August 2018 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

AU G U ST 2018

E! QU IZ M

Insights on Proposed Changes to Competitive Bidding P.16

Athlete-Inspired O&P Innovations P.30

NUPOC Professor Advances Lower-Limb Research Agenda

EARN

2

BUSINESS CE

CREDITS P.17

Staffing

UP

RAISING THE BAR FOR O&P HIRING PRACTICES

P.20

P.36

O&P Device Replacement Guidelines P.52

WWW.AOPANET.ORG

This Just In: The Future of Reimbursement for Off-the-Shelf Orthoses P.18

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Experience all the AOPA National Assembly has to offer while visiting Vancouver.

contents

AUG UST 2018 | VOL. 67, NO. 8

AUGUST 2018 | O&P ALMANAC

20 | StaďŹƒng Up O&P facilities have become more strategic in their hiring practices in today’s increasingly competitive health-care climate, rife with reimbursement challenges. Some companies are hiring employees with targeted expertise in compliance, research, and marketing, while others are adding more care extenders, such as assistants and fitters, to their payrolls.

By Christine Umbrell

18 | This Just In

ClariďŹ cation on Competitive Bidding A newly proposed rule from CMS would make several changes to the Medicare competitive bidding program and solicits suggestions for improving the gap-filling methodology used for establishing Medicare fee schedules. These developments could have repercussions relating to off-the-shelf orthoses.

PHOTO: Nike

2

COVER STORY

FEATURES

30 | Patient-Centric Problem Solving

O&P innovation is sometimes spurred by consumers who have a deep understanding of their O&P needs and the componentry required for optimal mobility. Learn about recent products brought to market after O&P athletes sought targeted solutions to enhance their competitive performances.

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contents

PRINCIPAL INVESTIGATOR

DEPARTMENTS Views From AOPA Leadership .........5 Brad Ruhl details AOPA’s efforts to support the ongoing development of technology solutions

Stefania Fatone, PhD, BPO (Hons) ................................................................... 36 Meet a professor from Northwestern University Prosthetics-Orthotics Center who has expanded the O&P research well with studies on lower-limb prosthetics and orthotics.

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

Numbers ........................................................ 8 At-a-glance statistics and data

Happenings............................................... 10 Research, updates, and industry news

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

Split Decisions

Proposed changes to competitive bidding

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

CREDITS

P.16

P.12 Member Spotlight ............................... 40 ■ ■

Advanced O&P Solutions

People & Places .......................................14 Transitions in the profession

Blue Sky Orthotics and Prosthetics

AOPA News.............................................. 44 AOPA meetings, announcements, member benefits, and more

PAC Update ..............................................45 Welcome New Members ..................45 Careers........................................................ 46 Professional opportunities

Marketplace ............................................ 48 P.42

P.40

Ad Index..................................................... 49 Calendar .................................................... 50 Upcoming meetings and events

Ask AOPA ..................................................52 Rules for repaired and replacement devices 4

AUGUST 2018 | O&P ALMANAC

VIEWS FROM AOPA LEADERSHIP

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

AOPA’s Role in Supporting Technology

Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Chris Nolan Ottobock, Austin, TX Vice President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Immediate Past President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, MPH, PhD, BSPO Orthocare Innovations LLC, Edmonds, WA Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Dave McGill Össur Americas, Foothill Ranch, CA

D

URING THE PAST SEVERAL years, AOPA has tried very hard to

prioritize and fund needed outcomes research in an effort to help build the evidence base to support reimbursement of O&P devices. A general lack of high-quality, peer-reviewed, published evidence has been pointed to by many private payors and by Medicare to deny coding, coverage, or payment—the three critical elements of reimbursement—for many of our more advanced, higher value technologies. This is exactly the kind of activity AOPA should be involved in to support the ongoing investment companies make in developing innovative new technologies for the O&P field.

Helping suppliers and providers navigate through the complexities of establishing reimbursement needs to be a high priority for AOPA. This is especially important for those who are attempting to go down this path with truly “new to the world” technological advancements.

A little more than a year ago, the medical-technology industry association AdvaMed published an article titled, “A Future at Risk.” Although we don’t play in the same space as the Medtronics, J&J’s, and Boston Scientifics, we share a similar concern about the limited access people may have to advanced technology based on the current path we find ourselves on. The executive summary of the article stated that “policy changes are essential if the industry is to fulfill its potential for contributing to American economic growth and for the development of the new treatments, diagnostics, and cures that the stunning advances in the life sciences of recent decades have made possible.” We must take the same view in the field of O&P. Working together with AOPA to influence policy makers and decision makers gives us the best shot at being successful in positively influencing the lives of the users of our sometimes life-changing products and services.

Lastly, AOPA must continue to create opportunities—such as the National Assembly and the Leadership Conference—to highlight new technology and sponsor the education and training opportunities that complement the learning of practitioners and business owners outside their offices and clinics. AOPA should lead the efforts to bring its members together as often as possible to encourage collaboration and help raise the standards of care and access to technology that end users both need and deserve.

AOPA has done a lot to support the ongoing development of technology—both products and services—over the past 100 years. Who knows what the future will hold?

Rick Riley Thuasne USA, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

Brad Ruhl is a member of AOPA’s Board of Directors.

O&P ALMANAC | AUGUST 2018

5

AOPA CONTACTS

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

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

Our Mission Statement Through advocacy, research and education, AOPA improves patient access to quality orthotic and prosthetic care.

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide.

These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org Don DeBolt, chief financial officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org SPECIAL PROJECTS Ashlie White, MA, manager of advocacy, outreach, and special projects 571/431-0812, awhite@AOPAnet.org O&P ALMANAC

Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org

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

Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com

Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876

Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net

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

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AUGUST 2018 | O&P ALMANAC

Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@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 © 2018 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 11,800 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac18 for advertising options!

NUMBERS

Digital Health Care Clinician/patient relationships are evolving

Keeping up with the digital age is just as important for O&P clinicians as it is for other health-care professionals.

U.S. health-care consumers—from millennials through seniors—are becoming increasingly comfortable with social media, patient portals, and other aspects of online health care, according to recent surveys.

This trend opens up new avenues for providers, including O&P facilities, to engage with patients and raise the visibility of their organizations.

FRIENDS AND FOLLOWERS

MOTIVATED BY SOCIAL MEDIA

SENIORS AND DIGITAL/VIRTUAL HEALTH CARE

Portion of Americans who have taken an action related to their health as a result of information they read on social media.

Percentage of millennials who would like to “friend” or “follow” their health-care professionals on social media.

30 Percent Percentage of seniors ages 65-plus “likely” to have a live visit with a physician via an app on their smartphone if it cost less than a traditional option.

42 Percent Percentage of all adults who would like to “friend” or “follow” their health-care professionals on social media.

45 Percent

Percentage of seniors ages 65-plus “likely” to send a digital photo of a rash or skin problem to a dermatologist if it cost less than a traditional option.

15 Percent

Percentage of parents who have self-diagnosed a health concern as a result of information read on social media.

TOP REASONS TO USE A PATIENT PORTAL Among Adults Ages 50-80

84%

To view test results 43%

To refill a prescription To schedule an appointment To request an appointment reminder To get advice about a health problem

37% 34% 26%

SOURCE: “Logging In: Using Patient Portals To Access Health Information,” National Poll on Healthy Aging, University of Michigan, June 2018.

8

AUGUST 2018 | O&P ALMANAC

Percentage of adults who feel it is appropriate to use social media to contact their provider about a health issue.

51 Percent

Percentage of seniors ages 50 to 80 who have set up a patient portal.

“People—and young people in particular—don’t go to the doctor as often as they should, but they are interested in improving their health and wellness. If I can inspire a positive lifestyle change in someone through YouTube, then I’ve been an effective physician.”

—“Dr. Mike” Mikhail Varshavski, DO, recognized as the most “followed” doctor on social media

SOURCES: “Top Health Industry Issues of 2018,” PwC Health Research Institute; Online Harris Poll Conducted on Behalf of American Osteopathic Association, April 2018; “Logging In: Using Patient Portals To Access Health Information,” National Poll on Healthy Aging, University of Michigan, June 2018.

1/3

54 Percent

43 Percent

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Happenings RESEARCH ROUNDUP

Amputation Surgery Paired With Robotic Prosthesis Enables Proprioception Two agonist-antagonist myoneural interface devices (AMIs) were surgically created in the patient’s residual limb: One was electrically linked to the robotic ankle joint, and the other to the robotic subtalar joint.

of ankle-foot positions and movement, even when blindfolded,” according to a statement from the MIT Media Lab. Researchers evaluated Ewing’s progress postsurgery using the newly developed prosthesis, which is made of carbon fiber, is similar in weight to a biological foot, and enables two-way communication. Compared to four subjects who underwent traditional amputation, Ewing performed better on a variety of tasks, such as climbing and descending stairs and flexing his prosthetic foot. The research team found that the AMI provides feedback to the user, allowing the user to correct and adjust limb position, speed, and rotation.

“We are excited to see the results of this work in Jim’s ability to interface with the prosthetic to restore proprioception and perform complex movements, which are far beyond what we typically witness in patients with standard amputations,” said Carty. “His progress is enabling us to transform limb salvage and leverage all that is technically possible to restore function.”

