August 2022 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

AUG UST 2 0 2 2

How Will Reimbursement Trends Affect Your Business? P.14

Recruiting the Next Generation of O&P Professionals P.30

Preview the 2022 Award-Winning Thranhardt Presentations best P.36

show

TAILORED

SPACES STATE-OF-THE-ART FACILITIES ACCOMMODATE SPECIFIC PATIENT NEEDS

Quiz Me!

P.18

EARN 2 B USIN ESS CE CREDITS

WWW.AOPANET.ORG

P.16

YOUR CONNECTION TO

EVERYTHING O&P

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

R E G I ST

RATION

OW! N N E P O

’T WAIT WE CAN OU! Y TO SEE

MEMBERSHIP HAS ITS BENEFITS

Members save up to $300 on Assembly Registration

Earn up to 100+ CE Credits

Registration Is Open! NEW! Stellar partnership with the Texas Society of Orthotic and Prosthetic Professionals (TXSOPP) NEW! Innovative two-day education track on O&P Digital Care and Post Mastectomy Care. NEW! The O&P Experience Zone—A fun interactive event in the Exhibit Hall featuring patient success stories and their clinician caregiver. NEW! Digital O&P Care Showcase A Who’s Who line up of experts presenting the most relevant education. Customizable meeting experience to fit your needs Earn over 100 CE Credits.

San Antonio

Join us September 28-October 1, 2022, for an ideal combination of top-notch education and entertainment at the 105th AOPA National Assembly in San Antonio, TX.

For more info and to register, visit:

www.AOPAassembly.org

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AUGUST 2022 | VOL. 71, NO. 7

contents

FEATURES

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

COVER STORY

Preview the 2022 National Assembly

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

18 | Tailored Spaces Several high-performing O&P facilities have distinguished themselves by identifying a special area of focus—be it a specific patient base, a specific technology, or a specific approach to patient care. Learn how these unique businesses run their operations and provide optimal outcomes for patients. By Christine Umbrell

30 | Recruiting Gen Z Given the growing demand for certified prosthetists and orthotists, several O&P stakeholders have launched initiatives to raise awareness of the profession among high school students. Find out what O&P businesses, master’s programs, and organizations are doing to spark interest among Gen Z. By Michael Coleman

36 | Best of Show Don’t miss this year’s Thranhardt Awards at the 2022 National Assembly. Preview the award-winning presentations, which will showcase an innovative run-walk prosthesis from Jennifer Johansson, MS, and a predictive methodology for cranial remolding orthosis treatment from Tiffany Graham, MSPO, CPO, LPO, FAAOP. By Deborah Conn

beosf t show

How to reach staff

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 13

Transitions in the profession

P.12 Reimbursement Page.......................... 14

Bracing for Impact

Prepare now for the changes that prior authorization and competitive bidding will bring Opportunity to earn up to two CE credits by taking the online quiz.

Member Spotlight................................ 44 n n

Protosthetics Achilles Prosthetics & Orthotics

AOPA News................................................ 47

AOPA advocacy, announcements, member benefits, and more

Welcome New Members................... 47 Marketplace............................................. 48

PRINCIPAL INVESTIGATOR Geoff Balkman, MSPO, PhD, CPO, LPO..........................................................................40 Meet an assistant professor from the University of Washington who researches and creates outcome measurement instruments, including a new tool for measuring mobility of lower-limb orthosis users. 2

AUGUST 2022 | O&P ALMANAC

Careers......................................................... 52

Professional opportunities

Ad Index....................................................... 53 Calendar...................................................... 54

Upcoming meetings and events

State By State........................................... 56

California, Colorado, Iowa, and North Carolina

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VIEWS FROM AOPA LEADERSHIP

2022 National Assembly: Your Intersection Point of Education and Connection

ITH THE 2022 NATIONAL ASSEMBLY less than two months away, I am excited to invite you to be with us in San Antonio. Connecting with AOPA members in person—especially after the past few years—is something I look forward to with a renewed appreciation of just how special that opportunity is. As I have written and talked about before, AOPA launched new strategic priorities at the beginning of this year—priorities that were developed and informed in response to feedback that you, our members, gave us. Building on that, our Assembly Planning Committee and AOPA staff have been hard at work to not only bring you those sessions and events that keep bringing you back to the National Assembly, but to elevate the experience by providing you with even better content, enhanced engagement, and more value. Highlights of the upcoming Assembly include the following: • Insightful clinical, business, and technical education sessions, including two new tracks: O&P Digital Care and Postmastectomy Care • Guest speakers from Medicare, Department of Veterans Affairs, and Department of Defense • A new O&P Experience Zone • Learnings from top researchers, practitioners, and business experts • Key takeaways from AOPA-funded research • A full exhibit hall highlighting the most transformative prosthetic and orthotic devices, solutions, and services • Welcome Reception • Women in O&P event • AOPA O&P PAC Reception • The ability to earn more than 100 CE credits!

While I hope to see all of you personally in San Antonio, AOPA also will offer all of the Assembly education virtually. This content will be available for 60 days starting October 17. However, if you come in person, you also will have access to the virtual content, enabling you to see sessions that you may not have been able to attend in person due to conflicts in your schedule. If the past two years have shown us anything, it is the importance of connection, serving our members, and ensuring their needs are met. Those are the key elements supporting the launch of our new vision, mission, brand, and 2022 strategic priorities. Our goal at the 2022 National Assembly is to connect you to each other and serve your professional needs. As we have all learned, as much as technology can help reduce barriers between us, there is nothing that replicates the experience of face-to-face interaction. San Antonio is a great city, we have a fantastic agenda, and having the opportunity to speak to your peers in person and learn about how they are dealing with this rapidly changing profession is something you shouldn’t pass up. If you haven’t done so yet, please visit the AOPA website and register soon. I hope to see all of you in person at the end of next month. And if you absolutely cannot make it to Texas, please join us virtually. Either way, we welcome you to participate in the AOPA 2022 National Assembly! Dave McGill is president of AOPA.

AUGUST 2022 | O&P ALMANAC

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

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

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

A world where orthotic and prosthetic care transforms lives.

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

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

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

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AOPA Bookstore: 571/431-0876 REIMBURSEMENT SERVICES

HEALTH POLICY & STRATEGIC ALLIANCES

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

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

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

MEMBERSHIP & COMMUNICATIONS

EXECUTIVE OFFICES

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

AUGUST 2022 | O&P ALMANAC

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Our Vision

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

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

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

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2022 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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

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NUMBERS

Studying Prosthetic Feet and Their Coding Recently published research evaluated the effectiveness of common prosthetic foot models

STUDY METHODS

A new study conducted by Hanger Inc. showed no significant difference in functional mobility for individuals with prosthetic feet that recently had their coding modified to L5981 by the Pricing, Data Analysis, and Coding (PDAC) contractor. The study, “OASIS 2: Mobility Differences With Specific Prosthetic Feet Across Procedure Codes,” by Taavy A. Miller, PhD; James H. Campbell, PhD; Dwiesha L. England, MS; Phillip M. Stevens, MEd; and Shane R. Wurdeman, PhD, was published in Journal of Rehabilitation and Assistive Technologies Engineering. Additional information on OASIS 2 and previously published research is available at https://hangerclinic.com/for-professionals/ research-innovation/.

SUBJECT DEMOGRAPHICS

526

Unique observations included in the final analytic sample

Categories of feet examined

PROSTHETIC CODES

L5987

78%

83%

Original CMS code for a shank foot system with vertical loading pylon

Transtibial amputation

Male

52.5

Average age, +/- 13.9 years

L5981

Code for a “flex-walk system or equal,” recently given to several former L5987 systems, at a lower reimbursement rate than L5987

PROSTHETIC FEET STUDIED Number of individuals based on prosthetic foot type (brand and model) per foot category

Category

Description

Type of Foot

Sustained 87

Previously reviewed by PDAC and assigned L5987

Ottobock Triton VS and Proteor Rush Rogue

Modified

Previously considered within the field with the L5987 base code but now PDAC-recommended for L5981

Fillauer All-Pro and Blatchford Elite 2

Not Reviewed

Not yet been submitted for PDAC review

Proteor Agilix, Ottobock Maverick Xtreme, and Ottobock Renegade

250

Original 81

Previously reviewed by PDAC and assigned L5981 (control group)

Proteor Highlander, Ossur Vari-Flex, and Ottobock Triton LP

114

AUGUST 2022 | O&P ALMANAC

Count 79 83

Different prosthetic foot types studied

Tasks measured via the PLUS-M mobility measurement tool “PDAC reclassified several L5987 feet to an L5981 code due to the lack of an obvious, visible additional vertical shock absorption unit. This was done without consideration for the performance or observed function of the feet. … The purpose of this analysis was to investigate real-world evidence on several highly utilized prosthetic feet that were previously coded as L5987, and compare this to those that retained their L5987 coding as well as those that were and remain L5981 coded feet. “Results showed there was no significant difference in functional mobility for those individuals with the feet that had their coding modified compared to those that retained their L5987 designation. Consistent with previous work, outcomes associated with these feet were greater than those measured in patients with L5981 feet. “These results call into question as to whether prosthetic feet and componentry should be categorized based on the appearance of the mechanisms and materials used or the functional benefits they provide.” —“OASIS 2: Mobility Differences With Specific Prosthetic Feet Across Procedure Codes”

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Happenings Canadian Researchers Develop Rehabilitation Self-Management Tool A team of researchers from the University of British Columbia and Vancouver Coastal Research Institute have developed an online self-management program for individuals with lower-limb loss. Called the SelfManagement for Amputee Rehabilitation Using Technology (SMART) program, the tool provides education and supportive skills to manage health-related physical and psychological challenges. The SMART program comprises four stakeholder-informed modules, with 18 total sections. The content includes information on limb care, diet, fatigue, and energy, among other topics. The research team tested the program on a cohort of adults with lower-limb loss. Participants reviewed the modules during O&P CYBERSECURITY

Healthcare Data Breaches On the Rise

an online video conference session with an assessor. They were asked to complete 11 tasks, including entering the SMART program, setting goals, finding skin care, and reading the content of 10 sections. When participants were interviewed about their experiences, they generally found the program to be straightforward, easy to navigate, and accessible, but they noted some challenges with navigation, presentation, and language. The researchers are currently in the process of redesigning the program to address the usability issues, and plan to further explore the perceived usefulness of SMART. Details were published in June in Prosthetics and Orthotics International.

Visual Inputs Impact Balance Control Deficits Among Individuals With Transtibial Amputation

Between Jan. 1 and May 31, 2022, the U.S. Department of Health and Human Services listed 244 electronic data breaches of healthcare organizations with at least 500 victims on its site. The figure for that same time period in 2021 was 137. SOURCE: HHS Breach Portal

AUGUST 2022 | O&P ALMANAC

Individuals with transtibial amputation present a greater reliance on the intact lower limb, according to a team of researchers from Laval University and the Centre for Interdisciplinary Research in Rehabilitation and Social Integration in Canada. The researchers conducted a biomechanical assessment of subjects with below-knee amputation during 30-second quiet standing tasks with their eyes open, and again with eyes closed. They calculated

mean trunk, hip, knee, and ankle angles, as well of center-of-pressure and center-of-mass excursions. The research team concluded that transtibial patients demonstrate greater ankle plantarflexion and anteroposterior and mediolateral center-of-pressure excursions for intact limbs compared with amputated limbs during quiet standing tasks. When subjects’ eyes were closed, both the amputee group and the control group exhibited greater mediolateral center-of-pressure excursions compared with eyes open, which suggests less postural stability, according to the researchers. “These differences may place them at greater risk of falling,” they noted. The study was published in April in Prosthetics and Orthotics International.

