The Magazine for the Orthotics & Prosthetics Profession
AU G U ST 2017
Get Better Results During Claims Submissions P.16
Applying Triple Aim Principles to O&P P.32
Foot-Care Strategies for the Future P.44
Payments During Skilled Nursing Facility Stays P.68
Celebration of the
CENTURY EVERYTHING YOU NEED TO KNOW ABOUT NEXT MONTH'S AOPA WORLD CONGRESS AND CENTENNIAL CELEBRATION P.22
E! QU IZ M EARN
2
BUSINESS CE
CREDITS
WWW.AOPANET.ORG
P.18
This Just In: Recipients of 2017-2018 COPL Research Grants Announced P.20
YOUR CONNECTION TO
EVERYTHING O&P
AOPA Celebrates
Health Care Compliance & Ethics Week November 5-11, 2017
Why Should you Participate? • Demonstrate your company’s commitment to ethical business practices. • Create awareness of the Code of Conduct, relevant laws, and regulations. • Provide your staff with recognition for training completion, compliance, and ethics successes. • Reinforcement—of the culture of compliance for which your organization strives.
AOPA has developed tools and resources to assist you. Learn more about our products, special webinars, compliance tip of the day, how to win prizes and more at bit.ly/aopaethics.
www.AOPAnet.org
contents
AUG UST 2017 | VOL. 66, NO. 8
COVER STORY
FEATURES
32 | The Power of Three Many O&P businesses are already implementing strategies that align with the Triple Aim approach to providing care, which focuses on improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. But to fully embrace the concept, facilities will need to step up their efforts to increase patient satisfaction and quality of care, and contribute to clinical outcomes studies. By Christine Umbrell
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AUGUST 2017 | O&P ALMANAC
22 | Celebration of the Century The global O&P community will commemorate AOPA’s 100-year anniversary during the World Congress in Las Vegas next month. From historical displays to social gatherings and photo opportunities, the event will celebrate the history of AOPA as well as the entire O&P profession. International education and exhibits will position attendees to succeed in their businesses and begin making a history of their own. By Lia K. Dangelico
20 | This Just In Funding the Future O&P clinicians and researchers are stepping up their efforts to conduct cost-effectiveness and comparative effectiveness studies and related research, answering the call for more scientific data to validate the efficacy of O&P intervention. Find out which prosthetic and orthotic grant proposals were recently awarded funding from AOPA.
contents
SPECIAL SECTION
DEPARTMENTS
AOPA’S 100 ANNIVERSARY TH
Views From AOPA Leadership......... 4 Insights from AOPA Board Member David A. Boone, PhD, MPH
AND WORLD CONGRESS PREVIEW
AOPA Contacts.......................................... 6 How to reach staff
40 | Then & Now
Numbers......................................................... 8
Revisiting 100 years of National Assemblies
Happenings............................................... 10
At-a-glance statistics and data
Research, updates, and industry news
44 | Bridge to the Future Strategies for keeping diabetes patients mobile
46 | The Global Professional Meet a Canadian pedorthist
P.10 People & Places........................................14 Transitions in the profession
COLUMNS
AOPA News...............................................54
Reimbursement Page.......................... 16
Tips for Preventing DME MAC Denials
Member Spotlight................................ 50 n
Five ways to improve your chances of reimbursement
n
Tom Watson’s Prosthetics and Orthotics Lab The Bremer Group Co.
AOPA meetings, announcements, member benefits, and more
Welcome New Members ..................58 PAC Update ..............................................59 Marketplace............................................. 60
CE Opportunity to earn up to two CE credits by taking the online quiz.
CREDITS
Calendar..................................................... 64 Upcoming meetings and events
Ad Index...................................................... 67 Ask AOPA.................................................. 68 Payments during inpatient stays, PDAC approvals, and more P.16
P.50
O&P ALMANAC | AUGUST 2017
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VIEWS FROM AOPA LEADERSHIP
Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.
The RAND Study
B
EFORE LONG, THE HOTTEST TOPIC in O&P will be the most ambitious
research contribution ever sponsored by AOPA: “The RAND Study” for short. With every new challenge on reimbursement or treatment policy, there is a demand from all sides for “data” supporting our positions as a profession. The publication of this cost-effectiveness study will mark a seminal moment in the availability of impactful data we have at hand to support the best care options for our patients. The RAND Corp. is a nonprofit, nonpartisan research institution respected for decades of key contributions to inform public policy debates. By enlisting RAND to evaluate cost effectiveness in the O&P realm, AOPA is putting down a marker that will not only answer specific questions about the cost effectiveness of technology utilization, but also provide an O&P-specific basis for a generation of researchers and health economists to build upon. RAND will publish its results independently in the coming months after its extremely careful evaluation and editing process. In general terms, the RAND study follows rigorous, well-accepted methods for formal health-care cost-effectiveness analysis. This is a complex analytical endeavor, but the results are not too difficult to interpret. For a specific “event pathway” for treatment and outcomes, probabilities of results are calculated and summed up, as are the associated costs. The primary measure used to convey the end result of the analysis is called an “incremental cost-effectiveness ratio.” The incremental cost-effectiveness ratio equals the difference (increment) in cost divided by the difference (increment) in effectiveness or outcome between alternative treatments. The outcome is just as important as cost. If you have better outcomes, this improves the cost-effectiveness ratio just as much as decreasing cost would. The cheapest option is not necessarily the best option. A scientific study seeks to answer carefully specified questions, and we must be careful not to generalize beyond the data we have. For example, in the current study, RAND can only draw firm conclusions where there is sufficient published peer-reviewed data already available. The continued collection and publication of high-quality data about our patient populations, alternative treatments, and outcomes is essential. The O&P field as a whole must recognize that in addition to the intrinsic value of demonstrating individual patient outcomes in our daily practice, collective sharing of data regarding treatments and outcomes will lead to the solid analyses necessary for protecting and improving the care we provide. New multisite and national data acquisition activities will be needed, and AOPA is working actively on how it might facilitate this vital and ongoing imperative. David A. Boone, PhD, MPH, is a member of AOPA’s Board of Directors.
Board of Directors OFFICERS President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL President-Elect Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Vice President Chris Nolan, LPO Ottobock North America, Austin, TX Immediate Past President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Edmonds, WA Traci Dralle, CFm Fillauer Companies Inc., Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Townsend Design, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX
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AUGUST 2017 | O&P ALMANAC
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PROFESSIONAL LIABILITY | GENERAL LIABILITY | PROPERTY
| AUTO | UMBRELLA | WORKERS COMP & MORE
AOPA CONTACTS
American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org
Editorial Management Content Communicators LLC
Our Mission Statement The mission of the American Orthotic & Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation, and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.
Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.
EXECUTIVE OFFICES
REIMBURSEMENT SERVICES
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org
Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org SPECIAL PROJECTS Ashlie White, MA, manager of projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org
Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org
Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com
Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org
Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com
AOPA Bookstore: 571/431-0865
Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com
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AUGUST 2017 | O&P ALMANAC
Publisher Thomas F. Fise, JD
Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email landerson@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
Advertise With Us! Reach out to AOPA’s membership and more than 12,500 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options!
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NUMBERS
Pedorthist Profile
Seasoned professionals work as certified pedorthists treating foot-related problems caused by diabetes and other diagnoses
TIME SPENT IN PEDORTHIC PRACTICE AREAS— ABC-CERTIFIED PEDORTHISTS
34 PERCENT
Percentage of time working on footwear.
41 PERCENT
10 PERCENT
Percentage of time working on retail solutions.
14 PERCENT
YEARS CERTIFIED— BOC-CERTIFIED PEDORTHISTS
49 Percent 10 Percent
www.bocusa.org
TYPICAL PATIENT POPULATION— ABC-CERTIFIED PEDORTHISTS
14 PERCENT
Patients with arthritis.
Percentage of time working on orthoses.
48 PERCENT
Percentage of time working on “other.”
Three to five years.
11 years or more.
Percentage of time working on shoe modifications.
1 PERCENT
31 Percent
Six to 10 years.
11 PERCENT
Congenital.
13
PERCENT
10 Percent Two years or less.
CERTIFIED PEDORTHISTS BY AGE
The largest majorities of certified pedorthists are in their 40s and 50s.*
Patients with posterior tibial tendon dysfunction. Diabetes patients.
14 PERCENT
Prefer to not answer
65 and Older
5% 5%
34% 55-64
10% 25-34
19% 35-44
ABC 28% 45-54
Other.
1% 71 and Older
USE OF CENTRAL FABRICATION (C-FAB) AMONG ABC-CERTIFIED PEDORTHISTS Percentage of custom devices Custom Foot Custom Ankle-Foot fabricated onsite or at a c-fab Orthoses Orthoses Onsite
47% 22%
C-fab
53% 43%
14%
Prefer to not answer
5% 7%
30 or younger
61-70
21% 51-60
BOC
24% 31-40
27% 41-50
N/A or do not provide 0% 35% Source: “Practice Analysis of Certified Pedorthists,” ABC
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AUGUST 2017 | O&P ALMANAC
*NOTE: Percentages may not total 100 due to rounding.
SOURCES: “Practice Analysis of Certified Pedorthists,” American Board for Certification in Orthotics, Prosthetics, and Pedorthics; Board of Certification/Accreditation.
Certified pedorthists comprise a key segment of the O&P profession. Working alone or on teams with orthotists, physicians, or other healthcare professionals, pedorthists address patients’ varying footwear needs. Here, the two organizations that have certified pedorthists—the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) and the Board of Credentialing/Accreditation (BOC)— share some interesting statistics about the pedorthist population.
I N T R OI D N UT CR I O ND G URCE IANK G T I V C RB O U S I LST O W V IE TRH
P D E
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Happenings RESEARCH ROUNDUP
Amputees Fit With DARPA’s LUKE Arms
Fred Downs, one of two veterans to receive LUKE arms in June
who lost their arms while on active duty in 1968 and 1969, respectively, were “gifted” with the LUKE arms by VA Secretary David Shulkin, MD, in a ceremony June 30, 2017. The devices were manufactured by Mobius Bionics in Manchester, New Hampshire, and eventually will be available for civilian purchase. During a demonstration in June at the VA New York Harbor Health-Care System in Manhattan, Downs used his LUKE prosthetic thumb and index finger to peel a banana. “These may seem like very simple, routine things, but to someone who can’t do it, to be able to be given this function is like magic,” said Downs.
PHOTOS: DARPA
Two Army veterans became the first recipients of Life Under Kinetic Evolution (LUKE) arms, robotic arms that use computers, sensors, and motors to enable dexterous arm and hand movement via an intuitive control system. The LUKE arm system was developed via an eight-year research project involving the U.S. Department of Veterans Affairs (VA), the Defense Advanced Research Projects Agency (DARPA), and private companies. The LUKE system allows users to control multiple joints simultaneously, and allows for a variety of grips and grip forces, by means of wireless signals generated by sensors worn on the feet or via other controllers. Motors at the shoulder, elbow, wrist, and hand enable flexing, turning, and lifting. “This is the first device that intuitively moves multiple joints at one time,” said Leif Nelson, DPT, ATP, CSCS, a project leader. The limbs provide “unprecedented, near-natural arm and hand motion,” according to a DARPA press release. The project was initially undertaken to spur private research and development for more human-like prosthetic arms, which are needed by a smaller population than prosthetic legs, according to Nelson. After years of research and development, the final version of the modular, battery-powered arms was tested at Walter Reed National Military Medical Center in December 2016. Army veterans Fred Downs and Artie McAuley,
University of Calgary Researchers Design Smart Prostheses
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AUGUST 2017 | O&P ALMANAC
control it so that we can return it to the person in a useful way,” said Kuo. The research team is examining how to use sensors to detect what a prosthesis wearer is doing, and try to “restore the energy to them in a way that isn’t too different from the way an able-bodied person uses their ankle.” Kuo’s goal is to implant prostheses with a smart technology that can sense what part of the gait cycle a person is in, then use that information to more effectively capture and release energy. Kuo and his team have begun testing prototypes, and additional testing is planned.
PHOTO: Riley Brandt, University of Calgary
Arthur Kuo, PhD, is a professor in the faculty of kinesiology at the University of Calgary, and Canada research chair in neuromusculoskeletal biomechanics.
Arthur Kuo, PhD, a professor of biomechanics on the faculty of kinesiology at the University of Calgary, is leading a team in studying and developing smart prosthetics to offer lower-limb amputees greater mobility on uneven terrain. The team’s goal is to improve control over the energy storage and return in prostheses built with springs. “What we have been developing is a set of prosthetic devices that can store energy from the person wearing them that they would normally lose, and what we try to do is capture that energy and
HAPPENINGS
HISTORICAL O&P
Researchers Examine 3,000-Year-Old Wooden Toe A 3,000-year-old Egyptian prosthetic toe first discovered 17 years ago was recently examined and found to be much more complex than originally thought. Researchers from the University of Basel, the University of Zurich, and the Egyptian Museum in Cairo used X-ray technology, computer tomography, and microscopy to examine the prosthesis, which is being kept at the Cairo museum. “By using a sophisticated way of fixing the individual parts of the prosthesis to each other, the artificial limb had a balancing effect and gave, to some extent, a freedom of movement,” said Andrea Loprieno-Gnirs, PhD, of the University of Basel’s department of ancient civilizations. The prosthesis, which was designed to look natural and to be worn with sandals, according to the scientists, features a carved-out toenail. The device was discovered attached to the skeleton of an Egyptian woman—the daughter of
a priest—who had an amputated right toe. “Based on our scientific examinations, our team was able to verify at least four materials used for manufacturing the prosthetic device,” Loprieno-Gnirs said. “We could also determine two phases of refitting of the prosthesis during lifetime and identify signs of longer use… . The quality of the prosthetic device gives us an indication of the elite status of its user or her family and that a realistic and aesthetical appeal of the artificial limb was of importance, beside its aspect as a walking aid.” The research team is continuing to examine the prosthesis and hopes to determine the type of wood used as well as the types of tools used to build the device. The team plans to publish complete findings at a future date.
O&P OUTREACH
Stakeholders Attend Congressional Briefing on Rehabilitative Services
PHOTO: Getty Images/Siri Stafford
On June 27, the Independence Through Enhancement of Medicare and Medicaid Coalition, the Coalition to Preserve Rehabilitation, and the Habilitation Benefits Coalition held a congressional briefing on the value of rehabilitation and habilitation services and devices in America’s health-care system. Attendees discussed the importance of intensive inpatient hospital rehabilitation, outpatient rehabilitation and habilitation therapies, prosthetic limbs, and other assistive devices and technologies. Among the speakers were Sen. Tammy Duckworth (D-Illinois), a bilateral leg amputee injured in Iraq; Rep. G.T. Thompson (R-Pennsylvania), a former therapist/rehab services manager; Eric LeGrand, a former Rutgers football player who sustained a spinal cord injury; Roseann Sdoia, a Boston bombing survivor who sustained an above-knee amputation; and Isabella Smith, the mother of a child with a developmental disability. AOPA and the Amputee Coalition held a news teleconference immediately following the congressional briefing,
where they shared information about the “big three” priority issues for amputees: • No cuts to Medicaid that would restrict access to needed treatment and state-of-the-art devices • No waivers as to rehabilitative and habilitative services (an essential health benefit) that could be used to deny access to care and treatment for amputees • No changes to authorize higher premiums with respect to amputation as a pre-existing condition that could interfere with coverage access. News teleconference speakers included Duckworth; AOPA President Michael Oros, CPO, LPO, FAAOP; Jeffrey Cain, MD, head of the advocacy program of the Amputee Coalition; Kelly Miller, an amputee from Baltimore; and Ann McSweeney, a Chicago area mother of twins who wear orthoses. The conference generated news articles in The Sacramento Bee, Healio, Tank & Purpose, and HME News. Audio and video of the events are available at www.AOPAnet.org.
