockets in-house using fused deposition modeling to print devices made most often of polylactic acid material. His 3D printers are “not fancy, but they do the job” of making check sockets that are fitted on patients in the early stages, and these can be printed overnight. Macy says there are significant benefits from creating sockets in this fashion in conjunction with in-house CAD capabilities. “It’s all about the design,” he says. “To get a socket that fits, it’s an iterative process. You can see what worked, and what didn’t.” He believes that sculpting by CAD via overlays of modified and unmodified mold and using the software to fix mistakes and imperfections is far more precise than sculpting by hand with plaster.

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that go with posterior-mounted feet. He recently created a socket for a long Symes patient—“and the whole prosthesis weighed just 1 pound, 6 ounces,” he says. “There’s no hardware in these sockets, so they’re very light.” Wright prefers Multi-Jet Fusion over selective laser sintering due to its ability to achieve airtight and watertight components—critical for suction sockets. Looking to the future, Wright believes there is a lot of interest in 3D printing “because of what it can do for patients,” he says. “The beauty of it is you’re only limited by your imagination.”

Brent Wright, CP, BOCO, recently leveraged additive manufacturing to create a socket for a long Symes patient; the prosthesis weighed just 1 pound, 6 ounces.

After determining the final socket design, Macy partners with vendors that house Multi-Jet Fusion 3D printers to create the final socket. “We email the file; at that point, the design is done, and height and alignment are complete,” he says. The final sockets are made using thermoplastic polyurethane for the flexible socket liners and nylon PA-12 for the definitive device, and the turnaround time for these components is about one week, according to Macy.

Macy says his patients experience improved fit and comfort as well as more precise height and alignment in their sockets. The sockets have also proven to be durable. Using 3D printing, 40

AUGUST 2020 | O&P ALMANAC

While O&P students and residents may have the most familiarity with 3D printing techniques, more experienced clinicians bring their experience and knowledge to 3D printing. “Older clinicians who are used to traditional manufacturing can now build the sockets that they had always dreamed of,” says Wright. “They know how to design, and they know how prostheses are supposed to go together.” Filippis believes that the prosthetic community will be adopting many more aspects of 3D printing over the next five years. “You’ll see a lot more 3D-printed devices, covers, and component parts” in the coming years, he says. “I see that as a huge part of our industry going forward—but first, there will be more testing and figuring out the strength of materials.”

PHOTO: Brent Wright, CP, BOCO, EastPoint

Paul Macy, MS, CPO

“you can do things that you can’t do with traditional methods,” explains Macy, “like achieve variable wall thicknesses of the flexible liner and the frame. You can be far more precise.” Macy predicts that more prosthetists will embrace 3D printing in the coming years, an opinion echoed by Brent Wright, CP, BOCO, a practitioner at EastPoint Prosthetics and Orthotics in Raleigh, North Carolina, and co-owner of Additive America. Clinicians at EastPoint fit some patients with definitive sockets made at Additive America, which leverages Multi-Jet Fusion 3D printing and advanced materials. Wright notes that the new technology is durable and can be used “to create flexible and nonflexible areas for definitive sockets and can be used at different thicknesses”—as thin as 1.75 millimeters. Wright is excited about using additive manufacturing to make sockets

Brent Wright, CP, BOCO

Prosthetists prepare to treat more osseointegration patients.

Osseointegration “is no longer a novelty,” says Kurt Collier, CP, vice president of prosthetics at Integrum Inc. “It’s becoming a viable option in rehabilitative care.” The one-stage or two-stage surgical procedure enables amputees to receive a percutaneous implant to which a prosthesis can be attached, offering some individuals— particularly those who find sockets to be problematic—the benefits of stability and comfort. Some Americans have received implants while participating in clinical studies conducted at the Department of Defense Osseointegration Program. But as each year goes by, more civilians are considering this option. Some lower-limb amputees have travelled to international implant centers, such as the Osseointegration Group of Australia, while others are working with U.S. surgeons; several hospitals

have publicly announced they have the ability to perform osseointegration surgeries using Integrum’s OPRA™ Implant System, including the University of California—San Francisco, Walter Reed National Military Medical Center, Presbyterian/ St. Luke’s Medical Center, and The Johns Hopkins Hospital. A handful of other hospitals also are performing the surgery, according to Collier. Transfemoral amputees may undergo surgery to receive OPRA implants as part of a humanitarian device exemption from the U.S. Food and Drug Administration (meaning the OPRA system has been FDA-approved and is commercially available in the U.S. marketplace, according to Collier). Over the past five years, says Collier, between 100 and 200 Americans have received OPRA implants, with some others receiving implants via other forms of osseointegration.

As the momentum associated with osseointegration continues, it’s becoming more important for prosthetists to become educated about treating patients who have received implants. Last year, the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) released a statement noting that “certified prosthetists do play a role in the provision of prostheses. Once the surgical procedure has been completed and the surgeon has cleared the patient for weight bearing, the certified prosthetist evaluates the individual for the provision of the prosthesis. This type of prosthetic intervention has unique requirements concerning the type of connector component used with the external adaptor. Consistent with ABC’s accreditation standards, the certified prosthetist must follow the specific manufacturer’s guidelines for the use of the connector associated with the osseointegration component.”

