August 2015 O&P Almanac by AOPA

2015 AOPA NATIONAL ASSEMBLY UNITES THE BEST MINDS IN O&P P.32 The Magazine for the Orthotics & Prosthetics Profession

AU G U ST 2015

When Is Medicare a Secondary Payor? P. 16

AOPA and COPL Accelerate O&P Research P.20

Using Patient Preferences To Fuel Change

DATA DISRUPTION

HOW THE O&P PROFESSION IS USING BIG DATA AND MORE TO IMPROVE OUTCOMES AND VALIDATE PATIENT CARE P.24

P.36

E! Q U IZ M EARN 2 BUSINESS CE

CREDITS P.18

Late-Breaking News:

Patients & Providers in Serious Peril!

GEN

WWW.AOPANET.ORG

Call to Action on Policy Revision for Lower-Limb Prostheses P.10

YOUR CONNECTION TO

EVERYTHING O&P

R EG American Orthotic & Prosthetic Association

IST

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ION

The premier meeting for orthotic, prosthetic, and pedorthic professionals

IS N

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Register Today! The 98th Annual AOPA National Assembly in conjunction with the Texas Academy Chapter Meeting October 7-10, 2015 The Henry B. Gonzalez Convention Center On the Riverwalk in San Antonio, TX Experience an ideal combination of top-notch education, exhibits, and entertainment at the 98th AOPA National Assembly in San Antonio, Texas. We look forward to seeing you!

Earn over

35 CE Credits For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.

O&P Almanac readers are invited to tour the AOPA National Assembly Exhibit Hall on Saturday, October 10, at the Henry B. Gonzalez Convention Center in San Antonio. You may choose to pre-register online at bit.ly/aopa2015 and use the promocode OPALMANAC (Be sure to select the registration category, Exhibit Hall Only, and then Saturday, Oct. 10) or you may choose to bring the adjacent coupon to the registration desk in San Antonio.

AOPAnet.org

Valid for Admission to the AOPA National Assembly Exhibit Hall Only on Saturday, October 10, 2015 Henry B. Gonzalez Convention Center San Antonio, Texas

Free Admission

$75 Value

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Cannot be combined with any other offer. Valid on Saturday, October 10 only.

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contents

AUG UST 2015 | VOL. 64, NO. 8

COVER STORY

FEATURES

DEPARTMENTS | COLUMNS

24 | The Data Disruption

President’s View....................................... 4

Insights from AOPA President Charles Dankmeyer, Jr., CPO

Effective data management is becoming increasingly important for successful O&P business owners and practitioners. O&P professionals must begin to collect, analyze, interpret, and act on patient data to contribute to the outcomes measurements that will be vital to ensuring future reimbursement. Find out how wearable technologies will contribute to patient data capture, and learn how health-care cost data may impact O&P pricing.

At-a-glance statistics and data

By Christine Umbrell

Transitions in the profession

20 | This Just In

P. 20

Accelerating O&P Research AOPA is pursuing several initiatives to bolster the O&P research pipeline. Working in conjunction with the Center for Orthotic and Prosthetic Learning, AOPA is funding several systemic reviews and pilot grants. The AOPA board also has voted to acquire the 2011-2014 CMS beneficiary claims data to undertake an updated analysis of Medicare O&P expenditures.

32 | 2015 AOPA National Assembly The Best Minds in O&P

Before making any big changes to facility programs and services, find out exactly what it is that your patients may be missing. Follow the example of practitioners who have successfully implemented patient-centered programs—such as preamputation consultations and postsurgery management programs—after seeking patient input via satisfaction surveys, phone calls, and informal office interactions.

How to reach staff

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

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

Research, updates, and industry news

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

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

Mastering the MSP Provisions

Identifying the six provisions that render Medicare a secondary payor

CE Opportunity to earn up to 2 CE credits by taking the online quiz.

CREDITS

Member Spotlight................................ 40 n

P. 32

World-renowned O&P experts will come together in San Antonio to share their expertise on the hottest topics in the industry. Learn why some researchers believe transtibial amputations may provide better outcomes than partial-foot amputations; discover the optimal orthotic protocols for pediatric patients; get takeaways on the optimal fitting of hydraulic ankles; and much more.

36 | Gathering Patient Insights

AOPA Contacts............................................6

BiOM Shriners Hospitals for Children

AOPA News................................................ 43

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 45 Marketplace..............................................46

P. 36

Careers......................................................... 49

Professional opportunities

Calendar..................................................... 50

Upcoming meetings and events

Ad Index........................................................ 51 Ask AOPA................................................... 52 Expert answers to your questions about proof of delivery rules

By Wendy Miller, BOCO, LO, CDME O&P ALMANAC | AUGUST 2015

PRESIDENT’S VIEW

Setting the Record Straight

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

AST SEPTEMBER 28, several O&P colleagues joined me

in attending the Prosthetists Meet Printers Conference on 3D-printed prosthetics, which was sponsored by e-NABLE and held at Johns Hopkins University. e-NABLE is a global group of about 1,500 members who create and design 3D-printed assistive hands for those in need. Since then, a lot of publicity—most of it very misleading—has entered the mainstream press. Several articles have compared the cost of 3D-printed hands, at about $100, to prosthetic hands provided by prosthetists, which they have published as costing $40,000 or more. There have been many groans from our field as we see these claims in the media because, of course, it just isn’t so. The truth is that conventional hand prostheses are available at about $1,500 depending on the technology and functionality. Naturally, the media conveniently leave out the appropriate evaluation, design, assessment, fitting, training, medical documentation, and follow-up provided by a prosthetist—not to mention the lack of FDA approval for the current crop of 3D-produced devices. The 3D-printed hand, in its present stage of development, certainly fills a need for many around the world, especially for children. I, for one, hope these e-NABLE volunteers continue their good work. What I strongly object to is the commercialization of these devices without undergoing the approval process of the Food and Drug Administration (FDA), to which all other prosthetic components are subjected. It is not the volunteer groups like e-NABLE that are the problem; it is the scoundrels who have decided to turn the work of these volunteers into a for-profit company. One example was the Parade magazine article of Oct. 11, 2014, where a Robohand made on a 3D printer was provided by a “hand specialist” at a cost of $2,000 while claiming a traditional prosthesis would have cost $60,000! The obvious sensitivity from our community is the discomfort at being made to look like “robber barons” instead of dedicated providers who restore function and quality of life. My personal view is to applaud this volunteer effort while doing everything possible to correct any misleading comparisons to what traditional prosthetists do. AOPA recently published a policy statement that acknowledges the efforts of volunteers using 3D technology but expresses caution for the absence of approvals for 3D hands as a medical device by the FDA. Commercial distribution of these devices without FDA approval is illegal. The policy, which is available at www.AOPAnet.org/ media, recommends that members encourage media to fact check when comparing costs of 3D devices with traditional prostheses. As the November 2014 O&P Almanac story pointed out, the O&P community has been engaged in 3D printing for years, particularly in producing prototypes of components for devices as part of the research and development process for new devices. One manufacturer noted that one specific new part—which previously took 10 weeks to produce in final form—can now be produced in two weeks; the simplicity of 3D prototypes helps to identify flaws that can be corrected and tested in a matter of minutes instead of days. My guess is that 3D is here to stay as it plays an increasingly important role in what we do for patients. We will need to embrace it, encourage it, and make sure the media gets the facts right when writing the next story. What’s your opinion? Let me know at info@aopanet.org. Charles H. Dankmeyer Jr., CPO AOPA President 4

AUGUST 2015 | O&P ALMANAC

Board of Directors OFFICERS

President Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD President-Elect James Campbell, PhD, CO, FAAOP Becker Orthopedic Appliance Co., Troy, MI Vice President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Immediate Past President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis Inc., Rochester Hills, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Scott Schneider Ottobock, Austin, TX Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

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AOPA CONTACTS

American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

Publisher Thomas F. Fise, JD Editorial Management Content Communicators LLC

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org

MEMBERSHIP & MEETINGS Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

AUGUST 2015 | O&P ALMANAC

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, cumbrell@contentcommunicators.com

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2015 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise with Us! Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options!

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NUMBERS

Wanted: O&P Professionals Many more credentialed practitioners will be needed in 10 years to meet growing demand.

CURRENT STATE OF THE PROFESSION

ANNUAL ATTRITION RATES

YEAR 2025 OUTLOOK

5 PERCENT

Attrition rate for orthotists.

4.5 PERCENT

18,816

Number of credentialed O&P providers (orthotists, prosthetists, pedorthists, fitters, assistants, and technicians) that are needed today.

1.3 TO 1

Attrition rate for pedorthists.

Demand for Providers

Current demand-to-supply ratio of needed O&P providers to available providers.

O&P PROFESSIONALS NEEDED Number of orthotists, prosthetists, pedorthists, assistants, and fitters needed in 10 years due to growing patient population.

<13,000

PRACTITIONERS AVAILABLE

Number of credentialed professionals who will be practicing, according to estimated attrition rates and expected graduation rates.

Predicted Demand for and Supply of O&P Professionals in

2025

Supply of Credentialed Providers Demand-to-Supply Ratio

Orthotists

4,000

2,109

1.9 to 1

Prosthetists

1,305

1,376

0.9 to 1

Prosthetists/Orthotists

1,635

1,401

1.2 to 1

Pedorthists

1,168

1,019

1.1 to 1

Fitters

4,703

5,279

0.9 to 1

Assistants

2,200

752

2.9 to 1

Technicians

5,492

838

6.6 to 1

AUGUST 2015 | O&P ALMANAC

Number of credentialed providers currently practicing.

>20,500

Attrition rate for prosthetists.

4.7 PERCENT

14,905

“As the demand continues to grow over time due to aging of baby boomers and the extended life expectancy of the population, the demand for services will outpace the supply of credentialed providers. With relatively few O&P educational programs currently available, the expected attrition rate will outpace the growth in credentialed supply.” —“Projecting the Adequacy of Workforce Supply To Meet Patient Demand: Analysis of the Orthotics and Prosthetics Profession,” Dobson-DaVanzo Associates/NCOPE

SOURCE: “Projecting the Adequacy of Workforce Supply To Meet Patient Demand: Analysis of the Orthotics and Prosthetics Profession,” Dobson-DaVanzo Associates/NCOPE

Looking ahead to 2025, the overall number of credentialed O&P providers will need to increase approximately 60 percent to meet the growing patient demand, according to a recent study conducted by Dobson-DaVanzo under the direction of the National Commission on Orthotic and Prosthetic Education (NCOPE). In particular, certified orthotists, prosthetists, assistants, and technicians will be needed.

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Happenings LATE BREAKING NEWS

Visit www.AOPAvotes.org for details.

CODING CORNER

Urgent Call to Action: Proposed LCD and Policy Article Threatens O&P Practices Make Your Voice Heard at AOPAvotes.org On July 16, the four durable medical equipment Medicare administrative contractors (DME MACs) released a draft local coverage determination (LCD) and policy article that, when finalized, will govern Medicare coverage of lower-limb prostheses. The draft policy contains significant revisions from the existing lower-limb prosthesis medical policy. On the day the joint proposal was released, AOPA issued an urgent notification to all members alerting them to the policy article and inviting members to share feedback. Already it is clear from O&P professionals that these proposed changes, if adopted in their totality, would almost certainly delay patient access to prosthetic care and reduce the quality of both the prosthetic limbs patients receive and patient outcomes. What’s more, these revisions would fundamentally change

the payment structure in a way that would threaten the viability of many O&P practices already riddled by excessive and unfair recovery audit contractor audits and prepayment audits. In response, AOPA (a) has released its comprehensive summary of the proposed LCD and policy article, accompanied by an executive summary; (b) has developed a comment portal where AOPA members can express their thoughts with respect to how the proposal could be improved; (c) has provided a summary for patients so they may understand how these proposals would impact their care; (d) has convened on August 4 its officers and members of the AOPA Coding and Reimbursement Committee to formulate and prioritize responses to the proposal; and (e) has activated an easy mechanism for AOPA members and patients to provide comments to

the DME MACs on the proposal. AOPA will be coordinating with the O&P Alliance and other stakeholder interests to encourage movement toward the most reasonable possible result from the DME MAC-proposed revisions to the proposed LCD and policy article. The deadline for comments is Aug. 31, 2015. Please visit www.AOPAvotes.org for details and to access letters that practitioners and prosthetic patients can submit on the proposed lower-limb prosthetic policy. Visit www.AOPAnet.org to access a complete copy of the LCD proposal and AOPA’s executive summary and detailed analysis. Those wishing to write directly to the DME MACs should submit comments electronically to the DME MAC medical director no later than close of business on Aug. 31, 2015, at DMAC_Draft_LCD_ Comments@anthem.com.