O&P ALMANAC | AUGUST 2017
11
HAPPENINGS
DIGITAL DOWNLOAD
Health-Care Entities Adopt Mobile Health Strategies
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AUGUST 2017 | O&P ALMANAC
Jurisdiction D Releases Audit Results for Walking Boots, Spinal Orthoses, and Knee Orthoses Code Denial Rate L4361 66% L0648 79% L0650 88% L1832 100% L1843 100%
Noridian Healthcare Services, the Jurisdiction D durable medical equipment Medicare administrative contractor, has released the results of prepayment audits for walking boots described by L4361 and spinal orthoses described by L0648 and L0650. While the overall denial rates for these audits remain high, they are slightly lower than they have been in the past. The prepayment review for L4361 included 704 claims, of which 462 were denied, for an overall denial rate of 66 percent. Common reasons for denial included failure to respond to requests for additional documentation, invalid proof of delivery documentation, and an incomplete or missing detailed written order. The prepayment review for L0648 included 399 claims, of which 314 were denied, for an overall denial rate of 79 percent. The prepayment review for L0650 included 1,126 claims, of which 986 were denied, for an overall denial rate of 88 percent. In addition to the reasons above, many claims for these spinal orthoses were denied as same or similar to a previous claim. Based on the overall denial rates, Noridian will continue its prepayment
review of services described by L4361, L0648, and L0650. Noridian also released the results of its ongoing prepayment review of knee orthoses described by codes L1832 and L1843 reviewed from January through April 2017. There were 139 claims selected for review for L1832 and 117 claims selected for review for L1843, and the denial rate for both codes was 100 percent. The four top denial reasons were the following: • Documentation does not support custom-fit criteria. • Documentation does not support coverage criteria. • There was a lack of response to request for additional documentation. • Proof of delivery is incomplete or missing elements. The report from Noridian does not specify how many claims were denied for each of the reasons above. AOPA has had discussions with Noridian regarding potential reasons for such high denial rates, especially for knee orthoses, and will work with Noridian on education strategies to reduce the overall denial rate for these services.
PHOTO: Getty Images/Thomas Northcut
More health-care facilities will be using mobile health to deliver a range of health-care services, such as data collection and remote patient monitoring, according to a report by GBI research. Rapid advances in new mobile devices, the expansion of communication coverage, and the rise of less expensive wireless technologies are contributing to the increasing popularity of mobile health, according to the report, “Mobile Health (m-health) Technologies: Global Market.” As the nation shifts toward valuebased health care, new technologies have the potential “to bridge the gap within existing health-care systems, offering an alternative form of healthcare communication and treatment at a distance,” said Rodrigo Gutierrez Gamboa, managing analyst for GBI Research. “As the uptake of m-health technologies increases, support from health-care professionals, reimbursement entities, and government agencies also will increase as the body of literature documenting the wide range of m-health’s benefits continues to grow. Furthermore, the continued acceleration of mobile penetration at a global level will continue to make m-health services and solutions possible even in the most remote areas.” The report identified the need for more costeffective means to deliver health care as the most important growth driver in the m-health market. O&P facilities seeking to remain competitive in the increasingly digital health-care climate will likely need to examine their own mobile health strategies and consider how they align with those of their referral sources, patients, and payors.
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HAPPENINGS
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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS
The Board of Certification/ Accreditation (BOC) has announced that Harry “J.R.” Brandt, BOCO, CO, LO, has been named the inaugural recipient of the Jim Newberry Award for Extraordinary Service. Brandt was selected for the honor due to his accomplishments as a highly Harry “J.R.” Brandt, BOCO, CO, LO, Lynne Newberry, respected practitioner and and the late James “Jim” Newberry Jr. at the 2015 AOPA National Assembly O&P advocate, as well as his significant role in BOC’s growth and success, according to BOC Board Chair L. Bradley “Brad” Watson, BOCO, BOCP, LP. Brandt is a former member and chair of BOC’s board of directors, and aided in developing the organization’s accreditation process. He also supervised BOC’s cadre of site surveyors, and served as a BOC representative to the O&P Alliance and as a test development volunteer. Throughout his career, Brandt has demonstrated expert knowledge of O&P, specifically of Medicare and other accreditation standards, according to BOC. Brett M. Rosen, CPO, has been hired at Ability's patient-care facility in Charlotte, North Carolina. Most recently an area clinic manager for Hanger Clinic practices in South Florida, Rosen graduated from Florida Brett M. Rosen, State University in 2004 with a bachelor’s CPO degree in exercise science and an emphasis in sports medicine/athletic training. He completed his postgraduate work in prosthetics and orthotics at the Newington Certificate Program in Newington, Connecticut. Harold H. Sears, PhD, has retired as president of Motion Control, effective July 1, 2017, according to an announcement from Fillauer Companies Inc. He will continue working with the company on a part-time basis in a new role as president emeritus of Motion Control. During Sears’ 35 years of leadership, Motion Control developed extensive myoelectric upper-extremity technology. Sears shared his knowledge and expertise by traveling to multiple countries providing myoelectric, upper-limb clinical education to prosthetists, therapists, physicians, and their patients, according to Fillauer. With Sears’ retirement, Arthur (Art) Dyck, Motion Control’s vice president for operations, has been named the new president of Motion Control. Dyck began his career at Motion Control in 1988, and holds a degree in electrical engineering from the Alberta Institute of Technology.
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AUGUST 2017 | O&P ALMANAC
Cody Smith, MSPO
Cody Smith, MSPO, has been hired as an orthotic practitioner at Ability's patient-care facility in Charlotte, North Carolina. Smith is an American Board for Certification (ABC) board-eligible orthotist and resident prosthetist.
BUSINESSES ANNOUNCEMENTS AND TRANSITIONS
Hanger Clinic has announced the launch of its #AmputeeLifeHacks contest, designed to encourage the sharing of “life hacks”— strategies to manage one’s time and daily activities in a more efficient way—among the limb loss and limb difference community. Entrants are encouraged to submit a short video showcasing a tip or trick that helps them conquer everyday tasks. The grand prize winner and a guest will be awarded a trip to Florida to meet movie star and amputee Winter the dolphin, who resides at the Clearwater Marine Aquarium. In addition, a panel of judges will select a monthly winner throughout the three-month contest to receive a prize of a $100 gift card and Hanger Clinic T-shirt. Following the conclusion of the contest period, 10 finalists will be announced in late October 2017, and voting will open to the public for a two-week period. The grand prize winner will be announced in mid-November 2017. Details are available at www.AmputeeLifeHacks.com. Ottobock HealthCare has announced that it is a supporter of the Invictus Games, to be held Sept. 23-30 in Toronto. Ottobock will provide athletes in the competition with prosthetic and orthotic technical services for the third year since its 2014 inaugural event in London. The Invictus Games, an international adaptive sporting event for ill, wounded, and injured military service members, expects 550 competitors from 17 nations this year. The technical services team will be staffed with experienced Paralympic and Invictus team experts who will be available to adjust, repair, or replace a limb or brace for participants competing in 12 adaptive sports events, including archery, indoor rowing, power-lifting, cycling, swimming, wheelchair basketball, wheelchair rugby, track and field events, and golf.
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REIMBURSEMENT PAGE
By DEVON BERNARD
Tips for Preventing DME MAC Denials
E! QU IZ M EARN
CREDITS
Five reasons for denials and how you can improve your chances of reimbursement Editor’s Note—Readers of Reimbursement Page are 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.
CE
CREDITS
B
Y NOW EVERYONE IS aware of
and has seen the results of certain Medicare prepayment reviews being conducted by the durable medical equipment Medicare administrative contractors (DME MACs). The DME MACs are reporting high error and claim denial rates—as high as 100 percent in some jurisdictions for certain product categories. With these high error rates, the DME MACs have decided, in most cases, to continue with prepayment audits/reviews. This month’s Reimbursement Page examines some of the more common denial reasons as reported by the DME MACs, and offers tips to help lower the overall claim denial and error rates.
No documentation was received in response to an additional documentation request.
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visit on a routine basis, make sure those addresses are correct as well— and consider changing the Medicare correspondence address for those offices to the address of your main office so all Medicare correspondence is sent to one central location. Next, develop specific protocols for those individuals tasked with opening, sorting, and delivering the mail. These individuals should be able to identify incoming ADR requests, know to whom they should be forwarded, and understand they must be acted upon immediately. Finally, be sure you have at least one person in charge of responding to and collecting all of the information requested in ADRs; this will eliminate any duplicate work and ensure ADRs are being handled in a timely manner.
Documentation is insufficient to support that substantial modifications were made for the custom-fitted item billed. For split-code orthoses, there is no difference in the function or design of the off-the-shelf version and the custom-fit version; the difference comes in the amount of modifications required to fit the orthosis to a particular patient. In other words, the difference is that a custom-fit item has been substantially trimmed, bent, molded, assembled, and/or otherwise modified by a person with expertise to fit one specific patient only. With these guidelines, as they are currently published in policy and other coding bulletins, documenting just the “why” (medical necessity) is no longer sufficient for split codes; documenting
PHOTO: Getty Images/Andresr
A typical review or audit starts with an additional documentation request (ADR); you are required to respond to the ADR within 45 days. This time period is defined as 45 days from the date listed on the ADR letter, rather than the date the letter is received. If you do not respond to the ADR, your claim will automatically be denied. Fortunately, there are a few things you can do to ensure that you respond within in the allotted time period. First, check your correspondence address, as listed on your Medicare application, and make sure it matches your existing location’s address. If the addresses don’t match, you’ll need to update the address with Medicare. Also, if you have multiple locations, including offices you may not use or
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BUSINESS CE
REIMBURSEMENT PAGE
Remember your notes may be used to corroborate the physician’s notes. The physician’s notes must contain some information/ documentation that may be used to support your notes.
PHOTO: Getty Images/AJ_Watt
the “what”—the specific modifications that were made to an orthosis to achieve a custom fit—is essential. When documenting your modifications, it is important to demonstrate that the modifications go beyond basic cutting and bending, and that they are more substantial. Document exactly what was modified—for example, how much of the orthosis was trimmed or bent and where the modifications were made. In addition, document the time it took to achieve each modification, and list the tools used for each modification. It also is important to document any lastminute modifications that were made at the time of the final fitting and delivery. Also document who carried out all of the modifications. In order for custom-fitted items to be covered, the modifications must have been conducted by a certified orthotist or someone with similar expertise and training; this doesn’t include certified fitters or technicians , according to CMS’ interpretation of the policy. Finally, be sure to document why the custom fitting was required, as this will help explain what modifications were needed and made.
Documentation doesn’t support custom fabrication. A custom-fabricated orthosis is considered medically necessary/covered when there is a documented reason or physical characteristic that would require the use of a custom-fabricated orthosis instead of a prefabricated orthosis. Typically, this information must be documented not only in your records but also in the records of the treating/ordering physician. However, your documentation can and will be used to corroborate the information found in the physician’s records. The ankle-foot orthosis/kneeankle-foot orthosis (AFO/KAFO) policy is pretty clear in what is acceptable in terms of documentation for the need of a custom-fabricated item. There must be documentation to support one of five possible reasons: patient could not be fit with a prefabricated item; condition is expected to last longer than six months; need to control the ankle/knee/foot in more than one plane; custom fabricating over a model to prevent tissue injury; or patient has abnormal healing fracture. Although other policies don’t list these types of reasons, you may use the AFO/KAFO policy rules as your guidelines concerning what you should be documenting and/or looking for in
the physician’s records when providing other custom-fabricated orthoses. Under ideal circumstances, the ordering/referring physician will spell out exactly one of the above-listed reasons for a custom-fabricated orthosis in his or her notes, or state that a “custom-fabricated brace is needed because…” However, this is not a requirement. Remember your notes may be used to corroborate the physician’s notes. The physician’s notes must contain some information/documentation that may be used to support your notes. For example, if a physician orders a brace and states that the patient should come back in six months for a follow-up, or the notes show a history of drop foot over the years, these comments would be an indication that the condition would be long lasting and a custom brace may be required. Remember that it is acceptable for you to work with your referral sources to educate them on what needs to be documented, and that they may amend their notes as well. Consider explaining the “why not” when documenting the need for a custom-fabricated item over a prefabricated item. In other words, if you are providing a custom item because the patient cannot be fit with standard prefabricated sized braces, explain why the prefabricated options (including
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REIMBURSEMENT PAGE
pediatric brace sizes or a brace with extra straps) would not work or benefit the patient. Also, document and confer with the physician about prior brace usage, if applicable, as this could show a need for long-lasting care; if a prefabricated brace was tried in the past and was not sufficient to meet the patient’s needs, that information should be documented. Lastly, when providing a customfabricated AFO/KAFO, and certain knee orthoses (KOs), remember to document the need for custom over prefabricated, but also be sure to document that the patient is ambulatory. This is one of the key factors in covering all custom AFOs/KAFOs and certain KOs.
Documentation was not authenticated.
When an item is denied because “documentation was not authenticated,” it means the documentation provided was not signed or the signature of the ordering/referring physician or provider was illegible. It is well established that the ordering/ referring physician must sign the prescriptions and documents, such as the certifying statements. However, Medicare also requires that the signatures of anyone documenting the medical necessity or need for items/services received by Medicare beneficiaries must be identifiable; each provider must sign each and every entry in the patient’s medical record. This includes the entries you make in your charts as well. There are two main types of valid signatures: electronic signatures and handwritten signatures. Stamped signatures, in most cases, are no longer acceptable; however, if an individual uses a stamp because he or she has a disability that doesn’t allow 18
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for a handwritten signature, then a stamped signature is acceptable. An electronic signature is considered valid if the signature is accompanied by a statement such as the following (this is not an all-inclusive list): • Electronically signed by • Authenticated by • Approved by • Completed by • Signed by • Entered by. A handwritten signature is any mark or sign by an individual signifying knowledge, approval, acceptance, or obligation. When talking about Medicare-approved or valid handwritten signatures, remember the signature must be “legible.” If a signature (a full name, a first initial and last name, or initials) is legible, then it is automatically considered valid. When a document is missing a signature or the signature has been deemed illegible and invalid, there are two common and acceptable ways to authenticate the signature and/or the medical record: via signature log or an attestation statement. The signature log or attestation statement does not have to be submitted with the ADR request, but you should have it ready to go in case you must appeal a “documentation was not authenticated” denial.
No need for replacement designated.
A replacement item—the provision of an identical or nearly identical item to the original—is normally covered by Medicare under certain circumstances, including when the original item was lost or stolen, the original item is irreparably damaged (damage not caused by normal wear and tear), or there was a change in the patient’s condition (weight, functional needs, change of medications, etc.) that requires a new item. When providing a replacement brace or prosthesis, you must document that at least one of the above replacement criteria has been met. This is especially true when providing a replacement item if the original brace or prosthesis was
still within its reasonable useful lifetime, or when you are providing an item you feel may be denied as same or similar. If the item is being replaced because it was lost or stolen, consider including a written affidavit explaining that the item was lost/stolen by the patient, facility, insurance company, police department, etc. If the item is being replaced because of irreparable wear, describe the event that caused the damage and the extent of the damage. Since a replacement item requires a new prescription/order, the physician also must document the need for the replacement, and/or the continuing need and use of the item being replaced. This documentation should be included in the patient’s record; however, with prosthetics (and only with prosthetics), the need for the replacement can be included on the prescription only and does not need to be in the patient’s record. Remember that it is acceptable for you to work with referral sources to educate them on what needs to be documented for the replacement.
Knowledge Is Power
Now that you understand some of the more common denial reasons for the DME MAC prepayment audits/ reviews, be sure you take the proper steps to avoid making mistakes. In addition, consider tracking the results of your DME MAC audits/reviews; if you can demonstrate a high level of compliance or low error rate, you may be able to petition the DME MAC to be removed from the audit list. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:
www.bocusa.org
Hiring National Float Pool Positions
Service. Variety. Adventure. Travel. Discover. Explore. You have demonstrated your commitment to providing exceptional outcomes through patient-focused care. Leverage your clinical expertise to provide orthotic and prosthetic care while serving on short-term rotating assignments (up to 16 weeks per assignment) throughout the year at one of our 750 locations nationwide. At Hanger Clinic, you can enjoy delivering care in a variety of settings, meet fascinating people, increase your professional network, and further hone your clinical skills. Contact us today to discover the many ways Hanger works for you. Packages include: n Competitive base pay n Lodging n Rental car n Per diem n Paid time off n All Hanger Clinic benefits as an eligible full-time regular employee To view available positions and apply online, visit www.hanger.com/careers or call Rosie Alvarez at (512) 777-3814.
Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law.
STUDENT LOAN DEBT? You have made the investment in a world-class education so that you can provide exceptional service and deliver superior patient-focused care.
Let us invest in you! Hanger Clinic is proud to offer a student loan pay-down program reducing years of payments and saving you thousands of dollars in interest (for select locations nationwide). Contact us today to discover the many ways Hanger works for you. Competitive salaries/benefits, continuing education, leading-edge technologies, career advancement, and paid leave to assist in humanitarian causes are all within your reach. To view available positions and apply online, visit www.hanger.com/careers.
Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state, or local law.
ELIGIBLE LOCATIONS Billings, MT Meridian, MS Jackson, MS Salt Lake City, UT Bangor, ME Jackson, TN El Paso, TX Other select locations may be available as well.
