April 2017 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

AP R I L 2017

Resolving the Backlogs in Medicare Appeals P.16

Inside the Brand-New Shirley Ryan AbilityLab P.30

Is Your Facility HIPAA-Compliant?

P.36

A German Perspective on O&P Care

Better

Together PARTNERING WITH PATIENTS TO BOLSTER O&P ADVOCACY INITIATIVES P.22

P.44

E! QU IZ M EARN

4

WWW.AOPANET.ORG

BUSINESS CE

CREDITS P.18 & 39

Exclusive: Next Steps for the Proposed Section 427 Rule P.19

YOUR CONNECTION TO

EVERYTHING O&P

Why should you attend?

Educate lawmakers on the issues that are important to YOU:

The Policy Forum is your

BEST OPPORTUNITY

to learn the latest legislative and regulatory details and how they will affect you, your business and your patients.

• Make sure O&P has a place in any new health-care legislation • Ensure O&P has fair representation in any O&P LCDs • Make sure Prior Authorization is administered fairly • Prevent the expansion of off-the-shelf orthoses and competitive bidding

Once you are armed with the facts, we as a profession will educate our members of Congress to offer common sense solutions and share how the O&P profession restores lives and puts people back to work.

Questions regarding registration, travel or the agenda should be directed to Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876. Questions regarding programming, congressional visits or key issues should be directed to Devon Bernard at dbernard@AOPAnet.org or 571/431-0854.

REGISTER TODAY

2017

HOST HOTEL: Ritz Carlton, 1250 South Hayes Street, Arlington, VA 22202 Reserve online at http://www.ritzcarlton.com/en/hotels/washington-dc/ pentagon-city with the code AOIAOIA, or by phone at 1-800241-3333, with the Group Name: AOPA 2017 Policy Forum Reservations must be received by May 2 for AOPA’s rate of $279.

Meet your member of Congress and tell them how, through orthotics and prosthetics:

Visit www.AOPAnet.org to learn more.

7

contents

APR I L 2017 | VOL. 66, NO. 4

PHOTO: Virginia Prosthetics & Orthotics

APRIL 2017 | O&P ALMANAC

22 | Better Together As the nation transitions to a value-based health-care model, the O&P community is ramping up efforts to advocate on behalf of the O&P profession and demonstrate the professionalism of the O&P provider community. Many clinicians and O&P business owners are finding that inviting patients to join them in discussions with legislators and regulators results in more impactful conversations and more productive advocacy efforts.

By Christine Umbrell

19 | This Just In Constructive Comments The January publication of a proposed regulation to implement Section 427 of the Benefits Improvement and Protection Act is a step in the right direction in ensuring only qualified O&P professionals provide prostheses and custom-fabricated orthoses. However, some improvements to the regulation are needed to bring implementation in line with the legislation’s original intent, according to AOPA and other O&P stakeholders.

30 | Role Model PHOTO: Shirley Ryan AbilityLab

2

COVER STORY

FEATURES

Orthotic and prosthetic patients at the new Shirley Ryan AbilityLab in Chicago will experience an innovative model of care and benefit from a team approach to treatment. The facility has been designed to enable clinicians, researchers, and other members of the health-care team to work collaboratively throughout the treatment process, and to allow research to be translated into patient care almost immediately.

By Lia K. Dangelico

contents

SPECIAL SECTION

AOPA’S 100TH ANNIVERSARY AND WORLD CONGRESS PREVIEW

Decades of value in AOPA’s financial benchmarking reports

42 | Bridge to the Future Leveraging new technologies throughout the O&P facility

44 | The Global Professional Q&A with a CEO and clinician from Germany

P.10

PHOTO: Liberating Technologies Inc.

40 | Then & Now

DEPARTMENTS Views From AOPA Leadership......... 4 Insights from AOPA Treasurer Jeff Collins, CPA

AOPA Contacts.......................................... 6 How to reach staff

Numbers......................................................... 8 At-a-glance statistics and data

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

COLUMNS

Research, updates, and industry news

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

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

Dealing With Delays

Transitions in the profession

Addressing the backlogs in Medicare appeals

AOPA News.............................................. 50

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

AOPA meetings, announcements, member benefits, and more

CREDITS

Compliance Corner............................... 36

Help With HIPAA

P.16

Marketplace.............................................. 55

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

Careers......................................................... 57

CREDITS

Professional opportunities

Member Spotlight.................................46 n

Bulldog Tools Inc. Decker Integrated Orthotics & Prosthetics

Welcome New Members ..................54 Ad Index......................................................54

Protecting patients’ private health information

n

PAC Update...............................................52

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

P.36

Ask AOPA.................................................. 60 Labor codes, interest rates, and more

O&P ALMANAC | APRIL 2017

3

VIEWS FROM AOPA LEADERSHIP

How’s Your Performance?

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

E

VERY YEAR, AOPA PUBLISHES the Operating Performance Report, which outlines financial performance results and general industry statistics for the previous year.

The information published is a summary of information collected from a broad base of O&P facilities that provide their individual information via a confidential survey to an outside, third-party firm, Industry Insights, which specializes in these types of industry studies.

If you have not already done so, I encourage you to review the most recent report— it can be especially meaningful during this time of year when we are all closing out the results of the prior year, filing taxes and fine-tuning budgets, and making operating and performance plans for this year. The information in the AOPA report can be used to help assess your results and validate your plans against the benchmarks and industry trends summarized therein.

There are major trends apparent in the Operating Performance Report that are worth noting and considering: • Consolidation in our industry is underway. It’s clear that we have fewer companies representing more facilities.

• Net revenue growth is encouraging. While changes to the Medicare fee schedule for O&P have been meager at best, revenue growth among survey respondents showed an increase of 2.1 percent to 7.3 percent during the same timeframe.

• Productivity is up. It’s no surprise that we’re seeing increases in revenue per practitioner given the consolidation underway and the revenue growth seen in the face of increases in contractual allowances. Outsourcing work to maintain and increase productivity is a natural outlet and likely to continue.

• Financial performance shows strength. Net profit margins dipped between 2011 and 2014, but picked back up in 2015, showing 7.3 percent in the most current report.

These are but a few areas of interest outlined by this valuable report, and should beg the question, “How am I doing in relation to these benchmarks and trends?”

Below are a few suggestions: • Order a copy of the 2016 Operating Performance Report and compare it to those facts and figures you are already poring over to file your taxes. AOPA members receive a discount on this report at www.aopanetonline.org/store.

• Participate in next year’s survey by submitting data before June 15. Each year AOPA sends out an invitation to participate in the Operating Performance Report by contributing your facility information to www.AOPA-survey.com, with a deadline for submission of June 15. Participating AOPA members receive an individual Company Performance Report personalized for their facility, and free access to the Business Optimization Analysis Tool, www.AOPA-BOAT.com, which is a management tool to store your facility’s information, monitor performance trends, and create customized analysis.

Improving performance begins with understanding yours and setting your baseline, comparing it to established benchmarks, identifying areas for improvement, and implementing changes to your operations. Knowing how you are progressing requires ongoing monitoring, and these AOPA tools and resources help do just that.

Jeff Collins, CPA, is treasurer of AOPA’s Board of Directors.

4

APRIL 2017 | O&P ALMANAC

Board of Directors OFFICERS President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL President-Elect James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Vice President Chris Nolan Ottobock North America, Austin, TX Immediate Past President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Edmonds, WA Traci Dralle Fillauer Companies Inc., Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Townsend Design, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

At Renewal, Remember

CAILOR FLEMING

Call first thing

&P O t n bes e pla d Fin uranc ins

r Call Cailo Fleming 495 8

800-796-

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Contact Us Today • 800-796-8495 www.Cailorfleming.com/OandP.asp Orthotics and Prosthetics Program Application 4610 Market Street, PO Box 3989 Youngstown, Ohio 44513

1. Download the O&P Program Application at:

bit.ly/cailorflemingOandP

Policy Effective Date:

I. ACCOUNT INFORMATION 1. Business Name: 2. Mailing Address: 3. City: 5. Contact Name and Phone Number: 7. Coastal State: Yes

No

State:

Zip:

4. Phone: 6. Fax: 8. Number of locations:

(If yes, distance to body of water):

9. Do you have a website? Yes 10. Email address:

No

(If yes, URL):

II. DESCRIPTION OF OPERATIONS 1. FEDERAL TAX ID #: 2.Corporation:Yes 3. Provide a brief description of operations including years in business:

An ENDORSED MEMBER of AOPA

Individual: Yes

No

4. If new venture, please explain your prior experience, how many years, and what position and field this experience is in: 5. Practitioner for Patient Care Certified by ABC or BOC? Yes 6. Any business conducted other than Orthotics & Prosthetics? Yes 7. Current Insurance Carrier:

GENERAL LIABILITY

(If yes, please describe):

Years with carrier:

9. Check off if you are a member of any of the following: AAOP

Pedorthic Footwear Association

Is the facility accredited? Yes

AOPA

Other:

No

III. CLAIMS HISTORY 1. Have you had any losses in the past 3 years? Yes

No

(If yes, please describe below):

Description of Loss

Practitioners trust us most because we know your O&P business and we know insurance unlike any other program.

|

No No

Premium:

8. Prior Insurance Carriers and policy dates:

AOPA’S INSURANCE PROGRAM

PROFESSIONAL LIABILITY

No

Date of Loss

Amount Paid

IV. PLEASE INDICATE ESTIMATED SALES FOR EACH CATEGORY Last Term’s Sales

$ $ $

Retail Sales: Sales/ Revenue includes pre-fab items that you rent/sell to others. Off-the-shelf items that you do not repackage. Includes ‘prefab’ custom fit braces.

$

$

Medical Equipment Repair: Sales/ Revenue of Medical Equipment that is repaired, installed (no retail sales)

$

$

No direct sales to patients.

|

Est. updated sales for current term

$ Manufacturing: Items manufactured by you and sold to others to distribute. There is no patient care for this class $ $ Wholesale Distribution: Includes all items purchased from others that you resell to other facilities.

Practitioner Patient Care: Includes all items fabricated for patients. Custom Products.

PROPERTY

|

2. Fill out the form.

3. Email the form to dfoley@cailorfleming.com Cailor Fleming Insurance will quickly provide your individual program quote.

AUTO

|

UMBRELLA

|

WORKERS COMP & MORE

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

Editorial Management Content Communicators LLC

Our Mission Statement The mission of the American Orthotic & Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation, and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.

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

Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org SPECIAL PROJECTS Ashlie White, MA, manager of projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org

Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org

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

Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org

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

AOPA Bookstore: 571/431-0865

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

6

APRIL 2017 | O&P ALMANAC

Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC 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 landerson@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 © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

COVER PHOTO: AOPA

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac17 for advertising options!

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NUMBERS

U.S. Diabetes Outlook O&P professionals can help educate patients at risk of developing diabetes

As diabetes continues to be called a global health-care epidemic, it is estimated that one in four individuals in the United States do not know they have the disease. Orthotists and prosthetists, as well as other members of the health-care team, should understand the signs and risks associated with diabetes—which in some cases leads to amputation—and learn to educate at-risk patients.

DIABETES

PREDIABETES

COST

86 Million 90 Percent

Percentage who do not know they have prediabetes.

15 to 30 Percent Percentage of those with prediabetes who will develop Type 2 diabetes within five years.

Individuals in the United States who have diabetes.

25 Percent Percentage who are unaware they have diabetes.

AMPUTATION RISKS

$245 Billion

Annual U.S. medical costs and lost work and wages for people with diagnosed diabetes.

2X

Medical costs for people with diabetes are twice as high as for people without diabetes.

Percentage of nontraumatic lower-limb amputations among adults attributed to people with diagnosed diabetes.

Percentage of overall health-care spending in the United States attributed to people with diagnosed diabetes.

“People with prediabetes who take part in a structured

Rates of Diagnosed Diabetes in U.S. by Ethnicity

Non-Hispanic Blacks

13.2%

Hispanics

12.8%

Asian Americans Non-Hispanic Whites

8

APRIL 2017 | O&P ALMANAC

9% 7.6%

SOURCE: American Diabetes Association

15.9%

Number of nontraumatic lower-limb amputations performed in adults with diagnosed diabetes in 2010.

60 Percent

>20 Percent

American Indians/Alaskan Natives

73,000

lifestyle change program can cut their

risk of developing Type 2 diabetes by as much as 58 percent.”

—National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention

SOURCES: “Diabetes at a Glance 2016,” Centers for Disease Control and Prevention; American Diabetes Association.

Number of adults who have prediabetes.

29.1 Million

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Happenings RESEARCH ROUNDUP

Researchers Design Improved Hand-Wrist Prostheses AOPA-Funded Systematic Review Published in Open Access Journal

Worcester Polytechnic Institute researchers Xinming Huang and Edward Clancy

10

APRIL 2017 | O&P ALMANAC

Professor Edward Clancy demonstrates a hand-wrist prosthesis.

A research project led by Edward Clancy and Xinming Huang, professors of electrical and computer engineering at Worcester Polytechnic Institute (WPI), is underway to design hand-wrist prostheses using two degrees of freedom. The goal is to enable the hand and wrist to work simultaneously, instead of one at a time.

Clancy and Huang are using electrical impulses generated by remnant muscles in the forearm to achieve their goal.

The research is funded by a $700,000 subaward from Liberating Technologies Inc. and is aimed, in part, at improving prosthetic options for returning soldiers with amputations who have found it challenging to perform tasks of daily living using traditional onedegree-of-freedom hand-wrist prostheses. The potential users of the devices under development include individuals with congenital limb loss as well as individuals with traumatic amputations. “While this field is relatively small, there has been an increased research effort in recent years, particularly in response to providing better prosthesis options for soldiers returning from Iraq and Afghanistan with upper-limb

amputation injuries,” says Clancy.

The researchers are focusing on how to translate signals picked up from muscle activity in the forearm into appropriate movements of the hand and wrist prostheses. To ensure the device does not become too burdensome or impractical, the researchers are collecting data from as few as four electrodes. The team is developing new algorithms and methods to select optimal locations for the four electrodes; these algorithms will be embedded into a microprocessor within a prototype prosthesis. The researchers are working to develop a more convenient and robust multielectrode clinical prosthesis fitting system that will determine the electrode locations and convert muscle activity into the movement of motors in the prosthesis and hand and wrist components. They also will seek to wirelessly connect the electrodes using embedded low-power integrated circuits and rechargeable batters.

