April 2022 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

AP R I L 2022

New Requirements for Six Orthotic Codes P.16

Leadership Series: DEI in the O&P Profession P.28

Studying Prosthetic Feet After PDAC Reclassification P.32

AFO GAME

CHANGERS ADVANCED ORTHOTIC ANKLE JOINTS AND A DIAGNOSTIC TOOL EXPAND RESOURCES FOR ORTHOTISTS P.20

WWW.AOPANET.ORG

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EARN 2 B USI NESS CE CREDITS P.19

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APR I L 2022 | VOL. 71, NO. 4

contents

COVER STORY

FEATURES

DEPARTMENTS | COLUMNS Views From AOPA Leadership......... 4

AOPA’s state-based advocacy initiatives

20 | AFO Game Changers

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

Numbers........................................................ 8

Designs of ankle-foot orthoses (AFOs) have evolved over the past several years, with technology playing a key role in advancing the possibilities for individuals with weak muscles or other ankle issues. Learn how advanced orthotic ankle joint systems and an instrumented AFO are improving stability and mobility for some patients. By Christine Umbrell

At-a-glance statistics and data

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

Research, updates, and industry news

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

Transitions in the profession

P.11

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

Face Time

28 |

O&P Almanac Leadership Series: All Included

How is your organization’s diversity, equity, and inclusion strategy faring? Four industry leaders discuss their organizations’ initiatives and explain their journey toward a more inclusive profession. Interviews Conducted By Josephine Rossi

CMS rule sets requirements for face-to-face visits and WOPDs for six orthotic codes Opportunity to earn up to two CE credits by taking the online quiz.

Member Spotlight................................. 38 n n

Stability Prosthetics ALPS

AOPA News................................................. 41

AOPA advocacy, announcements, member benefits, and more

Welcome New Members.................... 41

PRINCIPAL INVESTIGATOR Phil Stevens, MEd, CPO, FAAOP............... 34 Meet a director of clinical and scientific affairs at Hanger. Phil Stevens, MEd, CPO, FAAOP, is a prolific researcher who has been part of many landmark investigations that help demonstrate the value of O&P intervention.

Marketplace..............................................42 Careers......................................................... 45

Professional opportunities

Calendar......................................................46

Upcoming meetings and events

Ad Index....................................................... 47 State By State.......................................... 48

California, Colorado, Iowa, and Tennessee 2

APRIL 2022 | O&P ALMANAC

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VIEWS FROM AOPA LEADERSHIP

Put AOPA To Work in Your State

NE OF AOPA’S STRATEGIC priorities is to help members succeed in the changing healthcare environment. This month, I’d like to talk about how AOPA is supporting its members through state-based advocacy. We frequently talk about our efforts at a national level—for example, the Medicare Orthotics and Prosthetics Patient-Centered Care Act—but what’s happening in your home state is just as important. Last fall, AOPA invested in additional staff who dedicate time to digging in and helping you at the state level. AOPA’s work in states is both reactive (based on member requests and information) and proactive (tracking all state-level activity using legislative and regulatory tracking software). When AOPA affirmatively identifies legislation or regulations that could affect O&P, we approach members in the relevant state to identify ways we can collaborate and support them. We diligently update members about what’s happening via the AOPA Co-OP and the State by State column in O&P Almanac because issues cropping up in one state are often similar to or harbingers of those that might arise in other states. What types of issues is AOPA helping members address at the state level? Here are some recent examples: North Carolina: North Carolina Medicaid requested a meeting with AOPA to discuss the proposed update to the coverage policy for cranial remolding orthotic (CRO) intervention. AOPA convened its CRO Intervention Workgroup, which includes clinical experts from AOPA member companies, and prepped the group for this meeting to ensure that there was consensus regarding the limitations of the policy in question. The workgroup has a draft medical policy and white paper in progress that can assist with similar efforts in other states. New York: AOPA drafted a Medicaid coverage study bill that was introduced in both chambers of the New York state legislature. AOPA also is supporting an active group of New York advocates as they work to increase Medicaid reimbursement. AOPA has created a New York advocacy center to support grassroots advocacy. California: AOPA has been working closely with the California Orthotic and Prosthetic Association over the past year on its Medicaid budget resolution and supporting legislation. AOPA has created a California advocacy center to support grassroots advocacy. Iowa: AOPA is supporting Iowa’s effort to get replacement and repairs added into the workers’ compensation law. AOPA has created an Iowa advocacy center to support grassroots advocacy. Colorado: AOPA worked with clinicians in the state to thwart a 45% decrease to the state’s CRO reimbursement rate. This included submission of a request for a rate study and a letter in support of the clinicians in the state providing CRO intervention. Colorado Medicaid is currently working through that rate-setting process. AOPA will continue to track the progress and is prepared to launch a grassroots advocacy campaign, if needed.

If there’s an issue of concern in your state, please reach out to AOPA staff—they are ready to help. Let me close by reminding you that if you want to hone your advocacy skills and fight for the issues important to O&P, please register for the 2022 Policy Forum, which will take place May 17-18 in Washington, DC. The skills and tools targeting advocacy at the federal level that you will take away from the Policy Forum are just as applicable to work at the state level. Wherever you are, that’s where we want to help! Dave McGill is president of AOPA.

APRIL 2022 | O&P ALMANAC

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

Board of Directors OFFICERS President Dave McGill Össur Americas, Foothill Ranch, CA President-Elect Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Vice President Mitchell Dobson, CPO Hanger, Austin, TX Immediate Past President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS Jeffrey M. Brandt, CPO Ottobock, Exton, PA Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY Jim Kingsley Hanger Clinic, Oakbrook Terrace, IL Linda Wise WillowWood, Mount Sterling, OH Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair, Hanger Clinic, Houston Medical Center, Houston, TX James O. Young Jr., CP, LP, FAAOP Amputee Prosthetic Clinic, Tifton, GA

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AOPA CONTACTS

Our Mission Statement A trusted partner, advocating for and serving the orthotic and prosthetic community by: • Fostering relationships with decision makers to ensure equitable access • Providing education that promotes professional excellence • Supporting research that informs innovative care • Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.

A world where orthotic and prosthetic care transforms lives.

Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Nicole Ver Kuilen, manager of public engagement, 571/431-0836, nverkuilen@AOPAnet.org

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

Timishia Bannister, membership coordinator, 571/431-0835, tbannisterAOPAnet.org

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org

AOPA Bookstore: 571/431-0876 REIMBURSEMENT SERVICES

HEALTH POLICY & STRATEGIC ALLIANCES

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

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

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

Sam Miller, manager, state and federal advocacy, 571/431-0814, smiller@AOPAnet.org MEETINGS & EDUCATION Tina Carlson, CMP, senior director, education and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, senior manager of meetings and exhibition, 571/431-0852, kelly.oneill@AOPAnet.org Kristen Bean, digital meetings specialist, 571/431-0876, kbean@AOPAnet.org

MEMBERSHIP & COMMUNICATIONS

EXECUTIVE OFFICES

Susannah Engdahl, PhD, manager, health policy and research, 571/431-0843, sengdahl@AOPAnet.org

APRIL 2022 | O&P ALMANAC

Editorial Management Content Communicators LLC Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan

Our Vision

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

Publisher Eve Lee, MBA, CAE

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

O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/520-9632 , bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, 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 info@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 © 2022 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2022 for advertising options!

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NUMBERS

Women in O&P Female representation is on the rise, but more men than women fill clinical roles

STEADY GROWTH IN NUMBER OF FEMALE ABC-CERTIFIED CLINICIANS

ABC-CERTIFIED CLINICIANS

ABC-CERTIFIED ASSISTANTS

19%

Year

Total Number of Clinicians

Number of Female Clinicians

Percentage Female

2022

5,890

1,705

29%

2014

5,860

1,163

20%

2009

4,560

703

15%

2004

3,701

461

12% Data provided by ABC

16%

ABC-CERTIFIED TECHNICIANS

ABC-CERTIFIED FITTERS

15%

Percentage of female CPAs

Percentage of female CTPs

Percentage of female CFos

28%

33%

19%

99%

Percentage of female COs

Percentage of female COAs

Percentage of female CTOs

Percentage of female CFms

33%

16%

17%

60%

Percentage of female CPOs

O&P RESIDENTS

Percentage of female CPOAs

Percentage of female CTPOs

Percentage of female CFtss

Women Comprise More Than Half of Orthotist and Prosthetist Students Academic Year

2020-2021 56% Percentage of female residents starting in 2021 8

50%

Percentage of female CPs

APRIL 2022 | O&P ALMANAC

2019-2020 2018-2019

.17% 0% 0%

62%

38% 42% 44%

58%

Female Male Other Gender

56%

Data provided by NCOPE. Note data is reflective of gender. Percentages are rounded.

SOURCE: Sources: Data provided by American Board for Certification in Orthotics, Prosthetics, and Pedorthics; and National Commission on Orthotic and Prosthetic Education.

As AOPA and the O&P community commit to improving diversity, equity, and inclusion in the profession, the number of women in the profession is growing. More women are currently pursuing O&P degrees—but within the ranks of certified professionals, men still represent a majority.

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Happenings AWARENESS

O&P OUTCOMES

Limb Loss and Preservation Registry Goes Live Remember April Is Limb Loss and Awareness Month Themed “Your Ordinary Is Extraordinary,” April 2022’s Limb Loss and Limb Difference Awareness Month celebrates the limb loss and limb difference community and the need to support efforts that advance equitable medical access, care, and coverage. Visit AOPA’s website and social media pages to learn how AOPA is sharing members’ stories this month via the We Are O and P social media campaign. Throughout the month, 16 AOPA members are answering the question: What is one of the most important interactions you have had with the limb loss/limb difference community, and what role did you play? INSURANCE INSIGHTS

Coverage Among Black Americans On the Rise From 2011 to 2019, the number of Black Americans without health insurance who were younger than 65 dropped from 7.1 million people to 4.4 million—or from about 20 percent of the Black population to 12 percent. SOURCE: “Health Insurance Coverage and Access to Care Among Black Americans,” Office of the Assistant Secretary for Planning and Evaluation, February 2022

APRIL 2022 | O&P ALMANAC

After several years of planning and preparation, the O&P industry’s first Limb Loss and Preservation Registry (LLPR) has launched and is now “open The LLPR provides a home for for business,” according to Kenton outcome measures. Its primary value is Kaufman, PhD, PE, a Mayo Clinic to enhance treatment and care for limb researcher and LLPR program director. preservation and patients with limb loss, Mayo Clinic is the prime contractor according to the project’s official stateof the project, with funding provided ment of purpose. The registry has been by the Department of Defense and designed to accomplish National Institutes of several additional goals: Health (NIH), and in create a unified voice for partnership with AOPA all stakeholders, identify and the American and support under-served Academy of Orthotists populations, drive and Prosthetists. enhanced reimbursements, Mayo Clinic recently validate design concepts, received authorization generate real-time outfrom the Federal Risk comes, and provide data and Authorization points for evidence-based Kenton Kaufman, PhD, PE Management Program medicine and aftercare. to begin operating the LLPR, which Contributing data to the LLPR serves as a national collaborative “won’t require any extra work in [O&P warehouse for data on individuals who professionals’] practice,” Kaufman said. have lost limbs. “We are now enrolling “We are working with the O&P EHR sites to participate in the registry and [electronic health record] vendors to have had several sites sign up in these have them send the data to the registry. first [few] weeks,” said Kaufman. He If an O&P facility signs up, their O&P encourages individuals and companies EHR vendor will be notified to pass the that are interested in participating to fill data to the LLPR. At this point, there is out a form at www.llpregistry.org/join. no additional cost.” In the future, the LLPR administrators may add a small charge to sustain the registry, but at this time the costs are covered by a federal contract with NIH, Kaufman said. “It’s important to collect data to show that we provide better care,” said Kaufman. “Measurement is the first step that leads to improvement. If you don’t measure and document it, you will never know. And, you won’t be able to prove to the insurance companies that you provide better care.”