O&P ALMANAC | AUGUST 2017
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This Just In
Funding the Future AOPA announces COPL grant awardees for 2017-2018
A
DVANCING O&P RESEARCH IS
one of AOPA’s top priorities. There are many ways AOPA is involved in these efforts, including funding cost-effectiveness and comparative effectiveness studies, developing a patient registry, leading the Prosthetics 2020 project, and spearheading other special initiatives. Payors are demanding scientific data to validate orthotic and prosthetic care, and O&P research has some catching up to do compared to other health fields. One of AOPA’s longstanding commitments to evidence-based research is through the Center for O&P Learning Outcomes/EvidenceBased Practice (COPL). Since 2009, AOPA has been sponsoring small research grants through COPL, governed by a board consisting of one representative from each of the
AUGUST 2017 | O&P ALMANAC
PHOTO: Getty Images/29mokara
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organizations in the O&P field. Thirtythree small grants have been funded since the 2009 inception of COPL, including six funded for 2017-2018. Most years, AOPA funds four grants at up to $15,000 each, but AOPA made an exception to expand the number of grants in 2016 to seven, for funding totaling $90,000. Earlier this year, AOPA, in partnership with COPL, announced a Request for Pilot Grant Proposals for 2017-2018 in 16 key areas of orthotic and prosthetic research, including an open topic. AOPA received an unprecedented 34 high-quality submissions, and again increased funding to make this necessary research possible. AOPA is pleased to fund three orthotic projects and three prosthetic projects for 2017-2018. The 2017-2018 COPL grants that were recommended for funding by the COPL board and approved by the AOPA board are listed below: • Sarah Anderson, La Trobe University, “Comparison of Quality of Life in People With Partial Foot or Transtibial Amputation” • Brian Kaluf, BSE, CP, Ability Prosthetics and Orthotics Inc., “Hydraulic and MicroprocessorControlled Ankle-Foot Prostheses for Limited Community Ambulators With Unilateral Transtibial Amputation: Pilot Study” • Sarah Chang, PhD, Northwestern University, “A Pilot Study To Evaluate the Effects of Hydraulic Ankle-Foot Prostheses on Standing and Walking in K2-Level Ambulators”
This Just In
• Benjamin Padilla, MD, University of California—San Francisco Benoiff Children’s Hospital, “The Effects of a Custom Pectus Carinatum Orthosis on Dosing Response and Quality of Life” • Eric Weber, CPO, FAAOP, Hanger Clinic, Department of Clinical and Scientific Affairs, “Mobility and Global Health Among Users of Lower-Limb Orthoses: The Establishment of a National Database” • Chris Hovorka, PhD, CPO, LPO, FAAOP, Georgia Institute of Technology, “Gait and Motion Control Benefits of CustomMolded Passive-Dynamic Ankle-Foot Orthoses (AFOs) Versus Custom-Fit Carbon Composite AFOs in Persons With Neuromuscular Impairment” • Kenton Kaufman PhD, PE, Mayo Clinic, “Prevalence, Correlates, and Risk of Prescription Drug Use and Abuse in Individuals With Above Knee Amputations.”
Recipients of COPL grants are encouraged to submit their abstracts for presentation at the AOPA National Assembly. At this year’s 2017 AOPA World Congress, several grant recipients will be presenting their work. Be sure to attend “Unique Considerations in Prosthetic Clinical Care—A Free Paper Session (C11)” on Thursday, Sept. 7, from 4:30 to 5:30 p.m. Fan Gao, PhD, of the University of Texas Southwestern Medical Center at Dallas, will be presenting the research from his 2015-2016 grant, “Effects of Prosthetic Socket Suspension on Knee Proprioception and Dynamic Balance in Transtibial Amputees (C11E).” This presentation will give an overview of an investigation of the effects of prosthetic socket suspension including VASS, suction, and locking-pin on knee proprioception and dynamic balance in unilateral transtibial amputees. Shane Wurdeman, PhD, MSPO, CP, FAAOP, of Hanger Clinic was awarded a 2016-2017 grant, and will be presenting on a panel during the
symposium “Driving Improved Patient Care: Examples From Clinicians on Outcomes Use (C6).” Make sure your schedule includes the Thursday, 1:30–3:00 p.m. symposium, where Wurdeman and three other panelists will provide real-life case studies from clinicians using outcomes, demonstrating benefits to the patient and improved processes for delivering better patient care. See bit.ly/aoparesearch for all projects funded by AOPA.
Save the Date!
“Unique Considerations in Prosthetic Clinical Care—A Free Paper Session (C11)” on Thursday, Sept. 7, from 4:30 to 5:30 p.m.
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O&P ALMANAC | AUGUST 2017
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COVER STORY
Celebration of the
Century
The AOPA World Congress and 100th Anniversary Celebration will draw thousands of global O&P stakeholders to collaborate and commemorate BY LIA K. DANGELICO
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COVER STORY
Need To Know • Thousands of practitioners, researchers, physicians, manufacturers, facility owners, business managers, and other O&P stakeholders from across the globe will convene in Las Vegas next month during the 2017 AOPA World Congress for top-notch education and unparalleled networking opportunities.
• New this year, O&P inventors and researchers will have the opportunity to share their innovative ideas with potential investors and venture capitalists during a “Shark-Tank”-like Technology Transfer program. The program will be followed by a networking reception where the discussions will continue.
• AOPA will commemorate its 100-year anniversary during the World Congress with an array of social events, including a Walk Through Time displaying historical O&P memorabilia; a Centennial Celebration on Thursday evening; and a Party With a Purpose—a can’t-miss ticketed fundraising event.
• Clinical and business educational programming will be filled with sessions led by renowned researchers from across the globe. Physicians and PhDs from nearly a dozen countries will share their techniques, research, and strategies during more than 75 presentations.
• O&P companies from all over the world will share their latest products and technologies on the Exhibit Hall floor. During the Welcome Reception, exhibitors will compete to show off all that Vegas has to offer and win attendee votes.
• The 2017 World Congress Presidential Papers will present a new opportunity to spotlight cutting-edge research. The top 10 clinical education submissions of original research backed by a full manuscript will be recognized and published in a special supplement of the Journal of NeuroEngineering and Rehabilitation, courtesy of ABC.
A
LL YEAR LONG, AOPA members and staff have been reflecting
on what it means to celebrate the association’s 100-year anniversary—from “Throwback Thursday” posts depicting past events and milestones on social media, to articles and interviews in this magazine and on AOPA’s dedicated centennial website, www.AOPA100.org. The momentum has been building and will culminate at the 2017 AOPA World Congress Sept. 6-9, 2017, at the Mandalay Bay Resort in Las Vegas. Hosted by AOPA and supported by nine partner organizations, this will be the second-ever World Congress; the first was held in Orlando in 2013 and saw more than 2,500 participants from 43 countries. With the theme of “Celebrating a Century, Envisioning the Next,” the four-day event is expected to attract a record number of attendees from around the globe. The World Congress will feature a celebration of AOPA members and all they’ve brought to the O&P community during the past 100 years. In that vein, the event was designed for everyone—from clinicians and engineers to programmers and manufacturers. The event will bring together people from all walks of life and from across and outside the industry to learn, share, engage, and collaborate; to explore exciting new topics, products, and approaches—all with the aim of elevating O&P care.
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COVER STORY
Spotlighting NEW RESEARCH AOPA is dedicated to advancing the value and efficacy of the O&P profession through its support of outcomes- and evidence-based research generated by clinicians, institutions, manufacturers, specialists, and others. Here are two opportunities to hear some of the latest research at the World Congress: The award-winning Thranhardt Lectures will be presented Friday, Sept. 8, from 8:00 to 9:00 a.m. during the general session. The following presentations will be featured: • “Introducing the Prosthetic Homologue for Embodiment,” presented by Michael Wininger, PhD • “Reference Values for Temporal Gait and Loading Symmetry of Lower-Limb Amputees Can Help in Refocusing Rehabilitation Targets,” presented by Andrea Giovanni Cutti, PhD, and Gennaro Verni, MEng • “Do Foot Orthoses Work? Outcomes From a Multiclinic Study of 6,658 Pedorthic Patient Visits,” presented by Michael Ryan, PhD, CPed • “The Microprocessor-Controlled Orthosis: What Is the Impact to the User Versus the Stance Control Orthosis and Conventional Locked Knee-Ankle-Foot Orthosis?” presented by Shenan Hoppe-Ludwig, CPO Sponsored by the American Board for Certification in Orthotics, Prosthetics, & Pedorthics and organized by the Clinical Content Committee, the 2017 World Congress Presidential Papers present a new opportunity this year to spotlight clinical research. The top 10 clinical education submissions of original research backed by a full manuscript will be recognized and published in a special supplement of the Journal of NeuroEngineering and Rehabilitation. The research also will be made available online through the journal and accompanying search indexes, such as Medline.
AWARD-
WINNING
LECTURES
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Each of AOPA’s annual meetings offers a dynamic educational program, and each year the program gets stronger. The 2017 World Congress brings an unprecedented 40-plus continuing education credit hours, with sessions led by international experts on a wide range of O&P and related specialties, from osseointegration to pediatric lower-extremity orthotics to neurorehabilitation, as well as vital business topics, such as materials management and cybersecurity. The meeting also offers a spectrum of engaging and meaningful activities and touch points, from the Walk Through Time to the Party With a Purpose, that will connect attendees, exhibitors, and AOPA staff and leadership in creative and memorable ways.
Cutting-Edge Education
For those arriving in Las Vegas eager to learn, AOPA has built a strong educational program with five dedicated tracks tailored to its membership: orthotists, prosthetists, pedorthists, technicians, and business owners. With representatives hailing from 11 countries, AOPA’s education planning committees designed the curriculum to incorporate best pracChris Nolan tices from all over the world, says Chris Nolan, vice president of orthotics at Ottobock and chair of the AOPA World Congress Planning Committee. “For example, we know that prosthetic care in the United States is different than in Europe, than Asia, than Africa and South America. It’s very different in what’s available from a technology standpoint, the surgical techniques are different, some of the root causes of amputations are different. Being able to bring in the academics from around the world, we had that global perspective when planning the education sessions,” says Nolan. The result is the largest, most diverse program AOPA has ever offered, with more than 75 presentations from physicians and PhDs from nearly a dozen countries, including
COVER STORY
At Your Fingertips
Download the AOPA365 app to stay on top of all things World Congress, and be sure to use the official #AOPA2017 hashtag on all your social media posts!
Beatriz Samitier, MD, PhD, of Spain; Burhan Dhar, CPO, of Saudi Arabia; Tsurayuki Murakami, BSc (Hons), of Singapore; and many others. “The quality of the presenters and the papers that they’re presenting will give individuals a very accurate picture of where the profession is heading, in terms of clinical care for orthotics and prosthetics,” says Thomas DiBello, CO, LO, FAAOP, director of clinical and scientific affairs at Hanger Clinic and AOPA’s clinical education chair. One such example is the symposium, “Driving Improved Patient Thomas DiBello, Care: Examples CO, LO, FAAOP From Clinicians on Outcomes Use,” a lecture to be presented by Andrea Kinsinger, PT; Matt Luetke, CPO; Shane Wurdeman, PhD, MSPO, CP, FAAOP; and James Wynne, CPO; on Thursday, Sept. 7, from 1:30 to 3:00 p.m. This lecture and others will provide valuable takeaways for clinicians across O&P and other specialties. Another notable theme is how to better treat pediatric orthotic cases and improve quality of life for these patients, according to Nolan. For clinicians who are interested in the pediatric space, he suggests two symposia on upper- and lowerextremity function and design, which are listed below under “Orthotics.” On the prosthetics side, several of the lectures examine how a certain technology or approach is evolving and would look in practice, Nolan explains. The sessions will answer some critical questions about how new O&P technologies—for example, robotics—are being developed, how some of them are already working in the field, and whether or not the market is ready for those that are still in development. Several can’t-miss clinical presentations include the following:
Orthotics:
• “Symposium: Orthotic Management of Post-Stroke Gait Dysfunction,” presented by Stefania 26
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Fatone, PhD, BPO (Hons), and Jill Seale, PT, PhD, NCS, Thursday, Sept. 7, 10:30 a.m. to Noon. • “Symposium: Pediatric LowerExtremity Orthotic Gait and Functional Design, Tuning, and Alignment,” presented by Bryan Malas, MHPE, CO, and Klaas Postema, MD, PhD, Friday, Sept. 8, 1:30 to 3:00 p.m. • “Symposium: Pediatric UpperExtremity Functional Orthotics for Children With Neuromuscular Diseases,” presented by Tim Lewandowski, CO; Jonathan Naft, CPO; Vivian Rose, CPO; and Michael Schaefer, CPO, Dipl., Saturday, Sept. 9, 10:30 a.m. to Noon.
Prosthetics
• “Pre-Show Transfemoral Socket Symposium,” Tuesday, Sept. 5, 1:00 to 5:00 p.m. (Tickets required.) • “Symposium: Future of Prosthetics: Analyzing the Tissue Socket Interface,” presented by Alexander Dickinson, MEng, PhD, CEng MIMechE; Hugh Herr, PhD; Peter Lee, PhD, BEng (Hon); Ellankavi Ramasamy, MSc; and Urs Schneider, MD, PhD, Thursday, Sept. 7, 10:30 a.m. to Noon. • “Lunch and Learn: Exoskeletons and Neurorehab—Where Are We Headed?” presented by Kern Bhugra, MSEE; Hugh Herr, PhD; and Larry Jasinski, MBA, Thursday, Sept. 7, Noon to 1:00 p.m. (Tickets required.)
Pedorthics:
• “Symposium: Current Strategies for Managing Charcot-Marie Tooth Disease,” presented by David Cooney, PT, CPO; Kenneth Cornell, CO; Marmaduke Loke, CPO; David Misener, BSc (HK), CPO, MBA; and Glenn B. Pfeffer, MD, Thursday, Sept. 7, 10:30 a.m. to Noon. If you’re looking for a more hands-on approach to clinical care, a series of workshops by leading O&P manufacturers and suppliers begins Wednesday, Sept. 6, and will provide more education on the newest products and latest technologies to hit the market.
COVER STORY
Accommodations
AOPA has reserved a block of hotel rooms for attendees at the Mandalay Bay Resort. Visit bit.ly/wchotel.
The technical education and business education programs also have a lot to offer attendees. The technical track features a closer look at emerging technologies and new approaches for O&P sockets, for example. On the business side, planners sought to explore “relevant topics to health care and the practice of O&P today and in the future,” says Eileen Levis, president and chief executive officer of Orthologix and chair of AOPA’s Business Education Workgroup. “Anyone in practice today has heard of security breaches, hacking, and cyber theft, but they may not know O&P has been attacked and what the cost to that attack was,” she says. “Anyone practicing today needs to know what the Triple Aim is, how it has transformed all of health care, and how it affects O&P.” (For more on Triple Aim, see “The Power of Three” on page 32.) Make plans now to attend
these business sessions: • “Cybersecurity—Is It Safe? Be Prepared!” presented by Daniel Nelson, Jeffrey Schultz, and Rebecca Snell, Friday, Sept. 8, 10:30 a.m. to Noon • “Triple Aim”: Five lectures and a panel discussion, Friday, Sept. 8, 1:30 to 5:00 p.m.
Sights, Sounds, and Celebrations
Outside its unparalleled education program, the World Congress schedule offers ample downTraci Dralle time for meetings, networking, and simply catching up with old friends and colleagues. AOPA is hosting several special events and activities that encourage attendees to celebrate and reflect its 100-year anniversary while also getting a chance to enjoy a
Step It Up! Who will take the most steps at this year’s World Congress? Make every step you take in Las Vegas count by registering for the free Step It Up Challenge, sponsored by MD Orthopaedics.
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Participation is easy: Simply record your steps using your current device (phone or fitness tracker); if you don’t have a device, stop by the Step It Up Race Headquarters for a free pedometer. Daily prizes will be awarded!
taste of Vegas. “AOPA’s history is our history,” says Traci Dralle, vice president of Fillauer Companies Inc. and chair of the Exhibits and Marketing workgroups. “The centennial celebration is a time for everyone to join together as one to celebrate the O&P industry with their friends and colleagues.” On Wednesday, Sept. 6, attendees who enjoy playing the holes may sign up for the Thranhardt Golf Classic, hosted from 1:00 to 5:00 p.m., with proceeds supporting AOPA’s Capitol Connection, and the Orthotic & Prosthetic Activities Foundation (OPAF)'s First Clinics. At that evening’s Welcome Reception, held from 5:30 to 7:30 p.m., attendees will enjoy refreshments while exhibitors compete to show off all that Vegas has to offer and win attendee votes. As was the tradition at AOPA’s early meetings, the organization will capture group photos of attendees, exhibitors, and staff and leadership during the reception. In addition to the clinical programming, several general session talks are generating their fair share of buzz. “Professional Women of O&P Celebrating Success” is a casual networking brunch and opportunity to learn from successful women in the industry. Held Thursday, Sept. 7, 9:00 to 10:00 a.m., the discussion will be led by Marita Dorsh-Carozza, CP, FAAOP; Rosie Jované; and Wendy Beattie, CPO, FAAOP.