“We want to be able to control two degrees of freedom while making instrumentation that is really tiny and easy to apply,” Clancy says.

PHOTO: Top—Liberating Technologies Inc.; Bottom left—Worcester Polytechnic Institute

A review titled “Outcomes of Dysvascular Partial Foot Amputation and How These Compare to Transtibial Amputation: A Michael Dillon, PhD Systematic Review for the Development of Shared Decision-Making Resources” has been accepted and published to the peer-reviewed, open access journal Systematic Reviews on the BioMed Central database. The review, led by Michael Dillon, PhD, of LaTrobe University, was funded

by AOPA via the association’s 2015 request for proposals for systematic reviews. Visit BioMed Central to see the article in published form.

HAPPENINGS

TECH TRENDS

VA Builds 3-D Printing Network

PHOTO: Getty Images/Suljo

The U.S. Department of Veterans Affairs’ (VA’s) Veterans Health Administration has partnered with Stratasys, a 3-D printer manufacturer with headquarters in Israel and the Minneapolis area, to build a nationwide 3-D printing network.

Stratasys recently donated five printers, bringing the VA’s total to 12 printers, with plans to expand the network.

To build the network, the VA is identifying 3-D printing experts throughout its medical centers to locate specialists for different types of devices.

Past uses of 3-D printing at the VA include creating models used by surgeons to practice before a surgery and printing custom surgical tools and assistive devices that help veterans with physical mobility and motor functions.

But much of that work has taken place in siloes, says Beth Ripley, MD, an attending radiologist at VA Medical Center Puget Sound in Seattle who is leading the creation of the network.

“What we realized is we have a lot of great talent throughout the VA, and we want to be able to share that more seamlessly across the network,” Ripley says. “The question was, how do we link up personnel throughout the VA, and how do we link up printers to provide better care for veterans?”

The network will be designed to identify experts in specific kinds of 3-D printing, such as orthotics or surgical tools, and route design requests through those specific medical centers. The goal is to foster greater communication and interaction to inspire cross-pollination of knowledge sharing, and to ensure use of the 3-D printers is optimized.

While the VA isn't yet using 3-D printers to create prostheses, the new network is expected to help the VA move in that direction, Ripley says. The network is a part of the VA’s Center for Innovation, which identifies new approaches to care.

CODING CORNER

Claim Denial Rates 74%

L0648

84%

L0650

Noridian Releases Prepayment Review Results Noridian, the Jurisdiction D durable medical equipment Medicare administrative contractor, has released quarterly results of its review for claims involving the Health-Care Common Procedure Coding System codes L0648 and L0650.

Between October 2016 and January 2017, Noridian reviewed 383 claims for L0648 and 853 claims for L0650. The claim denial rate for L0648 was 74 percent, and the

claim denial rate for L0650 was 84 percent.

The top three denial reasons were listed as 1) documentation does not support coverage criteria; 2) documentation was not submitted in response to the additional documentation request; and 3) claim is same or similar to another claim on file.

Based on the high denial/error rates, Noridian will continue with prepayment reviews for L0648 and L0650.

O&P ALMANAC | APRIL 2017

11

HAPPENINGS

O&P AWARENESS

O&P ATHLETICS

O&P Community Celebrates Limb Loss Awareness Month

Plans Underway for 2018 Winter Paralympics

The month of April has been designated as National Limb Loss Awareness Month by the Amputee Coalition. The organization has several events planned for the month, including securing 42 state proclamations and federal recognition of the month, celebrating Show Your Mettle Day, and organizing Hill Day April 25-26.

The goal of the month-long awareness is to celebrate the limb loss community as a whole, and to shine a spotlight on the issues and accomplishments of the limb loss and limb difference community.

The Amputee Coalition has invited both amputees and their family members to visit amputee-coalition.org; consider speaking out to civics groups, churches, city business associations, and

The next Winter Paralympic Games will take place in less than a year, March 9-18, 2018, in PyeongChang, South Korea. The Games are expected to feature up to 670 athletes in 80 medal events across six sports: alpine skiing, biathlon, cross country skiing, ice hockey, snowboarding, and wheelchair curling.

The United States will enter the Games as the defending champion in sled hockey, having won Gold medals at Sochi 2014 and in Vancouver 2010. Participants in the various sports will take part in qualifying competitions to earn spots on Team USA. As part of hosting the Games, the PyeongChang 2018 Organizing Committee has launched “Actualizing the Dream,” a project aimed at promoting Paralympic winter sports and securing the social inclusion of people with disabilities. An Asiatic black bear named “Bandabi”—a symbol of strong will and courage—has been selected as the mascot of the 2018 Paralympics.

12

APRIL 2017 | O&P ALMANAC

THE LIGHTER SIDE

IMAGES: wikipedia.org/Fair use

Bandabi, mascot of the PyeongChang 2018 Paralympic Winter Games

schools to educate others about limb loss; and participate in planned activities toward the end of the month.

During Hill Day, attendees will travel to Washington, D.C., and take part in education sessions designed to prepare them for visits with legislators and their aides the following day. Topics of discussion will include the Insurance Fairness for Amputees Act, the potential repeal and replacement of the Affordable Care Act, and more transparency and accountability in the development of Local Coverage Determinations.

On April 29, individuals with limb loss will be asked to “Show Your Mettle” by sharing photos under the #SHOW YOUR METTLE hashtag. Visit the Amputee Coalition website for details.

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PEOPLE & PLACES BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Wright & Filippis along with its partner Carolina Orthotics & Prosthetics, announced the acquisition of the Greenville, South Carolina, operations of Ability Prosthetics & Orthotics Inc. Ability P&O has several locations in Pennsylvania, Maryland, and North Carolina, but was only operating one location in South Carolina. Nikki Hooks, CO, who specializes in pediatric Orthotics, will remain in practice, so patients should see no interruption of service.

Ability Prosthetics & Orthotics also has opened a patientcare center in Rockville, Maryland. Tyler Manee, CPO, is the lead practitioner.

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) has announced its contribution to a new nonprofit group and the establishment of a state-of-the-art center for O&P excellence. The Orthotics and Prosthetics International Institute Foundation Inc. has announced plans to open the International Institute of Orthotics & Prosthetics (IIOP) in Tampa, Florida, in 2017.

The Institute will offer several O&P activities with the mission of improving lives of veterans, their families, and patients through education, training, research, and collaboration worldwide. The Institute will offer office and conference space for the Florida International University’s O&P master’s program as well as services for O&P education, veterans’ rehabilitation, amputee counseling, and peer programs, along with community health services for mind and body wellness.

The Institute will work with O&P researchers, clinicians, statisticians, patients, and manufacturers to develop O&P outcome measures for use throughout the profession.

These efforts will include working with researchers seeking grants for O&P research and innovation.

Create O&P and Vorum have announced a new 3-D printing solution for North American providers of custom prosthetic devices. Create O&P now offers Vorum’s Canfit™ 3-D O&P Design software as part of its latest printing system package.

The new CAD/CAM package is designed to enable clinicians to scan, modify, and manufacture devices digitally, in their clinic.

Ottobock HealthCare has announced a collaboration with Integrum involving the company’s osseointegration products and Ottobock’s devices. The U.S. Food and Drug Administration (FDA) has approved the OPRA (Osseoanchored Prostheses for the Rehabilitation of Amputees) Implant System from Integrum AB for use in the United States. Ottobock is 14

APRIL 2017 | O&P ALMANAC

partnering with Integrum for distribution of prosthetic connection elements, specifically the OPRA Axor II connectors, related to Integrum’s OPRA implant system.

The OPRA implant system has been designed to help improve the quality of life for amputees without the need for a traditional limb socket. During osseointegration, an anchoring fixture is implanted in the patient’s bone. The prosthesis can then be attached to the fixture via the OPRA Axor II adapter.

Ottobock HealthCare also has acquired Bostonbased BionX Medical Technologies Inc. (BionX), which produces an active prosthetic foot and ankle solution that replaces the function of the muscles and tendons with an actively driven ankle joint and supports the user by supplying additional energy while walking. Ottobock continues to expand its portfolio of mechatronic prosthetic feet with the acquisition.

PEOPLE IN MEMORIAM

Robert C. Manfredi Sr., CPO, CPed Robert C. Manfredi Sr., CPO, CPed, of Rumson, New Jersey, passed away March 16, 2017, at the age of 79. Manfredi was born in New York and lived in the Vailsburg section of Newark, New Jersey, before moving to Monmouth County in 1958. He also maintained a home in the Florida Keys.

Manfredi was a graduate of the New York University prosthetics and orthotics program. He founded Manfredi Surgical and Orthopedics in Long Branch, New Jersey, in 1958 and remained its owner until 2003. He served as one of several ambassadors to China representing AOPA when the country was seeking to improve its medical techniques.

Manfredi served as chairman of the New Jersey Board for Licensure in Orthotics and Prosthetics, and the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. He served on the AOPA Board of Directors from 1993 until 1996. He also served as a member of the board of directors of the Orthotic & Prosthetic Assistance Fund, served as president of the United Cerebral Palsy of Monmouth and Ocean Counties, and was a member of the Long Branch Lions Club. He also served in the U.S. Navy Reserves.

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REIMBURSEMENT PAGE

By DEVON BERNARD

Dealing With Delays Proposals and strategies to address the backlogs in the Medicare appeals process

By DEVON BERNARD

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T

HE O&P COMMUNITY IS well aware of the delays and issues facing the Medicare appeals process, but not everyone knows what Medicare is doing to address the issue. This month’s Reimbursement Page looks at some of the strategies and steps being taken

by CMS and the U.S. Department of Health and Human Services (HHS) to help alleviate and eliminate the delays in the appeals process—especially the backlog at the third level of appeals, the administrative law judge (ALJ) level.

To address the issue of the ever-increasing number of appeals, and the current backlog of appeals to be reviewed, HHS and CMS have adopted three strategies.

First, the agencies are requesting and investing in new resources at all levels of appeal to increase adjudication capacity and implement new 16

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PHOTO: Getty Images/phototechno

Three-Pronged Approach

strategies to alleviate the current backlog. For example, the FY 2017 budget presented by the Office of Medicare Hearing and Appeals (OMHA) requested additional funding for the purpose of creating five new field offices. The number of offices has already increased from four to six during the last two years, and new administrative law judges have been added, with the goal of increasing the ALJs’ adjudication capacity to 120,000 appeals annually.

The estimated current adjudication capacity is 92,000 appeals annually, or roughly 1,000 appeals per ALJ. Second, the agencies are taking administrative actions to reduce the number of pending appeals and implement new strategies to alleviate the current backlog and encourage resolution of appeals earlier in the process.

This would include some of the recent

REIMBURSEMENT PAGE

changes to the recovery audit program and the introduction and use of prior authorization. Another example of this strategy is the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Discussion Demonstration project, currently underway in Jurisdictions C and D. The demonstration project allows providers and suppliers to interact directly with the medical review staff, via telephone, regarding the qualified independent contractor (QIC) handling the second level of appeals in an attempt to resolve the issues that caused the claim to be previously denied. The project allows the supplier/provider to submit additional documentation and possibly receive some guidance on CMS policies and requirements. Preliminary results indicate the demonstration project is proving successful, with a denial overturn rate of close to 86 percent, resulting in fewer claims being escalated to the next level of appeal.

Third, the agencies are proposing legislative reforms that provide additional funding and new authorities to address the volume of appeals. Some examples of this approach are outlined in OMHA’s FY 2017 budget, but it is important to note that none of the following examples are currently in play or in the works—they are merely recommendations OMHA is making in its budget requests to Congress.

One recommendation is to establish a refundable appeal filing fee per claim per level of appeal. OMHA also has suggested increasing the amount in controversy (AIC), or monetary threshold required to file an appeal, to be equal for both the ALJ level and the judicial review level. This would, in essence, increase the AIC for the ALJ.

January 2017 Final Rule

Since HHS and CMS are attempting to put the strategies outlined above into action, it’s a good time to review the overall appeals process and Medicare’s most recent step in attempting to reduce or eliminate the appeals backlog.

In January 2017, CMS published a final rule titled “Medicare Program:

decision. The review will be handled by a QIC; the current QIC is C2C Solutions Inc. Reconsideration is your last opportunity to provide any new evidence or documentation to support your claim.

• Administrative law judge. The ALJs will perform an independent review/hearing of a claim based only upon the information that has been submitted during prior levels of appeal. An ALJ hearing request must be made in writing and within 60 days of the receipt of the reconsideration decision, and you must meet a minimum AIC threshold. The AIC for 2017 is $160.

Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures.”

Before analyzing the changes made by the final rule, let’s quickly review the appeals process.

The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) and the Medicare Modernization Act of 2003 (MMA) provided the original blueprints for the current Medicare appeals process, including the five levels and the timeframes for filing appeals, which are outlined below: • Redetermination. You have 120 days from receipt of a claim determination to file an appeal.

The appeal will be reviewed by the durable medical equipment Medicare administrative contractor (DME MAC) that initially processed/denied claim, but by someone other than the person who made the initial determination. You may submit new evidence or documentation that was not present during the initial review.

• Reconsideration. All reconsideration requests must be made in writing and within 180 days of receipt of the redetermination

• Departmental appeals board (DAB). A request for review by the DAB—also known as a Medicare Appeals Council (MAC)—must be made within 60 days of receipt of the ALJ decision. The DAB will review only the information present in the administrative record (the information that was presented to the ALJ), and will review only the issues addressed in the decision of the ALJ with which you disagree.

The results of a DAB/MAC review are published and made public.

• Judicial review. This level of appeal involves filing a civil lawsuit, within 60 days of receiving the DAB’s decision, against the Medicare program in federal court; an AIC of $1,560 must be met.

The final rule published in January, which was scheduled to take effect March 20, 2017, mainly makes changes at the ALJ level and above. All appeals filed on or after March 20, 2017, and appeals that were filed, but not decided, dismissed, or remanded, prior to March 20, 2017, will be subject to the changes outlined in the final rule—with some exceptions. A lot of the changes in the final rule are minor, such as clerical modifications; however, there are two major changes that should be noted.

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First, the rule allows certain decisions/ verdicts from the DAB/MAC to become binding or precedential for future determinations, redeterminations, reconsiderations, and ALJ hearings.