Details on the procedure and early outcomes were published in the May 30 issue of Science Translational Medicine.

IMAGE MIT Media Lab/Biomechatronics group. Original artwork by Stephanie Ku.

After undergoing a newly pioneered amputation surgery and being fit with an innovative brain-controlled prosthesis, Jim Ewing, who lost his left leg below the knee, has been able to experience proprioception, according to researchers from the Massachusetts Institute of Technology (MIT).

A new procedure called a dynamic-model amputation, or the “Ewing amputation,” has been developed by Matthew Carty, MD, a Brigham and Women’s Hospital surgeon, and Hugh Herr, a professor at MIT. Ewing became the first person to undergo the complicated procedure, which was designed to maintain signaling between the muscles and brain—to eventually allow a patient to flex and point his prosthetic foot, turn his ankle, and complete other complex actions using a hightech prosthesis developed by Herr’s team at MIT Media Lab. During the amputation procedure, surgeons constructed two agonist-antagonist myoneural interfaces (AMIs) within the residual limb. Each AMI sends control signals to one joint of a robotic ankle-foot prosthesis and provides proprioceptive information pertaining to the movement of that joint back to the patient’s central nervous system. “When the patient moves his phantom limb, the reconnected muscles move naturally in dynamic pairs, sending proprioceptive information through nerves to his brain. He consequently experiences natural sensations

Engineers Develop Solar-Powered Skin With Prosthetic Applications

10

AUGUST 2018 | O&P ALMANAC

a flexible solar cell, which could have applications for the detailed movement required by an advanced prosthesis. The skin requires 20 nanowatts of power per square centimeter.

“The next step for us is to further develop the powergeneration technology which underpins this research and use it to power the motors which drive the prosthetic hand itself. This could allow the creation of an entirely energy-autonomous prosthetic limb,” said Dahiya.

The researchers also have developed a graphene supercapacitor, which uses layers of flexible, 3-D porous foam formed from graphene and silver; the supercapacitor may have applications in the next generation of wearable health sensors.

Details were published in a recent issue of Nano Energy.

IMAGE: University of Glasgow

Engineers at the University of Glasgow have developed synthetic skin that may one day be used as a touch-sensitive covering for prosthetic devices.

Led by Ravinder Dahiya, a professor of electronics and nanoengineering, a research team integrated powergenerating photovoltaic cells into electronic skin.

The skin is made of graphene, a flexible form of graphite that is strong, electrically conductive, and transparent. Because 98 percent of the light that strikes its surface can pass directly through the material, graphene can be used to gather sun to generate power, according to the researchers. The prototype is a graphene-based touch-sensitive layer integrated onto

HAPPENINGS

LOWER-LIMB REIMBURSEMENT

Interagency Workgroup Releases Recommendations on LCD and MPKs Following the recommendations of the Lower-Limb Prostheses Interagency Workgroup, the durable medical equipment Medicare administrative contractors (DME MACs) released a joint publication announcing the retirement of the draft Local Coverage of Determination (LCD) and Policy Article on lower-limb prosthetics. The draft LCD and Policy Article were initially published on July 16, 2015, and, if enacted, would have delayed patient access to prosthetic care and reduced the quality of the prosthetic limbs patients receive as well as patient outcomes.

In 2016, CMS convened the LowerLimb Prostheses Interagency Workgroup in response to the comments received in regard to the 2015 draft LCD. The workgroup’s purpose was to “develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower-limb prostheses.”

The workgroup recently completed its review and released a consensus statement.

Based on the findings and recommendations of the workgroup, the following actions were or are being taken: • CMS instructed the DME MACs to remove the draft LCD. • CMS instructed the DME MACs that coverage for lower-limb prostheses will remain under the current LCD, with no changes.

• Future LCD changes must follow procedures set forth in the 21st Century Cures Act. • CMS is considering creating a National Coverage Determination (NCD) to evaluate the use of microprocessor knees (MPKs) in those individuals utilizing their prostheses as a limited community ambulator (K-2 functional level).

The removal of the draft LCD has been an aim of AOPA and its lobbying efforts since it was introduced in 2015, so the latest instructions from CMS are considered a major victory.

AOPA is currently reviewing the full findings of the workgroup and the consensus document. There are some areas where AOPA will likely disagree and wish to provide additional comments. For example, it appears that the consensus document may have been written before the February 2018 enactment of Section 50402 of the Bipartisan Budget Act of 2018, which recognizes the legitimacy of orthotist’s and prosthetist’s notes in the medical record for the justification of medical necessity. CMS has yet to revise the Program Integrity Manual to reflect the directions from the deputy director, the head of CMS’s own Program Integrity Center, and the current status of the prosthetist’s notes continues to be misstated.

In addition, the possibility that MPKs for K-2 limited community ambulators may be considered in an NCD is an important step forward as it represents CMS taking back this authority from the DME MACs. LCDs are the province of the DME MACs, while an NCD is a strict Federal Register CMS-driven rulemaking process. CMS has consistently said that the only way it could take this matter out of the authority of the DME MACs would be to invoke an NCD. AOPA will be submitting comments on the proposed NCD and the potential for microprocessor knees to be used by K-2 limited community ambulators in accordance with established guidelines.

The DME MACs also recently released a revised version of the controversial August 2011 “Dear Physician” letter on lower-limb prosthetics. The revised version included this statement regarding the new law: “CMS is in the process of considering any program changes that may be necessary as a result of this legislation. Thus, this article is being retired pending instructions from CMS.” The retirement of the letter is an indication that CMS acknowledges and understands that the provisions of the original Dear Physician letter are no longer consistent with the law and can no longer be used as the sole justification for denying a Medicare claim.

PROOF OF IDENTITY

Medicare Beneficiary Identifiers Continue To Roll Out The new Medicare identification cards featuring a Medicare Beneficiary Identifier (MBI), replacing the Health Insurance Claim Number (HICN), are being mailed to beneficiaries in Alaska, California, Oregon, Hawaii, American Samoa, Guam, and the Northern Mariana Islands.

New Medicare cards will continue to be sent to people who are newly enrolled with Medicare and beneficiaries in Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia.

Recipients of the new MBI cards may start using them immediately.

Medicare beneficiaries may use either HICN or MBI identifiers through Dec. 31, 2019. Lookup tools to verify whether patients have received new cards are available on the websites of the durable medical equipment Medicare administrative contractors.

O&P ALMANAC | AUGUST 2018

11

HAPPENINGS

AMPUTEE ATHLETICS

South Carolina Mobility-Impaired Runner in 100th Race O&P Companies Competes Beth Deloria has become the first mobilityHost First impaired runner to compete in 100 Rock ‘n’ Cycle Clinic

AUGUST 2018 | O&P ALMANAC

Prosthetist Wins Iowa Amputee Golf Association Tournament IAGA golf tournament Nick Ackerman, CP, LP, demonstrates that director of prosthetics amputation doesn’t at American Prosthetics have to diminish quality and Orthotics (APO) in of life, achievement, Clive, Iowa, came in first or participation,” place overall at the 27th Watson said. “Anything Annual Iowa Amputee is possible.”

Golf Association (IAGA) The competition Tournament with rounds raises scholarship of 78 and 69. Ackerman, a funds for Iowa bilateral amputee, also is amputees as well vice president of IAGA. IAGA President Cory A. Watson presents as immediate The tournament was Nick Ackerman, CP, LP, with a trophy for family members held in July at the Willow his tournament victory. of amputees. APO Creek Golf Course in West was the major sponsor of the Des Moines. The amputees-only event; other sponsors included rounds had 40 golfers playing 18 Össur, Orange Coast Lender holes over the course of two days.

Services, Cascade Orthopedic “Every year we are treated to Supply, Ottobock, and University outstanding golf,” said Cory A. of Iowa Community Credit Union.

Watson, president of IAGA. “The

PHOTO: Nick Ackerman, CP, LP

12

in a one-mile “Walk a Mile in Our Shoes” walk to bring attention to foot drop and the ankle-foot orthoses that can restore quality of life for those living with mobility challenges.

PHOTO:TeamUP

PHOTO: OPAF First Cycle Clinic

Individuals with physical or mobility challenges were recently invited to participate in an OPAF First Cycle Clinic in upstate South Carolina.

The event, sponsored by Advanced Prosthetics, Nabtesco-Proteor, and Friddle’s Orthopedic Appliances, offered participants, volunteers, and their families the chance to test adaptive bikes and cycles on the bike paths of Camp Spearhead in Marietta, South Carolina. The event was made possible with partnerships with Roger C. Peace Rehab and Heather’s Ride, local suppliers of adaptive cycling.

The event provided a “great opportunity to try adaptive cycling and meet and make friends,” said Peter Ferris, CPO, a practitioner at Advanced Prosthetics. “Camp Spearhead is set just out of town and in the foothills. I learned the difference between a recumbent and upright cycling.”

OPAF will return to the Greenville area this fall with a First Swim Training and Clinic on Saturday, October 20, sponsored in part by Shriners Hospital for Children.