HAPPENINGS

COMORBIDITY CONCERNS

Individuals With Diabetes and Lower-Limb Loss at Greater Risk for Osteoarthritis Limb loss patients could be at a higher risk of developing lower-limb osteoarthritis, compared to individuals without limb loss, according to researchers at University of North Texas Health Science Center. The researchers sought to investigate the high co-occurrence of type II diabetes with lower-limb amputations. They measured hip and knee joint space, as indicators of osteoarthritis, in four groups: lower-limb amputees with diabetes; lower-limb amputees without diabetes; diabetic controls; and healthy controls. Individuals with limb loss showed significantly narrower hip and knee joint space bilaterally compared to diabetic and healthy controls, putting them at greater risk for developing the degenerative joint disease. Patients with osteoarthritis may experience pain, limited mobility, and decreased quality of life.

MEDICARE MATTERS

Sequestration Reduction Ends

The partial 1% sequestration reduction applied to final Medicare payment amounts officially ended June 30. As of July 1, 2022, the full sequestration amount of 2% will be applied to final Medicare payment amounts. The findings also suggest that “amputees with diabetes are at increased risk of developing osteoarthritis compared to amputees without diabetes,” according to the researchers. They suggested that “perhaps the aggressive management of blood glucose and postamputation physiotherapy treatments could help reduce joint deterioration in these patients.” The full study was published in May in The FASEB Journal.

SOURCE: AOPA

INSURANCE INSIGHTS

More Children Covered Via ACA Marketplace New data from CMS shows 1.3 million children were

ASSEMBLY UPDATE

enrolled in marketplace

San Antonio, By the Numbers

plans during the 2022

Participants at the 2022 National Assembly can expect an impactful experience, filled with educational content, exhibits, networking opportunities, and more:

Marketplace Open

152+

1,500+

32+

100+

Featured Speakers

Attendees

Hours of Content

Exhibitors

Enrollment Period, either through Healthcare.gov or their state’s marketplace. This represents a 29 percent increase compared to 2021 child enrollment levels. SOURCE: “2022 Open Enrollment,” CMS

O&P ALMANAC | AUGUST 2022

HAPPENINGS

SEEKING PARTICIPANTS

O&P ATHLETICS

Volunteers Needed for Survey on Upper-Limb loss Researchers from Johns Hopkins Medicine are asking that adults with upper-limb amputation consider participating in a 10-minute questionnaire. The survey is part of an IRB-approved study, led by Jeremy D. Brown, PhD, and Marlis Gonzalez-Fernandez, MD, PhD, which seeks to better understand the experience of individuals with upper-extremity limb loss, including their perceptions about their prostheses and noninvasive sensory feedback provided by such devices. Participants will have a chance to win one of several $25 gift cards. Interested parties are asked to visit the QR code below.

FIRST Clinics Make a Comeback

OPAF and the FIRST Clinics held its first events back since the pandemic, holding both golf and swimming clinics in Albany, Georgia. Several individuals with limb loss enjoyed the First Swing golf event at River Point Golf Club, which was hosted by the organization’s clinical sponsor, Amputee Prosthetic Clinic. First Swing is brought to participants by The National Amputee Golf Association, and the instructor, David Windsor, was provided through the Georgia State Golf Association. Participants in the First Swim event enjoyed learning tips for water activities. First Swim was hosted by Life Unlimbited

Inc., a nonprofit support group that also hosts adaptive recreation days, and instructed by Mabio Costa. Ottobock provided lunch for the clinics.

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AUGUST 2022 | O&P ALMANAC

PEOPLE & PLACES BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Hanger Inc. announced it has entered into a definitive agreement to be acquired by Patient Square Capital, a dedicated healthcare investment firm. Under the terms of the agreement, which has been unanimously approved by Hanger’s Board of Directors, Hanger stockholders will receive $18.75 in cash per share, representing an approximately 29% premium to the 30-calendar-day volume-weighted average price ending July 20, 2022, and a total enterprise value of approximately $1.25 billion. Upon completion of the transaction, Hanger will become a privately held company, and its common stock will no longer be traded on the New York Stock Exchange. “We are excited to have signed a definitive agreement with Patient Square Capital, which means we will become a private company,” said Vinit Asar, Hanger’s president and CEO. “With the support of Patient Square Capital, we believe we will be able to more effectively fulfill our mantra of empowering human potential, and positively impact more lives. We are thrilled with the opportunities this will bring us.” Asar said the transaction will result in “immediate and substantial value creation” for the company’s stockholders. “This transaction represents a culmination of an extensive review by our Board of Directors of strategic alternatives to provide value to our stockholders and to offer financial flexibility for our company to pursue future growth initiatives,” he said. “Patient Square Capital recognizes the value of our brand and the quality of our world-class team, and is grounded in similar values that guide our actions. They share the same long-term vision for our company, which makes them an excellent partner for the next phase of our journey.” Patient Square Capital is a patient-centered investment firm with a team of seasoned executives that uses deep healthcare expertise, a broad network of relationships, and a partnership approach to make investments in companies to grow and thrive, partnering with organizations who they believe have the ability to improve patient lives, strengthen communities, and create a healthier world, according to Hanger. Jim Momtazee, managing partner of Patient Square Capital,

said, “I have closely followed Hanger’s impactful work for most of my career and genuinely respect the positive impact they have on their patients and customers. Patient Square values the steps taken by the leadership team to strengthen the company’s position and is thrilled to partner with the Hanger management team to support the next phase of their growth.” The transaction will be financed through a combination of committed equity financing provided by Patient Square Equity Partners LP, as well as committed debt financing to be led by funds managed by Ares Capital Management LLC. The transaction is expected to close in the fourth quarter of 2022, subject to the receipt of stockholder approval, regulatory approvals, and the satisfaction of other customary closing conditions. Following the close of the transaction, Hanger will continue to be led by Asar, who has been its president and CEO for more than a decade, and will maintain its headquarters in Austin, Texas. WillowWood Global LLC has announced that it has acquired MAKstride Prosthetics. The transaction represents WillowWood’s first strategic acquisition since partnering with growth-oriented private equity firm Blue Sea Capital LLC in December 2021. Based in Mesa, Arizona, MAKstride develops, designs, and manufactures prosthetic devices and componentry, including prosthetic feet, foot shells, and high-precision machined components. The company emphasizes its R&D function, precision machining capabilities, and manufacturing expertise across metals, fiberglass, carbon fiber, and plastics. “The MAKstride acquisition marks the culmination of a multiyear, collaborative partnership … to co-develop cutting-edge innovation for the prosthetics industry, including the recent launch of our groundbreaking Meta Shock X product within the broader META foot platform,” said Daniel Rubin, COO of WillowWood. “We are excited and fortunate to have them as part of the WillowWood family.” Monty Moshier, PhD, founder and CEO of MAKstride, will continue to lead MAKstride as managing director and will serve as a research fellow for WillowWood’s R&D efforts, including several upcoming META product launches.

O&P ALMANAC | AUGUST 2022

REIMBURSEMENT PAGE

By JOE MCTERNAN

Bracing for Impact How will prior authorization, competitive bidding, and other trends affect your O&P business?

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 16 to take the Reimbursement Page quiz. Receive a score of at least 80%, and AOPA will transmit the information to the certifying boards.

E! QUIZ M EARN

BUSINESS CE

CREDITS P.16

NE OF THE CHALLENGES in

today’s fast-evolving business environment is understanding how changes that are happening today will impact your business in the future. This is especially true for O&P businesses, which have faced several significant changes in recent months. Changes are not necessarily bad for business, but how you react and adjust to change will determine how successfully your business navigates change. This month’s Reimbursement Page reviews some of the changes and trends impacting the O&P business world and discusses how they may affect your facility in the future.

can be frustrating, it also provides an opportunity to adjust your business practices based on the quickly emerging trend. If prior authorization requests are not receiving affirmations, then it may be time to provide additional education to your referral sources and adjust how you document in your own records. At the moment, Medicare prior authorization for orthotics is limited to five orthosis codes, but it is likely the program will be expanded. Learning how to improve your chances for success with a limited number of impacted Healthcare Common Procedure Coding System codes will pay dividends as Medicare prior authorization expands to other areas.

Prior Authorization

Competitive Bidding

Medicare prior authorization is a relatively new program for O&P services and is currently limited to six lower-limb prosthesis codes, two spinal orthosis codes, and three knee orthosis codes. While the Medicare prior authorization program has gone very well for lower-limb prostheses, with almost all requests receiving affirmation upon the initial submission, prior authorization requests for spinal and knee orthoses have proven to be a bit more difficult. Issues that have caused denials in the past, such as the lack of measurable objective joint laxity in osteoarthritic knees, are lowering the initial affirmation rates for orthoses that now require Medicare prior authorization as a condition of payment. While this situation 14

AUGUST 2022 | O&P ALMANAC

The Medicare competitive bidding program is viewed by many as a tremendously successful program—not only for O&P services, but for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in general. Currently, only off-the shelf (OTS) orthoses remain subject to Medicare competitive bidding. The most recent round of competitive bidding, also known as Round 2021, removed all of the DMEPOS categories that were previously subject to Medicare competitive bidding. The stated reason for this was that competitive bidding resulted in significant cost savings, and future rounds of competitive bidding would most likely not lead to additional savings to the Medicare program.

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REIMBURSEMENT PAGE

Removal of the durable medical equipment product categories from competitive bidding no longer restricted access for patients since they could once again receive services from any enrolled supplier, but competitive bidding had already resulted in reductions to the Medicare fee schedule. While it is possible that future rounds of Medicare competitive bidding may expand the number of OTS orthoses subject to competitive bidding, the trend that we witnessed in durable medical equipment may result in the elimination of competitive bidding for OTS orthoses. This would no longer require O&P providers to participate in competitive bidding but would include the Medicare fee schedule reductions that have already been implemented for the OTS orthosis codes that are currently part of Competitive Bidding Round 2021.

part of O&P business operations—and there are lessons to be learned from the trends that they have created. RAC auditors are the only Medicare contractors that are paid a percentage of the overpayments they identify—between 9% and 12%. This is a significant revenue opportunity for the RAC contractor, which is looking for the “low-hanging fruit” that will represent the biggest profit opportunity for their organization. Two of the contractual requirements that RAC contractors must follow involve obtaining CMS approval for any new audit activities, and publishing their current approved issues on their website: www.performantcorp.com/cms-rac/ cms-rac-resources/region-5/default.aspx. Spending a few minutes on this website on a regular basis will help you ensure your documentation adequately supports the services that the RAC is likely to be looking at. While documentation practices should be consistent for all of the services you provide, having this information will certainly contribute to your success in RAC audit situations.

PDAC Coding Verification

In another key O&P trend, the number of procedure codes that are subject to code verification by the Pricing, Data Analysis, and Coding (PDAC) contractor has been increasing. CMS and the durable medical equipment Medicare administrative contractors (DME MACs) may require, as a condition of claim payment, that the PDAC verify that certain products are correctly coded. PDAC verification was recently incorporated into the Medicare prior authorization process to help facilitate timely decisions by verifying correct coding in advance. PDAC is currently using the physical attributes of products as the primary factor when performing code verifications. AOPA believes that product function also is a relevant factor that the PDAC should consider when performing code verification. Keep in mind that, in addition to PDAC code verifications being required for payment in specific situations, they also are binding on the supplier community—even if a product is submitted for PDAC review voluntarily. While PDAC coding verification requirements can be frustrating, understanding what is required—and when—can be helpful in avoiding unnecessary claim denials. 16

AUGUST 2022 | O&P ALMANAC

Correct Coding Bulletins

The DME MACs and PDAC have increased the number of correct coding bulletins they are releasing. Correct coding bulletins are not considered medical policy and are therefore not subject to the same public notice and comment requirements that govern changes and updates to Local Coverage Determinations. Correct coding bulletins are designed to communicate the requirements that a product must meet to properly meet the language of a particular code descriptor. Correct coding bulletins have become increasingly more specific in recent years. While technically not formal policy, correct coding bulletins are being used when making coverage decisions for individual claims. These bulletins, if not followed or understood, may result in unnecessary and costly claim denials.

