April 2023 O&P Almanac

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CHRISTINE UMBRELL

Meet Ronnie Dickson, CP, owner of POA Tennessee, who worked closely with a patient who had extra tissue surrounding his residual limb due to weight loss. Learn how Dickson created a specialized liner and novel adjustable socket to improve comfort and inspire activity for his patient.

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Views From AOPA Leadership

It’s the Most Wonderful Time of Year To Advocate!

Greetings to all! As the snow melts in Minnesota and the spring begins to boast all its beauty, we are reminded that with the change of seasons come welcomed transitions and traditions. It is the time of year in O&P that we transition some of our energy beyond the exam room to advocate for those we are privileged to serve. It also is the time of year we get to take part in the O&P traditions of the AOPA Policy Forum in Washington, DC, and the Limb Loss and Limb Difference Awareness Month (LLLDAM) events, where the Amputee Coalition, AOPA, and all of our sister organizations of the O&P Alliance join together to raise awareness for those living with limb loss and limb differences.

There is no doubt that advocating and educating helps to ensure the future of our profession. Advocacy allows us to demonstrate the impact we make in the lives of those we serve each and every day. The 2023 Policy Forum is the perfect opportunity to help make your mark on the O&P future. And, we need your voice. This will be my 13th Policy Forum—and it is by far the event I most look forward to on the O&P calendar. AOPA’s longstanding commitment to advocacy is what brought me to serve on the AOPA Board of Directors and as president.

During the Policy Forum, we meet with legislators and their staff. Having many diverse perspectives represented in these meetings helps us advance the O&P profession. So, whether you are a business owner, a practitioner, a student, a resident, a technician, an administrator, an educator, or a patient—or several of the above—we encourage you to attend. I also strongly encourage you to invite one or more of your patients or friends who are impacted by the O&P services we provide. Their stories help educate and relay the need for the policy issues we deliver. There is strength in numbers, so the more people we have, the better.

In addition, the Policy Forum is one of the best opportunities to acquire or hone your advocacy skills and learn about the legislative and regulatory issues facing the O&P profession. Prior to meeting with our elected officials, we will spend a full day getting up-to-speed and comfortable with advocating and educating with a purpose—to provide access to O&P care for those we are privileged to serve.

This year we will continue our work to see that the Medicare Orthotics and Prosthetics Patient-Centered Care Act becomes law. This legislation would prohibit “drop shipping” of custom orthoses and prostheses to Medicare beneficiaries; ensure Medicare beneficiaries can access the full range of orthotic care from one O&P practitioner rather than requiring patients to visit multiple providers when the treating orthotist or prosthetist does not have a competitive bidding contract; and ensure Medicare beneficiaries can access replacement custom-fitted and custom-fabricated orthoses when a change in their condition or clinical needs occurs.

Advocacy does not just happen at the federal level; state-based advocacy is extremely important and makes a big impact. Our latest initiative, So Kids Can Move, asks state legislators to provide access to O&P devices used for physical activity for kids. Some states have included adults in their legislation as well. Some have included insurance fairness and/or provisions against discriminatory practices in the provision of O&P care. During the Policy Forum, we will talk about the success of some of these state O&P bills, and we hope you will become motivated to advocate in your state as well.

Please join us and attend the Policy Forum this year. You can register at http://bit.ly/4028vN8 I am confident you will leave informed, inspired, and energized. This event is yet another great example of our profession connecting with one another and working together to make our O&P world a better place.

I very much look forward to seeing many of you May 10-11 at the 2023 AOPA Policy Forum!

Very truly yours,

Teri Kuffel, JD

Teri Kuffel, JD, is president of AOPA.

Board of Directors

OFFICERS

President

Teri Kuffel, JD

Arise Orthotics & Prosthetics, Spring Lake Park, MN

President-Elect

Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX

Vice President

Jeffrey M. Brandt, CPO Brandt Ventures, Exton, PA

Immediate Past President

Dave McGill Össur Americas, Foothill Ranch, CA

Treasurer Rick Riley Bakersfield, CA

Executive Director/Secretary

Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS

Arlene Gillis, MEd, CP, LPO International Institute of Orthotics and Prosthetics, Tampa, FL

Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX

Kimberly Hanson, CPRH Ottobock, Austin, TX

John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY

James Kingsley Hanger Clinic, Oakbrook Terrace, IL

Lesleigh Sisson, CFo, CFm Prosthetic Center of Excellence, Las Vegas, NV

Linda Wise Fillauer Companies, Chattanooga, TN

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D)

Research Chair

Hanger Clinic, Houston Medical Center, Houston, TX

A world where orthotic and prosthetic care transforms lives.

Our Mission

AOPA staff and volunteers are committed to our mission of being 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.

Our Vision

A world where orthotic and prosthetic care transforms lives.

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 | AOPAnet.org

EXECUTIVE OFFICES

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HEALTH POLICY AND ADVOCACY

Joe McTernan, director of health policy and advocacy, 571-431-0811, jmcternan@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

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

MEETINGS & EDUCATION

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MEMBERSHIP & COMMUNICATIONS

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O&P ALMANAC

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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.

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Copyright © 2023 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.

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Happenings

RESEARCH ROUNDUP Orthoses Improve Plantar Pressure Distribution

Children with infantile tibia vara (ITV), or Blount’s disease, present with one or two legs with a bow or bend in the leg below the knee; left untreated, the condition can worsen over time and create increased risk of joint arthritis of the knee or other degenerative changes.

Children with ITV are frequently prescribed knee-ankle-foot orthoses at an early age to correct the deformity. In a new study, researchers from Ankara University in Turkey studied the effect of orthoses on plantar pressure among children with ITV.

CONGENITAL LIMB DIFFERENCE

Every year, approximately 1 in every 1,900 babies born in the U.S. is born with a congenital limb difference. Some of these babies will have both upperand lower-limb reduction defects.

The researchers assembled a study group of 14 children between 1 and 3 years of age who had been diagnosed with ITV who could walk independently and who had not had surgery, as well as a control group of children who could walk independently without

health problems. They evaluated plantar pressures on five specified sites on the children’s feet using a WALKINSENSE plantar pressure evaluation device, measuring how much pressure the children applied to each sensor in the three phases of gait.

Following orthosis use, the pressure in the lateral hindfoot decreased in the children with ITV, while the pressure in the medial increased and the pressure in the medial forefoot decreased, according to the researchers: “We found that an orthosis in children with ITV was effective in decreasing the plantar pressure distribution closer to the level reported in healthy children,” they reported. The study was published February in Scientific Reports

Novel Tool Aids Terminal Device Selection

A decision-making tool developed by researchers from the Netherlands can assist individuals with upper-limb loss in determining preferences regarding terminal devices. Because studies have shown that patient-centered upperlimb prosthetic fittings may enhance prosthetic acceptance rates, the researchers created a patient decision aid with a primary focus on terminal devices, called the PDA-TULA.

The research team queried prosthetists to determine which terminal devices to include, then collected manufacturer information about the features of the various devices included in the tool. The PDA-TULA consists of instructions for users, an explanation of aims and scope, and

LACK OF SLEEP INCREASES PAD RISK

Individuals who sleep less than five hours per night have a 74% higher chance of developing peripheral artery disease, compared with those who sleep seven to eight hours per night.

a request for personal information, followed by terminal device information, personal values related to terminal devices, and terminal device feature comparisons.

The PDA-TULA enables patients to educate themselves about the various attributes of different devices and consider their preferences, and recommends that patients and clinicians discuss the results of the assessment during their next consultation. Rehabilitation teams at different facilities and institutions can use the same educational materials to assist patients and make informed terminal device decisions. Details were published March in Prosthetics and Orthotics International

DIABETES DOWNLOAD

HEALTHCARE COSTS OF DFUS

Diabetic foot ulcers place an enormous burden on the U.S. healthcare system, costing between $9 and $13 million annually.

SOURCE: “HUMAN WOUNDS AND ITS BURDEN,” JOURNAL OF ADVANCED WOUND CARE

PEDIATRIC PROSTHETICS New Center Focuses on Children’s Blast Injuries

A first-of-its-kind institution dedicated to advancing care for children with blast injuries opened in London last month. Imperial College London and Save the Children joined forces to launch The Centre for Pediatric Blast Injury Studies at Imperial’s White City campus.

Experts at the center will use motion capture technology and 3D-printing technologies to advance the care of children with blast injuries. They plan to develop low-cost, age-appropriate prostheses that take into consideration growth and physiological development in conflict-affected areas.

Medics, engineers, pain specialists, operational humanitarians, prosthetists, and rehabilitation specialists will work together to address the lack of prostheses for musculoskeletal and extremity injuries in Ukraine, where four children are injured or killed each day amid the ongoing war, according to Imperial College London. Children are seven times more likely to die from blast injuries compared to adults,

O&P By the Numbers

and they experience different types of injuries than adults—requiring specialized care, according to the launch team.

“As more and more children today live in conflict zones, we need child-specific, translational research that looks at everything from the initial emergency response, to treatments, to prosthetics and development into adulthood,” said Anthony Bull, director. “This new center will address an unmet need: treating children with blast injuries in a researchled, highly translational way to help them become healthy adults.”