100 YEARS
COVER STORY
What Does 100 YEARS of AOPA Mean to You? O&P Almanac asked long-time AOPA members and past leaders to share their thoughts on the association’s centennial.
“I
find it amazing that a small industry trade organization has been able to grow, adapt, and benefit the members over the last 100 years—a century that has seen unprecedented, continual, and major changes. “AOPA leadership and staff have Walter L. Racette, done an outstanding job in the face CPO(E) of all the changes—adapting to internal and external challenges that have allowed AOPA to benefit all members, big and small. “On a personal note, having served on the AOPA board and going through the chairs, I found the connection most valuable to keep on the cutting edge of the profession, and most importantly, I cherish all the wonderful friendships made over the years.”
“T
irst off, any organization that achieves 100 years should be commended! AOPA represents O&P practices across the country. Even though we are a small part of health care, we know we make a Rod Cheney, CPO difference in our patients’ lives. “Probably the biggest impact that AOPA has been able to resolve is giving O&P practices a voice in Washington, D.C. With the advent of the AOPA Policy Forum, individuals are able to meet with key legislators about current O&P issues. These meetings are near-to-impossible to coordinate without AOPA’s key connections, and they help educate legislators when decisions affecting patient outcomes are being made. “AOPA staff work tirelessly for members; when news of negative legislation hits the airwaves, AOPA staff use email chains and other campaigns to diffuse such news. “Congratulations to AOPA and the 100-year anniversary!”
he more things change, the more they stay the same. When I first started in the late ’60s, [Veterans Affairs (VA)] had a national contracting system and Medicare was divided into states and regions. Today, the VA is divided into regions and Medicare Charles H. Dankmeyer is centralized. No matter, AOPA adapts to Jr., CPO provide advocacy to protect the interests of prosthetists and orthotists and the patients we serve. “Throughout my career, AOPA has fought to have credentials and accreditation recognized in regulations and legislation, to provide funding for education, grants for research, and protection from unfair regulation and taxation. Just a few years ago, AOPA saved O&P from a 2.3 percent excise tax that hit most other medical devices. That was a huge savings. Like many accomplishments, it goes unnoticed because we never felt the pain of paying that tax. That ounce of prevention is certainly worth a pound of cure. It represents what AOPA does for us, day in and day out. If AOPA had not advocated for O&P to be a defined benefit when Medicare was enacted, we would not have been included. “All of medicine lives in a hostile regulatory and legislative environment. More than ever, AOPA initiates and advocates through legislation on Capitol Hill. The Policy Forum is a must-attend for every practice and practitioner. No other organization provides the advocacy that is so important for survival in today’s world of medicine. Think about it. Medicare fees are the national standard for payment used by virtually every insurer as a base for added or reduced benefits. All of the fee cuts, fee freezes, discounts, repricing, area contracting, putting new technology and procedures into legacy codes with insufficient reimbursement—all of those activities constitute a denial of benefits! AOPA singularly works to correct these injustices, which prevent the application of appropriate care. The survival of O&P depends on the solid advocacy provided by AOPA. “Over my career, I have found lasting friendships in the colleagues I have met because I participated in AOPA meetings. Many of my colleagues are like family, with frequent visits not related to the profession.”
—ROD CHENEY, CPO, Executive Vice President, American Prosthetics/Orthotics Inc.; AOPA Board Member, 2002-2008
—CHARLES H. DANKMEYER JR., CPO, Consultant, Dankmeyer Prosthetics & Orthotics; AOPA President, 2014-2015
—WALTER L. RACETTE, CPO(E), AOPA Board Member, 1987-1991 and 2002-2007; AOPA President, 2005-2006
“F
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COVER STORY
A Truly Global Perspective THIS YEAR’S WORLD CONGRESS offers a unique opportunity to learn from and network with O&P professionals from across the globe. Attendees will have the chance to improve their patient-care and business strategies by hearing about the O&P strategies and protocols in place not only in the United States but also in dozens of other countries. The global impact will be felt from the lecture rooms to the Exhibit Hall floor, where companies from all over the world will be sharing their latest products and technologies. Don’t miss these sessions led by international experts in their fields:
• “Symposium: Implementing an Integrated Care Model Into Your Practice,” presented by Silvia Raschke, PhD, of Canada; Andrea Giovanni Cutti, PhD, of Italy; Michael Schaefer, CPO, Dipl., of Germany; and John Miguelez, CP, FAAOP(D), Paul Prusakowski, CPO, and Tiffany Ryan, MOT, OTR/L, of the United States; on Thursday, Sept. 7, from 4:30 to 5:30 p.m. • “Symposium: New Technologies for Prosthetics and Orthotics,” presented by Thor Besier, PhD, of New Zealand; Andrew Hansen, PhD, of the United States; and Jannis Breuniger, MSc, Urs Schneider, MD, PhD, and Michael Schaefer, CPO, Dipl., of Germany; on Thursday, Sept. 7, from 1:30 to 3:00 p.m. • “A Case Study of a Hip Disarticulation Amputee Converting to a Transfemoral Amputee,” presented by Burhan Dhar, CPO, of Saudi Arabia, on Thursday, Sept. 7, from 3:50 to 3:58 p.m., as part of “Prosthetic Management of the Lower Limb Amputee—A Free Paper Session,” held from 3:15 p.m. to 4:30 p.m. • “Development of a Novel Modular Hand Prosthesis System for Children and Adolescents,” presented by Wilfried J. Elspass, PhD, and Fabian Schollenberger, MSc, of Switzerland, on Thursday, Sept. 7, from 3:00 to 3:08 p.m., and on Friday, Sept. 8, from 11:00 to 11:08 a.m., as part of Thursday’s “Specializing in Upper-Limb Prosthetics—A Free Paper Session,” held from 1:30 to 3:10 p.m., and Friday’s “Improving Function for the Orthotic Patient—A Free Paper Session,” held from 10:30 a.m. to Noon.
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Another potential highlight is the chance to hear from U.S. Secretary of Health and Human Services Tom Price, who has been invited to speak at the event. Formerly a U.S. senator from Georgia, Price—a former orthopedic surgeon—was a champion of O&P during his time in Congress. He brings a wealth of knowledge to the current health-care debate, and he would bring substantial fanfare to the program. As the sun begins to set Thursday, the festivities will kick into high gear. The Centennial Celebration, taking place from 5:30 to 6:30 p.m. in the Exhibit Hall, is a chance for all participants to celebrate AOPA’s centennial and 100 years of the formalized O&P profession with a champagne toast. The Party With a Purpose, held at the 1929 Bourbon Bar from 6:30 to 9:30 p.m., is a ticketed fundraising event in support of the O&P PAC. (Rules apply; contact AOPA for details.) The 1920s-themed event “provides a unique and fun opportunity to enjoy great food, drinks, and music with
COVER STORY
colleagues, while supporting the only PAC representing the O&P practitioner’s voice on Capitol Hill,” says Dralle. In short, “it celebrates 100 years of AOPA, it allows networking opportunities to connect with others in the industry that you may not ordinarily get to see, and it also helps raise funds for the PAC, which will in turn be able to affect policy down the road,” says Nolan. For first-time visitors to Vegas or those looking to get outside and explore, AOPA will offer a private Las Vegas Guest Tour from 9:00 a.m. to 1:00 p.m. on Friday, Sept. 8. During the tour, a guide will show off the colorful history and attractions of the city, including Fremont Street, the Las Vegas High Roller, and the famous Las Vegas sign. Of course, there is always plenty to see, do, and eat in Vegas—from fabulous restaurants to world-class entertainment, shopping, and more. On Friday afternoon, AOPA will host its first-ever Technology Transfer program, from 3:15 to 4:30 p.m. In the style of the “Shark Tank” reality television program, this event brings together inventors and researchers from a range of specialties and industries to present their biggest, brightest ideas to an audience of manufacturing and clinical representatives, investors, and venture capitalists. “The opportunity to have inventors and academics coming together just to share their ideas in this fashion is really unique,” says Nolan. “I can’t wait to see how it turns out.” The program will be followed by a one-hour networking reception where inventors and investors can mix, mingle, and discuss their ideas. Throughout the four-day event, attendees can stroll through AOPA and O&P history at the Walk Through Time, a visual display of the many ways the association and profession have grown over the years. In addition to AOPA’s display, exhibitors and patient-care facilities will be featuring their own versions. “It’s an opportunity for individuals, clinicians, manufacturers, or amputees who have
Earn more than
40 CE
CREDITS
a piece of history—an old prosthesis, an old orthosis, an old literature piece, catalogs—it could be any sort of memorabilia from the past,” to be a part of the story, says Nolan. “As someone who’s been in the industry for 20 years, I’ve seen some changes, but I can only imagine what the individuals who have been in it for 40 or 50 years have seen.” After years of planning, the committee members are excited for September to arrive. “I am looking forward to the entire week,” says Dralle, “from the energy that the welcoming ceremony provides, to the attentive silence a respected speaker receives from attendees listening intently to their every word, to the camaraderie and networking that
occur when seeing friends and meeting new ones.” “If you are only going to one AOPA meeting every three years, this is the one to go to,” adds Nolan. “Yes, clinical education is a big draw, but so are the networking opportunities for other professionals who come to these events just to see people they only see once a year. So we try to bring in the manufacturers, the speakers, and the attendees, and make this an event that everyone can have a special moment in, and I really think we’ve done that,” he says. “I’m just happy to be a part of it.” Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com.
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By CHRISTINE UMBRELL
The Power of
THREE
Embracing the ‘Triple Aim’ concept positions O&P facilities for success as the nation moves to value-based health care
NEED TO KNOW • Many public and private health-care entities have adopted the Triple Aim approach to providing care, which encompasses the simultaneous pursuit of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. • O&P facilities seeking to provide optimal patient care and to partner more seamlessly with other health-care providers and payors should consider integrating the Triple Aim concept into their business practices. • Most O&P facilities are already implementing strategies to improve the patient-care experience, via patient satisfaction surveys and similar patient-focused endeavors. Under Triple Aim, practitioners are expected to focus on safe, effective, patient-centered, timely, efficient, and equitable care. • Reducing per capita health-care costs means not only managing facility costs, but also focusing on value for money. Practitioners should spread the message that O&P is uniquely positioned as value-providing and cost-saving health care. • The O&P community can do its part to improve the population’s health by participating in the development and promotion of outcomes-based research and clinical practice guidelines, which will help ensure O&P patients nationwide receive a recognized standard of care.
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Improving population’s health
Reducing per capita healthcare costs
TRIPLE AIM
Improving patient-care experience
I
N ITS SIMPLEST TERMS,
the concept. In 2015, CMS state of flux, with potentially impactful reported that “delivery changes on the horizon, the concept of the “Triple Aim” concept is system transformation across “value” defined by Triple Aim will likely a common-sense approach to the country has made signifnot be diminished, agrees Rebecca Hast, health care: The three aims Hanger senior vice president and chief include improving the patienticant progress in achieving compliance officer. “It’s hard to argue care experience, improving the [goals of ] Triple Aim.” that it doesn’t make practical sense in the the population’s health, and O&P professionals should long term of patient care. As the market reducing the per capita health- Michael Oros, CPO, understand what Triple LPO, FAAOP determines what changes will ultimately care costs. But embracing those Aim means and consider be rolled out, it is a good time to prepare objectives simultaneously—as implementing strategies in ourselves and think about our clinics intended when the concept was initheir workplaces to achieve its goals. through this lens of Triple Aim.” This holds true even if the Affordable tially developed 10 years ago—actually Care Act (ACA)—which incorporates requires a great deal of forethought Triple Aim concepts—is repealed, says and strategic planning. O&P Under Triple Aim Michael Oros, CPO, LPO, FAAOP, presChallenging as it may seem, O&P While most health-care professionals businesses will need to understand understand the concept of Triple Aim, ident of AOPA and president of Scheck and adopt the Triple Aim framenot everyone has translated it into & Siress Inc. Oros believes Triple Aim discrete correlated activities in their will survive the health-care reform work if they are to succeed in today’s clinics, says Hast. “‘Value,’ initiatives currently underway: demanding health-care environment. as it pertains to smaller “With all of the momentum and In 2008, the Institute for Healthcare ancillary services like O&P, attempts to repeal and replace the Improvement (IHI) created the is still in the process of concept as a guide for the development ACA in some manner, the core receiving a clear and robust principles embedded in Triple of new approaches to the appropriate definition from payors, Aim will likely carry on, regarddelivery of health-care services. (See which will help clinics as sidebar, “Evolution of Triple Aim.”) less of changes to the legislation,” they determine how to Since then, public and private healthhe says. Rebecca Hast apply Triple Aim to their care entities across the nation have Even though the U.S. healthown practices,” she says. been moving forward in embracing care legislative climate is in a O&P ALMANAC | AUGUST 2017
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Focusing on the aims may be a natural fit for O&P facilities, considering Triple Aim is all about “value coupled with the right clinical solution for the patient,” says Hast. Improving satisfaction means meeting and exceeding patient expectations. Hast suggests that O&P facilities look at Triple Aim as “good business and clinical practice, with thought around ‘patient experience’ and cost-effective operations.” Hanger has been incorporating the Triple Aim concepts into its day-to-day activities for several years, according to Hast. “Hanger’s interest preceded the onset of ACA in 2010, but the market dialog began in earnest at that point—particularly fueled by accountable care organizations and patient-centered medical homes,” recalls Hast. “None of those concepts were new, but looking at them as coordinated and having correlation to one another was intriguing. It signified the industry is moving to a longer-term strategy, recognizing that each component is important and interrelated to the others in order to be successful.” Hanger integrated this kind of thinking into its business practices by developing patient satisfaction surveys and feedback initiatives, publishing clinical guidelines, and managing its cost structure. For those who have not studied the concept, now is the time to take action and revamp business practices 34
AUGUST 2017 | O&P ALMANAC
notes that such efforts can be as simple as sending postcards through the mail or using online survey software. “There are many options for this, and collecting a large enough sample on a timely basis will provide valuable insight into the patient experience. Take the feedback seriously and be committed to make the changes,” she suggests. But fully embracing Triple Aim means taking “satisfaction” strategies one step further and considering the entire patient experience. The IHI defines “patient experience” by the six Institute of Medicine dimensions: safe, effective, patient-centered, timely, efficient, and equitable. Providing care based on these factors is critical. Focusing on the six dimensions to in alignment with Triple Aim. The improve the entire patient experience national movement toward Triple Aim is dependent on the “attitude and will have a significant impact on how behavior of the people on the front health care will be delivered going line,” explains Sandy Rogers, global forward, says Oros, so “every O&P customer loyalty practice leader for facility needs to be marching toward it. FranklinCovey, who will O&P facilities that are fragspeak on the topic at the mented should start thinking AOPA World Congress. At of how they can integrate more an O&P facility, the frontinto the system, so O&P is not line workers include the left out on an island.” orthotist/prosthetist, the Taking a closer look at each technician, the receptionist, of the aims offers O&P profesthe billing department—“anysionals a chance to determine Sandy Rogers how their facilities are already body who interacts with the aligned with Triple Aim and patient,” says Rogers. identify areas where they need to “Loyalty is earned one great expeadopt new business practices to align rience at a time. Improving patient more closely with its principles. loyalty requires our front-line people to deliver great experiences to patients more consistently,” acknowledges Improving the Patient-Care Rogers. “And to change the behavior Experience of front-line people, they need inspiraPerhaps the easiest way for O&P facilities to embrace business practices that tion and accountability.” According to are based on Triple Aim theories is by Rogers, inspiration at an O&P facility working to improve the patient expecomes from the front-line leader—the facility owner or manager. “The most rience. “O&P has a longer history of recording patient satisfaction—more so important role of a front-line leader is to put their people into a position than documenting clinical outcomes,” to enrich the lives of their co-workers says Oros. and patients,” he says. “The easiest thing to do is to start Accountability also is important: getting feedback from patients about “You need trustworthy metrics so their care—not just from the patients front-line leaders can celebrate the who are satisfied,” says Hast. “This people on the team doing great work type of information is helpful to any and so they also know who needs addifacility, whether large or small.” And it doesn’t have to be difficult—Hast tional coaching,” says Rogers.