RESEARCH ROUNDUP

DEPARTME NT OF

FDA Approves Osseo-Anchored Prosthesis The U.S. Food and Drug Administration (FDA) in July authorized the use of the first prosthesis marketed in the United States for transfemoral amputees who are not good candidates for traditional socket prostheses. The FDA approved the use of the osseo-anchored prosthesis for the rehabilitation of amputees (OPRA) device for amputees who do not have enough residual limb to support a conventional artificial limb. The OPRA device—a cylindershaped titanium fixture—can be surgically attached to a patient’s residual limb via two procedures. During the initial surgery, the fixture is implanted into the central canal of the remaining thigh bone. Following a six-month 10

AUGUST 2015 | O&P ALMANAC

waiting period to ensure tissue is growing correctly, a second operation is conducted, during which a rod is implanted that attaches to the fixture from the previous surgery. The patient can then be fit with a prosthesis that is attached directly to the rod, and will continue to be monitored with a training device for six months before being fit with a customized prosthesis. FDA approval came after the results of a two-year-long clinical trial were released. Fifty-one test subjects reported increased prosthetic use and improved mobility, comfort, function, and quality of life. The Swedish-made OPRA device makes use of antiinfection technology called intraosseous

HEALTH & HUMA

N SERV

ICES Public Health

July 16,

2015

Service

Food and Drug Adminis 10903 New tration Hampsh Docume nt Control ire Avenue Silver Spring, Center MD 20993-0– WO66-G609 002

Integrum AB ℅ Mr. Marco Velez-Dura President n M Squar ed 901 King Associates, Incorp Street, Suite orated Alexandria, 101 Virginia 22314 Re: H080004 HUD NUM Osseoancho BER 08-0197 Filed: Octobred Prostheses for the Rehab Amended: er 20, 2008 ilitation January of Ampu 6, 2009; tees (OPR February July 6, 2009; A) Devic 3, 2009; e July 14, March April 15, 2013; July 2009; July 28, 2009;26, 2009; April 27, 29, 2013; Procode: October 6, 2014; June 2, 2014;April 10, 2012; 2009; June 25 2009; PJY January August 22, January 18, 2013; 26, 2015 2014; Octob Dear Mr. Velez-Dura er 3, 2014; n: The Cente r (FDA) has for Devices and Radio comp logical Healt leted its Osseoancho h (CDR red Prosth review of your humanitaria H) of the Food eses for the Rehab and Drug n device The OPRA ilitation Administra of Ampu exemption (HDE and who device is indica tees (OPR ) application tion ted have A) Devic for the OPRA devic rehabilitation for patients who e. proble have e is intend ed for skeletms with, or canno transfemoral ampu t use, tation due ally matur The patien to traum e patients. a conventional t failed to a or cance socket prosth receive benef r esis. The it from a • Recur socket prosth rent skin eses due infections • Pain to proble and ulcera ms such tions in the • A short as: socke stump t contact preve • Volum area e fluctuation nting the use of • Soft socket prosth in the stump tissue scarri esis • Exten ng sive area of skin graftin • Socke t retention g • Restri problems cted mobil due to exces ity. sive persp iration

transcutaneous amputation prosthesis, which is designed to improve mobility while reducing the risk of infection. The OPRA device received a Humanitarian Use Device designation and was reviewed through the Humanitarian Device Exemption pathway. Currently, the FDA has limited its approval to adults who have transfemoral amputations, although the technology may be used in the future with arm, hand, and lower-leg prostheses.

HAPPENINGS

DIABETES DOWNLOAD

Jurisdiction B Announces 97 Percent Denial Rate for LSOs/TLSOs

Diabetes-Related Amputations Reach Record Highs in UK

National Government Services, the Jurisdiction B durable medical equipment Medicare administrative contractor (DME MAC), has released the first-quarter results of its widespread prepayment review of all lumbosacral orthoses (LSOs) and thoracolumbosacral orthoses (TLSOs). Between Jan. 1, 2015, and March 31, 2015, NGS reviewed 424 claims and denied 413 claims; this represents a 97 percent claim denial/error rate. A majority of the denials (131 in total) were a result of the supplier not submitting the appropriate documentation in a timely manner. Some of the other top denial reasons include the following: • A detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary was not submitted. • No pricing, data analysis, and coding verification.

The number of diabetes-related amputations each week in England has reached an all-time high record of 135, according to research released in July by Diabetes UK. The figures were calculated using Public Health England data. The annual number of diabetes-related amputations in England is now more than 7,000, compared to the 6,677 previously. While the amputation rate for major and minor amputations combined in people with diabetes has not changed, there has been a sharp increase in the number of people diagnosed with diabetes in England over the past 20 years. “We have seen some areas making real efforts to improve the poor state of diabetes foot care, but these figures are a stark reminder that there is still so much more to be done,” says Barbara Young, chief executive of Diabetes UK. The organization is calling on the government to do more to tackle the problem of diabetesrelated amputation.

32%

In of the denied claims, the supplier did not submit the appropriate documentation in a timely manner. • No proof of delivery from the supplier. • The detailed written order was not submitted. • No medical records were submitted. Based on these results, the Jurisdiction B DME MAC will continue the widespread prepayment review for LSOs and TLSOs.

DoD Collaboration To Bring Sensorized Prosthetic Arm to More Patients The Department of Defense (DoD) has awarded Deka Innovative Solutions Corp. a 57-month contract valued at almost $7 million. The cost-plus-fixedfee contract calls for Deka to design, develop, manufacture, and deliver The central nervous system receives touch and proprioception information from sensory nerves (yellow) and generates movements by sending signals to muscles via motor nerves (red)

IMAGE: DARPA

sensorized prosthetic arms for use under the Defense Advanced Research Project Agency’s (DARPA’s) Hand Proprioception & Touch Interfaces (HAPTIX) program. Deka also will provide technical support, repair, and maintenance for the prostheses. The Deka arm, which was the first prosthetic arm on the U.S. market to translate muscle signals into action, is designed to perform multiple simultaneous powered movements, controlled by electrical signals. Electrodes send signals to a processor after sensing electrical activity in

muscles near the prosthesis, which are translated into movement. This collaboration will allow HAPTIX to develop new technology to achieve closed-loop control of the Deka arm to provide amputees with the feel and function of natural limbs, according to the DoD. “These efforts will position the government with the required data to seek market approval and deliver the system into the wider patient population,” reports DoD. These studies also will validate prescription criteria and explore other control techniques, with the aim of ensuring the prosthetic arm system “can accommodate the broadest user community possible.” O&P ALMANAC | AUGUST 2015

HAPPENINGS

O&P ADVOCACY

AOPA Member Briefs Legislators on Mitochondrial Disease Dino Scanio, CO, LO, of Shriners Hospitals for Children in Tampa, Florida, visited Capitol Hill in June to advocate for a cure for mitochondrial disease. Scanio was accompanied by his nineyear-old son, Giovanni; both advocated on behalf of Scanio’s four-year-old son, Gianluca, who suffers from the disease. Mitochondrial diseases result from failure of the mitochondria, which are responsible for creating more than 90 percent of the energy needed by the body to sustain life and support growth. When they fail, increasingly less energy is generated within the cell. Cell injury and even cell death follow. If this process is repeated throughout the body, whole systems begin to fail. Symptoms of the disease, which primarily affects children, include loss of motor control, muscle weakness and pain, gastrointestinal disorders and swallowing difficulties, poor growth, cardiac disease, liver disease, diabetes, respiratory complications, seizures, visual/hearing problems, lactic acidosis, and developmental delays. While in Washington, Scanio spoke to his Florida representatives, including Rep. Gus Bilirakis (R-Florida) and staffer Bill Nelson, about the effects of mitochondrial disease and how it has affected his life as an orthotist. Gianluca uses solid high-profile ankle-foot orthoses and is evaluated yearly for bracing needs; he will likely progress into knee-ankle-foot orthoses as the disease advances. “It’s already difficult enough casting your own son for braces, but knowing it will not fix the problem leaves me hollow,” Scanio told legislators. “It will only get worse and hard to maintain successful bracing.” Scanio hopes his advocacy efforts will help spur funding into finding a cure. 12

AUGUST 2015 | O&P ALMANAC

CMS SIGHTINGS

Some Hospitals Choose Discounted Reimbursements In an effort to clear out some of the Medicare payment appeals process, CMS paid out $1.3 billion to more than 1,900 hospitals as of June 1. Many hospitals chose to receive quick, discounted Medicare reimbursements rather than complete the appeals process for claims denials. One year ago, CMS announced it would pay hospitals 68 percent of the value of inpatient claims that are caught in Medicare’s hearings and appeals process. Acute-care and critical-access hospitals had until Oct. 31, 2014, to file paperwork and request the settlements, and they had to agree to drop all appeals. Those hospitals that agreed to the deal were promised checks within 60 days. CMS announced in June that the 1,900 hospitals that accepted reduced payments represented 300,000 claims across all levels of appeals. “CMS believes that this settlement alleviates the administrative burden and litigation risk for all parties willing and eligible to resolve their pending appeals through this method in exchange for timely payment.” While $1.3 billion sounds like a significant amount, AOPA Executive Director Tom Fise, JD, points out that it is a relatively modest portion of the pending

hospital recovery audit contractor (RAC) claims. “The majority of hospitals did not choose to settle their pending RAC claims with CMS at the 68-cents-onthe-dollar terms that were offered. Most hospitals declined, and are pursuing their remedy through the appeals/administrative law judge (ALJ) process,” he says. Late last year, AOPA pushed a proposal that would allow O&P providers to similarly settle appeals, asking CMS to follow the precedent set with the hospital RAC appeals and offer to settle outstanding O&P claims at 87 cents on the dollar, based on the higher success rate of O&P claims. However, AOPA received no response to this proposal. The Medicare O&P Improvement Act of 2015, H.R. 1530, includes a provision that would direct CMS to offer a settlement remedy to Medicare Part B providers such as O&P, similar to the settlement offered by CMS to Part A hospitals but at a higher percentage reimbursement rate. In addition, “there has been significant interest from Chairman Kevin Brady (R-Texas) and his House Ways & Means Subcommittee in incorporating such a Part B settlement option in eventual legislation on RAC, fraud, and ALJ issues,” says Fise.

CMS Preps for ICD-10

With less than two months remaining until the nation switches from diagnosis codes defined by the ninth edition of the International Classification of Diseases (ICD-9) to the 10th edition, ICD-10, CMS and the American Medical Association (AMA) have announced efforts to help physicians prepare for the October 1 deadline. This announcement indicates a shift in the AMA’s recommendation for a delay in implementation to a position of cooperation in preparing for the transition. To learn more about the changes and gain a general understanding of the impact the transition will have on O&P providers, read the Reimbursement Page article in the June 2015 issue of the O&P Almanac, available at on the O&P bookshelf at www.aopanet.org/publications/digital-edition/. Watch for AOPA announcement on ICD-10 conversion service for members only.

HAPPENINGS

MEETING MASHUP

OTWorld Issues Call for Papers OTWorld—International Trade Show and World Congress will be held in Leipzig, Germany, May 3-6, 2016. The meeting is expected to attract prosthetists and orthotists, orthopedic shoemakers, rehabilitation technicians, specialist retailers, engineers, doctors, and physiotherapists from around the globe. The biannual event was last held in 2014 and hosted more than 20,000 visitors from 80 countries. The interdisciplinary OTWorld congress and trade show run concurrently, offering insight into the newest methods of research, product development, and training via professional development sessions led by industry experts.

FOCUS ON PHILANTHROPY

2015 Youth Camp Achieves Record Numbers

A record 115 campers participated in the 2015 Paddy Rossbach More information is available at Youth Camp July 10-15. This http://ot-world.com. Research/practiyear, national sponsors and donors contributed enough cal presentations or descriptions of funds to increase the number of case studies will be accepted on the attendees and extend the length following topics: prosthetics, orthotof the camp by one extra day. ics, foot and shoe/orthopedic shoe The six-day traditional summer technology, rehabilitation, rehabilitation youth camp, designed for children technology, sports/sports medicine, with limb loss or differences, offers and open topics. Abstracts must be a full range of activities, including submitted by September 6 and will fishing, swimming, arts and crafts, be accepted online only, at www. zip-lining, canoeing, sitting volot-world.com/abstractsubmission. leyball, hiking, a high ropes course, dance, archery, and more. Many of the first-time camp participants Amputee Coalition 2015 National Conferencehave never seen another child with limb loss. Because campers are not accompanied by their parents, they often are inspired to take on amputee-coalition.org/2015-national-conference new challenges, be independent, The Amputee Coalition celebrated its test themselves, and build new 29th year at its 2015 National Conference, friendships in a supportive, caring held in Tucson, Arizona, July 23-25. The environment, says Susan Stout, event featured educational seminars, president and chief executive networking, clinics, adaptive sports, peer officer of the Amputee Coalition, group and support group training, and which sponsors the camp. social events designed for individuals with “We sincerely thank our limb loss or limb difference. sponsors and major donors who The theme for the 2015 conference have generously provided us was “Everyone’s a Star.” Highlights with financial and other supincluded a 3D-printing plenary session led by leaders in the industry, 16 port,” says Stout. Sponsors technology sessions, and an exhibit include Hanger Clinic; Freedom hall featuring more than 80 vendors. Innovations; Össur; Ottobock; “While we join together with Ability Dynamics; BiOM Personal old friends and meet new friends, Bionics; College Park Industries; we all continue to learn from each Fillauer; WillowWood; Thorlo; the other—not just for these three days American Board for Certification but throughout the year,” says 2015 in Orthotics, Prosthetics, regional Limb Loss Education Days Education and Conference Advisory and Pedorthics; the Board of (LLEDs) to keep the limb loss Committee Chair and board member Certification/Accreditation; and community engaged and informed. Jack Richmond. “Many of us have so Scheck & Siress. Major donors This year an LLED has already been much to share, while others are just include Cincinnati Dreams JW Marriott Starr Pass Resort & Spa held in Washington, D.C., and two beginning their lives with limb loss.” Thursday, July 23 – Saturday, July 25, 2015 Come True, the Jordan Thomas us at 888/267-5669 or visit amputee-coalition.org for more info. more are scheduled for Columbus, In addition to the National Conference, Contact Foundation, and Lizbeth Thomas. Ohio, and Portland, Oregon. the Amputee Coalition also holds

Tucson Plays Host to Amputee Coalition National Conference

Tucson

Arizona

O&P ALMANAC | AUGUST 2015

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

John “Mo” Kenney, CPO, LPO, FAAOP, was recently named 2015 Hero of the Year by the American Red Cross Bluegrass Chapter. The Heroes Campaign is a community awareness and fundraising initiative that raises John “Mo” Kenney, money for critical Red Cross services and CPO, LPO, FAAOP recognizes those people making a difference in the community. Kenney is an amputee and certified practitioner who works both locally and globally on humanitarian missions, seeing amputees who do not have insurance, financial resources, or access to quality care, resulting in the fabrication of customized prosthetics from used and donated parts. He also partners with Paralympic athletes to offer an Amputee Walking School, designed to improve gait and quality of life for amputees. Brian Mayle, CO, has joined the Ottobock Activity and Sports Medicine Team, filling the role of OTS sales specialist. He will work closely with key clinical customers, create and deliver scientific education, and provide in-depth product knowledge. Lydia Middleton, MBA, CAE, has been appointed executive director of the American Academy of Orthotists and Prosthetists. Middleton, who has more than 20 years of management experience in the nonprofit Lydia Middleton, health-care industry, previously served as MBA, CAE president and chief executive officer of the Association of University Programs in Health Administration from 2004 to 2013. She then served as a consultant, providing leadership, management, and assessment services to the academic and association communities.

