The Magazine for the Orthotics & Prosthetics Profession
AP R I L 2018
E! QU IZ M EARN
4
BUSINESS CE
CREDITS PP.17 & 43
Re-Examining Documentation Practices P.16
Pediatric Orthotics: Teaming With PTs P.32
When Do You Need a Business Associate Agreement? P.40
Translational Research in O&P
Telling the
O&P Story O&P ADVOCATES SHARE THEIR MESSAGES WITH LEGISLATORS AT THE AOPA POLICY FORUM P.20
WWW.AOPANET.ORG
P.44
This Just In: CMS Sets Fee Schedule for Code K0903 P.18
YOUR CONNECTION TO
EVERYTHING O&P
THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.
PASSPORT
INNOVATION
Vancouver is easy to explore during your time at the downtown Vancouver Convention Centre as there are many nearby top attractions. • • • • • •
Capilano Suspension Bridge Vancouver Aquarium Forbidden Vancouver Stanley Park Horse-Drawn Tours Harbour Cruises & Events Flyover Canada
• Vancouver Lookout • Dr. Sun Yat-Sen Classical Chinese Garden • Vancouver Art Gallery • Science World • Grouse Mountain
Experience Beyond Vancouver’s unbeatable location makes it the perfect gateway to the rest of British Columbia and beyond, providing you with outstanding opportunities for pre- and post-conference travel. • Whistler • Okanagan Valley • Jasper • Victoria • Banff • Cruise to Alaska
AOPAnet.org
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Experience all the AOPA National Assembly has to offer while visiting Vancouver.
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contents
APR I L 2018 | VOL. 67, NO. 4
COVER STORY
FEATURES
20 | Telling the O&P Story Building on the momentum from the recent O&P clinician note victory, participants at the 2018 AOPA Policy Forum were encouraged to “tell their story” when advocating for O&P patients and the profession. Several attendees describe their visits with legislators, explaining how they emphasized the impact of O&P services on patients’ lives and called for the enactment of the remaining provisions from the Medicare O&P Improvement Act. By Lia K. Dangelico and Josephine Rossi
18 | This Just In
Equitable Reimbursement
The O&P community scored a win with the announcement that the fee schedule for code K0903—a temporary code that describes custom-fabricated, direct-milled diabetic inserts—has been set at the same amount as the current fee schedule for code A5513. The decision is important not only for what it represents for providers of diabetic inserts, but also for the precedent that it sets for future issues involving the use of scanning and other technologies.
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APRIL 2018 | O&P ALMANAC
32 |
The PT Connection
Teaming up may be the best solution for orthotists treating pediatric patients who also require intervention from physical therapists (PTs). During joint collaborations, clinicians can work with PTs to devise optimal solutions, taking into account information about mobility and related issues gleaned from PTs during previous interactions. In addition, fostering relationships with PTs can lead to referrals as well as new business opportunities for orthotists. By Christine Umbrell
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* Responsibility for accurate coding lies solely with the provider treating the patient. Össur assumes no responsibility or liability for the provider’s coding decisions. Össur’s coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system.
© Össur, 02.2018
contents
PRINCIPAL INVESTIGATOR Michael Dillon, BPO (Hons), PhD.....................................44 A professor and researcher at Australia’s La Trobe University details his career path and discusses the importance of translational research in the O&P field.
DEPARTMENTS Views From AOPA Leadership..........5 AOPA Vice President Jeffrey Lutz, CPO, details research priorities
AOPA Contacts.......................................... 6 How to reach staff
Numbers......................................................... 8 At-a-glance statistics and data
Happenings............................................... 10 Research, updates, and industry news
COLUMNS Reimbursement Page.......................... 16
Chronological and Consistent
Documentation tips for newly recognized O&P clinician notes CE Opportunity to earn up to two CE credits by taking the online quiz.
CREDITS
P.13
Compliance Corner.............................. 40
Getting Down to Business
People & Places........................................14
Business associates and patients’ right to access CE Opportunity to earn up to two CE credits by taking the online quiz.
Transitions in the profession P.16
CREDITS
AOPA meetings, announcements, member benefits, and more
Member Spotlight................................ 48 n
Medcuro
n
Ferrier Coupler
AOPA News...............................................52
PAC Update............................................... 53 Careers.........................................................54 Marketplace.............................................. 55 P.40
Ad Index...................................................... 57 Calendar......................................................58 Upcoming meetings and events
Ask AOPA.................................................. 60 Audits and the Target, Probe, and Educate Program
P.48
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P.50
VIEWS FROM AOPA LEADERSHIP
Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.
Research Priorities
A
S REIMBURSEMENT FOR HEALTH CARE continues to migrate from fee-for-service
Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Chris Nolan Ottobock, Austin, TX Vice President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Immediate Past President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, MPH, PhD Orthocare Innovations LLC, Edmonds, WA Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Thuasne USA, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX
to fee-for-value, proving the efficacy and proper application of O&P care remains our industry’s single biggest challenge and priority. What we have always accepted as common knowledge—that O&P care helps patients and saves money—is simply not enough to ensure our future. Our medical practice must become evidence and outcome based. The type of research needed in today’s health-care environment will support the clinical efficacy and application of our care, rather than research to support new product features and design for their own sake. This statement is not meant to discourage the next revolutionary iteration of a device but to emphasize the basic need to provide scientific evidence of efficacy and better outcomes in patients who receive our care. The high level of training offered in the O&P master’s degree and doctorate programs is preparing tomorrow’s leaders in clinical research and practice. I recently heard Jón Sigurðsson, president and chief executive officer of Össur, compare modern prosthetists’/orthotists’ lack of formal fabrication training with physician training that used to teach doctors how to grind and compound specific medicines. The old training has not only lost its relevance, but been replaced with relevant training in scientific research. We are in a great position to better serve our patients and advance our profession by leveraging this training. Examples of recent AOPA-supported research studies that support evidence-based practice are the RAND Corp.’s “Economic Value of Advanced Transfemoral Prosthetics,” which studies microprocessor knees, and Dobson-DaVanzo’s updated “Medicare Services” data report, which compares Medicare spend for Medicare patients who received O&P care versus those who did not receive a device. Another important study, “Mobility Analysis of AmpuTees (MAAT I),” by Shane Wurdeman, PhD, CP, FAAOP, Phillip Stevens, MEd, CPO, FAAOP, and James Campbell, PhD, CO, FAAOP, was recently published in Prosthetics and Orthotics International. This research consistently obtained outcome measures from 509 patients with a lower-limb prosthesis. Mobility was found to be positively correlated with quality of life. This is exactly the kind of information that starts to support value of care. A basic challenge we have is to apply what we learn from the outcomes of the population of our patients to the unique case of the individual for whom we are providing care. Outcomes data must be utilized to learn how to best treat individuals, and not just reduce each clinical encounter to the lowest common denominator proven in a population. This is why it is imperative for prosthetists and orthotists to assert and maintain a leading position in all of our priorities. As clinical efficacy research becomes our profession’s priority, it is evident that there is a clear need for a patient registry. A patient registry is a broad collection of standardized information about a group of patients who share a condition or experience. A registry will provide researchers a real-world view of clinical practice, patient outcomes, safety, and comparative effectiveness. AOPA and other industry organizations are engaged in ongoing efforts toward the funding and formulation of an O&P patient registry. To be most effective, the registry will ultimately rely on each of our practice’s participation to collect data across the entire profession. For the sake of our profession and patients, we should all be ready to contribute. Jeffrey Lutz, CPO, is vice president of AOPA.
O&P ALMANAC | APRIL 2018
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AOPA CONTACTS
American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org
Publisher Thomas F. Fise, JD Editorial Management Content Communicators LLC
Our Mission Statement Through advocacy, education, and research, AOPA improves patient access to quality orthotic and prosthetic care.
Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan
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
Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org Don DeBolt, chief financial officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@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 Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, assistant manager of meetings, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865
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 Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com
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APRIL 2018 | O&P ALMANAC
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 © 2018 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
Advertise With Us! Reach out to AOPA’s membership and more than 11,800 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac18 for advertising options!
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NUMBERS
Paralympic Domination Team USA outscores the competition
TEAM USA DEMOGRAPHICS
The United States came away from the 2018 Winter Paralympic Games in PyeongChang, South Korea, with the highest number of medals of any country and a team victory in sled hockey.
TEAM USA MEDALS BY EVENTS
13
18
Military veterans
Returning Paralympians
36
Total medals during the 2018 Games
ON-SITE REPAIRS
15
Four
Skiing medals: six in alpine and nine in cross country
Seven
Biathlon medals
One
23
Technical service repair centers located throughout the PyeongChang venues
Ottobock experts on site to repair prostheses, wheelchairs, and other devices
300 Square Meters
10
Languages spoken by Ottobock experts
Size of repair center located in Athletes’ Village
Sled hockey medal: a Gold for Team USA in a 2-1 victory over Canada
PHOTO: Buda Mendes/Getty Images
Snowboarding medals: six in snowboard cross and seven in banked slalom
41
74
Qualified athletes
“I’ll just throw it out there. Declan Farmer, in my eyes, is the
Team United States
Total Medals
Gold
Silver
Bronze
36
13
15
8
Canada
28
8
4
16
Neutral Paralympic Athletes
24
8
10
6
Ukraine
22
7
7
8
France
20
7
8
5
SOURCE: www.teamusa.org/pyeongchang-2018-paralympic-winter-games
8
greatest player alive.
APRIL 2018 | O&P ALMANAC
He’s the best overall sled hockey player to ever play the game.” —Team USA Goalie Steve Cash, after Farmer scored a goal in the last minute of regulation time to tie the game and scored the winning goal in overtime
SOURCES: www.teamusa.org; www.paralympic.org
2018 Paralympics: Total Medals for Top Five Finishers
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www.fillauer.com Š 2018 Fillauer LLC
Happenings RESEARCH ROUNDUP
Researchers Restore Movement Sensation in Upper-Limb Amputees
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APRIL 2018 | O&P ALMANAC
Illusory movement perception improves motor control for prosthetic hands.
portion of the upper arm that remained intact. When the participants’ reinnervated muscles were vibrated, providing illusory movement, they reported feeling their missing limbs move and were able to use the sensations to intentionally manipulate prosthetic devices to accurately guide complex grips. Once they had acclimated to the new system, study participants were able to carry out several tasks while blindfolded. “When you make a movement and then you feel it occur, you intrinsically know that you are the author of that movement and that you have a sense of control, or ‘agency,’ over your actions,” said Marasco. “People who have had an amputation lose that feeling of control, which leaves them feeling frustrated and disconnected from their prosthetic limbs. The illusions we generate restore the sensation of movement and re-establish their sense of agency over their prosthetics. This helps people with amputation to feel more in control.” Future applications include wearable
Cleveland Clinic Lerner Research Institute researcher manipulates prosthetic arm.
or other feedback systems that might allow amputees to guide and control their prostheses intuitively, according to the researchers. In addition to the limb loss population, the approach also may aid individuals impaired by stroke, movement disorder, or spinal injury, said Marasco. Details of the study were published in the March 14 edition of Science Translational Medicine.
IMAGES: Courtesy of Cleveland Clinic
Scientists from the Cleveland Clinic’s Lerner Research Institute have devised a robotic system that delivers vibrations to the muscles in an amputee’s arm when a prosthetic hand moves. The location and intensity of the vibrations reportedly create an illusory “kinesthetic sense” that amputees are moving their own hand. The researchers, led by Paul Marasco, PhD, used small robots to vibrate specific muscles to jumpstart study participants’ sensation of movement, allowing them to feel that their fingers and hands were moving and that they were an integrated part of their own body. “Decades of research have shown that muscles need to sense movement to work properly. This system basically hacks the neural circuits behind that system,” said James W. Gnadt, PhD, program director at the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health, which partially supported the study. “This approach takes the field of prosthetic medicine to a new level, which we hope will improve the lives of many.” The researchers began by working with able-bodied volunteers and mapping the most effective system of feedback. Using that information, they devised a menu of vibrations that would signal 22 separate hand movements. The team then worked with six upper-limb amputees who had undergone targeted nerve reinnervation, a procedure that establishes a neuralmachine interface by redirecting amputated nerves to remaining muscles. Using a hand-held vibration unit, they delivered a slight buzz to muscles in the
HAPPENINGS
DATA DOWNLOAD
STANDARDS CENTRAL
Could an 'Insider' Be the Cause of a Data Breach at Your Facility? More than half of data breaches involving protected health information (PHI) involve internal actors, according to Verizon’s “2018 Protected Health Information Data Breach Report.” The report, which analyzed 1,368 security incidents with a focus on the health-care sector, found that 58 percent of PHI breaches involved organization insiders. The report focused on incidents where medical record information was either confirmed as disclosed or at risk. “Health care is the only industry in which internal actors are the biggest threat to an organization,” according to Verizon. These internal breaches are often “driven by financial gain,” the report noted, with the responsible parties engaging in tax fraud or opening lines of credit with stolen information (48 percent); looking up the personal records of celebrities or family members for fun or curiosity (31 percent); or violating the laws out of simple convenience (10 percent).
While breaches of electronic medical records were most prevalent, the researchers found that 27 percent of incidents were related to the exposure of sensitive data on paper. “The very nature of how PHI paperwork is handled and transferred by medical staff has led to preventable weaknesses,” wrote the authors of the report. Examples of at-risk paperwork included sensitive data being misdelivered (20 percent), thrown away without shredding (15 percent), and lost (8 percent). Lost and stolen laptops containing unencrypted PHI accounted for 21 percent of breach incidents. The study authors suggested that “more employee education is required to ensure that basic security measures are put in place.” Having an overall incident response plan in place, should a cyberattack occur, “will also enable quicker reactions, and can often make a difference to the level of impact an incident has on an organization.”
CMS Launches Patient Data Initiative CMS Administrator Seema Verma has announced the launch of a new initiative called “MyHealthEData.” The goal of the project is “to empower patients by giving them control of their health-care data and allowing it to follow them through their health-care journey,” according to the CMS website. The initiative is being led by the White House Office of American Innovation, with participation from the U.S. Department of Health and Human Services and the U.S. Department of Veterans Affairs. “MyHealthEData will help to break down the barriers that prevent patients from having electronic access and true control of their own health records from the device or application of their choice. Patients will be able to choose the provider that best meets their needs
and then give that provider secure access to their data, leading to greater competition and reducing costs,” according to the CMS announcement. “The MyHealthEData initiative will work to make clear that patients deserve to not only electronically receive a copy of their entire health record, but also be able to share their data with whomever they want, making the patient the center of the health-care system. Patients can use their information to actively seek out providers and services that meet their unique health-care needs, have a better understanding of their overall health, prevent disease, and make more informed decisions about their care.” Details on the implementation of the initiative will be reported as they become available.