Roll races, which span distances of up to marathon length and take place all over the globe.

Deloria, who runs with foot drop paralysis, is a part of TeamUP, a national team of people united by foot drop who raise awareness about the condition.

While not everyone on TeamUP is able to run, several of Deloria’s teammates competed alongside her in the 5-kilometer or half-marathon distances. In addition, all 12 TeamUP members participated

HAPPENINGS

DIABETES DOWNLOAD

U.S. Sees Rise in Economic Burden of Diabetes The total estimated cost of diagnosed diabetes last year was $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity, according to a new article published in Diabetes Care, “Economic Costs of Diabetes in the U.S. in 2017.” Care for individuals with diagnosed diabetes accounted for $1 out of every $4 in U.S. health-care dollars, with more than half of those expenses directly attributable to diabetes, according to the study.

Researchers found that people with diagnosed diabetes incurred average medical expenditures of approximately $16,750 per year, which are 2.3 times higher than what expenditures would have been in the absence of diabetes.

Indirect costs associated with diabetes among the employed population

included increased absenteeism, which cost $3.3 billion, and reduced productivity while at work, which cost $26.9 billion. For individuals who were not in the labor force, indirect costs included reduced productivity ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).

Total economic costs of diabetes increased by 26 percent between 2012 and 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes, after adjusting for inflation. “The estimates … show that diabetes places an enormous burden on society and has increased over time—both in economic terms presented here and in reduced quality of life,” concluded the researchers.

THE LIGHTER SIDE

MEETING MASHUP

NYSAAOP Announces 2019 Meeting The New York state chapter of the American Academy of Orthotists & Prosthetists (NYSAAOP) has announced that the 2019 NYSAAOP Annual Meeting and Scientific Sessions will take place May 15-17, 2019, at the Rivers Casino and Resort in Schenectady, New York. The meeting is open to clinicians, researchers, patient advocates, vendors, manufacturers, and presenters in prosthetics, orthotics, and pedorthics to learn about the latest advances in O&P and translate that knowledge into more effective patient care.

O&P ALMANAC | AUGUST 2018

13

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

American Prosthetics & Orthotics (APO) has announced two promotions. Malena Billups, CPO, LPO, has been named director of education, and Matt Husnik, CPO, LPO, ATC, has been promoted to assistant manager of the Iowa City office.

Malena Billups, Billups, an APO employee since 2007, sees CPO, LPO patients at APO’s three Iowa City offices. She is a graduate of the University of Iowa with a degree in athletic training and completed orthotic and prosthetic studies at Northwestern University. She also is a member of the Iowa Prosthetic, Orthotic, and Pedorthic Association (IPOPA).

Matt Husnik, CPO, Husnik studied physiology at the University LPO, ATC of Iowa and has a background in athletic training. He began his career at APO in 2009 as an orthotic resident. He received his certification in orthotics in 2011 and prosthetics in 2013 from Northwestern University’s Prosthetic-Orthotic Center. Husnik is the resident mentor for the Iowa City offices and is a member of IPOPA. Jennifer Fayter has been hired as director of sales at Coyote Design. Fayter, who has been involved in the O&P industry since 2001, has been an active volunteer, serving on the OPAF Board of Directors and on the Industry Jennifer Fayter Advisory Council for O&P News. “I’m excited to be able to join the Coyote team. … I look forward to building relationships with our customers and helping them improve the quality of life for their patients,” said Fayter.

Philipp Schulte-Noelle has joined the Ottobock management team as chief financial officer. In this position, he serves under Chief Executive Officer (CEO) Oliver Scheel, MD, and completes the Management Board under majority Philipp Schulteshareholder Professor Hans Georg Näder.

Noelle Scheel assumed the position of CEO in January 2018. With the addition of Schulte-Noelle, “we have put together a new management team within half a year, enabling us to work on our profitability and growth targets with a full line-up in the third quarter,” said Scheel.

In view of a possible IPO, Schulte-Noelle will focus on speeding up reporting and complying with the International Financial Reporting Standards in the future, among other duties. His field of responsibility includes risk management in addition to finance. “I am very pleased to drive the development of Ottobock as part of the team under [Scheel] and the shareholders,” said Schulte-Noelle. “Getting a family company that has been helping people recover their mobility for nearly 100 years ready for an IPO is an exciting challenge.”

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AUGUST 2018 | O&P ALMANAC

PROFESSIONALS IN MEMORIAM

Gregory S. Gruman, CP Gregory S. Gruman, CP, passed away in July at the age of 69 following a battle with cancer. Gruman was the fourth-generation owner of Winkley Orthotics & Prosthetics, originally founded in 1888.

Gruman spent time at the family’s facility as a child and became an official Winkley employee in 1970. He took over the company in 1984 after his father retired. He introduced computers into the workplace and moved the facility into the technological age.

Gruman participated in various industry professional organizations and served as president of the American Board for Certification in Orthotics and Prosthetics in 1989.

The Winkley facility is currently being run by Gruman’s children, Alexander Gruman, CPO, and Amalia Gruman Laird, CP.

Sam E. Hamontree, CP(E) Sam E. Hamontree, CP(E), passed away in July following an illness, near his home in Newport Beach, California. Hamontree, Sam E. Hamontree, for whom AOPA’s Sam E. Hamontree, CP, CP(E) Business Education Award, was named, played a pivotal role in the O&P profession and served in several leadership positions within the industry.

Hamontree, who at one time was chief executive officer of ORPro, served as president of the American Board for Certification in Orthotics and Prosthetics in 1970. He was awarded the American Academy of Orthotists and Prosthetists’ Titus Ferguson Award in 2003 and was honored with the AOPA Lifetime Achievement Award in 2000.

Hamontree also held business-related positions within AOPA, including chair of the AOPA Business Procedures & Liaison Committee, and he helped develop the AOPA Business Survey and the AOPA Cost Accounting Manual.

He also contributed to the development of the Relative Values schedule, which was used to establish the HealthCare Common Procedure Coding System L-code system.

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REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

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BUSINESS CE

CREDITS P.17

Split Decisions Could proposed changes regarding competitive bidding mean more equitable reimbursement for off-the-shelf orthoses?

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

Currently, CMS has defined the items subject to competitive bidding through 2019 and has yet to include OTS orthoses in the list of competitively bid services.

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AUGUST 2018 | O&P ALMANAC

C

OMPETITIVE BIDDING IS A term that makes most of us feel uncomfortable. It conjures thoughts of reduced reimbursement in an already challenging business environment, and generally makes people nervous about what the future holds.

While competitive bidding seems to be an eventual reality, it is important to stay up to date on where the program currently stands and how it may ultimately affect your O&P business.

This month’s Reimbursement Page provides an update on the Medicare competitive bidding program, including some proposed changes that have the potential to improve the program from the provider perspective.

list for competitive bidding 2019, which is slated to run through 2021, was announced without reference to OTS orthoses, this program has been placed on hold pending review of the competitive bid program in general by the current administration.

The future of the competitive bidding program has been further delayed by the recent publication of a proposed rule that attempts to improve the competitive bidding program by reducing the overall burden on providers submitting bids to participate in the program and to ensure that reimbursement rates under competitive bidding do not prevent Medicare beneficiaries from having access to the services they require.

Impact of Split Codes

Proposed Changes

When CMS created and released a series of “split” code pairs, where the same device is coded according to whether it was custom fitted by an individual with appropriate education and training or whether it was delivered as an off-the-shelf (OTS) device, competitive bidding for OTS orthoses appeared to be inevitable. However, despite signs leading to competitive bidding for OTS orthoses, CMS has yet to include these orthoses in the list of items subject to competitive bidding.

Currently, CMS has defined the items subject to competitive bidding through 2019 and has yet to include OTS orthoses in the list of competitively bid services. While the product

The proposed rule that addresses durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding was released on July 11, 2018, and proposed several changes to the DMEPOS competitive bidding program.

First, the proposed rule introduces a change in reimbursement methodology that would base what are called single payment amounts (SPAs) on the maximum winning bid for the “lead item” within a product category.

This lead item SPA would then be used to calculate the SPA for other items within the benefit category.

Previously, the Medicare competitive bidding program used the

him at jmcternan@AOPAnet.org. bursement services at AOPA. Reach Joe McTernan is director of reim-

REIMBURSEMENT PAGE

median winning bid amount to set the SPA for each item within a product category. The proposed change in reimbursement methodology would significantly reduce the burden on providers by allowing them to calculate their bid pricing on only the lead item within a product category. Previously, providers had to submit a separate bid for every Health-Care Common Procedure Coding System (HCPCS) code within a product category included in the competitive bidding program.

While providers will still need to consider the impact of their lead price bid on other codes within the product category, the actual process of bid submission should be less time-consuming for providers. In addition, the use of the maximum winning bid of the lead item to establish the SPA amounts will result in higher reimbursements for providers who are awarded bids. Using the maximum winning bid of the lead item to set the SPA for the codes within the product category will ensure that providers will not be forced to accept contracts for amounts below their actual bid amount.

This was one of the major provider complaints under the previous competitive bidding reimbursement methodology.