O&P ALMANAC | AUGUST 2020

Prosthetists who work with osseointegration patients play key roles in rehabilitation. With this population, “optimization of gait” is critical, Collier explains. “We have to continue to modify alignment to work with the increased skill of the patients as they progress,” he says. “The refinement of ambulating in a new manner comes over a period of time. It’s very important for prosthetists to be involved and make very specific alignment changes for optimization.”

Kurt Collier, CP

Collier predicts that many more individuals will seek prosthetic implants, especially now that several hospitals are performing the procedures. In addition, a few insurance companies are beginning to pay for osseointegration procedures as well as the connection/failsafe devices that are required componentry, says Collier. “We need prosthetists to understand what osseointegration is, know the different types of implants, and understand the potential for topical skin infections versus deep bone infections,” he says. “Prosthetists can help patients make decisions” when they are considering the surgery.

Telehealth plays a larger role in lower-limb patient care.

AUGUST 2020 | O&P ALMANAC

recent amputee. In addition, “We like to do pre-op consults to help patients feel better, and to explain to them that they’ll be able to walk again,” he says. For wound care, “we may see a patient 15 or 20 times before they get their prosthesis, and we may have to work with surgeons, to share photos for wound care,” he says. In many cases, a telehealth appointment can enable two or more healthcare professionals to work with a patient in a collaborative manner. Many O&P professionals predict that telehealth will continue to play a larger role in O&P care, even after the pandemic has abated.

Facilities embrace evidencebased practice for more informed decision making.

Another trend gaining ground at many facilities is analyzing outcomes data to aid in componentry selection. “At Hanger, we have collected tens of thousands of outcomes” that have been compiled for reference, says Carroll. “When we look at a product, we can look at what the expected outcomes are” and leverage this to form recommendations when deciding which prosthesis to fit on a particular patient. Other facilities are capturing their

own outcome measures data for use in similar ways. And the entire industry will benefit from the Limb Loss and Preservation Registry (LLPR), being developed by the Mayo Clinic, with funding provided by DoD and National Institutes of Health, and in partnership with AOPA and the American Academy of Orthotists and Prosthetists. The LLPR’s primary value is to enhance treatment and care for limb preservation and patients with limb loss, according to the project’s official statement of purpose. Once the registry moves into advanced stages, it will provide a home for outcome measures data and other data points related to O&P. Five years from now, the LLPR data set will ideally be available to help patients make decisions based on their specific circumstances, according to the LLPR statement of purpose. “The data analytics will forecast probabilities on what is possible given a patient’s functional status. [It] will provide education and generate knowledge and discovery.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

PHOTO: Integrum Inc.

The ongoing COVID-19 pandemic has prompted facilities of all sizes and patient populations to test telehealth. Filippis believes that telehealth will continue to have important uses in post-op care for new lower-limb amputees. “There will be more virtual visits for some of the standard follow-up or even post-op care,” says Filippis. He notes that prosthetists may use HIPAA-compliant platforms to collaborate with surgeons during visits with patients, or to look at incisions when a nurse conducts a home visit with a

A group of patients who have undergone osseointegration surgery using the OPRA Implant System

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2020 AOPA Virtual National Assembly Preview

Meet the Assembly Exhibitors T

HIS YEAR’S VIRTUAL exhibit hall will be one of the most exciting elements

of the 2020 AOPA Virtual National Assembly. Exhibitors will have virtual booths open during certain hours for attendees to “drop by” and engage in video chats. Using tags attached to exhibitors’ profiles, registrants will be able to find the companies best suited to their needs, while exhibitors can use registrants’ tags to identify the people most likely to need their products and services. Use the following list to plan your virtual visits to see the latest O&P products and services at this year’s online conference.

Bold listings indicate the exhibitor is a member of the American Orthotic & Prosthetic Association (AOPA) Indicates the exhibitor is a Supplier Plus Partner with AOPA ● New exhibitors for 2020.

Exhibitors as of Aug. 5, 2020 ● 3D O&P

College Park Industries

ACRM, American Congress of Rehabilitation Medicine

Comfort Products Inc.

Alps South LLC American Academy of Orthotists & Prosthetists (AAOP)

Cypress Adaptive LLC ESP LLC Fillauer

American Board for Certification in Orthotics, Prosthetics, & Pedorthics (ABC)

Freedom Innovations LLC

American Orthotic & Prosthetic Association (AOPA)

Infinite Biomedical Technologies

Amputee Coalition Apis Footwear Co. Arizona AFO, an OHI Company Becker Orthopedic Appliance Co. Blatchford Inc. BLUEWAVE Technologies Inc. Board of Certification/Accreditation (BOC) Boston O&P Brightree LLC Bulldog Tools Inc. Cailor Fleming Insurance Cascade Orthopedic Supply CBS Medical Billing & Consulting LLC Coapt LLC

Coyote Prosthetics & Orthotics

AUGUST 2020 | O&P ALMANAC

Hope to Walk

International Institute of Orthotics & Prosthetics KISS Technologies LLC Knit-Rite Inc. MD Orthopaedics Inc. Medex International Inc. Monetek LLC National Commission on O&P Education (NCOPE)

Ottobock Paceline PROTEOR USA Soletech Inc. Spinal Technology Inc. SPS SteeperUSA Surestep

nora systems GmbH

Tamarack Habilitation Technologies Inc.