RAC Audits

Dealing with recovery audit contractor (RAC) audits has become a standard

Stay Alert

The areas identified in this month’s Reimbursement Page comprise just a few of the trends you should be closely following to determine their potential impact on your O&P business. Success often is created not by how reactive you are to what is happening— but by how proactive you are regarding what may happen in the future. Joe McTernan is director of coding and reimbursement services, education, and programming at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: Board of Certification/Accreditation

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COVER STORY

TAILORED

SPACES

State-of-the-art O&P facilities understand their patient populations and design their facilities with clients’ needs in mind By CHRISTINE UMBRELL

AUGUST 2022 | O&P ALMANAC

COVER STORY

NEED TO KNOW • Most future-focused O&P facilities prioritize patient satisfaction and adaptability over time, and some of the most successful O&P businesses distinguish themselves by focusing on a specific goal. • Some clinics identify specific patient populations—for example, active limb loss patients, or limb salvage patients—and equip their clinics to best meet those patients’ needs. • Other facilities embrace a particular technology—such as 3D printing—and build a reputation as an innovator in that arena. • Still other businesses focus on patient experience and design their spaces to be welcoming, responsive, and technologically advanced. • Specialization is a trend that may help smaller O&P facilities remain profitable into the future.

IGHLY SUCCESSFUL O&P facilities

share several traits in common: They are willing to adapt; they focus on patient satisfaction; and they explore new technologies. Facilities that match these descriptions can be found throughout the country. Among these high-performing facilities, a few state-of-the-art clinics have set themselves apart even further. These facilities have identified a special area of focus—be it a specific patient base, a specific technology, or a specific approach to patient care. How did they do it? Several successful owners share how they distinguish their facilities and offer inspiration for others looking to do the same.

FACILITY FOCUS: Active Prosthetic Patients

Prosthetic and Orthotic Associates (POA) in Orlando is a one-of-a-kind facility for a niche patient population. There, clinicians specialize in active

patients, seeing a high percentage of both elite-level athletes and less competitive—but highly mobile— individuals with amputation. Owner Stan Patterson, CP, LP, launched POA about 25 years ago, working out of his garage. Today, the facility encompasses 23,000 square feet, including a full gym, a 40-meter indoor track area, and plenty of outdoor space. “When we started, I wanted to have a facility that concentrated on more active patients”—where his expertise lies—rather than on dysvascular and diabetic patients, he says. To cater to the more active population, POA’s current space is an open-concept design, which includes a fitting/training area with a fully equipped fitness center, plus lounge and kitchen areas where patients can socialize. A dedicated children’s corner features a rock-climbing wall, activity table, and toys. “We also have a fun-loving canine crew that provides entertainment for all,” Patterson says. O&P ALMANAC | AUGUST 2022

COVER STORY

POA features an open-concept design, which includes training equipment plus lounge and kitchen areas.

Other features at POA include a socket fabrication area, laser posture equipment, and a OHM machine that creates drag as athletes run.

AUGUST 2022 | O&P ALMANAC

PHOTOS: Prosthetic and Orthotic Associates (POA)

POA has an in-house silicone house for fabricating custom liners.

Patterson’s decision to allocate open space where patients can test prostheses, participate in physical therapy, and engage in athletic training was inspired by a visit to Walter Reed Army Medical Center more than 15 years ago. “I saw soldiers in the big physical therapy room [at Walter Reed], and I noticed they were building off each other in trying new things. It was almost like a big support group.” At POA today, “the camaraderie within the open space provides a sense of community and belonging, which is invaluable, no matter where you are in the recovery process,” says Patterson. In addition to four sets of 20-foot parallel bars and two sets of smaller parallel bars, the open space boasts high-tech features that encourage patients to improve their walking or running techniques, including zerogravity treadmills, treadmills that measure stride length and pressure during walking/running, and a large

golf simulation room. At the track, clinicians use digital timers and an OHM machine that creates drag as athletes run. To ensure proper alignment, “we use a lot of slow-motion videos, via drones that fly beside the person,” Patterson says. Cameras are clipped directly to athletes, “or you can just follow along and the camera steadies itself. We can get footage from overhead, or from the side; we can get whatever angle that we need” to help adjust devices to optimize mobility for patients. Fabrication at POA is kept in-house, which “allows us to maintain control over the quality of the prosthesis from start to finish,” while minimizing fabrication times, says Patterson. Twelve technicians work in the fabrication lab. The facility also has a fully stocked machine shop and an in-house silicone house “so we can make custom liners in a day.” POA’s expansive social media presence and word-of-mouth has boosted its reputation as a travel destination for active athletes. Videos and posts highlighting the facility’s specialization have garnered the attention of active individuals across the country and around the world. “Because we specialize” in prostheses for active patients and frequently treat difficult-to-fit patients—such as individuals with hip disarticulation and proximal femoral focal deficiency—a significant portion of patients travel from outside of Florida to be seen by Patterson and his staff.

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The Hanger Clinic in Gig Harbor, Washington, has been designed to cater to limb salvage patients, with a high percentage of patients visiting the facility to use the ExoSym device at the 13,000-square-foot facility.

FACILITY FOCUS: Limb Salvage

AUGUST 2022 | O&P ALMANAC

O&P clinic, we have a fully capable, 5,000-square-foot gym and training space outfitted with workout and rehabilitative equipment for all needs and abilities, including treadmills, weights, sleds, stairs, ramps, and an ambulatory rail harness system.” Over the past several years, Blanck has built important relationships with nearby referral sources and hospitals, which have been central to the facility’s success. “The center in Gig Harbor has excellent relationships with local trauma centers and the surgeons and rehab teams that support the limb salvage and amputation recovery process, as well as many trauma centers across the country,” he says.

FACILITY FOCUS: Additive Manufacturing and Mobile O&P

At EastPoint Prosthetics & Orthotics, with locations in North Carolina, Ohio, and Pennsylvania, owner Paul Sugg, MA, CPO, CPed, FAAOP, was an early adopter of additive manufacturing in both prosthetics and orthotics. He has invested in equipment to leverage new 3D printing technologies to meet patients’ rapidly evolving needs.

PHOTOS: Hanger Clinic

A Hanger Clinic in Gig Harbor, Washington, is another high-tech spot designed to cater to a specific patient population: limb salvage patients. While the facility also sees prosthetic patients, a high percentage of patients visit the facility to use the ExoSym device, a hybrid prosthetic-orthotic device that is custom-made to

ensure optimal alignment, position, off-loading, and control, says Ryan Blanck, CPO, LPO, ExoSym program director and national upper-limb specialist. “The majority of my patients travel here from across North America, Europe, Asia, and the Middle East and typically stay for one to two weeks of focused care at a time. The facility was specifically designed to support this model and deliver the highest level of care for a variety of needs and devices.” The 13,000-square-foot facility was designed “based on my experiences at the Department of Defenseoperated Center for the Intrepid in San Antonio … with a large training space, including a gym, equipment, and systems to help both limb salvage patients and patients with limb loss or limb difference achieve their maximal functional abilities,” says Blanck. The ExoSym Limb Salvage program involves custom-designing and fitting each device on-site, then typically working for several weeks with the individual patient to observe the functionality of the device in real time, according to Blanck. “In addition to patient rooms, a reception area, and other typical features of an

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EastPoint staff leverage software programs to send modifications for 3D printing; the facility has invested in both fused deposition modeling printers and a hightech multi jet fusion printer.

AUGUST 2022 | O&P ALMANAC

says Sugg. “By using state-of-the-art technologies and new materials, we’ll see the best quality outcomes.” Sugg also has embraced a mobile model of patient care. The company’s two brick-and-mortar locations in North Carolina and its single-office locations in Ohio and Pennsylvania are supplemented by 14 fully equipped O&P mobile vans that travel to patients on a regular basis. The facility offered mobile services even before COVID, but has seen a surge in demand for mobile care since 2020—a trend that puts them on the cutting edge of O&P, according to Sugg. “We’re seeing the VA and larger national O&P companies starting to do mobile,” he says. Housing a full fleet of mobile vans allows for specialization. “Each van

EastPoint clinicians provide mobile O&P care and can visit patients at their homes to adjust prostheses.

PHOTOS: EastPoint Prosthetics & Orthotics

“We have a willingness to try new materials, new design types, and new technologies—such as 3D printing—to advance the profession,” says Sugg, explaining that his facility merges a traditional O&P model with the digital model. While many facilities have begun to use additive manufacturing for simple prosthetic components, EastPoint is “pushing the envelope” with more advanced uses, including 3D-printed prosthetic components for patients with knee disarticulation, hip disarticulation, and partial feet, as well as orthotic components—an area that is newer to the 3D-printed space. The fabrication area at EastPoint is a hybrid space that combines traditional fabrication with additive manufacturing. In addition to lower-cost, and more familiar, fused deposition modeling printers, Sugg has invested in a high-tech multi jet fusion printer—enabling clinicians to

design more complicated components. Creating 3D-printed components, where appropriate, helps meet patient demand, according to Sugg. “Many patients—especially younger patients— are asking for lighter devices, and they want to be able to do more” with their componentry, he says. An added benefit of the 3D printing process for EastPoint staff is a healthier lab. “My techs experience less carbon fiber dust from grinding, and laminating fumes also are reduced, so it’s safer,” Sugg says. EastPoint also uses a hybrid scanning system, leveraging both digital imaging and traditional casting, depending on the purpose and the patient. “Our digital practice, combined with a mobile model, is meeting patients where they are,”

COVER STORY

The Nashville location of Hanger Clinic encompasses 12,000 square feet spread over two floors and features separate adult and pediatric wings. is set up specifically for the patient population”—be it spinal, pediatric orthotic, geriatric, or another O&P subgroup, says Sugg. Components and equipment inside the van target the specific patient base. Mobile visits give clinicians a better understanding of patients’ componentry needs and abilities, according to Sugg. They can meet with patients at therapist or doctor appointments, and in their own environments, which helps with compliance and provides a more accommodating experience, he says.

PHOTOS: Hanger Clinic, Nashville

FACILITY FOCUS: Aligning With Allied Healthcare

Some O&P businesses design their facilities to align with the needs of nearby hospitals and healthcare facilities—such is the case for the Hanger Clinic facility in Nashville. The Nashville location encompasses 12,000 square feet spread over two floors and is located in a medical center in Nashville’s Midtown neighborhood, known for its high concentration of world-class hospitals and healthcare systems, says Brett Parrish, MSPO, CPO, LPO, clinic manager of Hanger Clinic in Nashville and vice president of Tennessee Society of Orthotics and Prosthetics. “The clinic is aligned with local healthcare systems so that patients can conveniently access all the services they need when, for example, recovering from an amputation,

including physical and occupational therapy and postdischarge rehabilitation,” explains Parrish. The facility has separate adult and pediatric wings. The pediatric area is decorated to appeal to children and families, and supports cranial remolding and other custom pediatric care. There are 22 total patient evaluation rooms, says Parrish, including five in the pediatrics wing, seven orthotic patient rooms, six prosthetic gait rooms, and an upper-extremity evaluation room. On-site fabrication takes place in a 1,500-square-foot lab, and “we implement every casting/rendering style available for O&P devices,” says Parrish, including hydrostatic casting and hand casting and carving, “which is catered to each patient based off their anatomical and functional needs.” The clinic offers several tools for scanning orthoses and prostheses, including a Symphonie casting

system. “We have patient-care rooms specifically dedicated to upperlimb patient training with different devices and TVs, so that the training can be streamed for family members and friends,” says Parrish. “We have multiple-terrain walkways that allow patients to experience how their lower-limb prosthesis or orthosis will interact with the variable landscape of their environments at home, and we partner with local therapists to allow for higher densities of therapy, including but not limited to, aquatic therapy with a device, dry needling for phantom pain, and manual therapy.” Looking to the future, the Hanger Nashville site aims to grow its interdisciplinary team by partnering with more therapists to offer gait training on-site, “giving us the ability to make real-time adjustments without as many follow-up appointments being needed for the patient,” says Parrish.