HAPPENINGS

RESEARCH ROUNDUP

Armband May Improve Control for Prosthesis Users

PHOTO CREDIT: Alex Dolce, Florida Atlantic University

Erik Engeberg, PhD (seated), led a study investigating use of an armband with haptic feedback in conjunction with a prosthetic hand. Researchers at Florida Atlantic University (FAU) designed a novel multichannel wearable soft robotic armband to convey artificial sensations to robotic hand users. The armband was fitted with soft actuators to convey a proportional sense of contact forces, and the design included vibrotactile stimulators to indicate if a grasped object had been broken. The research team, led by Erik Engeberg, PhD, an FAU professor, and Moaed A. Abd, a doctoral student at FAU, designed the armband for haptic feedback at three locations: the thumb, index finger, and little finger. They studied the armband in an investigation exploring whether people could precisely control the grip forces applied to two different objects grasped simultaneously with a dexterous artificial hand. They also studied the role of visual feedback during these tasks by systematically blocking visual and haptic feedback in the experimental design. Engeberg and his team found that multiple channels of haptic feedback enabled subjects to successfully grasp and transport two objects

simultaneously with the dexterous artificial hand without breaking or dropping them, even when their vision of both objects was obstructed. They also found that the simultaneous control approach improved the time required to transport and deliver both objects, when compared to a one-at-atime approach. Subjects reported that haptic feedback was considerably more important than visual feedback, even when vision was available, because there was often little to no visually perceptible warning before grasped objects were broken or dropped. “Our study is the first to demonstrate the feasibility of this complex simultaneous control task while integrating multiple channels of haptic feedback noninvasively,” Engeberg said. “None of our study participants had significant prior use of EMG-controlled artificial hands, yet they were able to learn to harness this multitasking functionality after two short training sessions.” Details of the study were published in February in Scientific Reports.

Researchers Examine Indoor Prosthetic Use Japanese researchers studied the rate of indoor prosthetic use among individuals with lower limb loss with regard to instrumental activities of daily living (IADLs). By examining patients’ medical records and questionnaire responses, a research team from Kobe University Graduate School of Medicine and Hyogo Rehabilitation Center assessed relationships between outcomes and indoor prosthetic use. Among prosthetic users, 71% used their prosthesis both indoors and outdoors, and 29% only used their prosthesis outdoors. The researchers found that three factors positively correlated to indoor prosthetic use: a small household, transtibial amputation, and a high score on the domestic chores of the Frenchay Activities Index. “Training of motions that are desirable to use the prosthesis and participation in domestic chores frequently based on IADLs before hospitalization may increase the frequency of prosthesis use in people with transfemoral amputation who use their prosthesis outdoors,” concluded the researchers. The study was published in February in Prosthetics and Orthotics International. FAST FACT

Texas Tops List of States With Most O&P Clinicians States with the highest numbers of orthotists and prosthetists include Texas, California, Ohio, Pennsylvania, and Michigan.

SOURCE: U.S. Bureau of Labor Statistics, Occupational Employment and Wages

O&P ALMANAC | APRIL 2022

HAPPENINGS

O&P ADVOCACY

Connect With Members of Congress at the AOPA Policy Forum

Use Your Voice. Educate. Advocate. Celebrate.

Plan now to take part in the 2022 AOPA Policy Forum, which will be held in person, May 17 and 18, at the Hilton Crystal City in Arlington, Virginia. After two years of a virtual event due to the COVID-19 pandemic, AOPA will reunite O&P stakeholders to advocate on behalf of the profession and patients. During the event, participants will learn about the latest legislative and regulatory issues and how they will affect clinicians, businesses, and patients. Attendees also will have an opportunity to educate members of Congress about the importance of O&P care for patients living with limb loss/ difference and limb impairment. For details, contact Sam Miller, AOPA manager of state and federal advocacy, at smiller@AOPAnet.org.

RESEARCH ROUNDUP

Acoustic Medicine May Play a Role in Treating Musculoskeletal Injuries Sustained acoustic medicine could be a viable option to treat individuals with musculoskeletal injuries, according to a new study from researchers at the Haley Veteran Administration Hospital in Tampa, Florida. The research team, led by Sandra Winkler, PhD, OTR/L, studied an emerging prescription home-use mechanotransductive device to stimulate cellular proliferation, to increase microstreaming and cavitation in situ, and to increase tissue profusion and permeability. Winkler’s team conducted a systematic literature review of studies that focused on individuals with neck and back myofascial pain and injury, knee pain and knee osteoarthritis, and generalized soft-tissue injury of the elbow, shoulder, back and ankle with limited function. As a result of

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APRIL 2022 | O&P ALMANAC

sustained acoustic medicine treatment, some of these patients experienced a daily change in pain intensity, a change in responses to the Western Ontario McMaster Osteoarthritis Questionnaire, a change in Global Rate of Change, and functional outcome measures, including dynamometry, grip strength, and range of motion. “When patients failed to respond to physical therapy, sustained acoustic medicine proved to be a useful adjunct to facilitate healing and return to work,” concluded the researchers. “As a noninvasive and nonnarcotic treatment option with an excellent safety profile, sustained acoustic medicine may be considered a good therapeutic option for practitioners.” The study was published in December in BMC Sports Science, Medicine, and Rehabilitation.

Sixty-five Team USA athletes competed in six sports during the 2022 Paralympic Games in Beijing in March, comprising the second largest delegation of athletes at the Games. For the fourth consecutive time, the men’s sled hockey team took home the gold, defeating Canada 5-0 in the championship game. The team’s five goals in the final were the most by a team in a gold-medal Paralympic sled hockey game. U.S. team members also won gold medals in different categories of snowboarding, biathlon, and cross-country skiing. Veteran and former Paralympic gold-medal winner Oksana Masters took home the top prize in two biathlon events and para cross country skiing (mixed relay), and fan favorite Brenna Huckaby took the gold in snowboard—women’s banked slalom. Overall, the U.S. came in fourth place in the Beijing medal count with six gold, 11 silver, and three bronze medals, for a total of 20. The countries with the highest medal counts were China with 61, Ukraine with 29, and Canada with 25.

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PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Jeffrey M. Brandt, CPO

ANNOUNCEMENTS AND TRANSITIONS

AOPA Board Member Jeffrey M. Brandt, CPO, was awarded the American Academy of Orthotists and Prosthetists’ Distinguished Practitioner Award during the Academy Annual Meeting in March.

Cristalei Polk has been selected as the recipient of the Russell Walker CP, LP, Emerging Leader Grant Program. Polk is a prosthetic resident at ProCare Prosthetics in Buford, Georgia. Orthotic Prosthetic Group of America (OPGA) and Össur announced the recipient during the Academy Annual Meeting & Scientific Symposium on March 3. “The Rusty Walker Grant is designed to pay tribute to a practitioner that was passionate about mentoring the next generation of O&P leaders, as well as providing annual funding to a current O&P resident that will allow them attend and participate in two different events that are outside of the clinical setting and realm but are highly important to the O&P profession and the patients it serves,” said Todd Eagen, president of OPGA. “Össur is honored to partner with OPGA to provide professional development opportunities for the future leaders of O&P while memorializing Rusty Walker and the imprint he left on the lives of his patients and colleagues,” said Jenna Matz, director of sales and marketing for Össur. “We look forward to facilitating these resident experiences as they aid in elevating the O&P profession.”

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APRIL 2022 | O&P ALMANAC

Adapttech, a biomedical startup, announced it has raised funds from investors, including Mercia Asset Management, ACF Investors, Wren Capital, and Wealth Club, and has launched the INSIGHT Range, a family of products designed for fitting lower-limb prostheses and improving patient outcomes. The new funding will be used by Adapttech to further develop smart, wearable technologies. The company combines 3D scanning with dynamic pressure data to improve efficiencies for O&P clinics and their patients. “This new funding comes at a time when we are developing exciting new technologies to benefit our O&P clinic customers and their patients,” said CEO Frederico Carpinteiro. Adapttech recently signed licensing deals with Modus Health for its StepWatch step-count software, the University of Washington for the Prosthetic Limb Users Survey of Mobility (PLUS-M) self-reporting tool, and Advanced Rehabilitation Therapy for the Amputee Mobility Predictors (AMPPro/AMPnoPro). These industry measurement tools will be incorporated into future product designs and patient outcome models. Allard USA is celebrating the 25-year anniversary of its ToeOFF® AFO, a carbon-composite dynamic response ankle-foot orthosis. Allard USA has developed a full range of products for adults and children that provide “Support for Better Life” by improving gait and walking capacity. Hanger Clinic’s AmpuShield® postamputation residual limb protector has received an Innovative Technology contract from Vizient Inc., a member-driven healthcare performance improvement company. The contract was awarded based on the recommendation of AmpuShield by hospital experts who serve on one of Vizient’s member-led councils. Innovative Technology contracts are recommended after review and interaction with products submitted through Vizient’s Innovative Technology Program. Vizient member-led councils identify technologies that have the potential to enhance clinical care, patient safety, or healthcare worker safety, or improve healthcare organizations’ business operations. “We’re honored that Vizient has recognized the AmpuShield as an innovative technology with the potential to greatly enhance postoperative care for people undergoing amputation surgeries,” said Pete Stoy, chief operating officer, Hanger Inc.

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REIMBURSEMENT PAGE

By DEVON BERNARD

Face Time

Six orthotic codes now require face-to-face physician encounters and written orders prior to delivery

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focused on the expansion of prior authorization as described in the Jan. 13, 2022, CMS rule, “Medicare Program; Updates to Lists Related to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Conditions of Payment.” This new rule also introduced a set of orthotic codes that will be subject to face-to-face encounters and written orders prior to delivery (WOPDs). This month’s Reimbursement Page reviews the codes that will require both WOPDs and faceto-face physician encounters, and explains what these requirements entail and when they take effect.