Early Receipt of a Prosthesis Reduces Healthcare Costs and Emergency Department Visits

Findings from “Hanger Institute for Clinical Research and Education 2022 Annual Report” show benefits for patients who receive prostheses within first three months postamputation

REDUCED HEALTHCARE UTILIZATION AND COST

LESS LIKELY TO RECIVE CARE IN AN EMERGENCY DEPARTMENT

Percentage of ED Use By Group

CREDITS: BRENDAN FOSTER PHOTOGRAPHY

The new Centre for Pediatric Blast Injury Studies includes space for equipment that simulates the effects of different types of blasts (right) and a machine that tests how prostheses perform when faced with specific high-intensity forces and strains (below)

U.S. ADULTS SAY MEDICARE MUST EVOLVE

In a March survey, 73% of respondents agreed changes need to be made to the Medicare program to keep it financially sustainable for the future.

RESEARCH ROUNDUP VA Researchers Adapt PEQ for Upper-Limb Use

Researchers at the VA Medical Center and Brown University School of Public Health modified the Residual Limb Health Scale of the Prosthetic Evaluation Questionnaire (PEQ) for use in persons with upper-limb amputation. Let by Linda Resnik, PT, PhD, FAPTA, the team modified the PEQ response scale to a Likert scale and conducted a telephone survey of 392 upper-limb prosthesis users, with a 40-person retest sample.

Results of the PEQ-designed phone survey indicated that the upper-limb prosthesis users experienced sweating (91%), prosthesis odor (73%), blisters/ sores (12%), and ingrown hairs (8%).

The researchers found that the modified scale had “excellent structural validity, fair person reliability, very good test-retest reliability, and no floor or ceiling effects” and is recommended for use among patients with wrist disarticulation, transradial amputation, elbow disarticulation, and aboveelbow amputation. Details were published March in Prosthetics and Orthotics International

TECH TALK

CODING CORNER DME MACs Announce Retirement of Upper-Extremity Correct Coding Guidance

Last month, the durable medical equipment Medicare administrative contractors (DME MACs) and the Pricing, Data, and Coding (PDAC) contractor announced the retirement of their previously published correct coding guidance for upper-extremity prostheses. The correct coding guidance, originally published March 31, 2022, resulted in significant concern from AOPA and its partners in the O&P Alliance about the impact the correct coding guidance was having on access to clinically appropriate, medically necessary upper-extremity prosthetic care, not only for Medicare beneficiaries but also for individuals covered by other insurers who adopted the correct coding guidance into policy decisions.

The O&P Alliance submitted extensive written comments regarding its concern about the correct coding guidance. After several months of follow-up communication, last month AOPA and the O&P Alliance had a productive meeting with CMS representatives, the DME MACs, and PDAC.

The DME MACs and PDAC announced March 15 the official retirement of the previously published upper-extremity prostheses correct coding guidance. This positive development shows the value of open and trusted communication, according to AOPA, and is an important step in working toward the development of proper guidance that will ensure adequate access to clinically appropriate, medically necessary upper-extremity prosthetic care for Medicare beneficiaries.

How Could ChatGPT Impact O&P Research?

The AI-powered chatbot ChatGPT, released by OpenAI in November, simulates human conversation and has garnered much attention and scrutiny across industries. In a new “Ideas and Opinions” piece published in the March Annals of Internal Medicine, researchers from Amsterdam University Medical Center outlined the possible benefits and problems associated with the technology and discussed the future of medical research assisted or written by AI applications like ChatGPT and the soon-to-be released Apprentice Bard from Google.

The authors noted that these new technologies will allow researchers to create manuscripts more efficiently by assisting in generating complete, standard scientific text. However, they warned that the knowledge bases of software like ChatGPT are limited, so those leveraging the technology should cross-check information to ensure accuracy. They also pointed out that ChatGPT’s tendency to generate nonexistent references may complicate the writing. They recommended that journals create clear policies for using ChatGPT transparently.

Happenings

Q: What do you recommend for patients who participate in physical activities such as dance, gymnastics or even football?

PROFESSIONALS

Jim Campbell, PhD, CO, FAAOP, was honored with the Titus Ferguson Lifetime Achievement Award by the American Academy of Orthotists and Prosthetists during the Academy’s Annual Meeting & Scientific Symposium in March.

Campbell has been involved in the O&P profession since 1976 when he attended Strathclyde University. In 1988, he started his first position in the United States with the Cleveland Clinic, and in 1994 he returned to his alma mater, where he received a doctorate in bioengineering. Campbell returned to the United States in 1997 to join Becker Orthopedic, and in 2015, he joined Hanger as the company’s first chief clinical officer. He currently serves as senior vice president and chief clinical officer and leads the Department of Clinical and Scientific Affairs. Campbell was instrumental in the launch of the Hanger Institute for Clinical Research & Education in 2020.

In addition to his role at Hanger, Campbell has served on AOPA’s Board of Directors, including serving as president in 2016.

“I have known and worked with Kit for over 15 years,” said Wayne van Halem, president of The van Halem Group. “She is a widely recognized thoughtleader in our industry, and I am proud to have her on our team.”

An industry speaker, Shellhouse will continue to participate and present at industry events and trade shows. “Working with The van Halem Group is such an exciting opportunity,” said Shellhouse. “I look forward to connecting with their clients and sharing the immensely important work they do for our industry.”

Jerrica Thurman has been named chief strategy and communications officer for the Amputee Coalition. She leads the information technology, communications, development, and events initiatives for the organization. Thurman’s focus is to increase awareness of limb loss and limb difference, expand the organization’s reach, and grow engagement opportunities that advance national efforts to serve people living with limb loss and limb difference.

A: Many practitioners advise patients to take a break from their scoliosis TLSO during such activities, but there is also an alternative.

The Providence Nocturnal Scoliosis® System does not require taking breaks from wearing the brace during daytime activities such as school and sports because it is only worn at night.

Learn More about this alternative solution Spinal.Tech/Providence 508-957-8311

“Jim’s tenure at Hanger has brought tremendous milestones, from landmark research studies to unmatched clinical education and outcomes, that continue to push the envelope and move our industry forward,” said Vinit Asar, Hanger chairman and chief executive officer. “He is truly a pioneer in O&P, whose dedication has elevated not only our field, but the entire healthcare profession.”

Kit Shellhouse, formerly of ECS North and ACU-Serve, has joined The van Halem Group, a division of VGM Group, as the director of business development. With more than 20 years of experience in the home medical equipment industry, her duties will include managing key partnerships, generating new clientele, and fostering relationships while building The van Halem Group brand.

BUSINESSES

Hanger Clinic is celebrating Limb Loss and Limb Difference Awareness Month in April by hosting a Virtual Recognition Board, where members of the amputee community can recognize a fellow community member who embodies the Amputee Coalition’s 2023 theme “Inspire to Elevate.” Throughout the month of April, the Recognition Board is being updated with photos and submissions highlighting the impact members of the limb loss and limb difference community have had on one another.

Jim Campbell, PhD, CO, FAAOP

Kit Shellhouse

Add your facility’s name to the growing list of providers that have already joined the LLPR:

American Prosthetic Institute, Ltd.

Arise Orthotics & Prosthetics

Bionic P&O Group

Clark & Associates Orthotics & Prosthetics Inc.

Dynamic by DESIGN

Horton’s Orthotics & Prosthetics

Kenney Orthopedics Prosthetics & Orthotics

Mayo Clinic

Nevada Orthotics & Prosthetics Inc.

Orthocare Innovations LLC

Prosthetic Center of Excellence

Quantum Prosthetics & Orthotics

UAB Medicine

UCHealth Hospital System

Union Orthotics & Prosthetics Inc.

University of Michigan Health

UTHealth Houston System

Victory Orthotics & Prosthetics

Calling all clinical practices!

You’re invited to join the Limb Loss & Preservation Registry (LLPR)

The LLPR is the first national quality database designed and built to generate knowledge about which O&P advances and treatments produce the best outcomes for individuals with limb loss, limb difference, and limb preservation. The LLPR collects and standardizes data from hospitals, providers, and patients over time. This data is used to improve prevention, treatment, and rehabilitation approaches for this population. Join the growing list of O&P providers and hospital systems contributing data to help demonstrate the quality and impact of the care practitioners provide.

Why join?

“A patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure.”

—RICHARD GLIKLICH, MD

Using the data from the LLPR, practitioners, clinical leaders, and operators can:

X Evaluate treatment options and care plans to improve and maximize patient function

X Set meaningful, realistic, and consistent goals and objectives with patients and the care team

X Critically assess the care provided compared to regional and national benchmarks

X Use patient population and social disparities to risk-adjust outcomes.

Participating in clinical registries allows smaller practices to effectively leverage larger volumes of data and requires no additional practitioner time to collect information.

Connecting is easy, secure, cost effective, and sustainable for ALL practice sizes

The registry has partnered with OPIE, OPSolutions, and Nymbl to make exporting data convenient. The LLPR is designated a Federal Risk and Authorization Management Program (FedRAMP) Moderate Impact Level secure database. Providers push their data to the registry—the LLPR does NOT and cannot access a provider’s electronic medical records system.