EVOLUTION of Triple Aim The Institute for Healthcare Improvement (IHI) developed Triple Aim in 2008 as a guide for the development of new approaches to the appropriate delivery of health-care services. At the time, seeking to achieve all three goals—improving patient care and the population’s overall health while also reducing costs— simultaneously was “considered somewhat radical,” according to IHI’s Primer on Defining the Triple Aim. Still, the concept moved into the spotlight during the development of the Affordable Care Act (ACA). The legislation, passed in 2010, similarly focuses on achieving improved care at lower costs, and it is widely believed that IHI’s Triple Aim framework was referenced by many of the stakeholders involved in writing the ACA. Triple Aim was pushed forward by Don Berwick, one of its architects and the CMS administrator when the ACA was passed. Berwick made transforming the U.S. health-care system in accord Eileen Levis with the vision set forth in Triple Aim his highest priority, says Eileen Levis, president/chief executive officer of Orthologix and coordinator for the session on Triple Aim at the upcoming AOPA World Congress. “Health-care providers throughout the country began then, and are continuing, to aggressively tackle performance improvement within their own organizations, and evidence shows that their efforts are working,” Levis says. In 2015, the U.S. Department of Health and Human Services (HHS) launched the Health Care Payment Learning and Action Network to help advance the work being done across sectors to increase the adoption of value-based payments and alternative payment models in support of Triple Aim, says Levis. HHS is working with partners in the private, public, and nonprofit sectors to transform the nation’s health system to emphasize value over volume: “HHS has set a goal of tying 50 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2018,” Levis explains. “HHS also has set a goal of tying 85 percent of all Medicare fee-for-service to quality or value by 90 percent by 2018.”
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O&P facilities that focus on patient satisfaction, and develop inspired and accountable management and staff, will be best positioned for success in the area of patient experience.
Reducing Per Capita Health-Care Costs
Finding ways to reduce costs has been critical to the survival of O&P facilities in recent years. While the reimbursement climate is decidedly difficult, O&P facilities should nevertheless seek to manage their costs to improve profitability. “There is now, and will continue to be, pressure on reimbursement,” notes Hast. She recommends that O&P facilities examine how much time it’s taking to provide services. “Begin to think about your cost structure, and whether you are as efficient as you can be.” In addition to considering in-facility cost savings, reducing per capita costs has a larger meaning, according to IHI: Focusing on value for money invested, rather than cost reduction, is the optimal way to achieve this aim. IHI’s Primer on Defining the Triple Aim states that simply slowing unsustainable growth in costs “is not good enough; we must find ways to reduce per capita costs and allow society to use these resources in other ways.” “Cost-effective care is not just about what patients pay to get care, but also about examining whether the service or product is the best benefit,” says Hast. “Cost-effective care is really about the best outcome for the patient, given an honest assessment of where the patient is. And it’s more complicated than simply providing the ‘least expensive’ device.” “Lowering costs doesn’t necessarily mean lowering prices,” agrees Oros. “It can mean improving the quality of care,” which leads to overall improved outcomes. To work toward that aim, it’s important to know the value of the services you are delivering, says Oros. “Our value is much more encompassed in the entire service model—including the clinician’s time, expertise, and time spent with the patient.”
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Looking to Surgeons as a Model O&P facilities looking to adopt a Triple Aim approach to health care can follow the lead of hip and knee surgeons. Mark Froimson, MD, MBA, president of the American Association of Hip and Knee Surgeons (AAHKS), says that AAHKS members have “reimagined health care centered around the patient.” Froimson, who will speak on the topic at the Mark Froimson, AOPA World Congress, says the key is to think about MD, MBA delivery of care from the patient’s perspective. “We need to provide care that is well-coordinated, that integrates into patients’ lives, and that is understandable to them,” he says. This will result in better outcomes as well as lower costs because there will be fewer problems along the way, he suggests. For the hip and knee surgeon community, for example, comprehensive restoration of joint function “starts at the moment the patient concedes they have a need for care,” says Froimson. “We engage the patients early, understand their preferences, and, if it is decided to proceed surgically, then we replace the joint. We continue care all the way through to follow-up.”
Given the ability of orthotic and prosthetic intervention to return patients to more active lifestyles—and often return patients to work—O&P is uniquely positioned as value-providing health care, which fits naturally within the tenets of Triple Aim, says Hast. “We can use our care and expertise to keep patients mobile,” she says. With a focus on cost-effective care comes an opportunity to educate others about the value of O&P intervention. O&P professionals should do their part to teach payors that certain O&P treatment protocols have an effect on health-care savings “downstream,” so that payors will be able to “make the connection between staying mobile and mid- to long-term benefits to patients and payors,” says Hast. She encourages O&P professionals to stay in touch with some of the larger payors and “have conversations about how they’re viewing value…especially as it has to do with ancillary services.” 38
AUGUST 2017 | O&P ALMANAC
Oros also believes educating payors can lead to recognition of O&P as a cost-saving health-care service. “For example, orthotic intervention lowers overall health-care costs and results in shorter hospital stays,” as proven by the recent AOPA-sponsored Dobson-Davanzo studies, says Oros. The soon-to-be-released RAND study is expected to further support the value of O&P care and will likely provide evidence of the ability of timely O&P intervention to deliver payor savings. These studies hit the Triple Aim’s point of lowering costs, as well as increasing patient satisfaction, Oros notes.
Improving the Population’s Health
The aim to focus on improved overall population health is the portion of the Triple Aim concept that is most often overlooked—but just as important as the other two aims, according to IHI. “True Triple Aim improvement cannot be realized by health-care
systems acting alone, nor by solely delivering high-quality care at lower costs,” reports the Primer. “Improving health is a challenge that requires the engagement of partners across the community to address the broader determinants of health.” For O&P specifically, the development of further outcomes-based research and clinical practice guidelines (CPGs) will be critical to achieving this aim. “The O&P industry needs to be able to gather around and commonly agree there are certain best practices that we can demonstrate to other stakeholders,” explains Hast. “The most complicated piece [of Triple Aim] for individual practices will be clinical guidelines and standards.” She expects there will be more and more information available on the subject of clinical practice outcomes and guidelines in the literature and from associations, and encourages O&P clinicians to stay informed on this topic. “This is where the associations, like AOPA, will be helpful, and staying abreast of development in the industry will be important.” Clinicians at Scheck & Siress are “making more of a commitment to studying clinical outcomes,” says Oros. “We are working on understanding the ‘before’ and ‘after’ of O&P intervention”—for example, recording what the expected clinical outcome was, and whether the expected outcome was achieved—and if not, why it wasn’t. “We are trying to document clinical outcomes that matter to patients,” says Oros. Several O&P clinicians and researchers are already doing their part to advance the O&P evidencebased research pool by writing CPGs, which are generally designed to promote quality by reducing healthcare variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective—or potentially harmful—interventions. Late last year, Hanger Clinic colleagues treaded into the CPG waters when they developed and presented guidelines on two O&P topics at a meeting of the American Congress
of Rehabilitation Medicine (ACRM). These O&P CPGs also were published in the Archives of Physical Medicine and Rehabilitation. The documents focused on two important areas within the prosthetic profession: “Acute Postoperative Care of the Residual Limb Following Transtibial Amputation” and “Prosthetic Foot Selection for Individuals With LowerLimb Amputation.” And in January, a CPG on cranial orthosis treatment of positional skull deformation in infants, written by Hanger Clinic Cranial Specialist Jim Brookshier, MSPO, CLPO, in conjunction with Texas Children’s Hospital, was published in the Journal of Neurosurgery: Pediatrics. In addition, the U.S. Department of Veterans Affairs (VA) has published several CPGs of its own. Two of the VA’s CPGs focus specifically on O&P-related topics, including “Lower-Limb Amputation” and “The Management of Upper-Limb Extremity Amputation Rehabilitation.”
Beyond considering outcomesbased research and CPGs, O&P facilities that seek to adopt Triple Aim objectives and integrate into a value-based health-care model will need to look outside of their individual facilities and into the broader U.S. health-care arena to determine how O&P can contribute to the greater goal of improving the population’s health.
principles ultimately are guiding principles for good patient care,” says Oros. “It’s the right thing to do for patients.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.
A Common Goal
IHI’s original goal in developing the Triple Aim framework was to “galvanize large-scale health improvement.” O&P facilities that adapt their business practices to adopt the three aims— simultaneously—will put their facilities on the track to a more consistent and focused approach to patient care. As U.S. health care transitions from fee-for-service to newer payment models, O&P businesses and clinicians will need to understand how to succeed in the new climate. “Regardless of what happens with health-care reform, the Triple Aim
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O&P ALMANAC | AUGUST 2017
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& NOW
THEN
1918 ALMA Annual Meeting
The National Assembly Turns 100 AOPA members have forged strong connections over the years by attending AOPA’s annual meetings Then & Now is a monthly department for 2017. As part of AOPA’s centennial celebration, O&P Almanac will feature a different AOPA product or service and discuss how it has evolved over the years. This month, we focus on the association’s annual convention, the AOPA National Assembly.
N
EXT MONTH’S AOPA WORLD CONGRESS and 100th Anniversary
Celebration will bring together AOPA members and O&P stakeholders from across the world to engage in clinical education, view the latest technologies, and celebrate 100 years of the formalized O&P profession in the United States. While technological innovations have made it much easier for members to engage in “virtual interactions” such as online learning sessions, webinars,
1940 ALMA Annual Meeting
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AUGUST 2017 | O&P ALMANAC
discussion groups, and social media hubs, the value of in-person meetings has never diminished. Over the years, AOPA’s National Assembly—and World Congress this year—have empowered members of the orthotic and prosthetic profession and community to forge strong personal connections and build partnerships. This September, AOPA members and international stakeholders will convene in Las Vegas to continue the tradition that began one century ago.
THEN
When AOPA was first established as the Artificial Limb Manufacturers Association (ALMA) in 1917, just 12 representative limb manufacturers comprised the organization. But those 12 members immediately sought to expand membership to “all reputable and trustworthy manufacturers of the
United States and Canada who were willing to pledge themselves to strict propriety, and to use every effort to purge the industry of the incompetent and unscrupulous,” according to ALMA’s 1922 “Open Letter to Each Physician and Surgeon of the Land.” By the following year, 33 members assembled at the 1918 Annual Convention in Indianapolis. Between the years of 1917 and 1922, ALMA held eight meetings in different states, and set up regional offices throughout the country. A 1937 issue of The ALMAnac—the association’s seminal publication— featured a “Convention News” section that described the 18th Annual Artificial Limb Manufacturers Association and Convention in great detail. Approximately 100 members and their guests attended the meeting, which was held October 4-5 at the La Salle Hotel in Chicago. The convention was described in The ALMAnac as “by far the most successful our organization has enjoyed since its birth.” The program was “educational and outstanding not only to limb manufacturers but to supply dealers and guests as well.” Highlights included a President’s breakfast; the annual meeting; exhibits, including displays by Ohio Willow Wood, Minneapolis Artificial Limb Co., Knit Rite Co., and more; and evening social activities, including private dinners.
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THEN & NOW
1967 AOPA National Assembly and 50th Anniversary celebration
Thirty years later, the 1967 National Assembly was held at the Fontainebleau Hotel in Miami Beach, Florida—dubbed “the world’s most beautiful resort hotel” at the time. Educational and scientific displays were a big focus that year; some of the featured displays included a sampling of experimental plastic leg braces, a 20-foot display on prosthetics from the VA Prosthetics Research Center of New York City, and a scientific exhibit from the Orthotics Research Project of the University of Michigan Medical School, according to the July 1967 AOPA Almanac. In the 1970s, the yearly AOPA National Assembly continued to be a popular member benefit. At the time, most Assembly activities were planned and organized by members, says Don Hardin, who volunteered for the National Assembly Committee in the 1970s and 1980s and served as AOPA president in 1991-1992. The
conventions continued to be held in hotels rather than convention centers. Attendees always enjoyed these annual gatherings, which were anticipated each year as fun networking opportunities; participants enjoyed the socializing aspect as much as the exhibit and educational components, Hardin recalls. A significant addition to the yearly meeting was made in 1995, when it was announced at AOPA’s September Assembly that J.E. Hanger Inc. had established the Howard R. Thranhardt Education Series in memory of Howard R. Thranhardt. The fund would be used to provide a $1,000 honorarium for one hour of programming at each year’s AOPA National Assembly and Academy Annual Meeting for the next 30 years. The stockholders and directors of the company stated that the honorarium should be awarded to the presenter or presenters selected by the educational chairman of the meeting. Since this program debuted, the Thranhardt Lecture Series has been one of the most popular and well-attended sessions at the AOPA National Assembly, generating and disseminating important O&P research.
2013 World Congress
1967 AOPA National Assembly ribbon cutting
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AUGUST 2017 | O&P ALMANAC
Another milestone occurred in 2013, when AOPA hosted the first World Congress during its National Assembly at the Gaylord Palm Resort in Orlando, Florida, September 18-21. The international event brought together thousands of prosthetists, orthotists, physicians, technicians, scientists, researchers, engineers, pedorthists, and others, and featured a
140,000-square-foot exhibit hall. The success of this event prompted AOPA to host the second World Congress, to be held next month.
NOW
The popularity of the AOPA National Assembly continues to grow, with thousands of attendees gathering yearly to share ideas, attend educational sessions, view exhibits, and network in a different location each year. “You make a lot of lifelong friends in this profession, and there’s a lot of personal commitment,” says Charles H. Dankmeyer Jr., CPO, who served as AOPA president in 2014-2015. Those friendships thrive in the personal interactions unique to the AOPA National Assembly—even in the digital age. This year’s event, at the Mandalay Bay Resort and Casino, will be truly unique, as it will bring international O&P stakeholders to the World Congress while featuring special events to commemorate 100 years of AOPA’s rich history. In addition to the always-anticipated educational sessions, exhibits, and networking opportunities, attendees will have the opportunity to take part in centennial celebrations. At the Walk Through Time, participants will view a display highlighting the evolution of O&P devices over time. The Technology Transfer session will provide an opportunity for inventors to meet with potential investors to advance the development of new technologies. And the closing event—the Party With a Purpose—will be a blowout social event that also serves as a fundraiser for the O&P PAC. Over the years, AOPA members have made it a point to participate in AOPA’s annual National Assembly, to interact with like-minded O&P professionals and advance their knowledge base. With this year’s centennial celebration integrated into the meeting, the World Congress and 100th Anniversary Celebration is another event bound to go down in AOPA history.
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BRIDGE TO THE FUTURE: THE INTERVIEWS
High-Tech Gait Salvage How new technologies are keeping diabetes patients mobile and preventing amputations
Bridge to the Future: The Interviews is a monthly column for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will look to the next 100 years—by interviewing noted experts in the O&P field to learn their vision for the future of O&P. This month, we speak with David G. Armstrong, DPM, MD, PhD, on the topic of gait salvage and new technologies supporting increased mobility.
M
ANY O&P PROFESSIONALS SPEND a significant amount
of time treating diabetes patients— amputees and nonamputees alike. Educating patients about ways to prevent and reduce ulcers and other foot problems may lead to a healthier, more mobile diabetes population. As we look to the future and seek more innovative treatment protocols, it’s important to examine new technologies—such as sensors and wearables—designed for the early detection or prevention of ulcers and infections among the diabetes population.