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Under the January 13 CMS rule, six orthotic Healthcare Common Procedure Coding System (HCPCS) codes, with dates of service on or after April 13, 2022, will require a face-to-face encounter and a WOPD as a condition of payment:

• L0648: Lumbosacral Orthosis, Sagittal Control, With Rigid Anterior and Posterior Panels, Posterior Extends From Sacrococcygeal Junction to T-9 Vertebra, Produces Intracavitary Pressure To Reduce Load on the Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-the-Shelf • L0650: Lumbosacral Orthosis, Sagittal-Coronal Control, With Rigid Anterior and Posterior Frame/ Panel(s), Posterior Extends From Sacrococcygeal Junction to T-9 Vertebra, Lateral Strength Provided by Rigid Lateral Frame/Panel(s), Produces Intracavitary Pressure To Reduce Load on Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-the-Shelf

• L1832: Knee Orthosis, Adjustable Knee Joints (Unicentric or Polycentric), Positional Orthosis, Rigid Support, Prefabricated Item That Has Been Trimmed, Bent, Molded, Assembled, or Otherwise Customized To Fit a Specific Patient by an Individual With Expertise • L1833: Knee Orthosis, Adjustable Knee Joints (Unicentric or Polycentric), Positional Orthosis, Rigid Support, Prefabricated, Off-the-Shelf • L1851: Knee Orthosis, Single Upright, Thigh and Calf, With Adjustable Flexion and Extension Joint (Unicentric or Polycentric), Medial-Lateral and Rotation Control, With or Without Varus/Valgus Adjustment, Prefabricated, Off-the-Shelf • L3960: Shoulder-Elbow-Wrist-Hand Orthosis, Abduction Positioning, Airplane Design, Prefabricated, Includes Fitting and Adjustment.

Written Orders

Typically, you are required to have a standard written order (SWO) on file prior to billing. However, if you are providing an orthosis described by one of the six codes listed above on

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or after April 13, you will be required to have a complete and valid SWO on file prior to delivery—called a WOPD. This requirement may not be a wholesale change for all providers as many already obtain a complete and valid order prior to delivery. The core elements of an SWO and a WOPD are the same, but they differ in the timing of when the order must be on file: The SWO is prior to billing and the WOPD is prior to delivery. Both an SWO and a WOPD require several key elements: • The patient/beneficiary. This may be done by using either the patient’s name or their Medicare Beneficiary Identifier number. • Order date. This is typically when the order is created/written. • Description of the item, including any and all supply items and accessories or options. This description could be a brief narrative or general description, such as “knee brace”; the appropriate HCPCS code and/or the HCPCS code narrative; or the brand name or model number of the item. With the increase in separation of the type of items being ordered and delivered (i.e., custom fabricated, custom fitted, off-the-shelf, etc.) and sometimes not knowing which base code will be billed until the time of delivery, consider avoiding use of HCPCS codes and descriptors with your orders. This could save some time and headaches down the road, including the possibility of having to get a new and revised order. • If applicable, the quantity of the items being ordered and dispensed. • The treating practitioner’s name (whether a physician, nurse practitioner, or physician assistant) or their NPI number. • Signature of the treating practitioner. The practitioner does not need to date the order when they sign, but their signature is required. When using a WOPD, note that one difference from a traditional 18

APRIL 2022 | O&P ALMANAC

SWO is that the treating practitioner must document and communicate to you—the supplier—that they have had a face-to-face encounter with the patient within the six months preceding the date on the written order.

Face-to-Face Encounters

The new requirement for a face-to-face encounter does not mean a mandatory face-to-face meeting with the orthotist for delivery or evaluations. It refers to the patient having to see or have a faceto-face encounter with the ordering physician, or other eligible professional, prior to the order being written for one of the six mandated braces described by HCPCS codes L0648, L0650, L1832, L1833, L1851, and L3960. Several requirements must be met for a face-to-face meeting to be considered valid under the new rule.

orthosis is being ordered, which may include physical exams, diagnostic tests, progress notes, treatment plans, etc. Third, all of the subjective and objective findings and notes must be documented in the patient’s medical record. Fourth, this documentation and the subsequent order must be kept on file by you, as the supplier, and made available upon request. Finally, the use of telehealth is acceptable for the face-to-face encounter, provided that all of the regulatory requirements for a telehealth visit have been met. Under normal circumstances, O&P services would not meet the regulatory requirements for a telehealth visit and the patient would have to have a physical encounter with their physician. However, under the current public health emergency (PHE) for COVID-19, telehealth encounters have been expanded to include O&P services, and the PHE was extended for 90 more days on Jan. 16, 2022. This recent PHE extension ends April 16, 2022—right around the April 13 start of the face-to-face encounter requirement—unless it is extended again.

Prior Authorization

First, it must occur within the six months preceding when the physician, or other eligible professional, wrote the order for one or more of the six orthoses. So, if the patient has not seen their physician within the past six months and the physician orders an L1851 style knee orthosis, you must make sure the patient goes back to their physician for a new face-to-face meeting. Second, the meeting must be used by the ordering practitioner to gather information associated with the diagnosis, treatment, or management of a clinical condition for which the

As a reminder, the expansion of Medicare prior authorization now includes five orthotic HCPCS codes. Phase 1 of the expansion begins with claims on or after April 13, 2022, for facilities and/or patients in New York, Illinois, Florida, and California. Phase 2 begins with claims on or after July 12, 2022, and includes Maryland, Pennsylvania, New Jersey, Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona, and Washington. The final phase of the expansion begins Oct. 10, 2022, and includes all remaining states and territories. The following five codes have been added to the Medicare prior authorization program: • L0648: Lumbosacral Orthosis, Sagittal Control, With Rigid Anterior and Posterior Panels, Posterior Extends From Sacrococcygeal Junction to T-9 Vertebra, Produces Intracavitary Pressure To Reduce

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Load on the Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-the-Shelf • L0650: Lumbosacral Orthosis, Sagittal-Coronal Control, With Rigid Anterior and Posterior Frame/ Panel(s), Posterior Extends From Sacrococcygeal Junction to T-9 Vertebra, Lateral Strength Provided by Rigid Lateral Frame/Panel(s), Produces Intracavitary Pressure To Reduce Load on Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-the-Shelf • L1832: Knee Orthosis, Adjustable Knee Joints (Unicentric or Polycentric), Positional Orthosis, Rigid Support, Prefabricated Item That Has Been Trimmed, Bent, Molded, Assembled, or Otherwise Customized To Fit a Specific Patient by an Individual With Expertise

• L1833: Knee Orthosis, Adjustable Knee Joints (Unicentric or Polycentric), Positional Orthosis, Rigid Support, Prefabricated, Off-the-Shelf • L1851: Knee Orthosis, Single Upright, Thigh and Calf, With Adjustable Flexion and Extension Joint (Unicentric or Polycentric), MedialLateral and Rotation Control, With or Without Varus/Valgus Adjustment, Prefabricated, Off-the-Shelf. The need for the prior authorization will be based on where the patient resides, and not where the care is being provided. So, even if your facility is not part of Phase 1 or Phase 2, you may be required to submit a prior authorization request before the October 10 implementation date. Be aware that the current stated turnaround time for initial and resubmitted prior authorization requests for these codes is five days, and the expedited turnaround time is two days.

Prepare Now

With all of these changes taking effect, be sure to update your policies and procedures and educate your staff. Prepare your team for the implementation of WOPD, the new face-to-face requirements, and the expanded prior authorization program. 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: www.bocusa.org

O&P ALMANAC | APRIL 2022

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NEED TO KNOW: • At least three companies offer versions of advanced orthotic ankle joints, which represent “a dramatic departure from anything we’ve had before in lower-extremity orthotics,” according to Thomas DiBello, CO, LO, FAAOP, an early adopter of the technology. • Advanced orthotic ankle joint systems are designed to harness ground-reaction force to replace or augment the multiplanar function of the ankle, and stabilize the knee during stance in individuals with weakness in their lower-limb musculature. • An instrumented AFO (iAFO) developed by Géza Kogler, PhD, CO, and his team enables orthotists to more objectively assess stiffness needs for AFOs. • Kogler’s team recently leveraged the iAFO during in-clinic gait studies; findings suggest that the diagnostic iAFO has the potential to provide clinically relevant measures that would be helpful at formulating prescriptions, according to Kogler.

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are must-haves for patients with footdrop and a variety of other conditions that impair mobility due to their ability to support weak muscles and help control the position and motion of the ankle. As technology has progressed, material and design options have rapidly expanded. Two recent groundbreaking advancements in the world of AFOs are advanced orthotic ankle joints that allow fine-tuning of

alignment and motion control and an instrumented AFO designed as a clinical diagnostic tool. These significant innovations were discussed during a popular session at AOPA’s National Assembly in September. Thomas DiBello, CO, LO, FAAOP, and Géza Kogler, PhD, CO, shared their experiences with these key cutting-edge concepts and explained how these technologies will aid orthotists in providing optimal clinical care. O&P ALMANAC | APRIL 2022

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Clinical Applications of Advanced Orthotic Ankle Joints

APRIL 2022 | O&P ALMANAC

Conventional double-action ankle control systems are sometimes overwhelmed by the magnitude of the external moments associated with normal walking, but new orthotic ankle control systems have the ability to manage the forces associated with those moments more effectively, according to DiBello.

Thomas DiBello, LO, CO, FAAOP

Advanced orthotic ankle joints, now available from several manufacturers, represent a “dramatic departure from anything we’ve had before in lower-extremity orthotics,” DiBello said. These innovations allow orthotists “to affect all of the parameters necessary to dial in the patient’s alignment and motion control at the ankle.” In his role as a director in the Department of Clinical and Scientific Affairs at Hanger Clinic, DiBello became an enthusiastic early adopter when he had the opportunity to use these joints upon their release. These sophisticated mechanical ankle control systems can be leveraged to control motion at the ankle in AFOs and knee-ankle-foot orthoses (KAFOs). Designed to harness ground-reaction force, they replace or augment the multiplanar function of the ankle and stabilize the knee during stance in individuals with weakness or diminished capacity in their lower-limb musculature. “These systems allow the clinician or the user to adjust the range of motion, resistance, stiffness, and alignment of the shank of the orthosis in relation to the foot and allow each to be adjusted independently of the other,” DiBello explained.

IMAGES: Becker Orthopedic

Becker Orthopedic, Ottobock, and Fior & Gentz offer versions of advanced orthotic ankle joints for use with anklefoot orthoses (AFOs). During the AOPA National Assembly, clinicians from Becker and Ottobock shared information about recent trials and patient experiences with these new systems. “These components are in an entirely different class, and they will allow you to preserve the gait rockers while, at the same time, having a functional benefit to the patient—which is a tool that we have needed and haven’t had in the past,” explained Nicholas LeCursi, CO, vice president of service and chief technology officer at Becker Orthopedic. “Our objective is to minimize the restriction of the ankle … while maximizing the therapeutic benefit to the patient,” said LeCursi. His team has worked with collaborators to conduct research supporting these abilities and has demonstrated improved patient outcomes. “The main features of these new joints are an increased range of motion and … very well controlled resistances Becker’s Triple Action for dorsi- and plantarflexion, realized ankle joint by a system of various specific spring elements,” added Thomas Schmalz, PhD, head of the biomechanics lab at Otto Bock in Germany. In addition to their use in AFOs, advanced ankle joint systems may be used in some knee-ankle-foot orthoses to improve outcomes, according to Schmalz. These devices may improve mobility during shortstep walking and in ascending ramps, particularly among individuals using stance control orthoses (SCOs). “The novel advanced orthotic ankle joint can lead to new functional options to optimize individual SCO fittings,” he said. The devices also have applications in conjunction with Ottobock’s C-brace, according to Ted Friedman, CO, a member of Ottobock’s professional clinical services team. Company clinicians have evaluated several patients using the technology in this way, and they have seen improvement in stability and safety during gait, as well as hands-free walking in some patients who previously relied on crutches or canes while using orthoses. “It really improves quality of life,” Friedman said.