AUGUST 2015 | O&P ALMANAC

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The Amputee Coalition has announced that four recipients will receive the Scott Decker, MD, Memorial Scholarship for 2015. These students will each be awarded $1,000 toward their college tuition for the 2015-2016 academic year: Austin Brown of Kennewick, Washington, who will attend Washington State University; Tyson Higel of Clatonia, Nebraska, who attends Northwest Missouri State University; Brickelle Bro of Castle Pines, Colorado, a member of the U.S. Paralympic swim team who will attend Stanford University; and Amy Frank of Cypress, Texas, who will attend Texas A&M. The annual scholarship is eligible to high school seniors, recent high school graduates, adults returning to school, and current college students. Carolina Orthotics and Prosthetics (COP), an affiliate of Wright and Filippis, opened a new office in Orangeburg, South Carolina, which is in close proximity to the Orangeburg Regional Medical Center. Last year, COP also purchased Coastal Orthotics and Prosthetics in Murrells Inlet, South Carolina. The Dralla Foundation has announced the recipients of its 2015 grants, which are intended to assist organizations in funding events and programs to help people with physical challenges have fun. This year’s grant recipients are the Bay Area Outreach & Recreation Program, Colorado Adaptive Sports Foundation, Daring Adventures, Heroes on the Water, Kinetic Kids Inc., Rehabilitation Institute of Chicago, and Telluride Adaptive Sports Program. Events that will be funded range from a day of sailing on Lake Michigan, where participants learn about adaptive sailing and get a chance to steer a boat, to a day of race car training on an Autocross course at Pikes Peak International Speedway in Colorado Springs. Dralla is able to provide grants thanks to generous donations from Rockaway-based company Allard USA, owned by Peter Allard. The funds come from a percentage of every ToeOFF® anklefoot orthosis sold.

PEOPLE & PLACES

Hattingh Inc. dba Prosthetic Care of Virginia has been selected for the 2015 Best of Leesburg Award in the health and medical category. The annual awards program honors the achievements and accomplishments of local businesses throughout the Leesburg, Virginia, area. Recognition is given to those companies that have shown the ability to use their best practices and implement programs to generate competitive advantages and long-term value. The Orthotic & Prosthetic Activities Foundation (OPAF) has begun its annual search for individuals who would like to participate within the O&P community through service on the OPAF Board of Directors. Board members serve a three-year term and are required to attend at least one of the two face-to-face board meetings held in conjunction with the national meetings of AOPA and the American Academy of Orthotists and Prosthetists. Additionally, directors are expected to be vitally involved in the ongoing work of OPAF & First Clinics with adaptive recreation and to take an active role with fundraising efforts. Nominees are needed for at least one and up to three seats on the board of directors, one of whom must be a credentialed practitioner. More information and all nomination materials and instructions can be found at www.opafonline.org/about.

Ottobock recently introduced the first microprocessor knee designed for the K2 population, the Kenevo. Individuals in the K2 population range from new amputees to older individuals who occasionally use a walking aid. Ottobock reports that while traditional mechanical knees are common, “a systematic review of clinical literature shows that use of microprocessor-controlled knees may significantly reduce uncontrolled falls by up to 80 percent.” The new component offers increased support for essential functions such as sitting, standing, walking, and stumble recovery. The technology enables real-time gait and movement monitoring. Scheck & Siress has announced the acquisition of Woodfield Orthotics and Prosthetics, a Chicago-based provider of orthotic and prosthetic care owned by Brett Kramer, CPO. Wright & Filippis has announced the acquisition of Williams Orthotics Services in Flint, Michigan.

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O&P ALMANAC | AUGUST 2015

REIMBURSEMENT PAGE

By DEVON BERNARD

Mastering the MSP Provisions Learn to identify the six provisions that render Medicare a secondary payor

E! QU IZ M EARN

BUSINESS CE

CREDITS P.18

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HEN MEDICARE WAS FIRST

created, it was determined that it would serve as the primary payor for all services provided, except for those services involving workers’ compensation claims. However, this policy changed in the 1980s when Congress fashioned some provisions that made Medicare the secondary payor—but only to certain types of primary plans. This change was intended to transfer the costs from the Medicare program, or Medicare Trust Fund, to other private payors. These provisions, which are found in Section 1862(b) of the Social Security Act, became known as the Medicare Secondary Payor (MSP) provisions. There are six provisions that will always render Medicare to secondary payor status, meaning that the patient’s other insurance must be billed before you may bill Medicare. These provisions cover the following: working-aged individuals, end-stage renal disease (ESRD) beneficiaries, disabled beneficiaries, workers’ compensation claims, liability insurance, and no-fault insurance. This month’s Reimbursement Page examines each of these provisions and offers insight into how each contingency operates—and how it may affect Medicare’s payment status.

Working-Aged Provision

The working-aged individuals provision is the most common of the six provisions that render Medicare to secondary payor status. Under this provision, a person has become entitled to Medicare benefits, based on age, but has not yet retired. For patients to be considered working aged, they must be at least 65 years of age and enrolled in their employer’s group health plan (EGHP); the employer must have at least 20 employees. The EGHP may cover the patient’s spouse, who also would also be considered “working aged” even if retired. For many years, federal law typically defined a “spouse” as “a person of the opposite sex who is a husband or a wife.” Thus, for the purpose of the MSP provisions for the working aged, a domestic partner was not recognized as a spouse. However, as of Jan. 1, 2015, the term “spouse” was expanded to include same-sex partners, as long as the marriage was legally entered into in a U.S. jurisdiction that recognizes the marriage. Also as of Jan. 1, 2015, any time an employer, insurer, thirdparty administrator, group health plan, etc., has a more inclusive definition of spouse, it may assume primary payment PROVISION

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

REIMBURSEMENT PAGE

responsibility for the individual in question; and if the individual is reported as a spouse, Medicare will pay accordingly. The recent U.S. Supreme Court decision in Obergefell v. Hodges legalized same-sex marriages in all states and may alter some aspects of the working-aged provisions; however, at this time nothing has been updated or changed in the Medicare regulations. If a patient has a retirement plan provided by his or her employer and he or she is 65 or older, Medicare is considered the primary payor. If the patient chooses not to be covered by the EGHP and prefers Medicare as his or her primary insurer, he or she cannot receive any benefits from the EGHP.

ESRD Provision

PROVISION

Under the end-stage renal disease provision, if a patient is diagnosed with ESRD, he or she is entitled to receive Medicare benefits even if he or she is under the age of 65. If ESRD is the only reason a patient has Medicare benefits, and he or she is covered by an EGHP, then Medicare will be secondary to the EGHP. The ESRD provision is a little more complicated than some of the other MSP provisions because there are certain situations when Medicare will retain its primary payor status when a patient has ESRD. Medicare will be secondary for ESRD patients for a total of 30 months, which is called the ESRD coordination period. The coordination period begins when the patient first becomes eligible for Medicare benefits. After the coordination period ends, Medicare will become the primary payor. If a patient is under 65 and has Medicare benefits solely because of ESRD, the patient is entitled to all Medicare benefit categories, not just those related to the treatment of the ESRD; however, his or her entitlement to Medicare benefits will expire 12 months after his or her last dialysis treatment or 36 months after a successful kidney treatment. If you have a patient who has Medicare coverage due to ESRD, you should routinely check his or her coverage or status to verify whether Medicare is still a primary payor for that patient.

According to the disability insurance provision, Medicare offers benefits to anyone who has a permanent disability, other than ESRD, regardless of age. If someone is receiving Medicare benefits because of a disability, Medicare will usually be primary. Certain criteria must be met in order for Medicare to become the secondary payor for someone with a disability: The patient must be under 65, receiving Medicare benefits solely because of a disability, and must have other health-care coverage under a large group health plan (LGHP). The coverage from the LGHP may be through the patient’s current employment or the current employment of a family member, such as a parent or spouse. An LGHP is slightly different than an EGHP discussed with the working-aged provision. For a group health plan to be considered an LGHP, there must be at least 100 people employed by the sponsoring company, or, in the case of a plan that covers multiple employers, at least one employer in the group must have at least 100 employees.

Workers’ Comp Provision

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No-Fault and Liability Insurance Provisions

Under the workers’ compensation provision, Medicare is rendered a secondary payor due to a workers’ compensation claim resulting from an injury that occurred on the job. Medicare normally will not make payments on a workers’ compensation claim, but there are times when you may send such a claim to Medicare. If you don’t agree to accept the workers’ compensation payment as your payment in full, and your state allows you to collect your full charge, you may submit the workers’ compensation claim to Medicare for secondary payment. PROVISION

Disability Insurance Provision

PROVISION

The no-fault insurance and liability insurance provisions involve coverage by an insurance company, typically involving some type of accident that does not occur at work. No-fault insurance (personal injury protection or medical expense coverage) covers expenses due to injuries that occurred on the insured’s property, or in the use of the insured’s vehicle, regardless of who is responsible for the accident. O&P ALMANAC | AUGUST 2015

REIMBURSEMENT PAGE

Liability insurance applies when someone is found to be at fault for causing an injury and payment is based on the policyholder’s legal liability for injury. The two most common types of liability insurance are auto and malpractice insurance.

Set-Aside Arrangements and Conditional Payments

What happens when Medicare is not the primary payor, but the primary payor does not or cannot pay you in a timely manner? Under the Medicare MSP provisions, Medicare typically will not pay primary for items when payment has been or is expected to be made. However, with liability insurance, no-fault insurance, and workers’ compensation insurance claims, and to some extent claims involving group health plans, you have the ability to seek a conditional payment. Medicare may make a primary payment when there is evidence that the primary payor will not or cannot pay the claim promptly. This payment is only made on the condition that upon final reimbursement by the primary payor Medicare will recover its payment, typically directly from the payor. Thus, if you believe the primary insurer will not pay a claim in a prompt manner (with “prompt” defined by Medicare as 120 days), you may submit the claim to Medicare for a conditional payment. However, if it is determined that someone else should 18

AUGUST 2015 | O&P ALMANAC

have paid first, or if you eventually receive payment from the primary insurer, you must refund Medicare. Also, keep in mind that you may not seek primary payment from two insurers simultaneously. If you choose to seek a conditional payment from Medicare, you must withdraw any claims you have with the primary insurer and/or drop any liens you may have placed on the beneficiary. In some cases involving workers’ compensation, no-fault insurance, or liability insurance, the claim may involve what is called a “set-aside arrangement.” A set-aside arrangement is “an administrative mechanism used to allocate a portion of a settlement, judgment, or award for future medical and/or future prescription drug expenses.” In situations when a set-aside arrangement has been made, especially with workers’ compensation set-aside arrangements, you may not have the ability to bill Medicare. Medicare may not be billed or make a payment when a set-aside agreement is in place, until you can provide evidence that the money in the set-aside agreement has been exhausted and the money was spent on appropriate medical expenses.

Determining Medicare’s Payment

One of the biggest questions that arises when dealing with the MSP provisions is: What will Medicare pay? The obvious answer is that Medicare

will never pay more than its allowable, so the most Medicare will pay in an MSP claim is its allowable. To determine the exact amount Medicare will pay, you will need to refer to a set of three calculations, and Medicare will pay the lesser of the amounts derived from the three calculations. Under Calculation 1, Medicare determines the amount it would pay if it were the primary, or if it were the only payor. Under Calculation 2, Medicare calculates its liability with regard to the primary insurer’s payment. This calculation is made by subtracting the primary insurer’s payment (what it actually pays) from either the Medicare allowable or the insurer’s allowable (how much it could pay). Under calculation 3, you would subtract your submitted charge minus the payment made by the primary insurer. These calculations can get confusing, but you do not have to determine the calculations on your own. Each of the durable medical equipment Medicare administrative contractor websites has aids or calculators to help you determine Medicare’s liability when Medicare is relegated to secondary payor status. Finally, remember there are resources to help you when dealing with Medicare as a secondary payor. Review the “Medicare Secondary Payor Manual” on the CMS website at www. cms.gov/Regulations-and-Guidance/ Guidance/Manuals/Internet-OnlyManuals-IOMs.html, or contact AOPA for further assistance. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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This Just In

Accelerating O&P Research AOPA funds grants and procures Medicare claims data to drive research efforts

T ITS JUNE MEETING, AOPA’s board of directors aggressively advanced the O&P research agenda under the leadership of AOPA President Charles H. Dankmeyer Jr., CPO, and President-Elect James Campbell, PhD, CO, FAAOP. Both men have been at the forefront of championing a robust research agenda for O&P. In the June issue of the O&P Almanac, Dankmeyer wrote the following in his President’s View column: “Without data and good outcomes, it’s clear we will have a tough, if not impossible, road to survival.” He further elaborated on funding earmarked in January by AOPA’s board for additional research studies. At that time, the board allocated $240,000 to fund systematic literature reviews and cost-effective studies; another $40,000 toward developing a patient registry project; and $60,000 to fund up to four smaller pilot grants up to $15,000 each. Many of these projects have come into being as the Center for Orthotic and Prosthetic Learning (COPL) recently reviewed submissions forwarded in response to official request for proposals. At the June AOPA board meeting, COPL recommended several research awards. Three systematic reviews were awarded for 2015:

AUGUST 2015 | O&P ALMANAC

• “Cost Efficacy of Transtibial Interventions”—$29,930 Jason Highsmith, PT, PhD, CP, FAAOP, University of South Florida • “Established Treatment Guidelines To Determine Postamputation Functional Performance Level and Develop a Prosthetic Candidacy Treatment Algorithm”—$43,947 Jason Kahle, MSMS, CPO, FAAOP, Prosthetic Design and Research • “Evaluating Outcomes of Dysvascular Partial Foot and Transtibial Amputation: A Systematic Review and Development of Shared Decision Making Resources”—$59,005 Michael Dillon, PhD, La Trobe University, Australia Three pilot grants were awarded for 2015: • “Concurrent Validation of the Continuous Scale Physical Functional Performance Test (CS PFP-10) in Transfemoral Amputees”—$15,000 Jason Highsmith, PT, PhD, CP, FAAOP, University of South Florida

This Just In

2014 COPL Research Projects Well Underway LAST FALL, three O&P professionals were awarded grants to conduct O&P research for evidence-based clinical application through the partnership between AOPA and Center for Orthotic and Prosthetic Learning. The researchers who were awarded grants last year have made significant progress and are preparing to present their findings. Here are synopses of their work so far.