A Growing Problem
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AUGUST 2017 | O&P ALMANAC
PHOTO: Getty Images/FangXiaNuo
Diabetes is one of the leading causes of amputations among Americans: About 60 percent of nontraumatic lowerlimb amputations among adults occur in people with diagnosed diabetes, according to the American Diabetes Association. Several factors contribute to amputation among diabetics, including nerve damage or diabetic neuropathy, nonhealing ulcers, skin and foot problems related to peripheral arterial disease, and calluses. David G. Armstrong, DPM, MD, PhD, has focused his work as a podiatric surgeon on improving foot health to promote gait salvage among diabetics. Armstrong, who until recently was professor of surgery at the University of Arizona
and deputy director of the Arizona Center for Accelerated Biomedical Innovation, took a new position as director of the Southwestern Academic Limb Salvage Alliance a the University of Southern California. He also is co-founder of the Southern Arizona Limb Salvage Alliance (SALSA). Armstrong describes himself as a “toe mechanic” by training and believes all foot-care professionals should coordinate their efforts to optimize diabetic patient care. “Podiatrists, orthotists, pedorthists—we all work together to help people move through the world,” he says. “The most common reason someone ends up in the hospital for diabetes is because of their feet,” Armstrong says. Many diabetes patients develop ulcers, half of which get infected—and “20 to 30 percent of those end up in some form of amputation,” he says. Armstrong notes that three quarters of people with wounds are likely to have another wound within five years. “The diabetic foot is a lot like cancer—care of lower-extremity diabetes is more expensive now than costs associated with the five top cancers,” he says. More than half of diabetics who have amputations die within the next five years, according to Armstrong. “The reason they die
BRIDGE TO THE FUTURE: THE INTERVIEWS
PHOTO: Getty Images/FangXiaNuo
is cardiovascular morbidity and mortality—but it’s really because they’re not moving,” he says. Armstrong believes that helping people move through the world is an important responsibility for all health-care providers. “The good news is that many of these [wounds and infections] can be prevented,” he says. There are several new procedures and technologies to help navigate in this space, according to Armstrong. “Gait salvage is really about getting people moving—getting them walking into the clinic.”
High-Tech Solutions
Armstrong has been working on “wearables” for diabetes care for 25 years. Often paired with smartphones and mobile apps, “wearables are ubiquitous now and provide astonishing data,” he says. Smartphones can collect activity data and monitor other vital signs and indicators. “There are algorithms that can nudge patients to move, so they don’t get pressure sores,” he explains. Several up-and-coming technologies will help patients “salvage their gait,” according to Armstrong. For example, the work of his team at SALSA, in conjunction with Harvard Business School and the Massachusetts Institute of Technology, has led to the development of numerous technologies, including a “supercool bath mat” that facilitates foot health for people with diabetes. “Our team has published several studies showing that a wound
PHOTO: https://siren.care
Siren Care’s “smart socks”
David G. Armstrong, DPM, MD, PhD
will heat up before it breaks down,” he explains. Evaluating skin temperature can help a patient seek treatment before a wound becomes a problem, says Armstrong. People can step on the next-generation bath mat each day and easily have their foot temperature measured. The bath mat then “communicates” via a text, phone call, or the mat itself, when a toe has gotten hotter. This information prompts the diabetic to visit a clinician before a wound develops fully. Taking this idea one step further, some companies have designed wearables, such as wireless shoe inserts and boots that detect foot issues. The work of Armstrong’s team in the area of intelligent textiles ultimately led a company to develop one of the most innovative of these types of wearables: “smart socks.” Siren Care’s recently released smart socks measure temperature, and, according to Armstrong, “They look ordinary, and they are not costly. Being that wounds heat up before they break down, they can signal inflammation and help prevent amputation.” Ran Ma, the company’s co-founder, began working on the socks while at Northwestern University. The socks use temperature sensors to detect inflammation in real time for patients. All data is stored on the sock, on an app, and in the cloud; when the sock detects a high-temperature difference,
the app sends an alert to have the foot checked, says Armstrong. “This is an example of how wearables and consumer electronics are becoming merged and blurred,” he says. In addition to wearables, researchers also are exploring “implantable sensors.” Armstrong notes that implanting sensors to detect glucose levels or to assist in artificial blood vessels in bypass surgery are the next steps in preventive medicine. Finally, Armstrong predicts that “wearable robots” are no longer just a sci-fi fantasy. These will provide a solution to the problem of, “How can we help people move through the world, without completely doing it for them?” he says. “We envision that very soon, patients getting out of bed, instead of using a wheelchair or walker or even prosthetic leg, could be walking into a partial exoskeleton” that can help them achieve their mobility goals. As technologies such as the ones being developed by Armstrong and his colleagues come to market and become available for widespread adoption, it is hoped that more patients will seek treatments that prevent amputations and promote mobility. “The whole idea of ‘gait salvage’ is the fundamental nexus of what it means to be a human being,” says Armstrong.
Don’t Miss the Gait Salvage Session at the World Congress
Hear more on this topic by attending the “Gait Salvage: The Importance of Mobility” session at the upcoming AOPA World Congress and 100th National Assembly. The session, scheduled for Thursday, September 7, 3:15-4:30 p.m., will be presented by David G. Armstrong, DPM, MD, PhD, along with Eric Burns, CPO; Mallory Lemons, CPO; and Holly Olszewski, CPO.
O&P ALMANAC | AUGUST 2017
45
THE GLOBAL PROFESSIONAL
Katia Langton, CPed, CPed(C), DC Vancouver Island, Canada Canadian pedorthist/chiropractor shares experiences in treating the neuropathic foot and painful foot conditions
O&P ALMANAC: Describe a typical
work day for you.
KATIA LANGTON, CPED, CPED(C), DC:
As the O&P profession prepares for the Second O&P World Congress, to be held in conjunction with AOPA’s 100th anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a question-and-answer section with international O&P experts. Each month, we spotlight an O&P professional from a different part of the world to find out how O&P is practiced across the globe.
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PHOTO: Katia Langton, CPed, CPed(C), DC
Canada
I work in both a private clinic and a public screening clinic, and in both clinics we see patients with foot, ankle, knee, hip, and low-back problems. I assess, risk-categorize, educate, and treat patients with the goal of keeping the patients on the ground and mobile so we can prevent chronic lifestylerelated diseases (of sedentary behavior), the largest being diabetes—the global pandemic with its complications of diabetic foot disease. The public screening clinic is the Central Vancouver Island Foot and Ulcer Protection Clinic, a multidisciplinary clinic that provides diabetic foot screening and risk assessment to diabetic patients on a regular basis. We risk-categorize patients from a 0 to 3 scale, with 3 being assigned to patients who already have wounds or amputations. I am also the owner of Island Pedorthic FootCare, where we assess and treat diabetic patients aggressively in risk categories 1 and 2 to prevent progression to risk category 3. Our focus is preventative off-loading with diabetic orthotics, which will reduce the number of ulcerations and foot complications we will see in the future. In both clinics we educate patients
on neuropathy, and we also address toenail fungus aggressively when found in conjunction with the neuropathic foot as this increases the rate of foot complications. Additionally, I lecture and teach health-care practitioners globally on differentially diagnosing the patients with stenosis and/or diabetic peripheral neuropathy. Stenosis—or neurogenic intermittent claudication— occurs when there is a degeneration of the lower spine, causing narrowing that puts pressure on the blood supply to the nerves of the back and lower extremities. This causes pain, cramping, and muscle weakness depending on where it is affecting the spinal cord. This pain mirrors and mimics diabetic neuropathy, but these must be differentially diagnosed and treated differently. Stenosis, which is prevalent in 60 to 70 percent of the aging population, can be reversible, but neuropathy is irreversible. In my private clinic, I follow a protocol developed by the Mount Sinai Hospital in Toronto using spinal mobility and core stability exercises. Additionally, I use cold laser therapy to treat both spinal stenosis and painful diabetic neuropathy. For the neuropathic foot, we protect against ulcers and amputations by off-loading with accommodative diabetic orthotics and orthopedic shoes with rigid rocker modifications.
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THE GLOBAL PROFESSIONAL
O&P ALMANAC: Describe the location
them from becoming sedentary and possibly diabetic. I also treat a lot of posterior tibial tendon dysfunction, as we find it is under-recognized and misdiagnosed and therefore treated inappropriately. Because I am a doctor of chiropractic as well as a pedorthist, I can treat the whole body. I use orthotics, footwear, and footwear modifications to treat neuropathy patients and mechanical foot pain. I use the stenosis protocol with cold laser therapy to treat stenosis patients. For ulcerations and Charcot foot, I use removable cast walkers, air casts, and off-loading wound shoes in order to close the wounds aggressively.
cover orthotics and chiropractic. All of the above will cover off-loading wound shoes and removable cast walkers. Patients who are not under any of those pay privately and have no coverage for off-loading wound shoes or removable cast walkers even if they are in grave danger of an amputation. However, prosthetic devices are covered after an amputation that was 85 percent preventable.
patients do you typically see, and what types of devices do you fit for these patients?
O&P ALMANAC: How are the devices
LANGTON: We do not have an audit
LANGTON: When a patient comes in,
Nations, they are covered for orthotics by the government. Disability/Social Services patients are covered by the government for shoes and orthotics. Patients in the Department of Veterans Affairs are covered for orthotics and shoes. Employer-extended benefits
where you provide services.
LANGTON: My private practice, Island Pedorthic Footcare, is located in Nanaimo on Vancouver Island in British Columbia, Canada. The Central Vancouver Island Foot and Ulcer Protection Clinic is located nearby in a large clinic with 33 medical doctors. I spend about half of my time at each location. Additionally, I travel to multiple First Nations communities [equivalent to Native Americans in the United States] to provide foot-screening services. O&P ALMANAC: What types of
they are in one of three categories: stenosis patients, diabetic neuropathy patients, or patients with mechanical foot pain. The goal with the stenosis and mechanical foot pain patients is to keep them active and mobile to prevent
you provide paid for?
LANGTON: If patients are from First
O&P ALMANAC: If the payor is other
than the patient, do nonpatient payors have an audit process? If there is an audit process, do you consider it to be fair? process. However, we do have to go through a lot of paperwork to get devices covered. If we treat a patient from Disability/ Social Services or First Nations, we don’t get paid for the exams. We do have to complete paperwork, and we do get paid for the device, but not for the exam. We also have to be careful that exams are conducted within the proper time frames so that they are covered. O&P ALMANAC: Describe your edu-
s Content
A guide
for hea
ions mendat
ction Introdu Peripheral Diabeticropathy Neu Peripheral Disease Arterial Ulcers
Foot Diabetic n Infectio Neuroy Charcot thropath osteoar
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AUGUST 2017 | O&P ALMANAC
cational background and any certifications you have. How do you keep your skills sharp? LANGTON: I first studied and became
a doctor of chiropractic, then I became a CPed, then a Canadian CPed(C). I’ve also taken several courses, such as the stenosis treatment protocol course, cold laser therapy, and advanced treatment of posterior tibial tendon dysfunction.
PHOTOS: Katia Langton, CPed, CPed(C), DC
m ice Reco ical Pract 017 IDF Clin iabetic Foot – 2 D e on th lthcare professionals
Foreword
THE GLOBAL PROFESSIONAL
I was appointed in April 2016 to the Diabetic Foot Stream Committee of the International Diabetes Federation (IDF), where we’ve been working for the past year or so on developing guidelines to prevent ulcers and amputations; these were just published in the document “IDF Clinical Practice Recommendations on the Diabetic Foot—2017” (www.idf.org/our-activities/ care-prevention/diabetic-foot.html). I’ve done a lot of research in this capacity. I lecture at conferences to all health-care practitioners on preventing diabetic foot ulcerations and amputations on a global level. Loss of protective sensation, coupled with limited joint mobility and foot deformities, leads to a predictable pattern and outcome of ulceration, Charcot arthropathy, and amputation. These are largely preventable—but little understood—by most health-care practitioners and patients. Preventative off-loading will reduce the number of ulcerations and foot complications we will see in the future. Systematic adherence to international best practice guidelines will reduce
overall costs and make health care sustainable in the future as diabetes progresses on a global level. O&P ALMANAC: What’s the biggest challenge you face as a practitioner, and how do you deal with it? LANGTON: Patients arrive in our
clinics all the time and have never had a diabetic foot exam and have had diabetes for five, 10, 20, or 30 years. A lot of times, they already have advanced diabetic peripheral neuropathy, and sometimes they already have ulcers or a Charcot foot. These patients come in without any education, sometimes little funding available, and we have limited time and resources to educate, treat, and prevent deleterious complications with financial restraints. The patients are so thankful for the help and education and to have their mobility increased and a new lease on life if we can help them and protect their feet. O&P ALMANAC: Describe any chari-
table work you or your organization does.
LANGTON: I travel with my foot-care
nurse, and we do a lot of diabetic foot screenings in our community and neighboring communities on a volunteer basis. Working with the IDF to create diabetic foot guidelines is a volunteer appointment. I do a number of educational conferences globally each year on a volunteer basis to teach prevention of diabetic foot amputations and ulcerations, including teaching at the Leprosy Hospital in Karigiri, India, in February 2017. I’m also working on a research project with Edward Jude, MD, MRCP, a professor and endocrinologist in the United Kingdom; we are looking at patients who have been sent into wound clinics with neuropathy diagnoses who actually have stenosis—or both conditions. We will be presenting that research in Portugal later this year to raise awareness with health-care practitioners on the need to differentially diagnose these and refer for treatment for each condition separately.
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O&P ALMANAC | AUGUST 2017
49
MEMBER SPOTLIGHT
Tom Watson’s Prosthetics and Orthotics Lab
Lifelong Commitment to Veterans Practitioner has spent decades treating military amputees as well as the civilian population
T
OM WATSON’S PROSTHETICS AND ORTHOTICS LAB
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AUGUST 2017 | O&P ALMANAC
Jeffrey Phelps, CPO, vice president of the facility, works with a patient.
FACILITY: Tom Watson’s Prosthetics and Orthotics Lab OWNERS: Tom Watson, CP, and Barbara Watson LOCATIONS: Owensboro, Kentucky, and Evansville, Indiana HISTORY: Thirty-six years
Tom Watson, CP
In recent years, the facility has adapted its business practices in response to changes in reimbursement and regulation. “Fortunately, we lived through the prepayment audit, ‘Dear Physician’ letter period of 2012,” Watson says, “and like everyone else, we continue to fight for reimbursement.” The facility has two clinicians today, and has increased administrative staff to deal with reimbursement and compliance issues. The company has adopted an electronic medical records system, “almost a ‘must’ with authorizations and collection of physician notes for documentation,” says Watson. “We also hired a billing service in Indiana that handles denials and appeals, and we haven’t had any auditing issues. In fact, we actually received payment for claims dating back to 2012.” Watson received AOPA’s Lifetime Achievement Award in 2016, in recognition of his commitment to the field. A past president of the association, Watson is still active in legislative
affairs, an area dear to his heart. “The field is so small and we have such an unusual story, if we don’t tell it, nobody will,” he says. “We represent a small number of people, but our product is expensive, and many legislators just don’t understand. They think it just comes out of a box.” Watson counts among his accomplishments his involvement in the passage of licensure in Kentucky, and he expects additional states to enact similar statutes before long. A constant in Watson’s political and professional life is his interest in veterans. Early in his O&P career, he provided prosthetic services to a 90-year-old veteran of the Spanish Civil War, and since then has treated veterans from World Wars I and II, Korea, Vietnam, Iraq, and Afghanistan. “I have such a strong feeling about sacrifice and what they did,” he says. “And today, young folks are volunteering for that sacrifice. It is an obligation to make sure everyone is aware of it.” As mayor, Watson helps send off a Rolling Thunder contingent to Washington each Memorial Day and supports such events as concerts, highway dedications, and video showings in support of veterans. As a practitioner, he works with veterans and has been a member of AOPA’s VA Committee for more than 20 years. Looking ahead, Watson expects to continue his O&P work until the end of his mayoral term in 2020. “Once I get things squared away with the city, I’m buying a Class B motor home and taking off with my wife. After 48 years in O&P, I’ll be ready to make up for all the time we didn’t spend together.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
PHOTOS: Tom Watson’s Prosthetics and Orthotics Lab
has been a fixture in the two communities it serves for decades. In fact, many orthotic and prosthetic patients in and around Owensboro, Kentucky, and—just across the Ohio River—Evansville, Indiana, have frequented the facility since the 1980s. Owner and President Tom Watson, CP, has fostered a deep commitment to the community, where he was recently re-elected mayor of Owensboro after a hiatus of eight years. His family is likewise invested in the company—Watson’s wife, Barbara, is co-owner and handles the books. Their son, Jeffrey Phelps, CPO, grew up in the family business and currently serves as vice president. Watson, an above-knee amputee himself since 1970, has personally witnessed the advance of prosthetic technology. Today, his facility fits many microprocessor feet and ankles, knees, and upper-extremity devices. In addition, “we still do orthotic shoe inserts for the U.S. Department of Veterans Affairs (VA),” he says. He and Phelps use computeraided design in-house for nearly all prosthetic sockets. The use of central fabrication also comes into play, as Watson appreciates the quick turnaround. He believes central fab is the way of the future. “Facilities have to cut employee costs, and I think eventually practitioners will end up doing only extremely custom devices,” he says.
By DEBORAH CONN
NEW! Co-OP
Co-OP
An AOPA Member Benefit As an online reimbursement, coding, and policy resource, this site includes a collection of detailed information with links to supporting documentation for the topics most important to AOPA Members. Like a Wikipedia of all things O&P, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of our membership body.