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Designing and Testing a Diagnostic Tool

The instrumented AFO (iAFO) developed by Kogler’s team fills a long-standing need among orthotists to more objectively assess stiffness needs for AFOs. At most O&P facilities, the current method to assess AFO stiffness is subjective. “It’s experiential, and it’s based upon a good guess,” Kogler said. “If we want to advance the profession, we need to be conducting more diagnostic test measurements, and they must be part of our clinical practice.” More diagnostic data can help orthotists in estimating prognosis, determining treatment, and evaluating the effectiveness of treatments.

Géza Kogler, PhD, CO

Kogler, who is program director for Kennesaw State University’s MSPO program, worked with a team of researchers, including Omer Inan, PhD; Nicholas Bolus; and Caitlin Teague, at his former university affiliation with Georgia Institute of Technology to develop the iAFO, for which he currently has a patent pending. The wearable and portable passive exoskeletal device embedded with sensors includes an orthotic control feature that enables the clinician or researcher to modulate ankle joint stiffness with a series of interchangeable extension springs, study the wearer’s biomechanical response to such a perturbation, and ultimately identify and prescribe an optimal orthosis stiffness on a patient-specific basis. The design of the iAFO imposes rotational resistance in only one direction at a time, and preserves the critical functions of a clinically prescribed AFO, according to Kogler.

IMAGE: Ottobock

“When used in concert with a propenergy, and allowing the momentum of erly designed orthosis, the literature the swing limb to pull the heel off the has shown that this category of joints ground into terminal stance.” creates magnitudes greater of change Orthotists play a key role in in the kinetics of the knee and ankle, ensuring patients can maximize the and in energy storage and return, benefits of these joints, according to as compared to conventional ankle DiBello. “The effectiveness of these control systems in swing phase—and, advanced systems is dependent on as a result, can positively affect the their use in an appropriately designed kinematics of the limb in swing phase,” orthosis, which, at a minimum, said DiBello. represents an intimate fit, correct He described why the design of alignment, appropriate material stiffadvanced ankle joints is so ness, plantar surface pitch, impactful: When patients and toe ramp angle.” He wearing AFOs tranreiterated the imporsition from double tance of mechanical support to single control systems support, the point that are powerful of contact of the enough to effecheel is behind the tively manage the ankle joint, which significant forces creates signifiaround the ankle cant plantarflexion at mid-stance and movement during terminal stance. “The Nexgear Tango the transition. “In the control system must past, we had a simple coil continue to absorb energy, spring that was moderating and then begin to release it as a the movement of the limb to the patient moves into pre-swing.” ground, and if we wanted to increase For orthotists seeking these joint that stiffness, we had to reduce the systems, DiBello identified three range of motion there,” which might companies offering options: Fior & cause a perturbation (external flexion Gentz, the first company to develop moment) at the knee, said DiBello. the technology; Becker Orthopedic; However, when AFOs are paired with and Ottobock. DiBello has used prodadvanced ankle joint systems, “we can ucts from all three manufacturers dial that in without changing the range and has observed that they are able of motion. We can allow the movement to manage the challenge associated to occur, from initial contact to loading with mid-stance hyperextension, the response, in a very controlled way.” sudden snapping back of the knee in New designs enable orthotists to mid-stance, by allowing the patient increase torque without affecting the to shift their weight forward into the range and to meter the movement of resistance of the anterior module the tibia forward. “We begin,” DiBello of the joint, allowing for more erect noted, “to affect the things from the posture and symmetrical gait in some very beginning of a stance period.” patients. The design also is impactful during Despite their value to patients, mid-stance, when orthotists seek to Medicare and most private insurance stabilize the tibia in a few degrees of plans do not yet cover these compoinclination. Without advanced ankle nents. DiBello encouraged orthotists joints, “we have a stop,” explained to try these devices on patients, as DiBello. But the new designs “allow appropriate and when funding exists, us to actually absorb the momentum to evaluate their efficacy. He also from the movement of the swing limb recommended O&P researchers to as it swings past the stance limb,” he conduct randomized comparative said. “It is storing that power and that effectiveness trials.

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The instrumented AFO serves as a diagnostic tool for orthotists.

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gait analysis alone. Kogler leveraged the iAFO during in-clinic gait studies using healthy subjects as a baseline, to evaluate the paradigm for orthotic fit and function. Users were equipped with the iAFO for walking, slope walking, and stair walking. Researchers calibrated the sensors and acclimated the subjects to various settings ahead of time. The subjects tested at five stiffnesses, compared to a control with no stiffness. Kogler and his team recorded data continuously during two-minute trials. In his first study, Kogler’s team looked at 10 healthy subjects, with two resistance modes: dorsiflexion resistant and plantarflexion resistant. Trials were conducted on a treadmill at zero degrees for a duration of up to two minutes, with five discrete different stiffness settings. Reviewing the collected data, Kogler and his team examined the degree in magnitude that occurs with various stiffnesses. “With increasing stiffness, there’s a decrease in the range of movement,” Kogler noted. “This demonstrates that if an AFO is too stiff, then we have truly impeded their ability during stance phase walking. And in an ideal world, if we could achieve toe phase clearance during swing, but still maintain as close as we can to the normal

Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

IMAGE: Courtesy of Géza Kogler, PhD, CO

The diagnostic tool is “in-clinic friendly,” enabling clinicians to view sensor readings via a tablet. It features a comprehensive sensor suite to allow for monitoring of a patient’s sagittal plane ankle kinematics, kinetics, muscle activity, plantar pressures, and orthotic interface pressures between the device and the user. The system works in conjunction with a desktop computer to store and display data and allows users to participate in tasks other than normal walking level, including sloped walking, stair walking, and uneven terrain/obstacle evasion tasks, with the potential to be used outside the confines of a gait analysis lab. According to Kogler, clinicians can use the information from this system to make informed decisions about how best to modify device geometry and “dose” orthotic stiffness. The iAFO can report on the following gait parameters: ankle range of motion, peak torque applied by the device, biomechanical “power” lost to the device across a gait cycle, time spent in single-limb support on the affected limb, changes to gait symmetry, peak impulse applied at the device-to-user interface, training/ motor-learning effects over time, and ankle angle and amount of “shock” at initial contact—information that cannot be obtained via observational

range of movement during walking, that would be the optimal goal with the orthosis.” Results from the proof of concept suggest that a diagnostic iAFO has the potential to provide clinically relevant measures that aren’t currently being used in clinical practice, which would be helpful at formulating prescriptions, according to Kogler. “The data also suggests that there is a correlation between the ankle torque resistance at the ankle during level treadmill walking,” he said. “This is intuitive, but now we know the exact degree that this may occur.” Kogler noted several benefits of data-driven clinical decision-making associated with AFOs. “It can provide a new opportunity for best practices with orthotic management and should be included in our clinical measurements to optimize for the user, essentially, that we should be able to measure the required stiffness in the user of how much it takes to achieve toe phase clearance, determine what the stiffness should be, and then engineer the orthosis to optimize the final performance,” Kogler said. “That would mean that once the diagnostics are determined through tests that are conducted in the clinic, and then the device is made to those specifications, it would require us to actually test the stiffness of the AFO before it’s applied to the user.” Ultimately, the iAFO serves a key purpose in the clinic, according to Kogler. It can be used to quantify users’ performance for different specified ankle joint stiffnesses for level walking, and “it can help predict the user’s response to various orthotic ankle stiffnesses and estimate the target stiffnesses for various types of walking.” Kogler’s work was supported by the Department of Defense through the Congressionally Directed Medical Research Programs, under Grant Award W81XWH-15-1-0479.

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All Included O&P stakeholders discuss their organizations’ current diversity, equity, and inclusion initiatives and plans for the future Interviews conducted by JOSEPHINE ROSSI

EDITOR’S NOTE: For 2022, O&P Almanac has revived the popular Leadership Series, which originally appeared in the magazine in 2015, to once again feature revealing insights and opinions from senior-level leaders on topics of critical importance to the future of the profession. To complement AOPA’s launch of a new mission and vision and emphasis on “reimagining the profession,” subsequent installments of this feature will include interviews with O&P stakeholders on topics of key importance to O&P clinicians, manufacturers, researchers, and educators.

OW IS YOUR ORGANIZATION’S diversity,

equity, and inclusion (DEI) strategy faring? As businesses continue to recover and rebuild from the pandemic, some that have halted or deprioritized efforts during the crisis may soon find themselves at a disadvantage not only for current and prospective employee retention, but also for overall performance and organizational health. As the profession increasingly investigates the social determinants of health, health inequity, and health disparity within O&P patient populations, it is appropriate to provide safe, fair, and equal treatment for all individuals. It is also appropriate that all individuals are fairly represented within our profession, ensuring patients see themselves reflected in those who care for them. In this second installment of the revamped Leadership Series, O&P Almanac convened four industry leaders to discuss the progress their organizations have made in their DEI initiatives, bumps in the road, and sustainability for these programs in the long run.

APRIL 2022 | O&P ALMANAC

O&P Almanac: What kinds of diversity does your organization’s initiative(s) address? Nina Bondre, CPO: To us at Ottobock, diversity is much broader than the color of one’s skin or gender identity. We have been intentional in our presentation of DEI as encompassing but not limited to race, sexual orientation, gender identity, socioeconomic status, religion, nationality, and political affiliation, to name a few elements. J. Chad Duncan, CPO, PhD, CRC: We are seeking as much diversity as possible by creating an environment of belonging and cultural humility. We’re trying to be open to everyone who’s interested in orthotics and prosthetics, and reaching out to various universities within the rehabilitation field. With technology coming quickly, being more accessible, individuals who traditionally might not have seen O&P as an avenue for their work and profession are now becoming open to it. Salus is recruiting individuals who are highly interested and motivated in O&P. At the same time, we’re thinking of ways to accommodate individuals’ differences, no matter what those differences may be. …The university has been around for 100 years, but they changed their name, 14 years ago, to Salus, which actually in Latin means health and well-being [in reference to the] idea of health and well-being impacting the future of healthcare, education, and professional practice. What you’re alluding to is [about] thinking outside the box of who the next O&P professional may be. Or maybe could be. Lisa Lodyga-Uhl: Our goal is to create a work environment where each and every team member can be their true, authentic self at work, and be valued for their unique perspectives and experiences. In that respect, we celebrate all dimensions of diversity.