CMS also has proposed that, assuming there will be a gap in the competitive bidding program while new contracts are being solicited and executed, CMS will apply established competitive bidding rates in both existing competitive bidding areas (CBAs) and non-CBAs using the proposed SPA calculation method.

While this proposed change will not impact O&P providers as OTS orthoses are not part of any current competitive bidding program, it confirms CMS’s recognition that the current competitive bidding program was unsustainable and was causing significant access-to-care issues for Medicare beneficiaries. CMS’s acknowledgement of the shortfalls of the current program will hopefully lead to improvements in the future, when and if OTS orthoses are included in competitive bidding.

A second important part of the proposed rule is the solicitation for comments on how to improve the

“gap-filling” process that Medicare currently uses to establish fee schedule amounts for products that are new to the market or receive new HCPCS codes. As discussed in this month’s This Just In column (see page 18), federal statute requires that when establishing a Medicare fee schedule amount for a new code or product that is new to the market, CMS must use the average reasonable charge information from 1986 or 1987 as a baseline and then apply the annual Medicare increase to the base fee to establish a relevant current fee schedule.

While this process has long been used by CMS to establish Medicare fee schedules for new HCPCS codes, it has never been transparent or necessarily accurate in representing fair and equitable reimbursement for products that are new to the market.

AOPA will be submitting comments on ways to improve the gap-filling process, both individually and through its partnership in the O&P Alliance.

Potential for Positive Change

While competitive bidding remains a possibility in the future, it does not appear that CMS is aggressively moving toward inclusion of OTS orthoses in competitive bidding. The proposed rule has acknowledged that no new requests for contracts will be issued until the proposed rule is finalized and

that they expect there to be a significant gap between the expiration of existing contracts at the end of 2018 and the award of new contracts.

While OTS orthoses have not been identified as a product category for inclusion in competitive bidding in the past, the creation of the split code set several years ago indicates that it will eventually occur.

The proposed changes to the competitive bidding program have been met with general optimism by durable medical equipment providers who believe the proposed changes will result in more equitable reimbursement and a more sustainable program. While AOPA members will not be immediately affected by the proposed changes, they may prove beneficial in the future.

Joseph McTernan is director of reimbursement services 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:

www.bocusa.org

O&P ALMANAC | AUGUST 2018

17

This Just In

Clarification on Competitive Bidding Changes may eventually impact reimbursement for off-the-shelf orthoses

O

N JULY 11, 2018, CMS released

a proposed rule that suggests several changes to the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. The proposed rule also solicits comments regarding ways to improve the gapfilling methodology that is used to establish Medicare fee schedule amounts for new items and technologies.

While off-the-shelf (OTS) orthoses have been eligible for inclusion as a product category since the Medicare competitive bidding program was announced, the proposed rule does not provide any indication that OTS orthoses are being considered for inclusion in any upcoming rounds of competitive bidding. In fact, the proposed rule acknowledges that the proposed changes to the competitive bidding program will most likely delay the issuance of new contracts once the existing competitive bidding contracts expire at the end of 2018. While it does not appear that competitive bidding of OTS orthoses is imminent, several changes that have been introduced as part of the proposed rule may eventually impact reimbursement for OTS orthoses, should they ultimately be included in competitive bidding.

In general, the proposed changes to

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AUGUST 2018 | O&P ALMANAC

The proposed rule acknowledges significant flaws in both the Medicare competitive bidding program and the gapfilling methodology used to establish Medicare fee schedule amounts. competitive bidding are advantageous to Medicare providers. The proposed rule includes a change in reimbursement methodology that would base what are called single payment amounts (SPAs) on the maximum winning bid for the “lead item� within a product category. This lead item SPA would then be used to calculate the SPA for other items within the benefit category.

Previously, the Medicare competitive bidding program used the median winning bid amount to set the SPA

This Just In

for each item within a product category. Without getting into actuarial detail, the SPA reimbursement method contained in the proposed rule should result in better reimbursement rates for providers while reducing the burden involved in completing the request from contract.

CMS also has proposed that, assuming there will be a gap in the competitive bidding program while new contracts are being solicited and executed, CMS will apply established competitive bidding rates in both existing competitive bidding areas (CBAs) and non-CBAs using the proposed SPA calculation method. While this will not directly impact traditional O&P providers, it confirms CMS’s recognition that the current competitive bidding program was unsustainable and was causing significant access-to-care issues for Medicare beneficiaries.

A second important part of the proposed rule is the solicitation for

comments on how to improve the “gap-filling” process that Medicare currently uses to establish fee schedule amounts for products that are new to the market or receive new HealthCare Common Procedure Coding System (HCPCS) codes. Federal statute requires that when establishing a Medicare fee schedule amount for a new code or product that is new to the market, CMS must use the average reasonable charge information from 1986 or 1987 as a baseline and then apply the annual Medicare increase to the base fee to establish a relevant current fee schedule. This process is known as gap filling.

AOPA has shared its concern regarding this method of fee schedule calculation for years due to its lack of transparency, the failure to recognize the service component of HCPCS codes, and the arbitrary methods used to establish base pricing. The proposed rule acknowledges significant issues with the gap-filling methodology and

requests suggestions on how it can be improved without contradicting the statute. AOPA will be paying special attention to this relatively small component of the overall proposed rule as it may have the most immediate effect on O&P reimbursement.

While the proposed rule is far from perfect, it acknowledges significant flaws in both the Medicare competitive bidding program as well as the gap-filling methodology used to establish Medicare fee schedule amounts.

The proposed rule suggests specific ways to improve the treatment of Medicare’s provider partners through more reasonable reimbursement rates associated with the competitive bidding program and solicits the help of the Medicare provider community in improving the gap-filling process so that it is more effective in the future.

AOPA will complete a comprehensive review of the 368-page proposed rule and offer relevant comments to CMS where appropriate.

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19

COVER STORY

Staffing Up In addition to top-notch clinicians, today’s

successful O&P companies are employing individuals with targeted expertise in compliance, outcomes measures, marketing, and more

By CHRISTINE UMBRELL

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AUGUST 2018 | O&P ALMANAC

COVER STORY

Need To Know As O&P companies grow and documentation requirements increase, more facilities are moving past traditional staffing structures and experimenting with new positions.

An increasingly competitive healthcare market also has spurred a need for a stronger marketing presence at many O&P practices.

There is no exact formula for proper staffing; instead, staffing needs will vary based on each facility’s size, geographic scope, and practice model.

Another way O&P facilities are optimizing the use and effectiveness of their resources in an increasingly demanding reimbursement environment is by hiring more care extenders, such as assistants and fitters.

Many companies are adding “compliance officer” responsibilities, either as full-time positions or as partial job duties. These staff members ensure companies are compliant with all payor requirements to secure more favorable reimbursement.

Some facilities are creating clinical outcomes and research positions, tasking employees with oversight of data analysis and developing partnerships with research institutes.

Smaller facilities may not have the resources to hire full-time staff tasked with compliance or research duties, but they can ensure success by “starting small” and assigning these responsibilities to current staff members as one small segment of their job description.

S

of O&P interventions. “When I was getting into the field [in 1989], the key facilities across the nation are to a good prosthetist was someone who evolving, with many companies worked well with patients and who employing more people with specific could build a beautiful socket,” says skill sets to strategically position facilScott Sabolich, CP, owner of Sabolich ities for productivity and efficiencies.

Prosthetics & Research. “Today, that “O&P has long been a cottage industry prosthetist also has to be compliant with a lot of small private owners,” says with notes and insurance, and compeJeff Brandt, CPO, chief executive officer tent with outcomes and founder of testing,” he says.

Ability Prosthetics While high& Orthotics. “But quality patient as I think we would all agree, Jeff Brandt, CPO care remains paramount, “you it is never more have to keep the apparent that we doors open” by need to get more being productive sophisticated.”

The staffing challenges at O&P facil- and cost-efficient, Sabolich says. He believes the best way to staff a facility ities have become particularly difficult is by employing the minimum number over the past several years, with stricter documentation rules and lower of people to deliver the maximum output, while providing optimal reimbursement rates forcing O&P patient care—without overworking companies to focus on compliance and each staff member. find new ways to support the efficacy TAFFING STRUCTURES AT O&P

O&P ALMANAC | AUGUST 2018

21

COVER STORY

Baseline Strategies

works great at one location may not work well at another office.”

Sabolich has spent some time thinking about the optimal ratio of support staff to clinicians at his company, which is a More Targeted Tasks “destination facility,” with all aspects of As O&P companies grow and administhe business completed on-site. There, trative burdens increase, more pracoperations run most efficiently with tices are hiring management staff to one or two administrators for every relieve some of the burdens. prosthetist, and up Management to one technician at Reach Orthotic per prosthetist, & Prosthetic Sabolich says.