The facility features a 1,500-square-foot lab for on-site fabrication and offers a wide variety of casting/rendering styles for O&P devices. O&P ALMANAC | AUGUST 2022

COVER STORY

Sabolich Prosthetics & Research was an early adopter of outcomes-driven care and features an 11,000-square-foot full-capacity lab for quick repairs and one-day casting-to-fitting turnaround.

FACILITY FOCUS Outcomes-Driven Prosthetic Care

AUGUST 2022 | O&P ALMANAC

PHOTOS: Scott Sabolich Prosthetics & Research

Prosthetic patients travel from outside of Oklahoma to be fit with a wide array of high-tech options.

Scott Sabolich Prosthetics & Research in Oklahoma City was an early adopter of outcome measures, implementing a process to measure progress and quantify prosthetic patient outcomes before many other O&P facilities began doing so. Clinicians at the facility use the measures to determine the best possible outcome for prosthetic fitting, according to Jaime Perkins, the facility’s clinical liaison. The facility’s mission is to provide the “Sabolich experience” for each patient who comes in the door, says Perkins. “Our entire staff is committed to the patient experience, from the very first phone call. The front office staff knows each patient by name—it’s like a family. We pride ourselves on the longevity of our staff.” The main Sabolich facility is a 21,000-square-foot space in Oklahoma City, which includes an 11,000-square-foot full-capacity lab for quick repairs and one-day castingto-first fitting turnaround; the space includes a full built-in exhaust system. Fabrication is completed in-house, with casting done by hand. “It’s an

open and transparent facility,” says Perkins. “Anyone can come in and take a tour.” The facility’s reputation has grown worldwide; a large percentage of the patients travel from outside of Oklahoma, according to Perkins. Sabolich offers an array of hightech options for its prosthetic patients. “We have always combined intensive research efforts with daily clinical practice,” explains Kyle Wagner, CP, LP, chief prosthetist. “The prosthetics research and development industry is entering a groundbreaking and exciting era. Revolutionary technology promises to radically enhance the capabilities of our patients.” The facility is exploring artificial intelligence, environmental feedback, materials design, motorized articulation, and 3D printing, according to Wagner. “We are creating designs that are radically different than conventional thinking by using advanced sensor technologies, smart control systems, and innovative computer modeling,” Wagner adds. “We understand the immense importance of research and development and the direct impact it has on our patients’ ability to get back to 100% functionality.”

COVER STORY

PHOTOS: Bulow Orthotic and Prosthetic Solutions

FACILITY FOCUS: Inviting Physical Spaces

Matt Bulow, CP, owner of Bulow Orthotic and Prosthetic Solutions, wanted patients to feel confident and comfortable at his facility, headquartered in Nashville. With that in mind, he created a high-tech space that is both comforting and clean. “Upkeep shows you take pride in your work,” he says. While the facility originally focused specifically on prosthetic patients, it has grown to offer all types of O&P care. Some service offerings have been tailored for specific patient populations, including orthopedic/ trauma patients; vascular patients; and pediatric patients. The facility also partners with Vanderbilt Hospital’s Ingram Cancer Center in treating patients who have lost limbs due to cancer. The facility strives to provide one-on-one-personal attention and “nurturing guidance,” according to Bulow. The headquarters building features an exposed ceiling, wide hallways, and a large waiting area with a coffee bar where patients often congregate. Two of the patient rooms are oversized, with permanent 24-foot parallel bars where patients can work privately with their clinician. High-end posters of patients—from high-end special ops military limb loss patients to everyday community ambulators, complete with signatures of the patients—decorate the walls. A separate “word wall” showcases 10 words, chosen by staff, that describe “the culture of our practice,” says Bulow. Bulow O&P emphasizes the value of teamwork in its staffing, and encourages clinicians to collaborate with residents and technicians in finding solutions in complicated cases, says Bulow. With several recently built satellite locations outside of Nashville, the facility is now structured in a “hub-and-spoke” model so patients don’t have to come into the city for O&P care, says Bulow.

The lobby, lab, and gait room at Bulow Orthotic and Prosthetic Solutions have been intentionally designed to help patients feel comfortable as well as confident in their devices. O&P ALMANAC | AUGUST 2022

COVER STORY

Keeping Patients Top-of-Mind

Tips for Small Facilities

Any facility can strive to be state of the art, regardless of size. Below are some tips for facilities seeking to optimize their patient-care experiences. “Always make yourself available and tailor the care to each patient and their specific needs. Listen to their concerns, and be creative with the resources you have. Make the most of your situation. That goes farther and has more impact than just providing care in the most advanced center or facility available. In the end, when the patient knows you will stop at nothing to help them succeed, your facility will be excellent in the outcomes it provides.” —Ryan Blanck, CPO, LPO

“Maintain as much communication with your local referral partners and therapists as possible, and continue to remain outcomesfocused. The future of healthcare will be completely driven by those that provide the best evidence of superior patient outcomes. In addition, never stop innovating and never stop educating your entire staff—both clinical and administrative. Stagnancy and complacency are the greatest detriments to any clinic.” —Brett Parrish, MSPO, CPO, LPO

—James Campbell, PhD, Hanger senior vice president and chief clinical officer

AUGUST 2022 | O&P ALMANAC

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

PHOTO: Hanger Clinic, Nashville

“Facility modernization goes beyond size; it can also include technology enhancements, staffing arrangements, increased use of digital technologies, functioning as part of a multidisciplinary team, and being local, available, and convenient to patients. Regardless of the size of their facility or available resources, clinicians can provide excellent care by prioritizing the patient experience and using functional outcomes to drive success and meet the patient’s goals.”

Not every facility can be “state of the art,” but every facility can make small changes to modernize and better meet the needs of its targeted patient base. For those facilities without big budgets, simply identifying a special area of focus, and committing to excel in that area, can result in expanded patient interest and recognition as a unique O&P provider. Of course, any facility that seeks to prosper into the future should continue to explore new technologies and implement processes and procedures that improve the patient experience. “The field of healthcare is an everchanging professional landscape full of regular innovation that requires constant continuing education and adaptation so that the latest proven techniques can be used to provide superior care to our patients,” says Parrish. Keeping up with the latest trends will benefit both the facility and the patients its serves. Patterson believes specialization is a trend that will help keep smaller O&P facilities relevant, even as the O&P field sees increased merger and acquisition activity. “Patients are searching out the particular type of care they need” by going online, and are willing to travel to be seen when they find the right fit, he says. He encourages O&P clinicians to consider opening their own small businesses, with a focus on the area of O&P at which they excel. “There is room in this space for independent practitioners,” he says. “Our prosthetic industry is getting better and better, with people specializing in arms, or lower limb, or orthotics or even cranial remolding,” Patterson says. Patterson encourages small facilities to ask questions and visit other facilities for new ideas. “Sharing knowledge is very important in this field—and will help elevate the profession.”

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Recruiting

Gen Z

How stakeholders are drawing high school students to the profession

NEED TO KNOW: • With a growing need for O&P services within the United States and a recognition that employment of O&P professionals should grow by 18% by 2030, raising awareness of the profession among today’s students has become a priority. • To help attract students to the profession, ABC recently launched an initiative to promote the profession to Gen Z, and AOPA invited high school students to participate in some facets of next month’s Assembly in San Antonio. • Several universities and private practices have developed their own awareness initiatives and created internship opportunities for local students. • Some awareness programs focus on introducing the O&P profession to students of color, which may cultivate more diversity in the O&P profession. • O&P clinicians should consider becoming industry “ambassadors” to connect with students as part of ABC’s whatispop.org program.

AUGUST 2022 | O&P ALMANAC

N THE SUMMER OF 2021, leaders at

the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) started a conversation about the industry’s future, assessing where the next generation of O&P professionals would come from and how to attract students to pursue careers in O&P. The group quickly realized they had a lot of work to do. After all, the U.S. Department of Education has declared O&P training a “national priority” because a shortage of practitioners can’t keep up with the surging demand for services as aging baby boomers become less mobile and national obesity and diabetes rates continue to rise. Providing costeffective, clinically appropriate O&P care to Americans in the years ahead will require a large pool of welleducated certified orthotists and prosthetists. Currently, there is no guarantee that need can be met. “There is obviously going to be a huge need for more orthotists and prosthetists in the future, so we’re trying to help get people interested,” says Debbie Ayres, director of ABC’s

marketing and communications. “By the time that we have this great need [in the future], we’ll need to have people who are able and educated and certified to do it.” The good news is that the O&P profession has a promising future to sell to career-seeking high school and college students. The U.S. Bureau of Labor Statistics has projected that employment of orthotists and prosthetists will grow by 18% from 2020 to 2030, much faster than the average for all occupations. About 1,000 openings for orthotists and prosthetists are projected each year, on average, during the current decade.

Drawing Gen Z to O&P

With extensive in-house research in hand, ABC leaders have developed a long-range plan for convincing students to consider careers in O&P. In June, ABC launched an interactive website, whatispop.org, and filled it with information about the profession, including ways to plug into educational opportunities, connect with accomplished practitioners, and learn about different O&P career paths. ABC also created accounts on TikTok, Twitch, Instagram, and other social media platforms, advertising on each in an effort to meet Generation Z—anyone between 14 and 24—where

they spend the most time online. Ayres encourages O&P professionals who would like to serve as industry “ambassadors,” and who are willing to talk to young people about the profession or even serve as mentors, to contact ABC to join the current initiative. “Our research shows that [young people] want to hear from the people who are in the profession, and from people who are beneficiaries of the profession. We want as many people as possible who are willing to talk to students.” Meanwhile, AOPA is doing its part to bring the O&P profession to the attention of young people. Next month, high school students from San Antonio will take part in the 2022 National Assembly. Joanna Kenton, MHA, CPO, LPO, FAAOP, co-chair of the AOPA Assembly Planning Committee, is leading the effort to welcome students from two local, health career and STEM-focused high schools to AOPA’s annual conference. Approximately 80 students will participate in a short presentation to learn about the O&P profession and glean insights from keynote speaker Mona Patel, executive director at the San Antonio Amputee Foundation. The students will break up into smaller groups to view the exhibits with tour guides, where they’ll learn about O&P products and

technologies and how they can help patients improve their lives. “This is a valuable opportunity to share about our amazing profession,” Kenton says. “To hear from us and our stakeholders will be a powerful introduction to explore a career in O&P.”

Localized Recruitment

National outreach efforts by AOPA and ABC are in some ways an outgrowth of more localized educational outreach that O&P practitioners across the United States have been doing for years. Paul Irving, CPO, who manages three clinical practices at the University of California, San Francisco (UCSF) Orthotic and Prosthetic Centers, became involved in high school outreach and mentoring through the Science and Health Education Partnership that connected UCSF and the Phillip and Sala Burton Academic High School in San Francisco. The partnership, established in 1987, helps students of color explore careers in the health sciences. “We have learning sessions with these high school kids over the two or three weeks that they’re on campus,” Irving explains. “We’ll have them taking casts of each other and doing stuff that is really memorable, but it’s also about being able to put it in a context of careers in O&P.” O&P ALMANAC | AUGUST 2022

create opportunities to spread the word about O&P; he suggests that O&P professionals determine how their contributions could fit in with school curricula and teachers’ lesson plans. “I think it’s critically important to create a partnership over time, and it’s really inappropriate to ask the school to suspend what they’re doing in order to meet our agenda,” he says. “Rather, we should ask how our [agenda] can meet their preexisting curriculum.”