• “Does Vacuum-Assisted Socket System Improve Knee Proprioception and Dynamic Balance in Transtibial Amputees?”—$15,000 Fan Gao, PhD, University of Texas Southwestern Medical Center at Dallas • “Transfemoral Interfaces With Vacuum-Assisted Suspension Comparison of Biomechanics Using the CAREn: Ischial Containment Versus Brimless”—$15,000 Jason Kahle, MSMS, CPO, FAAOP, University of South Florida No recommendations were made by COPL for funding cost-effectiveness studies at this point. 22

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“The World Is Not Flat: Justifying Prosthetic Feet With Multiaxial Features Being Used on Uneven Terrain”

Walter Lee Childers, PhD, MSPO, CP This project is being conducted at the Biomechanics and Motor Control Laboratory at Alabama State University in Montgomery. By building a lab area with two parallel walkways (even and uneven, 24 feet in length), researchers were able to collect data on 11 subjects. “We have completed data collection and analysis and we are now writing the manuscripts to publish these results,” says Childers. “We were able to demonstrate feet with the L5986 code (feet incorporating multiaxial features) increase gait stability over uneven terrain, thereby providing evidence to support their use in clinic.” Childers presented initial results on five subjects in February 2015 at the Hanger Education Fair and will offer a more complete presentation at the AOPA National Assembly in October. To round out the near-term research agenda, the board also made commitments to update the 20072010 CMS claims data that resulted in the first cost-effectiveness study conducted by Dobson-DaVanzo, which was the subject of a May 1, 2015, congressional briefing sponsored by AOPA and the Amputee Coalition. The board provided funding to acquire the 2011-2014 CMS beneficiary claims data, which will further enhance the value of an updated analysis of Medicare O&P expenditures using CMS’s own data. The first study showed that timely O&P intervention saves money. Adding to the completeness and credibility of future cost-effectiveness studies was the board’s decision that AOPA seek a data use agreement with

CMS to expand 2007-2014 CMS Part D data so the cost of prescription drugs can be factored into the longerterm costs of care for beneficiaries receiving timely O&P intervention versus those not receiving treatment. As in the earlier study, the updated analysis will track cost differences in two cohorts of patients with the same diagnoses, in which only one cohort receive O&P treatment. The board also voted to provide funding in an amount up to $28,283 for a research project by Kenton Kaufman, PhD, PE, of the Mayo Clinic, titled, “Risk Factors and Costs Associated With Accidental Falls Among Adults With Above-Knee Amputations: A Populations-Based Study (Meta-Analysis of Olmsted County Database for Falls of

This Just In

“Physiologic Range of Step-By-Step Variations in Lower-Limb Prosthesis Forces During Walking”

Goeran Fiedler, PhD, CPO This study investigates the hypothesis that step-by-step variability, when walking with a transtibial prosthesis, is linked to the alignment quality of the prosthesis. “If such a connection could be established, it would become possible to objectively measure alignment quality and thereby provide useful information for the improvement of lower-limb prostheses,” says Fiedler. “Our protocol utilizes a prosthesis-integrated load cell for the collection of gait data, which has big advantages over conventional gait laboratory setups, as we can record multiple consecutive steps on regular flooring. A challenge within this pilot study is to identify the most appropriate gait variable and the most appropriate definition of step-bystep variability for our purposes.” Fiedler’s team has concluded data collection with 12 subjects and has begun to postprocess and evaluate the data. Fiedler presented a report on the preliminary results at the ISPO World Congress in Lyon in June and will present the research at the AOPA National Assembly in October. Amputees, Matched Nonamputees— Frequency and Costs).” The Mayo Clinic also received a grant for preliminary work in advancing an O&P patient registry. This project, which is being pursued in conjunction with an ongoing orthopedic registry, will require strong, longer-term financial support. A unique opportunity arose for AOPA to sponsor the Private Sector O&P Care Panel at the December 2015 Association of Military Surgeons of the U.S. (AMSUS) Conference. In addition to panel participation, the conference may offer the opportunity for important O&P research manuscripts to be submitted to a journal publication arising from the meeting. The AOPA Board of Directors also reaffirmed its commitment to the

“Comparison of Postoperative Care Following Transtibial Amputation”

Dennis E. Clark, CPO Clark and his team have received approval to gather data from qualifying transtibial patients to compare immediate postoperative systems at two hospitals in Iowa, one in Wisconsin, and the Mayo Clinic. They have begun collecting data from the first set of patients and are awaiting motion analysis data. Because several different groups of surgeons hospitals are involved, Clark is confident his team will get a robust cross section of patients from which to compare data.

Prosthetics 2020 imperative that will involve a minimum of $35,000 in AOPA annual support, along with commitments at that same level each from Endolite, Freedom Innovations, Hanger, Össur, and Ottobock; these funds will help defray the expense associated with the recent creation of the Medical Advisory Board (MAB). The MAB met June 11 for its initial meeting, and it is expected that research needs will be identified that will further focus on cost effectiveness and evidence-based outcomes of existing and emerging higher technology prosthetics. (For more information on the June 11 MAB meeting, see the “Prosthetics 2020” sidebar in the “The Data Disruption” article on page 24 of this issue of the O&P Almanac.)

Those research projects will involve further financial outlays for participants, in addition to their annual MAB support commitment. All AOPA members have been invited to be part of this consortium, with an option available that smaller firms may wish to pool their financial resources to share the minimum annual $35,000 support level. There is general acceptance that O&P is behind the curve on needed outcomes and evidence-based research data. While recent board action certainly advances the agenda, there is still a great deal of catchup for O&P to continue as a serious player in the emerging value-based health-care marketplace to ensure optimal patient care and secure equitable reimbursement for that care. O&P ALMANAC | AUGUST 2015

COVER STORY

DATA

DISRUPTION IN THIS SECOND OF A TWO-PART SERIES, DISCOVER HOW THE O&P PROFESSION CAN LEVERAGE DATA TO IMPROVE OUTCOMES AND VALIDATE O&P INTERVENTIONS By CHRISTINE UMBRELL

AUGUST 2015 | O&P ALMANAC

COVER STORY

KEY NOTES: • “Big Data” can be thought of as collections of small data sets that have the potential for interoperability. When matched together, they can provide more information about patients, treatments, outcomes, and preventive health care, and, can answer specific health-related questions. • Smartphones and Internet connectivity are enabling technologies for wearable devices, which capture patient information passively to help practitioners better understand how patients are functioning and the types of devices best suited for their activity level. • Several companies have developed utilization monitors that O&P patients can wear to track cadence, step count, gait symmetry, and accuracy in step direction, among other factors. • As more data becomes available about the pricing of various medical expenses and cost comparisons become more prevalent, pricing for health-care-related items will become more competitive, and one expert predicts that more access to cost data will increase the pressure on price transparency. • To transition the profession toward being more accountable to both payors and patients, AOPA recently launched the Prosthetics 2020 initiative, which will encourage an understanding of the use of advanced O&P componentry and the collection of data to support evidenced-based research.

ROVIDING EXCELLENT PATIENT CARE in 2015 requires more than

treating each individual patient with an appropriate device to improve function. While personalized care is important, effective data management also plays a pivotal role in ensuring optimal treatment and facility success. As more practitioners begin to collect, analyze, interpret, and act on data for specific performance measurements, the O&P profession as a whole will be able to track outcomes and identify which components are best suited for specific patients. Expanded data not only will capture results in improved patient treatment—it also will help build the pool of measurable quality outcomes that payors have come to expect of all health-care fields. A foundation of hard data will give the O&P profession a stronger voice when communicating with payors in justifying the reimbursements necessary for high-quality prostheses and orthoses. But just what types of data are important? How can O&P embrace wearable technologies to increase the amount of patient data available? And what effect will health-care pricing data have on the future costs of orthotic and prosthetic devices? O&P Almanac spoke with several health-care data experts, who shared their thoughts on data collection, smart technologies, and pricing issues.

O&P ALMANAC | AUGUST 2015

COVER STORY

Big Data Defined

AUGUST 2015 | O&P ALMANAC

Greg Mannino, BOCP, a clinician and former competitive athlete, wears a StepWatch.

Michael Lovdal, PhD

Harnessing Data Via Wearable Technology

PHOTO: Douglas McCormack/Modus Health

Many health-care experts believe the advent of Big Data—extremely large data sets from which value can be extracted for micro-analysis or predictive analysis—will change the way health care is delivered over the next several years. Within the general health care realm, Big Data already is being used to help prevent epidemics, cure diseases, improve quality of life, avoid preventable deaths, and boost profits, according to a recent article in Forbes magazine titled “How Big Data Is Changing Health Care.” But what many call “Big Data” can be interpreted as collections of small data sets that have the potential for interoperability, says Chris Boone, PhD, chief executive officer of the Health Data Consortium. More information about patients, treatments, outcomes, and preventive health care will become available “by matching small data sets of high quality with different small data sets of high quality, to answer specific health-related questions,” says Boone. The O&P industry’s recent movement to begin collecting more small data sets of high quality—such as outcomes data—is an important step toward providing concrete evidence of the value of O&P interventions. “The O&P profession has always added value to the health-care system, but unfortunately the lack of formal clinical practice guidelines and clinical data has led to the perception by payors that we are simply using high technology for the sake of using it,” says Sam Liang, president of Hanger Clinic and a member of the Prosthetics 2020 Steering Committee. (Read more about Prosthetics 2020 on page 28.) “Using an ‘outcomes-based medicine’ approach, the collection of outcomes data and its translation into the endpoints that matter to a payor will be vitally important for the survival of the profession. “All other well-reimbursed professions have well-documented clinical practice guidelines or algorithms that clinicians use to treat patients with

diagnosed conditions in a consistent manner with set measurable quality outcomes. These outcomes ultimately reduce the cost of the health-care system. For example, if we can demonstrate that the application of high-technology microprocessor-controlled knees in K3 or even K2 patients reduces falls, keeps them out of the hospital, and saves the health-care system the costs of treating those falls, the payors will be more apt to pay for these claims,” adds Liang. “As we define these endpoints that matter, the long-term implications for O&P are positive as this work will further define how we treat patients more consistently, and what specific patients will best benefit from which technologies,” he says.

Data stemming from patients themselves will revolutionize treatment and outcomes for many health conditions. Smartphones and Internet connectivity are “the enabling foundations for disruptive consumer healthcare technologies,” says Michael Lovdal, PhD, a retired partner at Oliver Wyman with 25 years of experience providing strategic planning and alignment assistance to clients in health care and other fields. Today, three quarters of Americans have household Internet connections, and 90 percent have smartphones or cell phones; with such easy access, “health care will become an information technology business,” he says. Some of the tools that will become more commonplace due to technology include disease monitoring apps, instant heart rate monitors, glucose-tracking devices, and—most relevant to O&P—utilization monitors. “With wearable technologies that are becoming available not just for people but for devices, we can capture patient information in a more passive way,” says Boone. “Wearables give us the ability to use sensor technology to better understand patient responses. They allow us to get a better idea of the quality of life of patients and to learn how much and what types of activities patients are engaging in”—which helps determine the types of devices best suited for individual patients.

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COVER STORY

2020

Prosthetics 2020: O&P Stakeholders Address Data Shortages

Initial efforts will focus on lower-extremity microprocessor prostheses

N A MOVE THAT will transition the

prostheses. To achieve this goal, the O&P industry will need to conduct systemic profession toward being more accountliterature and data reviews with potential able to both payors and patients, AOPA meta analyses. “And if data doesn’t exist, is involved in a number of initiatives that then we will need to generate data via encourage an understanding of the use well-designed clinical studies,” says Sam of advanced O&P componentry and the Liang, president of Hanger Clinic and a collection of data to support evidencedmember of the Prosthetics 2020 Steering based research. Committee. AOPA recently launched the Charles Dankmeyer Jr., CPO “The goal of Prosthetics 2020 is ‘to Prosthetics 2020 initiative, a partnership protect and grow the lower-extremity prosthetic (LEP) open to companies that wish to take a proactive role market through an outcomes-based medicine approach in shaping the drivers of prosthetic patient care durthat demonstrates timely prosthetic services saves lives ing the next five years. As first steps in this initiative, and money,’” says Liang. “We will accomplish this by AOPA appointed a Medical Advisory Board and Steering first defining and establishing the health economic Committee, which held its inaugural meeting at AOPA value of current LEP products and services and, second, Headquarters on June 11. by expanding the value of LEP products and services “The focus of the meeting centered on the need to by defining new patient indications and populations have current lower-extremity microprocessor prosthetic that will benefit from current and new prosthetic devices made available to the amputee population,” says technologies. AOPA President Charles Dankmeyer Jr., CPO. “The “As we work through the Prosthetics 2020 plan, we group discussed how policy from CMS and private insurbelieve the other benefits will be the improvement of the ers has limited the availability future reimbursement landscape for LEP, the definiof current technology that is appropriate for a wide range tion and provision of the appropriate technology to of patients. Prosthetics 2020 the appropriate patients to reduce the current trend of will be working on alternative providing the lowest cost technology to all patients, the methods and more comprehenidentification of new patient segments that can benefit from LEP technology, and the separation of the O&P sive health-care cost data to profession from durable medical equipment in the minds effect policy change and public of payors,” says Liang. perception to allow the use of appropriate technology to all patients for whom it would be beneficial.” One of the goals of Prosthetics 2020 is to drive positive policy and coverage decisions, starting with lowerSam Liang, MBA extremity microprocessor

AUGUST 2015 | O&P ALMANAC

COVER STORY

PHOTO: Douglas McCormack/Modus Health

Several companies have developed utilization monitors that O&P patients can wear—similar to activity monitors but designed specifically for the O&P population—to track cadence, step count, gait symmetry, and accuracy in step direction, among other factors. “These technologies in different forms have been around for a while, but it’s taken some time to get provider buy-in, and also payor buy-in,” says Douglas McCormack, founder and executive chairman of Modus Health. Wearable devices are “an easy mechanism to start to implement outcomes research,” he says. One of these monitors, the StepWatch, which was originally developed specifically for people who use prostheses or have impaired gait, has been adopted by the Department of Veterans Affairs (VA) to collect data from veteran O&P patients. “The StepWatch is a medical-grade, FDAapproved FitBit-type device that gives very good insight on how patients are functioning,” says McCormack. While earlier iterations were used for research purposes, a new version will debut soon, first at the Rehabilitation Institute of Chicago to measure compliance with physical therapy protocols in patients post-stroke, and then at other rehab hospitals. The VA has developed and implemented a program to offer wearables such as the StepWatch to veterans, and “the government is paying for this wearable technology,” says McCormack. The StepWatch measures factors such as cadence variability (to aid in determining functional level), periods of peak performance, and the Modus index (a score of 0 to 100 to compare activity level of the wearer with healthy, able-bodied persons on an age-adjusted basis). The device is designed for use in conjunction with the Modus Trex system that provides metrics, algorithms, and outcome reports to interpret the data collected by the wearables.