Currently, there is no cost to join, send data, and receive basic dashboard reports from the registry. Beginning in 2024, subscription plans offering varying levels of benchmarking, progress, and performance will be available for purchase.

For more information, including scheduling a one-hour Q&A with the LLPR team, visit the LLPR website, llpregistry.org, or email info@llpregistry.org

Richard Gliklich, MD, is the Leffenfeld Professor of Otolaryngology at Harvard Medical School who has done foundational work in healthcare outcomes and analytics. He is senior editor of the landmark publication, Registries for Evaluating Patient Outcomes: A User’s Guide

DEVON BERNARD

Take Notice

Know when and how to use ABNs for traditional Medicare fee-for-service claims

An Advanced Beneficiary Notice of Noncoverage (ABN) can be a valuable and useful billing tool for you, your facility, and your bottom line. It can protect you from unnecessary financial liability in certain circumstances, if used properly, or allow you to provide services when you normally would not be able to. However, you must use the form properly to ensure you don’t develop a false sense of security.

Before reviewing some of the basic rules and purposes of the ABN, remember that the form is only to be used with traditional Medicare fee-for-service claims—and not with Medicare Advantage plans or private payor plans.

Purpose and Conditions

The ABN has two distinct purposes regarding when it may be used within the Medicare program: mandatory and voluntary.

The mandatory use is to inform the Medicare beneficiary that you, as the supplier and biller of record, believe that Medicare may deny a claim as not medically

necessary, and in that case, the beneficiary will be financially responsible to pay for the services rendered. This essentially shifts the financial liability from you to the beneficiary. This usage is considered mandatory because you are required to have an ABN signed and on file if you wish to transfer financial liability to the beneficiary.

When used for this purpose, several conditions must be met to render the ABN valid. For example, the ABN must be provided to the beneficiary within a reasonable timeframe for the beneficiary to make an informed decision regarding whether to accept financial responsibility for the service, should Medicare deem it not medically necessary. In most cases, you should not provide an ABN to the beneficiary at the time of delivery and make them choose between signing the ABN or receiving their care. However, in some circumstances, late delivery of an ABN may not be avoidable; when this occurs, note the time the ABN was provided to the beneficiary and the time they signed, and note if they had any questions or concerns.

This will document that the beneficiary had time to review the ABN and make an informed choice.

In addition, you must state the specific reason why you believe Medicare will deny the claim as not medically necessary and provide a good faith estimate of what the beneficiary’s liabilities may be if the claim is denied.

These are just two examples of conditions that must be met for an ABN to be considered valid. In addition, you must use the correct and current ABN form, obtain a signature from the beneficiary indicating that they understand the provisions of the ABN and accept financial liability, and include your proper identification information.

The voluntary option for the ABN form, on the other hand, occurs when it is used as a voluntary notice that a particular item or service is not a statutorily covered benefit under the Medicare program. This voluntary usage does not have any impact on financial liability for the claim because statutorily noncovered items are always

the financial responsibility of the beneficiary; however, it may be used for the purposes of informing the beneficiary of the noncovered status of an item as a courtesy to the beneficiary, and as documentation that you informed the beneficiary.

Examples of Usage

ABNs should only be used when they are warranted. You should use an ABN if there is a specific reason why you believe Medicare will deny a claim as not medically necessary. This could include denials stemming from policy coverage criteria have not been met, or that you don’t have sufficient documentation from the referring physician. A not medically necessary denial also would cover frequency issues, reasonable useful lifetime issues, or same or similar.

However, some other very specific scenarios may arise when an ABN is mandatory—for example, if you don’t meet the supplier number requirements, if you don’t have a valid supplier number, or if you are not a registered supplier of select Medicare benefit categories. So, if you have applied for a supplier number but

have not yet received it, and some Medicare beneficiaries are awaiting your care, you would have to ask the beneficiaries to sign an ABN and inform them that you are not an eligible Medicare supplier.

a very specific reason. If the beneficiary reviews the ABN then signs and dates it, indicating that they have made an informed decision to receive the item or service, they may be held financially responsible for payment for the service (up to your full usual and customary charge) should Medicare deny the claim as not medically necessary. For the ABN to be considered valid, the beneficiary must sign and date it prior to delivery.

A more current example for using a mandatory ABN among orthotic suppliers is the emergence of competitive bidding. If you are in a competitive bidding area but you don’t have a contract, the only way you would be allowed to provide an item subject to competitive bidding is if a beneficiary signs an ABN.

For a recap, the purpose of the ABN in these instances is to inform the beneficiary, in advance of receiving the service or item, that you believe Medicare will deny the claim as not medically necessary, for

In other instances, you may ask a beneficiary to sign an ABN in the voluntary category because a specific service is simply not a benefit under the Medicare program, or because Medicare would never pay for the item under any circumstance. This may occur when delivering items such as orthopedic shoes and inserts that are not an integral part of a brace, elastic-style braces, or diabetic inserts or modifications above the beneficiary’s allotted and allowed amounts. It also may apply when providing items or features that are primarily used for comfort and convenience, for which there is no medical or clinical benefit.

For the ABN to be considered valid, the beneficiary must sign and date it prior to delivery.

In these situations, it is not mandatory to use the ABN; you may use another method to inform the beneficiary of their financial obligations. The ABN is simply being used as a courtesy: The beneficiary would not be required to choose a billing option (Options 1-3 on the ABN form), and you would not be required to adhere to the other guidelines for the ABN, such as having the beneficiary sign it, or ensuring the ABN is provided prior to delivery.

ABN Advantages

A properly executed and valid ABN allows you, as the supplier and biller of record, to possibly collect your full usual and customary charge for a service at the time of delivery. While you remain obligated to submit a claim upon the request of the beneficiary (Option 1 on the ABN form, or Section G), if Medicare denies that claim due to the reason stated on the ABN, you are not required to refund the beneficiary any payment collected and you may bill the beneficiary directly for the service if no payment was collected at the time of delivery.

This is important because the general Medicare limitation of liability rules protect the beneficiary from financial liability for services or items denied due to medically necessity unless it can be shown that the beneficiary was made aware that the service or item in question would most likely be considered not medically necessary by Medicare. The ABN serves as proof that the beneficiary made an informed decision and can be held liable for payment.

Avoiding Routine Use

Providing ABNs to beneficiaries where there is no specific, identifiable reason to believe Medicare will not pay is considered “routine use,” and this practice is not allowed. Medicare has stated that ABNs may not be routinely used—and if they are, they will be considered invalid.

An example of a routine ABN would be a generic or general ABN: ABNs that do not list a specific reason for why the item or service may be considered not medically necessary, or simply state that a denial is possible or may happen. You must include a proper explanation of why you believe

Medicare will deny the claim as not medically necessary. If the reason documented on the ABN is overly vague, or if Medicare denies the claim as not medically necessary for a different reason, the ABN is invalid, and the beneficiary would not be responsible for payment.

Refusal To Sign

If the beneficiary refuses to choose an option or refuses to sign the ABN, you are under no obligation to provide care and deliver the item or service to the beneficiary, and thus accept the financial liability. The only time this may not apply is in an emergency situation.

If a patient refuses to complete or sign the form, make a notation on the original ABN form in Section H explaining that the beneficiary refused to sign; then provide a copy of the updated ABN to the beneficiary. Retain a copy of the document in your records as well.

Modifiers

Another example of a routine ABN would be the provision of a blank ABN for the beneficiary to sign. An ABN should not be part of your general intake paperwork that a beneficiary fills out during a visit. The same goes for blanket ABNs, or providing an ABN to every single beneficiary that comes to your facility. ABNs, by nature and design, are circumstantial and therefore should never be provided to every beneficiary as standard procedure. It is possible that the routine use of ABNs as a means to shift financial liability to Medicare beneficiaries can be considered an abusive practice, which may lead to negative consequences for you as the supplier—so avoid routine ABNs.

Also note that an ABN may not be used or issued under emergency situations, or if the beneficiary is under any notable duress. In either of these situations, the beneficiary likely cannot make a reasonable and formative decision about their care and their potential liabilities.

An ABN may not be used to bypass the Medicare prior authorization program. You may obtain and use an ABN if you have received a nonaffirmative prior authorization request, or if you are intending to bill a secondary insurance, but you may not have the beneficiary sign an ABN because you do not wish to submit a prior authorization request.

Six modifiers may possibly be used when submitting a claim and using an ABN. The two most commonly used modifiers are GA—waiver of liability statement issued as required by payor policy, individual case; and GY—item or service statutorily excluded, does not meet the definition of any Medicare benefit, or, for non-Medicare insurers, is not a contract benefit.

The GA is appropriate when billing Medicare and you have a valid ABN on file, and you believe a covered item may be denied due to medical necessity—for mandatory ABN uses. The GY is appropriate when you are billing Medicare for a noncovered item, or when you use the ABN in voluntary situations. Do not use the GA modifier if you voluntarily use an ABN for noncovered items.

Now that you know and understand some of the basic rules and purposes of the ABN, use it with confidence.

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

Editor’s Note: The Office of Management and Budget recently approved the latest version of the Medicare ABN. This version of the ABN can be identified by its expiration date of January 31, 2026, located in the lower left corner of the form. The new version of the ABN is mandatory for use on or after July 1, 2023.