OPIE Software

TechMed 3D Inc.

OPTEC USA Inc.

Townsend Design (Thuasne USA)

Orfit Industries America

Turbomed Orthotics Inc.

Orthomerica Products Inc.

VitalFitsr

Osseointegration Group of Australia

Vorum

Össur Americas Inc.

WillowWood

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PRINCIPAL INVESTIGATOR

Answering Payors’ Questions Andreas Kannenberg, MD (Germany/EU), PhD, leads Ottobock Healthcare’s research team in North America, partnering with facilities and universities in evidence-based investigations

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Andreas Kannenberg, MD (Germany/EU), PhD

AUGUST 2020 | O&P ALMANAC

professional, Andreas Kannenberg, MD (Germany/EU), PhD, medical director at Ottobock, was born and raised in Berlin. He graduated from medical school at the University of Berlin in 1989, then spent 10 years as a physician in his native Germany. But he found that he was seeking something more. “Back in 2001, I was looking for a new job in clinical research and was intrigued by the opportunity to establish and shape the framework of clinical research on the corporate/manufacturer side of this industry, which was more or less a blank slate at the time,” he recalls. He served as the founding member of the Medical Affairs Department of Ottobock in Duderstadt, Germany. Since then, he was worked to grow the department—which now employs about 35 specialists of various healthcare and research professions around the world. Today, Kannenberg is the medical director of Ottobock’s North American branch in Austin, Texas, where he directs and oversees clinical research with Ottobock products in the Americas. He and his team work with a network of O&P research institutions, including the University of Washington, Shirley Ryan AbilityLab, and University of South Florida, “to run full-blown clinical trials,” he explains. The team also works with O&P clinics to collect clinical data for product and outcomes registries.

Recently, his team has started conducting multicenter clinical studies with several O&P clinics, “as access to patients is absolutely crucial for clinical research— and one of the big limitations of academic centers,” he explains. “Universities usually have research staff, time, and equipment, but no—or too few—patients.” O&P clinics, on the other hand, have many patients but usually no research staff, time, and equipment. “That’s why we need to find innovative ways to overcome this obstacle to answer all the research questions that payors are asking,” he says. As a physician, Kannenberg has a unique perspective on research and clinical considerations that is “much broader than that of the typical CPO,” he says. “I think that makes me well-prepared for what will be coming in the future as payors increasingly apply rules for physicians and other health professions to O&P.”

Ongoing Investigations

While at Ottobock, Kannenberg has been involved in almost all of the microprocessor-controlled knee (MPK)-related clinical research projects. He also has worked on investigations relating to prosthetic feet, hips, and hands. Currently, he is overseeing three clinical studies. The first is a randomized controlled trial with the Kenevo MPK, developed specifically for lower-mobility

PRINCIPAL INVESTIGATOR

above-knee amputees. Principal Investigator Sara Morgan, CPO, PhD, is conducting the study at the University of Washington in Seattle. “This study investigates the potential benefits of using an MPK or non-MPK as the first prosthetic knee in rehabilitation after amputation over a period of six months,” Kannenberg explains. “Patients are randomized to one of two groups: One group undergoes rehabilitation with a prosthesis with the Kenevo MPK and the other group with a prosthesis with a non-MPK.” The first three months of the study were funded by a grant from the U.S. Department of Defense, and Ottobock is funding the extension from months four to six. In addition, Kannenberg is directing two active clinical trials with the C-Brace, a microprocessor swing- and stancecontrol knee-ankle-foot orthosis (KAFO). One study is a randomized, controlled multicenter study with four Hanger Clinic facilities in the United States and four sites in Europe. “This study investigates the potential benefits of the C-Brace in current users of locked KAFOs with a comprehensive set of

performance-based and self-reported outcome measures after three months’ use of each type of orthosis,” he says. The other C-Brace-focused project is an exploratory study being conducted at the Shirley Ryan AbilityLab in Chicago; researchers are investigating the potential of the orthosis in rehabilitation after incomplete spinal cord injury. Kannenberg also is working on publishing the results of a “first-of-its-kind” study conducted as a master’s thesis by a now-former student of the Baylor Orthotics and Prosthetics Program in Houston. The study involved a survey of 57 patients with unilateral transtibial amputation who had been fitted with a powered ankle-foot component to study their musculoskeletal pain compared to their previous passive prosthetic feet. The study found that powered foot users suffer from less pain in their sound knee, amputated side knee, and low back. They also experience significantly less knee pain-related ADL restrictions and back pain-related disability, Kannenberg reports. The project was so successful that Kannenberg is working with Baylor to

define more projects for students’ master’s theses. “It’s a great idea to engage students in research projects that kill two birds with one stone—give students topics for their master’s theses and generate helpful evidence for the whole industry,” he says. “That´s the best way to get clinicians who do patient care and have a strong interest in research topics.”