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COVER STORY

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AUGUST 2015 | O&P ALMANAC

provide additional data to help clinicians make better decisions. “Patients’ self-report of how they’re doing is often inaccurate. Our goal is to arm clinicians with real-world data on how patients are actually functioning in the real world.”

Data and Health-Care Pricing

In addition to its impact on health-care practitioners and patients, the availability of more data concerning pricing in the medical field is sure to affect costs, sooner rather than later. As more data becomes available about the pricing of various medical expenses and cost comparisons become more prevalent, pricing for health-care-related items become more competitive, says Lovdal. “The transparency revolution has already reshaped other consumer-facing industries—such as hotels and banking—and will do so for health care as well,” he says. Lovdal predicts that more access to cost data will increase the pressure on price transparency. CMS is required to release Medicare payment data, and two states —Massachusetts and North Carolina —have passed price transparency laws, with others planning to implement similar legislation. What’s more, disparities in health-care pricing have captured media attention, says Lovdal —particularly for knee and hip replacement surgeries, where the

More Equitable Health Care

The health-care industry is evolving in both the way patients are being treated and in the way products and services are being priced—and many of these changes are stemming directly from access to data. Going forward, orthotists and prosthetists will need to do their part to collect patient data and share patient outcomes, using new technologies when possible. Doing so will help reduce disparities in treatments and elevate the profession in the eyes of payors, ultimately improving the quality of O&P patient care. Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com. EDITOR’S NOTE: To learn more about other surgical and manufacturing disruptors— BMI, TMR, and 3D printing—and their roles in the future of O&P care, see the July issue of O&P Almanac.

PHOTO: Douglas McCormack/Modus Health

Under the VA program, the VA “will pay practitioners to bring patients back twice a year to evaluate veterans and assess their function, in part by evaluating data collected by the wearables,” explains McCormack. Patients will actually “own” their own data, and will be asked to consent to share that data with third parties to allow for analysis. When patients share data with their clinician, the clinician can produce a detailed report with a number of metrics—which offers a snapshot of how the patient is doing with his or her O&P device. At this time, much remains unknown about how the data from wearable tracking devices will be put to use. “Once there are larger data sets, then it will get more interesting,” says McCormack. Although wearables are clearly making inroads specifically within the veteran application, they are available for nonmilitary patients as well. McCormack notes that his company signed an exclusive distribution agreement with SPS in June to make the Modus Trex StepWatch technology available to all clinicians. For practitioners who are hesitant to delve into wearable technologies, McCormack recommends viewing utilization monitors not as instruments that are taking decision making away from clinicians, but rather as tools that

most expensive procedure was recently found to cost 15 times the cost of the least expensive surgery. Payors and employers are demanding more information about the costs of medical procedures and are arming themselves with data to support reference pricing, says Lovdal. Several employers recently set caps on specific procedures based on data of typical procedural costs. For example, Lovdal notes that a national grocery chain set a reference price of $1,250 for diagnostic colonoscopies, another chain capped prices for certain MRIs and CT scans at $800, and a major financial institution set a reference price of $30,000 for orthopedic joint replacement surgery. O&P providers need to be aware of this trend and understand that patients and payors alike will have access to cost comparisons for orthotic and prosthetic care. Business owners will need to price care competitively to earn the trust of both patients and payors—and to retain business.

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The

Best Minds in O&P O&P subject matter experts unite in San Antonio to share cutting-edge research and advance the knowledge of the profession

TTENDEES OF THE 2015 AOPA National Assembly should plan to

arrive ready to learn from speakers who represent the “best of the best” of the global orthotic and prosthetic profession. The Assembly Planning Committee has scheduled a comprehensive and engaging itinerary of educational sessions on a diverse array of topics, with a focus on current industry trends and developments. Whether you are new to the industry or a seasoned veteran, you will gain valuable information, including research summaries and treatment strategies during your trip this October. Among the high-level industry-specific content planned for the Assembly are several can’t-miss sessions from world-renowned O&P professionals. The following is just a sampling of some of the presentations from every niche of the profession. Be sure to check the AOPA 2015 National Assembly webpage at www.aopanet.org/ education/2015-assembly for schedule updates as they happen.

AUGUST 2015 | O&P ALMANAC

Prevent Diabetic Ulcers

Assembly attendees will hear innovative research insights from Canada during a session titled “Preventing the Preventable in the Global Fight Against Diabetic Foot Ulcers and Amputations,” led by Katia Langton, CPed, DC, who works at the Central Vancouver Island Foot and Ulcer Protection Clinic and specializes in lower-extremity amputation prevention and comprehensive management and treatment of the neuropathic foot. She frequently represents the Canadian Diabetes Association, lecturing and educating patients with high-risk feet due to diabetic neuropathy, and educating policy makers. Langton will share an overview of the burden and impact of the diabetes pandemic and peripheral neuropathy leading to the preventable loss of limbs and lives. “There is a critical need for a paradigm shift in the area of prevention through comprehensive assessments and diabetic foot screenings to prevent foot complications,” she says. “Diabetes, ulcers, and amputations are poised to overwhelm nations and cripple health-care budgets. This disease is skyrocketing globally. A critical paradigm shift in treating the diabetic foot is necessary to prepare for the increasing incidence and severity of the disease and its complications.” Langton also will discuss the importance of funding “preventive care, preventive devices, and devices that will close the ulcers more quickly will reduce overall costs and make health-care sustainable in the future as the disease progresses on a global level.” Plan to attend her session at 11 a.m. on October 8, and learn how you can help alter the mindset to a more preventive outlook for long-term diabetes care.

Center for the Intrepid Practitioners To Share

Expertise at Assembly

SOME OF THE MOST ADVANCED and useful O&P innovations have originated from research undertaken to improve quality of life for U.S. military casualties. Many recent O&P advancements started from the work being conducted at Brooke Army Medical Center’s Center for the Intrepid (CFI), and this year’s Assembly Planning Committee is honored to have CFI’s participation in San Antonio. CFI was conceived in the spring of 2005, when Arnold Fisher and the board of directors of the Intrepid Fallen Heroes proffered a rehabilitation facility. The $50 million, 65,000-square-foot outpatient facility was funded by contributions from more than 600,000 Americans, and opened for patient care in February 2007. CFI provides rehabilitation for U.S. service members who have sustained amputation, burns, or functional limb loss. In addition, the institution provides education to Department of Defense and Department of Veterans Affairs (VA) professionals on cutting-edge rehabilitation modalities, and promotes O&P and related research. State-of-the-art staffing and equipment has been a priority at CFI since its inception. The facility is staffed by active-duty Army medical staff, Department of the Army civilians, contract providers, and nine full-time VA employees. Together they work to maximize the patients’ rehabilitative potential and to facilitate reintegration, whether patients remain on active duty or return to civilian life. CFI features a Computer-Assisted Rehabilitation Environment (CAREN) that provides virtual reality training, as well as a Motion Analysis Lab, which allows specialists to detect gait deviations not discernable to the naked eye. Jason Wilken, PT, PhD, and John R. Fergason, CPO—two prominent CFI researchers who will present at the National Assembly—were instrumental in the development of the CAREN and Motion Analysis labs. Staff at CFI have made great use of the high-tech equipment to develop new techniques and devices to benefit military amputees—and these advances ultimately benefit the civilian population as well. Several staff members will participate in the AOPA National Assembly in San Antonio. Be sure to look for the following CFI representatives in October: • Andrea Ikeda, MS, CP • Robert Kuenzi, MS, CP • Christopher Rábago, PT, PhD • Elizabeth Russell Esposito, PhD

Katia Langton, CPed, DC

• Riley Sheehan, PhD • Jason Wilken, PT, PhD To learn more and access videos on CFI, visit www.bamc.amedd.army.mil/ departments/orthopaedic/cfi/vignettes.asp.

O&P ALMANAC | AUGUST 2015

Get Advice From Military O&P Experts

Louis DeCaro, DPM, FACFAP

Explore Pediatric Treatment Strategies

During a session titled, “Age-Specific Biomechanical Podopedriatric Protocols, Ages 1-18,” Louis DeCaro, DPM, FACFAP, will share his expertise on treating children with orthoses. A podiatric physician who specializes in pediatrics, DeCaro is in private practice in West Hatfield, Massachusetts, and is a member of the surgical and medical staff at Franklin Medical Center as well as Holyoke Medical Center. He is president and fellow of the American College of Foot & Ankle Pediatrics and is a board-certified diplomat of the American Board of Multiple Specialties in Podiatry. He has a special interest in sports medicine and biomechanics for both adults and children, and he shares a patent on foot types. DeCaro has broad experience evaluating and treating the most challenging of biomechanics patients, with extensive exposure in his position as director and originator of the Adult & Pediatric Gait Labs Biomechanics Clinic. The goal of the multidisciplinary clinic is to help patients find answers through orthoses and therapy. Session attendees will advance their knowledge via review of the most common foot and ankle pathologies and the foot types associated with each. Those who attend this session at 11 a.m. on October 9 will gain an advanced understanding of the basic biomechanical principles of the foot and lower extremity as a function of gait in the pediatric population. 34

AUGUST 2015 | O&P ALMANAC

A pair of experts from the Center for the Intrepid (CFI) will team up during a symposium at 2 p.m. on October 9. “Enhancing Your Clinical Practice by Applying a Combined Approach of Evidence and Experience” will be presented by John Fergason, L/CPO, chief prosthetist at the CFI at San Antonio Military Medical Center, and Jason Wilken, PhD, MPT, site senior scientist for the DoD/VA Extremity Trauma and Amputation Center of Excellence, director of the Military Performance Laboratory in the CFI, and director of orthopedic and rehabilitation research at the San Antonio Military Medical Center. Wilken directs an active and diverse research program, including assessment of advanced O&P technologies, development of virtual reality-based environments for the assessment and treatment of cognitive and physical impairments, and outcomes assessment to guide clinical practice. Fergason has developed an expertise in prosthetic care for the multilimb amputee as well as preservation of the severely injured lower limb. “We will highlight the advantages of combining research literature, emerging evidence, and clinical reasoning to guide clinical practice,” says Wilken. “This includes matching patients with the right devices and rehabilitation approaches, implementation of new prosthetic and orthotic technologies, and use of standardized outcomes to better understand and enhance your clinical practice, and support reimbursement.” Be sure to add this leading-edge session to your list of “must-attends” for San Antonio.

Jason Wilken, PhD, MPT

Michael Dillon, PhD, BP&O Hons

Access New Data on Partial Foot Amputations

A session on diabetes-related amputations spearheaded by Australian O&P expert Michael Dillon, PhD, BP&O Hons, is expected to be a highlight of this year’s Assembly. Dillon, immediate past president of ISPO-Australia, is a senior lecturer at La Trobe University and an honorary research fellow at Royal Melbourne Hospital, and is renowned for his research addressing partial foot amputation and the influence of O&P intervention. Dillon’s early work tested theories suggesting that orthoses and prostheses are able to restore lost foot length and thereby normalize gait. More recently, his research has focused on the outcomes of partial foot amputation, with a view to inform difficult decisions about lower-limb amputation. Dillon has contributed to the work of the Australian Orthotic and Prosthetic Association and will travel to Texas to present his recent research, which challenges long-held beliefs that partial foot amputation results in better outcomes compared to more proximal amputation. “Emerging research suggests that quality of life, energy expenditure, and gait are very similar in people with partial foot and transtibial amputation,” says Dillon. “Given this emerging evidence, it is increasingly difficult to justify a partial foot amputation on the basis of these purported benefits, particularly given the disproportionally high rates of complications and reamputations that affect between 30 and 50 percent of people with an initial partial foot amputation.”

Be sure to take part in this important session, titled “Comparison of Quality of Life in People With Partial Foot or Transtibial Amputation,” on October 9, at 3:30 p.m., and find out how Dillon’s findings will alter how you assist patients in making difficult amputation decisions.

Jon Schull

Compare Hydraulic Ankles

After seven years and 30,000 fittings of hydraulic ankles, Saeed Zahedi, OBE, FREng, PhD, is an expert on the topic, and he plans to share his knowledge with National Assembly attendees. Zahedi, who serves as technical director at Endolite in the United Kingdom, has studied the benefits of ground compliance in reducing interface pressure at the socket; reducing risk of falls due to toe clearance and enhancing confidence and comfort; equal loading of both limbs; improvements on posture and balance in standing; and evidence of the devices’ medical necessity. Zahedi has spent the past 35 years working in O&P and has held positions in academia, government, and industry. His focus has been to meet the “unmet needs of amputee and orthotic users and stakeholders through innovations,” he says. For more than two decades, Zahedi has been a member of an ISO working group responsible for developing standards for safety of O&P products and a regulatory roadmap for future autonomous devices. He has been working toward “integrating products and services to meet the challenges of the future in a growing global market,” and is currently translating his experiences into the long-term care of elderly for independent living. Zahedi will impart his words of wisdom during his presentation, “Review of Prosthetic Hydraulic

Ankles—Clinical Evidence, Benefits, and Research up to 2015.” This session also is slotted for 3:30 p.m. on October 9.