CHRISTINE UMBRELL

WHOLE CHILD CARE

Consider patients’ emotional and psychological needs when treating children with limb loss

How well do you know your pediatric and adolescent patients? Could you spot the signs of a mental health challenge during a routine visit? You should. Given the wide range of emotions that come from living with limb loss or limb difference, many pediatric O&P patients benefit from mental health intervention.

“Youth with limb loss or difference are overwhelmingly resilient, and research shows high rates of positive adjustment as they reach maturity; however, their journey can be very hard at times,” says Catherine

NEED TO KNOW:

f Many children with limb loss benefit from psychological counseling to help them manage their emotions relating specifically to their limb difference—in addition to more general mental health challenges that arise.

f Children may experience shifting challenges as they grow and enjoy gains in their cognition and abstract reasoning; they may develop “feelings of difference,” and seek ways to overcome limitations.

McClellan, PhD, chief of behavioral health at Shriners Children’s—Portland. “Unwanted attention about their limb difference has been identified as one of the hardest parts of growing up with limb loss,” says McClellan. “Importantly, we know that the degree to which a patient is ‘bothered’ by this attention moderates the negative impact it can have. Psychologists and therapists can support these patients by preparing them with healthy ways to manage the distress that can be associated with unwanted attention to their limb difference.”

f It’s important for O&P professionals to pay attention to children’s mental health needs beyond the issues associated with their limb loss—particularly given the high levels of anxiety and depression among children and teenagers.

f Both mental health professionals and O&P clinicians benefit from collaborating. Prosthetists can seek out local psychologists, and offer training on limb loss or difference to mental health professionals.

f Prosthetists should consider offering programs that could help boost mental health among young patients— for example, “partnering” patients with other patients of similar age, or hosting support groups for families.

Among the many issues facing pediatric O&P patients are a disproportionate degree of bullying; distress surrounding their limb difference, including worries about future employment; feelings of difference; and feeling left out of athletics or other social rites of passage, according to McClellan.

Benefits of Intervention

Ginger Depp Cline, PhD, ABPP, a board-certified pediatric psychologist at Texas Children’s Hospital and associate professor at Baylor College of Medicine, sees many patients throughout all stages of amputation and prosthetic care. Cline points to a two-step process in working with children with limb loss: “First, let them talk about what it’s like for them—talk about their differences, and reflect back the emotions they’re experiencing—i.e., it’s not fair, feeling sad, etc.,” she says. “Then, you can work on supporting their adjustment if needed.” She prioritizes open, honest, and developmentally appropriate communication as well as active listening.

Many pediatric psychologists leverage cognitive behavioral therapy (CBT) tactics, which can be particularly useful among children with limb loss, according to Julia Kovalenko, PhD, a pediatric psychology fellow at Texas Children’s Hospital. CBT has been demonstrated to be effective for a range of problems including depression, anxiety disorders, eating disorders, and severe mental illness, according to the American Psychological Association (APA). CBT treatment usually involves efforts to change thinking patterns, by learning to recognize one’s distortions in thinking and reevaluating them in light of reality; using problem-solving skills to cope with difficult situations; and learning to develop a greater sense of confidence in one’s own abilities.

As children recover from an amputation and progress through rehab, psychological intervention can be necessary. “Some kids do really well returning to their activities” postamputation, says Kovalenko, “but we want to make sure we are improving their quality of life.” Children can develop anxiety before or after surgery, or they can feel anxious about using their prosthesis correctly. “They may experience changes in mood from not being able to participate in activities in the same way, or develop self-esteem issues,” she says. Mental health professionals also can assist patients in learning to manage chronic or phantom pain.

McClellan helps patients develop strategies to cope with unwanted attention, promote positive thinking about appearance, and develop confidence and robust social skills to manage limb loss-related anxiety and depression. “Cultivating body confidence can also be important to interpersonal relationships, especially future romantic relationships. Additionally, for youth who faced

amputation after trauma or cancer, mental health intervention is often needed to address this major change and treat associated trauma,” she says.

Psychological intervention can help promote prosthesis use, “especially when it is initially introduced, and in facilitating parentchild dynamics surrounding prosthesis use,” adds McClellan, who, in addition to her responsibilities in developing and implementing hospital-wide programming, works with prosthetic and orthotic patients. She completes presurgical consultations for youth and families facing amputation, provides counseling for those adjusting to limb loss and youth who have congenital amputation, and promotes TLSO bracing adherence for scoliosis patients.

Considerations by Age

O&P professionals should be aware that psychological approaches and treatment goals differ tremendously by age, according to McClellan.

“For very young patients, much of the work is supporting parents so that they can model adaptive coping, manage their feelings of grief and guilt, and build a support network, often with other parents of children with limb difference,” says McClellan. “Research shows that parents typically overestimate the negative impacts of limb loss on their child functioning, which can result in overly accommodating or protective behaviors. Very young children may not be fully aware of their difference, and preschool age youth are often very accepting of limb loss or difference.”

Parental grief can be particularly strong for parents of children with congenital limb loss, adds Emily Gale, PhD, LP, ABPP, a pediatric psychologist at Scottish Rite for Children. “We can figure out the best way to support those families,” some of whom may be feeling unwarranted guilt over their children being born with limb difference.

Needs shift among school-age children, ages 6-11, who “enjoy gains in their cognition and abstract reasoning,” says McClellan. At this age, many children go through a grieving process and begin to experience increased scrutiny for their physiological difference from their peers.

Ginger Depp Cline, PhD, ABPP

Julia Kovalenko, PhD

“As children get older, they typically start noticing other people noticing their limb difference,” says Cline. “They may need normalization support of others being curious, and then coaching for how they want to respond to this.”

“Most kids do great until middle school,” agrees Gale. “That feeling of ‘difference’ is salient in the middle school years, but for someone whose body looks different in a very visible way, it can be really difficult. A lot of kids start to wear pants even in summer” to hide their prosthesis. “A lot of my work with that age group is about accepting your body, thinking of your prosthetic as a part of you but also as a tool that helps you keep up with other kids, that also helps you play the sports you want to play or do the activities you want to do.” She also helps patients build resiliency if they are being bullied or feeling different.

During high school, issues with depression or anxiety may emerge, says Gale. There may be less concern about the actual prosthesis, “and more concern about you as an emerging adult who needs psychological support.” Some teenagers also need help accepting—or overcoming—their limitations in activities, she says. “It’s about normalizing that process and figuring out how they can adapt to wearing a prosthesis in sports.”

Gale also works with teenagers as they get ready to graduate high school and move out on their own. “Some kids will still have their parents help them with care for their prosthesis, or help figure out socks and liners, and when they need a new prosthesis,” she

explains. “We work on moving toward the teenager taking over those self-care skills they’ll need in managing their prosthesis for the rest of their life.”

General Anxiety and Depression

It’s important for O&P professionals to pay attention to children’s mental health needs beyond the issues associated with their limb loss—particularly given the high levels of anxiety and depression among children and teens in the U.S. More than 2.7 million children and adolescents are living with severe mental depression, and 60% of youth with major depression receive no mental health treatment, according to a 2023 report from Mental Health America. Statistics like those demonstrate the value of all healthcare providers monitoring for signs of depression and anxiety, and connecting children with mental health professionals who can help.

“Our country is facing a major mental health challenge, and our children and teens are the most impacted,” says McClellan. Young people increased their usage of screen time and social media during the pandemic, “resulting in worsening mental health and body image,” she says—with “unique impacts on our youth with limb loss and difference.” For example, she notes that families who have lost income or insurance may struggle to travel to, or afford, prosthetic care. “There has been a decrease in opportunities for social activities and pursuits, which increases isolation and reduces healthy peer interaction and feelings of proficiency and achievement.”

PHOTO CREDITS: HARLAN PINE/SHRINERS CHILDREN’S—PORTLAND

Catherine McClellan, PhD, chief of behavioral health at Shriners Children’s—Portland, and Todd DeWees, CPO, manager of the Shriners O&P Group, work collaboratively with a patient.

FABRICATED WITH ACCURACY & PRECISION

At Hersco, we pride ourselves on being on the leading edge of technology. We have mastered the art of accepting scans and 3D printing to bring you precise orthotics every time. Our team works to deliver custom orthotics tailored to each individual’s needs and specifications. We also keep an exact digital record of each patient’s foot orthotics for ease of reproduction.

CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES

Continuous Psychological Care

For some pediatric patients who undergo amputation at children’s orthopedic hospitals, psychological care is part of the continuum of care, starting before surgery.

Emily Gale, PhD, LP, ABPP, a pediatric psychologist at Scottish Rite for Children, sees many patients throughout the amputation and rehabilitation process. Her patients include those with congenital limb loss or difference, as well as trauma and cancer patients. Tailoring the treatment to the needs of the patients and their families is extremely important, says Gale, with some children benefiting from extra visits.

“We’ll talk about any psychiatric symptoms that are present; we’ll do some preoperative education about what the family knows, and what the family needs to know; and we’ll set some realistic preoperative and postoperative expectations,” she says. “Most of my preoperative consultations focus on pain management and family support—making sure that everyone knows how to manage pain and what the goals are for the surgery.”