Meet Our Contributors: Nina Bondre, CPO, is the clinical educator for Cascade Orthopedic Supply Inc. She enjoys learning about new technologies and componentry to assist clinicians and advocating for DEI efforts in O&P. Bondre co-founded Ottobock’s North American Diversity Council, which works to create a more inclusive environment through mentorship, education, and representation initiatives. She frequently presents on subjects relating to DEI, women’s leadership, O&P clinical topics, and communication skills. J. Chad Duncan, CPO, PhD, CRC, has been working in higher education for more than 15 years, of which 10 years have been in O&P education. He started out as a technician in the early 1990s and later graduated from Northwestern’s O&P certificate program. After working as a clinician, he went on to earn his doctorate in rehabilitation. Duncan currently is chair of the Department of Orthotics and Prosthetics at Salus University, where he is developing a new O&P education program. Lisa Lodyga-Uhl is the vice president of talent management, learning, and development, and chief diversity and inclusion officer at Hanger Inc. Before joining Hanger, she held several corporate positions, including a diversity strategist for Dell Inc. She is experienced in developing human resource strategies to foster an employer-of-choice brand through programs that attract, develop, and retain talent. She is motivated by developing and implementing diversity and inclusion programs and building relationships to drive change. Linda Wise is vice president strategic partnerships at WillowWood, where she manages U.S. and Latin America distributor relations and oversees a customer care team. With a passion for helping women develop and advance their careers and leadership skills, Wise founded the Women in Leadership organization at WillowWood, has co-chaired the AOPA Women in O&P event, and serves on the AOPA Board of Directors and is the board chair of the AOPA Diversity, Equity, and Inclusion Committee.

O&P ALMANAC | APRIL 2022

We also recognize that there are benefits to providing starting points for team members to engage in our diversity and inclusion journey, which is why we offer internal affinity groups centered around race, cultural background, veteran status, women, LGBTQ+, and disabilities awareness.

O&P Almanac: How does your initiative address equity/fairness and inclusion? Bondre: We have started a mentorship program to pair employees across different levels of our organization to encourage building connections and community at Ottobock. We are also reviewing our hiring practices and workforce composition to understand where we can improve. Duncan: Salus hired a full-time DEI position this year. She will be looking at … how our curriculum is presented and how our teaching practices must evolve to be more welcoming and opening. We can let a lot of diverse individuals come in, but if we don’t connect with them from an educational or knowledge-translation standpoint, then it creates that barrier, and they don’t identify with our profession. Another piece is the admissions process: Are we being informative to individuals who might be first-generation college students or from minoritized backgrounds? Are we being educational in the process, so they can make informed decisions? Then there is the well-being piece. …[We] even set aside a mindfulness space for students just to be able to connect within themselves. That [resonates] with a lot of individuals who might not be from a “traditional” background. Lodyga-Uhl: One of our main initiatives, the Hanger Foundation Diversity Scholarship Program, specifically addresses equity, fairness, and inclusion by recruiting underrepresented students of color into the O&P 30

APRIL 2022 | O&P ALMANAC

profession. The scholarship program, which started in 2020, supplements the cost of the two-year Master of Science in Prosthetics and Orthotics program, and also offers a two-year mentorship with the option of pursuing a residency with Hanger Clinic. We are excited about this actionable step to promote diversity and inclusion within the company and the broader healthcare community.

“We have been intentional in our presentation of DEI as encompassing but not limited to race, sexual orientation, gender identity, socioeconomic status, religion, nationality, and political affiliation, to name a few elements.” —NINA BONDRE, CPO

In addition to our efforts to bring more diverse candidates into O&P programs, Hanger’s D&I Pledge addresses other areas, including dedicated clinical research into understanding why amputation is significantly more prevalent among people of color in the United States; the Hanger Diversity & Inclusion Council to help us identify specific actions we can take at Hanger and in the O&P profession to foster more inclusion; unconscious bias training throughout our organization to increase awareness and identify ways to mitigate bias at work; and internal employee affinity groups to create spaces for employees and allies to connect.

O&P Almanac: What is the business case for DEI, and is your organization realizing any of these benefits from your efforts? Bondre: While there is plenty of research which shows the high creativity and innovativeness of diverse teams, the business case for DEI is that it is the right thing to do. Business leaders should not need to see the dollars from these efforts as an incentive to build out DEI efforts. Creating an inclusive workplace where employees are comfortable to be themselves and participate fully is value in and of itself. Duncan: [DEI] can’t be seen as a business decision. I see it more as a necessity for any organization—especially in education—if we want to produce the next generation of competent clinicians. We must be intentional about how we go about creating an environment of belonging and acceptance. It can’t be a plug-and-play approach. Once you commit to it, it becomes the fabric of your organization and a life-long process. The benefit really is a diverse classroom, diverse input. It prevents that groupthink of everybody agreeing on how to approach a case in O&P. Everybody has a different opinion, and when you bring in life experiences, that makes it an even richer learning experience. Lodyga-Uhl: There is a lot of research indicating that when diversity and inclusion is approached strategically in the workplace, it can lead to increased employee engagement, better decision making, and greater innovation. While it’s difficult to make direct correlations between D&I efforts and these business indicators—especially so early on in our efforts—we are experiencing positive trends that suggest we are moving in the right direction: increased employee participation and engagement around our efforts, team member suggestions for future initiatives, and potential team members asking about our D&I initiatives during the interview process.

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Linda Wise: AOPA has created the Diversity, Equity and Inclusion Committee, which is charged with advising the board on initiatives that can be implemented to address improving diversity, equity, and inclusion within the O&P profession. It is the hope of the board that through the committee’s efforts AOPA creates an inclusive culture for all members and future members; we define our role in helping address health disparities in the O&P community; and we provide our members with the support and resources they need to address DEI within their own business.

O&P Almanac: What has been the reaction from employees, and how does your organization handle those who are noncompliant or who do not agree with policies? Bondre: We have received support from our colleagues at all levels of Ottobock North America and globally. There is a lot of interest in making DEI an integral part of the employee experience and weaving it into everything that we do. Duncan: I have had nothing but positive responses from [Salus] faculty and staff about my approach to cultural humility and DEI policies. Luckily, we have not had to handle any issues around noncompliance. I have had people approach me outside of my organization questioning the intent and saying it is not needed. I listen to their concerns, then try to provide some education on the need and reasons for how important it is to be aware of others and the challenges and barriers others may have had that we didn’t. DEI is not about putting anyone down; it’s about building humanity and better awareness. The idea within cultural humility is compassion. Some people roll their eyes and such. But we all look at situations differently. So, if somebody’s chuckling about it, you use that as a teachable moment. 32

APRIL 2022 | O&P ALMANAC

Lodyga-Uhl: Team members are excited about and proud of our initiatives—particularly the public D&I Pledge we made in 2020. The pledge and its five focus areas illustrate our commitment to diversity and inclusion not only within Hanger, but also for the O&P and allied health professions. We recognize that individuals are in different places along their own personal D&I journey, which is why we will continue to focus on creating awareness around how leveraging diversity and fostering inclusion can positively impact our teams and the patient care we provide. Wise: AOPA’s DEI Committee is in the process of creating a launch package that will be sent to members informing them of its vision, goals, and timeline. A survey will follow the launch announcement to collect feedback on our members’ DEI efforts and how AOPA can best support them in advancing equality to strengthen their practices/organizations and the O&P profession as well as improve the lives of patients.

O&P Almanac: What have been some pain points in your efforts so far? How did you handle them? Bondre: Something I have learned from interacting with both the local and global initiatives is that working with a large group of dedicated individuals can be challenging to manage and organize efforts. Defining initiatives with a small subset of these individuals and then presenting these to the larger group for discussion can be more productive and help to guide the group’s efforts. Duncan: I worked at one institution that did not support my views and approach of acceptance of my students, no matter their background or identification. This ostracized me from certain functions. I was OK with it because I knew I was creating a better environment for those who wanted to learn. I

“DEI is not about putting anyone down; it’s about building humanity and better awareness. The idea within cultural humility is compassion.” —J. CHAD DUNCAN, CPO, PHD, CRC

was also keenly aware that my positionality allowed me to keep moving forward, where for others, that may not have been the case. Lodyga-Uhl: One challenge with some of our more event-based initiatives— think webinars and workshops—is working them into the busy schedules at our clinics. As others in healthcare know, the schedule for patient appointments can be very fluid, and our priority is delivering exceptional patient care. We will continue to look for innovative ways to design and deliver solutions that are effective in our unique work environment. Wise: Getting started is always the most challenging part of a new initiative, especially one whose purpose is to drive change. Given the importance and sensitivity of DEI, the AOPA Board of Directors made the decision to hire a firm that specializes in helping organizations successfully implement DEI strategies, programs, and initiatives. The firm provided training to both the AOPA board and AOPA staff to create a collective appreciation for the initiative and help us develop an effective DEI strategy, including the structure and launch plan for the committee.

O&P Almanac: How do you plan to sustain the effort long-term? Bondre: We plan to hire a chief diversity officer in the future who can lead these efforts as their primary duties with a team to support them. In the interim, this will be done with volunteers from across the global organization. We have also created short- and long-term [key performance indicators] for our council to keep ourselves on track and be able to measure our own success. Duncan: There are groups that are sprinting to DEI, and that sprint is going to create “DEI fatigue.” You’re using up all your energy to get something going and forgetting the long-term goal. I think [the way] to sustain and prevent that fatigue is to be very intentional in

the approach. … Take your time. Communicate. Discuss. Process. Question. Communicate. My mentor says, “Don’t make it about a certain population or group. Make it about humanity.” Because if you make it about humanity, that’s everything that you’re involved in. Your grandparents. Your significant others. Your friends. They all have these lived experiences. If you see that as part of humanity, then you’re truly engaging in the practice of accepting others who are different from you. Lodyga-Uhl: We look forward to sustaining our long-term efforts through continued support from Hanger’s senior leadership team and our Diversity & Inclusion Council, chaired by Hanger CEO Vinit Asar and comprising leaders from our different

business units, who have been key in our progress and will remain essential to our long-term success. Wise: AOPA is very excited to have an extremely engaged DEI Committee that is passionate about creating awareness and driving change. The work is just getting started, and we already have a lot of great ideas to pursue. We also know that our membership will have a lot to offer, and we look forward to learning what that is through the survey. We believe consistently communicating our goals, progress, and successes to membership as well as soliciting their feedback and making adjustments when and where needed will generate interest for more members to get involved and make an impact within our profession.

O&P ALMANAC | APRIL 2022

PRINCIPAL INVESTIGATOR

Building a Tower of Understanding Phil Stevens, MEd, CPO, FAAOP, leads efforts to investigate O&P outcomes and devices to inform clinical decisions and benefit individual patients

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

APRIL 2022 | O&P ALMANAC

NEW STUDY ON PROSTHETIC

feet provides important information for prosthetists across the United States, and could prove consequential for reimbursement purposes. Phil Stevens, MEd, CPO, FAAOP, a director of clinical and scientific affairs at Hanger, worked with a team to study the outcomes associated with some prosthetic feet after the Pricing, Data Analysis, and Coding (PDAC) reclassified several devices. “The recent decisions by PDAC to categorize feet based on the presence or absence of distinct mechanical features, rather than observed performance and outcomes, has really impacted the field,” explains Stevens. “The result has been a reversion of sorts to taller, heavier feet that satisfied the PDAC requirement.” Team members examined the outcomes data to determine if the trends they saw in mobility correlated to features or functionality. Specifically, they studied L5987 feet that retained that coding profile, L5987 feet that were reclassified as L5981 feet, legacy L5981 feet, and L5987 feet that were never submitted to PDAC. This landmark study is one of many undertaken by Stevens and his colleagues to take a closer look at important O&P topics. As an associate

within the Hanger Institute for Clinical Research and Education, Stevens develops evidence-based clinical programs designed to help patients improve their orthotic and prosthetic outcomes. In collaboration with his associates, he is involved in outcomes implementation, groundbreaking research studies, and the establishment of Clinical Practice Guidelines and national standards of care. His interest in research dates back to his early days as a clinician—when he first sought to better understand why certain O&P devices are appropriate for specific patients.