Committee Develops Standards for Exoskeletons and Exosuits
A new committee from ASTM International, Committee F48 on Exoskeletons and Exosuits, held its first meeting in February. The committee was developed in response to a growing need for technical standards alongside the rising use of exoskeletons in manufacturing, military, health, and other applications. Donald R. Peterson, PhD, the dean and a professor of mechanical engineering at the College of Engineering and Engineering Technology at Northern Illinois University, chairs the committee. One of the group’s first standards will support terminology that defines vocabulary, fosters a common understanding of key terms, and supports future technical standards. Other subcommittees and task groups will focus on design and manufacturing issues such as energy storage systems and passive versus active systems; human factors and ergonomics issues including usability, safety, training, and anthropometric variables; task performance and environmental considerations; maintenance and disposal issues, including decontamination; and security and information technology, including data privacy. O&P ALMANAC | APRIL 2018
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HAPPENINGS
MEETING MASHUP
UCSF To Host Innovative Technologies Conference The University of California—San Francisco will host the Orthotic and Prosthetic Innovative Technologies Conference in San Francisco May 11-12. The conference aims to foster emerging technologies that can advance patient care and have a transformative impact on the O&P field. The conference is expected to draw clinicians, business owners, scientists, researchers, and investors engaged in the development of O&P technologies and systems. Attendees will take part in informational sessions and browse exhibits. Learn more at optech.ucsf.edu. FAST FACT
The global foot and ankle devices market is expected to reach
$3.4 billion by 2025. The market is expected to undergo exponential growth during the forecast period due to the rising incidence of ankle sprains, hammertoe, bunions, osteoporosis, and rheumatoid arthritis. SOURCE: “Global Orthopedic Device Market 2018-2012”
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APRIL 2018 | O&P ALMANAC
AWARENESS EFFORTS
O&P Community Celebrates Limb Loss Awareness Month The Amputee Coalition is once again celebrating National Limb Loss Awareness Month in April. The organization has several events planned for the month, with an overarching goal of celebrating the limb loss community as a whole, and shining a spotlight on the issues and accomplishments of the limb loss and limb difference community. Following the visibility of amputee athletes during the 2018 Paralympic Games, the Amputee Coalition plans to “translate the heightened awareness of limb loss into understanding and support,” said Karen Lundquist, chief
communication officer for the organization. “We’re planting those seeds with a series of activities and advocacy scheduled to build awareness.” Planned activities include requesting state proclamations and federal recognition of the month, hosting webinars on advocacy and “person-first language,” a Friday Facebook focus on peer visitors, “Show Your Mettle” Day on April 28, and Hill Days April 16-17. During Hill Days, 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.
INSURANCE INSIGHTS
AOPA Comments on Proposed Rule That Would Redefine ‘Employer’ AOPA submitted comments in March regarding a proposed rule that would change the definition of the term “employer” as it relates to association health plans and the requirement to cover Essential Health Benefits (EHBs) under provisions of the Affordable Care Act (ACA). The proposed rule states that by expanding the definition of the term “employer,” association-based health plans will have new opportunities to negotiate terms with insurance companies, which could benefit their members. Of primary concern to AOPA is that the proposed expansion of association health plans will significantly reduce the requirements for these plans to provide coverage for health
benefits, including orthotics and prosthetics, which have been designated as EHBs by provisions of the ACA. “AOPA’s interest in this proposed rule is limited only to our concern that prosthetic and orthotic patients retain the right to reasonable coverage of devices that have literally transformed their lives,” wrote AOPA Executive Director Thomas F. Fise, JD. “Any proposal that reduces access to high-quality, clinically appropriate care should be considered universally unacceptable even if the intent of the proposal is not to directly deny access to needed health-care services. The positive and negative impact on patients must be paramount before any regulation is finalized.”
HAPPENINGS
NATIONAL ASSEMBLY NEWS
AMPUTEE ATHLETICS
Top Off Your Conference Experience With an Excursion to Whistler
First Amputee Runner Completes World Marathon Challenge
Join AOPA for the 2018 AOPA National Assembly in Vancouver, British Columbia, September 26-29, and use this event as your jumping off point to explore more of Canada: Consider a day trip to the town of Whistler. Just a two-hour drive from downtown Vancouver, Whistler is internationally known as one of the world’s leading ski resorts and as Vancouver’s partner city for the 2010 Olympic and Paralympic Winter Games. The scenic Sea-to-Sky Highway makes the journey the destination. Along the route, there are several opportunities for stops, including the
Britannia Mine Museum, the Sea-to-Sky Gondola in the small town of Squamish, and natural highlights such as Shannon Falls and Brandywine Falls. Enjoy a stroll around Whistler Village to pick up souvenirs to take home, and find a scenic lunch spot. Rental cars are available at most hotels. In addition, buses and escorted tours are available.
AMPUTEE ATHLETICS
NFL Prospect With Prosthesis Impresses Scouts Shaquem Griffin, who played defensive back at the University of Central Florida (UCF) and was named the 2018 Peach Bowl Defensive MVP, completed 20 repetitions of 225 pounds on the bench press at the National Football League (NFL) Combine in March. Griffin, a hand amputee, completed the feat using a prosthetic device clamped to the weight bar. Griffin was born with amniotic band syndrome affecting his left hand, and had his hand amputated at age four. Throughout his youth, he competed in track, baseball, and football alongside
his twin brother Shaquill, also a football player at UCF. He earned recognition as the American Athletic Defensive Player of the Year in 2016, with 57 solo tackles, 11.5 sacks, and one interception. For the 2017 season, he was a first-team all-conference choice. Though not initially invited to the combine, the NFL extended an invitation to Griffin after an impressive Senior Bowl performance. During the combine he also showcased his speed, running a 4.38-second 40-yard dash. Griffin hopes to be selected by one of the NFL teams during the draft April 26-28.
Sarah Reinertsen crossing the final finish line in Miami Team Össur member Sarah Reinertsen has become the first amputee runner to complete the 777 World Marathon Challenge, running seven half-marathons on seven continents in seven days. Reinertsen raised awareness of other-abled athletes and funds for the Challenged Athletes Foundation while running a total of 148 kilometers, or 92 miles, in Novo, Antarctica; Cape Town, South Africa; Perth, Australia; Dubai; Lisbon, Portugal; Cartagena, Colombia; and Miami, Florida. Reinertsen also is the first female leg amputee to run all seven continents on the globe.
Reinertsen running in Cartagena, Columbia O&P ALMANAC | APRIL 2018
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PEOPLE & PLACES PROFESSIONALS
THE LIGHTER SIDE
ANNOUNCEMENTS AND TRANSITIONS
Chris Fink, MSPO, CPO, LO, has joined the clinical practice of Fillauer Orthotics and Prosthetics. Fink will be specializing in fitting the latest lowerand upper-extremity prosthetic technology. Fink earned his bachelor’s degree in exerChris Fink, MSPO, cise science from Ithaca College in 2007, CPO, LO followed by a master’s degree in prosthetics and orthotics from Georgia Tech in 2009. He completed his residency with Atlanta Prosthetics and Orthotics and became a clinical manager for Hanger Clinic in Atlanta. Cecilia (Cissi) Schaffer has been appointed chief executive officer and chair of the Board of Managers at Create Orthotics & Prosthetics, which offers custom-designed, 3-D-printed leg covers as well as 3-D printers, software, and education for O&P clinicians. Founder and former chief executive officer Jeff Erenstone, CPO, will assume the role of chief technology officer at Create. “This is an important step in the next phase of Create’s development and expansion,” says Erenstone. “This will allow me to fully Jeff Erenstone, CPO embrace my role as chief technology officer and put my full energy into developing and testing new products, which is what led me to start this company.”
BUSINESSES ANNOUNCEMENTS AND TRANSITIONS
O&P Labs has opened the Prosthetic Center, a full-service practice space, in Springfield, Massachusetts. Co-owners Jim Haas, CO, and Blaine Drysdale, CP, MSPT, hosted Springfield Mayor Domenic Sarno and state Rep. Carlos González (D), along with team members, patients, medical care providers, friends, and family, for a ribbon-cutting ceremony on February 15. The new space features reallife experiences including a bike trainer, ramp, solo step track system, parallel bars, private rooms, and more.
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APRIL 2018 | O&P ALMANAC
Mark Your Calendar!
REIMBURSEMENT PAGE
By JOSEPH MCTERNAN
E! QU IZ M EARN
2
BUSINESS CE
CREDITS P.17
Chronological and Consistent Recognition of O&P clinical notes comes with a responsibility to provide thorough and accurate documentation
Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.
CE
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F
OR MANY YEARS, AOPA has fought
to have the clinical notes of orthotists and prosthetists included in patients’ medical records for purposes of medical review. It has been a long battle that has faced many obstacles. At times, it felt like the effort was futile, but finally progress has been made. As part of the Bipartisan Budget Act of 2018 that was passed by Congress on Feb. 9, 2018, Medicare must, by law, for the first time ever, consider the clinical notes of orthotists and prosthetists as part of the patient’s medical record when considering the medical necessity of an O&P service. This legal recognition of O&P practitioners as a valuable member of the rehabilitation team is truly a great step forward. That is why it is so important to understand not only how to document, but also what to document and why to document. This month’s Reimbursement Page takes a closer look at clinical documentation from the perspective of the orthotist and/or prosthetist. Documentation is more than just a series of words on a page. It is a process that begins the minute your patient walks through the door and does not end until that patient leaves your care permanently. Documentation tells a story and does so in a chronological
order. It is multifaceted, consisting of more than just the observations of the clinician. It is a valuable part of the overall plan of care and involves more than just the interaction between the clinician and the patient.
Starting the Process
The process of clinical documentation begins the moment the patient walks into your facility. This first interaction, often referred to as the “intake process,” is one of the most important phases of the documentation process. It is here that you gather information from the patient that may be relevant to your plan of care. What is the patient’s medical history? What other health conditions does he or she have that may be relevant to your treatment? What medications does the patient take? What is his or her current weight and height? Have there been any recent changes to the patient’s overall health and well-being? While these are questions that are typically answered by the patient, what you do with that information is as important, if not more important, than the questions themselves. Good documentation practices use that information to build a picture of the patient’s status before they enter your care and are a valuable part of the medical record.
REIMBURSEMENT PAGE
The Patient Encounter
While documentation begins at intake, the documentation process at each patient encounter is arguably the most important part of the equation— especially when using your documentation to defend your treatment decisions. The key to proper documentation is consistency. Documentation is a process and should be treated as one. Documentation should always be chronological, and an outside observer should be able to follow the path of the patient’s clinical treatment by reading the clinical notes of the practitioner. Several formats can be used to document clinical care, but the “SOAP format” is the most commonly accepted. “SOAP” is an acronym that stands for “subjective, objective, assessment, and plan.” The SOAP format uses a repeatable process that allows the clinician to document the chronological progress of the patient through the treatment process. The process begins with subjective documentation (S): what the patient is reporting. What are his or her symptoms? How is he or she feeling today? If treatment is a result of an injury, how did that injury occur? Subjective documentation is limited only to those things that are being reported by the patient or the caregiver. The process continues with objective documentation (O): what the clinician observes and how the patient is presenting. Objective documentation includes important information such as the patient’s current height and weight, obvious swelling, skin breakdown or conditions, and overall patient appearance. Objective documentation should be just that—objective. It should be devoid of any conclusions or opinions of the practitioner. Objective documentation should not make assumptions. For example, objective documentation may indicate a deformity at the ankle, but it should not assume there is a fracture unless there is confirmation of the injury via X-ray or other means. This will be handled during the next phase of the documentation process. Objective documentation is important
because it records information regarding the patient’s current state based on the clinical knowledge and expertise of the O&P practitioner. The third step in the SOAP process is the assessment (A): the clinical opinion of the practitioner based on both subjective information provided by the patient and objective information observed by the practitioner. Assessment documentation is where the practitioner relies on his or her clinical knowledge and expertise to determine what is actually affecting the patient. This is the appropriate place to record results of X-rays and clinical tests (e.g., PAVET, AMP Pro, timed-up-and-go test, six-minute walk test, etc.). Assessment documentation is crucial to establishing medical necessity for any proposed treatment of the patient. The final step in the SOAP process is the plan (P): the proposed treatment the practitioner intends to provide based on the previous steps in the process. Documentation of the plan of treatment is crucial to the process as it ties all of the other steps together and documents what will actually be provided to the patient.