Even more alarming, “we have seen a sharp increase in the rates of youth suicide in the U.S., often stemming from feelings of difference, poor body image, and social dynamics,” McClellan says. “Youth with limb difference experience these feelings of difference at a higher rate than youth without orthopedic conditions.”

Those feelings may be exacerbated among patients with lower-limb loss, who are more likely to experience bullying and have fewer opportunities to participate in sports and social activities, says McClellan. “Some work has shown that youth with unilateral upper-limb difference compare similarly to their non-limb-difference peers on measures of health-related quality of life.” She also notes that gender is a contributing factor: “Interestingly, girls and young women with limb loss or difference typically fare worse than their male counterparts, regardless of the site of the limb loss or difference. With our increasingly appearance-focused society, cultivating a healthy body image can be an uphill battle.”

O&P practitioners can help identify patients at risk. Some signs to look for include struggles adhering to the recommended treatment protocol, intense parent-child conflict, apathy, and novel patterns of disengagement, according to McClellan. At Shriners Children’s—Portland, “we instituted universal suicide screenings, and it has been immensely helpful in identifying youth at risk,” she says. “It is important for providers to have the information they need, should a patient voice suicidal ideation, including where patients can go for an urgent mental health consultation—often

Postsurgery, Gale continues to follow her patients through the prosthetic process. Children who are going through their first amputation comprise Gale’s biggest patient population: “making sure they understand not only the surgery process, but also the recovery, getting into a prosthesis, and adjusting to life with a prosthesis.” She likes to “keep the expectations realistic” and monitor patients to ensure they’re not experiencing mood changes; she also helps them with general adjustments to life with a prosthesis.

“Sometimes [the rehab process] can feel a little frustrating, especially for high-functioning kids who just want to get back to activities they enjoyed preamputation, such as sports,” Gale says. “It can be hard to slow them down and let them adjust to the prosthesis, so keeping those expectations very realistic is my main role.”

offered through community mental health sites.” She suggests that O&P providers normalize discussions of mental health by posting flyers or making resources available in their clinic. “The National Child Traumatic Stress Network is a wonderful site for resources.”

Prosthetist-Psychologist Connections

Partnerships between both mental health professionals and O&P clinicians can be mutually beneficial. Gale works closely with many of the prosthetists who treat her patients. “They’re seeing these patients a lot more frequently than I am, so I rely on them to tell me if they notice changes in their patients, or find that they’ve stopped participating in some activities.”

When working with children, Cline suggests that prosthetists solicit some general adjustment feedback. “Ask: ‘What things are going well, and what’s been hard for you? What’s making you feel sad/happy/frustrated/worried/hopeful lately? How have you been feeling?’ These questions open the door,” she says. If the patient appears to be in any type of distress, it may be helpful to reflect their feelings back and possibly “consult with a psychologist” and/or refer the child/family to mental health services. Cline also suggests that O&P professionals encourage parents to look for resources in their children’s schools (i.e., Section 504 accommodations for returning to school, etc.), and to check with their insurance for referral options.

McClellan suggests contacting the state association of psychologists to reach providers who have an interest in pediatric psychology or specialized experience or training. O&P professionals could provide training on limb loss or difference, or be available for consultation as needed, to help psychologists and mental

Emily Gale, PhD, LP, ABPP

Catherine McClellan, PhD

health professionals “get up to speed so that they can modify their approaches to meet the unique needs of the population,” she says. “Many psychologists would welcome the opportunity to learn more about the limb loss/difference population and develop expertise, but opportunities are needed to foster this collaboration.”

Prosthetists also should consider offering programs that help boost mental health among young patients—for example, “partnering” patients with other patients of similar ages, ensuring patient privacy and HIPAA compliance, says Cline. She also recommends that prosthetists educate patients and families about camps and local activities for children with limb loss.

McClellan believes O&P professionals are positioned to model adaptive approaches to limb difference, to emphasize ability, and to instill pride. “They can check with patients on negative comments or unwanted attention, and share how other patients have found adaptive ways to cope. Pairing families with mentor families provides reassurance and a sense of community that can be hard to replicate.”

She also suggests using positively framed language when speaking with pediatric patients. For example, “providers are encouraged to reconsider using the term ‘stump’ to describe a residual limb,” McClellan says. Prosthetists should ask patients how they would like to refer to their shorter or residual limb: “While the terminology ‘stump’ is well-understood and commonly used within medical

settings, this term is neither attractive nor sensitive to the needs of youth who may already be hyperaware of their body difference.”

“It is so important to be aware of the impact that a medical care provider can have on a patient’s self-concept and sense of selfworth, and how it can result in optimal care,” adds McClellan. “While our O&P providers are not with patients on a daily basis, they are often a consistent and long-term presence in the life of a child. Making a connection with the child about their personal interests, sharing stories of patient successes and frustrations, and normalizing how hard unwanted attention can be helps youth feel heard and understood.”

“I just hope that the conversation about mental health is something that more people start to feel more comfortable discussing,” says Gale. “We have to treat the whole child. I really encourage clinicians to educate themselves about how they can talk to kids more competently about mental health, in a non-stigmatizing way. And know that if a child tells you something, there are mental health professionals who are willing to help. Sometimes addressing those mental health needs can help your prosthetic goals move a lot faster.”

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

Precision Changes

Tennessee prosthetist designed a unique liner and socket solution for a patient with extra tissue on his residual limb

In each issue of O&P Almanac, the Transformations column features the success story of an O&P clinician who has worked with an inspiring or challenging patient. This month, we speak with Ronnie Dickson, CP, who helped Eric Crump improve his mobility after an elective transfemoral amputation.

When Eric Crump first visited an O&P facility, he already knew a lot about Ronnie Dickson, CP, and the Chattanooga, Tennessee, branch of Prosthetic & Orthotic Associates (POA). Crump, who elected to have his right leg amputated above the knee in fall 2020, had done a great deal of “homework” on options for O&P care. During his

research, Crump learned that Dickson, founder of the Chattanooga branch of POA, had implemented cutting-edge fitting techniques for lower-limb patients; understood the needs of active patients and had extensive experience treating them; and—like Crump—had lost his leg during an elective amputation. Crump decided Dickson was an ideal clinician for his prosthetic care.

Eric Crump has improved his mobility and increased his activity after being fit with a customized liner and socket by Ronnie Dickson, CP.

Ronnie Dickson, CP

Crump made a good decision. Dickson ended up creating a tailored prosthetic solution to meet his unique needs. Crump, who was 6-foot-3-inches and 46 years old when he first entered POA, had injured his knee in his early 20s playing football in college. His leg never fully recovered. Over the years, the pain rendered him unable to exercise,

and he developed back problems. He gained a significant amount of weight, rising to 400 pounds.

In his early 40s, Crump adjusted his nutrition and underwent gastric bypass surgery, losing 125 pounds. He decided he no longer wanted to live with severe knee pain and scheduled a transfemoral amputation—but

his prosthetic needs were complicated by excessive tissue surrounding his residual limb. Dickson diligently designed a unique liner and double-wall socket (with an outer adjustable socket), providing much-needed anterior-posterior compression, which enabled Crump to become more active than he’s been in decades.

Dickson and his team designed a thick liner and an innovative adaptable double-wall socket with an outer adjustable socket for Crump.

Tailoring a Solution

Because Crump contacted POA prior to his amputation, Dickson was able to counsel him on what to expect. “My amputation was also elective,” says Dickson, “so we discussed” the decision-making process and potential outcomes after an elective amputation.

As a child, Dickson had Trevor’s disease, or dysplasia epiphysealis hemimelica, a rare skeletal development disorder characterized by asymmetric overgrowth of cartilage in the epiphyses. “It was a congenital deformity that affected the growth plates in my left knee and my left ankle,” he says. Dickson spent a lot of his childhood at Shriner’s Hospital. “After some surgeries, I ended up with a limb that was very painful, and there really wasn’t any light at the end of the tunnel in terms of how that was going to get better,” he says. “When I was 17, I decided to have my leg amputated above the knee after my high school graduation.”

Dickson got involved with the Challenged Athletes Foundation (CAF) and started rock climbing, participating in the Extremity Games. He met Stan Patterson, CP, LP, founder of POA in Florida, who provided Dickson’s “first comfortable prosthesis”—that encounter set him on the path to becoming a prosthetist himself and founding the Tennessee branch of POA.

Dickson’s first-hand experience was an advantage for his relationship with Crump. Dickson communicated closely with Crump through his amputation and rehabilitation, then delivered Crump’s first prosthesis in March 2021. “What we did for him initially was our standard double-wall socket,” a design pioneered at POA in Orlando.

Crump did well with his first prosthesis, according to Dickson. No longer forced to walk on an injured knee, Crump became much more mobile following rehab. He ramped up his activity level and continued to lose weight.

“He was really inspired with this new mobility because he started doing things he hadn’t been able to do for a very long time,” says Dickson. At one point, he and Crump went hiking together at one of Dickson’s favorite rock-climbing areas. “I think that inspired him to go and start hiking all around Tennessee,” he recalls. Crump went on to hike the Cumberland Trail—two or three times a week, five or six miles at a time—to challenge his mobility and get back into shape. He also dropped to 240 pounds.