Future Studies

As Kannenberg looks ahead, he notes that demonstrating significant and clinically meaningful safety and mobility benefits of new-generation advanced lower-limb prosthetic technologies has become increasingly difficult. The devices “usually deliver incremental, rather than leap-frog, improvements compared to their previous generations,” he says. For that reason, future research into lower-limb prosthetics will need to address “patient groups that are currently put at a disadvantage by coverage policies as they have only access to outdated prosthetic technologies that were developed decades ago.” He also believes investigations will be needed

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O&P ALMANAC | AUGUST 2020

PRINCIPAL INVESTIGATOR

to determine the “potential benefits that we haven´t thought of in the past, such as the impact of components on musculoskeletal pain in individuals with lower-limb amputations,” he explains. Research related to lower-limb orthotics, on the other hand, is at a less advanced stage. Orthotic technology “has lagged behind lower-limb prosthetics for more than 20 years,” he says. “As we´re adopting modified microprocessor-controlled prosthetics to orthotics now, we´ll have to demonstrate that all the benefits of advanced technology to individuals with lower-limb amputation also apply to patients with lower-limb paresis.” Doing so will be a challenge, as many insurers “don´t even accept the same clinical presentation of a paresis as one condition that may have been caused by a number of different diseases—they just sort patients by their underlying disease,” he says. “As a result, you may have to run 10 studies for the same paresis as it may be caused by 10 different conditions.”

Andreas Kannenberg, MD (Germany/EU), PhD, at the 2019 AOPA National Assembly Regarding upper-limb prosthetics, Kannenberg notes that multiarticulating hands already offer more functions than patients can easily control. “Therefore, future research will have to focus on new control technologies, such as pattern recognition and targeted muscle reinnervation.”

Proving Efficacy for Payors

Studies such as the investigations overseen by Kannenberg and similar research projects have taken on 48

AUGUST 2020 | O&P ALMANAC

NOTABLE WORKS Andreas Kannenberg, MD (Germany/EU), PhD, is the author or co-author of dozens of peer-reviewed articles and conference presentations. Some of his most impactful contributions include the following: • Kannenberg, A., Zacharias, B., Pröbsting, E. “Benefits of Microprocessor Prosthetic Knees to Limited Community Ambulators: A Systematic Review.” J Rehabil Res Dev, 2014; 51(10): 1469-1496. doi: 10.1682/JRRD.2014.05.0118. • Pröbsting, E., Kannenberg, A., Conyers, D., Cutti, A.G., Miguelez, J., Ryan, T., Shonhowd, T.P. “Ease of Activities of Daily Living With Conventional and Multigrip Myoelectric Hands.” J Prosthet Orthot, 2015; 27(2): 46-52. • Pröbsting, E., Zacharias, B., Kannenberg, A. “Safety and Walking Ability of KAFO Users With the C-Brace®, a New Microprocessor Stance and Swing Control Orthosis.” Prosthet Orthot Int, 2017; Feb. 41(1): 65-77. doi: 10.1177/0309364616637954. Epub: 2016 Jul 10. PMID: 27151648. • Fuenzalida Squella, S.A., Kannenberg, A., Brandão Benetti, Â. “Enhancement of a Prosthetic Knee With a Microprocessor-Controlled Gait Phase Switch Reduces Falls and Improves Balance Confidence and Gait Speed in Community Ambulators With Unilateral Transfemoral Amputation.” Prosthet Orthot Int, 2017; Jul 1: 309364617716207. doi: 10.1177/0309364617716207. [Epub ahead of print]

greater importance in recent years as payors require more objective justification of advanced technologies. “With the implementation of the 21st Century Cures Act in the Medicare Program Integrity Manual— specifically, the updated Chapter 13 on the development of Local Coverage Determinations—the role and importance of published clinical research for coverage decisions of Medicare have been lifted to a completely new level,” he says. “Basically, there is no chance to achieve Medicare coverage for new technologies in O&P that are currently not covered without sound clinical research that has been published in peer-reviewed medical journals. And as Medicare coverage has an increasing impact on coverage policies of private health insurances, that new process will have a trickle effect on private insurances as well.” He believes that future investigations may help patients with a K2 functional level achieve coverage for microprocessor knee and foot

technology. “Medicare has indicated that they still find the evidence for microprocessor technology in that patient group too limited to grant coverage,” he explains. He also hopes studies will help neurologic patients with lower-limb paresis achieve coverage for microprocessor-controlled orthotic technology. Plus, he believes that upper-limb studies will lead to myoelectric prostheses becoming “the standard of care” in the United States. Kannenberg is hopeful that comprehensive studies that involve all O&P stakeholders—and increased communication between prosthetists and payors—will help ensure patients gain access to the most appropriate componentry to meet their needs and improve their quality of life. “I have found out that CPOs have thought processes that differ substantially from those of physicians and nurses who usually call the shots on the insurance side,” he says. “Learning their thought processes and language will be key to succeeding in the long term.”