Solving Clinical Problems

For Stevens, O&P research is key to improving clinical skills—and ultimately, patient outcomes. “Especially as a young clinician, I didn’t feel my experience was enough to provide the best care for my patients,” he recalls. “I saw research and literature as a way to augment my limited experience.” Stevens, who graduated from the University of Washington’s O&P program, performed his first systematic review shortly after he finished his first round of board exams. “I remember being very frustrated with one of the

PHOTO: Hanger Clinic

Phil Stevens, MEd, CPO, FAAOP, presents at the annual meeting of the American Academy of Orthotists and Prosthetists.

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PRINCIPAL INVESTIGATOR

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Stevens has spoken on a variety of important O&P topics at industry meetings over the years. have some guardrails and guidelines in place.” Patient families, clinicians, and referral partners have appreciated the clarity that comes with those types of standards, according to Stevens. “We’ve since produced similar guidelines in association with prosthetic foot and knee selection, transtibial interfaces, suspension and alignment, and the prosthetic management of unilateral transradial amputation.”

Demonstrating the Value of O&P

Stevens has played a part in several important large-scale investigations at Hanger Clinic that delve into patient data to demonstrate efficacy of O&P intervention. The Mobility Analysis of AmpuTees (MAAT) series “has been quite significant, reporting upon study groups much larger than we have historically had in the field,” he explains. “MAAT I confirmed a strong correlation between prosthetic mobility and well-being. MAAT II confirmed that co-morbid health conditions do not innately compromise prosthetic mobility. MAAT III confirmed that microprocessor knees appear to compensate for roughly half of the mobility compromise that is observed between transtibial and transfemoral prosthesis use. MAAT V confirmed higher mobility levels with more advanced prosthetic feet. MAAT VI confirmed that both well-being and prosthetic mobility appear to remain

stable as much as seven years following vascular amputation,” he says. He and his colleagues recently announced the publication of the seventh manuscript in the MAAT series, which further explores the theme of prosthetic mobility across amputation etiologies. Hanger Clinic’s OASIS series, which focuses on outcomes assessment observed with specific prosthetic components, offers studies comparing the effectiveness of a variety of O&P components across different patient groups to enhance patient outcomes. “We are uniquely positioned to provide objective insights in the performance associated with certain prosthetic components,” Stevens explains. “For example, in OASIS 1, we were able to report on the injurious fall rates associated with several different makes and models of microprocessor knee.” The Hanger team also recently published its first Stability and Falls Evaluations in AMPutees (SAFE-AMP) study, which will significantly impact clinical decision making and patient outcomes, according to Stevens: “We reported on the relationship between prosthetic knee selection and injurious falls among elderly K3 patients with unilateral transfemoral amputation of vascular etiology,” he says. “Fall risk is especially concerning in this group, with the overlapping risks of vascular disease, amputation, and advanced age.” Their data identified that individuals fit with a nonmicroprocessor

PHOTOS: Hanger Clinic

written simulation questions where I was answering the question according to my early experiences in a very pediatricbased facility, and I could tell my answers didn’t align with the treatment pathway that the exam wanted me to pursue,” he says. “The result was a deep dive into the literature associated with the orthotic management of muscular dystrophy. If there was a better way to manage those children, I wanted to understand what it was.” Over the years, Stevens, who has a master’s degree in allied health education and administration from the University of Houston, has been involved in many impactful studies, in both orthotics and prosthetics. “This has included strategic discussions on how to examine some of our internal outcomes data and external collaborations with academic institutions and medical centers,” he explains. For example, he studied the postoperative orthotic management of craniosynostosis—a relatively recent area of practice. “Prior to the proliferation of endoscopic surgical techniques, the various presentations of craniosynostosis were poorly understood within the orthotic community,” he explains. Stevens and the co-authors published their early experiences following total vault reconstruction surgeries—one of the first attempts to describe these clinical presentations and their orthotic management to O&P professionals. “One of the fair criticisms of that early publication was that the standard cranial measurements used in deformational plagiocephaly aren’t optimal for other cranial pathologies,” he says. “I’m happy to note that in recent years, we’ve published separate papers defining novel measurement indices specifically developed to track outcomes in certain presentations of craniosynostosis.” Stevens also worked with a team to study the more common deformational plagiocephaly. “We used a Delphi consensus process to define care standards associated with deformational plagiocephaly,” he explains. “In an area that’s always had to contend with subjectivity, it’s been nice to

PRINCIPAL INVESTIGATOR

knee are 2.5 times more likely to experience an injurious fall during the preceding six months than their peers fit with a microprocessor knee.

Now that the COVID-19 pandemic is easing and many clinical practices are at full capacity, Stevens has spent some time thinking about the future of O&P research. He believes it’s time to move away from simply studying “mechanisms and features” and shift the emphasis toward performance and outcomes. “I’m hoping we see less dialogue over whether a foot has 5 degrees of motion or 7 degrees of motion, or whether a waterproof microprocessor knee is suitable for saltwater use or only freshwater use, and more research into how these components impact the larger concerns of our patient populations—things like mobility, activity levels, and stability,” Stevens says. Studying these larger issues will surely have beneficial repercussions on the patients who rely on orthoses and prostheses to improve their quality of life.

Circling Back to Patients

Patient welfare should be the priority for collecting outcome data, according Stevens. “Each of those patient encounters constitutes a brick in whatever wall or tower of understanding we’re actively Stevens (second from right) plays keyboard trying to build. But as the during a driveway concert with his son and field migrates toward broader neighbors during the COVID-19 pandemic. implementation of outcomes, it’s extremely important that we sit more musicians over, invite the neighdown with the patient who just proborhood, and play concerts on our vided us with these outcomes and driveway,” he recalls. “Social distancing place their responses in some sort was always encouraged, but it gave the of meaningful context for them. community an excuse to get out of their “We should never exploit patients for houses and interact with each other outcomes without a commitment to use in a safe outdoor environment. Those that data to improve their individual situ- driveway concerts were certainly my ations,” Stevens asserts. “Properly done, highlights throughout the pandemic.” outcomes can help patients understand where they are in their own rehabilitation and what their next steps may look like. If we can leverage large-scale outcomes to produce data—that’s optimal. Phil Stevens, MEd, CPO, FAAOP, has been involved in hundreds But individual outcomes should benefit of impactful published studies, including the following: individual patients, irrespective of what • Stevens, P.M., Hollier, L.H., Stal, S. “Postoperative Use of Remolding Orthoses we do with those larger data sets.” Following Cranial Vault Remodeling: A Case Series.” Prosthet Orthot Int, 2007; Beyond his dedication to research, 31(4): 327-341. Stevens is involved in furthering the • Ramsey, J.A., Stevens, P.M., Wurdeman, S.R., Bonfield, C.M. “Quantifying O&P profession in other ways. A Orthotic Correction of Trigonocephaly Using Optical Surface Scanning.” former president of the American J Craniofac Surg, 2021; 32(5): 1727-1733. Academy of Orthotists and Prosthetists, • Lin, R.S., Stevens, P.M., Wininger, M., Castiglione, C.L. “Orthotic Management Stevens currently sits on the editorial of Deformational Plagiocephaly: Consensus Clinical Standards of Care.” Cleft board of the Journal of Prosthetics and Pal Craniofac J, 2016; 53(4): 394-403. Orthotics, is actively editing the fifth • Stevens, P., Wurdeman, S. “Prosthetic Knee Selection for Individuals With edition of the Atlas of Amputation Unilateral Transfemoral Amputation: A Clinical Practice Guideline.” J Prosthet and Limb Deficiencies, and holds Orthot. 2019; 31:2-8. adjunct faculty positions within • Wurdeman, S.R., Stevens, P., Campbell, J.H. “Mobility Analysis of AmpuTees the University of Utah’s Division of (MAAT) II: “Comorbidities and Mobility in Lower-Limb Prosthesis Users.” Physical Medicine and Rehabilitation Am J Phys Med Rehabil, 2018; 97: 782-788. and Concordia University’s O&P • Campbell, J.H., Stevens, P.M., Wurdeman, S.R. “OASIS I: Retrospective program. He also is an avid musician. Analysis of Four Different Microprocessor Knee Types.” J Rehabil Assist Tech “I studied jazz piano in college and Engineer, 2020; 7: 1-10. have continued to play since then,” • Wurdeman, S.R., Miller, T.A., Stevens, P.M., Campbell, J.H. “Stability and Falls Stevens says. His musical prowess Evaluations in AMPutees (SAFEAMP 1): Microprocessor Knee Technology inspired one of his sons to take up Reduces Odds of Incurring an Injurious Fall for Individuals With Diabetic/ the piano and trumpet. “Throughout Dysvascular Amputation.” Assist Tech, published ahead of print. the pandemic, we would invite a few

PHOTO: Phil Stevens, MEd, CPO, FAAOP

NOTABLE WORKS

O&P ALMANAC | APRIL 2022

MEMBER SPOTLIGHT

Stability Prosthetics

By DEBORAH CONN

Thriving Amid the Pandemic Facility launched in 2019 finds dedicated patients despite COVID-19 challenges

N HINDSIGHT, OPENING A

APRIL 2022 | O&P ALMANAC

Heather Duncan, Randy Duncan, CPO, and Steven Carter is overwhelmingly diabetic,” says

FACILITY: Duncan. In addition to providing Stability Prosthetics prostheses and orthoses, Stability is OWNER: Randy Duncan, CPO LOCATION: McKinney, Texas HISTORY: Three years

Sockets

one of very few local facilities that provide diabetic shoes. “It’s not a moneymaker,” he says, “but we are all about what our patients need.” That philosophy underlies Stability’s core mission: to focus on what each patient needs, not on what is most lucrative. “We are very patient-first,” Duncan explains. “One of our efforts is to put patients in touch with ancillary services they may need. The point is not just to provide them with a device, but to make sure they use it every day to restore as much as possible the level of function they had before an amputation. So we work closely with rehab and skilled nursing facilities to get patients the help they need.” While Stability uses 3D scanning with some external fabrication services, Duncan enjoys hand casting. “I like the physical part of it,” he notes. “That is a lot of what drew me to the profession in the first place: It’s a good blend of patient care and tinkering. Every device is a different challenge