Resources include: • State-specific insurance policy updates, • L code search capability, • Data and evidence resources, and so much more!
Learn more and sign up at
www.AOPAnet.org/co-op. www.AOPAnet.org
MEMBER SPOTLIGHT
The Bremer Group Co.
By DEBORAH CONN
Familial Support Florida brace maker builds on family tradition
T
HE BREMER GROUP DESIGNS and produces
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AUGUST 2017 | O&P ALMANAC
Patient wearing the VertAlign Spinal Support System
COMPANY: The Bremer Group Co. OWNER: Ross Bremer, CPO LOCATION: Jacksonville, Florida HISTORY: 23 years
Ross Bremer, CPO
or two sizes of ring fit virtually any head.” says Ross Bremer. The company patented the new Bremer Halo System and then came out with the Bremer halo crown, the first of open-backed rigid halo rings that allowed users to rest their head on a pillow. “We kept developing the product and added a lighterweight vest that was more comfortable than those made of thick plastic,” says Bremer. At the same time, Bremer Medical developed an offshoot of the airplane splint for upper arm fractures and shoulder issues, and an improvement on the foot abduction orthosis that could be used on either leg in infants born with tibial torsion. Bremer Brace of Florida was sold to its employees in 2016, and Bremer Medical to Acromed, which merged with DePuy Spine, a Johnson & Johnson Company. The Bremer Group Co. had its debut in 1994, when Ross Bremer sought to develop and commercialize a line of components for
Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
PHOTOS: The Bremer Group Co.
lumbosacral and thoracic lumbosacral back braces, including its flagship products, the ComfAlign and VertAlign spinal support systems. Founded by Ross Bremer, CPO, in 1994, the company can trace its origins back to 1934, when Bremer’s father, Wilmore, first became involved in manufacturing orthoses. D. Wilmore Bremer was a shop teacher in Jacksonville, Florida, who first encountered orthotics when a local doctor asked him to design a pediatric back brace, then an ankle-foot orthosis and polio bracing for his daughter. In 1935, Wilmore started Bremer Brace Manufacturing, renamed Bremer Brace of Florida Inc. when his son Ross purchased the business from him in 1968. Ross Bremer, born one year after the company’s debut, eventually became an orthotist, opening Bremer Brace patientcare facilities in Tampa and Clearwater while his father and uncle ran the Jacksonville location. Ross was prone to “make a better, kinder mousetrap” when dissatisfied with existing products and their effect on patients. When he became more active with trauma calls at the local hospital, he channeled his inner inventor in creating the Bremer halo. He and his brother, Paul, founded Bremer Orthopedic Co., later called Bremer Medical Co., to produce the halo. The Bremer halo was made of lightweight aluminum with interlocking teeth in the joints. “It had an adjustable ring so the orthotist could make one
thoracolumbosacral orthoses and lumbosacral orthoses called the VertAlign Spinal Support System. His wife, Karen, an attorney, soon joined the team to focus on administrative, regulatory, and health-care law issues. Today she is vice president of the Bremer Group. The Bremer Group next developed and patented the ConfAlign, a lumbosacral orthosis, as well as custom back braces, for use in O&P facilities, acute care hospitals, and rehabilitation centers. “We found that we could come up with a series of molds using the 3,000-plus custom plaster models of past customers. Practitioners can combine these to create more than 550 sizes and configurations, with minimal additional work to fit, customize, trim, and adjust,” he says. “It’s faster and less expensive.” One practice that sets him apart from other manufacturers, Ross Bremer believes, is his approach to supplying braces. He places a full inventory of his mix-and-match spinal brace components in every customer’s facility, on consignment. “So without up-front costs, clinicians can professionally custom fit someone within 45 minutes and then reorder what was used. This saves on expensive overnight shipping costs and lets the practitioner provide immediate orthotic care,” he explains. Bremer is always looking for ways to improve his products and services, and is a member of the North American Spine Society. “It keeps me informed on the orthotic needs, standards of practice, and the new and dramatic changes going on in the treatment of spinal issues.” No doubt, he will respond with new products and, in all likelihood, new companies.
Congratulations AOPA on 100 years of leading the profession. We are proud to have served together for generations.
AOPA NEWS
Mark Your Calendar for Health Care Compliance and Ethics Week, November 5-11, 2017!
A
OPA HAS PARTNERED WITH the Health Care Compliance
employees for one or all of the online seminars that will be Association to provide resources for members—including offered during the week: • Gift Giving: Show Your Thanks & Remain Compliant, many at no cost—to facilitate participation during the week and leading up to it. scheduled for Wednesday, Nov. 8. This week-long focus on compliance and ethics will give • Compliance and Ethics Association’s hosted webinar your organization the opportunity to introduce and reinforce on Thursday, Nov. 9 (free for AOPA members). the compliance and ethics standards your employees are • Teaching Professionalism and Ethics During Residency, expected to meet. Participation may contribute to positive on Friday, Nov. 10 (free for AOPA members). perceptions from the broader community about your facility’s Nearly all of the materials are WEBINAR | WEBINAR | WEBINAR commitment to ethical business made available on a complimentary practices. Taking part in Health basis. This is a cost-effective NOVEMBER 9, 2017 Care Compliance and Ethics Week opportunity to instill a sense of provides an opportunity to thank commitment to a value system employees and create a meaningful documented by your written dialog. It’s not only the right compliance and ethics program of a Compliance Program— thing to do, but it’s just common that is a win/win for your company Compliance Officer, Legal, and Human sense to have an effective written and for your patients. Resources—Can Work Together to compliance and ethics program for Tools to celebrate the week are Support and Advance an Effective your business. available at bit.ly/aopaethics. See Compliance Program AOPA will make available tools to the order form on the website, or assist in your participation. Use the on the following page, to access Free to AOPA Members! press release template AOPA has these resources. Fax this form to (Nonmembers $50) developed to let your community AOPA at 571/431-0899 and get know of your organization’s commitstarted with your celebration! ment. We will be sending out daily compliance tips and the chance to win prizes, and will be offering special educational opportunities, during Health Care Compliance and Ethics Week. See order form on right to prepare for Posters and giveaways are available to keep your staff Health Care Compliance and Ethics Week! engaged. If you don’t have a compliance officer on staff, this is the opportunity to assign that responsibility. Register
“Three Amigos”
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AUGUST 2017 | O&P ALMANAC
AOPA 2017 HEALTH-CARE COMPLIANCE & ETHICS WEEK
ORDER FORM
Health-Care Compliance & Ethics Week products
Questions about your order? Contact Ryan Gleeson at 571/431-0836 or email rgleeson@AOPAnet.org. American Orthotic & Prosthetic Association 330 John Carlyle St., #200 Alexandria, VA 22314 Phone: 571-431-0876 • Fax: 571-431-0899 www.AOPAnet.org • info@AOPAnet.org
www.AOPAnetonline.org/store
Sign up online at bit.ly/aopastore
Enter your user name and password for member discounts
Find products to use for fun giveaways to staff, and to help keep you compliant. Publication Title
Price
or fax this form to 571/431-0899.
Price
Member
Qty.
Nonmember
AOPA Compliance Guide CD This product will assist you in developing a compliance plan for your facility, as recommended by the Office of the Inspector General.
$159
$318
Health-Care Compliance & Ethics Week Tumblers 16 oz. Text reads: “Make Good Decisions” and includes the HCEW logo. Comes in a pack of 4.
$30
$30
Health-Care Compliance & Ethics Week Bic Grip Roller Pen Text reads: “Make Good Decisions” and includes the HCEW logo. Comes in a pack of 4.
$6
$8
Health-Care Compliance & Ethics Week Poster 20x28 Poster. Text reads “In any moment of decision, the best thing you can do is the right thing” and has AOPA and HCEW logos.
$5
$5
Total SUBTOTAL $ ______________ (include $7.00 shipping for products)
TOTAL $ _________________
Payment Information ______________________________ CONTACT NAME
Health-Care Compliance & Ethics Week Bundle (4-pack) 4 tumblers, 4 pens, 1 poster
$35
$35
Health-Care Compliance & Ethics Week Bundle (12-pack) 12 tumblers, 12 pens, 1 poster
$99
$99
______________________________ COMPANY
______________________________ ADDRESS
Webinars
Sign up online at bit.ly/2017webinars.
______________________________
Enter promo code “member” for the member rate.
All webinars begin at 1:00 PM EST and last 1 hour. Date
Webinar Title
______________________________
Price
Member
Price
Nonmember
November 8
Gift Giving: Show Your Thanks & Remain Compliant (Earn 1.5 CEs)
$99
$199
November 9
“Three Amigos” of a Compliance Program— Compliance Officer, Legal, and Human Resources—Can Work Together to Support and Advance an Effective Compliance Program
Free
$50
Teaching Professionalism and Ethics During Residency
Free
November 10
Total
CITY, STATE
______________________________ ZIP
______________________________ PHONE
______________________________ EMAIL
$50
______________________________ CREDIT CARD:
FREE White Papers and Samples
Access at bit.ly/aopaethics.
______________________________ NAME ON CARD
Take advantage of AOPA’s free resources to celebrate Health-Care Compliance & Ethics Week. AOPA will send you the following resources electronically. Free Resources
q f y
Price
White Paper: Why Do I Need a Compliance Plan?
Free
White Paper: Why Should I Celebrate?
Free
Sample Press Release Use this sample press release to announce that your company is celebrating Health-Care Compliance & Ethics Week.
Free
Sample emails to send your staff Tips on compliance, how to announce your daily activities
Free
Sample newsletter to send your staff Customize to announce your participation in CCEW and share information about your Compliance & Ethics plan
Free
Quantity
______________________________
Total
CREDIT CARD NUMBER
______________________________ EXPIRATION DATE
SECURITY CODE
______________________________ SIGNATURE
AOPA NEWS
AOPAversity Webinars AUGUST 9
SEPTEMBER 13
ABC Inspections & Accreditation Do you know everything you need to know about facility inspections and accreditation by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC)? Make sure your facility is meeting or exceeding expectations with regard to ABC accreditation by taking part in this webinar. Experts will discuss the following topics: • What can I expect during and after a site visit? • Which Quality Standards apply to O&P? • What can I do to prepare for accreditation? • Can you answer some accreditation myths and questions?
What the Medicare Audit Data Tells Us & How To Avoid Common Errors You can learn a lot about how to submit a claim that will be paid without delay just by examining Medicare audit data. Learn from the mistakes of others and pick up tips to avoid common errors. Log on for the August 9 AOPA webinar and hear from the experts on the following topics: • What claims and services are being denied? • Why are they being denied? • What can I fix, so my claims will not be denied?
AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2017webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Sign up for the half-year series and get three sessions FREE! This includes two bonus webinars added for Health-Care Compliance & Ethics Week Nov. 5-11. All webinars that you missed will be sent as a recording. Register at bit.ly/2017billing.
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Products & Services For Orthotic, Prosthetic & Pedorthic Professionals
AOPA Coding Experts Are Coming to Phoenix, AZ
EARN 14 CEs
PHOENIX
NOV. 6-7 | 2017
AOPA MASTERING MEDICARE:
Top 10 reasons to attend:
ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR
1.
Get your claims paid.
2.
Increase your company’s bottom line.
3.
Stay up-to-date on billing Medicare.
4.
Code complex devices
5.
Earn 14 CE credits.
6.
Learn about audit updates.
7.
Overturn denials.
8.
Submit your specific questions ahead of time.
9.
Advance your career.
Join AOPA November 6-7 in Phoenix to advance your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics. AOPA experts provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group. Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2017billing.
10. AOPA coding and billing experts have more than 70 years of combined experience.
Sheraton Grand Phoenix 340 North 3rd St, Phoenix, AZ Book by October 13 for the $179/night rate. bit.ly/2017billing Find the best practices to help you manage your business.
Participate in the 2017 Coding & Billing Seminar! Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .
www.AOPAnet.org
O&P ALMANAC | AUGUST 2017
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NEW MEMBERS
Elizur 9800A McKnight Road Pittsburgh, PA 15237 412/358-4523 Member Type: Patient-Care Facility Aaron Best, CO, BOCO
T
HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.
Aspire Prosthetics & Orthotics Inc. 506 Greenbriar Road York, PA 17404 717/430-6100 Member Type: Patient-Care Facility Knittel Ansa, CPO
Bioness 25103 Rye Canyon Loop Valencia, CA 91355 800/211-9136 Member Type: Supplier Level 1 Tom LeBlanc
Keystone Prosthetics & Orthotics 330 Main Street, Ste. 2 Dickson City, PA 18519 570/307-4191 Member Type: Patient-Care Facility Michele Summa, MBA Kinetic Prosthetics 720 E. Market Street, Ste. 102 West Chester, PA 19382 610/701-8266 Member Type: Patient-Care Facility Joshua Erickson, CTP Magnolia Medical LLC 5412 Dijon Drive Baton Rouge, LA 70808 225/615-8693 Member Type: Patient-Care Facility David Hyde
Magnolia Medical LLC 304 Highland Blvd., Ste. B Natchez, MS 39120 601/442-6493 Member Type: Affiliate Parent Company: Magnolia Medical LLC Magnolia Medical LLC 1950 E. 70th Street, Ste. H Shreveport, LA 71105 318/219-5219 Member Type: Affiliate Parent Company: Magnolia Medical LLC Nymbl Systems 201 E. Jefferson Street, Ste. 315E Louisville, KY 40202 859/333-7590 Member Type: Supplier Level 1 PLS—Pedorthic Lab Specialties 21500 Osborne Street Canoga Park, CA 91304 818/734-7080 Member Type: Supplier Level 1 Constantine Kumuryan
Morning, noon, or night— LCodeSearch.com allows you access to expert coding advice—24 hours a day, 7 days a week.
The Source for Orthotic & Prosthetic Coding
T
HE O&P CODING EXPERTISE the profession has come to rely on is available online 24/7! LCodeSearch.com allows users to search for information that matches L Codes with products in the orthotic and prosthetic industry. Users rely on it to search for L Codes and manufacturers, and to select appropriate codes for specific products. This exclusive service is available only for AOPA members.
Log on to LCodeSearch.com and start today. Need to renew your membership? Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org. www.AOPAnet.org
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AUGUST 2017 | O&P ALMANAC
O&P PAC UPDATE
We cordially invite you to attend 2017
T
HE O&P PAC UPDATE provides infor-
mation on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: • Jonathan Naft, CPO • Rick Riley The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level, which have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate, and other officials running for office, to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo. com/forms/op-pac-authorization.
with a
PURPOSE
SEPTEMBER
7TH 6:30-9:30 PM
MANDALAY BAY, LAS VEGAS This is a special event and will require a separate registration fee. For additional information about Party With A Purpose or to register, contact Devon Bernard at dbernard@AOPAnet.org.
• Enjoy a fun evening of Prohibition-style cocktails, a delicious dinner, live entertainment, and a cigar lounge • Support the PAC and the future of O&P at this special 100th Anniversary event *Due to publishing deadlines this list was created on July 1, 2017, and includes only donations/contributions made or received between June 1, 2017, and July 1, 2017. Any donations/contributions made or received on/or after July 1, 2017, will be published in the next issue of the O&P Almanac.
• Space is limited If you plan on attending the 2017 AOPA World Congress, Sept. 6-9 in Las Vegas, be sure to attend the “Party With a Purpose.” Space will be limited, so secure your spot early as the event is sure to be the cat’s pajamas! Stay tuned for more information on the event, including how to secure your spot, or contact Devon Bernard at dbernard@AOPAnet.org.
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MARKETPLACE
Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options.
Foam Box Lab Services for Diabetic, EVA, and Rigid Orthotics
2.0 Allard AFOs
Now all 2.0 Allard ankle-foot orthoses (AFOs) come with a Starter Interface Kit. Kit includes: One SoftKIT Pad and two Tibia Pads! For more information call customer service at 888/6786548. Make it a 2.0 Allard AFO today!
ALPS SP High Density Liner The SP High Density Liner features black fabric that allows for stability for active patients. The SP Liner has similar characteristics as silicone but provides the superior comfort of gel. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.
Custom Stealth Foot Orthotics Custom carbon-fiber foot orthotics—and boy, are they pretty. And strong. And lightweight. Trusted to protect the feet of our service members, this beauty goes more than skin deep. Fabrication available from foam boxes or Amfit digital files in two rigidities (firm or flex). Corrections and adjustments are molded into the carbon fiber to eliminate movement of pads and edges during wear. EVA heel counter maintains stability in the shoe or boot. Contact our customer service team to learn more today, orders@amfit.com or 800/356-FOOT(3668), x250.