MEMBER SPOTLIGHT

Precision Prosthetics & Orthotics

By DEBORAH CONN

European Roots Solo practitioner got his start—and love of the outdoors—in the Czech Republic

AMIL LEMAN, CPO, got

his start in prosthetics in his home country, the Czech Republic. In 2001, he immigrated to the United States to reunite with family members who arrived in the 1980s. In the Czech Republic, Leman had pursued interests in several business areas, but “I always knew I would come back to O&P,” he says. “It feels like part of my destiny.”

One area of the facility allows Leman to assess patients as they practice sitting and navigating steps. here is amazing, and the fishing

and hunting are terrific.” FACILITY: In 2007, Leman opened Precision Precision Prosthetics Prosthetics & Orthotics in Casper, & Orthotics

OWNER: Kamil Leman, CPO LOCATION: Casper, Wyoming Kamil Leman, CPO, works with a young patient.

AUGUST 2020 | O&P ALMANAC

Leman works on a new prosthesis.

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

PHOTOS: Precision Prosthetics & Orthotics

Once in the United States, Leman earned his O&P credentials from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, and began his career at a facility in Savannah, Georgia. “It was a great company, and I was learning a lot, including English,” recalls Leman. He spent three years in Georgia and, as much as he liked the facility, decided to move to a more northern climate. “I really enjoy winter sports and hunting,” he says. When he met a colleague at an AOPA conference in Reno who told him about Wyoming, “I agreed to come to look at the scenery, and I fell in love with the state,” he says. “The outdoors

HISTORY: 13 years

and he hasn’t looked back. “I love the people here. We all have the same hobbies, so we relate to each other very well. Wyoming is a great match for me.” He had a facility built to his specifications, which included windows in the fabrication lab and a dedicated suction and air cleaning system. Leman is the sole practitioner at his facility, which also employs an office and billing manager and a receptionist. He outsources bookkeeping functions and is interviewing for another full-time CPO. For now, the most popular member of Leman’s team is Choco, a rescue dog that spends her days in the facility under his desk. “When a patient comes in, Choco sits right next to them to give support,” he says. Another dog, Christina, may join Choco in her support duties—once she completes obedience training. Leman’s marketing strategy includes a website, social media, and television advertising. He keeps his website up to date and seeks out opportunities

to increase the visibility of his business. “I was able to use the latest technology to create a low-budget TV commercial that ran in the Casper area during the Superbowl,” he says. Each January, Leman tries to take a mission trip. He has been to Haiti and Guatemala, as well as Kenya, where he consulted with officials on opening a prosthetic facility in one of their hospitals, in addition to casting amputee patients for prostheses. As an essential business, Leman has kept his facility open during the COVID-19 pandemic, but most of his patients opted to stay home for the first month or so. “The shutdown was easy to project because of my contacts in Europe,” he says. “When I returned from Kenya in January, I knew I had to finish up all my prosthetic orders.” Recently, more people have been coming to the office, which Leman says could be the cleanest in the country. “We bought sanitizer, masks, and gloves right away, and I equipped the office with ultraviolet light sterilizing lamps,” he notes. “I even bought an ozone generator for the office as a whole, which we operate at night. I plan on continuing these precautions even after the pandemic has passed.” Once that happens, he would like to open a second facility a few hours away from Casper. “I like to keep things state-of-the-art, so we have extra equipment for a new office,” he says. “The main thing is to continue our mission of helping people.”

RIDE THE WAVE WITH

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AOPA NEWS

AOPA Speaks Out Against Systemic Racism AOPA has issued the following statement denouncing racism: The death of George Floyd, the protests, and the disproportionate impact COVID-19 is having on racial and ethnic minorities and the poor and socially disadvantaged among us have once again brought to the forefront the longstanding issue of systemic racism in this country. AOPA stands with our members in opposing systemic racism and believes it is time to meaningfully address the impacts it has on our society. Until we do, a large percentage of the patients AOPA members serve, those living with limb loss/difference and limb impairment in disadvantaged communities, will never be truly healthy. Now more than ever, it is imperative to reflect on the values of the orthotics and prosthetics profession and its patients, to remember character is not only what we believe but what we do. As Martin Luther King Jr. observed, “The ultimate tragedy is not the oppression and cruelty by the bad people but the silence over that by the good people.” Today, we reaffirm our values, beliefs, and commitments. We cannot solve these problems alone, but AOPA

is committed to the principles of diversity, equality, and inclusion with each other, our allied healthcare professionals, and in all patient interactions. AOPA is committed to health equity and to improving the health outcomes of our patient populations. AOPA stands united, ready to learn, grow, and work toward a better future.

Download Data From the CMS Data Portal DATA AT YOUR FINGERTIPS

AUGUST 2020 | O&P ALMANAC

Looking to develop a new product? Want to see who is currently using what product? AOPA members can access the CMS Data Portal to access comprehensive, easy-to-use, easyto-read, Medicare Part B orthotic and prosthetic claims data from the last five years; previous years are available with special request. You can download customized reports for use in your own reports and marketing material. The data is updated annually to ensure you have the most recent data at your fingertips. Just set your search parameters, and in a matter of minutes you’ll get data to help you do the following:

• Understand the current market in terms of size, geographic distribution, and provider specialty. • Predict growth and opportunities. • Compare historical and projected growth rates in Medicare. • Identify new product opportunities. This CMS Data Portal is free to AOPA members. To access it all you need is your AOPA member username and password. Visit the AOPA website, or contact Devon Bernard at dbernard@AOPAnet.org.