Services, for These ratios, he example, recently Scott Sabolich, CP suggests, lead to realized a need effective operations for a staff member and quick turnwith adminisaround times, as trative oversight well as administrators who are propand hired Mike Boggs to serve as the erly billing and collecting. company’s first chief operating officer But Sabolich emphasizes that the (COO). A former hospital executive, ratios at his facility may differ from Boggs supervises financial and operwhat works best at another O&P ational activities for the facility’s five company. He recommends O&P busilocations and guides strategic planning ness owners and managers consider for future expansion. the individual characteristics of their Reach owner John Robb, CPO, made facilities to determine what is most the decision to hire Boggs to take on appropriate, given the circumstances. some of the day-to-day managerial Jason Wening, MS, CPO, FAAOP, tasks, allowing Robb to focus more agrees that today’s O&P companies of his time on patient care. As COO, need to be thinking more strategiBoggs is responsible cally about their employees—and that for the business staffing needs will vary based on each side of operations— facility’s size, geographic scope, and including staffing, practice model. Once those factors are scheduling, clearly defined, facilities should deterbilling, marketing, mine the most appropriate staffing human resources, structure to ensure the clinical staff is accounting, and as effective, efficient, and knowledgefinance, among able as they can be, while taking into other responsibilities. “My role consideration the facility’s strategic contributes a lot to the strategic vision future, says Wening, who is a clinician, and implementing strategic initiatives,” residency director, and director of Boggs says. Before Boggs came on clinical values at Scheck & Siress. board, Robb was “spending too much “We have to recognize that the days of his time with office management.” of the CPO being the one that does Many O&P companies are alleeverything, start to finish, in a facility viating practitioners’ compliance are over,” says Wening. “The trick is burdens by adding personnel to figure out, given your staff and their tasked with compliance oversight. abilities, who to hire, what to hand off, “Regulatory and compliance changes and what to keep to ensure the best have been significant in recent years, patient results. resulting in more stringent processes,” “It takes real introspection to says Brad Gardner, COO at BCP Group. understand your business, your “We have increased our administrastaff ’s talents and expertise,” Wening tive staff in many instances to ensure continues. “And remember that what that we are compliant at delivery 22

AUGUST 2018 | O&P ALMANAC

with all payor requirements. We have expanded our compliance department to add a full-time compliance officer dedicated to ensuring we maintain our standards.”

The compliance officer position also plays a significant role at Sabolich Prosthetics & Research. “This is a bit of a paradigm shift, from 2010 to now,” Sabolich explains. “Today, we need a prosthetist who is very focused on being compliant,” he says. The job of the internal compliance officer—a fulltime position—is to double-check each claim at three stages: before casting, at delivery, and at billing, says Sabolich.

This position “makes our facility as audit-proof as possible,” says Sabolich.

Carolina Orthotics & Prosthetics also staffs a vice president of administrative services and compliance as part of its corporate team, explains C. Ralph Hooper Jr., CPO, the company’s president. As recently as five years ago, that position did not exist at many facilities, but today “the compliance officer job needs to be assigned to someone at an O&P company,” whether the associated responsibilities comprise all or just a portion of that individual’s job, says Hooper.

As Ability Mike Boggs P&O has grown, now with 10 locations throughout Maryland, North Carolina, and Pennsylvania, Brandt has dedicated resources to expanding the company’s management team. The company has developed roles for a COO, a chief compliance officer, and a chief financial officer, and added two regional directors who are charged with local management of the practices. Brandt also notes that Ability P&O has tasked one individual—Jeffrey Quelet, CPO, regional director—with the job of clinical management officer.

In that capacity, he serves as liaison between the company’s clinicians and the 30 or 40 manufacturing companies Ability partners with to support its outsourced manufacturing model.

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Research and Data Responsibilities

In addition to supporting increased administrative, compliance, and managerial duties, some O&P companies are now devoting resources to research and the collection of outcomes measures. “Getting visibility around your business is really important,” says Brandt. “It’s important to record data, mine it, and translate data, so you can use it to implement change,” he says.

Toward that end, Ability has a research arm that actively pursues grants and collaborations around new research projects typically have strucdeveloped with universities, research product development and clinical tured timelines and funding for the institutes, and VA and military hospioutcomes. “We have to prove through work,” he explains. “For some projects, tals,” he explains. “We have built quantitative and qualitative data that clinicians may participate in a small the device we provided to the patient is many projects and collaborations with role as a ‘research prosthetist,’ while the academia—and now I can barely keep working for them,” Brandt explains. university takes up with the opporExamining data helps facilities care of procedural tunities,” he says. gain a clearer understanding of both and administraIt’s not just historical trends and forward-looking tive tasks—so the clinicians who trends, which can “help you more Jason Wening, MS, clinician may benefit from discretely understand your business,” CPO, FAAOP devote only a small having a dedicated says Brandt. This data can be used to percentage of his staff member overdetermine where to invest resources or her time” on seeing research and draw referrals. research activities capabilities and To help aid in Ability’s research and will be able to keep up with his or partnerships at Ability—patients endeavors and commitment to her patient load as well. outcomes data, Brandt created a clinical also benefit from participating in Wening also has taken on research the studies, says Kaluf. Research outcome and research director posiresponsibilities as part of his job studies provide “a great opportunity tion, which is held by Brian Kaluf, CP. description at Scheck & Siress. He has to expose our patients to high-quality This position has grown organically been named the facility’s “director of clinical trials from Kaluf’s work clinical values,” a position that was and advanced in patient care created six months ago. Wening plans technology,” he to advance the to transition to the position slowly, says. “When our development of evolving from his previous position of patients have the patient outcomes Brian Kaluf, CP opportunity to give 80 percent patient care and 20 percent measures protomanagerial duties to 100 percent back in the form of cols for certain director of clinical values role in three participating in a types of O&P treatyears. In this new position, Wening will study, it enriches ments. As he began focus less on creating new research their experience—they feel they are analyzing data and performing retroprojects and more on collaborations giving back to their peers,” says Kaluf. spective chart reviews, Kaluf found with other institutions, he explains.

The growth of the research sector at that more and more of his time was Wening says the decision to add this Ability has led the management team being dedicated to research endeavors. position at Scheck & Siress was part to offer research internships. “And we He gradually transitioned from fullof a strategic move to address how the provide opportunities for our clinicians time clinical care to full-time research facility could succeed in a value-based to contribute and play an active role responsibilities with clear objectives. health-care community. The goal is to in our research,” Kaluf says. He also Part of Kaluf’s research responsibecome a highly efficient and clinically notes that, for some studies, facilities bilities include fostering partnerships skilled facility to garner good clinical can partner with academia and devote with other research-focused entities. outcomes that help the clinicians do a small portion of a clinician’s time to “The more research we performed, the their jobs better. participating in a study. “University more networking and relationships we 24

AUGUST 2018 | O&P ALMANAC

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COVER STORY

One of the unique roles at Sabolich Prosthetics & Research is an outcomes specialist, who ensures all outcomes testing is administered in a standard way for optimal data capture and comparison. Sabolich hired Jordynn Brittain to fill this role; she administers seven separate tests to capture outcome measures for patients over the course of the patient treatment process: at the very beginning of the evaluation of the patient, again one month after delivery, and then every six months until the patient needs a new prosthesis; then the cycle repeats itself.

More Marketing Staff

Of course, an increasingly competitive health-care market also has spurred a need for a “stronger marketing presence” at O&P facilities, says Brandt.

“Patient documentation is taking a larger and larger cut out of a practitioner’s day,” explains Anne Sych, marketing coordinator at Reach O&P Services. Sych is responsible for marketing activities, with a focus on digital and social media marketing efforts. She asserts that business owners and clinicians often “simply do not have time to market their own practice. Add to that the reality that our world has become digitally driven. Patients have become savvy, educating themselves and researching before they choose a provider. If they don’t find you, you can be sure they will find your competition.”

For today’s O&P practice to thrive, “it is essential they have someone telling their practice’s story to their geographic and digital community,” says Sych.

Brandt agrees: “We live in an age where there are many avenues to raise awareness and allow patients to tell their stories,” he says. “We can and should spread the message of outcomes and clinical value” about how O&P devices can help patients achieve their goals. Having 26

AUGUST 2018 | O&P ALMANAC

a marketing staff member in place to own that responsibility, to share the O&P message, has become increasingly important, says Brandt.

Fitters and Care Extenders

Another way O&P facilities are optimizing the use and effectiveness of their resources in an increasingly demanding reimbursement environment is by hiring more care extenders. “The Anne Sych health-care industry is struggling to fill positions, so we’re adding some assistant and care extender positions” at Reach, says Boggs. In fact, data from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) shows an upward trend in certification of assistants, technicians, and mastectomy fitters, comparing 2016 to 2017 data.

Assistants also play a significant role at BCP Group, according to Gardner, who has past experience in the dental field, “where we utilized dental assistants to maximize their capacity as allowed by licensure,” he explains.

“This ensured the dentist worked efficiently and spent time on the treatments and interactions that required them to do so.

“We take the same approach in our [O&P] markets,” says Gardner.

“We utilize fitters, assistants, and residents where licensure permits to ensure that we give outstanding care to our patients while ensuring that our licensed clinicians are as effective and efficient as possible.” These roles are important to the patient-care process because “they allow us to spend more quality time with the patient, understanding and documenting their needs, and testing and documenting their functional outcomes,” he adds. “The extender interaction, in coordination with the clinician expertise, ensures that we utilize the clinical time in a manner that will give the best outcome for the patient.”