Timing and Authentication
The timing of practitioner documentation is just as important as the content. Timely documentation ensures accuracy and helps to establish proper chronology of the delivery of care. Whenever possible, clinical documentation should be recorded during the patient encounter. If this is not possible, documentation should be entered immediately following the patient encounter. The more time that passes between the patient encounter and documentation, the more likely there will be omissions of important information or entry of incomplete documentation. In addition to choosing the proper format for entering documentation, remember that all documentation must be signed and dated by the practitioner creating the documentation. This is crucial in order to authenticate the author of the documentation
Several formats can be used to document clinical care, but the “SOAP format” is the most commonly accepted. “SOAP” is an acronym that stands for “subjective, objective, assessment, and plan.”
as well as the chronology of entries within the medical record. O&P practitioners have a great opportunity to establish their position within the rehab team. The recognition of O&P practitioner notes as part of the medical record is a huge step forward in this process, and proper documentation practices have never been more important. Now is a good time to review your documentation practices to ensure they are on par with the documentation practices of other members of the rehab team. Documentation has always been the key to success, but it has never been more important than it is today. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:
www.bocusa.org
O&P ALMANAC | APRIL 2018
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This Just In
Equitable Reimbursement AOPA secures advocacy victory on reimbursement for custom-fabricated, direct-milled diabetic inserts
T
HE MEDICARE FEE SCHEDULE
for code K0903—a temporary code from the Health-Care Common Procedure Coding System (HCPCS) effective April 1, 2018, that describes custom-fabricated, direct-milled diabetic inserts—has been set at the same amount as the current Medicare fee schedule for code A5513 ($43.56 for most states), which describes custom-fabricated diabetic inserts that are fabricated over a positive model of the patient’s foot. This decision comes at the end of a very long battle, one in which AOPA partnered with the American Podiatric Medical Association (APMA), the O&P Alliance, and the Amputee Coalition. This victory is important because diabetic inserts are not the only product for which scanning processes have evolved; the decision hopefully sets the right precedent for CMS. This development has been a long time coming. In July 2017, the durable medical equipment Medicare administrative contractor (DME MAC) and the pricing, data analysis, and coding (PDAC) contractor issued a joint bulletin stating that in order to meet the definition of “molded to patient model” contained in the descriptor for HCPCS code A5513, diabetic inserts must be fabricated over a physical model of the patient’s foot. The bulletin went on to state that digital or virtual models that were used to direct mill custom inserts are not considered a positive model, and inserts fabricated using this technique do not meet the code requirements of A5513 and
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APRIL 2018 | O&P ALMANAC
This decision sets a precedent for future issues involving the use of scanning and other technology to create alternate manufacturing processes in orthotics and prosthetics. therefore must be billed as A9270, a statutorily noncovered HCPCS code. On Sept. 28, 2017, AOPA and APMA submitted a joint letter to CMS expressing their concern over this bulletin as it represented a significant threat to the use of advanced technology to provide better clinical service. AOPA worked closely with APMA, the O&P Alliance, the office and staff of Rep. Brad Wenstrup (R-Ohio), and the House Committee on Veterans’ Affairs Subcommittee on Health to make sure that this issue remained at the forefront of the discussions. On Nov. 2, 2017, CMS announced a proposed change to the Quality Standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that would include the use of digital or virtual models to direct mill custom diabetic inserts as an acceptable method to meet the definition of “molded to patient model” contained in the code language for A5513. It should be noted
that this code, vital to protecting diabetic patients, had declined in utilization by 14 percent in the prior three years, largely because of unreasonable reimbursement. CMS then held an Open Door Forum call on Nov. 28, 2017, to allow experts to discuss the proposed changes to the DMEPOS Quality Standards. At the forum, CMS announced agreement that the processes were equivalent but also said that the scanned device required less work, and they expected to reduce the fee by about $7 for direct-milled inserts. A long battle ensued, where as a result of congressional pressure, the fee decision was shifted to the very highest levels in CMS. Ultimately, CMS reached the right decision that, as the processes are essentially equivalent, the fee also needs to be identical. One of several arguments AOPA mounted was that CMS’s own manuals say that when one code is “exploded” into two parallel codes, both new codes must retain the same fee. AOPA is proud of this advocacy victory, not only for what it represents for providers of diabetic inserts, but also for the precedent that it sets for future issues involving the use of scanning and other technology to create alternate manufacturing processes in orthotics and prosthetics. AOPA is greatly indebted to Rep. Wenstrup and his staffers, Derek Harley, Nick Uehlecke (of the U.S. House Committee on Ways and Means), and Greg Brooks, for their help, as well as Joe McTernan, Devon Bernard, Ashlie White, and others on AOPA’s lobbying team.
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COVER STORY
Telling the
O&P Story PARTICIPANTS IN THE 2018 AOPA POLICY FORUM SHARE THEIR EXPERIENCES AND EXPLAIN WHY ONGOING O&P ADVOCACY IS ESSENTIAL By LIA K. DANGELICO AND JOSEPHINE ROSSI
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APRIL 2018 | O&P ALMANAC
COVER STORY
NEED TO KNOW • Nearly 100 O&P business owners, clinicians, students, and patients took part in the 2018 AOPA Policy Forum, March 7-8 in Washington, D.C., and leveraged the momentum from the recent recognition of the O&P clinician’s notes to continue to advance the O&P legislative agenda and promote the value of orthotic and prosthetic intervention. • Participants met in a large group on day one of the event and listened to advice and suggestions from Reps. Mike Bishop (R-Michigan) and Peter Roskam (R-Illinois), representatives of the Amputee Coalition, AOPA Executive Director Thomas F. Fise, JD, and other AOPA staff, members, and lobbyists. • Sen. Ben Cardin (R-Maryland) set the tone on day two of the event, which culminated in participants taking part in 500 appointments with legislators or aides from across the spectrum of states and party affiliations.
B
UILDING ON THE MOMENTUM
from a significant legislative win with the recognition of O&P clinical notes as part of the medical record, the 2018 AOPA Policy Forum presented a timely opportunity for O&P stakeholders to advocate for the profession and approach lawmakers regarding additional provisions included in the Medicare O&P Improvement Act. Nearly 100 O&P professionals and patients came together in Washington, D.C., to hear from a panel of experts and members of Congress on March 7 and then take part in 500 appointments with legislators and their aides on March 8 to advance the O&P legislative agenda and promote the efficacy of O&P intervention for patients nationwide. The decision to hold the 2018 Forum earlier than in previous years was strategic, according to AOPA Executive Director Thomas F. Fise, JD. Typically held in May, this year’s event was scheduled just before Congress’s March 23 deadline to pass an omnibus appropriations bill to fund the government for the coming year
• Key talking points included implementation of the O&P notes provision, the remaining provisions in the Medicare O&P Improvement Act, veterans’ issues, licensure and a shortage of qualified O&P providers, education, and a host of other important topics. • This year’s participants felt encouraged by the welcome they received at many of the meetings and said the legislators and aides they spoke with seemed genuinely interested in what they had to say. • Continued progress on O&P legislative and regulatory initiatives will require O&P stakeholders to follow up on meetings from the Policy Forum, reach out to legislators who were not available in March, and participate in future advocacy initiatives spearheaded by AOPA and other industry organizations.
or, alternatively, to pass yet another short-term continuing resolution to fund it for six or so weeks. Fise emphasized the importance of timing. “This could very well be the last piece of legislation to have Medicare on it that comes down the tracks for quite some time,” he told attendees, hoping to make a lasting impact on senators and representatives at a critical time on the legislative calendar. On March 23, Congress passed a $1.3 trillion spending bill to fund the government through September of this year; it was signed into law by President Donald Trump the same day. Reps. Mike Bishop (R-Michigan) and Peter Roskam (R-Illinois) addressed and encouraged attendees on the first day of the event. “I commend all of you for your hard work, for your participation, for being here, and bringing your profession to Washington, D.C.,” said Bishop, who emphasized the positive impact of O&P intervention on communities throughout the country. “Your being here makes a big difference.”
Rep. Mike Bishop (R-Michigan)
O&P ALMANAC | APRIL 2018
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COVER STORY
(Above left) General Session (Top center) Jack Richmond (Bottom left) Michael Oros, CPO, LPO, FAAOP, Rep. Peter Roskam (R-Illinois), and Jim Kaiser, CP
Roskam reminded participants that although advocacy isn’t easy, it’s worth it. “It’s supposed to be challenging, arduous, and difficult to make changes, and it is,” he said. “But that’s not all bad. Because what happens as a result of that is you develop a consensus, and everyone is challenged, and you have to work hard to persuade and to get things done.” Participants also heard from a panel of industry experts—including AOPA staff, lobbyists, board members, and other industry stakeholders—who shared their insights on the O&P notes decision, discussed the seven provisions from the Medicare O&P Improvement Act that have yet to be enacted, and offered advice for advancing O&P’s legislative agenda. Seasoned industry advocacy veterans helped attendees identify “asks” and prepare for their meetings with legislators, and spoke on the power of storytelling. “Everyone has a story,” said Jack Richmond, president and chief executive officer of the Amputee Coalition. “You know it better than anyone else.” He highlighted three key points: “Tell your story. Define the issue. Make the ‘ask’ on each issue.” 22
APRIL 2018 | O&P ALMANAC
(Above right) Rep. Mike Bishop (R-Michigan) Fundraiser (Bottom right) Sen. Ben Cardin (D-Maryland)
Jeffrey Cain, MD, associate and issues regarding a lack of qualified professor of family medicine at the providers in the future, education, and University of Colorado School of a host of other important topics. This Medicine, told his story of being an year’s participants felt encouraged by attending doctor in a hospital’s intenthe welcome they received at many of the meetings and said the legislasive care unit who suddenly became an O&P patient after a trauma incitors and aides they spoke with seemed genuinely interested in what they had dent left him a bilateral below-knee to say. amputee. He encouraged participants O&P Almanac caught up with six to share their trials and successes participants before and after the 2018 to illustrate how O&P helps return Policy Forum to gauge their expecpatients to their lives. “I believe that if you have three things—a motivated tations, capture their takeaways, and amputee; a talented, trained prosthelearn from their stories. tist; and the right technology—you can do anything,” he said. “The same thing Focusing on Follow-Through is true here on Capitol Hill.” of Clinician’s Notes Provision On day two of the event, which Glenn Crumpton, CPO, LPO, CPed, led off with a pep talk from Sen. Ben chief executive officer of Alabama Cardin (D-Maryland), participants Artificial Limb & Orthopedic Service finalized their talking points and “asks” Inc. (AALOS), has been attending and headed to hundreds of meetthe Policy Forum since 2004. “As a third-generation prosthetist/orthotist, ings with legislators and their aides. I have always shared the Ninety-six attendees met same goals to protect our privately to discuss the profession as AOPA and other implementation of the practitioners and facilities in O&P notes provision, the U.S.,” he said. While he’s the remaining proviencouraged by O&P’s recent sions in the Medicare victory in getting clinicians’ O&P Improvement Act, Glenn Crumpton, CPO, notes included in the veterans’ issues, licensure LPO, CPed
COVER STORY
(From left) Juliana Lyn, Rep. Mike Rogers (R-Alabama), Glenn Crumpton, CPO, LPO, CPed, and Zipporah Gunn
Meeting with Alabama office
Meeting with Illinois office
patient’s medical record, “it is important now to encourage our legislators to press CMS to follow up and see that implementation is completed.” Crumpton took advantage of the March 8 meetings to ask for support for various pieces of legislation, including implementation of Section 427 of the Benefits Improvement and Protection Act (BIPA), as well as the Injured Amputee Veterans Bill of Rights. He also focused on an effort in his home state to address the shortage of O&P professionals entering the U.S. workforce, which definitely got legislators’ attention. “We have an HBCU [historically black college or university], Alabama State University, and the College of Health Sciences has one of the 12 MSPO programs in the nation,” he explained. “We [asked] for support to establish the program to have a $15 million, three-year grant known as the Wounded Warrior Education Enhancement Bill. It was important to emphasize the need for educational programs in the U.S. to have assistance and funding needed to expand class size and help fix the problem of a shortage of prosthetists and orthotists.” Crumpton and his group met with aides from the offices of Sens. Doug Jones (D-Alabama), Richard Shelby (R-Alaska), Tammy Duckworth
(D-Illinois), and Joe Manchin practitioners, etc., comes to D.C. and (D-West Virginia), as well as Reps. shares their story, and we need to Terri Sewell (D-Alabama) and Martha have ours heard as well.” Roby (R-Alabama). During the meetings, Crumpton shared the story of Explaining the Advantages AALOS, a small business dating back of Appropriate Care to the 1950s that has been a contracted Going into the Forum, Steve Filippis, O&P provider with the VA for several executive vice president of business decades. “In many cases, veterans development for Wright & Filippis, with amputations have been able to was managing expectations. Having decide where they want to receive been involved in the industry for their prosthetic care. … If the amputee 20 years and industry advocacy for veteran loses the ability to choose who a half a dozen, he understands that will best meet their prosthetic needs progress on Capitol Hill moves slowly because the VA will have sole authority and inspiring legislators to action can to direct the prosthetic be difficult. But he also care provider, it can lead to knows that you can’t get adverse consequences,” he your point across if you says. “There are numerous don’t make the effort to benefits to allowing amputee attend the Forum and veterans to be involved in meet with legislators—so the decisions regarding their he made it a priority to prosthetic provider, and they Steve Filippis take part in this year’s need to retain that ability.” seminal advocacy event. Crumpton typically has a favorable Most notably, Filippis met with response to the Forum, and this year, an aide of Rep. Bishop, who is on the he was particularly encouraged that House Ways and Means Committee O&P was united on substantive issues and helped add the language that led to and seems to be gaining more attenO&P clinicians’ notes being acknowltion and support. “It is so important edged in the patient medial record. for our legislators to hear from their Bishop has “been a supporter of the constituents,” he said. “I realize the O&P industry since before he was a expense and time required to do congressman,” he said. “His door has this is significant, but our voice and always been open, both to our business story need to be shared. Everyone in Michigan and to AOPA.” He added, in every other health-care profes“When you go to Washington, D.C., you talk to different aides of legislators, and sions, including physicians, physical you hope that they’ll hear your voice. therapists, certified registered nurse O&P ALMANAC | APRIL 2018
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COVER STORY
AOPA President Jim Weber, MBA
Pam Young and Jim Young, CPO
(From left) Mary Walsh, Brian Mayle, BOCO, Stephanie Greene, Esq., Marc Burkom, and Sara Whiteis
Working with Congressman Bishop is kind of the opposite. You already know that he hears what you have to say; he supports what you’re doing and wants to support you more.” Bishop has visited Wright and Filippis offices several times and interacted with patients. “He understands the importance of making sure qualified people are seeing patients,” Filippis said. In his meetings, Filippis conveyed the current battle that O&P is facing, which he described as “getting people in Washington, D.C., to understand that, hey, everybody’s happy when they see a child walking or running with an artificial leg [in a commercial or show], but if I can’t get it covered or I’ve got to fight with the insurance for a $2,000 or $3,000 copay or deductible, and the family can’t afford it,” then patients are losing out on optimal care. Filippis tried to convey the message that some necessary O&P devices “cost a lot of money—it’s a lot of technology,” but some insurance companies are refusing to cover or not reimbursing appropriately. Legislation aimed at addressing this issue will help insurance companies understand the importance of having qualified people fit these artificial legs and braces, he said. “Our story 24
APRIL 2018 | O&P ALMANAC
(From left) Lindsey Kline, Brian Childs, Marty Frana, and Teri Kuffel, JD
Curt Bertram, CPO, FAAOP, and Rep. Jackie Walorski (R-Indiana)
(Clockwise from left) Tom Fise, Jeremy Matthews, Maynard Carkhuff, Rep. Dunn (R-Florida), Eric Ramcharran, CPO, LPO, and Alexis Gagliardotto
Dunn enjoys the educational is showing how we affect people’s lives component of each Forum, the opporwith braces, with knee- and ankle-foot orthoses, and artificial legs. These are tunity to learn from AOPA and other stories that they’re willing to hear and clinicians about the issues affecting they’re open to.” O&P now and in the future. In meetFilippis went into the event with ings with legislators and staff, she said relatively low expectations, but “that’s she is always impressed with how not how I walked away from it,” he responsive and helpful they are. “They explained. “I came back home with a always ask good questions,” she said. new spring in my step. … People have She and her group met with staffers gotten their congressmen and from the offices of Sens. their senators involved and Cardin and Chris Van they are supporting us, more Hollen (D-Maryland) than I’ve ever seen in my life. and Reps. John … For the first time, I feel like Sarbanes (D-Maryland), we have support of people in Dutch Ruppersberger Washington … but even that is (D-Maryland), Andy not enough. We need more.” Harris (R-Maryland), June L. Dunn, CFo and John Delaney (D-Maryland). Her message for them? Addressing the Shortage “Please help us help our patients and of Qualified Clinicians continue to grow a successful busiFor June L. Dunn, CFo, owner of D&J Medical and newly acquired ness to serve the state of Maryland.” Maryland Orthotics & Prosthetics, Dunn and her husband Joe started getting involved in advocacy has been their company 17 years ago, and today it an exciting and surprising process. has grown to seven locations and more Having attended the past three Policy than 40 employees. She told her story Forums, she participated in the 2016 to help those on the Hill understand legislation-writing session headed by why many are concerned about the former Sen. Bob Kerrey (D-Nebraska) future of the O&P industry. “Without and, this year, had the privilege of implementation of the laws and policies seeing the momentum continue. we are supporting [through industry
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COVER STORY
advocacy efforts], our business will not be sustainable,” she explained. “Innovation of new products for our patients will be stunted. A 60 percent or greater deficit of new certified orthotists and prosthetists by 2025 is a real issue that we are feeling today. We have been searching for over six months for a
certified clinician and are now forced to search outside of the state of Maryland. Continued quality care for our patients will diminish with expansion of the definition of ‘minimal self-adjustment.’ We fear our patients will be in danger of future injury and poor outcomes that they truly do not deserve.”