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

AOPA NEWS

Webinars UPCOMING WEBINAR WEDNESDAY

AUG. 12

Contracting 101: Understanding the Basics

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

UPCOMING WEBINAR

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

WEDNESDAY

SEPT. 2

Everyone assumes they know the rules, but what about those special instances when the common rules don’t apply? When is your date of service different from the date of delivery? When is your place of service not the home? Get the answers to these questions and more.

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

ADVOCACY

RESEARCH EDUCATION

AOPA Offers Members Free Access to AOPAversity AOPA knows you and your employees are being tremendously impacted by COVID-19. To help, we are offering you, our AOPA members, the ability to access our online learning management system, AOPAversity, for free for the rest of 2020. It is our hope that this will make it easier to navigate the current unprecedented situation. What does this mean? You and your employees can now access all 72 online offerings, which are prerecorded videos available on demand. That’s 33 business offerings worth 34.5 Business Credits and 39 clinical offerings worth 60.5 Scientific Credits—all for free. If you do not currently have an AOPAversity account, visit www.AOPAnetonline.org/aopaversity/register to create a profile. You will need your AOPA member ID and the Zip code affiliated with your membership when you create 54

AUGUST 2020 | O&P ALMANAC

FREE ACCESS

your profile to access the free offering. Already have a profile? Log in at www.AOPAnetonline.org/aopaversity. Your username is the email used to create your profile. This offer is valid through Dec. 31, 2020, and excludes any refunds to purchases made prior to the start of this offer. We hope this benefit offers you additional support during this uncertain time. Contact Ryan Gleeson at rgleeson@AOPAnet.org with any questions.

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 companyâ&#x20AC;&#x2122;s ability to meet the qualifications and requirements of membership.

New Beginnings Orthotics & Prosthetics Inc. 300 Toll Gate Road, Ste. 101 B Warwick, RI 02886 401/593-6267 Patient-Care Facility

AD INDEX

Advertisers Index Company American Board for Certification in Orthotics, Prosthetics, & Pedorthics

Page Phone

Website

45 703/836-7114

www.abcop.org

Allard USA

866/678-6548

www.allardusa.com

ALPS South LLC

800/574-5426

www.easyliner.com

Amfit

31 800/356-3668

www.amfit.com

Apis Footwear Company

888/937-2747

www.apisfootwear.com

ARTech Laboratory Inc.

888/775-5501

www.artechlab-prosthetics.com

Board of Certification/Accreditation

877/776-2200

www.bocusa.org

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

Cascade Dafo Inc.

800/848-7332

www.cascadedafo.com

Coapt

7 844/262-7800

www.coaptengineering.com

College Park Industries

800/728-7950

www.college-park.com

ComfortFit Orthotic Labs Inc.

888/523-1600

www.comfortlabs.com

Coyote Design

800/819-5980

www.coyotedesign.com

Cypress Adaptive LLC

888/715-8003

www.cypressadaptive.com

ESP LLC

888-WEAR-ESP

www.wearesp.com

Fillauer Companies Inc.

800/251-6398

www.fillauer.com

Flo-Tech O&P Systems Inc.

800/356-8324

www.1800flo-tech.com

Hersco Naked Prosthetics

1 800/301-8275 43

888/977-6693

www.hersco.com www.npdevices.com

Orthomerica

11 800/446-6770

www.orthomerica.com

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

Phoenix Molded Shoes, Inserts, & Braces 49 PROTEOR USA

863/658-2616

www.phoenixmolded.com

9 855/450-7300

www.proteorusa.com

Surestep

33 877/462-0711

www.surestep.net

Spinal Technology Inc.

800/253-7868

www.spinaltech.com

TurboMed Orthotics

888/778-8726

www.turbomedorthotics.com

O&P ALMANAC | AUGUST 2020

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Technician

Job location key:

East Setauket, New York Wanted: Technician for busy Long Island practice. Excellent pay and comprehensive benefits package. Must be professional, experienced, and knowledgeable. Email your résumé and inquiries to:

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

Mark Goldberg Prosthetic & Orthotic Labs Email: joshua.goldberg@mgpolabs.com

- 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

Northeast

Member Nonmember $85 $150

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

AOPA’s O&P Career Center Connecting highly qualified O&P talent with career opportunities EMPLOYEE

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

AUGUST 2020 | O&P ALMANAC

• Apply online for job openings • Free résumé review

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.

• Research who is hiring

EMPLOYER

• Post your job in front of the most qualified group of O&P professionals • Search anonymous résumé database to find qualified candidates

LOG ON TODAY! https://jobs. AOPAnet.org

• Manage your posted jobs and applicant activity easily on this user-friendly site.

CAREERS

Career Opportunities... California

CO-Sacramento CO-Modesto

Washington

CPO–Wenatchee CO-Yakima Oregon CPO –Corvallis & Salem To apply, submit resume to: careers@pacmedical.com

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

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

AOPA’s Co-OP

Co-OP

An AOPA Member Benefit

As an online reimbursement, coding, and policy resource, this website includes a collection of detailed information with links to supporting documentation for the topics most important to AOPA members. Like a Wikipedia of all things O&P, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of our membership body.