Not all DAB/MAC decisions will become binding—only those that have been selected by the DAB/MAC chair. Those selected by the chair must “address, resolve, or clarify recurring legal issues, rules, or policies; or decisions that may have broad application or impact, or involve issues of public interest.” The selected precedents will be made public and will be published in the Federal Register and on a website created by HHS. Previously, the DAB/MAC did publish some results on a website, but the results were only binding on the appeal at hand. This meant that you could not use a published decision in your argument even if your case was almost identical to the one published.

This change is intended to provide a consistent set of appeal decisions, to help you determine if an appeal should be filed, and to increase the consistency of the decision making in the appeals process.

Second, OMHA will begin to use attorney adjudicators—licensed attorneys who know and understand Medicare coverage and payment laws and guidance—to help reduce the ALJs’ workload. The attorney adjudicators will handle items or requests that do not

APRIL 2017 | O&P ALMANAC

of circumstances. For example, if you were unable to obtain the evidence/ materials/documentation before C2C made its final decision, and you are able to provide evidence that shows you made reasonable attempts to obtain the evidence/materials/documentation before the C2C decision was made, then you may be able to submit new evidence at the ALJ level.

For a more detailed review of the final rule, visit http://bit.ly/appealssummary.

It may seem that there is no end to the ALJ backlog, but there is light at the end of the tunnel. Medicare is taking steps to address the problems, and AOPA will continue to work with CMS and all other interested parties to ensure the backlog is resolved fairly.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org.

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require a hearing. This would include handling dismissals of appeals when an appellant withdraws a request for an ALJ hearing. Another example would be if an appellant waives his or her right to a hearing, but is still appealing a claim denial and requesting an on-the-record review. In other words, the attorney adjudicators are doing some of the grunt work that takes the ALJs away from conducting hearings and reducing the appeals backlog. HHS estimates that the use of attorney adjudicators could remove almost 24,000 appeals annually from the workload of the ALJs. Note that if your appeal is handled by an attorney adjudicator and you are not satisfied with the results, appeal rights continue to be available.

The final rule also makes some administrative and procedural changes to the appeals process, with the idea of simplifying certain proceedings and enhancing efficiencies. One of these changes relates to the ability to submit new evidence at the ALJ level.

As demonstrated above, typically you may not submit any new materials after the reconsideration level of appeal, unless you can show “good cause” for why the information was not included prior to the reconsideration level. The final rule states that “good cause” will be determined by the ALJ or an attorney adjudicator, using a defined set

This Just In

This Just In

Constructive Comments O&P stakeholders view the proposed regulation regarding Section 427 as a good first step—with room for improvement

J

UST 17 YEARS AFTER Congress passed the Benefits Improvement and Protection Act (BIPA), which included Section 427 prohibiting Medicare from making payments to unqualified O&P providers (unlicensed or unaccredited), CMS issued on Jan. 12, 2017, a proposed regulation implementing its provisions as they apply to providers of prosthetics and custom orthotics.

Wow, finally! By and large, it’s a good news story as the proposed regulation further separates O&P from durable medical equipment and gives additional credence to the unique qualifications and training that O&P professionals possess, and which the proposed rule recognizes as being critically important to quality patient care. It also further acknowledges O&P providers as having an indispensable role in the allied health team for O&P services.

In part, the proposal responds to the continued effort by AOPA, the AOPA Policy Forum, and the AOPA-inspired letter of April 15, 2013, signed by 35 members of Congress urging CMS action on implementing BIPA 427 provisions. That letter was the direct result of AOPA members educating their legislators during the Policy Forum on the importance of BIPA 427 in combatting waste and fraud by paying only qualified providers.

Bloomberg BNA cited the congressional letter as one of the actions that reportedly convinced CMS to act.

The hundreds of letters sent by AOPA members seeking passage of provisions in the Medicare Orthotics and Prosthetics Improvement Act, most recently S. 829 and H.R. 1530 in the 114th Congress, also helped convince CMS to issue the proposal.

AOPA and members of the O&P Alliance filed comments by the March 13, 2017, deadline. In their comments, all of the organizations commended CMS on issuing the proposal but pointed out several changes and clarifications that are needed to improve the proposed regulation.

AOPA’s comments stated the following: “AOPA believes the publication of the proposed rule is the long-awaited first step toward accomplishing the statutory goal of BIPA Section 427 to ensure that only qualified providers and suppliers provide prostheses and custom-fabricated orthoses to Medicare beneficiaries.

“We propose that the final rule should include exemptions that would bring the implementation of Section 427 of BIPA in line with the legislation’s intent while still operating within the framework of the proposed rule.”

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This Just In

A key concern addressed by AOPA is the enforcement mechanism. The statute clearly states Medicare should not pay unlicensed and unaccredited parties. The rule ignores this provision and instead focuses only on revocation of Medicare privileges “after Medicare has improperly paid.”

The statute’s intent was to prevent improper payment in the first place.

AOPA’s statement recommended that CMS require qualified practitioners to submit their individual national provider identifier (NPI) number when submitting a claim. The NPI number, along with a supplier number, should be identified as a condition of payment, which would be a better method of enforcement than revocation of a supplier’s billing privileges.

The proposal also is unclear as to the requirement for equivalency to the standards from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, or the Board of Certification/Accreditation, for deemed accrediting organizations.

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In addition, a modification is needed to distinguish between standalone central fabrication facilities where no patient care is provided and fabrication that occurs within a patient-care facility.

Early legislation exempted those professionals identified as “qualified practitioners” from mandatory accreditation. AOPA’s comments support the continued ability of recognized

health-care professionals operating within their specific scope of practice to remain exempt from compliance with mandatory facility accreditation.

Another concern is the absence of flexibility in accommodating alternative techniques for custom fabrication; AOPA recommended that the final rule acknowledge current technology that is rapidly advancing to commercial application such as additive manufacturing, also known as 3-D printing.

AOPA’s comments were carefully developed using a subcommittee of the AOPA Board of Directors, consisting of one supplier and three patient-care facility representatives. AOPA sought the broad input of members through a survey sent to the entire membership, and these comments were reviewed

by AOPA members and staff involved in writing the AOPA comments. The final comments were then reviewed by the full AOPA Board of Directors and unanimously approved.

To review the final statement submitted to CMS, visit bit.ly/bipacomments.

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COVER STORY

TOGETHER O&P PROFESSIONALS PARTNER WITH PATIENTS IN ADVOCACY EFFORTS TO SEND IMPACTFUL MESSAGES TO LEGISLATORS AND REGULATORS

By CHRISTINE UMBRELL

NEED TO KNOW

3 O&P facilities across the country are engaging in campaigns to explain the value of O&P intervention and to promote a fair reimbursement environment for qualified providers. More and more are doing so by involving patients in these efforts.

3 Including patients in outreach efforts brings awareness to issues by highlighting the unique challenges amputees face and demonstrates to policy makers why O&P intervention is an essential benefit to patients.

3 Legislators cannot be expected to be experts on O&P. Team efforts to educate members of Congress can help draw attention to the value of appropriate O&P intervention while ensuring that the potential impact on amputees is part of the discussion when new rules and regulations are considered.

3 Joining forces with patients in advocacy efforts also demonstrates to O&P consumers that their facilities are focused on their best interests, and that their clinicians are willing to go “above and beyond simply treating them,� says J. Douglas Call, CP.

3 Identifying patients who may be potential partners in advocacy efforts begins by ensuring all patients are aware of recent legislative and reimbursement trends that may affect the limb loss community. Clinicians should approach individual patients who are likely candidates with care and reiterate that participation is voluntary.

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COVER STORY

M

ANY SUCCESSFUL ORTHOTISTS AND PROSTHETISTS already

recognize the value of “partnership” in O&P patient care—optimal results are achieved when O&P clinicians work together with patients to define goals and formulate a treatment plan. But some may not realize that the clinician-patient partnership can extend beyond the clinical arena to O&P advocacy initiatives.

PHOTO: AOPA

“Involving patients in outreach efforts brings awareness to the issue by highlighting the unique challenges amputees face,” says J. Douglas Call, CP, president, Virginia Prosthetics & Orthotics Inc., in Roanoke, Virginia. It also “broadens the J. Douglas outreach’s appeal, turning it into more of a Call, CP human interest story that can, potentially, affect a large percentage of the population, as opposed to it strictly being a business or health-care-related story that impacts or interests the O&P industry primarily,” adds Call.

Teri Kuffel, Esq., vice president of Arise Orthotics & Prosthetics Inc., says it’s important to involve patients in advocacy efforts because the end goal is about them. “Whether it be restoring mobility or enabling them to work or simply providing Teri Kuffel, Esq. support where there wasn't any, it remains about them,” says Kuffel. “Involving patients in advocacy efforts is invaluable to our profession as it helps policy makers see and hear the stories of why what we do is truly an essential benefit to our patients.”

While working side-by-side with patients has many benefits, it’s important that the appropriate person and the appropriate voice are used, says Jack Richmond, president and chief executive officer of the Amputee Jack Richmond Coalition. There is a time and a place for joint advocacy—but it also is important to have a strong, independent patient voice and a strong, independent professional voice. Learning how and when to partner with patients successfully can lead to more productive advocacy efforts and more impactful discussions with legislators and regulators.

O&P ALMANAC | APRIL 2017

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COVER STORY

The Patient Perspective Denise Hoffmann, a mother of three who lost her leg in college, has traveled on PHOTO: Teri Kuffel, Courtesy of Arise O&P

several occasions to share her story and support the O&P message being communicated by Jim Weber, MBA, president and chief executive officer of Prosthetic & Orthotic Care of St. Louis.

The first time Hoffmann traveled with Weber, she did it “because I was asked.”

Since then, she has continued to take part in O&P advocacy efforts—including the rally at the U.S. Health & Human Services building in August of 2015 and several AOPA Policy Forum congressional visits—because “I feel honored” to take part, she says.

A nurse married to a family physician, Hoffmann has always been heavily involved in patient care. But before joining Weber in advocacy efforts, “the policy side was foreign to me.” After becoming involved in these initiatives, “it’s been educational to learn who makes the decisions, and how the policies are made, and what we can do to try to make a change if there’s a bad policy,” she says.

Legislators and aides have always been cordial and welcoming, says Hoffmann. And she believes that her voice, as an O&P patient, tells a critical story. “Having me there totally makes a difference,” she says. “Legislators seem more concerned and really listen when they know you’re talking about something that personally affects your life. Putting a face to an issue, and telling a personal story, shows them first-hand how an issue really does have an effect on individuals.”

Joint Efforts

As the United States transitions to a value-based health-care model, it has become increasingly important to advocate on behalf of the O&P profession and demonstrate the professionalism of the O&P provider community. O&P facilities across the country are engaging in campaigns to explain the value of O&P intervention and to promote a fair reimbursement environment for qualified providers. More and more are doing so by involving patients in these efforts.

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Patients can be involved in a variety of advocacy initiatives—for example, they can write letters and emails to legislators; join O&P facilities during lawmaker visits; participate in rallies targeted to specific issues; and attend in-person meetings on Capitol Hill, such as the AOPA Policy Forum or Amputee Coalition’s Hill Day. It’s important to note that neither clinicians nor patients need to be professional-level lobbyists for these activities to be successful,

says Kuffel. “Communicating to others and educating them with regard to what matters in our patients’ lives is what is key.”

For the past several years, Kuffel and her staff at Arise O&P have invited patients to attend the annual AOPA Policy Forum, and they will do so again next month. At the Policy Forum, “O&P professionals from across the states meet with legislators and their staff, and we communicate with a purpose to educate,” Kuffel says. “We give voice to our patients’ stories, and we ask for help so we can continue to serve them to the best of our ability.”

Jim Weber, MBA, and AOPA president-elect, also believes that when O&P professionals advocate for better services Jim Weber, and coverage for their MBA patients, there’s no one better to represent the profession than the O&P patients themselves. Weber, who is president and chief executive officer of Prosthetic & Orthotic Care in St. Louis, says that patients today are more willing than ever to help advocate for O&P efforts.

“The 2015 proposed LCD [a proposal for substantial modifications to the Local Coverage of Determination on lower-limb prosthetics, which would have negatively impacted amputees] really motivated the patient community across the country,” he says. “It brought patients together in a way that hadn’t been done before.”

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COVER STORY

O&P Advocacy Resources AOPA offers several tools to assist O&P clinicians and business owners in advocacy efforts:

• Visit AOPAvotes.org for the most current “Send a Letter” campaign.

• Look for "The AOPA Co-OP," a new members-only benefit that will launch during the Policy Forum, which will feature information about current regional and state-specific issues facing O&P providers.

• Join the AOPA Google+ Community to share information and engage in conversations.

The Amputee Coalition also offers several resources geared toward individuals with limb loss that may be helpful in preparing for advocacy and educational initiatives, including “webinars, tools, and educational materials to help people understand insur-

Both staff members and patients from Powell O&P traveled from Richmond, Virginia, to take part in the rally at the U.S. Health and Human Services building in August 2015.

In fact, the proposed LCD prompted many facilities to invite patients to attend an AOPA-sponsored rally at the U.S. Health & Human Services building in August of 2015.

One such facility was Powell O&P, based in Richmond, Virginia. Christy Pratt, the facility’s marketing and office manager, led the facility’s effort to galvanize patients. Before the rally, she sent a mass mailing to prosthetic patients explaining the issue at hand, and patients readily volunteered to be part of the demonstration. “Patients know these LCD changes would limit prosthetic components, such as microprocessor knees and gel liners, and this would affect their lives, and many others’ quality of life as they

PHOTO: Powell O&P

• Visit www.aopanet.org, and access the legislative/ regulatory section of the site for information about all ongoing advocacy efforts.

know it. As many patients have put it, ‘Legs are not a luxury,’” says Pratt.

Including patients in the trip was important because “it’s more meaningful when patients are with you telling their stories.”

Call has asked patients to accompany him in local legislative efforts as well. “When Virginia’s General Assembly was considering passage of a mandate to provide insurance coverage for prostheses, we organized a rally at our headquarters involving numerous amputees and arranged for them to be interviewed by local media outlets,” says Call. “We then provided charter bus transportation to the state capital where amputees testified before their legislators.”

ance and how to be an advocate,” says Jack Richmond, president and chief executive officer of the Amputee Coalition. “I recommend they call and request our Insurance and Reimbursement Guide as a In addition, visit amplifyyourself. org, an ongoing advocacy project from the Amputee Coalition, in which AOPA is an active participant.