Policy Forum Attendee
Advocates On the Road Policy Forum participant Nicole Ver Kuilen has taken the “Tell your story” message espoused at the Forum to new levels. A lower-limb amputee since the age of 10, Ver Kuilen on several occasions has experienced denials and challenges to componentry she felt was necessary to continue an active lifestyle. She recently decided to share her story and advocate for legislative (From left) Justin Rhealt, Nicole changes to improve health-care Ver Kuilen, Rep. Suzan DelBene coverage for prosthetic care—by (D-Washington), Natalie Harold, completing a 1,500-mile triathlon and David A. Boone, MPH, PhD down the West Coast. Ver Kuilen recently completed her “Forrest Stump” journey, running, biking, and swimming down the West Coast, and raising awareness along the way. “I think we can all band together to use our collective voice,” she said. “My voice alone is very small, and in the amputee world, there are only 2 million of us, which is a very small percentage compared to the number of total people out there. So we need more people to advocate, to help lift my voice and the voices of other amputees.” Visit www.MobilitySaves.org for a video debrief, where you’ll learn more about the Forrest Stump project, the “1,500 Miles” documentary in progress, and Ver Kuilen’s experience in meetings with members of Congress on Capitol Hill during the 2018 AOPA Policy Forum.
Nicole Ver Kuilen, David A. Boone, MPH, PhD, and Nico Janssen, staffer to Sen. Maria Cantwell (D-Washington)
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Dunn was joined by Mary Walsh, a resident at D&J Medical. “So many people don’t really know about O&P unless they’ve directly had a personal experience with it,” said Walsh, “so while I’m sure a lot of the congressmen and women know what prosthetics are, they may not know what impact it makes to have these certain laws passed. I think just walking away knowing that they’ve heard—and they’ve understood—what we’re asking for, and how it’s actually going to directly impact their constituents, [is a] really big win.” Dunn is looking to get even more of her colleagues involved in future Forums and other activities. “I feel very positive about our efforts,” she said. “We need to continue to advocate and educate. It works!”
Emphasizing the Need for Qualified Providers
Clint Snell, CPO, president of Snell’s Orthotics and Prosthetics, arrived at the Policy Forum knowing what to expect. After being involved in advocacy Clint Snell, CPO via AOPA and other industry organizations for the past 12 to 15 years, “I had a good feeling about attending this year,” said Snell, an O&P consumer himself, as a post-polio patient who wears a knee-ankle-foot orthosis. “Over the last couple of years, we have gotten a warmer reception from either the congressional member or their aides, and it seemed to be on a little bit of an upswing—that they were more open to hearing about prosthetic and orthotic issues and being supportive.” Top of mind for Snell were a few specific issues, including the separation of O&P from durable medical equipment [DME]. “I was also interested in the implementation of Section 427 of BIPA,” which would require qualified providers to deliver orthotic and prosthetic care. In addition, Snell said he is a strong advocate of the Injured and Amputee Veterans Bill of Rights.
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COVER STORY
2018 Policy Forum State Reps Meeting
(From left)Tom Fise, Clint Snell, CPO, and Chris Snell, BOCP
Rep. Mike Bishop (R-Michigan) and Wendy Beattie, CPO, FAAOP
the staffer was just meeting with us Snell highlighted stories from his and taking our information, but their personal journey as a clinician. He heart wasn’t in it, or their attention shared how one patient arrived in wasn’t focused, but everyone we met his Shreveport office, “and we found with this time was very engaged,” Snell out that she had received her current noted. prosthesis when it was dropped off at “It’s very gratifying when we have her front porch,” he said. “And nobody accomplishments like the recognition took a test to actually measure her, just of our notes in medical review and took some tape measurements, and so records,” he said. “I have seen several there was no measuring nor fitting of changes over the years. It always the prosthesis that she was currently amazes me how slow the process is, but trying to wear. Obviously, she was I think it’s well worth all of our effort to having fitting and alignment problems, get it accomplished, and the more O&P but those were unqualified providers practitioners and patients and manu[providing the device].” His most notable meeting of the facturers attend and support candidates day was with Rep. Mike Johnson who are open to orthotic and prosthetic (R-Louisiana), who represents Snell’s issues, I think we’re all better off.” home district. “I think he was very supportive on the qualPrioritizing Education ified provider issue and Heading into the Forum, sounded like he might the most important issue join our efforts,” said for Wendy Beattie, CPO, Snell. His group also met FAAOP, was education. As with Rep. Clay Higgins clinical and program direc(R-Louisiana) and his tor for Eastern Michigan staff. “He was very direct Wendy Beattie, CPO, University’s Master of Science and straightforward, and FAAOP in Orthotics and Prosthetics especially interested in (MSOP) program, and as a the veterans’ care issues.” Additionally, member of the Board of Directors for they met with aides from the offices the National Commission on Orthotic of Rep. Ralph Abraham (R-Louisiana) and Prosthetic Education (NCOPE), and Sen. Bill Cassidy (R-Louisiana). Beattie is concerned about a lack of Overall, Snell found the meetings to funding for schools and education be very successful. “There have been a programs. “Education was originally few times in the past where I felt like designed in this country to be a public 28
APRIL 2018 | O&P ALMANAC
(From left) Tom Fise, Jovan Gonczar, and Wendy Beattie, CPO, FAAOP, meeting with Greg Sunstrum of Rep. Dingell’s office (D-Michigan)
good,” she said. “In the 1990s, roughly 60 percent of the cost of education was borne by the state of Michigan for public universities,” she explained. “Now that’s less than 20 percent, and that’s a huge burden on our young people.” She’s passionate because she knows supporting schools means prioritizing the next generation of researchers. “I love working with my students. They’re so driven, idealistic, and full of fresh ideas. It’s inspiring.” Part of the O&P industry since the 1990s, Beattie worked in clinical practice for 25 years prior to becoming an educator, so she has a unique perspective to share with legislators and their staff. This year, her primary message was that “O&P is a health-care service that involves significant education to protect patients.” Her group met with aides for Sen. Debbie Stabenow (D-Michigan), Rep. Debbie Dingell (D-Michigan), Rep. Sandy Levin (D-Michigan), and Rep. Paul Mitchell (R-Michigan). “Stabenow’s office was the most interested, and Levin possibly the least interested—but blunt about rationale,” she said. “As a member of the Ways and Means Committee, [Levin] feels he cannot co-sponsor legislation. The exception to this was the [Veterans Bill of Rights], which he may sign on to. This did not imply he would vote against these, just that he would not co-sponsor it.”
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COVER STORY
(From left) Ashlie White, David Sickles, Stella Sieber, Nancy Payne, and Brittany Stresing, CPO, FAAOP
Andy May, Sen. Dianne Feinstein, (D-California), and Andrew Seelhoff
Traci Dralle, CFM, Sen. Lamar Alexander (R-Tennessee), and Daryl Farler
Beattie is not new to advocacy, having engaged with AOPA and other industry organizations in Washington, D.C., and also in her home state of Michigan. While she explained it’s hard to gauge the success of this year’s Forum right away, she’s confident that the effort will have an impact. “This is the ultimate in being a member of a democracy,” she said. “If you want to cause change, you must make your opinions known. There is no better opportunity for this than to lobby members of Congress directly.”
Expressing Gratitude
A first-time Policy Forum participant, Brittany Stresing, CPO, FAAOP, president and founder of Limbionics of Durham, North Carolina, was eager to share her passion as a practitioner, business owner, and orthotic patient. “I entered the profession as a patient first and then fell more and more in love with the profession and the impact it has on people’s lives every day,” she said. Joining her in the North Carolina delegation were two prosthetic patients, who also are peer visitors; a practitioner who works with NCOPE 30
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Student delegation
and handles student affairs and concerns; and a limb loss coordinator nurse. “This allowed for a diverse group of opinions and viewpoints, which I feel was a great benefit to explaining our concerns and opinions,” she said. The group tackled a variety of topics, including review of the Medicare O&P Improvement Act and
concern around the fact that “changes to Local Coverage of Determinations are being done by an undisclosed group of staff that do not have any input from beneficiaries or prosthetists and orthotists, as far as we know.” Stresing also wanted to personally express her gratitude, on behalf of the entire industry and its patients, for
COVER STORY
allowing O&P clinicians’ better than [I was treated] notes to be part of the so that others wouldn’t medical record. “To me that have orthotic intervention was extremely important, too late or not sufficiently so they know we apprecared for.” Her group met with ciate them listening,” she staffers from the offices explained. “If we are able Brittany Stresing, CPO, of Reps. G.K. Butterfield to show them gratitude FAAOP (D-North Carolina), David and they understand the Price (D-North Carolina), importance of prosthetics Alma Adams (D-North Carolina), and and orthotics to people’s lives, then Mark Meadows (R-North Carolina) they are more likely to think about us and Sens. Richard Burr (R-North … or listen to us if we have something Carolina) and Thom Tillis (R-North that really needs attention and change Carolina). Stresing felt meetings in the future.” with the senators’ offices were most Stresing was proud to be able to impactful, noting that Tillis is an advospeak from the unique and often under-represented perspective of cate for veterans and Burr’s office has an orthotic patient. At age 13, she been integral in much of the progress was diagnosed with scoliosis, spina they have had as a state and profession. bifida occulta, and a two-inch leg “One of Tillis’s staffers was so incredlength discrepancy. “I was not treated ibly interested and has a roommate properly and within proper timelines that is an amputee,” she explained. but had orthotic treatment involving “He felt that much of the needs of shoe lifts and back bracing, as well our profession are common sense and as surgery,” she said. “As a frustrated needed. He took down a great deal of patient, I decided I wanted to get into notes and had very valuable feedback.” the profession in order to treat people She, too, counts the Policy Forum as
a success. “We were able to explain our stories and viewpoints about legislation and policy and the effects—good and bad—of bills introduced,” she said. “Those that we spoke to seemed to be receptive and interested and asked a great deal of questions.” To keep the momentum going, Stresing said it will be important for more people to attend future Policy Forums. “We need to think outside of the present day and be advocating and thinking about what will occur in one year, five years, and 10 years. This means we need to sometimes step out of our comfort zones,” she said. “I am incredibly thrilled to have students attend, since the younger generations will be greatly affected by any legislation changes; they have longer in the profession and just completed or are completing years of education in the profession.” Lia K. Dangelico is a contributing writer to O&P Almanac. Josephine Rossi is editor. Reach her at jrossi@ contentcommunicators.com.
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By CHRISTINE UMBRELL
PT
The CONNECTION Garth E. Shippen, CO, LO, works with physical therapist Kristie Bjornson, MS, PhD, PT, in treating a pediatric patient.
Joining forces with physical therapists can be a boon for orthotic practices and their pediatric patients
O
&P’S YOUNGEST PATIENTS ARE
NEED TO KNOW Collaborations between orthotists and therapists may be of special benefit to pediatric patients, many of whom require physical therapy in addition to bracing. Some orthotic patients have chronic neuromuscular conditions or progressive conditions, and joint appointments can lead to better long-term results.
Some orthotists believe they increase their knowledge and improve their skills by working collaboratively, and that participating in joint appointments can lead to more comprehensive patient evaluations and higher likelihood of patient compliance with wear instructions.
During joint collaborations, clinicians can work with PTs to devise optimal solutions, then PTs can serve as “eyes on the ground” to make sure patients are using their braces appropriately, without experiencing skin breakdown, between orthotist appointments.
Teaming up with therapists may lead to new business opportunities. PTs may refer new patients to those orthotists with whom they have worked well in the past, or may ask orthotists to participate in clinics.
In many cases, PTs have worked with patients previously and are familiar with a patient’s mobility. They also may have developed rapports with families and can provide valuable information to orthotists who are not as familiar with new patients.
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Successful orthotist/PT relationships stem from recognition of each other’s unique skill sets, proactive communications, and a focus on providing a solution that is in the best interest of the patient.
a diverse bunch with varied needs. Pediatric orthotic patients can run the gamut from children with chronic conditions, such as muscular dystrophies, cerebral palsy, or spina bifida, to adolescents with sports injuries. Many of these patients are under the care of several health-care professionals, often including physical therapists (PTs). Orthotists who work closely with PTs in a team approach to care are finding benefits for their patients and their businesses.