Resources include: • State-specific insurance policy updates • L Code search capability • Data and evidence resources, and so much more!

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

DOWNLOAD THE APP!

Download and use the Co-OP App on your mobile device.

O&P ALMANAC | AUGUST 2020

MARKETPLACE

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

Smart Orthotic Technology, Thumb Orthosis Allard’s Smart Orthotic Technology (SOT) line introduces a unique, anatomically shaped orthosis for the thumb and palm. The SOT thumb orthosis is designed to restrict movement in the CMC and MCP joints and to support the hand’s arch. This is done by positioning the thumb’s joints and muscles in a comfortable resting position. The SOT thumb will help to avoid overstretched ligaments that can lead to joint subluxation. The SOT thumb orthosis has an aluminum core that can be easily formed to fit individual anatomy. Call 888/678-6548 or email info@allardusa.com for more information and receive your free Tips & Tricks Brochure.

ALPS Valve Integrated Pump ALPS Valve Integrated Pump (VIP) is just what you need for elevated vacuum systems. Designed with the practitioner in mind, the VIP is easy to install and easy to use. Once the amputee dons the prosthesis and places a seal sleeve over the socket, the pump is activated from the user’s weight during heel strike, and draws elevated vacuum after toe-off during swing phase. Engineered out of a medical-grade silicone and two valves to control the airflow, the VIP is available with two different levels of vacuum to accommodate most users’ activity levels and skin types. Call us or visit www.easyliner.com for more information.

Apis

Apis custom program offers practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words. Call us at 1-888/937-2747.

2nd Generation Coapt Control Gen2 is the all-new and reimagined myoelectric pattern recognition control system from Coapt. Compatible as an add-on system to virtually every powered upper-limb prosthetic configuration, Gen2 unleashes an unprecedented level of personal, intuitive control for its wearers. Coapt’s Gen2 has enhanced the performance of the COMPLETE CONTROL pattern recognition core and introduces unrivaled new features, changing the field once again: • CONTROL COACHTM—An onboard A.I. companion guiding the wearer through accelerated learning and adoption of their prosthesis control • ADAPTIVE ADVANCETM—An extra machine learning layer capable of continuously improving Gen2’s harmony with its wearer. For more information, visit www.coaptengineering.com.

AUGUST 2020 | O&P ALMANAC

MARKETPLACE Coyote Prosthetics and Orthotics

Coyote is having a customer relief sale on some of our most popular products. Receive 10 percent off the Air-Lock, QUIK GLUE, the Proximal Lock, and the Kleenaire. Hurry, the sale ends Aug. 31, 2020. Go to www.coyotedesign.com for more details.

Aria Plate Valve by Cypress Adaptive The Aria Plate Valve by Cypress Adaptive is a simple and reliable solution for any suction suspension application that requires auto-expulsion function with push-button release. The Aria Plate Valve saves on fabrication time as it simply bolts to to any four-hole mounting plate. It is cost effective, durably constructed, and easily disassembled for cleaning and servicing. To learn more, visit us at www.cypressadaptive.com or call 888/715-8003.

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.

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

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. O&P ALMANAC | AUGUST 2020

MARKETPLACE Fuzion™ — An Alternative to Standard Orthoses

Patients experience greater fit, function, and freedom with Orthomerica’s Fuzion line of custom orthoses. The Fuzion’s design and materials ensure greater patient compliance for a variety of challenging clinical indications. Available for both select adult and pediatric patients. Learn more about Fuzion’s key benefits and read the clinical white papers online at www.orthomerica.com/fuzion.

Introducing 1C53 Taleo Low Profile From Ottobock Ready for everyday life. Designed for your active K3 patients with limited clearance, Taleo Low Profile is the newest carbon fiber foot in our portfolio. Give your patients the same smooth performance you’ve come to expect from the Taleo foot family. They will appreciate the ability to effortlessly navigate various indoor and outdoor environments, wherever life takes them. Benefits of 1C53 Taleo Low Profile: • Low build height for longer residual limbs • Smooth rollover and energy efficient return • Dynamic movement across varying terrain conditions. For more information, visit www.professionals.ottobockus.com or talk to your sales rep.

AUGUST 2020 | O&P ALMANAC

Ottobock Master Technicians at Your Service

At the Ottobock After-Sales Service Center, our mastertrained technicians are here to help with reliable, routine maintenance and high-quality repairs. We also offer the most generous loaner program in the industry so your patients can continue to live their lives safely while their devices are being serviced. Get peace of mind for you and your patients. For help with maintenance or repairs, call us at 800/328-4058.

Made in USA You want: 1) Quality product 2) Made in the USA 3) Veteran-owned company 4) Great customer service (our job is not complete until our product is dispensed, and everyone is satisfied) 5) A quick, reliable turnaround time. We have over 20 years’ experience making custom shoes, inserts, and lower-extremity bracing. We make custom footwear; custom PDAC-approved inserts; functional and accommodative, as well as plastic and metal, AFOs; and leather gauntlets (Sebring brace)—all with a five- to 14-day turnaround (depending on device). Visit us at www.phoenixmolded.com or call us at 863/658-2616.