Learn More About 3D Printing

You’ve probably read about e-NABLE— an online philanthropic community that designs, customizes, and fabricates open-sourced 3D-printed hands—and its efforts to distribute the devices to individuals without access to prostheses. But now you can hear from the organization’s leader just how the organization works—and how e-NABLE is partnering with certified prosthetists in some of its undertakings. Jon Schull, a research scientist at the Rochester Institute of Technology and the founder of e-NABLE, will speak at 8 a.m. on October 10, during his presentation, “The Brave New World of 3D-Printed Devices: Challenges and Opportunities.”

“The e-NABLE community is developing and distributing radically inexpensive devices for children and adults for whom standard upper-limb prosthetics are often out of reach,” says Schull. “I will discuss the evolution of this movement and the prospects of future collaboration, synergy, and disruption.” Schull will present with Jeff Erenstone, CPO, who serves on the Medical Matching Advisory Board for e-NABLE. Together they will explain how the organization has consulted with prosthetists and is seeking to create “new options for medical professionals as well as for amputees,” says Schull. Plan to participate in this session to learn more about the future of 3D-printing technology.

Ready, Set, Learn

This year’s all-star lineup of speakers at the AOPA National Assembly will cover the full spectrum of O&P educational topics. These presentations offer just a glimpse of the diverse sessions that will take place October 7-9 in San Antonio. Access the Assembly Preliminary Program to learn more about the educational, networking, and expo hall opportunities that will be available. Visit www.aopanet.org for more information.

Saeed Zahedi, OBE, FREng, PhD

O&P ALMANAC | AUGUST 2015

GATHERING Patient Insights Arm yourself with data about patient preferences before launching new services and programs By WENDY MILLER, BOCO, LO, CDME

N INTEGRATIVE TEAM APPROACH to patient treat-

NEED TO KNOW Successful O&P professionals are tuned in to their patients’ concerns and look for areas of improvement at their facilities. Many practitioners seek feedback via satisfaction surveys, verbal interactions with patients, and follow-up phone calls. BOC spoke with several certified practitioners who have introduced new or revamped services to find out how they have identified areas for improvement and followed through with the changes required to enhance patient care. Examples of programs that have been implemented at O&P facilities to increase patient satisfaction include preamputation consultation appointments, postsurgery amputee management programs, expanded appointment hours, and improved shipping services.

ment, healing, and recovery is becoming increasingly important. Such an approach requires collaboration and open lines of communication with patients, their support networks, and other health-care professionals included in the patients’ recovery plans. To learn more about this trend, staff from the Board of Certification/Accreditation (BOC) interviewed some of our certificants who manage O&P practices and asked them to provide examples of patient-care improvements they have made in response to observations, comments, patient surveys, and other patient resources. We asked these professionals how they remedied situations needing improvement and implemented positive changes. Practitioners who took the time to gather patient feedback and act on that data identified effective solutions—demonstrating the importance of communication in developing strategies to enhance the patient-care experience in the facility, before surgery, and postsurgery.

Improving Patient Services

Beth Davis, CMF 36

AUGUST 2015 | O&P ALMANAC

Beth Davis, CMF, manages Just Like You, a postmastectomy boutique in West Monroe, Louisiana. Davis implemented several patientcare improvements after reading comments on patient satisfaction surveys, which visitors are routinely asked to complete. Davis describes her facility’s patient satisfaction

near a coffee station and a fireplace, survey as a “living document” that is which is lit in winter months. “We find frequently updated to assess patient that when our patients come in with perspectives on the boutique’s current their spouses, they are much more business practices. relaxed when they feel their husbands In 2012, the boutique instituted are comfortable and not rushing them “summer hours,” opening an hour to move along,” says Davis. earlier and staying open until 5 p.m., three days per week. The new 7 a.m. start time received so much positive Implementing Early feedback on the patient satisfaction Intervention Processes surveys that Davis made a permanent Jeff Zeller, BOCO, BOCP, of Spectrum change; the facility now opens at Prosthetics & Orthotics in Redding, California, also has implemented 7 a.m. year-round. Not only did this changes stemming from patient feedchange better fit the needs of busy patients in scheduling more appointback. Zeller discovered that patients and prospective patients who are faced ments before work and school; it also with the difficult choice of whether was beneficial to the facility and its to amputate or continue limb salvage employees. Operating expenses were require extra support during their reduced when Just Like You moved decision-making process. He now from a four-day workweek of 7.5 hours offers “preamputation consultations” per day to a three-day workweek of as an early intervention resource. 10 hours per day, and employees have As a below-knee amputee of 35 eliminated a day of commuting. years, Zeller used his personal experi Davis also seeks patient feedback during follow-up calls, and recently ence to implement the preamputation made a change in shipping proceconsultations for his own patients. During his own journey, dures after hearing some he discovered a disconnecnegative feedback. During postmastectomy followtion between health-care up calls, Davis discovered providers, and it was a that several patients had conversation with another received damaged packamputee that helped him decide to discontinue limb ages—or had not received salvage of his lower leg, their shipments. Despite “That visit gave me the repeated requests for peace and understanding the shipping contractor Jeff Zeller, to make the life-changing to deliver packages only BOCO, BOCP decision,” Zeller shares. He after obtaining signatures is able to empathize with his patients to confirm receipt, Davis ended up and help them to set realistic expectaswitching her shipping business to a more reliable carrier with a stricter tions and life goals. delivery policy—and patient satisfac Zeller has established a healthy relationship and rapport with local tion greatly improved. orthopedic surgeons, which has Davis has found that even small resulted in a collaboration between patient interactions are opportunities Spectrum Prosthetics & Orthotics for improving patient service. After and surgeons to provide patients hearing a patient’s husband comment with preamputation consultations on the lack of reading material geared and an integrative patient experitoward men in the waiting area, staff at Just Like You took steps to rectify the ence. The consultations allow the situation with a creative solution: They facility’s practitioners to distribute created a “men’s corner” within the educational material, show patients waiting room. This area features two examples of prosthetic devices, and comfortable arm chairs and a basket explain the recovery process. They’re of magazines such as Field & Stream also an opportunity to discuss the and Reader’s Digest. The area is located pros and cons of continuing to work at

salvaging the limb versus amputation. Consultations can be valuable tools for setting expectations, says Zeller. “The preamputation consultation gets patients prepared for the journey. For example, it can help them understand how the residual limb may swell postamputation and what the suture line might look like,” he says. Communication is key, and Spectrum Prosthetics & Orthotics’ consultative and integrative approach is continually evolving. “We spend as much time as needed up front to educate the new amputee, and we’re constantly looking for more efficient and effective ways to refine this process through written word, technology, and visual presentations,” says Zeller. Because amputation surgery impacts the lives of people in the patient’s life—including caregivers, friends, spouses, and other family members—the consultation is open to anyone the patient chooses to include. Zeller has noted an increase in patient satisfaction and improved recoveries when the preamputation consultation is part of the formula. Patients who are well educated on the amputation process and have realistic expectations often experience better skin management, less pain, and shorter rehabilitation times. “Compliance with new lifestyle changes is higher when patients are invested in their own future as a new amputee,” Zeller says. O&P ALMANAC | AUGUST 2015

STEPS

To Bettering Your Facility

Implementing programs to improve patient experiences can be daunting, but you can take several steps to ease the process and find ways to change your facility to the benefit of your patients:

Start by gathering information from your patients. This can be accomplished with the help of surveys, focus groups, comment cards, phone calls, and similar tools.

Evaluate the information you collect, identify the most common themes, prioritize your objectives, and develop plans to improve on the areas identified.

Consider an integrative approach to patient care that involves other professionals and the patient’s support network.

Implement the improvements, and test them before rolling them out to your patients.

Advise your patients of program changes through your conversations with them, press releases, email communications, social media posts, and printed brochures.

Reinforce your message of continuous improvement by inviting future comments and suggestions and keeping lines of communication open with your patients. Advise your staff to listen for consistent themes in comments and complaints.

AUGUST 2015 | O&P ALMANAC

Acting on Informal Feedback

A collaborative/integrative care theme also is evident in an example provided by Robert Huddler, BOCP, PT, DPT, of Advantage Prosthetics & Orthotics in Pikesville, Maryland, where staff recently identified a need to optimize the postsurgical journey for patients. After consistently hearing comments from patients about feeling “lost” and “disconnected” from their vascular surgeons following amputation surgeries, Huddler Robert Huddler, developed the BOCP, PT, DPT Comprehensive Amputee Management Program (CAMP) in 2014 to facilitate the patient’s transition between surgery and returning to activities of daily living. Designed with a holistic approach, CAMP addresses aspects of the amputation experience that often are overlooked and establishes continuity of care and an integrative approach. As soon as a patient is accepted into the program, a “CAMP counselor” case manager is assigned to educate the patient and oversee numerous aspects of the postsurgical experience, including wound care, nutrition, rehabilitation, nursing, and psychological counseling. A home visit helps the counselor understand the environment the patient will need to navigate on a daily basis. After that visit, the counselor makes recommendations for improving recovery and life at home, emphasizing the value of exercise and good nutrition since improving health habits is proven to enhance healing, mobility, and quality of life. Throughout the CAMP experience, the surgeon receives weekly progress reports that provide updates on the patient’s postsurgical healing and adjustment. “Surgeons are personally invested in their patients, and they like to know the end result,” Huddler explains. Any complications

with the recovery can be noted in the report, and the surgeon can swiftly re-engage if needed. Fun, “campy” elements, such as campfire parties and s’mores, add some needed levity to the serious business of recovery. Since the implementation of CAMP one year ago, more than 50 patients ranging in age from 20 to 95 have embraced the program, and every hospital in the Baltimore area has sent referrals to Advantage Prosthetics & Orthotics. A new development in the facility’s integrative care approach is its partnership with the Amputee Walking Institute, an outpatient rehab facility that assists amputees with prostheses. Huddler is passionate about the program and the positive ways he can assist a patient with the amputation process. “We’re helping patients deal with a very

Orthotics office and in local hospitals. The facility also is making a video documenting the CAMP process, which will soon be available as an educational tool for promoting the details and benefits of the program.

Continuous Improvement

traumatic event in their lives,” he says. Every patient is different, but Huddler recognizes that many of their concerns are similar, and his promise to them is inspirational. He often says, “This [your prosthesis] is your badge of honor, and you will wear it proudly.” CAMP brochures create awareness about the program and are made available in the Advantage Prosthetics &

Ferrier Coupler Options!

The improvements Davis, Zeller, and Huddler implemented are greatly benefitting their patients and their support networks. Anyone can follow the lead of these practitioners in seeking patient feedback and refining services and programs to meet the specific needs of a patient population. Wendy Miller, BOCO, LO, CDME, is chief credentialing officer at the Board of Certification/Accreditation, headquartered in Owings Mills, Maryland.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.

Model A5

Model F5

Model P5

The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

Model FA5

Model FF5

Model FP5

NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.

Model T5

NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.

NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.

The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.

O&P ALMANAC | AUGUST 2015

MEMBER SPOTLIGHT

BiOM

By DEBORAH CONN

High-Power O&P Massachusetts manufacturer got its high-tech start from DoD research and development

AUGUST 2015 | O&P ALMANAC

BiOM’s advanced prosthesis was originally developed for recovering military amputees.

COMPANY: BiOM OWNER: Privately held LOCATION: Bedford, Massachusetts HISTORY: 8 years

BiOM has about 50 employees, primarily located at the company’s 16,000-square-foot headquarters in Bedford, Massachusetts, which holds engineering, manufacturing, testing, marketing, and administrative functions. A direct sales force covers the United States, while distributors handle the product in Canada and Europe. Carignan says BiOM will have a presence in nine countries, in addition to the United States, by the end of 2015. Staff prosthetists at BiOM offer continuing education courses to providers, which include a practical component in which clinicians must tune and fit the device on patients. Practitioners can take the course on site or through a webinar, but the fitting is hands on. “We ask them to come in with two patients, ideally with two different types or levels of amputation,” explains Carignan. BiOM also offers clinical education courses for nurse case managers who work with payors, helping them determine which patients are good candidates for the device. These classes are offered around the country at least monthly, with as many as 100 attendees at each session. “We often partner with a local O&P provider who can talk about

PHOTOS: BiOM

iOM (formerly known as iWalk), maker of an advanced powered ankle-foot prosthesis, was founded in 2007 by Hugh Herr, principal investigator of the Massachusetts Institute of Technology’s Biomechatronics Group and himself a double amputee. Herr’s early research was funded by the Department of Defense and the Department of Veterans Affairs in an effort to aid injured military personnel returning from wars in Iraq and Afghanistan. “Many of these soldiers had multiple amputations and at different levels,” says BiOM Chief Executive Officer Charles Carignan. “They needed more than conventional prosthetics could offer at that time.” Herr developed the BiOM ankle system, which offers power assist to replace lost muscle function during the walking stance phase, as well as programmable stiffness modulation. As a result, says Carignan, amputees have a more normal gait, with less joint stress, faster walking speeds, and lower energy consumption. Private investors joined government funders in 2007, and that venture capital turned the powered prosthesis into a commercial product and created a privately held company, then known as iWalk. In 2013 the company decided to change its name to that of its product: BiOM. “Our understanding from members of Congress is that BiOM is the first—and so far, the only—commercialized product from those DoD efforts,” says Carignan. “Today, more than 1,000 people are using it.”

the broader continuum of care for the patient, while we focus on the device,” says Carignan. “It’s been great because case managers are able to better understand the role of the prosthetist in the process, and they can advocate for appropriate patients with payors.” BiOM is continually refining the prosthesis and is launching its sixth generation of software this summer. The software includes a tuning application that works with a Bluetooth-enabled tablet. The company also has launched a new smartphone app. The app will enable users to track battery usage and select different operating modes, such as quiet mode or power boost. The app will track fitness parameters, such as number of steps, and help users set daily and cumulative goals, according to Carignan. “Eventually we will be able to create communities where similar patients can compare their performance and progress,” he says. “It will also enable payors to track fitness data for outcomes measurements and help wellness nurses see how patients are doing to help control diabetes and peripheral artery diseases. There’s a lot of valuable data that can come out in the app.” Initially, the app will be available only on Android devices, but will expand to Apple products within the next six months. In addition to the BiOM anklefoot prosthesis, the company is developing a powered orthotic device, now being tested at the Center for the Intrepid in San Antonio. “We continue to learn from and are inspired by our patients,” says Carignan. “And as our products evolve, we want to make sure that we meet the needs of prosthetists while also ensuring that our products make sense economically.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

Have you Heard the News That Mobility Saves?