Continuous Improvement

Dickson says his work with Crump was one of gradual improvements. As with many prosthetist-patient relationships, Crump learned to share feedback over time. “As the patient develops a history with their own prosthesis, that’s really where you can fine-tune and tweak things even better for that person.”

Crump appreciated his prosthesis, but Dickson noticed he could improve some areas. Because of his significant weight loss, “he had a lot of extra skin,” says Dickson. “So when he presented with the residual limb, the musculature had really atrophied—more so than normal. Eric is very active on his prosthesis,” and Dickson was inspired to make it even better.

Dickson and his team decided to create a stronger liner. POA creates its standard above-the-knee liners in-house. Made of silicone with a relatively soft durometer, they measure approximately 9 mm at the bottom, tapering to 3 mm at the top. “What we found with Eric is that, with all that soft tissue that’s all around his femur, we needed a liner that would” provide more support.

Dickson’s team custom made a thicker liner with a stiffer durometer, “so that the liner would squeeze and compress his tissue.” They did all work in-house, using a repurposed automotive robot as their CNC carver. The new liner “did a better job of controlling and supporting all of his tissue,” says Dickson, offering less slippage and more stability in the socket.

A few months later, Dickson and his team “isolated some issues with his prosthesis,” he says. “Inherently, with the double-wall system, his prosthesis was a little bit wider down toward the middle of his thigh than it was proximally. But the No. 1 thing with the double-wall system is that you have to be able to put the inside shell inside the outside shell. It has to pass through the top of it to get down to the bottom.”

It appeared as if Crump’s socket was tight on him, and “visually we were getting total contact,” says Dickson. “But because of how soft his tissue was, we realized there was actually much more compression that we could have, specifically in the front and back, anterior-posterior.”

Considering Crump’s height and size, Dickson hesitated “to do a traditional adjustable socket because I only wanted to compress [the residual limb] from front to

Crump has hiked several sections of the Cumberland Trail using his new prosthesis.

Dickson completed all work for Crump in-house on specialized equipment.

back, in the anterior-posterior.” Too much wear-and-tear on a more traditional device would require multiple replacements. Instead, Dickson created an innovative adaptable device: a double-wall socket with an outer adjustable socket.

“We engineered two pieces of webbing: one coming from the front of the socket and one coming from the back of the socket, meeting together at a ring that’s on the lateral wall of the socket,” Dickson explains. “So the direction of pull was getting redirected by a very heavy-duty ratchet.” That part of the design was fabricated and integrated into the lateral wall of the socket. Dickson and his technician incorporated a button to loosen the socket and a ratchet to tighten it that would “squeeze the front and the back of the socket together,” and offer increased compression, says Dickson.

“Between the changes that we made for the liner, and the changes that we made for the adjustability of the socket, he absolutely loved it,” says Dickson. “He feels like he is able to utilize more of his energy directly into the prosthesis now, instead of wiggling around the top of it and having more of that unstable feeling. Finally, we’re able to get it tight enough to where he feels properly supported.”

True Teamwork

Dickson credits his POA team with the final design for Crump’s prosthesis. “I can take credit for facilitating it and having the initial breakthrough of, ‘This is what we need to do.’ But we have a team of 11 people here, and they did a great job coming up with a solution.”

Over the past three years, Crump has had at least 40 appointments at POA—and Dickson’s team has gone above-and-beyond to ensure just the right solution. “For us, it’s important to not stop until we’ve done everything in our power to create the best outcome—in any given case,” he says. “Thankfully, we’re able to do that most of the time with our standard procedures. But there are cases that require thinking outside the box. We’ve got a young, energetic team of people who are motivated to see that mission through [and] to get the outcome we’re looking to achieve.

“Eric changed a lot, and it took a lot of effort to stay on top of his change and keep him feeling good,” adds Dickson. “He’s put in the time to work on the prosthesis, and the [POA team] has put in the time. Now

his residual limb volume is stable.” Dickson notes that seeing patients for so many appointments can be overwhelming, “but if you just keep doing the best that you can on any given day, and see the process through, there is light at the end of that tunnel,” he says. “Eric’s thankful we did the things that we did to keep him mobile.”

Going forward, Dickson is confident Crump will continue hiking and engaging in other activities. In addition to his regular prosthesis, Crump now has a running leg that was funded through a grant from CAF. Dickson is glad he and the POA team took the time to ensure an optimal solution for Crump: Seeing a former athlete return to activity after years of limited mobility is “really powerful.”

DO YOU HAVE A TRANSFORMATIVE PATIENT-CARE EXPERIENCE YOU’D LIKE TO SHARE WITH O&P ALMANAC READERS? Contact Editor Josephine Rossi, jrossi@contentcommunicators.com, with your story to be considered for an upcoming profile.

Dickson, here with another patient, often works off-grounds with patients to ensure their activity needs are met.

Dickson (fourth from left) and the team at POA Tennessee take a collaborative approach to ensure an optimal solution for each patient.

HISTORY: 38 years

Open Access

California facility welcomes patient questions and offers a 24/7 answering service

John McAtee, CP, FAAOP, launched Channel Islands Prosthetics & Orthotics in 1985 with Mark Warmuth, CO, a fellow graduate of UCLA, two years after they were certified. Warmuth sold his interest to one of their employees, Christopher Holloway, CO, in 2016. McAtee and Holloway have been co-owners since then.

Channel Islands P&O occupies a suite of offices in Ventura, California, in an industrial park close to the freeway for easy access to hospitals. The 3,600-square-foot facility features four fitting rooms, one with parallel bars; a front office; and about 2,400 square feet for fabrication and storage. The company has 10 employees, including its owners, two additional clinicians, and two certified technicians.

“We see all kinds of patients, from infants who need remolding helmets to the elderly,” says McAtee. “Most of our prosthetic patients have diabetes.” For now, the facility also sells diabetic shoes.

The Channel Islands team makes most devices in-house, and McAtee is still a proponent of hand casting with a total-surface bearing socket. “I handcast under vacuum, and for below-knee prostheses I like to use a two-stage casting technique with suction at each stage,” he says. “It gets a very good total surface-bearing negative and then positive mold that needs less time to modify.” He also is considering using a more technologically advanced casting technique, the Symphonie Aqua weight-bearing casting system.

The facility leverages scanning technology to create cranial molding orthoses and arch supports, among the few devices they send to a central fabrication service. McAtee and Holloway are proud of the time they spend up front making sure devices are accurate. “We take our time to listen and explain,” McAtee says. “By investing that time evaluating the residual limb and ensuring a good fit, we reduce problems down the road and probably spend less time overall.”

McAtee considers all of his patients’ success stories, but a few stand out. “We fit a young high

school student who was a very good softball player before she lost her arm below the elbow in an accident with an off-road vehicle,” he says. “We made a prosthesis she could use to hold the bat—and her first time up at bat, she hit a triple! The device worked in the outfield, too, as she figured out how to get the glove in her other hand, catch the ball, and throw it.”

Another patient is a marathon runner, who has run in multiple races—including the Boston Marathon.

Channel Islands P&O focuses its charitable efforts on providing free or low-cost prostheses to patients who cannot afford them, using high-quality used components. Holloway volunteers every year at the Angel City Games, an adaptive sports competition held in Los Angeles. Competitors can take part in track and field, wheelchair basketball and tennis, archery, swimming, sitting volleyball, and table tennis events.

McAtee and Holloway say they prioritize providing excellent patient care and follow-up. “After a fitting, I see patients at one week, two weeks, a month, six months, and then yearly if all goes well,” says McAtee. “We have a 24/7 answering service, but every patient also has my cell phone number. They can text me and I’ll get back to them as soon as possible. It’s surprising how many issues you can solve over the phone. Patients really appreciate having that access, and it saves time for them and for me.”

After many dedicated years of running Channel Islands P&O, both McAtee and Holloway are ready to hand over the reins to another owner, but both plan to stay on as employees. The two were in negotiations with a potential buyer and by press time, the facility may well have new owners. “Stepping down but continuing to practice will be a good exit strategy,” says McAtee. “We can continue to do what we love but reduce the time—and worry—spent on administrative tasks.”

One of the facility’s clinicians works with a patient on the parallel bars.

The Channel Islands team makes most devices in-house.

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

FACILITY: Channel Islands

Prosthetics & Orthotics

OWNERS: John McAtee, CP, FAAOP, and Christopher Holloway, CO

LOCATION: Ventura, California

Owners Christopher Holloway, CO, and John McAtee, CP, FAAOP

Meet the Xtern Line

100% dynamic AFO

No skin contact

Symmetrical design that fits left and right shoes

Conforms to eneven grounds and slopes

Lace clip technology that allows fast installation from shoe to shoe

Included lace clips

Warranty on plastic and\or carbon fiber par ts

insurance coverage such as VA, Medicare and MedicAid

HCPCS PDAC approved

Turbomedusa.com

2 years

3 years

See through design that is almost invisible when worn

25% lighter**

18% more dorsi-flexion power**

35% more medio-lateral strength**

2 years

Designed for patients with reduced dexterit y and hand mobility such as stroke patients

Unique front suppor t design

Easy rear entry thanks to revolutionary frontal design

Magnetized velcro strap is easily attached with one hand

25% more medio-lateral stability**

L-1951

L-1932 (pending)

L-1951

32 O&P Almanac April 2023

Hands-On Innovation

Medical robotics company offers solutions for individuals with upper-extremity amputation

A

Agrawal and Jiwakhan noticed the limitations of individuals with upper-extremity amputation and launched a startup to develop a better prosthetic hand. The result was the Zeus hand, a unique multiarticulating myoelectric hand.