Summer Study

ABC recently launched the interactive website whatispop.org. Ninety-eight percent of the students at Burton High School are minorities, and Irving says mentoring them is not only a way to show them a promising career path, but also an effort to cultivate more diversity in the O&P profession. “In many of the other medical disciplines, there’s very clear data that demonstrates when there is congruence between a patient’s racial identity and the clinician’s racial identity, outcomes are better,” Irving says. “Not only patient satisfaction—that’s certainly better— but actual medical outcomes.”

AUGUST 2022 | O&P ALMANAC

After getting involved with the Burton high school student program, Irving began reaching out to other schools and nonprofit community organizations in the San Francisco Bay Area, and showing up at career fairs to proselytize about the promising prospect of a career in orthotics and prosthetics. That has led to more opportunities to establish relationships with school administrators, teachers, and students. Irving encourages other O&P professionals to contact local schools to establish relationships that could

Angela J. Bryl, CPO, MBA, clinical director at Dankmeyer Inc. in Maryland, helps run a summer program for a small number of high school students—usually two to four at a time—that allows them to shadow clinicians and learn about various aspects of the job. She says Dankmeyer sees a wide array of applicants to the program. Some are drawn to the engineering element of O&P, while more artistic students may be attracted to the molding and crafting of prosthetics. Still others are more inclined toward the scientific or medical side of the profession, or have an interest in working with patients directly to help them create better, more mobile lives. Bryl has noticed a significant number of applicants with an interest in STEM, but the program “appeals to a wide variety of kids,” she says. Sometimes a brief high school or college internship results in a longstanding professional relationship, with the student coming back to Dankmeyer later as a resident and eventually becoming an in-house practitioner. In fact, Bryl took that path herself. “I started out as an intern at Dankmeyer during my college days, came back as a resident, then stayed on as a practitioner and have been with Dankmeyer officially for 16 years,” she says. “We have other practitioners who followed a similar path with some shadowing, residency, and they are still on staff. Our current resident is someone we first met years back when he shadowed with us before he went to O&P school.

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“Getting to know high schoolers and college students who are interested in the field has increased our networking for potential future practitioners,” Bryl adds. “We have found it beneficial for us and would recommend it as a pathway for others as well, as long as you are willing to put the time and effort in up front.” The internship process also benefits experienced practitioners, Bryl says. “We also learn from [the students]; they’ll bring in fresh ideas, things that we haven’t thought of. … Just being able to show and to teach helps you refine your own skills, too, because you

OP_Almanac_August2022.indd 2

AUGUST 2022 | O&P ALMANAC

have to explain it to someone else.” Asked what advice she would give to leaders of other clinics who would like to establish relationships with local high schools or organizations that cater to young career-minded people, Bryl says to “start small” until they’re certain their O&P office can accommodate more than one or two students in the workspace while ensuring the experience is beneficial to both the student and the patient-care facility.

Tech Outreach

It’s not just those working on the clinical side of the profession who aim

to convince high school students with the right aptitude to consider an O&P career path. Engineers and technicians on the manufacturing side are getting involved, too. And sometimes the high schools are the first to reach out. In 2017, students in the Technology and Engineering Program at Wilson High School in West Lawn, Pennsylvania, decided to develop a prosthetic device that would be affordable and comfortable, both of which are challenges facing many individuals with limb loss. The students approached New York-based Curbell Plastics, and that’s when Jeff Wilson, senior business development manager in the O&P division, got involved. Wilson provided the students with technical expertise and a plastic material donation for the project. Wilson says he’s encouraged by the recent growth in technical education in the industry, noting, for example, that Kennesaw State University in Georgia

3/7/2022 11:24:58 AM

now offers a two-year, full-time applied science O&P curriculum that includes O&P engineering. “They’re starting a technician program—just for technicians,” Wilson says. When talking to students, Wilson explains that entry into the O&P field doesn’t necessarily require a college degree, although most professionals in the field pursue certification. “There is a big shortage of skilled technicians at this time, and most of the larger labs will train someone that has no experience,” Wilson says. “For those who want to be a craftsman, who want to work with their hands—and you’ve got to want to get dirty because of all the plaster dust and stuff—there are some really good opportunities.”

Postsecondary Push

At the orthotics and prosthetics program at Baylor College of Medicine in Houston, Program Director Ashley Mullen, MSAT, CPO, LPO, has found

success connecting with college students who haven’t declared majors by establishing a relationship with career advisers at college campuses. “We’ve had a number of students who say, ‘You know, I was pre-med, or I was engineering, but I really didn’t know where I wanted to go.’ And then they sat down and talked to a career adviser, and they were excited when they were told about O&P. They didn’t even know this was a career. So, we’ve done a few presentations to a Texas network of academic advisers to try and make sure they’re well aware of the profession.” Baylor officials even convinced leaders at the nearby University of Houston to add an O&P landing page to their website for students interested in medical careers. “That helped because it gives students at that institution direct information on the courses that you need to take to make the prerequisites for school,” Mullen says.

Ferrier Coupler Options!

Mullen also taps into Baylor’s Center for Educational Outreach to connect with science teachers at area high schools. During summer camps or field trips during the school year, students learn about different medical programs offered at Baylor, including O&P. “We’ve actually had a number of students that have decided to pursue O&P through a presentation that they saw their freshman year of college in one of those classes,” Mullen says. “So that’s been very effective. “Ultimately, the students are looking for a career in healthcare because they want to make a difference in someone’s life. And we are able to show them a very concrete way they can have a career in which they’re doing that every day.” Michael Coleman is a contributing writer to O&P Almanac.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

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

Model A5

Model F5

Model P5

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

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

Model FA5

Model FF5

Model FP5

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

Model T5

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

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

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

O&P ALMANAC | AUGUST 2022

t s e B of Show

Preview this year’s award-winning Thranhardt presentations, featuring prosthetic and orthotic innovations

&P STAKEHOLDERS WILL CONVENE in

San Antonio to network, see new products and services, and experience in-person the latest in O&P education during the highly anticipated 2022 AOPA National Assembly, beginning September 28. Headlining a compelling and comprehensive mix of clinical education topics are this year’s Thranhardt Award presentations. The Thranhardt lecture series, established through a gift from J.E. Hanger to recognize individuals committed to advancing O&P education and research, memorializes Howard R. Thranhardt, CPO, who made major contributions to the professionalization of prosthetics and orthotics. The award, one of the most coveted in the O&P profession, will be presented during the general session Friday, September 30, at 8 a.m., to Jennifer Johansson, MS, for her work with a bimodal run-walk prosthesis, and to Tiffany Graham, MSPO, CPO, LPO, FAAOP, for her work in predicting treatment duration with cranial remolding orthoses. Read on to preview this year’s Thranhardt presentations and learn more about these important advancements.

AUGUST 2022 | O&P ALMANAC

beosf t show

PHOTO: Al Rendon

Bimodal Run-Walk Prosthesis

Johansson will take part in the 2022 National Assembly to share her involvement in the development of a novel bimodal prosthetic foot design during her session, “Design and Testing of the Caesar Foot: A Bimodal Run-Walk Prosthesis.” The new design is a single device with optimized design, alignment, and biomechanics for both walking and running, according to Johansson. A senior research engineer at Liberating Technologies Inc. (LTI), a Coapt R&D Co., Johansson says the study was sparked by reports that many individuals with limb loss cannot afford a running foot because their insurance does not deem it medically necessary. As a result, they are unable to participate in running-based activities or be as physically active as they wish. The team at LTI sought to develop a bimodal walking foot that would be covered by insurance but would offer excellent running capabilities as well. “The goal of our research was to develop a walking foot that was as good in walking mode as any other walking foot, but also operate as a running foot that performs as well as a blade—in other words, to be fully optimized for each activity,” she explains. “As a walking foot, it would be covered by insurance—but because it has this second mode, it allows the user to be more active and reap the associated benefits, such as improving their health and social well-being.” Johansson secured a Small Business Innovation Research grant from the Department of Defense to initiate the work in 2019. “People liked the concept,” she says. “To inform the design, we gathered input from several prosthetists who fit running blades, and we hosted multiple amputee focus groups that helped guide the design. For example, they wanted a sealed switching mechanism so nothing could get in and jam the works.” Although the device is suitable for both above- and below-knee amputees, most early testers had below-knee

Jennifer Johansson,

amputations because Johansson’s team wanted to focus on the foot first, without potential interaction from the prosthetic knee. LTI partnered with Deanna Gates, PhD, from the University of Michigan’s School of Kinesiology, for pilot testing of the Caesar foot. Each subject was tested under three conditions: using the bimodal Caesar foot, using a commercially available hybrid foot (AllPRo from Fillauer), and using the subject’s currently prescribed daily-use walking and running foot. The research team collected full-body kinematic and kinetic data as participants ran on a treadmill, walked overground

at different speeds, and walked on stairs and slopes. The team also measured the rate of oxygen consumption during running or walking (for those who do not run) as a measure of metabolic effort. “While this effort is still ongoing, early results have been promising,” notes Johansson. She is wrapping up the second phase of the project and applying for additional funding for the next iteration. She plans to use subjects at different activity levels, as well as in different weight classes and foot sizes. In addition, subjects will be able to test the feet at home, rather than confined to the lab. “We will be able to see how it behaves in the real world,” she says. “How will it hold up over time? How often will subjects switch between modes? How much will they actually use the foot every day?” Johansson believes the bimodal foot is part of a trend toward creating hybrid devices, but notes that, unlike other devices, the Caesar foot is optimized in each mode. “This is something that can really get people out and more active,” she says. “It can have a profound effect on their quality of life.” O&P ALMANAC | AUGUST 2022

beosf t show Predictive Methodology for CRO Treatment

Graham will head to San Antonio next month to present her latest research—a progression of her previous studies with cranial remolding orthoses (CROs). This year marks the third time Graham, an assistant professor at the University of Texas Southwestern (UTSW) Medical Center, has been honored with a Thranhardt Award. Her previous presentations focused on the significant factors that influenced outcomes among infants using CROs; her 2022 work, called "Development and Validation of a Prediction Model for the Treatment Time of Deformational Head Shapes Using a Cranial Remolding Orthosis,” is targeted toward developing a predictive methodology for the duration of treatment. “Once a parent or caregiver finds out their child will be pursuing orthotic treatment, the next question is almost always, ‘How long will it take?’” says Graham. “Right now, experienced clinicians can give very good estimates, but pediatricians or less experienced orthotists may find it difficult to answer this question. Our goal is to develop a scientific calculation that will predict treatment time.” Several factors influence the amount of treatment time needed in a CRO, notes Graham, including starting age of treatment and head shape severity. In addition, infants with torticollis seem to have extended treatment times compared to those without. Graham performed a retrospective study of 1,250 subjects with different

AUGUST 2022 | O&P ALMANAC

Tiffany Graham, MSP CP O, LP O, FAAOP

head shapes to see how much time was needed for CRO treatment. To develop the prediction models, Graham and her colleagues reviewed charts from Level 4 Prosthetics & Orthotics (Restore POC) in Addison, Texas, and from two locations in San Antonio. The three offices used the same methods to evaluate patients and fabricate orthoses, and they trained their clinicians in the same manner. All offices used the STARband brand CRO from Orthomerica, and subjects began CRO treatment between 3 and 18 months of gestational age. The input for the models included the gestational age of the infant at start of treatment; presence or absence of torticollis and prematurity; initial Cephalic Index (CI), or the width-tolength ratio of the head; initial Cranial Vault Asymmetry Index (CVAI), or proportion of deformity compared to the overall size of the head; and level of CVAI desired by the practitioner at the end of treatment.