Randy Duncan, CPO, with a patient

Duncan met another patient because she was his daughter’s preschool teacher, who happened to undergo a below-knee amputation the year his daughter was in her class. “I’ve been seeing her for nearly 10 years, and she is a great success story,” Duncan says. “She wants to help other amputees and has become a peer visitor through the Amputee Coalition.” Helping patients is key, he says. “This is an amazing career. Everyone wants to help others, but there are few opportunities to help someone in a way that is so tangible. When a patient wheels in and walks out, that’s pretty good.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Stability Prosthetics

new facility in October 2019 might not have been the best idea. That’s when Randy Duncan, CPO, incorporated Stability Prosthetics in McKinney, Texas. He started seeing patients in March 2020— just when the country went into COVID-19 lockdown. Nevertheless, Stability has flourished. “Our patients’ needs don’t go away, even in a pandemic,” Duncan says. He has been an O&P practitioner in the Dallas-Fort Worth region for nearly 20 years, so he had a devoted patient base. He was able to rely on emails and phone calls to connect with referral sources. His wife, Heather, is CFO of the business and “keeps everything going,” according to Duncan. By November 2020, the facility added marketing personnel and a chief operating officer, Steven Carter, bringing its employee count to 10. Carter lives in Waco, which was an impetus to open a second office there. “Steven is an incredible asset and has helped us grow as a company, especially in the marketing arena,” says Duncan. Stability will soon open a third office, also in Waco, and Duncan is looking for a practitioner, a technician, and additional marketing staff to add to the company’s presence in the Dallas-Fort Worth area. “We care deeply about our employees, and our employees are eager to carry out our mission of doing what’s best for patients,” he adds. The vast majority of Stability’s patients are older, with vascular issues. “We serve a population that

because each patient has different needs and experiences. If something doesn’t exist to solve their issues, then you have to create it.” Duncan is especially proud of his work for one patient who flew in from Kentucky. “He had been struggling for years to find a comfortable prosthesis,” Duncan recalls. “His leg had been amputated when he was 12, back in the 1950s, and we discovered from his medical records that the surgery caused vascular deficiency in the residual limb. We used a vacuum-assisted suspension system to create a negativepressure environment in the socket to keep blood flow more active. After he returned home, his sister and his mom wrote to tell us that he was like a totally different person. That is why I do this work!”

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MEMBER SPOTLIGHT

ALPS

By DEBORAH CONN

Innovating With Interfaces

Manufacturer provides liners, sleeves, and related O&P supplies

OUNDED IN 1988 BY Aldo

APRIL 2022 | O&P ALMANAC

ALPS Vacuum Integrated Pump

COMPANY: ALPS OWNER: Aldo Laghi LOCATIONS: St. Petersburg, Florida, with offices in China, Italy, Czech Republic, and Ukraine HISTORY: 34 years

ALPS Superior Performance Liner

Participants at the ALPS Golf Tournament levels and preexisting conditions,” he says. “We are efficient in production and manufacturing, and we are able to pass those savings on to clinicians and patients.” ALPS’ selection of liners can be broken down into four different types of fabric and gel, allowing for a variety of combinations to meet each patient’s needs. “The whole prosthesis depends on the suspension interface,” Nelson says. “The liner is the foundation—if it isn’t comfortable, it doesn’t matter how advanced the prosthesis is; it won’t work.” The company’s most popular liner is the Extreme Liner, for transfemoral and active transtibial amputees, categorized at K2 or K3 level, according to Nelson. The liner uses a medium-stretch brown fabric and offers “a choice of a grip gel or a stiffer high-density gel for those with higher activity levels,” he says. For patients at K3 and K4 levels, the Superior Performance Liner uses a black fabric with minimal vertical stretch and either type of gel. Other options include a

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

PHOTOS: ALPS

Laghi, ALPS South originally focused on the development of innovative silicone products. Five years later, the company moved to its current headquarters in St. Petersburg, Florida, where it expanded to manufacturing prosthetic devices for lower-limb amputations. Shortly after, in 1996, ALPS began formulating gel products. Since then, ALPS has been dedicated to innovation. The company collaborates with the medical community to uncover the unfulfilled needs of individuals with transfemoral and transtibial limb loss, and works to invent and manufacture creative solutions. Today, ALPS offers more than 20 products, including liners, sleeves, skincare products, orthotic braces, and prosthetic accessories. The company works with 120 distributors around the world and has offices in five countries—including Ukraine. Because of the war, ALPS has been working closely with a Polish foundation to purchase ambulances and medical equipment to help Ukrainian refugees get to safety. Some of the company’s Ukraine employees are in shelters, and others have fled to Poland, according to Lauren Banker, marketing specialist. ALPS will continue to find ways to help during the conflict. ALPS focuses on durability when designing its liners, says Nick Nelson, sales manager for ALPS’ Southeast territory. “We offer a wide variety of products to accommodate patients’ activity

tapered liner, liners designed for diabetic patients or those with sensitive skin, and an easy don/ doff liner for geriatric patients. The company recently developed the Silicone Pro liner, which is coated with a proprietary seamless knitted fabric for increased freedom of movement. “This liner has only one-fifth the friction of regular silicone, it’s easy to don and doff, and it offers reduced pistoning with distal constraint,” Nelson explains. Another offering, the Ecoliner, has a unique distal construction with reduced stretch, which helps control distal distraction, Nelson says. “It will reduce the vertical stretch of the liner without feeling like a tourniquet.” ALPS developed the VIP, an air expulsion integrated pump that creates an elevated vacuum for prosthetic sockets. The product “gives patients continuous total contact when they don the prosthesis, which helps distribute the suspension of the prosthesis over the whole surface of the residual limb,” explains Nelson. ALPS markets primarily through its distributors, PEL, Cascade, and SPS, in addition to social media and in-person visits by sales representatives. The company is committed to being a good corporate citizen, supporting groups such as Amputee Blade Runners, Limbs for Life, and the Limb Kind Foundation. “We sponsor tournaments and send Limbs for Life free liners, sleeves, and skincare products every month,” Nelson says. ALPS representatives frequently meet with clinicians to demonstrate the quality of the company’s products. Nelson says, “We also ask for feedback to help us develop new products that will meet their needs.”

AOPA NEWS

AOPAversity Webinars

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tion on specific topics during these one-hour webinars, held the second Wednesday of each month at 1 p.m. ET. One registration is all it takes to provide the most reliable business information and CE credits for your staff at a single office location. Visit www.AOPAnet.org/education/monthly-webinars for details and registration information.

UPCOMING WEBINARS

May 11 Supplier Standards & Revalidations

With site inspections and revalidations back in full swing— and new contractors taking the lead—it’s time to revisit the DMEPOS Supplier Standards. Log in to this webinar and learn tips to pass a Supplier Standards Inspection and Revalidation.

June 8 SWOs, PODs, ABNs, AOBs: Your “Must-Have” Documentation

Everyone focuses on the medical necessity documentation, but what about the everyday documentation you need to have in your records? The June webinar will focus on the administrative documentation that is required to be on file. Learn when you must obtain a new standard written order, and what it must include. Review when and who can sign an ABN, and much more.

Purchase the 2022 AOPA Quick Coder The 2022 AOPA Quick Coder is now available! A speedy reference to HCPCS codes for all orthotic, shoe, and prosthetic codes and modifiers, the Quick Coder also provides references for inpatient billing and offthe-shelf versus custom-fit coding. Changes are being made to the codes on a biannual basis. If a change is made during 2022, AOPA will notify you to ensure your Quick Coder remains up to date throughout the year. To purchase the Quick Coder, access your AOPA Connection account. Email questions to info@AOPAnet.org.

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic

Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. 2PD Limited Fusion Hive, North Shore Road STT TS182NB, United Kingdom 07917764175 www.2pd.co.uk/ Jason Timms Supplier Member

Danmar Products Inc. 221 Jackson Industrial Drive Ann Arbor, MI 48103 734/761-1990 www.danmarproducts.com Hidie Bowman Supplier Member

Aether Biomedical Sp.z o.o. Krolowej Jadwigi 43 Wielkopolskie 61871 Poznan, Poland 0048515856103 www.aetherbiomedical.com Dhruv Agrawal Supplier Member

Spentys Rue saint Denis 120 Brabant Wallon 1180 Brussels, Belgium 049 689-0210 www.spentys.com Tom Claes Supplier Member O&P ALMANAC | APRIL 2022

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KiddieFLOW™ by Allard USA

Allard USA has extended its pediatric AFO line with KiddieFLOW™ in response to clinician requests for an orthosis with more foot plate flexibility. KiddieFLOW™ allows for better control of foot positioning in late swing, which aids in stability during stance. FLOW models offer increased range of motion in the sagittal plane and a smoother transition (flow) throughout the gait cycle. For more information contact Customer Service at 888/678-6548 or info@allardusa.com and request your free Product Selection Guide!

Extreme Liner by ALPS ALPS South’s most popular liner, the Extreme Liner, is designed explicitly for transfemoral and active transtibial amputees. With 80% less vertical stretch than other gel liners by ALPS, amputees will benefit from the reduced movement of redundant tissue and experience increased control and stability. Plus, users have a choice between Grip Gel or the stiffer high-density (HD) gel, depending on needs and activity level. Top features and benefits include: • Brown fabric offers limited vertical stretch to reduce movement of redundant tissue and provides greater control of the prosthesis • Slightly tacky feel reduces bunching in the popliteal region • High circumferential stretch to assist with form fitting • Wider distal end proportionate to the size of the liner for ease of donning • Available in 3-mm and 6-mm uniform. To learn more about the ALPS Extreme Liner, visit www.easyliner.com or call 727/528-8566 or 800/574-5426.

APRIL 2022 | O&P ALMANAC

FITEC by Apis Apis’s all new low-cost diabetic shoe program FITEC offers a competitive selection and aims to add more cash to your bottom line. These shoes come with one pair of heat moldable tri-lam diabetic inserts (billable under A5512). Fly-knitted styles are breathable, water repellent and slip resistant, and are offered in a variety of widths and sizes. Call us for free display samples at 888/937-2747.

Coyote’s Dynamic Strut AFO Designed to flex and move with the patient, creating a more natural gait. It’s strong enough to climb stairs and offloads the foot and ankle. • Natural gait • Works great with thermoformed braces • Provides energy response. The unique varying thickness creates a comfortable, natural gait. Contact Coyote at 208/429-0026 or visit www.coyote.us.

www.coyote.us/dynamicstrut

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

MARKETPLACE More Torsion in a Lower Profile It’s the AllPro performance you have come to expect with an even smoother rollover and forgiveness on rough terrain or around town. The IP67 waterproof XTS unit provides adjustable torsion and vertical shock reduction without sacrificing build height. This field-serviceable unit is built with an active lifestyle in mind. Visit https://fillauer.com/allpro.

Naked Prosthetics

It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit www.npdevices.com.

Hersco 3D Printing Hersco is delighted to offer HP’s advanced 3D printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a biobased renewable material that has been tested and proven in research and industry. Call today, 800/301-8275, for a free sample.