Garth E. Shippen, CO, LO
The advantages of joint orthotist/ PT intervention are amplified for the pediatric population, says Garth E. Shippen, CO, LO. “Unlike most adult patients, children are growing and developing quite rapidly. What may have been clinically correct even a few weeks ago, may now need to be
adjusted for growth or improved functional capabilities,” says Shippen, who works for Hanger Clinic in Bellevue, Washington. “Since many of these children are seen in therapy on a weekly basis, the therapists are much more likely to recognize these changes and the need for orthotic modifications related to joint alignment and skin care issues.” Therapists also may have had the opportunity to get to know the children and their families on a more personal level and have valuable insight into issues that could arise regarding compliance and support, Shippen says. Brent Wright, CP, BOCO “The opportunity to collaborate in person, whether in our clinic or an outside therapy facility, ensures that all of us—therapist, orthotist, patient, and family—are on the same page and working together toward a common goal,” says Shippen. In some cases, one member of the team will pick up on a challenge the patient is having and solve a problem that may have otherwise continued without resolution. “This also allows us to utilize our time more efficiently during clinic visits.” A teamwork approach to pediatric patient care is a priority at EastPoint Prosthetics and Orthotics in Raleigh, North Carolina. Because EastPoint has mobile capabilities, clinicians regularly work with PTs—usually in the therapist’s office—to devise optimal solutions for patients, says Brent Wright, CP, BOCO. He refers to PTs as “our eyes on the ground, making sure the patient is using the brace and isn’t experiencing skin breakdown.” When working jointly, Wright meets with the patient, the family, and the therapist at the beginning of the process, and reconvenes with that group when delivering an orthosis, “so we can make adjustments and the therapist can see how the device works, and then the patient goes home with the
device,” he says. “With peds, you need to develop these types of relationships.” Joint appointments also serve to optimize the patient’s time, according to Wright. Many pediatric orthotic patients have special needs and are under the care of multiple medical professionals. A joint PT/orthotist visit “is one less appointment,” which parents appreciate.
Collaborating on Complicated Diagnoses
Not all children being fit with orthoses require physical therapy or joint intervention, but a team approach can be extremely beneficial for some populations. “Many children with multiple gait impediments, typically those with cerebral palsy, are great candidates to benefit from this collaboration,” says Shippen. Having the skill sets of both an orthotist and a PT “helps us work through some very complex presentations.” A PT, for example, may uncover “a range-of-motion limitation or lack of muscle strength that underlies a compensatory movement, which in turn guides a design feature of the orthosis I am fabricating,” he says. Pediatric patients who are taking part in any type of rehabilitation may benefit from a team approach to care, says Brian P. Emling, CPO, a clinician at the Children’s Healthcare of Atlanta (CHOA) who provides orthotic management in multidisciplinary clinics for patients with muscular dystrophy, cerebral palsy, spina bifida, and undiagnosed neuromuscular presentations. “A pediatric patient undergoing rehabilitation is also developing and growing longitudinally,” he says. “As an orthotist in a pediatric setting, I must consider the changes due to rehabilitation, the changes due to natural growth, and the combination of the two. A pediatric patient who is active in physical therapy will experience significant changes attributable to the rehabilitation process and growth. The physical therapist is often the first to witness the changes, as they typically see these patients more frequently.”
Brian P. Emling, CPO
Children with chronic neuromuscular conditions typically undergo regular PT sessions for mobility and gait training as well as contracture management, says Emling. “It is essential that our orthotic designs are in alignment with their PT goals,” he says. Emling also notes that the parents of children with progressive disorders “are processing a lot of vital information from multiple disciplines while internally coping with the realities of the diagnosis.” Working closely with PTs and occupational therapists (OTs) allows his team to determine the most appropriate interventions. Without such collaboration, the parents are responsible for instituting each of the interventions into their daily life, Emling says. “Left to their own plan, the parents may prioritize the interventions without fully understanding the goals. As a result, integral interventions may go by the wayside, and progression of the disease process may lead to irreversible changes.”
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Emling regularly takes part in a muscular dystrophy clinic, a multidisciplinary environment where representatives from PT, OT, and orthotics are all present. For this patient population, “the physical therapist and I work closely to determine which intervention will provide an improvement in sagittal ankle range of motion—nightwear AFOs, fiberglass custom casts, or serial casting. The PT and I must take into consideration the likelihood of follow-up, compliance with previous bracing, and current contracture severity to determine the most appropriate intervention to improve the patient’s sagittal ankle range of motion,” he says. Frequently, the long-term solution to preventing sagittal plane contractures is a combination of PT interventions and orthotic devices, according to Emling.
Marlies Beerli Cabell, CPO
Some orthotists also have benefitted from teaming up with PTs who work as early intervention therapists. Marlies Beerli Cabell, CPO, works closely with these specialists in her
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role as a clinician at Ability Prosthetics & Orthotics. Orthotists can increase their knowledge and improve their skills by working collaboratively, says Cabell. For example, she has learned to adjust the weight of some of the braces she designs. “We are usually taught to make things lighter, but, working with a therapist I have learned that adding weight can provide better functional benefit for certain kids—especially those with sensory problems who aren’t recognizing where their feet end,” she says. For those cases, Cabell has developed some creative solutions, such as custom-molded ankle-foot orthoses. “I’ve done a supramalleolar orthosis (SMO) that fits inside a fixed solid ankle-foot orthosis,” which allows the appropriate support for children who may have needs that change, and has patented a weighted AFO for children with sensory feedback problems. Cabell believes her presence at a therapy appointment can lead to a more comprehensive patient evaluation, rather than a focus on one particular developmental marker. “I am able to interact and suggest things that may bring a child to a developmental milestone or start interventions early—to make sure the patient isn’t under-served,” she says. Cabell notes that accountability
for orthosis wear increases when two health-care professionals work together. “If the [patients or their parents] don’t comply,” they have to explain noncompliance to two medical professionals, rather than one.
Boosting Your Business
Teaming up with therapists can lead not only to improved patient care but also to new business opportunities. An orthotist who works well with a particular PT may find that therapist reaching out for assistance with additional patients.
Chris Baughman, CP, BOCO
Chris Baughman, CP, BOCO, one of Wright’s co-workers at EastPoint P&O, has developed a close relationship with a PT facility that is under-served by orthotists in its area. After working jointly with a patient at Propel Pediatric Therapy in Winston-Salem a few years ago, Baughman was asked to participate in a regular clinic. Now he makes the hour-and-a-half drive from Raleigh every Monday to work in that clinic, seeing between six and 11 patients each visit in joint appointments with Propel’s therapists. The appointments are arranged by the Propel administrator, and patients arrive with written orders from their physicians. Baughman says the collaborative atmosphere during the clinic makes for more informative and productive appointments. “When I am performing an evaluation with Mom and Dad along with the therapist—who has seen the child many times—I can get a more comprehensive history of what’s been tried in the past, how it worked or didn’t work, low tone versus high tone, and how the child is progressing,” he notes. The PT also offers objective data on manual muscle testing and range of motion. “This is a great way to gather all of the information to decide what brace is needed for optimal outcomes.”
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Early Intervention Provider Emphasizes Benefits of Collaborating With Orthotists “Working as a team with an orthotist and the family is valuable for compliance with wearing the orthosis, and also for the family to understand what is being discussed regarding their child,” says Jennifer Gazan, DPT, an early intervention provider at Wellspan Pediatric Jennifer Gazan, Outpatient Rehabilitation and Esprit Pediatric DPT Rehab who works closely with Marlies Beerli Cabell, CPO, at Ability Prosthetics & Orthotics. Gazan says that it may be helpful to include a patient’s physical therapist (PT) when fitting and delivering an orthosis in cases where the PT has a greater familiarity with the patient. “Since the orthotist has a limited amount of time to see the patient, they are not always able to see how mobile the child actually is because it is a new person/environment, etc.,” she says. “By working as a team, I am able to confirm that the patient is, for example, pulling to stand and cruising, even if they sit in one spot the entire appointment.” For example, Gazan says she has had several patients who will not move during the orthotist appointment. In these cases, the PT can help explain the patient’s movement patterns and what level of gross motor development they have mastered. PTs typically see patients weekly and build a rapport with the families, “so we know what the family is comfortable doing for a home program and what their compliance is with a home program or doctor’s visits,” she says. “This information is needed when fitting for an orthosis. For a pediatric patient who is unable to speak for themselves, it is essential that a team approach be taken so that all factors are considered when bracing. Without the correct information, the wrong orthosis could be recommended, which leads to higher cost, family frustration, and noncompliance with wear.” An added benefit of good working relationships between PTs and orthotists is more business, says Gazan. “Once a relationship is established, it definitely leads to additional referrals, as it keeps the products that the orthotist introduces me to fresh. When I am treating another patient, I remember what orthotics are available that will help them meet their gross motor goals,” she says. Plus, orthotists “can show me the latest devices and educate me on what type of patient may benefit from them.”
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Because Baughman has established such regular ties with Propel, he communicates frequently between appointments via text and email with therapists—in a HIPAAcompliant manner. This is helpful if he needs additional information when designing or fine-turning an orthosis. The therapist also serves as Baughman’s “eyes and ears” after he delivers a brace because PTs usually meet with their patients at least once a week and can give feedback on adjustments that may be needed. Being a mobile facility also has enabled EastPoint orthotists to partner with PTs associated with school systems, says Baughman. On several occasions, he has visited local schools to work in conjunction with their PTs to see students who need orthoses through their school-sanctioned individualized educational programs (IEPs).
Building Relationships
The most successful partnerships with PTs often start when orthotists are proactive in communicating with their patients’ therapists. “I believe it is incumbent upon the orthotist to reach out to the therapist if they don’t already have an established relationship or the patient is a new referral,” says Shippen. “There are many different philosophies and training each of us has experienced, and reaching out to the therapy community on approach and outcome helps to ensure a beneficial working relationship.” He notes that it is typically more difficult for therapists and families to break from routine appointments at their clinics, “so, as an orthotist, I try to accommodate their needs as best I can.” Orthotists may need to overcome obstacles to make connections with PTs, but it’s worth the effort, says Wright. “Pediatric therapists all talk to each other so it’s not an easy thing to break into,” he explains. Presenting the facility in a professional manner and following through with commitments are the keys to building relationships, he says.
Cabell suggests orthotists reach out to therapists they have never worked with, for the benefit of the patient. When she first began working with early intervention therapists, none of them had ever been to an orthotist’s office. But over the years, she has developed strong connections, and they have learned to look together at patient videos in slow motion to identify, for example, flexible deformities causing developmental delays. “I look at the skeletal deformity, and they look for muscle weakness, and we can work together to solve problems,” says Cabell. Emling says that the best relationships happen when the therapist and orthotist are in communication before orthotic treatment even begins. “Our hospital EMR [electronic medical record system] allows me to see the therapists’ notes,” he says. “If I am seeing someone that is active in therapy, I will reach out to discuss the treatment plan and goals. Then I can consider these goals during my evaluation when creating my
orthotic treatment plan. I prefer to be proactive—otherwise, my first communication with the therapist is likely to be after there’s an issue with the design provided.” Shippen cites “communication” as critical to building relationships. “In addition to regular email or phone calls regarding particular cases, I regularly
set up in-services whenever I can to disseminate any new information and strengthen our existing relationships. Additionally, incorporating the therapists’ notes into our medical record, especially when needed to justify modifications or the provision of a new device, creates a more comprehensive record of care.”
O&P ALMANAC | APRIL 2018
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Not surprisingly, working so closely together occasionally leads to disagreements in terms of care plans. Learning to handle these situations can lead to optimal partnerships. “It can be healthy to disagree, then work through your opinions and compromise to get the best results,” says Wright. “For me, the most common situation in which a disagreement may arise usually happens when a child is a new patient to either of us and we have not met to discuss our views,” says Shippen. “If I can identify who the therapist is before proceeding with the fabrication of the orthosis, I will always make contact to ensure we have an understanding moving forward. The therapists are also often in close contact with the pediatrician prescribing the orthosis and therefore able to close the loop of communication and requisite paperwork in a more efficient manner.” Cabell notes that when she and an early intervention therapist have different ideas, she tries to explain how the nature of custom orthoses allows for adjustments. “I might explain how I can make custom modifications to a device so as the goals change, we can adjust—and not bill for a new device each time.” Above all, says Emling, “keep in mind you both want what is best for the patient, and both disciplines have their unique skill sets to bring to the table.”
done with her evaluation, we meet up and decide how we wish to proceed, and consult the family on the proposed plan moving forward.” Shippen and Bjornson have worked together often over the past several years, primarily seeing patients with developmental disabilities such as cerebral palsy, spina bifida, Down syndrome, autism, and spinal cord injuries. Bjornson says that joint appointments allow orthotists and PTs to discuss treatment and device decisions and to test temporary modifications during a visit, after which a permanent modification can be made.
Kristie Bjornson, MS, PhD, PT
The PT Perspective
PTs who collaborate with orthotists in seeing patients experience benefits from their end. Kristie Bjornson, MS, PhD, PT, a physical therapist who is an associate professor of pediatrics at the University of Washington and Seattle Children’s Research Institute, and who practices clinically at Seattle Children’s Hospital and in private practice, often works in tandem with Shippen, taking turns working with a patient during a single appointment. When Bjornson is conducting her evaluation and videotaping the patient’s gait, “I am prepping materials for casting or working on the devices for another patient later in the day,” Shippen says. “Once she is 38
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“Having a joint visit and assessment with an orthotist is wonderful,” Bjornson says. At these appointments, the orthotist is responsible for determining the bracing and shoe decisions and the PT devises therapy plans. “The orthotist sees how the orthoses and shoes can facilitate what we do in therapy, and we can optimize biomechanical alignment” during these sessions, says Bjornson. “The orthotist brings in expertise in biomechanics, shoe design, and materials, etc., so the PT can optimize” the child’s stance phase of mobility. Patients benefit from these joint consultations by
experiencing fewer falls, reduced incidents of skin issues, and greater mobility, according to Bjornson. Advances in technology—such as telemedicine—offer additional opportunities for collaboration, says Bjornson. For patients in more rural areas, she has worked with orthotists who are closer to patients, watching videos of patients and discussing treatment decisions via phone and Skype. Bjornson notes that not all PTs prefer to work in collaboration with orthotists, and not all are trained to do so effectively. She suggests that orthotists who are seeking to build relationships should start by finding therapists who are interested in collaborating and “who can speak your language.” It’s important that the orthotist and PT are using the same vocabulary and are conducting similar physical exams. “Watch each other’s physical exams and ‘shadow’ each other” to make sure you’re compatible, she says. Bjornson also suggests attending continuing education classes together.