At Carolina Orthotics & Prosthetics, care extenders have played a significant role ever since management took a closer look at “practitioner time versus care extender time,” a few years ago, says Hooper. Today, Carolina O&P uses assistants and fitters, under the supervision of certified practitioners and in compliance with Medicare guidelines.

“We utilize fitters as much and as often as we can so that our other clinicians are freed up to handle prosthetics and more complex orthotic cases,” he explains, noting that his facilities are working to ensure 100 percent of their staff are credentialed by either ABC or the Board of Certification.

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COVER STORY

that more care extenders will be able But Hooper also recognizes a to perform the jobs for which they discrepancy between the scope of were trained—in the future. practice for which ABC-certified assistants and ABC-certified fitters are trained and the scope of practice Right-Sizing for Smaller Facilities accepted by Medicare and private Not every facility can afford to hire insurance companies, which may not someone to fill all of the positions allow assistants and fitters to work needed in today’s competitive healthindependently. care environment.

He points out “But at a one-man that some care shop, a portion of extenders are the clinician has not allowed to to be a compliance Ralph Hooper perform some officer, a portion Jr., CPO of the tasks they has to do outcomes were trained to testing—you have do without being to wear a lot of constantly overseen by ABC-certified hats and be very good at what you do,” clinicians—which may defeat the says Sabolich. purpose of employing them. “We are Sabolich also advises other facilities not getting guidance from Medicare to recognize the strengths of each staff regarding which types of care member and play to those strengths extenders qualify as ‘individuals with when assigning roles and tasks. “You specialized training,’” says Hooper, have to be willing to change and adapt” citing the spinal reimbursement guideyour staffing to prosper in today’s lines in particular. He is hopeful that health-care climate, he adds. “This is the guidance will become clearer—and the new normal.”

Kaluf notes that a research position has the potential to be incorporated into almost any size facility—for example, as a part-time position at a smaller practice. He recommends starting slowly, “perhaps with part-time research duties for one of the research-minded clinicians.” But Kaluf admits that it can be challenging for clinicians to perform both clinical care duties and research responsibilities—with the demand of patients usually taking priority. He suggests that individuals in dual clinician/researcher roles need to be both responsive to the immediate demands of clinical care and simultaneously maintain the vision and endurance in regard to the “long, drawn-out, and rigorous research process.” These two responsibilities can have “very different timelines,” he says.

Ultimately, Kaluf says that clinicians at smaller facilities may be able to “develop their own” research opportunities, by choosing to research a topic that will eventually help improve the patient care offered at their facility.

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AUGUST 2018 | O&P ALMANAC

COVER STORY

Wening agrees that a researcher role can be an important position at a facility, but he highlights the need for facilities considering adding such a position to get “the right person” in place. Before proceeding, consider whether “you have the size to take one of your higher compensated staff and move them to a new position,” he says. That individual “will be making less revenue in terms of patient care—so what will [that individual] bring to the company since they’re not generating revenue in the classic O&P model? You will need to make sure this person makes the others in the company better or more profitable in their jobs.”

He also recommends starting small.

For example, at a one-location shop with three practitioners, “maybe just identify who, within the office, will be responsible for overseeing outcomes and data collection,” Wening suggests.

“Maybe it’s just 10 percent of their job,

or maybe it involves contracting with an outside party or partnering with a university.” In addition, Wening notes, “hospital systems are asking for specific types of outcomes data now— so we need to be proactive and get those systems in place.”

And Gardner stresses the continued importance of care extenders in the O&P staffing structure going forward—particularly as the O&P patient population grows.

“It has become increasingly difficult

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to find clinicians in certain markets, which means facilities will have to optimize existing clinical resources by delegating clinical and lab responsibilities as much as possible and ensure they are involved in the processes that require their expertise,” he says.

“The ability to work closely with our health-care providers is critical. Roles within our facilities that continue to build a collaborative relationship will also continue to expand as other health-care sectors expand their quality metrics.”

Whatever the staffing structure at an O&P facility, the good news is that, going forward, “this profession is going to be needed,” says Wening.

“Our job is to project out in the future and determine how to live in a very different world.”

Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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O&P ALMANAC | AUGUST 2018

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By MEGHAN HOLOHAN

Patient-Centric

PROBLEM SOLVING O&P consumers inspire innovative products developed by 2018 AOPA National Assembly keynotes Tobie Hatfield and Sarah Reinertsen

NEED TO KNOW Many O&P consumers have an intimate understanding of their individual prosthetic or orthotic needs. Recent O&P innovations have come to market as a direct result of O&P users developing their own componentry for specific and targeted purposes.

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AUGUST 2018 | O&P ALMANAC

Tobie Hatfield, director of innovation for Nike, worked closely with Sarah Reinertsen, an above-knee amputee and competitive runner, in developing soles

for use with prosthetic feet as well as specialized shoes designed for easier donning and doffing.

Both Schultz and Hatfield will be sharing their stories as O&P innovators during the AOPA National Assembly in Vancouver next month.

PHOTO: Nike

While many consumerdriven products are developed specifically for competitive use by amputee athletes, these products may cross over into the mainstream market.

“Monster” Mike Schultz, a competitive snocross athlete who became an above-knee amputee after a racing accident, invented his own prosthetic knee to use in snocross and motocross activities, eventually starting his own company to market the knee and other products.

A

S O&P CLINICIANS KNOW,

patient input is a critical component of O&P device selection.

O&P consumers often have the most intimate understanding of how their devices work. During office visits, patients work closely with their practitioners, explaining their mobility needs and goals, and sharing problems they have experienced with previous componentry.

So it comes as no surprise that some recent O&P innovations have come to market as a direct result of O&P users hatching their own ideas. That has been the case for “Monster” Mike Schultz, a competitive snocross athlete who became an above-knee amputee after a racing accident, and competitive runner Sarah Reinertsen, who was born with proximal femoral focal deficiency and became an above-knee amputee at age 7. Schultz designed a prosthetic knee and foot to facilitate his return to the competitive sports he loves, and Reinertsen served as the inspiration for Tobie Hatfield, director of innovations for Nike, in designing more prosthetic-friendly soles and shoes. Both Schultz and Hatfield will be discussing their innovations during the AOPA National Assembly in Vancouver next month.

From Competitor to Inventor

PHOTOS: Wayne Davies Photography

After a snocross racing accident in 2008 led to the amputation of Schultz’s left leg above the knee, the long-time athlete knew he wanted to return to competitive snocross as soon as possible. But when he searched for a knee that would allow him to race snowmobiles again, he found few promising choices.

“I was researching and learning more about prosthetic equipment. I didn’t find anything that performed the way that I thought it should,” Schultz says. “I thought this was a good opportunity to design something better for me to use.”

Throughout his racing career, Schultz worked on suspension systems for his snocross vehicles and understood how suspension is essential for performance. As he considered making

“Monster” Mike Schultz has raced competitively in snocross (left) and snowboarding (right) competitions using the Moto Knee he developed (front). a biomechanical knee, he thought about how a human knee was basically a version of a “suspension component”; this concept guided him as he built his own knee. Like any inventor, he pieced together his prototype knee from parts he had, including a shock absorber from a mountain bike. After finishing his design, he simply attached it to his prosthetic leg and began using it for snocross and motocross.

“I knew I wanted a specific range of motion,” he explains. “It worked pretty darn good right away. … I realized this is really going to work, and I was going to ride again.”

That early success motivated Schultz, and he began training for competition again. When the ESPN X Games started hosting adaptive motocross, he saw an opportunity to race. He started out with motocross racing and earned a Silver medal at his first Adaptive X Games. Then he began snocross racing again and picked up snowboarding, leveraging his unique knee to compete at a very high level.

After using the knee himself in several sports, Schultz realized there was an opportunity to help other athletes. “I fine-tuned the Moto Knee and started the business [BioDapt],” he says. “My understanding of body mechanisms, working with athletic

trainers, understanding extension components … I was kind of the perfect guy for the job.”

After founding BioDapt in 2011, adaptive snowboarders quickly began adopting the knee. By 2012, Schultz had perfected his Moto Knee and began working on the Versa Foot, also popular with snowboarders. The Versa Foot works for both above- and below-knee amputees and is designed for athletes as the target audience, though some amputees use it simply for walking.

As Schultz competed in the X Games, winning a total of eight medals in adaptive motocross and snocross, he continued snowboarding.

By 2014, he was competing in snowboarding at a national level. While he did well, he thought of snowboarding as a fun pursuit. “I went to a competition right after Sochi … and I did fairly well,” he says.

A coach approached Schultz and asked if he wanted to consider seriously training for a potential spot on Team USA’s Paralympic snowboard squad. Schultz initially balked; he was too busy with snocross, motocross, and his business. But something made him reconsider his position. “My wife and I thought, ‘This could be a real amazing opportunity,’” he says.

O&P ALMANAC | AUGUST 2018

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Meet “Monster” Mike Schultz and Tobie Hatfield in Vancouver Attend the keynote presentations at the 2018 AOPA National Assembly Learn more about patient-focused O&P design and development from the innovators highlighted in this article when you attend the keynote presentations at the AOPA National Assembly, September 26-29, at the Vancouver Convention Center: Thursday, September 27 7:30 – 8:00 a.m.