Virginia Prosthetics & Orthotics provided charter bus transportation to the state capital when Virginia's General Assembly was considering passage of a mandate to provide insurance coverage for prostheses.

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PHOTO: Virginia Prosthetics & Orthotics

starting point,” he says.

COVER STORY

Team efforts to educate legislators at all levels of government can help draw attention to the value of appropriate O&P intervention, says Kuffel—especially because very few lawmakers have direct familiarity with limb loss and limb impairment. “Our legislators need to be educated. In order for them to support our needs, they need to understand what they are and why they are important to us.

Educating them in what concerns our patients most is critical to effective advocacy,” she says.

“Given the wide range of issues they are confronted with daily, legislators can’t be expected to be experts on every subject and how their decisions may affect others. By Virginia Prosthetics & Orthotics serving as a patient advocate, we help legislators understand the issues confronting amputees and, at the same time, help protect our patients’ interests,” says Call. “Amputees represent a small portion of the population, and their needs and rights are often overlooked when it comes to formulating insurance coverage and legislative protections. Patient advocacy helps ensure that the potential impact on amputees is part of the discussion.”

Discussions of the value of O&P intervention from both clinicians and patients can be helpful during meetings with lawmakers, says Weber. “Sometimes we are restricted in the technology we are able to fit on a patient. Patients’ heartfelt explanations of why these restrictions negatively impact their lives can send a strong message.”

Forging Powerful Partnerships

PHOTOS: Teri Kuffel, Courtesy of Arise O&P

When the O&P community embraces an issue and takes part in advocacy efforts at the local or national level, both practitioners and patients stand to benefit if they work together, says Richmond. But it’s important, he says, to determine the roles of each voice for different initiatives and how messages are best communicated. It’s more powerful when professionals and patients speak from their own perspective, addressing the issues that they care about in their own words.

Tips for Patient Advocates Visiting Washington, D.C. Navigating Capitol Hill can be a challenge for anyone who has never been there—and it can be especially daunting for individuals with limb loss or limb difference. During a recent webinar preparing Amputee Coalition members for the organization’s Hill Day event, Aaron Holm, a bilateral above-knee amputee who has visited Washington, D.C., several times to advocate on behalf of the Amputee Coalition, offered the following tips to help make patients’ visits both successful and effective.

If patient advocates are flying into town, encourage them to wear shorts, a skirt, or pants that are easy to roll up, so it is obvious to airport TSA agents or Capitol Hill security that these individuals are missing a limb or have limb difference, says Holm. This should help security checks go a little smoother.

Warn patient advocates that Capitol “Hill” literally is situated on a hill, with a lot of steps to maneuver. Look for accessible entryways if necessary, and bring assistive devices, if needed, for long periods of walking or standing.

Pack light for congressional visits. Advise patients that they will be subjected to standard security screenings to enter federal buildings; bags will be searched and visitors will go through metal detectors and likely be “wanded.”

Tell patients advocates they should not be intimidated by Capitol Hill or their legislators. You don’t have to understand all government workings or be an experienced lobbyist to share your story or message. “We’re not lobbying as much as educating,” says Holm.

Most importantly, encourage patients to “bring their stories.”

Holm believes patient visits are most effective when these individuals share their life experiences, including insurance coverage challenges or positive stories about how specific prosthetic care or devices have changed their life for the better.

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Partnering With Patients for Facility PR Efforts O&P facilities’ public relations efforts are another area where patient involvement can make an impact If a few patients are on board with assisting in your facility’s outreach efforts, it can be a good idea to ask them to be “on call” if media events occur, says J. Douglas Call, CP, president, Virginia Prosthetics & Orthotics Inc. “On a local and ongoing basis, we work with and have patients available to our local media for interviews related to news stories we’ve pitched on a variety of subjects, including new products, human interest, our international medical mission, and legislative issues impacting amputees,” says Call.

Christy Pratt, marketing and office manager at Powell O&P in Richmond, Virginia, leads several efforts to market the facility to referral sources and prospective patients.

“By including patients in our public relations (PR) efforts, Christy Pratt

we can improve our bottom line and profitability,” she says.

Powell O&P has allocated a significant portion of its PR budget toward physician-based marketing strategies and tactics. The facility recently stepped up its efforts to attract trauma patients and determined the most effective strategy was through creating videos of successful patient-care stories.

Powell O&P recently hired Michelle Francis, a registered nurse and a hip disarticulation amputee, to assist with these marketing efforts. Her involvement “makes a big impact” in marketing efforts, says Pratt. Once the videos are complete, Pratt will pass them along to doctors, other referral sources, and the general public through electronic media such as the facility’s website, social media, and email. The videos also will be featured at in-services, where

Michelle Francis

the “more meaningful message from patients” will be shared with doctors who attend the educational sessions.

Pratt says the hiring of Francis, and the facility’s recent focus on referral sources, have led to an increase in the number of new prosthetic patients at Powell O&P. “More people are coming in having heard of us by word-of-mouth, because they hear we have great patient care, prosthetists, and support services, and that we advocate for our patients.”

Facilities that are seeking to increase patient involvement in PR efforts what you want to get out of the experience,” says Pratt. “Have a plan for how their involvement can help take your business to the next level.”

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PHOTOS: Powell O&P

should start by “thinking about how you want to involve patients, and

For example, delays in reimbursement caused by prolonged approvals, paperwork, and a long appeals process, may end up using more clinicians’ time at their facilities to navigate the challenging reimbursement network to ultimately receive payment. This is an area where clinicians should take the lead in efforts to advocate for a speedier appeals process and less cumbersome reimbursement climate.

For patients it is “about the challenges of functioning without a working prosthesis and delays in care.

This could mean extremes like using a wheelchair or crutches, which severely limits independence and mobility,” says Richmond. Delays “impact outcomes and rehabilitation times, and suboptimal or unfamiliar devices could lead to injury or a fall for the patient— delays in the process hurt people with limb loss.”

In discussions regarding access to care, on the other hand, it may be more appropriate for people with limb loss to take the lead, Richmond says. “When someone faces denials or lengthy appeals, or sees a cap or restriction on their prosthetic coverage, that can mean the difference between someone getting the care they need, paying substantial out-of-pocket costs, or not being able to reach their full potential,” he says. While such situations can be difficult for clinicians, “this is where the patient voice can shine through because patients can share their story about the impact coverage limitations have on them,” Richmond says.

Identifying patients who may be potential partners in advocacy efforts begins with making sure all patients are aware of recent legislative and reimbursement trends that may affect the limb loss community.

“Educating our patients about the challenges and policies that affect the care they receive in our facilities, denials for coverage from insurance companies, regulatory challenges or reimbursement-related obstacles, empowers them to advocate for themselves,” says Ashlie White, manager of projects for AOPA and a former

COVER STORY

clinical studies on the devices’ efficacy and ready to explain how they help patients return to activities of daily living. That clinician also may invite a patient to discuss his or her experience—and the patient can explain how he or she has used an elevated vacuum suspension system and why that system has helped him or her maintain or improve his or her quality of life.

A More Inclusive Strategy

PHOTO: Powell O&P

director of operations for an O&P company. “Informed patients are their own best advocates.”

“Keep your patients involved between appointments,” so they understand the greater O&P climate in the region and in the country, says Weber.

He suggests encouraging participation in peer support groups and other activities. “As a company, you have to commit to seeing beyond your practice. It’s your responsibility to help connect patients.”

O&P clinicians also should clearly explain any coverage issues that arise during appointments with individual patients, so they understand why denials or caps are occurring. “At times in the past, practitioners [may] have been reluctant to have conversations with patients about how their insurance does not cover something they feel is clinically appropriate care,” says Richmond. Clinicians can discuss not only how patients can support an appeal of insurance denials but also how patient advocacy can play a part in affecting reimbursement decisions at a policy level. He also advises patients to connect with the Amputee Coalition to learn how to talk about these issues and ways they can advocate for themselves, including using tools like Amplify Yourself (an insurance advocacy and policy tool), attending educational events and support groups,

and connecting with local certified peer visitors.

If there is a particular patient who may be a likely candidate for assisting with an advocacy initiative, “the individual approaching the patient with a request for participation should be someone with whom the patient has a level of familiarity and trust—usually their practitioner,” says Call. The clinician should assure the patient that “participation is completely voluntary and that there are no expectations on either party’s part, while emphasizing that the patient’s participation may help other amputees.”

Individuals in the O&P community can start conversations with their patients and families by simply asking whether they would like to be involved in helping others, says Kuffel. “I have found that most are flattered and interested to be a part of something they quickly realize is bigger than themselves. Advocating for people in need is something that simply feeds the soul.”

Richmond recommends that patients who participate in advocacy efforts be suited to “tell the story” underlying “the ask.” For example, if a clinician is visiting legislators to explain why coverage of elevated vacuum suspension systems is important, that clinician should arrive at the meeting armed with

O&P practitioners have a responsibility to engage in efforts to advance the profession to provide optimal O&P patient care, says Call: “Practitioners need to involve themselves with their patient and the patient’s family to ensure the best outcomes. We don’t simply treat patients and then turn them loose. We are the experts and understand the whole picture going forward. As such, it’s our responsibility to treat, educate, and advocate for the best interests of our patients.”

On the legislative front, patient involvement helps bring public attention and action to important issues that impact amputees, O&P businesses, and the profession, says Call. “Patient involvement also is another way to demonstrate to our patients that we’re focused on their best interests—and that our efforts go above and beyond simply treating them.”

Weber believes that advocating for prosthetic care is one of the most important tasks O&P clinicians take on. “If a patient can walk with you up to Capitol Hill and do something that will make life better for future patients—there’s nothing better,” he says. “Advocacy can sound like a chore, but it’s probably one of the most rewarding opportunities we have in this industry.”

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

O&P ALMANAC | APRIL 2017

29

By LIA K. DANGELICO

PHOTO: Design HDR Gensler Photography © 2017 HDR and Dan Schwalm

Role Model A new research hospital in Chicago places clinicians, researchers, and patients in shared spaces to innovate and drive outcomes

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APRIL 2017 | O&P ALMANAC

NEED TO KNOW MM The new Shirley Ryan AbilityLab, which opened last month in Chicago, is a state-of-the-art facility designed to help patients suffering from the most severe and complex injuries and conditions, including those with orthotic and prosthetic needs.

MM The facility is structured so that researchers and clinicians who focus on the same part of the body or the same pathology are working in the same spaces, and often they work together with the patient throughout the treatment process to produce immediate feedback and results. With this new model, research may be translated into patient care almost immediately.

MM The AbilityLab features innovative technology such as gait tracks and obstacle courses for patients working to improve mobility and navigate in the real world, as well as custom-made assisted staircases that help patients relearn walking and running up and down stairs.

MM O&P-related research goals at the AbilityLab include development of new upper- and lower-limb prosthetic and orthotic components, as well as new methods of control for O&P devices. Staff members also will be working to validate outcomes and the efficacy of existing O&P devices.

PHOTOS: Shirley Ryan AbilityLab

MM What’s most exciting for the clinical operations manager of the facility’s Prosthetics & Orthotics Clinical Center is “the potential of what we can contribute to the rehabilitation field in general and to the O&P field specifically,” says Nicole Soltys, CP. “I think that we have the space and the mechanisms available to really develop some new technologies and techniques that we can share with the rest of the field.”

Pae White installation on the 10th floor sky lobby of the Shirley Ryan AbilityLab

W

HEN YOU CLOSE YOUR EYES

and imagine the future of O&P and rehabilitative care, what do you see? What technologies enable your patients to walk with confidence? What devices improve their ability to drive a car or pick up their child? What do their faces look like as they experience their first breakthrough or success?

This exercise is the vision behind the Shirley Ryan AbilityLab (sralab.org), which opened in Chicago in late March. Formerly the Rehabilitation Institute of Chicago (RIC), the AbilityLab has reinvented itself with a new $550 million, 1.2 millionsquare-foot research hospital. The state-of-the-art facility aimed at “advancing human ability” features the latest innovations and advancements to help patients suffering from the most severe and complex injuries and conditions—from smart

thinking-speaking technology and equipment for stroke and head injury patients to experimental electromyography and movement analysis for patients with mobility issues.

Most innovative of all is the facility’s goal to remove the barriers between research labs and clinical spaces to allow for “science-driven breakthroughs in human ability.”

The organization is embracing the concept of translational medicine, which is defined by the European Society for Translational Medicine as “an interdisciplinary branch of the biomedical field supported by three main pillars: bench-side, bedside, and community. The goal of translational medicine is to combine disciplines, resources, expertise, and techniques within these pillars to promote enhancements in prevention, diagnosis, and therapies.”

O&P ALMANAC | APRIL 2017

31

PHOTO: HDR Architecture Inc. © 2017 HDR and Dan Schwalm

The Strength and Endurance Lab features a custom-made staircase and a three-dimensional flying system attached to a track with a suspended harness that patients use to learn to navigate steps.

The AbilityLab is “a space where researchers and clinical care, therapy services and physicians, will be intermingled and geographically together, not only to help stimulate new ideas for research but also to help translate research down into clinical care as quickly as possible,” says James Sliwa, DO, the facility’s chief medical officer and senior vice president of medical affairs.

As the O&P industry continues to carve out new avenues and approaches to care, the Shirley Ryan AbilityLab aims to offer an innovative model that champions collaboration and outcomes—from provider to provider, provider to patient, and patient to community.

James Sliwa, DO

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APRIL 2017 | O&P ALMANAC

Changing the Model

The AbilityLab is a result of the belief that “innovation and new ideas are too often left to chance encounters” between specialists. “It’s those conversations in passing that sometimes spark some big ideas,” says Nicole Soltys, CP, clinical operations manager of the facility’s Prosthetics & Orthotics Clinical Center. That’s why the facility is structured in such a way that researchers and clinicians who focus on the same part of the body or the same pathology are working in the same spaces. For example, the Center for Bionic Medicine and the clinical O&P department are on the same floor, where they share a patient waiting area as well as designated non-work areas where staff members can sit down and chat or have lunch together. “That’s really the most innovative for me,” she says, “the structure of getting the right people together to solve problems for our patients.”

For Soltys, the new undertaking is about the future of her patients and O&P care. “We are doing this to achieve better outcomes for our patients,” she says. These advancements in care and offerings are “what they have asked us for and challenged us to give them.” Of course, it’s natural for clinicians to collaborate with and

seek out patients’ feedback, but this new model gives clinicians another place to turn for support. “As [a prosthetist,] if I’m working with my patient… and I’m looking at all the available clinical options, and I’m still not able to help this patient meet his goals, I now have this additional team of scientists and researchers, and we can start looking into the problem from another angle to see if maybe we can develop a solution for that patient.”