Today, Aether has about 40 employees, including 30 engineers. Based in Chicago, Sarra Mullen, CP, serves as head of U.S. operations. Her background includes the then-Rehabilitation Institute of Chicago (now the Shirley Ryan AbilityLab), where she spent 10 years as a practitioner and five in organizational operations and outcomes. Her interest in data science and analytics led to a position at Rush University Medical Center, where she bridged the gap between the clinical team and the analysts. “I bring both clinical and tech skills to the table,” she notes.

The Zeus hand has a high grip force (152 N) and can lift 77 pounds, according to Mullen. Its seven modules are “plug and play,” allowing each to be swapped out and repaired by a clinician in less than 60 minutes, Mullen says: “Clinicians don’t need to order and wait for a loaner hand, which decreases how long the patient has to be without their device.”

The prosthesis offers 12 grip patterns that can be customized for each user and has a soft grip feature to allow users to safely handle delicate items. The fingers work individually, allowing them to conform to the shape of the object, regardless of shape and size. Other features include an impact resistance mechanism that allows the fingers to flex when facing a blow, which protects them from breaking.

Zeus comes with a digital platform, consisting of a web application for clinicians and mobile application for patients. Because it is web-based, clinicians don’t

ether Biomedical was founded in 2018 by Dhruv Agrawal and Faith Jiwakhan, who met in high school. As students, Agrawal and Jiwakhan shared a keen interest in the technological side of medicine and started teaching themselves electronics, programming, and mechanical design. Eventually, Jiwakhan studied medicine and earned a diploma in robotics; Agrawal completed a bachelor’s degree in management, followed by a master’s degree in regulatory affairs.need to download anything on their computer and can access their portal from any computer. Additionally, the system provides traceability, ensuring that multiple offices or clinicians within the same practice can view the history of the device and every change that has been made.

Clinicians can remotely connect with a patient device to make configuration adjustments and monitor device usage. That feature provides outcomes data that can be used to support insurance justifications and improve outcomes, according to Mullen.

“Right now we have a standard adult-size hand,” she says, “but in the fall we will be introducing a smaller version. We’re also launching a more aesthetic hand in April, the Zeus V1-T, which has a more anthropomorphic look.”

The Zeus hand is available exclusively through SPS and Hanger Direct, both of which maintain a stock of demonstration units. Aether representatives attend trade shows and meetings to promote the company. “We have been very fortunate that word-of-mouth about our products is spreading,” Mullen says.

As befits a company founded by engineers, Aether uses such advanced technologies as artificial intelligence, machine learning, IoT, and additive manufacturing to build the Zeus hand. As technology evolves in the O&P space, Mullen is confident that Aether Biomedical will remain at the forefront. “We look at the wide world of technology and see how it can be transferred into upper-limb care,” she says. “We also plan to expand into other areas of rehabilitation because we believe our technology can be used to help spinal cord and brain injury patients, as well as those with musculoskeletal impairment.”

Aether has focused its efforts helping the wounded soldiers of Ukraine, a close neighbor of Poland. The company brings Ukrainian soldiers to Poland and fits them with hands for free or at a greatly reduced cost.

“Our motto is to make bionics accessible to all,” says Mullen. “We want to make a hand where users can enhance their performance and achieve their goals.”

PHOTO CREDITS: AETHER BIOMEDICAL Member Spotlight BY DEBORAH CONN

The Aether Biomedical team

COMPANY:

OWNERS: Dhruv Agrawal and Faith Jiwakhan

Visit the AOPA Career Center

Are you thinking about a career change? Is your company looking to hire? Visit AOPA’s online Career Center! With dedicated pages for job seekers and employers, the Career Center is the perfect place to make O&P career matches.

The Career Center also features a Career Planning Portal to assist job seekers in their searches. Visit today at jobs.aopanet.org !

Don’t Miss Keynote Speaker Kyle Stepp at the AOPA Policy Forum

May 10-11 | Washington Marriott Capitol Hill | Washington, DC

Join forces with other O&P professionals to advocate on behalf of the profession—and your patients! The Policy Forum is your opportunity to learn about the latest legislative and regulatory issues and how they will affect you, your business, and your patients.

You won’t want to miss keynote speaker Kyle Stepp, an O&P advocate and paraathlete. Stepp, who has played a key role in the So New Mexicans Can Move initiative, will share his life experiences and the skills and knowledge gained from his recent advocacy efforts. Building off his keynote, other sessions will provide the knowledge and skills needed to go advocate for the profession and its patients.

Don’t miss this chance to learn advocacy tips, and to educate members of Congress about the

importance of O&P care for patients living with limb loss/difference and limb impairment. Visit the AOPA website for details.

Access the 2023 AOPA Monthly Webinar Series for $790

Stay up to speed on all of the rules and regulations for 2023— join AOPA’s regulatory staff and guest speakers for the 2023 monthly webinar series.

SAVE THE DATE SEPTEMBER 6-9

Mark your 2023 calendar now and start making plans to travel to Indianapolis September 6-9 for the 106th AOPA National Assembly! Visit AOPAassembly.org

Webinars provide relevant content and the opportunity to earn 1.5 continuing education credits each month. They are a great way to promote team building, providing an opportunity for your staff to come together and refresh their skills. One registration provides access for five staff members at your office location. (Contact Kristen Bean at kbean@AOPAnet.org to register more than one person from your facility— maximum of five per facility.)

New this year, and in response to feedback on preferred ways to access the webinars, all 2023 webinars will be available on demand (asynchronous) instead of live. Topics will be announced at the beginning of the month, and the webinars will be automatically delivered to AOPAversity accounts by the end of the month—then remain available. The

popular Clinician’s Corner session will be featured in several webinars.

The full-year series is $790 for AOPA members—a great value at 12 for the price of 10! Nonmembers may purchase the series for $1,999. Individual webinars may be purchased at $79 for AOPA members and $199 for nonmembers.

Register for the series at My AOPA Connection. You also may register for single topics.

Note that AOPA experts and guest speakers will be available to answer questions should they arise after you view the webinar. Contact AOPA’s experts with suggested webinar topics or questions: Email jmcternan@aopanet.org or dbernard@aopanet.org

BILLY Footwear

7112 S. 212th Street

Kent, WA 98032

425-890-8781

billyfootwear.com

Patrick Foster Supplier Startup

Welcome New AOPA Members

Bowman Medical International

14710 Weld County Road 7 Mead, CO 80542 970-652-6420

bowmanmedicalinternational.com

Roderick Bowman Supplier Startup

Complete Prosthetics & Orthotics LLC

130 W. River Heights Drive Meridian, ID 83646-5120

Gunnar Harrison Maughan, CPO Patient-Care Facility

Structure

1155 Canyon Blvd., Ste. 105 Boulder, CO 80302-5195

https://structure.io/ 415-890-5770

Jon Edwards Supplier Startup

The 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.

HAVE A PRODUCT OR SERVICE FOR MARKETPLACE?

Contact Bob Heiman at bob.rhmedia@comcast.net

CROSS™ Knee Hyperextension

Orthosis

CROSS™ Knee Hyperextension is intended for mild to moderate knee hyperextension due to neuromuscular diseases or other injuries. The orthosis can be used alone or together with any Allard AFO when knee hyperextension is present with foot drop. The CROSS knee orthosis has a preflexed anatomical shape to fit leg contours and be comfortably worn with any Allard AFO.

• Hyperextension resistance easily adjusted

• Easy-to-grasp wide cuff for single-handed donning

• “Donning aid” included for users with limited hand dexterity

• YouTube video fitting: https://www.youtube.com/watch?v=9jj6V2Dfbuc

• Available in sizes small, medium, large, and extra large. For more information contact Customer Service at 888-678-6548 or email info@allardusa.com

Children’s Foot Orthotics by Apis

Newly designed children’s foot orthotics feature a semirigid extended heel cup in UCBL style for extra ankle control and support. The orthotic is covered with an antimicrobial fabric top liner for effective moisture and odor control. They come in W width and sizes starting at T4-T13, Y1-Y6. Retail packaging and all sizes are in stock for immediate delivery. For free display samples, call 888-937-2747. Wholesale accounts only.

Coyote QUIK GLUE

Available in 30- and 90-second set times. 50 cc or 220 cc.

• Great for attaching componentry

• Multiple repair uses

• Very quick set with no sag. They ship nonhazardous and are safe with no odor.

For more information, call Coyote at 208-429-0026 or visit www.coyote.us

Dynion

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 wearesp.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.