TOBIE HATFIELD, director of innovation for Nike, will share world-class insights and recount his personal story of going from athletic coach to shoe developer during his keynote address.

In addition to these high-profile keynote addresses, plan now to take part in the 2018 Thranhardt and Hamontree award sessions, featuring cuttingedge clinical and business presentations, and stayed tuned to the October issue of O&P Almanac for interviews with the winners:

THE THRANHARDT LECTURE SERIES Thursday, September 27, 8:00 – 8:30 a.m., Exhibit Hall B Hear the two abstracts selected as the award-winning “Best of Show” Thranhardt Lectures. The 2018 award winners are “Significant Factors Influencing the Effectiveness of Cranial Remolding Orthoses in Infants with Deformational Plagiocephaly,” presented by Tiffany Graham, MSPO, CPO, LPO, and “Comparative Effectiveness of Microprocessor and EnergyStoring Prosthetic Ankles,” presented by Brian Kaluf, BSE, CP, FAAOP.

THE SAM E. HAMONTREE, CP(E), BUSINESS EDUCATION AWARD Friday, September 28, 10:00 a.m. – Noon, Ballroom B Created to recognize the best business education paper, idea, or proposal submitted for presentation, this session invites audience members to cast their vote for the award winner. Presentations will be given by Chris Field, MBA, on “Successful Contract Negotiations”; by Kenneth Gavin, CO, MEd, on “Organizational Mission Possible: Top 10 Developmental Impacts With Increasing Employee Engagement and Lean Strategies”; by Lesleigh Sisson, CFom, on “Top 10 Ways to Get and Keep Your Money”; and by Frank Bostock, CPO, FAAOP, on “Certified Orthotists and Prosthetists: Product Supplier or Knowledge Based Health-Care Professional?”

Saturday, September 29 7:30 – 8:00 a.m.

“MONSTER” MIKE SCHULTZ, Paralympic snowboarder, founder of BioDapt Inc., and ESPY award winner, will discuss how he became involved in prosthetic design after a snow mobile accident left him an above-knee amputee.

Of course, there will be plenty of can’t-miss special activities during the AOPA National Assembly. Mark your calendar to attend these popular events: Wednesday, September 26 Thranhardt Golf Classic, Furry Creek, 1:00 – 5:00 p.m.

Welcome to Vancouver Grand Opening Reception, Hall C, 5:30 – 7:30 p.m.

Thursday, September 27 Party With a Purpose, Level III, Meeting Rooms 301305, 6:30 – 9:30 p.m.

Friday, September 28 Professional Women of O&P Celebrating Success, Ballroom D, 8:45 – 9:45 a.m.

Exhibitor-Sponsored Happy Hour in Exhibit Hall, Hall C, 5:00 – 6:30 p.m.

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AUGUST 2018 | O&P ALMANAC

“I definitely want to continue being an athlete—maybe not a competitive one, [but] still being involved in the motorsports and snowboarding” in some way, he says.

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Schultz took home Gold and Silver medals from the 2018 Paralympic Games in PyeongChang.

PHOTO: Wayne Davis Photography

By fall, Schultz started training and competing in Europe—and he started winning. While four years felt like a long time, he set his eyes on making the Paralympic team for the 2018 PyeongChang games. “I got a shot at being one of the top guys. It has been a bit of rollercoaster,” he says.

Schultz wore his Moto Knee and Versa Foot during competition in PyeongChang, winning a Gold medal in the snowboard cross event and a Silver in banked slalom. He also provided knees for other U.S. snowboard athletes with lower-limb prostheses.

Altogether, athletes using the Moto Knee took home 11 medals from the Games. “The entire U.S. snowboard Paralympic team was using it … that’s pretty rad,” he says. “I took a Silver medal to a kid that I built a leg for, and he beat me by a second. I wasn’t too upset. I was pretty pumped.”

Earlier this summer, Schultz was presented with yet another award—an ESPY Award for Best Male Athlete With a Disability, as part of the U.S. Parasnowboard Team. Schultz called the recognition “truly an incredible honor and surprise.”

As a keynote speaker for the AOPA National Assembly, Schultz hopes to share his experience as an athlete and designer. Even though he can’t imagine leaving competitive sports behind, Schultz, now 36, loves that as an innovator he can help people fulfill their own dream of competing.

Schultz isn’t the only adaptive athlete who used his personal experience to drive innovation in prosthetic design.

Marathon runner, Paralympian, and triathlon athlete Reinertsen started making her own running soles for her prosthetic leg when she simply could not find a sole that worked for longdistance or trail runners. She would cut the soles off running shoes and glue them to the bottom or her running foot. It worked, but it wasn’t perfect. “I was doing the cobbling myself in the garage,” she says. “It was inconvenient and time consuming. I would lose training time, and I was limited by the type of soles and cushioning.”

When she met Hatfield, senior director, athlete innovation, at Nike in 2007, she explained her process to him. Hatfield saw an opportunity to help Reinertsen. “She also shared how putting cobbled shoes on was not only problematic for her, but also for most amputees, and how that prevented a lot of people from getting out and moving,” Hatfield says. “This led to our work on creating the Nike Sole.”

Reinertsen was born with proximal femoral focal deficiency, which affected her left leg. By the time she was 7, she had her leg amputated above the knee. Soon after, she started running and participated in junior and high school track. As a senior in high school in 1992, she participated in the Paralympic Games in Barcelona. While she loved her experience, she wanted to compete more often and found that marathon running and triathlon racing gave her that chance.

“I began running distance events because there was more opportunity, with races almost every weekend versus every four years,” she says. “And when I met another amputee athlete [who] was competing in the Hawaii Ironman, it inspired me to take my training to another level.”

PLATINUM

GOLD

SILVER

O&P ALMANAC | AUGUST 2018

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Tobie Hatfield and Sarah Reinertsen

Nike FlyEase

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AUGUST 2018 | O&P ALMANAC

Meghan Holohan is a contributing writer to O&P Almanac.

PHOTO: Nike

As the first woman with a prosthetic leg to compete in the Hawaii Ironman, Reinertsen faced a lot of pressure. She failed at her first attempt in 2004 but succeeded the following year in completing the challenging race on her second attempt, in a little over 15 hours. After becoming a Nike athlete, Reinertsen met Hatfield—and their partnership began almost immediately. “We discussed a lot of the sporting equipment that I used, but when he saw what I was using on my running leg—he immediately saw potential to improve the design,” she says.

Hatfield’s own experience in sports contributed to his career in design. He worked as a track and field coach for an NCAA Division 1 program and joined Nike in 1990 as part of the materials team. He took the listening skills that he honed as a coach and integrated those into how he designs products.

“My approach has always been to listen to the voice of the athlete first, and solve for their needs first,” he says. “I’ve been inspired by different aspects of the design and innovation process throughout my career at Nike, but, more than anything, my motivation stems from a desire to help athletes—from the elite to everyday to adaptive—reach their potential.”

When Hatfield met with

Reinertsen, he immediately knew that he could improve the soles she was using. “Tobie knew he could design something with more cushioning that was also more streamlined, aerodynamic, and easy to switch out within seconds,” Reinertsen explains.

Hatfield understood that designing a better sole would help not only Reinertsen but other athletes as well.

“It’s about innovating solutions that can advance footwear in a way that enables athletes at all levels to live more active and independent lives,” he explains.

As they developed the sole, Reinertsen felt inspired and immediately noticed how Hatfield’s designs changed her as an athlete. “We called them the ‘Sarah sole,’” she says. “I was totally stoked to have this equipment, something perfectly integrated that could help all runners.”

After Reinertsen tested several prototypes of the sole, it was ready for release for all athletes, renamed the Nike Sole. “It’s a great reminder that we as innovators are here to serve all athletes—that means athletes of all abilities, ages, and backgrounds. It’s not always about Gold medals or world records, it’s also about quality of life and helping people reach their starting line,” Hatfield says.

Following the success of the Nike Sole, Reinertsen and Hatfield have worked together on other adaptive technology. Most notably, they collaborated on the FlyEase, a tennis shoe with a wrap-around zipper. This shoe is designed for people who have a prosthetic foot—or for individuals with

cerebral palsy, Parkinson’s disease, or stroke, who might struggle to put on traditional shoes. The shoe is designed to make wearing tennis shoes easier.

“The Nike FlyEase is our lace-free system that connects an adjustable strap to a wraparound zipper, letting you open or close the shoe in one fluid motion. Ultimately FlyEase helps all athletes, regardless of their ability, get their shoes on and off quickly,” Hatfield explains.

The inspiration for the FlyEase came from a teen with cerebral palsy who loved Nike shoes but couldn’t get in them. He wrote to Nike Chief Executive Officer Mark Parker and asked for a shoe that he could use without too much work. Parker knew that Hatfield and Reinertsen were up for the task. In fact, Hatfield had already noticed that Reinertsen carried a shoehorn to help put her prosthetic foot into on her shoes.