With this increase in collaboration between researchers and clinical care providers, the hospital, which currently has more than 350 studies and trials underway, plans to rapidly expand its research scope. According to Soltys, its O&P-related goals include development of new upper- and lower-limb prosthetic and orthotic components, as well as new methods of control for O&P devices. They also will be working to validate outcomes and the efficacy of existing O&P devices.

The RIC has a reputation for developing research that has a real impact on patient outcomes, and that legacy will continue at the new facility. The Center for Bionic Medicine, its largest research group that is focused on O&P, has already brought a number of significant technologies and techniques to market, including targeted muscle

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PHOTOS: Shirley Ryan AbilityLab

Typical patient room

AbilityLab therapy pool

reinnervation and pattern recognition, to name a few. “The exciting thing is that those technologies are now standard clinical practices available to any prosthetist or orthotist in the field,” says Soltys. Other examples include a custom anklefoot orthosis that allows patients to switch between solid and articulating modes by themselves—an idea that was born out of a research study and brought to life in RIC’s lab by Donald McGovern, CPO, FAAOP, and Wesley Quigley, O&P technical coordinator.

Now, instead of the years of lag time that typically transpire between conducting a research study, getting it published, and seeing it take effect on a hospital floor, patients will be able to experience the impact on their care immediately, according to spokespeople.

Nicole Soltys, CP

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APRIL 2017 | O&P ALMANAC

The AbilityLab shares a similar philosophy and approach to care with that of other dynamic rehabilitation research hospitals, including the Center for the Intrepid at Brooke Army Medical Center and Walter Reed’s National Intrepid Center of Excellence. This new model, though, physically places clinical and research staff together with the patient throughout the treatment process to produce immediate feedback and results.

Planning for Success

The physical space at the AbilityLab reflects a forward-thinking and patient-centered focus. The hospital features floor-to-ceiling windows and therapeutic color schemes and artwork that promote healing. Its 242 patient rooms provide comfort, privacy, ample natural light, and ample bathrooms.

The hospital’s communal spaces, such as gardens, a café, and gathering areas, are designed for a therapeutic effect and offer opportunities for patients to practice daily living skills.

The 27-story facility is organized into five Innovation Centers that center on specific areas—Nerve, Muscle + Bone; Spinal Cord; Pediatric; Cancer; and Brain—and often contain subspecialties within their departments. Specialized “Ability Labs” focus on functional outcomes in their respective areas: Arms + Hands Lab; Pediatric Lab; Think + Speak Lab;

Strength + Endurance Lab; and Legs + Walking Lab. These spaces bring together doctors, clinicians, therapists, and nurses to work side-by-side with scientists, engineers, tech innovators, and entrepreneurs in the same room with the patient. As a result, patients are surrounded by experts throughout their care; clinicians provide treatments while researchers observe the process, measure results, and make improvements.

Across nearly 800,000 square feet of dedicated clinical space, the AbilityLab offers innovative technology that transforms the way patients experience treatment and receive care. For example, several of the Ability Labs feature gait tracks and obstacle courses for patients working to improve mobility and navigate in the real world. They also feature several one-of-a-kind, custommade assisted staircases: Each one is a 3-D flying system attached to a track with a suspended harness that allows patients to experience and relearn walking and running up and down stairs with bodyweight support.

Staff members are embracing the newly adopted care model, and are optimistic about “doing something that’s never been done before.” The hospital, which provides inpatient, outpatient, and DayRehab™ care, is structured in such a way that specialties are grouped together and oversight and support are provided at every

level. Clinical chairs oversee each of the Centers of Innovation, and each unit also has its own nursing leadership on each of the floors. Similarly, the Ability Labs are headed by research chairs who oversee and collaborate with the department’s physicians, specialists, and nurses. To ensure consistent, collaborative care, each patient has an assigned primary care team that includes all the disciplines.

In the O&P department, Soltys manages a staff of 35, which includes prosthetists, orthotists, technicians, and administrative support. Her team cares for inpatients at the hospital as well as outpatients from the community, who also may be working with an outside prosthetist or orthotist.

“We make sure we are taking care of patients throughout the entire continuum of care,” she says.

It may seem that this level of interaction and collaboration would present a litany of reimbursement challenges, but Soltys says she’s not worried. With a formal administrative staff in place, the organization has already established that “clinical work is clinical work, and research work is research. It

can be the same patient participating in both, but there is that distinction between those appointments [for billing purposes.]”

Flipping the Script

This new model is designed to offer benefits for all stakeholders—from clinicians to patients and the greater community. For researchers, especially those without clinical backgrounds, they are able to observe therapy and fittings and truly understand some of the challenges that O&P patients face. This will be a brand new concept for many of them, but the hope is that the process will enable them to uncover new solutions and better immerse themselves in the clinical world, says Soltys.

Similarly, clinicians will be able to develop a better understanding of the research process and be a part of quickly translating those findings into clinical care. Clinicians who also conduct O&P research get to experience the best of both worlds, she says.

Finally, patients will gain a better understanding of—and directly benefit from—the research and innovation

surrounding their injury or illness.

“They also benefit from getting a taste of new technology and techniques when they become involved in a research study as a subject,” says Sliwa.

What’s most exciting for Soltys is “the potential of what we can contribute to the rehabilitation field in general and to the O&P field specifically. I think that we have the space and the mechanisms available to really develop some new technologies and techniques that we can share with the rest of the field,” and with patients.

“We are re-scripting the way that care is going to be given going forward, so that is the most exciting thing, to see how researchers and clinicians are going to be working together and the change in the paradigm of the way that care is going to be provided,” says Sliwa. “While the building is beautiful and we’re very excited about it, it’s what the building is going to allow us to do that is most exciting.”

Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com.

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O&P ALMANAC | APRIL 2017

35

COMPLIANCE CORNER

By DEVON BERNARD

Help With HIPAA Tips for ensuring compliance with the regulations that protect patients’ private health information

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 39 to take the Compliance Corner quiz.

Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

CREDITS

What does the Health Insurance Portability and Accountability Act (HIPAA) mean for O&P professionals?

O

VER THE PAST FEW YEARS, as

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.39

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APRIL 2017 | O&P ALMANAC

?

In a nutshell, HIPAA and subsequent regulations require you to do five things: Put safeguards or protocols in place regarding patients’ protected health information (PHI); reasonably or cautiously limit the exposure or uses of the PHI to the minimum necessary amount to complete your intended goal (billing, for example); create procedures that limit who may access or view PHI; implement a training program for all employees on how to protect PHI; and create a way to notify a patient if his or her PHI has been compromised or breached, and understand how to identify if PHI has been compromised or breached.

the health-care arena has become more complex and health data more frequently shared, the five obligations outlined in HIPAA have become more important. HIPAA compliance is under increased scrutiny as enforcement activities have been ramped up due to the increased use and availability of PHI. The Office for Civil Rights (OCR), the entity charged with enforcing HIPAA, now conducts periodic audits on its own to gauge your compliance with the HIPAA Privacy, Security, and Breach Notification Rules—which are in addition to the audits and investigations OCR conducts as a result of a complaint or other issues. The consequences for not being compliant have become more substantial and frequent as well.

OCR uses a tiered approach for issuing civil monetary penalties, or fines, for HIPAA violations and/or noncompliance; these penalties range from $100 to $50,000 per violation, with a maximum penalty of $1.5 million per year

for violations of an identical violation.

The amount of the fine is based on your level of compliance or negligence and the number of patients involved.

The first tier is “did not know” or “reasonable diligence” violations. These are HIPAA violations that occur without your knowledge and could not have been foreseen due to the policies and procedures you have established. These violations may occur because you may not have had a complete understanding of the laws.

In these cases, the minimum penalty is $100 per violation, not to surpass $25,000 in one year for the same violation.

The second tier is “reasonable cause,” or a violation where you were unable to comply with the HIPAA standards, but made attempts to become compliant. This means you attempted to comply, but for some reason were unable to do so; you were not intentionally ignoring the laws. In these cases, the minimum penalty is $1,000 per violation, not to surpass $100,000 in one year for the same violation.

COMPLIANCE CORNER

Tiers three and tier four are linked because they both hinge on the term “willful neglect.” This means that you intentionally or willfully ignored your obligations under HIPAA. Tier three will be applied if you take actions to correct your shortcomings and violations.

This tier carries a minimum penalty of $10,000 per violation, not to surpass $250,000 in one year for the same violation. If no attempt is made to correct the violation, tier four will apply, and the penalty will be a minimum of $50,000 per violation, not to surpass $1.5 million in one year for the same violation.

The maximum amount for a violation in any tier is set at $50,000 per violation, with an annual maximum of $1.5 million.

In addition to monetary penalties, you also may be subject to criminal penalties, including jail time. The jail time may range between one and 10 years.

To help avoid these costly penalties and ensure compliance with HIPAA standards for privacy, security, and breaches, here are some examples of the top reasons companies and individuals have been found to have violated HIPAA. These examples come from OCR’s “Breach Portal: Notice to the Secretary of HHS Breach of Unsecured Protected Health Information.” It is a complete list of all breaches (the access/ use/disclosure of unsecured PHI, in a manner not permitted by HIPAA, which poses a significant risk of harm to the affected individual) affecting 500 or more individuals, and it currently includes 1,847 separate incidents.

2.

3.

Lost or Stolen Devices

Of the 1,847 incidents included in the “Breach Portal,” 924 were listed as lost or stolen; 604 of the lost or stolen items were described as a laptop or other portable device. This means that 32 percent of the reported breaches of health information result from a lost or stolen device.

The U.S. Department of Health & Human Services (HHS) has created a list of 11 tips for protecting and securing PHI when using a portable device: 1. Use passwords or other forms of authentication to gain access to the device and the files located on the device. It is suggested

4.

5.

6.

7.

that the password be at least six characters long and include a combination of upper- and lowercase letters, numbers, and symbols, and that you change passwords on a routine basis.

Install and enable some form of encryption software or apps or similar features on your devices.

Have the ability to activate remote disabling and/or wiping. (This is especially handy if your device is lost or stolen.) Remote wiping is a security feature that enables you to remotely erase the data on a mobile device; remote disabling is a security feature that enables you to remotely lock or completely erase data stored on a mobile device.

Many current portable devices already include these features, but you must be sure the features are activated and being used.

Consider disabling and/or not installing file sharing applications, as these can be a way for people to access your files without your knowledge.

Install and activate a firewall.

Once again, most devices and operating systems already have a firewall, but you must be sure it has been activated.

Use some type of security software.

Ensure your security software is up to date.

8. Before downloading any new applications, research them and understand how they work. For example, some apps may need to copy your files in order to work; these apps would jeopardize the health data stored on your phone.

9. Maintain physical control of your mobile device, as devices such as phones and tablets can be easily misplaced. Some methods of control include securing the device when it is not in use (via a locker or secure room, or by locking the screen) and making sure no one else uses the device.

10. Take precautions when using wifi networks. Use secured networks if you intend to transmit any health data, and use secured browsers. It also is suggested that you turn off wifi features when you are not using them.

11. Delete all stored health information. This is critical when you are replacing or upgrading your current devices. Consider using some type of “overwriting” software, and do not rely on the “delete” button, or emptying your trash, to achieve deletions.

For more information regarding securing electronic health information, including conducting risk analyses, visit www.healthit.gov.

O&P ALMANAC | APRIL 2017

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COMPLIANCE CORNER

Hacking

Nearly 300 of the 1,847 listed instances of breaches on the OCR website (282) were self-reported as being related to hacking/IT issues. To combat hacking issues, you can employ some of the same guidance given for protecting mobile devices. This includes using strong passwords (six or more characters, upper- and lowercase, etc.) and changing passwords on a regular basis. Also, be sure you are using firewalls, and that firewalls are maintained, updated, and adequate for your needs. Next, be sure your security software is routinely updated and is capable of searching out the newest versions of malware and viruses.

Be sure you are using firewalls, and that firewalls are maintained, updated, and adequate for your needs.

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APRIL 2017 | O&P ALMANAC

Improper Disposal

Improper disposal accounted for 65 of the 1,847 breaches listed on the OCR website.

When disposing of records, ensure that the information is made unreadable/ indecipherable and unable to be reconstructed. For paper files or records, consider measures such as shredding

or burning, or a means that ensures total destruction. Besides encryption, destruction is the only other way, under HIPAA, to ensure that health information is considered secured.

For electronic records and files, proper disposal includes using software to overwrite the files or destroying the hard drive.

This is especially important when you are disposing of old laptops, computers, or thumb drives, but you should check other equipment as well. Fax machines and copiers may store information on their hard drives, so be sure these are erased on a regular basis—especially if you are leasing the equipment.

Unauthorized Access/ Disclosure

Unauthorized access and/or disclosures accounted for 462 of the 1,847 breaches listed on the OCR website, accounting for roughly 25 percent of the breaches—the second biggest reason for breaches.

Disclosures are the means in which you communicate PHI to an outside entity, and these are allowed under HIPAA in many circumstances—for example, PHI may be emailed to a physician for treatment or to your billing company for billing, as long as it is communicated under secure measures. However, some disclosures are not allowed; under HIPAA, only certain people are allowed to access the data.

PHOTO: Getty/Welcomia

In addition, ensure information is encrypted—and encrypted to a standard acceptable under HIPAA. Note that while encryption is not necessarily a HIPAA requirement (your data/ health information is not required to be encrypted as long as you have other safeguards in place), the HIPAA regulations are clear that one of the only ways information is considered absolutely secured (unusable, unreadable, etc.) is via encryption. So, if the health information you are using is encrypted, that provides one more layer of protection, especially when dealing

with breaches. For maximum security, ensure data is being encrypted during all phases of usage: transmission, rest, and storage.

Another tool to safeguard against hacking is to have proper training and protocols in place. The training does not need to be technical or intense, but it’s important to educate your staff about potential threats and malicious software so they are able to identify it and report it. Also, make sure that everyone knows what links and attachments are secure and valid, and what to do if a staff member opens a link or attachment that should not have been opened.

Finally, to prevent hacking or to limit the effects of hacking, talk to your information technology (IT) department to ensure the steps outlined above are being taken. If you don’t have an IT department, you may want to speak with an IT consultant, preferably one with knowledge about HIPAA, and run an assessment of your vulnerabilities and risk.