A major new study has proven that prosthetic and orthotic care saves money for payers and improves lives for patients.

The Study A major new study shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. The study was commissioned by the Amputee Coalition and conducted by Dr. Allen Dobson, health economist and former director of the Office of Research at CMS. The study used Medicare data to compare patients with similar conditions who received prosthetics with patients who needed but did not receive prosthetics, over an 18 month period.

The Results

EXHIBIT 4.9 Lower Extremity Prostheses Cumulative Medicare Episode Payment by Cohort (18 Month Episodes from 2008-2010)

Lower Limb Prosthetics

•

The prosthetic patients could experience better quality of life and increased independence compared to patients who did not receive the prosthesis at essentially no additional cost to Medicare or to the patient.

100000

Study Group Average Cumulative Medicare Payments

•

The slope of the cumulative cost curve indicates that had the period of evaluation been longer the break-even would have been reached.

To learn more about the campaign, visit

80000

40000

20000

www.MobilitySaves.org.

Comparison Group

60000

9 10 11 12 13 14 15 16 17 18

Months from Index (Receipt of O&P)

Video and add your own experiences like Queen’s story!

Make Sure the Insurance Companies and Health Care Providers Know This Too! Get Involved and Submit Your Testimony to the Public Relations Campaign Spreading the Word.

Upload your 1-3 minute video or write your story about how your prosthetic has improved your life, like helping you get back to work, take care of your family, rejoin the community, etc. Upload your testimony at bit.ly/yourmobility or scan the QR code on left.

MEMBER SPOTLIGHT

Shriners Hospitals for Children

Pediatric Proficiency Shriners rolls out regional O&P programs with state-of-the-art equipment and fabrication

N THE EARLY 1900s, members

AUGUST 2015 | O&P ALMANAC

Dan Munoz, CO, works with a young patient.

FACILITY: Shriners Hospitals for Children OWNERS: Shriners International LOCATIONS: United States, Canada, and Mexico HISTORY: 93 years

Technician Michael Johnson, LO, CTO

Prior to 2009, Shriners Hospitals offered all care at no charge to patients or families. Since then, in response to rising health-care costs, hospitals have billed the insurance companies of covered patients. If a patient has no insurance, services are provided regardless of the ability to pay. Shriners began to bill insurers for O&P services in a few locations beginning in 2012. “The important thing in our mission and vision has always been to provide care and services, including orthotics and prosthetics, regardless of the families’ ability to pay,” says Joanne Kanas, PT, CPO, who is corporate director of Shriners Hospitals’ new regional program of pediatric orthotic and prosthetic services, or POPS. The POPS program calls for the creation of five regional POPS LLCs owned and operated by Shriners Hospitals for Children as limited liability corporations. “The mission and vison of POPS parallels the mission and vision of Shriners Hospitals for Children,” says Kanas. “POPS has staff in its home office, in Tampa, Florida, who are highly specialized in compliance, contracting, and billing of orthotics and prosthetics,”

she says. “The POPS locations will provide state-of-the-art orthotic and prosthetic care for children with congenital limb loss, amputations, cerebral palsy, spina bifida, spinal cord injuries, burns, and other orthopedic needs, including acute fractures.” Each POPS LLC will have one designated regional central fabrication facility to handle most custom fabrication, using the latest in computer-aided design and fabrication technology. “We are putting scanners, carvers, and software in every lab,” Kanas notes. “We are not removing O&P labs from the hospitals; they will continue to be staffed with clinicians and technicians. But the different locations will use their central fabrication facility whenever possible for efficiency and standardization.” All of the POPS will use the same O&P business management software, again to standardize operations. “It’s been great to implement these cutting-edge tools to understand data and outcomes,” Kanas adds. Now that Shriners Hospitals is obtaining some revenue for services, it is able to offset the cost of such technology and can provide more high-end O&P devices to those who need them. And the model already has shown results. For example, the Spokane location used to outsource many services to local providers. Today, the hospital can offer patients the option of on-site full-time O&P care, through POPS. “The whole goal of this rollout program is to improve compliance, standardization, efficiency, and growth,” Kanas says. “It is a big change for Shriners Hospitals for Children. And we want to establish the largest pediatric O&P practice in the country.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Shriners Hospitals for Children

of the Shriners fraternal organization, which was established in 1872, wanted to establish their own official charity. The group, which had more than 50,000 members, had contributed to survivors of the 1906 San Francisco earthquake and to European war victims, but felt it was time to create its own philanthropy that would gain the support and involvement of members. With urging from a fraternal leader who learned of the unmet orthopedic needs of children during a visit to Atlanta’s Scottish Rite Hospital for Crippled Children, the organization eventually decided to fund not just one children’s orthopedic hospital, but an entire network throughout North America. The first Shriners Hospital for Children opened in 1922 in Shreveport, Louisiana. Today, Shriners International supports 22 pediatric specialty care hospitals: 20 in the United States, and one each in Canada and Mexico. Shriners Hospitals for Children began with an exclusive focus on orthopedics in response to a polio epidemic sweeping across the country at the time, as well as providing orthotic and prosthetic services. Today, while the majority of Shriners Hospitals continue to provide expert pediatric orthopedic care, specific hospitals within the system also focus on burn injuries and related scarring, spinal cord injuries, and cleft lip and palate treatments. The hospitals largely serve outpatients, but most have inpatient beds as well. None have emergency rooms, and, with the exception of burn care, most cases involve elective procedures.

By DEBORAH CONN

AOPA NEWS

Join the Coding Experts in Las Vegas November 9-10 8th Annual AOPA

WINE TASTING

& AUCTION

Attend the Wine Auction in San Antonio—

The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of both O&P practitioners and O&P billing staff. The seminar will feature hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Join your colleagues November 9-10 in Las Vegas.

Top 10 Reasons To Go to Vegas: 1. Get Your claims paid. 2. Increase your company’s bottom line. 3. Stay up to date on Medicare billing. 4. Code complex devices. 5. Earn 14 CE credits. 6. Learn about audit updates. 7. Overturn denials. 8. Submit your specific questions ahead of time. 9. Advance your career. 10. Benefit from more than 70 years of combined experience from AOPA coding and billing experts. Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more at bit.ly/2015billing.

Support AOPA’s Government Relations Outreach

Thursday, October 8, 6:30-8 p.m. AOPA will be hosting the 8th Annual Wine Tasting & Auction during AOPA’s 2015 National Assembly in San Antonio, Texas. Plan to attend this can’t-miss event on Thursday, October 8, at 6:30 p.m. This popular event provides attendees with a unique opportunity to mingle, network, learn about, and taste a variety of wines. Most importantly, your attendance will help raise awareness of and funds for AOPA’s Government Relations outreach programs. Let’s keep the tradition of success alive and make the 8th Annual Wine Tasting & Auction the best ever. • Bid on a wide variety of items—previous events have featured wine, jewelry, cigars, vacations, and more. • Sample wines from an array of wineries and enjoy an open bar. • Enjoy camaraderie with a wide spectrum of O&P professionals. • Support an important cause! Register for the Wine Auction when you register for the Assembly. If you have already registered and wish to attend, contact rgleeson@AOPAnet.org to add your registration.

O&P ALMANAC | AUGUST 2015

AOPA NEWS

Have You Read the O&P Almanac’s Leadership Series?

Stay in the Know— Subscribe to AOPA’s Take!

Find out what senior-level O&P professionals have to say about the most critical issues facing the O&P profession. Several 2015 issues of the O&P Almanac have featured a new Leadership Series, showcasing Q&As with O&P experts on targeted topics of importance to the profession. Visit www.aopanet.org/publications/digital-edition/ to access past issues of the magazine and read what executives have shared, in their own words, on these important topics:

AOPA has designed AOPA’s Take, a new blog to keep you informed with important issues and real-time news that arise within the O&P world. This is a more immediate avenue to find the latest updates. AOPA’s Take is available at no charge to all members of the O&P community, and subscribing is simple. Go to www.aopastake.org and click on the subscribe button. Fill out a few fields, and you’re in! Welcome to AOPA’s Take…..Where you go when you need to know!

TURF WARS Has “poaching” by noncertified O&P practitioners had an adverse effect on O&P businesses or patients in general? Rick Riley; Cindy Henderson, BOCO; Charles Kuffel, MSM, CPO, FAAOP; and Tom Padilla, CPO, give their opinions. March 2015 O&P Almanac, page 34 FINDING YOUR NICHE What are the advantages and challenges associated with running a “niche” O&P facility? Jonathan Naft, CPO; Megan McCarthy, CO; Dennis Clark, CPO; and Jon Bengtsson offer up their experiences. April 2015 O&P Almanac, page 36 HOSPITALS—WHAT’S THE HYPE? Find out why it’s important to build relationships with hospitals and institutional networks now. Andrew Meyers, CPO; Jim Kingsley; and Rebecca Hast detail their success strategies. June 2015 O&P Almanac, page 34 TECHNOLOGY SMARTS Why and how should you integrate new technologies into your practice? David Boone, PhD, MPH; Jan Saunders, CPO; and Stephen Blatchford share their insights. July 2015 O&P Almanac, page 36

AUGUST 2015 | O&P ALMANAC

Learn how AOPA can help you

transform your business into a world-class provider of O&P Services with: Coding, Billing, and Audit Resources Education, Networking, and CE Opportunities Advocacy Research and Publications Business Discounts

Membership has its benefits:

BUILD A

Better BUSINESS WITH AOPA

Visit www.AOPAnet.org/join today!

AOPA NEWS

Sign Up for the Next AOPA Webinar AOPA’s monthly webinar series is the regulatory and business education that you can count on. No one in the O&P profession knows the ins and outs of Medicare, coding, billing, or Veterans Administration contracting like AOPA. Sign up for all 2015 webinars for only $990 for members, which includes two free webinars. If you missed one, we will send you the recording. The monthly webinars are a great way to bring your staff together for lunchtime learning by AOPA experts. Don’t miss any of the important topics in the webinars planned for the rest of the year.

August 12

Off the Shelf Versus Custom Fit: The True Story

September 9

Prior Authorization, How Does It Work?

October 14

Understanding the LSO/TLSO Policy

November 11

Make a Good Impression: Marketing Yourself to Referrals

December 9

Bringing in the New Year: New Codes and Changes for 2016

WELCOME NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publiwww.AOPAnet.org cation, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Advanced Prosthetic Services Inc. 2930 E. Moore Avenue Searcy, AR 72143 501/368-0868 Category: Patient-Care Facility Beth Durham

Anodyne 5050 S. 2nd Street Milwaukee, WI 53207 844/637-4637 Category: Supplier Level 1 Brian O’Reilly, CPed

Is Your Facility Celebrating a Special Milestone? O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@contentcommunicators.com.

Certified Orthotics & Prosthetics 2950 N. Palm Aire Drive, Ste. 307 Pompano Beach, FL 33069 954/970-1718 Category: Patient-Care Facility David Edwards, CPO, FAAOP DiaFoot 3281 Fairlane Farms Road, Ste. 7 Wellington, FL 33414 561/721-7063 Category: Affiliate Parent Company: Orthotic & Prosthetic Group of America (OPGA) MakStride Prosthetics 3970 S. 1540 East St. George, UT 84790 661/325-3338 Category: Supplier Level 1

Pinnacle Prosthetic Labs 11800 Prices Distillery Road Damascus, MD 20872 301/633-9230 Category: Supplier Level 1 Jackie Thomas PRIDE Rehabilitative Solutions 9546 River Road Marcy, NY 13403 315/733-0765 Category: Patient-Care Facility Nick Denroche, BOCP, CFo Surgi-Care Inc. 71 1st Avenue Waltham, MA 02451 781/290-1807 Category: Patient-Care Facility Steve Pica

O&P ALMANAC | AUGUST 2015

MARKETPLACE

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

ALPS Thinner Seamless Suspension Sleeve Formulated with the ALPS GripGel, the new SFB seamless suspension sleeve provides superior comfort with a single-piece construction. The SFB sleeve features a new black-knitted fabric that allows the user excellent freedom of knee flexion. This new sleeve seals with the skin without restricting circulation, while the GripGel sticks to the patient’s skin without causing shear forces. With a thinner profile of 2 mm, the SFB is an ideal choice for those concerned about bulk. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Ave., North St. Petersburg, FL 33714.

Amfit: CAD/CAM The best advertising? Happy patients. Send patient satisfaction soaring without sacrificing control over the orthotic design or the outcomes. 3D Digital Contact Casting (Contact Digitizer) and Amfit design software (Correct and Confirm) are powerful patient treatment tools. Save time and money with Amfit lab services, a full fabrication system, or the combination that fits your business best. • 30 years specializing in custom foot orthotics • 3D digital casting and fabrication systems • Laser scanning and fabrication systems • Casting and orthotic “design only” options • Financing available. Talk with us today about the best options for your business now and into the future.

New Sure Stance Knee by DAW This ultralight, true-variable cadence, multiaxis knee is the world’s first four-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

DawSkin New Mega Stretch DawSkin New MegaStretch is the most durable tear-free skin in the world. It is the ideal skin for your patient to shower on both legs (definitely the safer way). DawSkin MegaStretch provides the vertical ankle stretch required for multiaxis feet and energy restitution feet. “Heat-shrink” skins limit the ankle movement and will tear. DawSkin New EZ-Access dons on and off just like a sock yet provides all of the benefits of the DawSkin New MegaStretch. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the ground-reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

AUGUST 2015 | O&P ALMANAC

MARKETPLACE College Park: Introducing the OdysseyK2 Hydraulic Foot Hydraulic feet can provide K2 patients with an incredible range of controlled motion as well as assist in force absorption, enhance knee stability, and promote good posture. It also gives the patient the ability to maintain foot flat with a fluid transition from sit to stand, for a comfortable, natural look. The new OdysseyK2 foot from College Park has a patented curved hydraulic ankle, Intelliweave™ composite foot base, and customizable dual StrideControl™. This revolutionary foot provides a superior range of motion in a lightweight and low-profile design for an unbeatable combination of K2 patient benefits. See it in action at youtube.com/CollegeParkInd.