MARKETPLACE RUSH ROGUE® The RUSH ROGUE® provides the most realistic and dynamic foot and ankle motion available. The Vertical Loading Pylon (VLP) provides comfortable shock relief from high-impact loading while offering +/- 8 degrees of torsion, allowing the user to push the foot and their self to the limits. The foot is RUSH ROGUE made of our advanced fiberglass composite, which is three times more flexible that most conventional prosthetic feet. The roll through characteristics of the foot provide exceptional energy return, with no “dead spot,” allowing users to push themselves to the limits on the court or any terrain. Discover the exciting PROTEOR USA product line today at proteorusa.com. #humanfirst

Spinal Technology Inc.

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

Stabilizer From Surestep The Stabilizer is more than a preventative option for adults experiencing stability and balance issues. It is a solution that restores confidence, proprioception, and function. With the risk of falling greatly reduced, your patients are free to re-engage with day-to-day activities. It features a low-profile cuff as well as a molded inner boot. This prevents skin breakdown and keeps the heel back. And unlike other options, the Stabilizer allows greater sensory feedback by restricting the heel. For more information, contact Surestep at 877/462-0711 or visit Surestep.net.

The Xtern Foot Drop AFO From TurboMed Orthotics This unique ankle-foot orthosis (AFO) was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe. The Xtern is HCPCS code L1951 validated. Turbomed innovative products are now available through distributor partnerships in more than 26 countries. Its unique design and material composition give another meaning to walking and running. There is no limitation with the Xtern for the customers—not even a weight limit! For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the Xtern in less than five minutes. Available in USA from Cascade Supply, SPS, Lakes Medical Innovations, Kevin Orthopedic, and Physio Tech. For more information, visit www.turbomedorthotics.com.

O&P ALMANAC | AUGUST 2020

CALENDAR

September 24–26 (New rescheduled date)

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

September 25–26

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

October 1

APPLY ANYTIME. TEST ANYWHERE. Become a BOC-certified orthotic fitter, www.bocusa.org mastectomy fitter, or durable medical equipment specialist. Exams are offered year-round: in-person at test centers and select conferences and online from the location of your choice with a live, remote proctor! Visit www.bocusa.org/certification/apply.

Cascade Dafo Institute

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

2020 www.AOPAnet.org.

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

September 1

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

September 2

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

September 9–12

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

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 3

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

October 8–10 August 12

WEBINAR

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

AUGUST 2020 | O&P ALMANAC

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

October 9–10

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

October 12–17

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

October 14

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

CALENDAR

October 15–17 (New rescheduled date)

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

November 1

ABC: Application Deadline for Winter CPM Exams. Applications must be received by November 1 for individuals seeking to take the Winter CPM exams. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/ individual-certification.

2021 May 12-14

New York State Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Rivers Casino & Resort, Schenectady, NY. For more information, visit nysaaop.org/meeting.

September 9–12

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

November 1

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

November 4–6

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

November 11 WEBINAR

visit www.AOPAnet.org.

WEBINAR

www.AOPAnet.org.

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

December 9 New Year: New Codes, Fees, and Updates. For more information, visit

2020 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HealthCare Common Procedure Coding System (HCPCS) code changes with an array of 2020 AOPA coding products. Ensure each member of your staff has a 2020 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • 2020 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • 2020 Quick Coders: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

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 2020

STATE BY STATE

Banding Together Updates from Minnesota, New York, and Oregon

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more.

COVID-19 Updates AOPA is maintaining statespecific updates related to the coronavirus disease (COVID-19) on all state pages of the Co-OP. Please visit your state’s page for additional information.

AUGUST 2020 | O&P ALMANAC

AOPA is currently recruiting members that are interested in participating in the AOPA State Reps group for the following states: Connecticut, Colorado, Florida, Idaho, Kansas, Maine, Massachusetts, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oklahoma, Rhode Island, South Dakota, Utah, Vermont, West Virginia, and Wyoming.

Minnesota

The Minnesota O&P prescriber bill that was attached to SF 13 has been signed into law by Governor Tim Walz (D). The law authorizes that prescriptions written for O&P services by advanced practice registered nurses for patients with MN Medicaid are lawful.

New York

AOPA has issued a call to action and is working with the New York State Chapter of the American Academy of Orthotists and Prosthetists to help O&P practices fight for change to the Medicaid fee schedule, which is more than 33 years old. If you are in New York state, please consider taking action on one of the following: • Send information about O&P practices that have closed in the state. • Send information regarding which L codes are poorly reimbursed (or not covered at all) under New York Medicaid impacting your O&P practice.

• Share information about relationships or contacts you or your patients have with New York legislators. • Reach out to local state representatives. Please email awhite@aopanet.org and nysaaop@gmail.com with information, questions, or concerns.

Oregon

Providers in Oregon are requesting a review of the coverage policies for cranial remolding orthoses through the state’s Health Evidence Review Commission. AOPA is assisting with the draft request, which also will address the reimbursement rate for S1040, one of the lowest in the country at $476.19.

Submit Your State News

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

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