COMPLIANCE CORNER

Some examples of unauthorized access/disclosures include the following: • Not obtaining proper authorization to use patient videos or testimonials for your website or marketing materials.

• Insider peeking or people within your company looking at patients’ charts, when they have no need to view the charts as part of their daily duties.

• Sending/releasing the wrong patient’s information.

• Not having or using business associate agreements (BAAs), when required.

It’s important to ensure that no one accesses a patient’s medical records without proper authorization or approval as directed by your policy and procedures manual or under an employee’s job description and duties. If you use electronic health records, consider instituting tracking systems and/or clearance level passwords to prevent unauthorized access. Also, review all current BAAs to make sure they are up to date and valid, and review your interactions with other individuals and companies to determine if you need BAAs.

to address the issue and, if necessary, update your training and procedures.

Remember that you can best ensure patients’ privacy needs are met—and reduce the amounts you may be fined should a breach occur—if you implement a strong and reliable training program, maintain proof that everyone has received proper training, and show that you are doing your “due diligence.”

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org.

Protecting Your Facility

These are just some examples of HIPAA compliance issues that could impact an O&P facility. To review other issues related to HIPAA compliance, visit the OCR website and search under “HIPAA Compliance and Enforcement.” There you may review resolution agreements and other case examples. If you review a case example, resolution agreement, or another issue addressed above and identify a similar issue within your organization and realize you may be vulnerable, be sure

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O&P ALMANAC | APRIL 2017

39

& NOW

THEN

Financial Benchmarking Reports AOPA’s seminal Operating Performance Report and Compensation & Benefits Report help keep O&P facilities on track and profitable

Then & Now is a monthly department for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will feature a different AOPA product or service and discuss how it has evolved over the years. This month, we focus on the highly regarded Operating Performance Report and Compensation & Benefits Report.

M

ORE THAN 40 YEARS ago, AOPA launched an independent financial survey, and 50 AOPA members provided detailed financial data on their business operations. At that time, Sam Hamontree, CP, chair of AOPA’s Business Procedures and Liaison Committee, said, “The results of this initial survey and continuing surveys in subsequent years should provide information … that will be of immeasurable value in the business management Sam Hamontree, CP of an orthotic/prosthetic practice.”

From that forward-thinking event— which occurred in 1975—AOPA’s annual financial benchmarking survey of O&P businesses was born.

The survey continues today, and is manifested as the annual Operating Performance Report and biannual Compensation & Benefits Report.

But many well-planned features of the original survey remain the same—for example, the reports continue to abide by the following principles: • Confidentiality of information provided by participants is achieved by using an independent thirdparty consulting firm.

• Each participating company receives a free published report of the overall findings.

• Each participating company also receives a customized Company Performance Report with detailed findings for each participant, comparing that company’s key financial indicators with those of similar-sized organizations.

THEN

Average Sales

Throughout the past 40 years, the data presentation included in AOPA’s seminal benchmarking reports has been refined.

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APRIL 2017 | O&P ALMANAC

The data from O&P businesses is fascinating to review from a historical perspective. Comparing data from the 1970s to data from recent reports suggests a lot has changed in 40 years, as indicated in the tables below:

1978

$334,000

2015

$4.6 million

THEN & NOW

Sales Per Employee 1978

$37,100

2015

$163,000

Average Number of Employees 1979

9.0

2015

30.8

Some key indicators, however, remain similar, as the following tables illustrate:

Product Mix 1978

2016

Orthotics

42%

41%

Prosthetics

35%

50%

Pedorthics

3%

5%

20%

4%

Other

Cost of Goods Sold* 1978

51%

2015

53%

And some things never change. A note from the 1979 Business Survey Report sounds familiar: “Office and admin salaries are extremely high costs of doing business due to voluminous billing procedures and various required paperwork.”

NOW

AOPA mails the Operating Performance survey every year and the Compensation & Benefits survey every other year to its members in May. Participation for AOPA members is free, and includes

OPCA A TS PRODU

*“The direct cost of items sold continues to average slightly over 50 percent for every sales dollar.”—1979 Business Survey

Operating Expenses as a Percent of Net Sales 1979

33%

2016

39%

Editor’s Note: Contact Betty Leppin at bleppin@aopanet.org for more information on how to participate in the 2017 Operating Performance and Compensation & Benefits surveys.

tion and ompensa AOPA C Report Benefits

2015

a complimentary final published report—a $185 value—and a free customized Company Performance Report, comparing the company’s results to businesses of similar size and location. The surveys take about 60 minutes to complete, and can be submitted online, or companies may submit their financials and have the independent consulting firm confidentially enter the data.

Jim Weber, MBA, chair of the 2017 Operating Performance Committee, says, “There isn’t a better benchmarking tool to use to compare your O&P company’s performance with others in the field. This is a great resource for AOPA members to use for measuring and improving their business operations—and 40 years later, it continues to be offered as a free service for AOPA members.”

O&P ALMANAC | APRIL 2017 S O C I AT

O PA ION (A

)

41

BRIDGE TO THE FUTURE: THE INTERVIEWS

Leveraging New Technologies Finding innovative solutions to increase efficiency and reduce costs will be imperative in coming years

By CHRISTINE UMBRELL

N

EW TECHNOLOGIES ARE HAVING

Bridge to the Future: The Interviews is a monthly column for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will look to the next 100 years—by interviewing noted experts in the O&P field to learn their vision for the future of O&P. This month, we speak with Jeff Collins, CPA, on the topic of embracing new technologies in O&P distribution.

an impact on all aspects of O&P care—and those facilities that embrace appropriate technologies stand to benefit in the long run. Rather than viewing technology as the enemy, O&P professionals who recognize the value technology offers and learn to use it properly may gain a competitive advantage. Those who are willing to adapt and innovate while remaining ethical and true to the purpose of improving patients’ lives stand to benefit in many ways.

“It all begins with looking at what’s happening around us and adapting your solutions,” says Jeff Collins, CPA, chief executive officer of Cascade Orthopedic Supply and AOPA treasurer. This strategy is not unique to O&P—but it is important to recognize, and find ways to leverage new technologies to provide O&P services more efficiently and cost-effectively, when possible.

Case Study in Shipping

Collins recently put his words into action when he led his O&P distribution company in an overhaul of its shipping methods. Recently, the major shippers, including FedEx and UPS, moved to a dimension-based pricing model that resulted in not only increased shipping costs but also confusion when calculating those costs for O&P facilities. It became difficult for Cascade to accurately quote shipping costs to its customers, particularly for items with an irregular shape. This 42

APRIL 2017 | O&P ALMANAC

uncertainty also made it challenging for the company to audit its expenses to ensure it wasn’t being overcharged.

“The ability to quote freight costs to customers using our website had become a struggle, given the variety of items that we sell,” says Collins. “Since the carriers now use dimensional weights, just knowing the weight of individual products isn’t enough. We need to know the total dimensional size of every outgoing package to give customers a lot more transparency into total cost. We also saw this as an opportunity to differentiate ourselves from our competitors.”

Faced with these challenges, Collins and his team decided to search for technologies that could assist them in navigating the new shipping climate. Rather than tackling individual issues and improvements piecemeal, Cascade sought to create a new standard for industry best practice to improve distribution speed, cost effectiveness, and quality.

“We needed to adjust our operations to find technology solutions to adapt to the situation,” says Collins. Cascade was already using PathGuide’s core Latitude WMS functionality with the Manifest and Shipping System. But it found that adding Postea’s QubeVu DimStation for dimensioning, and integrating that new solution with the PathGuide system, resulted in a comprehensive solution that was competitively priced and fast and allowed for accurate dimension calculating for irregular shapes associated with many O&P items.

BRIDGE TO THE FUTURE: THE INTERVIEWS

The new solution “easily handles irregularly shaped items and things that come to us from our suppliers either loose or in polybags,” says Collins. “The Postea and PathGuide teams worked very closely with us to integrate everything into a streamlined, well-structured process.”

The transition to an integrated solution led to immediate benefits for Cascade, with instant dimensioning of all package shapes and a carrier-compliant system for manifesting and shipping. The technology also allows Cascade to compare prices between carriers to identify the most economical shipping method for each parcel and will enable the company to accurately quote shipping costs to customers online.

“QubeVu scans all of our outbound packages,” says Collins. “We’re able to provide those dimensions to carriers like UPS and FedEx, and we can go back through our data retroactively to test the accuracy of their billings.

When we first started using the system, we identified opportunities to ask our carriers for refunds due to inaccurate dimensions. The cost savings there alone helped to pay for a significant portion of the system.”

In addition to improving shipping processes, the new system “opens the door for optimizing our internal

operations and optimizing stock placements, and makes us more efficient,” says Collins.

Lessons Learned

By leveraging new technologies to make a change in processes and procedures, Cascade has found a way to reduce costs and improve service to its customers. Adopting a proactive mentality to look beyond “business as usual” to streamline processes and adopt new technologies becomes increasingly important in the current reimbursement climate.

“All providers in this space are looking at pressures in reimbursement, which cause pressures on service providers to be more efficient,” says Collins. “We need to rise up to these challenges.”

Payors are driving reimbursement rates—and both O&P providers and patients are greatly affected by reimbursement challenges. In response, O&P facilities are seeking ways to be more efficient by outsourcing to central fabrication (c-fab) facilities, using central billing services, and reducing administrative costs, says Collins. Leveraging innovative technologies “is one more way we are becoming more efficient,” he says. “It opens the door to more automation.

We can start to automate some of our

processes and reduce labor costs.”

Considering “outside-the-box” solutions—a strategy other industries are successfully adopting—is another way O&P companies may find success in the future. “Looking outside of O&P to consider best practices may help us survive in light of declining reimbursements,” says Collins.

Other trends to watch as O&P looks to improve profitability and accelerate care, according to Collins, include the increased utilization of c-fab, which frees up staff time for more patient interactions; adoption of technologies that help improve delivery and procurement of custom fabricated items; possible inclusion of 3-D printing technologies for small componentry or test parts; and scanning to improve delivery times of custom items.

Regardless of the methodologies and processes O&P professionals choose to adopt, flexibility and willingness to change will be key to successful O&P businesses in the coming years. Considering new technologies and evolving with the times will become increasingly important to the O&P community.

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

O&P ALMANAC | APRIL 2017

43

THE GLOBAL PROFESSIONAL

Michael Schäfer, CPO Traunstein, Germany Chief executive officer of Pohlig GmbH explains O&P care and reimbursement in Germany

As the O&P profession prepares for the Second O&P World Congress, to be held in conjunction with AOPA’s 100th Anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a question-andanswer section with international O&P experts. Each month, we spotlight an O&P professional from a different part of the world to find out how O&P is practiced across the globe, in anticipation of the upcoming World Congress.

Germany

O&P ALMANAC: Describe a typical

work day for you.

fields of individual O&P, patients from all over Europe visit our workshops.

MICHAEL SCHÄFER, CPO: A typical

O&P ALMANAC: What types of

work day for me starts between 6:30 and 7 a.m. and ends between 8 and 9 p.m. at Pohlig GmbH, a facility that engages in the research, design, and creation of health care and rehabilitative aids for children and seniors.

My daily work belongs to typical chief executive officer’s duties and strategic human resources, as well as interactive communication with our specialized units of O&P. Part of my day involves working together with our experienced CPOs during patient examinations with recommendations and discussions for the best O&P treatment—in these cases, my expertise helps me serve as a “firefighter” in difficult O&P cases.

That’s what my heart beats for.

Additionally, I travel a lot between our different workshops all over Germany, with similar expertise as mentioned above, and I spend some time working on national O&P, research, and political boards.

O&P ALMANAC: Describe the loca-

tion where you provide services.

SCHÄFER: In addition to our head-

44

APRIL 2017 | O&P ALMANAC

SCHÄFER: We specialize in highly individualized custom-made prostheses for upper and lower extremities, orthoses for upper and lower extremities, orthoses for the trunk and head, orthoprostheses for people with congenital malformations and syndromes, and individual seatings. Approximately 70 percent of our clients are children.

Adults are treated in specialized O&P teams, where our CPOs, physiotherapists, and doctors focus on the best outcome with our devices.

Our rehab offers special wheelchairs, beds, rehabilitation devices, home care, and wound management. We also have a division for shoe technology, with approximately 20 staff members offering individualized shoe production, insoles, diabetic footcare, and more.

So there are approximately 540 dedicated people who run our daily business.

O&P ALMANAC: How are the devices

you provide paid for?

SCHÄFER: Our devices for national patients are paid for by insurances from the German health-care system; most of them are public bodies, but some of them are private insurances.

Of course, we also have additional social insurances and a worker’s

PHOTOS: Pohlig GmbH

quarters in Traunstein, Bavaria, we run seven highly specialized orthopedic workshops all over Germany—in Hamburg, Berlin, Cologne, Heidelberg, Nuremberg, Munich, and Aschau, and one outside Germany in Vienna.

Because of the high specialization in the

patients do you typically see, and what types of devices do you fit for these patients?

THE GLOBAL PROFESSIONAL

compensation insurance, which is organized centrally in a concern-like structure and traditionally with a high scope of services. Devices for European and international patients are often paid privately, by international or European services or from national insurance departments that are ruled by agreements from the European community.

Most of the devices are described in a register called “Hilfsmittelverzeichnis.” As technological advances are protected by German law, most of the upcoming new devices—which support and significantly improve the people’s daily living—are paid for by the health-care system. Therefore we have to sign contracts, where the codes and the prices for the products are ruled in a pricelist. Most of the products in O&P are covered by the health-care system except a small amount (between 1 and 75 euros) that patients have to pay as a statutory co-payment. Additional extras and specialties, for instance design characters or high-end cosmetic devices and enhancements, often have to be paid on top by the patients themselves.

O&P ALMANAC: If the payor is other

than the patient, do nonpatient payors have an audit process? If there is an audit process, do you consider it to be fair?

PHOTOS: Pohlig GmbH

SCHÄFER: Of course, there are audit processes in Germany. Often nonpatient payors, like insurers, are trying to reduce the costs of an evaluated prosthetic or orthotic treatment by accepting cheaper devices than submitted. The patient here in Germany

is protected by law, so he or she can place an official protest, where all sides (representatives from insurance, medicine, therapy, and CPOs) have to argue the pros and cons of the recommended treatment. If the payor does not accept the argument, the patient still has the opportunity to go before the law, where a chief judge will render a judgment. The whole process can take a lot of time but at least will be absolutely fair.