Graham worked with a biostatistician to figure out how long treatment lasted among the subjects and applied that information to a separate data set of 210 infants treated by the University of Texas Health Science Center, San Antonio. When the prediction model’s output was rounded up to the nearest month for deformational plagiocephaly, actual treatment time was less than or equal to predicted treatment time in 85.19% of cases; when this was done for deformational brachycephaly, it was accurate in 56.67% of cases, and for asymmetrical brachycephaly, in 75.40% of cases. “We had moderate accuracy and were pleased with the first round,” Graham says. “When the calculation was not accurate, it was fairly close. … It did overestimate times, which was intentional, as it’s better to end treatment earlier than caregivers expect than later.” Graham is already involved in the second round of the derivation equation, adding in the second set of 210 infants to increase accuracy. She notes that the equations should be used as a tool to educate caregivers of probable treatment time, assuming their infant started treatment at their current age and with their current head shape. If caregivers decide to wait to start treatment, changes in the shape of the head over time could significantly affect overall treatment time. If the infant’s information or the practitioner’s treatment goals change, it would change the estimate. It’s important to note that the models apply only if the infant wears the CRO 23 hours a day. Graham discussed commercialization of the predictive model with her department at the UTSW Medical Center, perhaps as a cellphone app, but they decided to offer it to the public for free. Plans are underway to make the model available through the MDCalc website, which helps medical professionals do calculations, process algorithms and scores, and assess risks. The more people who use the

predictive model, the more accurate it will become, says Graham. “I’m curious to see what the feedback will be.” She plans further studies with larger sample sizes and says future investigations should compare infants at several different treatment centers, and those who use different brands of cranial orthoses. Ultimately, an accurate prediction of treatment time can contribute to the success of the intervention, Graham says. Parents and caretakers have a significant impact on the course and success of treatment by properly donning the CRO, ensuring it stays on 23 hours a day, inspecting the infant’s skin, and attending regular follow-up visits for adjustments. “A prediction model will allow practitioners to more accurately answer caregivers’ questions, thus improving their perception of treatment.”

Attend the Hamontree Presentations—and

Optimize Your Business Practices The Hamontree Business Education Award, established in honor of Sam E. Hamontree, (CP), is a business-themed counterpart to the clinical Thranhardt Award. This year, three nominees will share presentations geared toward improving O&P business practices during the 2022 National Assembly. Attendees will have the opportunity to vote for the best Hamontree presentation in San Antonio. Plan now to attend the Hamontree presentations, which will begin at 2 p.m. on Thursday, September 29: “The Three Things You Have Control Over To Speed Up Your Cash Flow” by Stacy Toner, CBCS

“Survey of Emotional Burnout and Its Effects on Innovation in O&P,” by Gerald Stark, MSEM, PhD, CPO, LPO, FAAOP(D)

Deborah Conn is a contributing writer to O&P Almanac.

“Using Outcome Measures To Justify Medical Necessity, Reimbursement, and Business Development in RealLife Settings,” by Jason Kahle, MSMS, CPO, LPO, FAAOP

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O&P ALMANAC | AUGUST 2022

PRINCIPAL INVESTIGATOR

Drawn to Data Geoff Balkman, MSPO, PhD, CPO, LPO, creates outcome measurement tools and conducts research at University of Washington

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

AUGUST 2022 | O&P ALMANAC

N ARTIST AT HEART, Geoff

Balkman, MSPO, PhD, CPO, LPO, earned an undergraduate degree in art and design from Utah Valley University, and he can often be found drawing or painting in his spare time. But Balkman also has an inquisitive side to his nature and is eager for knowledge. This led him to pursue a master’s degree in O&P—a profession many believe is a hybrid of science and art. Balkman was introduced to O&P in 2006 when his brother received his first prosthesis following amputation due to a boating accident. “His experience led both of us to careers in the field of prosthetics and orthotics,” says Balkman. He attended University of Pittsburgh to complete his MSPO degree in 2012, then became certified. He spent several years in clinical positions in California and Washington. While he enjoyed the clinical side of O&P, Balkman quickly became drawn to research. “As a practitioner, I recognized a need in our field for scientific evidence to guide clinical decisions and demonstrate the benefits of innovative technologies,” he says. “I decided to pursue a PhD in rehabilitation science at University of Washington (UW) to get involved in impactful research.” He

Balkman spent several years in clinical positions in California and Washington before pursuing a PhD in rehabilitation science at University of Washington—where he is now an assistant professor.

PHOTOS: Geoff Balkman, MSPO, PhD, CPO, LPO

PRINCIPAL INVESTIGATOR

has spent the past six years at UW, first completing his doctorate, then taking on his current assistant professor role. Today, Balkman focuses on research at UW, but he also teaches in the O&P master’s program and mentors students. His work related to outcome measurement tools—including designing an item bank for assessing mobility of lower-limb orthosis users—has already made an impact in the O&P field.

PHOTO: Geoff Balkman, MSPO, PhD, CPO, LPO

Meaning in Measurement

A significant amount of Balkman’s research has focused on developing and improving key measurement tools for O&P. As a doctoral student, he assisted UW professor Brian Hafner, PhD, with research projects related to the Prosthetic Limb Users Survey of Mobility (PLUS-M), a contemporary survey instrument—or item bank—for measuring mobility in lower-limb prosthetic patient populations. The self-report tool was developed with data from more than

1,500 prosthetic limb users, and it leverages modern psychometric methodology. The tool has rapidly grown in popularity among O&P facilities, and PLUS-M short forms are free for noncommercial use. Participating in the PLUS-M project inspired Balkman to begin developing a similar tool for orthosis users. “I helped Dr. Hafner with teaching an outcome measures course to MPO students, and realized there were very few instruments designed for evaluating lower-limb orthotic interventions,” recalls Balkman. “So, I focused my doctoral dissertation on developing a new item bank for measuring mobility of lower-limb orthosis users.” Balkman and his research team were “fortunate to receive grant funding” to conduct this research, which came from AOPA and Center for Orthotic and Prosthetic Learning and Outcomes/ Evidence-Based Practice, as well as the Department of Defense. Over the past two years, they completed the steps to

Geoff Balkman, MSPO, PhD, CPO, LPO, presented at the University of Washington’s Engineering Innovations in Health Fall Showcase in 2020.

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PRINCIPAL INVESTIGATOR

Balkman (right) presented at the 17th ISPO World Congress in Japan in 2019.

AUGUST 2022 | O&P ALMANAC

Other Investigations

Balkman has been involved in other O&P investigations including studies involving sensor technology. As a doctorate student, he collaborated with a lab at UW overseen by Joan Sanders, PhD, to conduct a pilot study that aimed to better understand how clinicians might use data obtained from transtibial prosthetic socket-mounted sensors. “The sensors were designed to record instances of donning and doffing, and duration of sitting, standing, and walking throughout each day,” he explains. “These sensors were relatively low-profile and easy for patients to tolerate, but I was interested in finding out whether prosthetists found the data useful.” Three prosthetist participants reviewed data collected from sensors attached to their patients’ prostheses for a two-week period. “The bioengineers gained important insights into the reasons prosthetists might use the sensor data, and the study helped me recognize the importance of obtaining clinicians’ perspectives when developing new technologies.”

Up next for Balkman is further study of tools for O&P clinicians. “I plan to examine the validity and reliability of the new instruments we are developing,” he says. He also will continue to develop assessment tools for clinicians to evaluate prosthetic and orthotic interventions. “I also hope to use available outcome measures in clinical trials to examine the holistic benefits of using O&P devices.”

Knowledge Sharing

In his teaching and mentoring roles, Balkman enjoys sharing the knowledge he has gained with the students in UW’s MPO program. The UW MPO curriculum includes research and outcomes measurement courses that help students understand how to interpret research findings and apply them in class projects, according to Balkman. “We provide learning opportunities to set up and administer outcome measures, select appropriate instruments for different clinical settings and patient scenarios, and present poster abstracts as if they were at a national scientific meeting,” he says. “We typically have additional opportunities for assisting with ongoing studies when students wish to get more involved in research.” Outside of work hours, Balkman devotes time to his artistic interests— but also enjoys his role as a husband and a father of four adventurous children. “Our family enjoys spending

Balkman (left) with his brother, Chandler Balkman, MSOP, CPO

PHOTOS: Geoff Balkman, MSPO, PhD, CPO, LPO

develop the orthotic item bank, including a review of existing survey questions relevant to orthotic interventions, a series of focus groups with orthosis users, an item selection process with stakeholders, item testing through interviews, and a cross-sectional study with a national sample of users. “We also included other patient-reported outcome measures in the cross-sectional survey to establish initial construct validity and learn more about aspects of health that may be important for clinicians to measure when providing orthotic care,” he says. The new item bank is called Orthotic Patient-Reported Outcomes Mobility (OPRO-M), and in July Balkman’s team launched a website to introduce it to the public, https://OPRO-M.org. Beyond the PLUS-M and the OPRO-M, Balkman is involved in additional research projects. He is currently contributing to several lower-limb prosthetics-focused projects led by Hafner. “We are designing new patient-reported outcome measures to evaluate fall-related constructs, expanding the PLUS-M item bank to measure highlevel mobility with greater precision, and developing a novel performance test

that can adapt to patients with different levels of mobility and requires only a few minutes to administer,” he says. Balkman believes his work will be important for evidence-based care. “We are designing outcome measure instruments that focus on activities, situations, and aspects of health that are likely to improve as a result of an intervention, and we expect these instruments to be sensitive to clinically important changes,” he says. “As a result, these tools should help clinicians provide payors with additional evidence of the benefits of O&P interventions. “Our goal in developing new outcome measures is to improve patient care and help clinicians with reimbursement issues,” Balkman adds. Just like PLUS-M, “the instruments we are currently developing will be made publicly available and free of charge. We involve clinicians and patients throughout the entire development process and place emphasis on clinical relevance and brief administration time.”

PRINCIPAL INVESTIGATOR

Notable Works Geoff Balkman, MSPO, PhD, CPO, LPO, has been involved in dozens of impactful published studies, including the following:

PHOTO: Geoff Balkman, MSPO, PhD, CPO, LPO

Balkman with his wife and four children time skiing, mountain biking, skateboarding, surfing, and hiking in the Pacific Northwest,” he says. Balkman plans to continue developing and fine-tuning O&P measurement tools, ensuring the O&P profession fully transitions to evidence-based practice that demonstrates the value of O&P intervention for those patients who benefit from O&P services.

• Balkman, G.S., Vamos, A.C., Sanders, J.E., Larsen, B.G., Hafner, B.J. “Prosthetists’ Perceptions of Information Obtained From a LowerLimb Prosthesis Monitoring System: A Pilot Study.” J Prosthet Orthot, 2019; 31(2):112-20. DOI: 10.1097/JPO.0000000000000203 • Balkman, G.S., Hafner, B.J., Rosen, R.E., Morgan, S.J. “Mobility Experiences of Adult Lower-Limb Orthosis Users: A Focus Group Study.” Disabil Rehabil, 2021; Nov 22:1-12. (in press). DOI: 10.1080/09638288.2021.2002437. • Balkman, G., Samejima, S., Fujimoto, K., Hafner, B. “Japanese Translation and Linguistic Validation of the Prosthetic Limb Users Survey of Mobility (PLUS-M).” Prosthet Orthot Int, 2022; 46(1):75-83. DOI: 10.1097/PXR.0000000000000059. • Morgan, S.J., Balkman, G.S., Gaunuard, I.A., Kristal, A., Amtman, D., Hafner, B.J. “Clinical Resources for Assessing Mobility of People With LowerLimb Amputation: Interviews With Rehabilitation Clinicians.” J Prosthet Orthot, 2022; 34(2):69-78. DOI: 10.1097/ JPO.0000000000000345.