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AUGUST 2017 | O&P ALMANAC
FootPrinter allows you to send your own boxes or use ours. Standard EVA orders manufactured in three to four business days; diabetic A5513, carbon fiber, and polypro in three to five days. PDAC-approved A5513 diabetic pricing includes shipping costs for bi-lam and tri-lam styles. EVA available in soft, medium, dual, firm, and cork blend. Carbon-fiber fabrication offered in flex or firm to best suit your patient. Milled polypropylene available in three widths and thicknesses for excellent fit and wear. Get started right away by emailing orders@amfit.com for an account form, or call 800/356-FOOT.
Anatomical Concepts Inc. PRAFO® RAPO™ Comparison • Totally adjustable and custom-fit ankle-foot orthoses that help manage numerous ankle/foot anomalies. • Custom-contoured aluminum heel connector bar helps control dorsi-plantar flexion by allowing infinite, measurable adjustments. Its ergonomically designed foot plate allows its liners to be replaced or cleaned easily without tools. • Universal right or left fit. What is the difference? The PRAFO® features a Kodel® vinyl reinforced liner which has hook-and-loop Velcro straps and chafes. The RAPO™ has one dorsum hook-and-loop Velcro strap and chafe, and two hook self-stick 1.5-inch Velcro straps secured directly to the liner. For more information, contact 800/837-3888 or visit AnatomicalConceptsInc.com.
MARKETPLACE CureVentions’s Pectus emBrace™ CureVentions’s Pectus emBrace™, invented by Joseph S. Pongratz, CPO, FAAOP, is designed exclusively for the treatment of pectus carinatum. The device works through implementing pressure gradients with Dynamic Force Plate technology to provide corrective compression over the pectus prominence. The Pectus emBrace™ was built with patient comfort in mind and promotes a new and more effective method of treating pectus carinatum. • 100 percent nonmetal components • Moisture-wicking KoolFlex™ fabric • Patent-pending Dynamic Force Plate • Latex-free and nonslip pads • Magnetic BOA™ closure for easy-on/easy-off • Allows 20+ hours of wearing time • Discreet low-profile design For more information, call 480/897-2207, or visit www.cureventions.com/pectus-embrace.
Introducing New Categories to the PDE© (Posterior Dynamic Element) Modular Composite Spring System Specifically designed for O&P devices, the PDE© is a modular composite spring system designed as a “plug and play” spring kit to address dynamic response bracing , unloading bracing, as well as prosthetic partial foot devices and more! Features: • Modular design • Contoured fit spring • Low profile • Now in nine categories • Exclusive Click Medical™ cuff system • Post align-able • Reusable Call for more details about our “PDE FOR FREE” c-fab special; call 800-FABTECH.
Custom Sockets When You Need Them! Custom sockets and systems are made from your measurements and adhere to the patented design principles established in our standard sizes. Shown here from left to right, Flexion Contracture, Ischial Weight Bearing TransTibial, Symes, and Knee Disarticulation custom sockets. At FLO-TECH® custom sockets and systems are shipped on the same day as ordered, if order is received prior to Noon Eastern Standard Time. We also have components for all systems. More info at www.1800flo-tech.com.
AP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com.
New 21A47 Soft Harness—Superior Comfort, Easy To Fit The 21A47 Active TH Harness is now available. Available in three sizes (small, medium, and large), this innovative harness may be used for transhumeral fittings with electronic or passive elbows. The support system, which consists of an arm sling and a sleeve, is not fastened to the socket, which makes it completely removable. Users will appreciate the soft, moisture-wicking material and added comfort provided by the axillary padding. Talk with your Ottobock sales representative at 800/328-4058 or log on to professionals.ottobockus.com.
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MARKETPLACE
Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options.
Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses. For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.
TayCo External Ankle Brace This external, over-the-shoe, and custom ankle-foot orthosis (AFO) offers adult patients increased stability and performance while allowing the continued use of existing footwear and foot orthoses. It’s an easy-to-use alternative to walking boots or other internal AFOs. Developed by the University of Notre Dame athletic trainer Michael Bean, in collaboration with Surestep and a team of physicians, the TayCo External Ankle Brace is available in both athletic and medical versions. Custom fabricated strictly from measurements, this device will allow patients to return to the field, work, and their lives much faster. Suggested L1970 and L2820. For more information, contact Surestep at 877/462-0711 or visit taycobrace.com.
SUBSCRIBE
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.
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Texas Assistive Devices (TAD) Texas Assistive Devices (TAD) products are designed for upper-extremity amputees and persons with hand dysfunction or partial hand amputation. The TAD system is meant to temporarily replace the hook or prosthetic hand on either body-powered or electronic upper-extremity prostheses to allow the user to efficiently and safely perform a wide range of activities. The system can also work with a W-H-O brace to which a quick disconnect coupler is attached in the palm area of the brace. TAD’s quick insert-release terminal device can hold a wide selection of interchangeable tools and implements including dining or cooking utensils, personal grooming devices, and tools for gardening, carpentry, mechanic work, sports, hobbies, etc. TAD’s recommended L code guide is available on request. Also, TAD offers a Demo Kit Loaner program to allow the practitioners and end users to evaluate the actual products in a clinical setting. Contact TAD for more info including catalogs and pricing. Call 800/532-6840 or email janet@n-abler.org. Visit www.n-abler.org.
Introducing New Titanium Digits for All i-limb® Hands!
• New titanium material increases the maximum carry load at the proximal segment by 50 percent • Titanium material improves the protection of the motor from impact forces • Titanium digits add 1 oz of weight to the i-limb hand • Available for i-limb™ quantum, revolution, ultra, and access hands—sizes S/M/L. Contact us to learn more! Call Touch Bionics at 855/MYiLimb or visit www.touchbionics.com.
MARKETPLACE The FS3000 Foot Drop AFO From TurboMed Orthotics This unique ankle-foot orthosis was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe. In the past 24 months, more than 7,500 units of the FS3000 have been sold worldwide. TurboMed innovative products are now available through distributor partnerships in more than 20 countries. Its unique design and material composition give another meaning to walking and running. For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the FS3000 in less than five minutes. Available in USA from Cascade Supply, SPS, and Lakes Medical Innovations. For more information, call 888/778-8726, or visit www.turbomedorthotics.com.
Catalyst Propel OA Now Available in Custom VQ OrthoCare now offers the successful Catalyst Propel Double Upright Osteoarthritis (OA) Knee Brace in a custom version with Q-hinges. The frame is custom-formed to the patient with the Q-hinges providing additional fine tuning of the desired OA correction. The double Q-hinges adjust the overall valgus/varus brace structure. This design allows the clinician to fine tune the corrective forces efficiently in the field during fitting for a compliant clinical effect. The Catalyst Propel OA brace is designed for maximum stability, relieving pain by reducing pressure in the affected compartment as well as addressing joint instabilities. For more information, contact VQ Orthocare at 800/652-1135 or visit www.vqorthocare.com.
2017 AOPA Coding Products
Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2017 AOPA coding products. Ensure each member of your staff has a 2017 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 call AOPA at 571/431-0876.
AOPA Compliance Guide CD—Updated This Compliance Handbook helps patient-care facilities follow the fraud and abuse prevention guidelines recommended by the Office of the Inspector General. This product will assist you in developing a compliance plan for your facility, including guidelines for developing a standard of conduct, billing policies and procedures, and much more. With the help of the AOPA Compliance Handbook CD, you will be able to create an effective audit/quality assurance program to monitor compliance and conduct introductory training sessions for employees. • AOPA Compliance Guide CD—Updated: $159 AOPA members, $318 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.
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CALENDAR
2017
sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org, or visit www.AOPAnet.org.
August 18-19
August 3-5
Amputee Coalition 2017 National Conference. Louisville, KY. Contact the Amputee Coalition at 401/766-4142 or amputeecoalition@expotrac.com.
ABC: Prosthetic Clinical Patient Management (CPM) Exam, International Institute of Orthotics & Prosthetics. Tampa, Florida. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
August 4-5
The Texas Chapter of the American Academy of Orthotists and Prosthetists 2017 Annual Meeting. Westin Galleria, Dallas. For information and registration, visit www.txaaop.org.
August 9
What the Medicare Audit Data Tells Us and How To Avoid Common Errors. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
August 11-12
ABC: Orthotic Clinical Patient Management (CPM) Exam, International Institute of Orthotics & Prosthetics. Tampa, Florida. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
September 1
ABC: Application Deadline for Certification Exams. Applications must be received by September 1 for individuals seeking to take the November Written and Written Simulation and Winter Practitioner CPM exams. Contact 703/836-7114, email certification@ abcop.org, or visit www.abcop.org/certification.
September 11-16
ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and technicians in 250 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
September 13
September 6-9
100th AOPA National Assembly and Second World Congress. Las Vegas. Mandalay Bay. For exhibitors and
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Free Online Training
Cascade Dafo Institute. Now offering a series of seven free ABC-approved online courses, designed for pediatric practitioners. Earn up to 10.25 CEUs. Visit cascadedafo.com or call 800/848-7332.
CE For information on continuing education credits, contact the sponsor. Questions? Email landerson@AOPAnet.org.
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ABC Inspections and Accreditation. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
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Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.
AUGUST 2017 | O&P ALMANAC
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AOPA Who’s Who 100th Anniversary Commemorative Membership Directory This special edition directory is a one-of-a-kind AOPA: Our Story Is Your Stor y keepsake with special A commemorative sections on O&P history celebrating a century of growth and advancement of the O&P profession. The directory includes contact information for all 2017 AOPA members and a supplier listing with a detailed product index.
s the American Orthotic and Prosthetic Association facilities through (AOPA) embarks challenging on its celebratin centenni al times and celebrati on, g successes clear that the along the way. it’s past 100 years AOPA and momentous the O&P professio have seen changes. Back matured and n have in 1917, when the associatio come into their own. While n was first it hasn’t always chartered, one could been an easy no facilities have imagined road, O&P and manufact the advances in medical urers have technology true to their stayed that would focus: restoring high-tech orthoses lead to O&P function for and prosthese patients. Today, O&P patients s, restoring Americans to a loss and limb with limb None of AOPA’s very high quality of life. difference are achieving better quality original members a have predicted of life at unpreced could levels, the evolution ented thanks practices that in business to the O&P would move professionals who are committe the industry a mom-andd to high-qual from care—and pop shop, hands-on AOPA, the associatio ity patient a spectrum of small-, medium-, industry, to the way n that leads in ensuring size companie and larges run the O&P business favorable treatment for certified orthotists by highly educated in laws, regulation , services; and prosthetis , and helping members of whom have ts—many earned master’s improve their management degrees. And no one could and have anticipated raising awarenes marketing skills; and the explosion of regulation s and understan s and laws the industry ding of that have led and the associatio heavily audited to a reimbursement n. The year 2017 which has climate, marks a signifi challenged stone for AOPA cant mileO&P practition to become and for O&P ers we celebrate documen in general. As this centennia working collabora tation experts while l and prepare a new century for to ensure optimal tively with physician s a look back of significance, we also outcomes for take at the history Throughout patients. of the associatio this evolution, and the O&P AOPA has worked n profession, side-by-side and pay tribute with members the events to of the past , guiding O&P that have led achievements to our today.
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Who’s Who
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CALENDAR
November 6-7
October 1
ABC: Practitioner Residency Completion Deadline for November and December Certification Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
October 1
ABC: Application Deadline for ABC/OPERF Student Award for Academic Achievement. Ten exceptional students will be selected to win $1,000 to cover educational expenses. For more info or to apply, go to operf.org.
October 11
AFO/KAFO Policy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
October 26-27
International African-American Prosthetic Orthotic Coalition Annual Meeting. Atlanta Marriott Suites Midtown, 35 14th Street NE, Atlanta, GA 30309. For more info, visit www.iaapoc.org or contact Tony Thaxton Jr. at thaxton.jr@comcast.net or 404/875-0066.
November 5-11
2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Phoenix. Sheraton Grand Phoenix, 340 N. 3rd Street, Phoenix. Book by October 13 for the $179 rate by calling 800/325-3535 or by calling the hotel directly at 602/262-2500. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar
November 8
Gift Giving: Show Your Thanks and Webinar Conference Remain Compliant. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
December 7-9
Shirley Ryan AbilityLab: Elaine Owen—Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. 25.5 ABC credits. For more information, contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/education.
December 13
New Codes and Other Updates for 2018. Webinar Conference Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
Health-Care Compliance & Ethics Week 2017. AOPA will be celebrating Health-Care Compliance & Ethics Week and will be providing resources to help members celebrate.
ADVERTISERS INDEX Company Allard USA ALPS South LLC American Board for Certification in Orthotics, Prosthetics, and Pedorthics Amfit Anatomical Concepts Cailor Fleming Insurance Fabtech Systems LLC Ferrier Coupler Inc. Flo-Tech O&P Systems Inc. Hanger Clinic Hersco Orthomerica Products Inc. Ottobock Spinal Technology Inc. Surestep Texas Assisted Devices Touch Bionics TurboMed Orthotics VQ Orthocare
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ASK AOPA CALENDAR
Payments and Approvals Answers to your questions regarding payments during inpatient stays, PDAC approvals, and more
AOPA receives hundreds of queries from readers Q 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.
If the patient’s primary physician orders an orthosis or prosthesis during an inpatient stay at a hospital or skilled nursing facility (SNF) and I provide it, can the facility refuse to pay me?
Q/
Unfortunately, yes. Because the facility has the responsibility to provide all medically necessary care during a Medicare Part A covered stay, the facility may choose the vendor that provides the care. If a physician provides you with an order and you provide the item without authorization from the facility, the facility may not be obligated to pay you.
A/
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AUGUST 2017 | O&P ALMANAC
This is not a Medicare issue, but more of a contractual issue. Since the facility is ultimately responsible for providing the care, that facility may decide who they want to provide the care. Do all diabetic shoes, inserts, and modifications require approval from the Pricing, Data Analysis, and Coding (PDAC) contractor?
Q/
No—not all diabetic shoes, inserts, and modifications require PDAC approval. Prefabricated diabetic shoe inserts, A5512, must be reviewed and verified by the PDAC. Custom-fabricated inserts, A5513, also require PDAC coding verification if fabricated by a central fabrication facility or manufacturer. In addition, if you fabricate a custom insert in-house and provide it directly to the patient, the insert is not required to be verified by the PDAC. However, you must be able to provide a list of materials used and a description of your fabrication process, if requested. All other diabetic shoes, inserts, and modifications do not require PDAC approval.
A/
Can I bill Medicare for concentric-style torsion joints provided with a custom or prefabricated orthosis?
Q/
The answer is yes, but how you code for and bill for the device will depend on the function of the joint. If the concentric adjustable torsion joints are used solely to provide an assistive function for joint motion, you may use the L2999 for lower-extremity
A/
orthoses and L3999 for upper-extremity orthoses. If the concentric-style torsion joints are used for any other purposes and are incorporated into the item you are providing, the device is no longer considered an orthosis; instead, it is considered to be a durable medical equipment item and must be coded and billed using one of the following codes: • E1800—Dynamic adjustable elbow extension/flexion device • E1802—Dynamic adjustable forearm pronation/supination device • E1805—Dynamic adjustable wrist extension/flexion device • E1810—Dynamic adjustable knee extension/flexion device • E1815—Dynamic adjustable ankle extension/flexion device. As a reminder, any claim for an L2999 or L3999 must include either a narrative description of the item or the manufacturer name and model name/number.
Looking towards the future while celebrating the past! Join us for the 2nd World Congress and AOPA’s 100th Anniversary Celebration in Las Vegas, September 6-9, 2017.
THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.
#AOPA2017
Why you should attend: • Celebrate 100 years of the formalized O&P Profession in the United States. • Clinical Education so remarkable that it will be memorialized in an international scientific journal. • The best speakers from around the world. Hear from physicians, researchers, and top-notch practitioners. • The largest exhibit hall in the Western Hemisphere will feature devices, products, services, tools, and the latest technology from exhibitors around the world. • Earn 40+ continuing education credits. • Participate in hands-on learning and demonstrations during workshops • Preparation for the changes that U.S. Healthcare reform is sure to bring and its influence on global health policy.
REGISTRATION IS OPEN
FOR THIS HISTORICAL EVENT Expand your knowledge, grow your market presence, and advance your career at this unique global gathering of high visibility and importance.
www.opworldcongressusa.org
• Networking with an elite and influential group of professionals. • Ideal Las Vegas location, chosen for its popularity, travel ease, and excitement. Register at www.opworldcongressusa.org. Earn more than
40 CE
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