Upping Your Game
Those orthotists who spend time initiating and building relationships with therapists find that their patients and their parents are grateful for their efforts. “Having the opportunity to work with [Bjornson] side by side for several hours, ensuring we have addressed every possible variable, has proven to be clinically superior to a quick office visit and phone calls,” says Shippen. “That said, even a small amount of teamwork between orthotists and therapists can help improve patient outcomes.” Working collaboratively with PTs “has made me a better orthotist,” adds Wright. In joint-care situations, “we have to step up our game since we’re fitting the device right in front of the patient and the therapist. A better product comes out.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.
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COMPLIANCE CORNER
By DEVON BERNARD
Getting Down to Business Know the rules for identifying business associates and understanding a patient’s right to access 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
APRIL 2018 | O&P ALMANAC
EARN
2
BUSINESS CE
CREDITS P.39
It may be tempting to put issues related to the Health Insurance Portability and Accountability ACT (HIPAA) on the backburner or to create a policy and forget about it. But doing so could be costly as fines for HIPAA violations are on the rise. This month’s Compliance Corner takes a look at two components of the HIPAA regulations: business associates/business associate agreements and a patient’s right to access information.
Business Associates and Agreements
A business associate (BA) is a person or entity, including a subcontractor, which provides services on behalf of or to covered entities, and requires the use and disclosure of protected health information (PHI) or electronic protected health information (ePHI). The BA also creates, receives, maintains, or transmits PHI on behalf of a covered entity. PHI, also called individually identifiable health information, is information created by a health-care provider that is used to identify an individual for the purpose of treatment and billing. PHI may include information such as the new Medicare Beneficiary Identifier (MBI) numbers, Social Security numbers, names, birth dates, addresses, and similar data. But this information by itself is not always considered PHI; to be considered PHI, the information must be used and related to the provision/billing of health care or the patient’s condition. For example, if a patient’s email address is listed by his or her employer or in some other directory, the email would not be considered PHI; but if the information is listed with payment information, then it could be considered PHI. 40
E! QU IZ M
It is easy to identify third-party billers, clearinghouses, or accrediting/ credentialing organizations as business associates; and it is easy to identify non-business associates, such as hospitals, referring physicians, or an Internet provider. However, some of the other entities you work with may not be as clear cut—entities such as manufacturers and cloud computing service providers. If you are using a cloud computing service provider for the purpose of storing or maintaining your files, including ePHI, then the provider would be considered a BA. This is true even if the cloud service provider is storing encrypted ePHI and is never viewing the information. The service provider is considered a BA because it is storing and maintaining the ePHI on behalf of you, the covered entity. With manufacturers, suppliers, and distributors, identifying whether they should be considered BAs is more difficult and depends on what functions they provide, as well as what functions they provide to you. In most instances, under the HIPAA Privacy Rule, device manufacturers would be considered health-care providers because they are providing services, support, guidance, or supplies related
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to the care of a patient—and as such they would not be considered a BA. In other instances, however, manufacturers, suppliers, and distributors could be considered BAs—for example, if they are providing you and the patient a cost-savings estimate or analysis of a particular product/service over another, and they require access to certain PHI/ePHI. In addition, if a manufacturer or distributor simply sells its products to you and you deliver the items, it could be considered a BA if you are providing it with PHI/ePHI. When dealing with BAs, you are required to have a business associate agreement (BAA) in place. The BAA is a contract between you (the covered entity) and the BA that provides assurances that the BA is properly handling and safeguarding PHI and/or ePHI. The BAA also lays the groundwork for the types of services the BA will perform for you and the amount of PHI/ePHI the BA requires to carry out these activities, as well as when the BA will have access to this information.
To help determine if someone is a potential BA and if a BAA is required, consider the following: • Is the PHI/ePHI being disclosed to someone in the capacity of his or her job as a member of your workforce? If yes, then a BAA would not be required. If no, then a BAA may be required. • Is the PHI/ePHI being disclosed to a health-care provider for treatment purposes? If yes, then a BAA would not be required. If no, then a BAA may be required. • Is the PHI being disclosed to a health plan/insurer for payment purposes? If yes, then a BAA would not be required. If no, then a BAA may be required. • Is the PHI being disclosed to another covered entity? If yes, then a BAA is not required. If no, then a BAA may be required. • Does the entity or individual receive, maintain, or transmit PHI/ePHI for the purpose of any of the following activities: claims
processing, administration, data analysis, utilization review, quality assurance, patient safety activities, billing, benefits management, practice management, etc.? If yes, then a BAA is required. If no, then a BAA may not be required. • Does the entity or individual provide you with any of the following services, and the services require the disclosure of PHI/ePHI: legal, accounting, consulting, data aggregation, management, administrative, accreditation, or financial? If yes, then a BAA would be required. If no, then a BAA may not be required. Once you have determined if an entity is a BA and whether a BAA is required, the next step is to create a BAA. There is no one standard form or document; the format of the BAA depends on the type of work the BA is doing and the amount of information needed to complete the job(s).
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COMPLIANCE CORNER
However, at a minimum, a BAA should accomplish the following 10 goals: • Establish what uses and disclosures are permitted by the BA. • Establish that no other uses or disclosures of PHI/ePHI are allowed unless granted by the BAA or as required by law. • Require that the BA implement appropriate safeguards to prevent unauthorized use or disclosure of PHI/ePHI. • Require the BA to report any uses or disclosures of PHI/ePHI not provided for by its contract, including the reporting of breaches of unsecured PHI/ePHI. • Require the BA to assist you with granting individuals access to their PHI/ePHI, amending their PHI/ePHI, and/or accounting of disclosures of their PHI/ePHI. • To the extent the BA is to carry out a covered entity’s obligation under the Privacy Rule, require that the BA comply with the requirements of the Privacy Rule. • Require the BA to make available its internal practices, books, and records relating to the use and disclosure of PHI/ePHI, and to make them available to Medicare or its contractors. • Require that at the termination of the BAA, the BA return or destroy all PHI/ePHI. • Require the BA to ensure that any subcontractors it may engage on its behalf that will have access to PHI/ ePHI agree to the same restrictions and conditions that apply to the BA with respect to the PHI/ePHI. • Be sure the BA provides you with the authority to terminate the BAA if the BA violates a material term of the BAA. These 10 elements are just the basic items to be addressed within your BAAs. You should create agreements that are specific to your needs and the actions performed by your BAs. If you are still uncertain if an individual or entity is acting as a BA, consult with your attorneys or consider having the BA sign a BAA. However, individuals 42
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or entities may be less inclined to sign a BAA if they are not required to do so, especially when it may place an undue burden on them. Also, be sure to review your BAAs carefully and make sure they are not imposing any unnecessary burdens or liabilities on you.
Patient’s Right to Access Information
Patients have a right to access—to simply view or receive copies of—a wide range of information about themselves and their care, even if the information is maintained by you or by a BA or subcontractor on your behalf in a designated record set (i.e., medical records, billing records, payment and claims records, as well as other records used, in whole or in part, by or for a covered entity to make decisions about individuals) for as long as the records exist. Patients also may request that this information be forwarded to a third party. However, patients may not request access to PHI/ePHI or other information if it is not part of a designated record set because the information is not used to make decisions about the patient’s care. This type of information may include quality assessments or quality control records, patient safety records, or management records that are used for business decisions rather than to make decisions about individuals and/or their care. For example, an individual does not have the right to access information related to your purchasing costs but may have the right to access the billing records or payment records.
There also is a mandatory exemption to the right to access information for psychotherapy notes and any information that may be related to any pending legal cases. How patients request access is up to you as a covered entity. You may require that patients request access in writing, or you may use an in-house form or online portal. Regardless of the method, the patient must be informed of your procedures to request access—for example, via your Notice of Privacy Practices. In addition, your method for requesting access must not create barriers or burdens to patients or unreasonably delay the patient in accessing the requested information. This would include requiring patients to come into your office in person to complete forms or to fill them out in triplicate. In granting access to the patient, you are required to provide access to the PHI/ePHI and information requested, in whole or in part, no later than 30 calendar days from receiving the individual’s request. But it should be done as soon as possible. If, for some reason, you are unable to provide access and complete the request within 30 days, you may extend the time, one time only, by an additional 30 days. When extending the timeframe, you must notify the patient in writing of the reasons for the delay and the date by which you will provide access and complete the request. A patient’s access to all or a portion of the information requested can be denied if the information is not part of a designated record set maintained by you or your BAs, or if the information is exempted from the right of access because it constitutes psychotherapy notes or is part of a legal proceeding. However, you may not withhold or deny an individual access to his or her PHI/ePHI on the grounds that he or she owes you money for other services or care provided. If you are denying access, in whole or in part, you must provide the reason in writing to the patient no later than 30 days after the request. As part of the patient’s request to access select information, the patient also may request that the information
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be provided in a desired format, such as via hard copy or electronic copy. You are obligated to provide the information in the form and format requested, if it is easy and readily available. If the patient is requesting copies— and not simply requesting to view the information—you may charge the patient a reasonable fee for the service of producing a copy on his or her behalf. If the patient makes copies on his or her own, or uses his or her mobile device to take pictures while viewing the chart and records, you may not charge the patient. The reasonable, cost-based fee to provide the patient or his or her representative with a copy of PHI/ePHI, or to provide a copy to a designated third party, may be based on either actual costs or average costs, but the fee should not be so high as to create barriers or persuade the patient against exercising his or her right to access the information. If you use actual costs as the basis for your fee, you may only include the cost of certain labor, supplies, and postage per request. The labor portion of your charge may only include the labor associated with creating and delivering the requested information in the form and format requested or
you maintain all PHI electronically and the patient is requesting an electronic copy, you also have the option of simply charging a flat fee, which may not exceed $6.50 per request.
A Good Start
agreed upon by the patient or his or her representative. The labor for copying should not include the costs or time associated with reviewing the request for access, or searching for and retrieving the information requested. The charge for supplies would include things like paper if the request is for a hard copy, or a disk or USB drive if that is the format the patient has requested. Postage may be charged when the patient requests that the copy be mailed. If you use average costs, you are not calculating your labor costs for each request; instead, you may use a flat cost based on the average amount of labor used in previous requests, and then factor in your supply costs and postage costs, if applicable. If
The information provided here is not a complete list of your responsibilities regarding BAs/BAAs and a patient’s rights to access information. However, it does provide you with a good framework to understand your obligations and determine whether you are on the right path to compliance. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:
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O&P ALMANAC | APRIL 2018
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PRINCIPAL INVESTIGATOR
Problem Solver Australia’s Michael Dillon, BPO (Hons), PhD, shares his experiences with translational research
For 2018, O&P Almanac is introducing individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and health-care professionals who have carried out studies and gathered quantitative and/or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.
M
ICHAEL DILLON, BPO (Hons),
PhD, associate professor and discipline lead in prosthetics and orthotics at Australia’s La Trobe University, has always enjoyed the physical part of the profession. But it was the intellectual aspects of problem solving that led him to O&P research. “I was drawn to working in prosthetics and orthotics because it encompassed so many of the things I was looking for in a job,” Dillon recalls. “I wanted a job where I would work closely with people and build long-term relationships. I wanted to work with my hands and make things, but it had to be academically challenging. Although my roles have varied over time—technician, clinician, or academic—the work has always included each of the things I was looking for.”
During his undergraduate years, Dillon discovered O&P research, which set him on a journey to become a recognized O&P investigator—most recently leading a study on shared decision making that was funded by AOPA and published in Prosthetics and Orthotics International. “I love that research is like a good puzzle or a problem to be nutted out. I love the critical and analytical thinking, as well as the light-bulb moments when you find a solution to a problem you’ve been stuck on,” says Dillon. “Perhaps most, I love learning things that are new. Seeing results from a study that show us something new … something that we didn’t know before … something that you know will change the way we understand the world or the way we practice prosthetics and orthotics. How cool is that!”
O&P Proving Grounds
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PHOTO: Michael Dillon, BPO (Hons), PhD
Dillon first became interested in research as an undergraduate student at La Trobe University, where he earned a bachelor of prosthetics and orthotics degree in 1996. One of his professors, Timothy Bach, PhD, distilled his own love of research while teaching biomechanics. “I remember sitting in a biomechanics class, learning how gait aids could reduce hip joint compressive forces, and thinking how cool it was that you could prove this using biomechanics,” says Dillon. “While I wasn’t a strong mathematics or physics student, I was so impressed by the promise of what you could learn using biomechanics.”
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PRINCIPAL INVESTIGATOR
Dillon recalls the journal clubs that were a feature of Bach’s research subjects. “I enjoyed the critical analysis and the academic debate,” he recalls. “It opened the door to how much we didn’t know about prosthetics and orthotics. I knew then that I wanted a role where I could do research in parallel with being a clinician or a teacher.” Dillon went on to earn a PhD from the Queensland Institute of Technology. Later, he worked briefly in the
Department of Prosthetics and Orthotics at Hong Kong Polytechnic University before returning as a lecturer to La Trobe. He continues to spend the majority of his time there—now teaching, conducting research, completing administrative tasks, and engaging in service to the profession and university in his current position. La Trobe—the largest provider of allied health education and training in Australia—offers a bachelor of applied science and master of clinical prosthetics
Notable Works
Michael Dillon, BPO (Hons), PhD, says that some of his most important work “has been the opportunity to challenge what we believe through editorials or other types of translational research.” He is most proud of the following three publications: • Dillon M.P., Fatone S., Quigley M. “Uncertainty With Long-Term Predictions of Lower-Limb Amputation Prevalence and What This Means for Prosthetic and Orthotic Research.” Journal of Prosthetics and Orthotics. In press. • Dillon M.P., Quigley M., Fatone S. “While Mortality Rates Differ Following Dysvascular Partial Foot and Transtibial Amputation, Should They Influence the Choice of Amputation Level?” Archives Physical Medicine and Rehabilitation, 2017; 98(9), 1900-2. Invited Editorial. doi.org/10.1016/j.apmr.2017.04.002. • Dillon M.P. , Fatone S. “Deliberations About the Functional Benefits and Complications of Transtibial and Partial Foot Amputation.” Archives of Physical Medicine and Rehabilitation. 2013; 94(8), 1429-35. Invited Editorial.
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and orthotics double degree (which takes four-and-a-half years full time) as well as a graduate-entry master degree in clinical prosthetics and orthotics (which takes two years full time). The university has been recognized as the first institution in Australia to graduate prosthetists/ orthotists with research training at honors and doctoral levels, according to Dillon.