WalkOn® Carbon-Fiber AFO

WalkOn AFOs are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally. WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return. WalkOn offers a full range of AFO sizes and designs, including the WalkOn Reaction junior pediatric sizes. Fast and easy to fit, the WalkOn footplate is trimmable and can be shaped with scissors, often requiring only one office visit. Contact us at 800/328-4058 or professionals.ottobockus.com for details. O&P ALMANAC | APRIL 2022

MARKETPLACE Ottobock iFab EasyScan 3D Scanning Solution

Equipped with an ergonomic and easy-to-use camera, enhanced tracking behavior, and texture detection, the EasyScan provides an accurate 3D image of the residual limb, even for the most complicated fittings. As you scan the residual limb, you can follow your results in real-time and make adjustments with Ottobock’s iFab platform solution. Contactless detection of the patient’s residual limb and shortened process times during scanning provide an improved experience for both you and your patient. Embrace the digital future and learn more about EasyScan at shop.ottobock.us/EasyScan or contact us at 800/328-4058.

Quattro by PROTEOR Freedom QUATTRO microprocessor knee (MPK) by PROTEOR is designed to give users the freedom to live their lives without interruption. With PROTEOR’s innovative H.A.R.T. Control Technology, Quattro is the first MPK to provide a unique customized experience that captures users’ distinctive gait patterns. Boasting 20 user modes, remote data capture, outcome measure reporting, and independent resistance for stairs/ramps and sitting, it challenges and drives the status quo for MPKs to the next level. For more information, visit www.FreedomQuattro.com. 44

APRIL 2022 | O&P ALMANAC

Movao: A Community for Amputees, Led by Amputees

Movao is the new global connection hub for patient and caregiver empowerment, driven by the community itself. During Limb Loss and Limb Difference Awareness Month, we encourage this community to come together to learn, grow, and share from each other’s experiences on a digital platform like no other. All in one place, patients and caregivers can ask questions, make new friends, plan events, seek mentorship and so much more. Together, we Move As One. Sign up for Movao at movao.community today.

The Xtern, a Life-Changing Solution for Foot Drop Patients by Turbomed Orthotics Say goodbye to your painful and stiff in-shoe orthosis! This revolutionary brace, specifically designed for people suffering from foot drop, has one thing in mind: movement. The Xtern sits entirely outside the shoe (and, to add to that, to any shoe!), and is so flexible that it allows maximal range of motion and calf muscle strength. No more rubbing injuries or skin breakdowns: You’ll barely notice it’s there. Walking, running, mountain climbing, skiing? Not a problem! The Xtern will follow you as far and as long as you want. Turbomed’s innovative products are designed in Quebec, Canada, sold in more than 30 countries around the world, and distributed by Cascade in the United States. Visit turbomedusa.com, and think outside the shoe!

AOPA NEWS

CAREERS

WANTED!

Opportunities for O&P Professionals

A few good businesses for sale.

Job Location Key: - Northeast

Lloyds Capital Inc. has sold over 150 practices in the last 26 years.

- Mid-Atlantic - Southeast - North Central

If you want to sell your business or just need to know its worth, please contact me in confidence.

- Inter-Mountain - Pacific

Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge.

Inter-Mountain

Refer to www.AOPAnet.org for content deadlines. 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. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, 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.

Certified Prosthetist

Salt Lake City, Utah Mobility Prosthetics is looking for a certified prosthetist in Salt Lake City. Our practice utilizes digital scanning, computer design, and 3D printing. We are offering a base salary of $75K-$90K with a quarterly performance-based bonus plan. We also offer full healthcare benefits, a company car, and many other perks. Send your résumé to info@mobilityprosthetics.com.

O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

Email: info@mobilityprosthetics.com

Finding your next job or hire just got

For Job Seekers: easier with the AOPA Career Center.

Finding your next job or hire just got Job searching is easy with the easier with the AOPA Career Center. pane-view job search page. Set up

ONLINE: O&P Job Board Rates For Job Seekers: Visit the only online job board in the industry at jobs.AOPAnet.org. Job searching is easy with the

pane-view job search page. Set up For Job Seekers: Member Nonmember job alerts, upload your resume or Job searching is easy with thean anonymous career proﬁle create $85 $280 pane-view job search page. upemployers to you. that Set leads

Job Board 50 or less

Finding your easier with th

job alerts, upload your resume or

For more opportunities, visit: http://jobs.AOPAnet.org. create an anonymous career proﬁle For Employers:

that leads employers to you.

Reach 4,500+ O&P professionals through the Job Flash™ email. For Employers: Ensure high visibility for your open positions through this highly Reach 4,500+ O&P professionals A large number of O&P Almanac engaging email.

job alerts, upload your resume or create an anonymous career proﬁle that leads employers to you. For Employers: Reach 4,500+ O&P professionals through the Job Flash™ email. Ensure high visibility for your open positions through this highly engaging email.

the Job Flash™ email. readers view through the digital issue— Ensure high visibility for your open If you’re missing out, visit positions through this highly issuu.com/americanoandp For more information on recruitment options, contact Customer engaging email. Log in at jobs.aopanet.org to get started! Service at clientserv@communitybrands.com or (727) 497-6565. to view your trusted source For more information on recruitment options, contact Customer Service at clientserv@communitybrands.com or (727) 497-6565. of everything O&P. For more information AOPA_PrintAd.indd on recruitment1 options, contact Customer Service at clientserv@communitybrands.com or (727) 497-6565.

Log

8/19/21 8:02 PM

AOPA_PrintAd.indd 1 AOPA_PrintAd.indd 1

O&P ALMANAC 8/19/21 8:02 PM

| APRIL 2022

CALENDAR

June 24–25

Nashville Renaissance Hotel and Conference Center In-Person Meeting. For more information, contact Cathie Pruitt at 901/359-3936, email pruittprimecare@gmail.com, or Jane Edwards at 888/388-5243, email jledwards@attnet. Visit www.primecareop.com.

July 13

Clinicians’ Corner—Orthotics: How To Get Started Into Digital Workflow. From Scanning, to Carving, to 3D Printing, the Next Step for O&P. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar

2022

August 10

Prosthetics Clinicians’ Corner. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar

April 1–30

ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at ABCop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org or visit ABCop.org/contact-us.

September 14

An Operations Presentation. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar

September 28–October 1

AOPA National Assembly. San Antonio, TX. For more information, visit www.AOPAnet.org.

May 10–13

OT World. Leipzig, Germany. For more information, visit www.ot-world.com/index-en.html.

November 9–11

New Jersey Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Atlantic City, NJ. For more information, visit www.njaaop.org/annual-meeting.

May 11

Supplier Standards & Revalidations. Monthly Webinar 1 PM ET. Register at www.AOPAnet.org.

May 17–18

AOPA Policy Forum. Hilton Crystal City, VA. Register at www.AOPAnet.org.

2023 May 19-20

May 18–20

Orthotic & Prosthetic Innovative Technologies Conference. Minneapolis, MN. For updates, check our website at optech.ucsf.edu. Email cme@gilletteSave Lorem Ipsum childrens.com tothe beDate! added to conference mailing list.

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

May 19 & 20, 2023

June 8

September 6–8

SWOs, PODs, ABNs, AOBs: Your Must-Have Documentation. 1 PM ET. Register at www.AOPAnet.org.

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

Monthly Webinar

Calendar Rates

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@ AOPAnet.org along with VISA or MasterCard number, cardholder name, 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 2022 | O&P ALMANAC

Words/Rate 25 or less 26-50 51+

Member $40 $50 $2.25/word

Nonmember $50 $60 $5.00/word

Color Ad Special 1/4 page Ad 1/2 page Ad

$482 $634

$678 $830

For information on continuing education credits, contact the sponsor. Questions? Email info@AOPAnet.org.

SAVE THE DATE MAY 17-18

Use Your Voice. Educate. Advocate. Celebrate. More details on the program to come. www.AOPAnet.org

AD INDEX

Advertisers Index Company

Page

Phone

Website

Allard USA Inc.

866/678-6548

www.allardusa.com

ALPS South LLC

800/574-5426

www.easyliner.com

Amfit

800/356-3668

www.amfit.com

Apis Footwear Company

888/937-2747

www.apisfootwear.com

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

College Park Industries

800/728-7950

www.college-park.com

Coyote

800/819-5980

www.coyotedesign.com

ESP LLC

888-WEAR-ESP

www.wearesp.com

Ferrier Coupler Inc.

810/688-4292

www.ferrier.coupler.com

Fillauer

800/251-6398

www.fillauer.com

Hersco

800/301-8275

www.hersco.com

888/977-6693

www.npdevices.com

15, C4

800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

855/450-7300

www.proteorusa.com

TurboMed Orthotics Inc.

888/778-8726

www.turbomedorthotics.com

Naked Prosthetics Ottobock

O&P ALMANAC | APRIL 2022

STATE BY STATE

Become an AOPA State Rep.

Expanding Coverage

If you are interested in participating in the AOPA State Reps network, email awhite@AOPAnet.org.

Updates from California, Colorado, Iowa, and Tennessee

Each month, State By State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/resources/co-op.

Member Resource Alert

AOPA has invested in a resource that allows us to track legislative and regulatory activity related to O&P in every state. We will be updating the state pages on the AOPA Co-OP with alerts as they arise.

California

Legislation affecting California Medicaid reimbursement rates has been introduced in the State Assembly. AB 1892 requires Medi-Cal reimbursement for O&P appliances to be set at 80% of the lowest maximum allowance for California established by Medicare, with annual adjustments to conform to any changes to Medicare. Currently, reimbursement for O&P appliances in California is prohibited from exceeding 80%. AOPA is tracking this legislation; for the complete text of the bill, visit the California page of the Co-OP.

Colorado

AOPA continues its advocacy efforts related to the Colorado Department of Healthcare Policy and Financing’s (DHCPF’s) rate setting for pediatric custom cranial orthoses (code S1040) following last year’s reimbursement reduction and subsequent reversion back to the original rate. In response to this project, AOPA has sent a comment letter to the DHCPF explaining

Submit Your State News

the nature of services related to cranial orthoses and articulating their value.

Iowa

HF 2411 (formerly HSB 668), the bill requiring employers to furnish medically necessary replacement prosthetic devices for workers’ compensation patients, has passed the Iowa House and will now be under consideration in the Senate. AOPA has implemented a grassroots campaign to gather support for the bill in collaboration with members across the state. For updates on HF 2411’s status and more information on this campaign, visit the Iowa page on the Co-OP.

Tennessee

As with other states across the country, Tennessee has introduced coverage mandate legislation. Companion bills SB 2140 and HB 2214 require that insurance providers in the state provide coverage for prosthetic devices that is at least equivalent to the coverage currently provided under Medicare, including repair and replacement. To read the text of the bills, visit Tennessee’s Co-OP page.

To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org. 48

APRIL 2022 | O&P ALMANAC

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

o i n o t n San A SEPTEMBER 28-OCTOBER 1

Join us September 28-October 1, 2022, for

Mark Your Calendars!

an ideal combination of top-notch education and entertainment at the 105th AOPA National Assembly in San Antonio, TX.

www.AOPAassembly.org

A community built for amputees, led by amputees! Say hello to Movao, the connection hub for amputees, those living with limb difference, and their loved ones. During Limb Loss and Limb Difference Awareness month (and beyond), there is nothing more important than sharing experiences with community.

April 2022 O&P Almanac

Articles inside

People & Places

State By State

Phil Stevens, MEd, CPO, FAAOP

Calendar

AOPA Contacts

Views From AOPA Leadership

Marketplace