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MEMBER SPOTLIGHT

Protosthetics

By DEBORAH CONN

Digital Design Company offers 3D printing and traditional fabrication to support O&P professionals

ROTOSTHETICS BEGAN AS

AUGUST 2022 | O&P ALMANAC

The Protosthetics team

COMPANY: Protosthetics OWNER: Darren Jacoby LOCATION: Fargo, North Dakota HISTORY: Seven years

Jacob Kinsella, head of fabrication, works on a socket.

Anthony Zaragoza, a product technician

time on devices to 12 hours or less, according to Jacoby. “And we include printer replacement every few years, so they always have the latest technology.” The contract has different pricing tiers based on clinic volume, unlimited customer support, and a full warranty and repair program. Protosthetics also offers short-term contracts that enable clinics to try 3D printing with very little risk, and the program can be cancelled without penalty, according to Jacoby. At this point, Galileo can produce check sockets, flexible inners, and copolymer definitive sockets that accommodate a range of suspension and attachment methods. When a patient needs a new socket, the stored digital data makes it easy to recall patient information without going through the entire design process again. “Our team of engineers is always figuring out new devices to offer to customers, so our product list will continue to grow,” says Jacoby. “Instead of every clinic having to reinvent the wheel on new devices, we can hire amazing biomedical

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

PHOTOS: Protosthetics

a student project at North Dakota State University. Founded as a university engineering project, the company aimed to make myoelectric arms that incorporated 3D printing, but soon moved to leveraging the technology to create more traditional O&P devices. Darren Jacoby, who is now CEO and company owner, began offering full-service central fabrication services to clinics, with an emphasis on 3D printing and digital design. Recently, Protosthetics launched a new program in response to feedback from O&P clinicians. “Our customers liked working with us on 3D-printed projects, but they wanted to have the technology in house,” explains Jacoby. “What they didn’t want was to have to learn digital design and become experts in 3D printing, taking time away from their ability to provide patient care.” The result was the Galileo program, an end-to-end offering that places 3D printers in clinics while Protosthetics does all the digital design work as requested by clinicians. Using a proprietary app, clinicians scan the patient and transmit the information to Protosthetics, where product engineers design the device and send digital instructions to the printer, which creates the product on site. This entire process happens seamlessly for the clinician, essentially providing a central fabrication clinician experience, but delivering the efficiency and cost savings of on-site 3D printing, says Jacoby. This system reduces turnaround

engineers and 3D printing experts to figure out new materials, designs, and products that can be done with 3D printing. These are then made available to Galileo members at no additional charge.” Protosthetics continues to offer central fabrication services using traditional methods, 3D printing, or a combination of the two. Additional products include its flagship fully custom 3D-printed pectus carinatum and rib flare braces, the Amphibian Water Leg, and functional, diabetic, and accommodative orthotic inserts. The company also makes ankle-foot orthoses and definitive sockets and offers 3D-printed check sockets. As technology evolves, the company hopes to be front and center, driving a trend toward more on-site fabrication while leveraging external support for clinicians so they can be as efficient as possible while maintaining control of the patient experience. Protosthetics occupies a facility of about 10,000 square feet in Fargo. Its 20 employees include biomedical engineers, kinesiologists, and certified fitters, and its equipment ranges from traditional tools to automated CNC mills and a fleet of 3D printers. The company works with a local nonprofit, Hope Inc., that offers children and adults with mobility challenges opportunities to participate in sports and recreational activities. Protosthetics employees volunteer at many of these events, including an upcoming golf tournament. As the company evolves, Protosthetics will continue to do what it can to help practitioners provide optimal O&P care. “Practitioners have a lot on their plates,” Jacoby says. “We want to make it as easy as possible for them.”

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MEMBER SPOTLIGHT

Achilles Prosthetics & Orthotics

By DEBORAH CONN

Modifying and Motivating Small facility seeks to continuously improve patient care

ETER BUFFINGTON, CPO,

AUGUST 2022 | O&P ALMANAC

Peter Buffington, CPO (right), with Carlos from Healing the Children “I’ve treated children flown in FACILITY: from Pakistan and the Caribbean, Achilles Prosthetics & and Central and South America,” Orthotics he says. “I also went to Ecuador with an orthopedic team in OWNER: 2019.” Recently, he helped the Peter Buffington, CPO organization raise money to fly in a young man with bilateral LOCATION: lower-limb loss, and fit him with Ramsey, New Jersey high-quality prostheses: “He was walking and literally dancing HISTORY: in them before he went back 14 years home,” Buffington recalls. Achilles’ commitment to improving patient care includes surveys given to each patient. “Depending on how they respond, we can track our successes or things we need to improve.” Buffington says most of the feedback is positive, although some comments led him to modify his communication with patients. “It helped me clarify the way I talk to patients, especially when giving directions,” he says. Elizabeth Shea, a One of Buffington’s favorite bilateral above-knee patient who has been in success stories is Elizabeth Shea, microprocessor knees for a bilateral above-knee patient almost a year

who lost her legs in an accident in the 1980s. Shea had moderate success with prostheses after the accident, he says, but on Sept. 11, 2001, she was trapped in lower Manhattan after the attack on the World Trade Center. “The experience so traumatized her that she took off her prostheses and said, ‘Never again,’” Buffington recounts. “But then, 20 years later, she decided to get moving again. She found us through the Amputee Coalition, and she started with ‘stubbies’ [foreshortened prostheses]. They got her up and moving, gaining strength, and she worked so hard. She’s been in microprocessor knees for almost a year and is now walking in the community. Elizabeth has been so committed to her rehabilitation and success—it has been an absolute joy to be along on the ride for this. She has achieved a level of success I never dreamed of!” Achilles relies mainly on word of mouth to attract new patients and referral sources, although the facility has a presence on Facebook and Instagram. Eventually, Buffington would like to expand, adding more practitioners—but not so many that he loses control of the quality and service given to patients. “I’ve been doing this for 30 years, and I like being the one who has to figure it out,” he says. “I love this profession. It’s a challenging blend of art and science that gives you the ability to have an impact on someone’s life.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Achilles Prosthetics & Orthotics

doesn’t dream of expanding his practice into a vast network of patient-care facilities. He likes the level of control he has in a small office where he is, for now, the sole practitioner. “We have a lot of control over how things get made and how people are treated,” he explains. “That level of control leads to better outcomes for our patients.” In 2008, Buffington bought out his partner, who ran an O&P facility in New York while Buffington headed the New Jersey office. He changed the name of the practice to Achilles Prosthetics and Orthotics. Buffington, along with an office manager, an assistant, and a technician, has been serving patients ever since. The facility sees a mix of orthotic and prosthetic patients of all ages, about of third of whom are pediatric. The office includes a large patient-care room and a fabrication lab where he and his technician build all devices. “I’m a little old school,” admits Buffington. “I still modify molds myself, doing all the hands-on work. I like it because there’s no intermediary—it’s a seamless and direct experience.” He does, however, welcome some hightech advances, such as the High Fidelity and Symphonie Aqua socket systems. “We try very hard not to stand still,” he says. Achilles offers continuing education courses on upper- and lower-extremity prosthetics and orthotics to local therapists. Buffington also works with the New Jersey branch of Healing the Children, a nonprofit that provides medical care to children in the United States and internationally.

AOPA NEWS

AOPAversity Webinars

OIN AOPA EXPERTS

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

UPCOMING WEBINARS

September 14 An Operations Presentation

Learn how your daily operations can impact your business: Discover strategies to improve your operations by preventing denials, improving practices for patient intakes, and more.

October 12 Clinicians’ Corner— Prosthetics Join AOPA for the final Clinicians’ Corner of 2022. Learn tips, tricks, and insights while earning scientific credits.

November 9 The Do’s and Don’ts of Gift Giving

Start preparing for the holiday season! When and how is it appropriate to give gifts to your patients and referral sources? This webinar reviews the rules surrounding gift giving and shares important steps to remain compliant.

NEW MEMBERS

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic

Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. ReWalk Robotics 200 Donald Lynch Blvd. Marlborough, MA 01752 508/251-1154 https://rewalk.com/ Larry Jasinski Supplier

W.T. Hinnant Artificial Limb Co. 3707 Latrobe Drive, Ste. 430 Charlotte, NC 28211 704/375-2587 http://wthinnant.com Jason Ralph Riffle, CP Patient-Care Facility

O&P ALMANAC | AUGUST 2022

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2022 for advertising options.

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

Children’s Foot Orthotics by Apis

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

ALPS Flex Sleeve (SFX) ALPS Flex Sleeve (SFX) is a prosthetic suspension sleeve made with seamless knitted construction in HighDensity Gel to provide maximum comfort and control for active amputees. With 30-degree preflexion, the SFX effectively allows for ease of bending and reduces bunching behind the knee. The SFX is available in one length and thickness that accommodates most users. Plus, you can choose from two sleek color options: black or beige. For more information, visit our website, www.easyliner.com, or call us today at 727/528-8566 or 800/574-5426.

AUGUST 2022 | O&P ALMANAC

Boston Orthotics & Prosthetics eLearning Center

Boston Orthotics & Prosthetics eLearning Center is pleased to offer six online courses. You can take advantage of this new training option from anywhere, including your home. With our new eLearning Center, you can stay connected with the most up-to-date technology and techniques with Boston O&P. Students, residents, certified orthotists, physical therapists, and other allied health professionals are welcome to register for our courses. CEUs are provided upon completion of the course. Questions? Contact Jim Wynne, CPO, FAAOP, at jwynne@bostonoandp.com. To gain access to our eLearning courses, simply use the following link: https://www.bostonoandp.com/ for-providers/education-and-training/online-training.

MARKETPLACE Vista Ankle

Naked Prosthetics

The Vista Ankle is a universal single-axis prosthetic ankle joint designed for elevated vacuum applications. The vacuum is generated from the ankle movements of plantarflexion and dorsiflexion during the gait cycle. The barb fitting for the vacuum hose connection is located inside the proximal tube clamp of the ankle, protecting it from damage. The distal female pyramid adapter is compatible with a wide range of prosthetic feet. The Vista Ankle is cost effective, low maintenance, and lightweight (13 oz/385 g) and has a weight limit of 275 lbs/125 kg. For more information, contact us at www.cypressadaptive.com, 888/715-8003.

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

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

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

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

O&P ALMANAC | AUGUST 2022

MARKETPLACE EZ Gauntlet™

Expert-Selected Lower-Limb Solutions

The EZ Gauntlet™ is specifically designed for easy donning and doffing. This custom ankle gauntlet features a single Dacron® strap to simplify the opening and closing process. The posterior plastic trim is designed to allow a semi-living hinge with greater flexibility. This allows the gauntlet to easily pass over the ankle bones and relax securely into place. The single strap can then be secured with one hand and allows tighter closure for effective ankle stabilization and support. For more information, visit www.orthomerica.com.

Ottobock iFab EasyScan 3D Scanning Solution

Ottobock’s product experts examined our full range of lower-limb products and designed winning combinations with ideal patient outcomes in mind. With six recommended combinations, there’s something for everyone. Winning combinations are driven by the priorities of your patient, such as activity level, foot preferences, hygiene needs, optimal volume management, and so much more. One of the winning combos even features the most preferred MPK, Ottobock’s trusted C-Leg. With these expert-curated options at a 25% discount, providing your patients with the best components for their desired outcomes is easier than ever. Learn more at shop.ottobock.us or scan the QR code.