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 are available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit npdevices.com

Dynion is the newest addition to the Ottobock mechanical knee family and our first mechanical knee with hydraulic default stance. Designed for active individuals (K level 3-4), Dynion is a single-axis, waterproof knee joint with a patented rotary hydraulic. The default stance feature provides stable hydraulic yielding support for active individuals throughout a wide range of daily activities. The sophisticated, adjustable stance release mechanism ensures high flexion resistance is there to provide support when needed. Modern features include an easy-access anterior adjustment panel and waterproof components. Dynion also offers both a bicycle mode and manual lock mode. For more information, visit ottobockus.com

bebionic

The multiarticulating hand you know and love with improved functionality—the bebionic hand! We’ve redesigned some of the most vulnerable and delicate components of the bebionic hand to improve overall durability and reduce service burden. The improved bebionic features a novel automotive coating in pearl white and matte black for a modern and sleek finish. Improved stand-by time to experience function all day long. Field serviceable interchangeable modular fingers for quick repair turn around for user-focused assistance, giving you greater clinical impact and control. For more information, visit ottobockus.com

KinnexTM 2.0

The KinnexTM 2.0 microprocessor ankle is designed for real life, without compromise. Featuring 30 degrees total range of motion available in the first step, heel height accommodation from barefoot up to 2-inch heels, a full-length carbon fiber footplate, and the ability the be fully submersed in water, users can confidently participate in their activities of daily living without worry. Kinnex has a patient app available on iOS and Android to save up to 100 shoes and adjust settings to ensure the most comfort regardless of footwear. Trial Kinnex today to stop compromising with your MPA! For more information, visit proteorusa.com

Tillges Technologies Propulsion® Prepreg Partial Foot Prosthesis

The Propulsion® prepreg Partial Foot Prosthesis is engineered by our clinical orthotic and prosthetic practitioners for our own patients, so we’re positive that our dynamic, ultra lightweight, adjustable, and modular designs using cutting-edge carbon-fiber materials will provide your patients with the stability, balance, and energy they need in every step. Propulsion prostheses are built for professionals, by professionals—gain better control and greater comfort. To learn more, visit TeamTillges.com or call us at 1-855-4TILTEC.

ProComp® Carbon-Infused Polypropylene Composite

Composite Material Science = Improved Fabrication Processing = Enhanced Clinical Performance. ProComp® is produced in a high-pressure laminating process that infuses discontinuous carbon fiber into homopolymer propylene. The patented prepreg composite sheeting is compatible with standard drape-encapsulation or bubble vacuum thermoforming. Finishing techniques are standard. Four standard gauges are available for both orthotic and prosthetic applications. Eligible for double L2755 application in thermoplastic AFOs and appropriate prosthetic addition codes. For more information, visit fabwithprocomp.com. Contact Gary G. Bedard, CO, FAAOP(D), managing principal, Rhode 401 LLC, at 650-773-3730 or email garyb@fabwithprocomp.com

Advertisers Index

The Xtern Line: A Step Up for Foot Drop By Turbomed Orthotics

Turbomed has extended its line of AFOs to include three models: Xtern Classic, Summit, and Frontier. The Xterns will allow running, walking, and even hiking as long and far as you want without discomfort. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees, and provides the user with unparalleled levels of function.

The Xtern Summit is lighter than the Classic, has more dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the shoe!

“I designed this composite to allow you to transition from plastic to composite thermoforming.”

GARY G. BEDARD, CO, FAAOP(D)

A confluence of coding, billing, and policy information, the AOPA Co-OP provides a cooperative space for collaboration among O&P colleagues. This easily accessible, online resource enables your organization to be successful in today’s everchanging healthcare environment.

Resources include:

State-specific insurance policy updates

L Code search capability

Data and evidence resources, and so much more!

Learn

.

Contact Bob Heiman at bob.rhmedia@comcast.net

April 13–15

Georgia Society of Orthotists & Prosthetists Annual Meeting. The Hotel at Avalon, Alpharetta, GA. Visit georgiaop.attendease.com

April 24–27

ISPO World Congress. Guadalajara, Mexico. Visit ispo-congress.com/en

May 1–5

Compliance & Ethics Week. For more information available soon, visit aopanet.org

May 1–31

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

May 5–6

Tennessee Society of Orthotics & Prosthetics Meeting. Nashville. Visit tennsop.org

May 10–11

AOPA Policy Forum. Washington Marriott Capitol Hill, Washington, DC. Visit aopanet.org

May 12

Kentucky Orthotic & Prosthetic Association Meeting. Castle & Key Distillery. Frankfort, KY. Visit kyopa.net

May 17–19

New York Chapter AAOP Annual Meeting. The Rivers Casino & Resort, Schenectady, NY. Visit nysaaop.com

Orthotic & Prosthetic Innovative Technologies Minneapolis. For updates, check our cme@gilletteto be added to conference mailing list.

Nashville Renaissance Hotel and Conference Center. In-Person Meeting. Contact Cathie Pruitt at 901-359-3936, ; or Jane Edwards jledwards88@att.net. For more primecareop.com

June 30

Deadline for Applications To Volunteer for an AOPA Workgroup or Committee. Visit aopanet.org/volunteer or contact Betty Leppin at bleppin@aopanet.org, 571-431-0810.

July 27–29

Alabama Prosthetic & Orthotic Association Meeting. Birmingham, AL. Visit alabamapoa.org

August 24–26

Texas Society of Orthotic & Prosthetic Professionals Meeting. San Antonio. Visit txsop.org.

September 6–9

AOPA National Assembly. Indianapolis. For more information, visit aopanet.org

November 8–10

New Jersey AAOP Annual Meeting. Harran’s Resort, Atlantic City, NJ. Visit njaaop.org

AOPA Monthly Webinar Series— Now On Demand!

Full-year series: AOPA member $790; Nonmember $1,999 Individual webinar: AOPA member $79: Nonmember $199 Register for the series at My AOPA Connection

Share Your Calendar Event

Advertise O&P events for maximum exposure with O&P Almanac Contact Bob Heiman at bob@rhmedia.comcast.net or learn more at bit.ly/23AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 223340711 or emailed to 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.

Advocates Make Inroads

Updates from Arkansas, Illinois, New York, and Oregon

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

Arkansas

Senate Bill (SB) 92, introduced Jan. 23, would set reimbursement for orthotics and prosthetic care under the state Medicaid program to 90% of Medicare. This increase was implemented through regulatory channels by Arkansas Medicaid Jan. 1, but SB 92 would codify the increase into law.

Illinois

Joining a growing list of states focusing on improving access to devices for children, Illinois has introduced So Kids Can Move legislation. In early February, Jim Kaiser, CP, LP, president of the Illinois Society of Orthotists and Prosthetists (ISOP), and other ISOP members

worked with Sen. Ann Gillespie and Rep. Will Guzzardi to introduce SB 2195 and House Bill 3036. These identical companion bills mandate coverage of activity-specific orthoses and prostheses in commercial health plans for enrollees of all ages. The So Kids Can Move team is working with ISOP to assist with legislative advocacy efforts.

New York

The New York legislature introduced three O&P bills early in the 2023 session.

SB 3131 directs the New York Commissioner of Health to conduct a study related to New York Medicaid’s reimbursement rate adequacy and patient access. This bill is identical to SB 7023 and Assembly Bill

(AB) 7892, companion bills that were introduced but failed to pass during the 2022 legislative session.

SB 3468 and AB 3408 require that Medicaid managed care organizations reimburse for orthotic and prosthetic care at no less than 100% of traditional Medicaid reimbursement rates. This bill’s Medicaid “floor” requirement is similar to that of Indiana’s HB 1018, discussed in O&P Almanac’s February and March State By State columns.

AB 4395 mandates that individual, group, and inpatient plans in the state provide coverage for prosthetic devices, including repair and replacement, that are intended for medically necessary rehabilitative and habilitative services as required by the Affordable Care Act’s Essential Health Benefits.

Oregon

SB 797, introduced in late January, implements insurance fairness for orthotic and prosthetic devices for enrollees of all ages in private group and individual health insurance plans in the state. Oregon previously enacted insurance fairness through HB 2517 in 2007; however, that bill was repealed in 2017 due to a sunset clause in Oregon statute. The bill’s sponsors, Sen. Sara Gelser Blouin and Rep. Lisa Reynolds, believe that this noncontroversial bill reinstituting a longstanding policy will likely see little resistance.

State Capitol of Arkansas

• Basic business acumen

• Practical knowledge to apply immediately to your work

• Techniques for developing better business practices

• How to think about improving your company’s returns

AREAS OF LEARNING

To complete the certificate program, you must register and complete one core course and one elective course from each of the four areas of learning within a four-year period

LEARNING CORE ELECTIVES

Healthcare Operations Healthcare Operations for

O&P

MANAGEMENT Increase

knowledge and skills to better manage multiple, individual, and team priorities.

HEALTHCARE SALES AND MARKETING Learn the functions of marketing along with a variety of tools and approaches to personal selling along with the many digital marketing tools available. 5

concepts and perspectives

A dynamic companion for every step.

Designed for motivated patients with higher mobility, the NEW Dynion mechanical knee is an ideal companion for independent, self-determined users who are ready to push their goals to the next level.