Evolution in Research Priorities Over the years, Dillon has noted a gradual shift in emphasis of O&P research priorities. During his undergraduate and graduate studies, biomechanics research was prominent. “There was a strong interest in questions about the effects of prosthetics and orthotics on gait,” he says. “Over time, as work in this area has matured, other questions have become more important—questions about the effects of amputation on quality of life, participation, or the experience of limb loss.” As researchers in the O&P field have developed experience and expertise, and the number of well-trained researchers has grown, “so, too, has the breadth of research skills,” Dillon notes. “As a community, we have much better skills and expertise to answer different types of research questions—questions about personal experiences, the ability to predict outcomes or synthesize complicated bodies of literature in a way that makes the take-home message clear.” Over the course of his career, Dillon has authored more than 30 peer-reviewed articles, has delivered 35 keynote or invited addresses at national and international meetings, and has served as a reviewer for peer-reviewed journals in prosthetics, orthotics, and rehabilitation. He also is a member of New South Wales Health working groups that focus on activity-based funding and review of clinical practice guidelines. Dillon’s most recent research efforts have focused on uniting different types of research to help inform difficult decisions about surgery, using a shared decisionmaking approach. This approach involved gathering research evidence on topics such as mortality outcomes, rates of surgical complications, quality
PRINCIPAL INVESTIGATOR
of life, or psychosocial outcomes and then “presenting this information in a way that helps those facing difficult decisions about amputation surgery become knowledgeable about the likely outcomes and risks,” he says. While providing individuals with access to quality information is important, says Dillon, “it has to be accompanied by meaningful conversations with health-care professionals who can help facilitate often difficult conversations. It is these conversations that are important to support patients as they deliberate on the decision they have to make. Hence, we’ve also been developing training resources for health professionals so they can develop the expertise to use a shared decision-making approach to have better conversations with those facing decisions about amputation surgery.”
Collaborating and Educating Dillon credits a variety of research collaborations with enabling him to
achieve his many accomplishments. “I’ve had opportunities to collaborate with epidemiologists, engineers, biomechanists, statisticians, and anatomists, as well as social workers and occupational therapists,” he says. While identifying people with the requisite skills and finding the time to collaborate can be challenging, Dillon notes that relationships have developed over time—and “the best ones have endured.” In his current role as associate professor and discipline lead in O&P at La Trobe, Dillon is in the classroom each week helping students learn more about research. “I particularly love the journal clubs, where we get to read and engage in meaningful discussion,” he says. “I love helping students see research in a whole new way. It is so rewarding to see their skills grow over time and watch them engage in increasingly more sophisticated discussions about research. I also value the opportunity to help students see there is still so much we have to learn.”
Ferrier Coupler Options!
Given Dillon’s dedication to students in their research endeavors, it comes as no surprise that he also is an ardent advocate of community service—which he engages in outside of the profession. Once a week he volunteers with an organization called “Tamil Feasts,” a social enterprise supporting recently settled asylum seekers through the celebration of food and culture. “Over time, I’ve had the privilege of working side-by-side with a group of Tamil men currently seeking asylum in Australia,” he explains. “I’ve learned a lot about Sri Lankan cuisine as these chefs share the food heritage of their homeland with the wider community. This unique enterprise creates a space in which Australians are able to show their support of individuals who are presently seeking asylum, while partaking in some seriously tasty food.” Whether in the classroom, pursuing research initiatives, or volunteering after-hours, Dillon continues to put his problem-solving skills to good use.
Interchange or Disconnect
The Ferrier Coupler provides you with options never before possible:
Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.
Model A5
Model F5
Model P5
The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.
The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.
Model FA5
Model FF5
Model FP5
NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.
Model T5
NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.
NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.
The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.
O&P ALMANAC | APRIL 2018
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MEMBER SPOTLIGHT
Medcuro Orthotics & Prosthetics
By DEBORAH CONN
Clinician Accessiblity St. Louis facility offers in-home visits and on-call hours to meet patients’ needs
M
EDCURO ORTHOTICS AND PROSTHETICS,
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Mark Bohning, CO, LO, delivers a brace (left) and prepares a cast for an ankle-foot orthosis.
FACILITY: Medcuro Orthotics & Prosthetics LOCATION: Two locations in St. Louis, Missouri OWNERS: Mark Bohning, CO, LO; Steven Finkeldei, CP; and Dale Watson, CO, CPed HISTORY: Nine years
Steve Finkeldei , CP, works with a below-knee check socket.
and custom-fit, made of metal, carbon graphite, and thermoformed plastic. The staff also fabricates a variety of molded shoe inserts and other types of custom foot orthoses. All fabrication is completed in house. The owners place great emphasis on personal care and attention. “We do in-home visits at no charge,” says Bohning. “Our prosthetists have great success with this approach. If there is a problem, they can go directly to a patient’s home. We keep tools in the car so that we can do adjustments on site. Patients don’t want to wait a week or more to see a clinician, so we are on call 24/7. We take the time needed, so we usually don’t have to make repeat visits. Still, it gives patients more confidence that if an issue arises, we’ll be there for them.” Medcuro uses CAD/CAM techniques on an as-needed basis for prosthetic devices but has had success with hand-casting
Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
PHOTOS: Medcuro Orthotics & Prosthetics
located in St. Louis, Missouri, employs a mix of the latest technology along with traditional casting methods in its practice. The company, which offers a full range of upper- and lowerlimb prostheses, specializes in pediatric orthotic management, diabetic wound-care management, and stroke and traumatic brain injury, according to Mark Bohning, CO, LO, one of Medcuro’s owners. The facility was opened nine years ago by Steve Finkeldei, CP, and Dale Watson, CO, CPed, who sought to offer more direct and personalized care after working for larger O&P companies. Bohning joined the ownership team four years later. “I specialize more in pediatric and geriatric cases, as well as stroke management and brain injury cases,” says Bohning. “Steve is certified in all the newest technology—Genium, C-leg, iLimb, Michelangelo hand.” Medcuro’s 3,500-square-foot main facility contains a full-service lab, two patient rooms, and a walk-in reception area. A second office, with 2,700 square feet, features three patient rooms and an orthotic lab. Medcuro employs a total of four practitioners, three technicians, and four administrative staff members. Bohning expresses great confidence in his staff, all but one of whom have more than 20 years of experience in orthotics and prosthetics. Along with prosthetic services, the company offers more than 600 different types of upper- and lower-limb orthoses, fabricated
techniques for orthoses, according to Bohning. “I use test casting and walk the patient in a cast to test the brace we’re going to use,” he explains. “I find it works great for solid ankle-foot orthoses because we can eliminate the need for a long-leg knee-ankle-foot orthosis in the majority of cases.” He adds, “The opportunity to test cast and customize is one of the reasons I like traditional methods. We use fiberglass for casting to simulate the rigidity of a functional orthosis. I’ve been doing it for years.” Medcuro, which uses an O&P office management system, is planning a partnership with Solution Outreach to improve customer contacts and information sharing. The text-based system will allow patients to reach practitioners directly and streamline the appointment process. Bohning says the company wants to grow slowly, through word-of-mouth and referrals, always maintaining quality of patient care for both old and new patients. Medcuro engages in some direct marketing as well, traveling to hospitals and physician offices to demonstrate the company’s product line. “Our goal is to provide exceptional care, so that our clients and patients will refer us,” Bohning says. “That’s been the best way to market.”
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MEMBER SPOTLIGHT
Ferrier Coupler
By DEBORAH CONN
Quick-Change Artists Family-run manufacturing business focuses on easier prosthesis removal
T
HE FERRIER FAMILY HAS
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Owner Brian Ferrier
COMPANY: Ferrier Coupler OWNER: Brian Ferrier and Cynthia Ferrier LOCATION: North Branch, Michigan HISTORY: 33 years
makes an all-terrain foot out of Delrin plastic that couples to a pylon leg. The foot is designed for outdoor activities because it is lightweight and impervious to water, sand, and dirt, says Brian. Because it is round, it has no toes to catch in branches or other obstacles. It comes with a stem that mounts inside a 30-millimeter pylon and offers about 23 degrees of rotation in all directions, allowing some ankle action so the foot is always solidly against the ground, according to Ferrier. The sole can be replaced. “My father wore his about 80 percent of the time,” Brian says. “Many amputees, especially the younger ones, don’t care if their prostheses look like real feet. They want function, and this is a functional alternative to a more complicated prosthesis that can be damaged by the elements.” Brian says he thoroughly enjoys the O&P industry. “It’s a small world, and it has a lot of nice people in it. We don’t work directly with patients, but we hear from them, and they are good people, just like the prosthetists.” He hopes the family business will continue, although he has no plans to step aside any time soon. “We’ve made it this long, I don’t see any reason to change.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
PHOTOS: Ferrier Coupler
been in business together for five generations, based on the same farm in North Branch, Michigan. The types of businesses have changed and expanded over the years, but the family involvement has been consistent. In the 1980s, third-generation farmer Lyle Ferrier lost his leg above the knee to cancer, but that didn’t stop him. He went on to add a campground to the farm and then an 18-hole golf course. Ferrier continued his work with all three businesses, but he became increasingly frustrated with his prosthesis. “He would get on his bulldozer and the leg would just be in the way,” explains Lyle’s son, Brian, who heads the family’s enterprises today. “He would have to pull down his pants, remove the socket and the leg, hand it to us, get dressed again, and then reverse the whole procedure when he was finished.” Lyle went to his prosthetist to find a coupling device that would allow him to remove the leg without taking off the socket. “He couldn’t find one, so he invented it,” says Brian. “He worked on it for a couple of years and patented the device. The hardest part was getting an L code, which took longer than getting the patent!” The family formed Ferrier Coupler Inc. in 1985 and began manufacturing and selling the couplers both directly
and through distributors to certified prosthetists. Lyle lived long enough to see the new business succeed, says his son, who took over after his father’s death in 1995. The family still runs the campground and the golf course, in addition to the coupler business, and Brian is joined by his wife, Cynthia, and daughter, Jennifer, in juggling the three enterprises. The coupler began as a way to easily remove a prosthetic limb. Skiers, for example, could uncouple their prosthesis at the top of a run, put it in a backpack, and ski to the bottom, where they could reattach the leg. Or amputees taking long car or airplane rides could uncouple their leg to sit more comfortably. “Previously, they would have to either travel without the limb or be uncomfortable,” says Brian. “Now they can just pull the pin, remove the leg, and place the residual limb in a more comfortable position.” Couplers have taken on a new role by allowing amputees to switch out devices. Women who want to change from flats to high heels can simply uncouple one leg and replace it with another, or athletes can switch to or among specialized legs for running, hunting, and other activities. In addition to several versions of the coupler, both in pyramid and four-bolt designs, Ferrier
LEARNING
NETWORKING
Get a competitive edge with exclusive face-to-face and distance learning opportunities on a variety of topics …plus valuable CEs!
It’s not just who you know, it’s who others know. Networking is powerful.
HAVE A VOICE Gain a say in what happens in government through AOPA’s advocacy efforts.
Why
JoOiPnA?
DISCOUNTS
A
Increase your purchasing power through members-only discounts on insurance, UPS, workplace apparel and credit card processing. B SCRU TOPS
VISIBILITY
Let your business stand out and get noticed by peers, patients, and your community. Mobility Saves Lives & Money.
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Improve documentation with coding, billing, and audit resources and research so you get fairly paid for services while providing excellent patient care.
Membership has its benefits:
JOIN US! Call 571-431-0876 or email info@aopanet.org.
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AOPA NEWS
AOPAversity Webinars MAY 9
JUNE 13
Coding: Understanding the Basics
Audits: Know the Types, Know the Players, and Know the Rules
Here’s where you’ll find the best “Coding 101” webinar you could ask for. Take part in the May 9 webinar to learn the background and basics regarding the all-important L-code system you use everyday. AOPA experts will address the following important topics: • History of the L-code system • How new codes are created • Basic tenets of code selection • “Base” codes vs. “Addition” codes.
Your source for advanced learning EARN CE CREDITS 52
APRIL 2018 | O&P ALMANAC
With the addition of the Target, Probe, and Educate TARGET (TPE) program comes new questions about audits and their resolutions. Take part TPE Program in the June 13 webinar to gain an understanding of the PROBE different audits and what happens during each. AOPA experts will share their knowledge on the following topics: • How many claims can a zone program integrity contactor (ZPIC) audit review? • How can we be removed from a TPE audit? • Who conducts the comprehensive error rate testing (CERT) audit? • What restrictions do the recovery audit contractors have? • What are my options when audited?
EDUCATION
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/2018webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Sign up for the entire series and get two conferences free. All webinars that you missed will be sent as a recording. Register at bit.ly/2018webinars.
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 members*: • Maynard Carkhuff • Shelly Hogan • Paul Prusakowski, CPO The O&P PAC recently made contributions to the following members of Congress*: • Sen. Ben Cardin (D-Maryland) • Sen. Clair McCaskill (D-Missouri) • Rep. Mike Bishop (R-Michigan) • Rep. Erik Paulsen (R-Minnesota) • Rep. Paul Roskam (R-Illinois) • Rep. Brad Wenstrup (R-Ohio) 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, and 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 15, 2018, and includes only donations/contributions made/ received between Feb. 15, 2018, and March 15, 2018. Any donations/contributions made or received on or after March 15, 2018, 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. 2018____________________________________________ 2019____________________________________________ 2020____________________________________________
Return completed form to: AOPA Attn: O&P PAC 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Or fax to: 571/431-0899
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. O&P ALMANAC | APRIL 2018
53
AOPA NEWS
CAREERS
Opportunities for O&P Professionals
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to 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. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad
Member $482 $634
Listing Word Count 50 or less 51-75 76-120 121+
Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word
Nonmember $678 $830
ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Member Nonmember $85 $150
For more opportunities, visit: http://jobs.aopanet.org.