O&P ALMANAC: Describe your

educational background and any certifications you have. How do you keep your skills sharp?

SCHÄFER: Before I started in the pro-

fession, I did my university entrance diploma in a German secondary school.

The professional education for O&P certificates lasts three years and runs in a dual system, where I worked in a company workshop, learning all the basics of practical O&P, and additionally in a specialized medical school, where all of the theoretical concepts were taught.

After doing my certificate as a CPO, I worked in a specialized O&P workshop for another four years, improving my performances of patient treatments, and then visited the O&P Bundesfachschule in Germany, where I focused on the German Meister Degree education and the ISPO CAT 1-certification in an additional one-year full-time study. It was certainly a lot of school and practice, but it was all intended to improve daily practice and allowed me to receive a deep background for my work.

In the 30 years of my business practice, I completed nearly 200 courses, including specialized certifications for O&P techniques, and I took all of the required refresher courses and visited a lot of conferences and colleagues. I also worked on the Meister Certification Board for 10 years.

I have given many lectures at national and international O&P conferences, workshops, and courses, and a lot of presentations. To be honest, every new presentation keeps me deeply up to date on the topic.

O&P ALMANAC: What’s the biggest

challenge you face as a practitioner, and how do you deal with it?

SCHÄFER: The biggest challenge as a practitioner in O&P is providing the best for our patients. Best performances in O&P will only be possible if you can offer understanding and empathy to the patients and, on the other side, the knowledge and the complete horizon of O&P methods and markets.

Therefore, continuous search, research work, and developments of new technologies, materials, and procedures for improving our quality of services in individual patient care are essential.

Every patient is different and most of our patients require individually adapted treatments. Out of our internal network of colleagues, quality circles, and research and development groups, there are so many good and new ideas coming up daily—and that is what my colleagues at Pohlig and myself are burning for.

O&P ALMANAC: Describe any

charitable work you or your organization does.

SCHÄFER: As we treat a lot of children with O&P devices in our company, every year a special amount of orthotic and prosthetic treatments for children will be donated to nonprofit organizations or poor children/families visiting us from developing countries.

We also have founded a registered society called “Pohlig hilft,” which means “Pohlig helps,” where we support disabled people here in Germany with fundraising efforts to improve their performances of daily living.

O&P ALMANAC | APRIL 2017

45

MEMBER SPOTLIGHT

Bulldog Tools Inc.

By DEBORAH CONN

From Agriculture to O&P Manufacturing facility has origins in the family farm The Bulldog facility in Lewisburg, Ohio, after the company’s 2012 expansion

D

ENNIS MEYER AND HIS

46

APRIL 2017 | O&P ALMANAC

Ohio State Sen. Bill Beagle attends Bulldog’s groundbreaking ceremony in September 2012.

COMPANY: Bulldog Tools Inc. OWNER: Dennis Meyer LOCATION: Lewisburg, Ohio HISTORY: 20 years

Founder Dennis Meyer and his son Robert Meyer, the company’s vice president, attend a meeting in the early years of the business.

a new method for thermoplastic sockets, says Robert Meyer.

“It is injection molded instead of an extrusion. Its design can reduce labor, give more uniform consistency, and reduce waste compared to using sheets of extruder plastic,” he says. “Our grain pattern pulls outward in the same shape as a prosthetic socket, which gives the socket consistent strength, and having an integrated frame means clinicians don’t have to clamp and unclamp the material over a frame.”

Bulldog has produced several products in response to customer feedback, including a patented push-button safety feature on the company’s shuttle locks that helps prevent accidental disengagement. Patients turn the push button 90 degrees once the pin is engaged. “We continue to work hard to provide the highest quality innovative products, to make them lighter, stronger, and safer,” says Robert Meyer.

The company’s marketing tactics vary, with the company leveraging print and electronic

advertising to market its products worldwide. Bulldog also sends technician Daniel Hickey to meetings and customer visits on behalf of the company.

“We have supported nearly every state and national orthotics and prosthetic show in the last 16 years,” says Robert Meyer.

“Even if we couldn’t attend a show in person, because too many meetings were happening at the same time, we’d try to financially support the meeting.

I’m proud of that commitment to our customers.

“Our main and best marketing technique has always been word of mouth,” he adds. “We are American owned and American made, and we mark all our products ‘Made in USA.’ That feature, the quality of our products, and our competitive pricing make us attractive to customers.”

Robert Meyer recognizes two factors in his company’s business success. First is the commitment of Bulldog’s employees. “We have a great group of people working here,” he says. “Everyone is focused on customer service and quality, and we commit ourselves to filling any needs our customers have.” And second, he notes that the customers in the O&P field are a great group to work with. “Many have become more like family,” he says. “We have enjoyed and appreciated our years servicing the professionals of the O&P market and look forward to the opportunity of many more.”

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

PHOTOS: Bulldog Tools Inc.

wife, Patricia, launched a manufacturing company in 1977 adjacent to the family corn and soybean farm in Ohio. The business grew into a full-service machine shop and injection molding facility that created products for a wide range of clients over the years.

In 1997, Meyer created Bulldog Tools Inc. to market the company’s own products and designs, and he soon added orthotic and prosthetic products as an active business line.

Today, the second generation of Meyers is running the business and farming, and Dennis Meyer continues to work on his farm. DM Tool & Plastics Inc., his original enterprise, continues to operate in Lewisburg and Brookville, Ohio.

“My siblings and I grew up working in the manufacturing and farming business,” says Robert Meyer, who is vice president of Bulldog Tools. Several members of his family—his wife Michelle, sister Tania Booker, brother Bill, and sisters-in-laws Denean and Jamie—have been involved in the business, with Bill and Robert assuming leadership roles.

Bulldog occupies a 75,000-square-foot facility in Lewisburg, Ohio, where it manufactures a wide range of innovative products for O&P and several other industries.

Among the company’s O&P product offerings are shuttle locks, adapters, and fabrication tools and supplies. Bulldog also offers the patented Ringmaster thermoforming plastic, which is

Anyone can wear a white coat.

But not everyone is ABC certified in Orthotics and Prosthetics.

Do your homework.

ABC. Simply the best.

American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc.

abcop.org 703.836.7114

Setting the standard for O&P certification for over 65 years.

MEMBER SPOTLIGHT

Decker Integrated Orthotics & Prosthetics

By DEBORAH CONN

In-House Adaptations Kansas facility keeps most fabrication on-site for pediatric and adult patient base

L

OREN DECKER, CP, OPENED

48

APRIL 2017 | O&P ALMANAC

Loren Decker, CP, fits an iLimb for a patient.

FACILITY: Decker Integrated Orthotics & Prosthetics OWNER: Loren Decker, CP LOCATION: Overland Park, Kansas HISTORY: Four years

A device in progress at Decker Integrated Orthotics & Prosthetics

the facility, and about half of the clientele are pediatric patients.

Decker finds his younger patients to be more fearless than adults.

“They are more willing to put on the leg and get up and go,” he says.

Communicating with parents is an essential part of the process.

“Make sure that you almost overcommunicate with them,” Decker advises. “They will be concerned and overly cautious, so it’s a good idea to beat back their concerns before they get to them.

Their kid will fall, and it’s okay.”

Clinicians at Decker O&P participate in a bimonthly clinic at Children’s Mercy Hospital in Kansas City, along with a team of specialists: physical and occupational therapists, social workers, and physicians. “Working with a team to continue with patients over time is satisfying,” says Decker. “It also reassures parents, who see we have a plan and they have input.”

Decker O&P has a strong presence in the community. The company sponsors a golf tournament to benefit Infant Toddler Services of Johnson County, an early childhood development and family support program for young

children with developmental disabilities or delays. The facility also support Steps of Faith, a foundation that provides prostheses to those in need, by offering both funding and fitting services.

“We make a point of attending sporting events or fun runs that our patients participate in,” Decker adds. “If they let us know, and we can get there, we love to cheer them on.”

One aspect of prosthetics that Decker and his colleagues particularly enjoy is creating adapted devices for particular uses. Doyle Collier, CP, recently designed special running prostheses for a young female bilateral amputee who is competing in the St. Louis Marathon in April.

Decker O&P clinicians also developed prosthetic arms for gymnasts that enable them to hang on a bar or rings, and the facility is in the process of devising lower-extremity swim fins for a bilateral below-knee amputee.

Other than word of mouth and referral visits, the facility markets its services through social media and by holding monthly continuing education classes for physical therapists.

Decker anticipates some growth for his facility, but he doesn’t want to get so big that he has to spend more time managing his business than caring for patients. Meanwhile, he will continue what his facility is known for: taking care of patients as if they were family.

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

PHOTOS: Decker Integrated Orthotics & Prosthetics

the doors to Decker Integrated Orthotics & Prosthetics in Overland Park, Kansas, in 2013, after spending 10 years as an independent prosthetist at another area practice. Decker and two part-time clinicians—a prosthetist and a prosthetist-orthotist— handle patients, while a full-time billing specialist and part-time office assistant manage administrative affairs.

The roughly 1,500-squarefoot facility features two patient rooms, an office, a walking hallway, and a lab. Decker and his colleagues fabricate about 80 percent of devices in house.

“We are our own techs,” he says.

“We like that. It’s nice to do something with your hands.”

Decker’s transition to a facility owner was facilitated by an extensive network of patients and payors, he notes. He also went door-to-door to speak with referring doctors to gain their business. While Decker had a thorough knowledge of prosthetics, running his own business did bring a few surprises. “I knew I’d have to juggle patient care with business management, but it was more difficult than I had expected,” he says. “I knew there were things to keep track of, but when you are the one responsible, it takes on a whole new light.”

The facility’s billing specialist ensures that cases have required physician documentation, while Decker oversees other aspects of fulfilling compliance and reimbursement regulations.

Prosthetics accounts for nearly 90 percent of patient care at

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR

PITTSBURGH

EARN

JULY 17-18 | 2017

AOPA Coding Experts Are Coming to Pittsburgh, PA

14 CEs

Top 10 reasons to attend: 1.

Get your claims paid.

2.

Increase your company’s bottom line.

3.

Stay up-to-date on billing Medicare.

4.

Code complex devices

5.

Earn 14 CE credits.

6.

Learn about audit updates.

7.

Overturn denials.

8.

Submit your specific questions ahead of time.

9.

Advance your career.

The DoubleTree by Hilton Hotel and Suites Pittsburgh

Join AOPA July 17-18 in Pittsburgh to advance your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up¬-to¬-date on all the hot topics.

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

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2017billing.

10. AOPA coding and billing experts have more than 70 years of combined experience.

Mark your calendar for the next seminar:

NOVEMBER 6-7

Phoenix, AZ Sheraton Grand Phoenix 340 North 3rd St, Phoenix, AZ

Find the best practices to help you manage your business.

Participate in the 2017 Coding & Billing Seminar!

Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

AOPA NEWS

APRIL 12

MAY 10

Grassroots Advocacy Your voice is needed to help elevate the profession and inform legislators about the value of O&P intervention.

Be part of the solution by getting involved in grassroots advocacy efforts. Find out more during the April 12 webinar on “Grassroots Advocacy,” where you will learn: • How to effectively lobby for fair treatment of O&P on the local and national level • How to work with patients to help them become advocates for their own cause • How to effectively communicate with representatives in Washington, D.C., and in your office • How to act locally to change things nationally.

Modifiers: What Do They Mean, and When Should They Be Used?

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2017webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2017billing.

50

APRIL 2017 | O&P ALMANAC

Don’t miss the May webinar! Hear the experts discuss the most important modifiers and how they should be used to ensure your coding is as accurate as possible. The following topics are a small sample of what will be covered during the webinar: • What is the difference between the RA and the RB modifier?

• Which modifier allows you to provide services to a patient under hospice care?

• What is the true meaning of the KX modifier?

• What modifiers are used for upgraded and deluxe features?

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2017webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2017billing.

OPA100 AOPA10 00AOPA 00 AOPA AOPA’s Centennial Commemorative Website

1917

WWW.AOPA100.ORG

1918

1935

The AOPA Centennial Commemorative Website is live!

Explore www. AOPA100.org for 100 years of AOPA:

Learn about AOPA’s 100 year history

1946

Listen to AOPA member’s stories and share your own!

Enjoy the interactive timeline Peruse the photo gallery

Dream about what’s NEXT—

Your Story is Our Story.

YOUR CONNECTION TO EVERYTHING O&P

TELL YOUR STORY TODAY

1951

O&P PAC UPDATE

O&P PAC Update The O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA member*: • George Breece The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level, which have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate as well as other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo. com/forms/op-pac-authorization, or contact Devon Bernard at dbernard@AOPAnet. org. You also may complete and return the authorization card at the bottom of this page.

*Due to publishing deadlines this list was created on March 1, 2017, and includes only donations/contributions made or received between Jan. 1, 2017, and March 1, 2017. Any donations or contributions made or received on or after March 1, 2017, will be published in the next issue of the O&P Almanac.

O&P PAC Authorization I authorize the O&P PAC to share information with me, executive, administrative, and professional personnel associated with the company designated by me below.

Name: __________________________________________________________________________ Company: _______________________________________________________________________ Address:_________________________________________________________________________ Telephone: ______________________________________________________________________ Email: __________________________________________________________________________ AOPA must obtain the signature of a corporate officer, or a person that can authorize for their company. Signing multiple dates eliminates the need to contact you for authorization approval in upcoming years and reinforces your commitment to the O&P PAC. 2017____________________________________________ 2018____________________________________________ 2019____________________________________________ As required by federal law, my company has not authorized a federal PAC solicitation by another trade association during any calendar year in which this “authorization” is granted to O&P PAC. Signing this card in no way obligates me or others to contribute; it just gives them the opportunity to do so.

52

APRIL 2017 | O&P ALMANAC

Return completed form to: AOPA Attn: O&P PAC 330 John Carlye Street, Suite 200 Alexandria, VA 22314 Or fax to: 571/431-0899

www.bocusa.org

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American Orthotic & Prosthetic Association 330 John Carlyle Street, Suite 200 Alexandria, VA 22314

AOPA NEWS WELCOME NEW MEMBERS

T

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

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Cypress Adaptive LLC 804 W. Bartlett Road Bartlett, IL 60103 888/715-8003 Member Type: Supplier Level 1 Lynn Snyder LimBionics of Durham 5007 Southpark Drive, Ste. 110 Durham, NC 27713 919/908-8975 Member Type: Patient-Care Facility Brittany Stresing

Ortho Illinois 5875 E. Riverside Blvd.