Fit, Finish, and Roll ... With the New Freedom DynAdapt™ The Freedom DynAdapt Foot is a slim-profile, carbon-fiber foot system with a slender, anatomic design for easy fit and finish. Its multiaxial function provides maximum comfort, and the uninterrupted strands of carbon fiber in the full-length heel provide patients with effortless rollover and a more natural gait. The new EnduraCore™ Technology composite laminate delivers up to three times the fatigue life of a standard laminate in a design that also returns more energy. The result is a highly durable product that preserves users’ energy so they can do more with confidence. Learn more about the Freedom DynAdapt Foot at Freedom Innovations LLC by calling 888/818-6777 or visiting www.freedom-innovations.com.

Maximum Shock ValueWith the New Freedom Agilix™ The Freedom Agilix is a multiaxial, shock-absorbing, flexible foot system designed to manage loading impacts, reduce socket shear forces, and improve comfort while walking on nearly any terrain. The ultra-lightweight design offers low-impact K3 ambulators shockingly comfortable performance at a value like no other. Learn more about the Agilix at Freedom Innovations LLC by calling 888/818-6777 or visiting www.freedom-innovations.com.

Dynamic Chopart Gait Stabilizer This unique ankle-foot orthosis (AFO) has been designed for Chopart amputees who wish to remain active. Often a traditional full-length AFO for this patient will be stiff, feeling unnatural. Using a hinged ankle and flexible foot plate with a segmented dynamic filler allows flexion before providing a “stop” that protects the residuum and prevents shoe vamp collapse. The PTB design and the anterior shell redistribute groundreaction forces up the lower extremity. For more information, contact at 800/301-8275 or visit www.hersco.com.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, contact at 800/301-8275 or visit www.hersco.com.

O&P ALMANAC | AUGUST 2015

MARKETPLACE

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

Ottobock’s New 3R106 Pro Polycentric Pneumatic Knee The key element of the new 3R106 Pro is the servo-pneumatic control unit. Its powerful dual-chamber pneumatic unit with progressive damping has a flexion valve set for the patient’s normal walking speed. At faster walking speeds, the flexion resistance increases, which prevents too much knee flexion. This helps provide more consistent swing phase even during fast walking. With three options for the proximal connection (pyramid, threaded connector, and lamination anchor) and a 275-lb weight limit, the 3R106 Pro offers you great fitting options. For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.

Ottobock: AxonSkin Silicone Glove for Michelangelo As the very first prosthetic silicone glove for the Michelangelo Hand, the AxonSkin silicone glove offers a more natural look and feel. The silicone is stain resistant and easy to clean. It does not show any change or reduced functionality in lower temperatures for more secure and reliable function. The glove’s interior features a CVD inside for better donning/ doffing and interaction with the Michelangelo Hand. Ask your sales rep about the AxonSkin silicone glove for Michelangelo at 800/328-4058.

2015 AOPA Coding Products

Get your facility up to speed, fast, on all of the O&P HCPCS code changes with an array of 2015 AOPA coding products. Ensure each member of your staff has a 2015 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers. • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers. • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers. • Illustrated Guide: $185 AOPA members, $425 nonmembers. • Quick Coder: $30 AOPA members, $80 nonmembers. Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

Ottobock: 28U90 Ankle-Foot Orthosis The 28U90 ankle-foot orthosis from Ottobock blocks foot drop during swing phase. Its thin-walled polypropylene construction has been optimized for increased resilience, providing effective support in an incredibly lightweight orthosis. The long sole provides precise foot guidance and good pressure distribution. New calf pads and closure straps are included and ensure a high level of wearer comfort. These can be adapted without additional tools. Ask your sales rep at 800/328-4058 about how the 28U90 can help your patients.

AUGUST 2015 | O&P ALMANAC

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

CAREERS Opportunities for O&P Professionals

Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board

Pacific

Member Nonmember $80 $140

For more opportunities, visit: http://jobs.aopanet.org. Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Southeast Certified Prosthetist-Orthotist

Johnson City, Tennessee Well-established multioffice ABC-certified O&P company is looking for certified individual with excellent orthotic and prosthetic skills to provide comprehensive treatment of patients. Excel offers competitive salary and bonus opportunity with full benefits package. Salary to be determined on experience. Send résumé to:

Email: sethwalters@excel-prosthetics.com

Orange County, Riverside County, and San Bernardino County, California Here we grow again: A reputable, well-established, multioffice, Southern California O&P company is looking for energetic and motivated individuals who possess strong clinical skills and experience to provide comprehensive patient assessments to determine patient needs, formulate and provide treatments, perform necessary protocols to ultimately deliver the best orthotic/prosthetic services, and provide follow-up patient care. Candidates must have excellent communication, patient-care, and interpersonal interaction skills, and always abide by the Canons of Ethical Conduct instilled by ABC. We offer competitive salaries and benefits. Salary is commensurate with experience. Local candidate preferred. Send résumé to:

Attention: Human Resources Inland Artificial Limb & Brace, Inc. Fax: 951/734-1538

Northeast Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Watertown, New York A well-established, multioffice practice has immediate openings for residents and ABC-certified CPOs/ CPs/ COs. Candidates must be motivated individuals who possess a strong clinical presence, technical experience, the ability to document all aspects of patient contact, and the desire to improve the quality of life for those who require our services. Northern Orthopedic Laboratory is based in Watertown, New York, located on the outskirts of scenic Lake Ontario and St. Lawrence River. We offer a competitive salary (commensurate with experience), medical, dental, vision, 401K, and profit sharing. Send résumé to:

Northern Orthopedic Laboratory Inc. 1012 Washington Street Watertown, NY 13601 Office: 315/782-9098 Email: nolcpo@aol.com www.northernorthopediclaboratory.com

O&P ALMANAC | AUGUST 2015

CALENDAR

2015

September 10-11

Orthomerica Wound & Limb Salvage Seminar, Orlando. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Orlando. Tuition is $495; each attendee receives two free OWLS products (a $750 value). For more information, visit www. orthomerica.com/education or call Isora Purvis at 877/737-8444.

August 12

Off the Shelf vs. Custom Fit: Webinar Conference The True Story. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

September 14-19

August 13-14

Orthomerica Wound & Limb Salvage Seminar, Chicago. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Schaumburg, IL. Tuition is $495; each attendee receives two free OWLS products (a $750 value). For more information, visit www.orthomerica.com/education or call Isora Purvis at 877/737-8444.

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

September 25-26

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Airport Plaza Hotel, New York. Contact Jon Shreter at 800/946-9170, ext. 108, or email jshreter@pomac.com.

September 1

ABC: Application Deadline for Certification Exams. Applications must be received by Sept. 1, 2015, for individuals seeking to take the December Practitioner CPM exams and November Written and Written Simulation certification exams. For more information, call 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

September 9

October 1-3

Prior Authorization, How Does It Work? Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

2015 NC-SC Annual Meeting. The Ballantyne, Charlotte, NC. More information online at www. ncaaop.com/joinrenew-membership. For exhibitors and sponsorship opportunities, contact Jennifer Ingraham, jingraham@spsco.com or 800/767-7776, x1173, or contact Skyland Prosthetics at 828/684-1644.

Year-Round Testing

Online Training

BOC Examinations. BOC has year-round testing for all of its exams and no application deadlines. Candidates can apply and test when ready and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

Cascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free ABC-approved online courses, designed for pediatric practitioners. Visit www.cascadedafo.com or call 800/848-7332.

www.bocusa.org

Calendar Rates Let us share your upcoming event! Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www. AOPAnet.org for content deadlines.

AUGUST 2015 | O&P ALMANAC

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

CREDITS

BONUS! Listings will be placed free of charge on the â&#x20AC;&#x153;Attend O&P Eventsâ&#x20AC;? section of www.AOPAnet.org.

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less 26-50 51+

$40

$50

1/4 page Ad

$482

$678

$50

$60

1/2 page Ad

$634

$830

$2.25/word $5.00/word

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations.

CALENDAR

Motion Control

SUPERCOURSE FALL 2015

October 7-10

AUGUST 19-22, 2015 Motion Control

98th AOPA National Assembly. The Henry B. Gonzalez Convention Center, San Antonio. More information at bit.ly/2015assembly. For exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/4310852, or koneill@AOPAnet.org. General inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

Fillauer Headquarters, Chattanooga, TN

SUPERCOURSE FALL 2015

• Latest MC components, • In-depth training of Utah AUGUST 19-22, 2015with i-limb, integrating Arm 3+ / Hybrid Arm / bebionic, and others ProPlusFillauer TDs andHeadquarters, Wrist Chattanooga, TN • Hands-on training with • In-depth training of Utah UI software Arm 3+ / Hybrid Arm / ProPlus TDs and Wrist • Casting/fitting/socket design • Hands-on training with for SD/FQ, T-H, T-R levels; UI software patient subjects provided

October 14

Understanding the LSO/TLSO Policy. Register online at bit.ly/ aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

• Convenient Wednesday • Latest MCschedule components, Saturday integrating with i-limb, bebionic, and others Plus training in the NEW

(Force Wednesday Limiting Auto•F.L.A.G. Convenient Grasp) featureschedule for ETD & Hand Saturday Plus training in the NEW

The 4-day SuperCourse fee is(Force $1,350.00 • Casting/fitting/socket design F.L.A.G. Limiting Auto for SD/FQ,CEUs: T-H, T-R levels; 28 (estimated) ABC/BOC Grasp) feature for ETD & Hand patient subjects provided

November 4-6

NJAAOP. The New Jersey Chapter of AAOP presents the 21st Annual Continuing Education Seminar. Harrah’s Atlantic City, NJ. For more information contact Lisa Lindenberg at 973/6092263, or email director@njaaop.org, or visit www.njaaop.com.

For more information or to register for 4-day SuperCourse fee is $1,350.00 theThe SuperCourse, email: info@UtahArm.com CEUs: 28 (estimated) ABC/BOC

November 6

COPA & UCSF: Orthotic and Prosthetic Innovation & Technology Symposium. Driving the Future of O&P—Connecting Innovators and Investors. Millberry Union Event & Meeting Center, University of California—San Francisco. Register at www.californiaoandp.com/Education. For more information, contact 415/206-8813, or email erin.simon@ucsf.edu.

For more information or to register for the SuperCourse, email: info@UtahArm.com 115 N. Wright Brothers Dr. • Salt Lake City, UT 84116 Phone: 801.326.3434 • Fax: 801.978.0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com

115 N. Wright Brothers Dr. • Salt Lake City, UT 84116 Phone: 801.326.3434 • Fax: 801.978.0848 O&P Almanac Calendar SuperCourse Fall 2015.indd 1• www.UtahArm.com 5/13/15 TollAd Free: 888.MYO.ARMS

November 9-10

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. The Flamingo, Las Vegas. December 9 O&P Almanac Calendar Ad SuperCourse Fall 2015.indd 1 5/13/15 Register online at bit.ly/2015billing. For more information, contact Bringing in the New Year: New Codes Webinar Conference Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. and Changes for 2016. Register online

November 11

How To Make a Good Impression: Marketing Yourself to Your Referrals. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

1:27 PM

at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Webinar Conference

ADVERTISERS INDEX Company

Page Phone

ALPS South LLC Amfit Arizona AFO Inc. Cascade Dafo College Park Industries DAW Industries Ferrier Coupler Inc. Flo-Tech O&P Systems Inc. Freedom Innovations Hersco Ottobock

5 19 27 21 9 1, 31 39 29 7 2 C4

Website

800/574-5426 www.easyliner.com 800/356-3668 www.amfit.com 877/780-8382 www.arizonaafo.com 800/848-7332 www.cascadedafo.com 800/728-7950 www.college-park.com 800/252-2828 www.daw-usa.com 810/688-4292 www.ferrier.coupler.com 800/356-8324 www.1800flo-tech.com 888/818-6777 www.freedom-innovations.com 800/301-8275 www.hersco.com 800/328-4058 www.professionals.ottobockus.com

O&P ALMANAC | AUGUST 2015

ASK AOPA

Burden of Proof Interpreting the changes to Medicare’s proof of delivery rules

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

With the recent joint announcement by the durable medical equipment Medicare administrative contractors (DME MACs) publicizing the change in listing items on a proof of delivery (POD), is it a requirement that we must now include the serial numbers for the items we are providing?

Yes and no. The joint DME MAC announcement states that you must provide a detailed description of the item(s) being provided, but it does not say that you must include the serial numbers. The announcement indicated that the best way, or the “preferred method,” to provide a detailed description of the item(s) being provided is to use: • Brand name and model number, or • Brand name and serial number, or • Manufacturer name and part number. This means that if you provide the brand name and model number of the item being delivered, the serial numbers are not required.

AUGUST 2015 | O&P ALMANAC

Can we still include the L codes on the proof of delivery?

Yes, you may still include the list of L codes on your proof of delivery. However, the L codes and their descriptors are not sufficient by themselves to provide a detailed description of the item being delivered.

Is it acceptable for our facility to date the proof of delivery form, or must the patient be the one to enter the date?

The date on the proof of delivery must be the date the patient receives the item or the date of service. The date of service/delivery date does not have to be entered by the patient when he or she signs the proof of delivery. The delivery date is not required to be personally entered by the patient; the date of delivery may be entered by the patient, or the patient’s designee, or by you and your facility. However, if you have entered the delivery date on your proof of delivery form and the patient signs and dates the form as well, then the date entered by the patient becomes your date of service, even if it is different than the date you entered.

The Source for Orthotic & Prosthetic Coding

The O&P expertise you’ve come to rely on is now available 24 hours a day. Match products to L codes and manufacturers—anywhere you connect to the Internet. This exclusive service is only available for AOPA members.

Here is what AOPA members are saying:

“LCode Search.com is my go to resource for quick and accurate coding advice.” “It’s one convenient location for codes and fees, so it saves me time and money.” “Coding for common devices is at my fingertips.”

Get Connected! Need to renew your membership? Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org. www.AOPAnet.org

Supplier Members: For information on listing your products, contact Devon Bernard at 571/431-0876, x254, or by email at dbernard@AOPAnet.org.

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www.professionals.ottobockus.com | www.professionals.ottobock.ca Ottobock Lower Limb Prosthetics

Ottobock USA

@OttobockUS