Freedom ShockWave™

Equipped with an ergonomic and easy-to-use camera, enhanced tracking behavior, and texture detection, the EasyScan provides an accurate 3D image of the residual limb, even for the most complicated fittings. As you scan the residual limb, you can follow your results in real-time and make adjustments with Ottobock’s iFab platform solution. Contactless detection of the patient’s residual limb and shortened process times during scanning provides an improved experience for both you and your patient. Embrace the digital future and learn more about EasyScan at shop.ottobock.us/EasyScan or contact us at 800/328-4058. 50

AUGUST 2022 | O&P ALMANAC

The Freedom ShockWave™ incorporates a Spherical Shock Unit (SSU) into the industry-leading classic Freedom foot design with its proprietary EnduraCore® hybrid composite technology. The SSU provides both vertical shock absorption and +/-15 degrees of axial rotation, giving the everyday and active K3/K4 patients a shockingly natural and comfortable experience. Visit www.proteorusa.com/freedomshockwave.

AOPA Member Benefit

AOPA’s Co-OP is

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

Resources include: State-specific insurance policy updates L Code search capability Data and evidence resources, and so much more!

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

DOWNLOAD THE APP!

After creating your Co-OP account, Download to your mobile device at aopanet.atlassian.net.

Learn more and sign up at www.AOPAnet.org/co-op. www.AOPAnet.org

AOPA NEWS

CAREERS

Opportunities for O&P Professionals Job Location Key:

WANTED! A few good businesses for sale.

- Northeast

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

- Mid-Atlantic - Southeast - North Central

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

- Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge. Refer to www.AOPAnet.org for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board 50 or less

Member $85

Nonmember $280

For more opportunities, visit: http://jobs.AOPAnet.org. SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.

AUGUST 2022 | O&P ALMANAC

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

Put AOPA to for YOU!

Join Us!

As an AOPA member, some of the benefits you’ll enjoy include: Strong, strategic advocacy for your O&P profession and patients Free Ask the Expert consultation for your coding, billing and audit questions Convenient access to earn CEs online, on-demand in AOPAversity

AOPA is centered on

YOU.

Let us support you.

www.AOPAnet.org

For more information on membership, or to join, call 571/431-0810 or email bleppin@AOPAnet.org.

CAREERS

Finding your next job or hire just got easier with the AOPA Career Center. For Job Seekers: Job searching is easy with the pane-view job search page. Set up job alerts, upload your resume or create an anonymous career proﬁle that leads employers to you. For Employers: Reach 4,500+ O&P professionals through the Job Flash™ email. Ensure high visibility for your open positions through this highly engaging email.

For more information on recruitment options, contact Customer Service at clientserv@communitybrands.com or (727) 497-6565.

8/19/21 8:02 PM AD INDEX

AOPA_PrintAd.indd 1

Advertisers Index Company

Page

Phone

Website

Allard USA

866/678-6548

www.allardusa.com

ALPS South LLC

800/574-5426

www.easyliner.com

Amfit

800/356-3668

www.amfit.com

Apis Footwear Company

888/937-2747

www.apisfootwear.com

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

Cascade Dafo Inc.

800/848-7332

www.cascadedafo.com

Cypress Adaptive

888/715-8003

www.cypressadaptive.com

ESP LLC

888/WEAR-ESP

www.wearesp.com

Ferrier Coupler Inc.

810/688-4292

www.ferrier.coupler.com

Flo-Tech O&P Systems Inc.

800/356-8324

www.1800flo-tech.com

800/301-8275

www.hersco.com

888/977-6693

www.npdevices.com

Hersco Naked Prosthetics Orthomerica

800/446-6770

www.orthmerica.com

800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

855/450-7300

www.proteorusa.com

Surestep

877/462-0711

www.surestep.net

TurboMed Orthotics

888/778-8726

www.turbomedorthotics.com

Ottobock

O&P ALMANAC | AUGUST 2022

CALENDAR

November 9–11

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

2023 May 19–20

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

2022 August 18–19

May 19 & 20, 2023

Shirley Ryan AbilityLab—Growing Up With CP: The Teenage Years. Chicago. Held virtually, 11 ABC credits. Contact Leslie Marriott at 312/238-6839 or visit www.sralab.org/CP22.

September 6–8

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

September 14

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

Board of Certification/Accreditation

September 28–October 1

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

October 12

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

TOP QUALITY ORTHOTIC, PROSTHETIC AND PEDORTHIC EDUCATION AND CE CREDITS FROM THE ORGANIZATION THAT KNOWS O&P.

October 15

POMAC’s One-Day Pedorthic, Orthotic, and Prosthetic Program. The Marriott New York LaGuardia Airport Hotel (across from LaGuardia Airport), East Elmhurst, NY. Contact Drew Shreter at 800/946-9170, ext. 101, or dshreter@pomac.com for more details.

November 9

The Do’s & Don’ts of Gift Giving. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar

Calendar Rates

AUGUST 2022 | O&P ALMANAC

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@ AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Start earning your credits today!

Words/Rate 25 or less 26-50 51+

Member $40 $50 $2.25/word

Nonmember $50 $60 $5.00/word

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

$482 $634

$678 $830

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

AOPA MEMBER BENEFIT

AOPA Affinity Health Plan AOPA has partnered with Cailor Fleming and World Insurance to bring a healthcare plan built exclusively for AOPA Members

WHY THE AOPA AFFINITY HEALTH PROGRAM? • A Nationwide network of doctors and pharmacies for complete coverage • Prosthetics and Orthotics coverage • Dental and Vision coverage • Multiple plan designs make it easy for you to find the right fit for your business • Cost savings of level-funding, without added risk • All AOPA-established benefit plans meet minimal essential coverage as mandated by the Affordable Care Act • An experienced, trusted team is always ready to provide expertise before and after you’ve chosen your plan

You, your employees, and your families are covered with the AOPA Affinity Health Plan. Visit www.AOPAnet.org to learn more and enroll.

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

Questions? Contact Cailor Fleming: Todd Mayle 330-782-8625, ext. 764 or AOPAHealthAffinity@cailorfleming.com.

www.AOPAnet.org

STATE BY STATE Become an AOPA State Rep.

Seeking More Favorable Laws

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

Updates from California, Colorado, Iowa, and North Carolina

California

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

AB 1892, the bill requiring Medi-Cal reimbursement for O&P appliances to be set at 80% of Medicare, has passed the California Assembly with a unanimous 76-0 vote in favor. With the support of the California Orthotic and Prosthetic Association, more than 150 letters were sent to Assembly members via AOPA’s Capitol Canary grassroots platform just ahead of the bill’s floor vote. AB 1892 will now head to the Senate for further consideration. For the complete legislative history and bill text, visit the California page of the AOPA Co-OP.

Colorado

The Department of Health and Human Services has approved Colorado’s request to implement the “Colorado Option,” a state-specific health coverage plan that increases enrollment and lowers costs. Authorized through Section 1332 of the Affordable Care Act, the Colorado Option is projected to make insurance more affordable and accessible for 10,000 Coloradans starting in 2023. For more information on the Colorado Option, visit the state’s page on the AOPA Co-OP. 56

AUGUST 2022 | O&P ALMANAC

Iowa

HF 2411, a bill that allows for replacement prosthetic devices for workers’ comp patients, has been signed into law by Gov. Kim Reynolds. The final version contains an amendment stating that the portion of a workers’ comp settlement identified as the estimated future cost of prosthetic repair and replacement over the course of a patient’s lifetime shall be placed under control of the state treasurer in a separate fund to be dispensed as medically necessary. To read the full text of the enacted bill, visit the Iowa page of the AOPA Co-OP.

North Carolina

Medicaid expansion legislation has been introduced in the North Carolina Senate. Although HB 149 started as a telehealth bill when it was introduced in the state House early last year, it was recently altered by the Senate to expand Medicaid to more than 500,000 North Carolinians. HB 149 represents an opportunity to expand O&P access but poses implementation challenges. Contact AOPA with any questions or concerns regarding this legislation.

Are you ready to take your career and your business expertise to new heights? The all new Certificate in O&P Business Management can help you do just that!

A comprehensive certificate program for business owners, managers, and practitioners of O&P patient care facilities, O&P manufacturers and AREAS OF LEARNING distributors to explore crucial business challenges as they relate to O&P.

This joint certificate program will provide you with: • Basic business acumen • Practical knowledge to apply immediately to your work • Techniques for developing better business practices • How to think about improving your company’s returns

Areas of Learning include:

HEALTHCARE OPERATIONS Learn techniques for planning, design, operation, control, and improvement of the processes needed to operate your business efficiently.

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

Certificate in O&P Business Management AREA OF LEARNING

CORE

ELECTIVES

Healthcare Operations

Healthcare Operations for O&P Professionals

Mastering Medicare

Healthcare Management

Healthcare Management for O&P Professionals

Elective

Finance

Financial Management for O&P Professionals

Elective

Sales and Marketing

Sales and Marketing for O&P Professionals

Elective

HEALTHCARE MANAGEMENT Increase your knowledge and skills to better manage multiple, individual, and team priorities.

FINANCE

SALES AND MARKETING

Learn business financial management concepts and perspectives for Healthcare Today, Business Models, Accounting & Finance Pillars, and Strategic Decisions

Learn the functions of marketing along with a variety of tools and approaches to personal selling along with the many digital marketing tools available.

EARNING YOUR CERTIFICATE IS AS YOUR CERTIFICATE EASY AS 1-2-3

EARNING IS AS EASY AS 1-2-3 1.

Select and complete within 4 years

• 4 core courses from UHart’s Barney 1. Sign up with AOPA for the program School of Business - Online • 4 elective courses through AOPA

3. Graduation ceremony at the National 2. Select and complete within 4 years Assembly • 4 core courses from UHart’s Barney School of Business - Online • 4 elective courses through AOPA

3. Graduation ceremony at the National Assembly

Visit bit.ly/AOPACP to sign up for the certificate program. Questions? Contact info@AOPAnet.org.

Trust, Move, Live.

Since the introduction of C-Leg and its groundbreaking control technology, Ottobock has never stopped inventing new ways to take your patients as far as they want to go. With a portfolio including the Kenevo, Genium, X3, and now the latest iteration of C-Leg 4, every microprocessor knee supports a journey toward a limitless future.

Scan the QR code to learn more!

Kenevo

C-Leg 4

Genium

IP 22

IP 67

IP 68

The Kenevo is designed specifically for users with mobility limitations who need a high level of stability. State-of-the-art technology allows users to feel safer and more independent in their everyday life. An IP 22 rating protects from dripping water or dust.

The C-Leg 4 provides exceptional reliability and dynamically adapts to a wide variety of everyday situations. The legacy lives on with the new C-Leg 4 Update with over 10 new features including supported descent on ramps and stairs. The C-Leg 4 is easier and more intuitive than ever before.

The Genium provides the highest degree of intuitive function to individuals who need to adapt to changing environments, move quickly over short distances, or require more than 2 days of battery life.

The Genium X3 is the most durable, intuitive and technologically advanced microprocessor knee available. With features that support activities like running, swimming and ascending stairs step-overstep, X3 supports individuals who push the boundaries of mobility.

An IP 67 rating provides protection from damage due to casual contact With an IP 68 rating, Genium An IP 67 rating provides protection or temporary submersion in fresh from damage due to casual contact water up to 1 meter for 30 minutes. also offers the highest level of water protection offered in a or temporary submersion in fresh microprocessor knee. water up to 1 meter for 30 minutes.

August 2022 O&P Almanac

Articles inside

Reimbursement Page

Marketplace

Ad Index

Member Spotlight

State By State

Happenings

People & Places

AOPA Contacts