Rockford, IL 61114 815/381-7431 Member Type: Patient-Care Facility Judy Larson Protosthetics 122 1/2 N. Broadway Fargo, ND 58102 218/354-2171 Member Type: Supplier Level 1 Josh Teigen

Monetek LLC 1145 W. Long Lake Road, Ste. 200 Bloomfield Hills, MI 48302 248/647-2299 Member Type: Supplier Level 1 Jill Neuvirth

ADVERTISERS INDEX

Company

Page Phone

Website

ABCOP—American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc.

47

703/836-7114

www.abcop.org

ALPS South LLC

13

800/574-5426

www.easyliner.com

Amfit

15 800/356-3668 www.amfit.com

Cailor Fleming Insurance

5

800/796-8495

www.cailorfleming.com

College Park Industries

25

800/728-7950

www.college-park.com

ComfortFit Orthotic Labs Inc.

20

888/523-1600

www.comfortfitlabs.com

Coyote Design

21

800/819-5980

www.coyotedesign.com

Ferrier Coupler Inc.

39

810/688-4292

www.ferrier.coupler.com

Hersco

1 800/301-8275 www.hersco.com

LIM Innovations

9

844/888-8LIM

www.liminnovations.com

Ottobock

C4 800/328-4058 www.professionals.ottobockus.com

Spinal Technology Inc.

33

800/253-7868

www.spinaltech.com

Touch Bionics

7

855/694-5462

www.touchbionics.com

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APRIL 2017 | O&P ALMANAC

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac17 for advertising options.

ALPS SP High-Density Liner The SP High-Density Liner features black fabric that allows for stability for active patients. The SP Liner has similar characteristics as silicone but provides the superior comfort of gel.

For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Custom Stealth Foot Orthotics Custom carbon fiber foot orthotics—and boy, are they pretty.

And strong. And lightweight. Trusted to protect the feet of our service members, this beauty goes more than skin deep. Fabrication available from foam boxes or Amfit digital files in two rigidities (firm or flex).

Corrections and adjustments are molded into the carbon fiber to eliminate movement of pads and edges during wear. EVA heel counter maintains stability in the shoe or boot.

Contact our customer service team to learn more today, orders@amfit.com or 800/356-FOOT(3668), x250.

Foam Box Lab Services for Diabetic, EVA, and Rigid Orthotics FootPrinter allows you to send your own boxes or use ours. Standard EVA orders manufactured in three to four business days; diabetic A5513, carbon fiber, and polypro in three to five days.

PDAC-approved A5513 diabetic pricing includes shipping costs for bi-lam and tri-lam styles. EVA available in soft, medium, dual, firm, and cork blend.

Carbon fiber fabrication offered in flex or firm to best suit your patient. Milled polypropylene available in three widths and thicknesses for excellent fit and wear.

Get started right away by emailing orders@amfit.com for an account form, or call 800/356-FOOT.

MARKETPLACE

New Shuttle Lock From College Park The College Park C100 cylindrical shuttle lock is made from a high-strength durable nylon and used as a traditional lock system for lower-limb prosthesis users. Retrofitable with similar shuttle locks, the C100 is lightweight and provides a secure fit, and the push pin can easily be cut to the appropriate length for the prosthesis.

The C100 lock is rated to 300 lbs with a two-year warranty and comes with two ratchet plunger pins with five different lengths from extra short to extra long.

Learn more at https://www.college-park.com/lower-limb/ shuttle-lock-systems.

Coyote Design Glue Sale Coyote Design is having a glue sale. Consult your distributor for special pricing.

We now have two glues to choose from: • Coyote Quick Adhesive— 30-second set time.

• Coyote Smooth Adhesive—new 60-second set time option.

Coyote’s glues are great for attaching componentry and multiple repairing uses. They ship nonhazardous and are safe with no odor. Visit www.coyotedesign.com.

Coyote Composite Coyote Composite is tough yet flexible. Ideal for AFOs and prosthetics.

• Costs less than carbon fiber; we guarantee it.

• Less itch than carbon fiber.

• Edges finish smooth.

Go to www.opqschool.com to learn more about Coyote Composite by taking our online course, “Alternatives to Carbon Fiber,” and earn 2.5 (S) CE-accredited continuing education credits. (Currently at no charge—offer good through July 1, 2017.)

Coyote Composite is a product of Coyote Design, visit www.coyotedesign.com.

O&P ALMANAC | APRIL 2017

55

MARKETPLACE 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.

3R62 Pheon Due to its swing phase control and stance phase security, the polycentric knee joint 3R62 Pheon is especially suitable for amputees with low mobility. The 3R62 is an ideal option to help patients achieve therapeutic objectives of restoring their ability to stand and safely walk. There are two versions of the knee: • The 3R62 includes a manual lock that can be engaged by patients for added security.

When the patient progresses to walking more securely, you can deactivate the manual lock.

• The 3R62=N does not include the manual lock feature.

Call your local sales representative at 800/328-4058 or go to professionals.ottobockus.com.

Dynamic Vacuum (DVS) The Dynamic Vacuum (DVS) bridges the gap between valve and Harmony socket technology.

Integrating innovative design with simplicity, the DVS reduces the movement between the limb and socket associated with limb volume fluctuations. The DVS generates vacuum during walking and maintains this elevated vacuum in both swing and stance phase. This sets it apart from passive systems, such as valve, where a vacuum is only generated in the swing phase.

Increased suspension forces and intimate fit enhances the user’s perception of the ground beneath them. Dynamically, it adjusts to the user’s activity level.

Call your local sales representative at 800/328-4058 or go to professionals.ottobockus.com.

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APRIL 2017 | O&P ALMANAC

Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with 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 Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses.

For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

Livingskin

livingskin devices are hand-crafted from high definition silicone and hand-painted to match skin tone and appearance.

In addition to the realistic appearance of our livingskin products, it’s important to remember that passive prostheses like these still have important functional capabilities. This includes actions such as: • Pushing • Pulling • Stabilizing • Supporting • Light grasping • Typing For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

CAREERS

Opportunities for O&P Professionals Job location key:

O&P Almanac Careers Rates

- Northeast - Mid-Atlantic - Southeast - North Central

Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

- Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@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.

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

Job Board

Member Nonmember $85 $150

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

Career Opportunities...

Oregon

Medford, CPO

California

Fresno, CP/CPO Sacramento, CP/CPO Salinas, CO

Washington

Richland, CP/CPO 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 foremast as demonstrated by our positive attitude, teamwork and professionalism.�

O&P ALMANAC | APRIL 2017

57

CALENDAR

2017

May 10

April 10-11

2017 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars.

Denver. The Westin Denver Downtown, 1672 Lawrence Street, Denver, CO 80202. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

April 12

Grassroots Advocacy. Register Webinar Conference online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

April 25-26

Amputee Coalition Hill Day. Washington, DC. To register or for more info, email federal@amputee-coalition.org or call 888/267-5669, ext. 7102.

May 1

ABC: Application Deadline for Certification Exams.

Applications must be received by May 1 for individuals seeking to take the July Written and Written Simulation and Summer Practitioner CPM exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

May 8-13

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 250 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

www.bocusa.org

AOPA Policy Forum. Washington, DC. Come make a difference! Educate Congress on issues affecting your patients. For more information, contact Devon Bernard at dbernard@AOPAnet.org or call 571/431-0876.

June 1

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

June 8-9

Michigan Orthotics & Prosthetics Association Continuing Education Seminar. DoubleTree by Hilton Hotel Bay City—Riverfront. Exhibitor and Sponsorship Opportunities Available! Attendees earn CE credits! For more information and registration, please contact Amy Shea at MichiganOPA@gmail.com or 810/733-3375.

June 14

Internal Audits: The Why and the How of Conducting Self-Audits. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

Let us

your next event!

Free Online Training

Cascade Dafo Institute. Now offering a series of seven free ABC-approved online courses, designed for pediatric practitioners. Earn up to 10.25 CEUs. Visit cascadedafo.com or call 800/848-7332.

CE For information on continuing education credits, contact the sponsor.

Questions? Email landerson@AOPAnet.org.

Calendar Rates

58

May 24-25

Apply Anytime!

Apply anytime for COF, CMF, CDME; test when ready; receive results instantly. Current BOCO, BOCP, BOCPD candidates have three years from application date to pass their exam(s). To learn more about our nationally recognized, in-demand credentials, or to apply now, visit www.bocusa.org.

SHARE

Modifiers: What Do They Mean and When Should They Be Used? Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

CREDITS

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 landerson@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.

APRIL 2017 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR June 16-17

PrimeFare East Regional Scientific Symposium 2017. Renaissance Hotel & Convention Center, Nashville. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

July 1

ABC: Application Deadline for Certification Exams.

Applications must be received by July 1 for individuals seeking to take the September ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

July 12

Know Your Resources: Where To Look To Find the Answers. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

July 17-18

2017 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars.

Pittsburgh. The DoubleTree by Hilton Hotel and Suites Pittsburgh Downtown, One Bigelow Square, Pittsburgh. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

August 4-5

October 26-27

International African-American Prosthetic Orthotic Coalition Annual Meeting. Atlanta Marriott Suites Midtown, 35 14th Street NE, Atlanta, GA, 30309. For more info, visit www.iaapoc.org or contact Tony Thaxton Jr. at thaxton.jr@comcast.net or 404/875-0066.

November 5-11

Health-Care Compliance & Ethics Week 2017. AOPA will be celebrating Health-Care Compliance & Ethics Week and will be providing resources to help members celebrate.

November 6-7

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

Phoenix. Sheraton Grand Phoenix, 340 N. 3rd Street, Phoenix.

Book by October 13 for the $179 rate by calling 800/325-3535 or by calling the hotel directly at 602/262-2500. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

November 8

Gift Giving: Show Your Thanks and Webinar Conference Remain Compliant. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

December 13

New Codes and Other Updates for 2018.

Webinar Conference Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

The Texas Chapter of the American Academy of Orthotists and Prosthetists 2017 Annual Meeting.

Westin Galleria, Dallas. For information and registration, visit www.txaaop.org.

BUILD A

August 9

Better

What the Medicare Audit Data Tells Us and How To Avoid Common Errors.

Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

BUSINESS WITH AOPA

September 6-9

100th AOPA National Assembly and Second World Congress. Las Vegas. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

September 13

ABC Inspections and Accreditation.

Webinar Conference Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Visit www.AOPAnet.org/join today!

Learn how AOPA can help you transform your business into a world class provider of O&P Services with: Coding, Billing, and Audit Resources Education, Networking, and CE Opportunities Advocacy

October 11

AFO/KAFO Policy. Register online at Webinar Conference bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Research and Publications Business Discounts

O&P ALMANAC | APRIL 2017

59

ASK AOPA CALENDAR

Labor Codes and Beyond Answers to your questions regarding repairs and adjustments, interest rates, and more

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry.

Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Q

prosthetics, orthotics, and supplies (DMEPOS). The reason the fees are not published with the DMEPOS fee schedule is because they are calculated differently than the other DMEPOS codes. The 2017 O&P labor (L4205, L7520) fee schedule is located in a MLN Matters article, Number MM98.

• Practice independently of a physician.

• Bill Medicare for other services under his or her own provider number.

• Be legally permitted to perform the tasks in the state in which the item is being delivered.

What is the current interest rate for Medicare overpayment and underpayment requests?

Q/

As of Jan. 19, 2017, the interest rate is set at 9.5 percent, which is a decrease of 0.125 percent from the previous quarter. The interest rates are adjusted quarterly by the U.S. Department of the Treasury. Over the past few years, the interest rate for overpayments and underpayments has fluctuated between 9.5 percent and 10.75 percent.

A/

What is included with the time/ labor component of the L4205 and L7520 codes, and does Medicare publish fees for these codes?

Q/

The labor codes include only the time associated with conducting the physical repair or adjustment of orthoses or prostheses.

These codes do not include things such as evaluations, education/training, taking measurements, follow-up visits, etc.

Medicare publishes and establishes fees for the labor codes; however, the fees are not typically included or published with the regular fee schedule for durable medical equipment,

A/

60

APRIL 2017 | O&P ALMANAC

Are nurse practitioners and physician assistants eligible to document medical necessity, order O&P services, and sign detailed written orders (DWOs)?

Q/

Yes, nurse practitioners (or clinical nurse specialists) and physician assistants are eligible under Medicare guidelines to order orthotic and prosthetic items/services, sign detailed prescriptions, and document medical necessity. However, there are some criteria that must be met.

In order for a nurse practitioner to prescribe an item and sign the detailed prescription, he or she must: • Be treating the patient for the condition for which the item is needed.

A/

For a physician assistant to prescribe an item and sign the detailed prescription, he or she must: • Meet the definition of a physician assistant, as defined in the Social Security Act. • Be treating the patient for the condition for which the item is needed.

• Practice under the supervision of a physician, either a doctor of medicine or a doctor of osteopathy.

• Have his or her own national provider identifier number.

• Be legally permitted to perform services in accordance with state law.

Keep in mind that if policy requires a specific action to be completed by a physician, then the action must be completed by a physician. For example, nurse practitioners and physician assistants may document the medical necessity for diabetic shoes, but they may not sign the certifying statement for diabetic shoes and inserts.

#AOPA2017

Make plans to participate in a

HISTORICAL EVENT The second World Congress combined with AOPA’s 100th Anniversary Celebration will take place in Las Vegas, Nevada on September 6-9, 2017.

WHY YOU SHOULD ATTEND:

• Celebrate 100 years of the formalized O&P Profession in the United States.

• Clinical Education so remarkable that it will be memorialized in an international scientific journal.

• The best speakers from around the world. Hear from physicians, researchers and top-notch practitioners.

• The largest exhibit hall in the Western Hemisphere will feature devices, products, services, tools and the latest technology from exhibitors around the world.

• Earn 35+ continuing education credits.

• Participate in hands-on learning and demonstrations during workshops

THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.

LAS VEGAS AOPAnet.org

• Preparation for the changes that U.S. Healthcare reform is sure to bring and its influence on global health policy.

• Networking with an elite and influential group of professionals.

• Ideal Las Vegas location, chosen for its popularity, travel ease excitement.

Visit AOPAnet.org to learn more.

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