Inter-Mountain
Certified Prosthetic/Orthotic Clinicians
Albuquerque and Santa Fe, New Mexico Advanced Prosthetics and Orthotics is currently seeking skilled, dedicated, and hard-working ABC-certified prosthetic/orthotic clinicians for our Albuquerque and Santa Fe offices. CPOs and COs must possess a strong clinical background as well as provide quality and compassionate care. We offer competitive salary; medical, dental, vision, and retirement options available. Email: rocket4464@gmail.com 54
Certified Prosthetist Orthotist (CPO) and Certified Orthotist (CO)
Job location key:
Job Board
Mid-Atlantic
APRIL 2018 | O&P ALMANAC
Central Virginia The Prosthetics and Orthotics Division in the University of Virginia’s School of Medicine seeks a certified prosthetist and orthotist (CPO) and a certified orthotist (CO) to consult, provide, and fabricate orthotic and prosthetic devices for adults and children with musculoskeletal impairments throughout Central Virginia. The successful candidates will be responsible for managing comprehensive orthotic and/ or prosthetic patient care. This includes patient assessment, formulation of a treatment plan, implementation of the treatment plan, and follow-up care and practice management. Candidates for both positions should have either a bachelor’s degree with completion of an NCOPE-affiliated certificate program and completion of NCOPE-affiliated residency program; or an associate degree with at least 10 years of direct P&O experience. Qualified candidates must be certified through the American Board for Certification in Prosthetics, Orthotics, and Pedorthics and have one year of postcertification experience. Some experience with foot/ ankle and pediatrics is required. Also, candidates should be knowledgeable with DME billing codes, insurance compliance, and current trends in the prosthetic and orthotic industry. Successful candidates for the CPO position should also possess interpersonal skills to help build referral bases. For these candidates, a history of prior practice management is preferred, and supervisory and/or office management skills are a plus. Applicants should complete a staff application through the Jobs@UVa website, and provide a cover letter, resume, and a list of three references. To apply for either position, visit https://jobs.virginia.edu, click on University Staff, and search for posting # 0622645 for the CPO position or posting # 0621917 for the CO position. For more information about the division, please visit https://med.virginia.edu/orthopaedic-surgery/orthopaedic-divisions/ orthotics-and-prosthetics/.
University of Virginia
Visit: https://jobs.virginia.edu This position is restricted and contingent upon continued funding. The University of Virginia is an equal opportunity and affirmative action employer. Women, minorities, veterans, and persons with disabilities are encouraged to apply.
Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac18 for advertising options.
ALPS Extreme AK/BK Gel Liner Designed with the end user in mind, the Extreme liner is the perfect fit for transfemoral and active transtibial patients. Offered in 3-mm and 6-mm uniform thickness, the Extreme offers 80 percent less vertical stretch, which allows for more control and stability during increased activity. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com.
Coyote Design Proximal Lock
Coyote Design’s locks are the all-terrain vehicles of prosthetic locks. Sand, mud, and water resistant, all of Coyote’s locks are tough enough for extreme activities and comfortable enough for everyday use. For more information, contact Coyote Design at 208/429-0026 or visit www.coyotedesign.com.
Make More Possible With the New 2018 ‘Crossover’ Knee The world’s first hybrid prosthetic knee that is user adaptable for walking, running, or sports. • Walking knee transforms into an activity knee • Mimics natural muscle function • Adjustable tendon durometers • Adjustable flexion range requiring no tools • Adjustable dampening and rebound • 275 lbs K2-K4+ activity • Use in any environment • Light and strong • Hybrid design.
MARKETPLACE
P.E.A.care 2.0 Splint and Clubycare Boots The P.E.A.care 2.0 splint, along with Clubycare boots, is a new option for the treatment of clubfoot according to the Dr. Ponseti method. The adjustable, quick-release splint provides easy donning and doffing of the padded Clubycare boots. The boots are made of soft leather and offer a Velcro closure with easily attachable soling for the P.E.A.care splint. For more information, contact Fillauer at 423/624-0946 or visit www.fillauer.com.
LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com.
Iceross Seal-In X Options Introducing the new Iceross Seal-In X-Classic, Seal-In X-Volume, and Seal-In X-Grip movable seals. For use with the Seal-In X and Seal-In X TF liners, these seals feature an improved textile donning aid and Easy Glide low-friction coating, making donning the socket easier without the use of alcohol or lubricant spray. Improve your patients’ skin and limb health, control volume, and reduce pistoning and rotation. Seal-In X provides personalized, optimal fit and secure suspension. Recommended for use with Unity sleeveless elevated vacuum for excellent volume control and suspension, with minimal added weight and no added build height. Ask your Össur rep about a demo today! For more information, contact Össur at 800/233-6263 or visit www.ossur.com.
Call us about our evaluation program! Call 800/322-8324 or visit www.fabtechsystems.com. O&P ALMANAC | APRIL 2018
55
MARKETPLACE Ottobock Microprocessor Feet (MPF) Ottobock’s advanced microprocessor, controlled foot technology allows your patients to experience life with fewer restrictions and provides a wide range of functionalities. With Ottobock Microprocessor Feet (MPF), patients have access to a unique “Relief” function that enables full-surface contact with the floor, and a more natural foot appearance. Empower® is the only prosthetic foot with powered propulsion, which emulates the function of lost muscles and tendons and delivers energy rather than consuming it, with each step. Empower also reduces stress on joints and offers patients the combination of power, control, and stability. Learn about our full MPF portfolio at professionals.ottobockus.com.
Ottobock Omo Neurexaplus Shoulder Orthosis Redefine recovery with Ottobock’s Omo Neurexaplus. The shoulder orthosis facilitates active rehabilitation by correctly positioning the arm and promoting movement for patients with shoulder subluxation. The Omo Neurexaplus inhibits pathological movement patterns, improves body posture and gait, and can be applied by patients themselves with one hand. For more information, call 800/328-4058 or visit professionals.ottobockus.com.
AOPA Compliance Guide CD—Updated This Compliance Handbook helps patient-care facilities follow the fraud and abuse prevention guidelines recommended by the Office of the Inspector General. This product will assist you in developing a compliance plan for your facility, including guidelines for developing a standard of conduct, billing policies and procedures, and much more. With the help of the AOPA Compliance Handbook CD, you will be able to create an effective audit/quality assurance program to monitor compliance and conduct introductory training sessions for employees. • AOPA Compliance Guide CD—Updated: $159 AOPA members, $318 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.
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APRIL 2018 | O&P ALMANAC
Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lowerlimb 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.
2018 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2018 AOPA coding products. Ensure each member of your staff has a 2018 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • 2018 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • 2018 CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • 2018 CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • 2018 Illustrated Guide: $185 AOPA members, $425 nonmembers • 2018 Quick Coder: $30 AOPA members, $80 nonmembers. Order at www.AOPAnet.org or call AOPA at 571/431-0876.
AD INDEX
Advertisers Index Company
Page
Allard
Phone
Website
25 866-678-6548
www.allardusa.com
ALPS
7 800-574-5426
www.easyliner.com
Amfit
39 800-356-3668
www.amfit.com
Anatomical Concepts Inc.
37
800-837-3888
www.anatomicalconceptsinc.com
Cascade Dafo
15
800-848-7332
www.cascadedafo.com
ComfortFit Orthotic Labs Inc.
31
888-523-1600
www.comfortfitlabs.com
Coyote Design
19
800-819-5980
www.coyotedesign.com
Fabtech Systems LLC
27
1-800-FABTECH
www.fabtechsystems.com
Ferrier Coupler Inc.
47
810-688-4292
www.ferrier.coupler.com
Fillauer
9 800-251-6398
Hersco
1 800-301-8275
Naked Prosthetics
29
888-977-6693
Össur
3 800-233-6263
www.fillauer.com www.hersco.com www.npdevices.copm www.ossur.com
Ottobock
C4 800-328-4058
www.professionals.ottobockus.com
Spinal Technology Inc.
35
www.spinaltech.com
Surestep
41 877-462-0711
800-253-7868
www.surestep.net
Make Your First Impressions Count
NE
W
!
With Customized Polo shirts, Scrub tops and Lab Coats for your O&P staff
Create an attractive business image, promote your brand, and foster team spirit with AOPA’s new Apparel Program. To order your apparel, go to
iconscrubs.com Enter access code: ICON-AOPA Enter your AOPA member id Create your user profile
AOPA is partnering with Encompass Group, a leading provider of health care apparel, to offer members special prices on customized polos, scrub tops, and lab coats.
AOPA Polo Shirts–Now for Sale Celebrate AOPA’s Centennial with us by ordering AOPA polo shirts for your office! The shirts are black with a white AOPA logo. Moisture wick, 100 percent polyester. Rib knit collar, hemmed sleeves, and side vents. The polos are unisex but the sizes are men’s M-2XXL. $25 plus shipping. Order in the bookstore at bit.ly/aopastore.
POLO TS SHIR
B SCRU TOPS
LAB COAT
O&P ALMANAC | APRIL 2018
57
CALENDAR
2018
May 4–5
ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
April 11
Enhancing Cash Flow & Increasing Your Accounts Receivable. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR
April 26–28
New York State Chapter Annual Meeting (NYSAAOP). Rivers Casino & Resort, Schenectady, NY. For more information, visit www.NYSAAOP.org.
April 30–May 1
2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars. San Antonio. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar
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 certification exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
May 7–12
ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
May 9
Coding: Understanding the Basics. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR
May 18–19
ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
June 1
ABC: Application Deadline for Fall CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/ certification.
Apply Anytime!
Apply anytime for COF, CMF, CDME; test when www.bocusa.org ready; receive results instantly. Current BOCO, BOCP, and 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
your next event!
58
Cascade Dafo Institute. Cascade Dafo Institute offers eight free ABC-approved online continuing education courses for pediatric practitioners. Earn up to 12.25 CE credits. 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 Let us
Free Online Training
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 2018 | 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
October 10
June 1
ABC: Practitioner Residency Completion Deadline for July Certification 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.
Year-End Review: What Should You Do To Wrap Up the Year & Get Ready for the New Year? Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR
October 18-20 June 13
Audits: Know the Types, Know the WEBINAR Players, and Know the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
International African-American Prosthetic Orthotic Coalition Annual Meeting. Embassy Suites Downtown Medical Center, Oklahoma City. For more information, contact Tony Thaxton Jr. at 404/875-0066, email thaxton.jr@comcast.net, or visit www.iaapoc.org.
November 4-10
July 11
Administrative Documentation: WEBINAR The Must Haves and the Sometimes Needed. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
Health-Care Compliance & Ethics Week. AOPA is celebrating Health-Care Compliance & Ethics Week and is providing resources to help members celebrate. Learn more at bit.ly/aopaethics.
November 12–13
July 13–14
PrimeFare East Regional Scientific Symposium. Hilton Downtown Nashville. Contact 888/388-5243, email primecarepruitt@gmail.com, or visit www.primecareop.com. 20th Anniversary of PrimeFare East!
July 23–24
2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars. St. Louis. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar
August 8
Outcomes & Patient Satisfaction Surveys. WEBINAR Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
August 10–11
The Texas Chapter of the American Academy of Orthotists and Prosthetists 2018 Annual Meeting. Westin Galleria, Dallas. For information and registration, visit www.txaaop.org
September 12
Medicare As a Secondary Payor: Knowing the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR
September 26–29
AOPA National Assembly. Vancouver Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0876 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.
2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Las Vegas. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar
November 14
Evaluating Your Compliance Plan & Procedures: How To Audit Your Practice. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR
December 12
New Codes, Medicare Changes, & Updates. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR
2019 September 25–28
AOPA National Assembly. San Diego Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0876 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.
2020 September 9–12
AOPA National Assembly. Mandalay Bay, Las Vegas. For general inquiries, contact Betty Leppin at 571/4310876 or bleppin@AOPAnet.org, or visit www.AOPAnet.org. O&P ALMANAC | APRIL 2018
59
ASK AOPA CALENDAR
Audit Answers Understanding the rules for recovery audits, the TPE program, 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
What items or services are currently under review or subject to a recovery audit by the recovery audit contractor (RAC)?
Q/
Performant, the RAC contractor for Region 5—which is responsible for all claims for durable medical equipment, prosthetics, orthotics, and supplies—only has two O&P-related issues under review at this time. First, Performant is currently conducting complex medical reviews for spinal orthoses described by the following codes: L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638, and L0640. This review has been in effect since Aug. 2, 2017. Second, complex medical reviews are underway for ankle-foot orthoses and knee-ankle-foot orthoses described by these codes: L1900, L1904, L1907, L1920, L1940, L1945, L1950, L1960, L1970, L1980, L1990, L2106, L2108, L4631, L2000, L2005, L2010, L2020, L2030, L2034, L2036, L2037, L2038, L2126, and L2128. This review has been in effect since July 5, 2017.
A/
Are the durable medical equipment Medicare administrative contractors (DME MACs) still conducting widespread prepayment reviews?
Q/
No. The DME MACs have shifted away from doing widespread reviews and are now conducting more focused reviews under the new Target, Probe, and Educate (TPE) program.
A/
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APRIL 2018 | O&P ALMANAC
Are there limits to the number of claims an audit contractor can review, or how far back the contractor can look?
Q/
The answer depends on the type of audit. For example, the TPE audits will typically only review between 20 and 40 claims per round. Because the TPE program involves a prepayment review, the auditors are not looking at previous claims. On the other hand, a RAC may look at claims that are three years old and may only look at 10 claims per 45 days for any one tax ID number.
A/
Did the introduction of the TPE program eliminate comprehensive error rate testing (CERT) audits or audits by the zone program integrity contactor (ZPIC)?
Q/
No. It is possible that you may still undergo a CERT audit from time to time, as the DME MAC contractors and their work in processing claims properly are still being audited. The ZPICs also remain in operation and will audit claims as they relate to fraudulent billing practices.
A/
AOPA Coding Experts Are Coming to
St. Louis July 23-24
ATLANTA
FEB. 26-27 | 2018
AOPA MASTERING MEDICARE:
ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA July 23-24 in St. Louis to advance your 14 CEs 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.
EARN
AOPA experts provide the most up-todate 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/2018billing.
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.
10. AOPA coding and billing experts have more than 70 years of combined experience. The Westin St. Louis 811 Spruce Street St. Louis, MO 63102 Book your hotel by July 6 for the $149/night rate.
Find the best practices to help you manage your business.
Participate in the 2018 Coding & Billing Seminar!
Register online at bit.ly/2018billing.
For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .
www.AOPAnet.org
3/18 ©2018 Ottobock HealthCare, LP, All rights reserved.
Triton® smart ankle | 1C66
Empower® | 1A1-1
Meridium® | 1B1
Know the difference Ottobock’s advanced microprocessor controlled foot technology enables amputees to experience life with fewer restrictions. It also provides a wide range of functionalities. With Ottobock Microprocessor Feet (MPF), patients have access to a unique Relief™ function that enables full-surface contact with the floor, and a more natural foot appearance when sitting or standing.
Check out how Empower’s powered propulsion emulates lost muscle function for more mobility; the Triton smart ankle actively responds to changes in terrain and speed to make walking easier, and Meridium offers a wide range of motion and provides more stability on uneven terrain. professionals.ottobockus.com