After years of use, she was used to it—but changing shoes quickly during a triathlon was a challenge.

“I [didn’t] want to tie my shoes,” she says. “I [was] also looking for an easier way to put on my shoes. It is kind of fascinating that my work as a competitive athlete has brought me back [to] innovation and access to sport.”

After several prototypes, the FlyEase was ready. Reinertsen knew immediately the shoes would help people like herself. “It is like a heel-entry shoe, which is important—especially for amputees who can’t articulate their ankle,” she says. “I love that my work with Nike helped inspire a range of Nike soles for the Össur prosthetic feet, and opened doors for more athletes than just myself,” she says.

Hatfield is looking forward to the AOPA National Assembly, where he plans to discuss how innovation helps all people have greater access. “I’m excited to share more about my work around FlyEase and how through design, Nike is removing barriers for athletes and creating more access to sport,” he says.

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PRINCIPAL INVESTIGATOR

Expanding O&P Research Stefania Fatone, PhD, BPO(Hons), relishes her roles as a researcher, professor, and mentor at NUPOC

For 2018, O&P Almanac is introducing individuals who have undertaken O&P-focused research projects.

Here, you will get to know colleagues and health-care 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.

S

TEFANIA FATONE, PhD, BPO (Hons), has been conducting O&P

research for more than two decades.

Over the years, Fatone, who is a professor at Northwestern University ProstheticsOrthotics Center (NUPOC) in Chicago, has authored more than 80 publications. Her research has been instrumental in guiding thinking on lower-limb orthotics and prosthetics, focusing on

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AUGUST 2018 | O&P ALMANAC

PHOTO: RJ Garrick

Stefania Fatone, PhD, BPO(Hons), leads a presentation to the Feinberg School of Medicine research administration services team on subischial socket research.

“the effects of prostheses and orthoses on human motion in order to increase understanding, establish efficacy, and improve effectiveness of prosthetic and orthotic interventions for people with physical impairments,” she explains.

Fatone—who was initially drawn to the profession because of its “blend” of art and science—is particularly interested in trying to better understand and quantify the effect of specific aspects of O&P design on function and synthesizing the evidence available to support O&P practice.

She spends most of her research time concentrating on two areas: the lower-limb orthotic management of persons with upper motor neuron lesions, such as stroke and cerebral palsy, and prosthetic sockets for persons with lower-limb amputation.

“My lower-limb prosthetics research explores ways to improve prosthetic sockets for persons with lower-limb amputation by developing more comfortable sockets, developing sensor-based tools for monitoring inside prosthetic sockets, and exploring features of socket design that might enhance function,” says Fatone.

“Additionally, I am interested in how we improve decision making regarding dysvascular partial foot amputation using shared decision making.”

PRINCIPAL INVESTIGATOR

In terms of lower-limb orthotics, Fatone’s research centers around assessing how ankle-foot orthoses can improve function in persons with upper motor neuron lesions and how to assess quality of care when providing anklefoot orthoses. Her upper-limb orthotic research focuses on how novel orthotic devices might improve upper-limb function in persons with brain injury.

Fatone is currently involved in eight research projects: three on the topic of lower-limb prosthetic sockets, three on upper-limb orthotics, and two collaborations in the areas of orthotic outcomes and shared decision making for dysvascular partial foot amputation. She also travels extensively with Scheck & Siress clinician Ryan Caldwell, CP, teaching prosthetists around the world about a new socket technique, the NU-FlexSIV socket, which was developed at NUPOC with funding from the Department of Defense.

Touting Teamwork

PHOTO: Stefania Fatone, PhD, BPO(Hons)

Fatone has been able to maintain an active and diverse research portfolio with funding from federal agencies, industry, and professional organizations—such as AOPA. “Joining the email listservs of various federal agencies and professional organizations that fund research has been the most effective way to find funding for my research,” she says.

Fatone’s body of work also has benefitted from several long-standing and productive research collaborations.

“Research is not possible without partners, and I have many research partners—both in terms of individual academics whom I collaborate with as well as institutional partners,” she says. For example, Fatone has worked with Allen Heinemann, PhD, at the Shirley Ryan AbilityLab, to study O&P outcome measures. She has collaborated with Steven Ondra, MD; Aruna Ganju, MD; and Tyler Koski, MD, in the Northwestern University Department of Neurological Surgery, in researching the role of the spine in walking. She also has studied partial foot amputation in conjunction with Michael Dillon, PhD, at La Trobe University in Australia.

Fatone (far right) takes part in Lewis Landsberg Research Day in April, a Northwestern University campus-wide event to promote faculty and trainee development through the sharing of research and conversation with colleagues.

In terms of O&P entities, Fatone cites Scheck & Siress Prosthetics Inc. as an important collaborator. “Their support of my research has been multifaceted,” she explains. The O&P company assists broadly with recruitment of study participants, actively collaborates on projects, and recently donated funds to support clinically relevant research projects, says Fatone.

Role Model

Teaching the next generation of clinicians while leading significant O&P research studies enables Fatone to contribute to the development of students at the country’s oldest and largest research and training program for orthotists and prosthetists. The NUPOC facility, which is part of the Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, features 20,000 square feet of purposefully designed space, divided between the education and research programs.

Each year, NUPOC graduates represent nearly half of all U.S. prosthetic and orthotic graduates. “The innovative ‘blended learning’ format provides a strong theoretical foundation,

combined with an intensive clinical practicum where students work directly with people who use the prosthetic and orthotic devices they have created,” Fatone explains. In addition to the MPO program, NUPOC conducts continuing professional education courses in prosthetics and orthotics for physicians and therapists as well as for prosthetists and orthotists.

“Through my contributions to the MPO program at NUPOC, I am involved in teaching and mentoring students about how to find, understand, and apply research evidence in clinical practice,” Fatone explains.

“When training clinicians, our focus is on ensuring that our graduates demonstrate the ability to use research findings to appropriately inform clinical practice.”

Fatone’s teaching duties are primarily within the research stream of the MPO program, and she is responsible for having developed the “Research II” and “Capstone” subjects. “I was capstone coordinator from 2013 to 2017 and continue to have an ongoing role as a faculty mentor for capstone projects,” she explains. She additionally contributes to the physician and therapist continuing education O&P ALMANAC | AUGUST 2018

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PRINCIPAL INVESTIGATOR

Eye to the Future

Fatone speaks at a promotion reception. within our professional organizations focused on research-related activities.

You can partner with academics to conduct research or be an industry sponsor of research. You can support the research initiatives of students and residents or contribute to requests to respond to research surveys.”

Above all, Fatone emphasizes the satisfaction that can come from playing a role in O&P research, and she hopes to ignite others to engage in research activities and ultimately feel the same sense of satisfaction. “I enjoy that it is a constant and evolving challenge; I’m always learning something new,” she says. “I also enjoy knowing that the research we do ultimately helps those who receive orthotic and prosthetic clinical care.”

For the time being, Fatone—who also enjoys travelling to visit family and friends around the world—is keeping busy at NUPOC, serving as teacher and mentor to graduate students, postdoctoral fellows, and junior faculty, with several research projects underway. She has grant applications pending for studies in many areas, including collaborations with several researchers across the United States and even internationally. “Most of these pending projects build on my prosthetic socket research and collaborations on shared decision making for dysvascular partial foot amputation, and also include the orthotic management of children with cerebral palsy and persons post-stroke,” she explains.

“Generally, I hope to continue to teach and evaluate the clinical impact and effectiveness of the NU-FlexSIV socket, test the real-world efficacy of the shared decision-making resources we have developed, continue to develop our interface monitoring system into a viable clinical tool, and continue to expand understanding and evidence for prosthetic socket design, upper-limb myoelectric orthoses, and ankle-foot orthoses,” says Fatone.

Notable Works Stefania Fatone, PhD, BPO(Hons), has authored more than 80 O&P-related publications. Some of her most impactful articles include the following: • Fatone S., Gard S., Malas B. “Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on Knee Kinematics and Kinetics in People With Hemiplegia.” Archives of Physical Medicine and Rehabilitation 2009, Vol. 90, No. 5, pp. 810-818. PMID: 19406301.

• Fatone S., Caldwell R. “Northwestern University Flexible Subischial Vacuum Socket for Persons With Transfemoral Amputation: Part 1, Description of Technique.” Prosthetics and Orthotics International 2017, Vol. 41, No. 3, pp. 237-245. PMID: 28094686.

• Dillon M., Quigley M., Fatone S. “Outcomes of Dysvascular Partial Foot Amputation and How These Compare to Transtibial Amputation: A Systematic Review for the Development of Shared Decision-Making Resources.” Systematic Reviews 2017, Vol. 14. No. 6(1), p. 54. DOI 10.1186/s13643-017-0433-7. PMID: 28288686.

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PHOTO: RJ Garrick

course and other Northwestern programming. “I also mentor biomedical engineering graduate students pursuing master’s and PhD degrees, in addition to postdoctoral fellows.”

More broadly, Fatone is “helping to train the next generation of orthotic and prosthetic researchers,” she says.

Through her role as chair of the Orthotic and Prosthetic Education and Research Foundation (OPERF), she contributes to the growth of new investigators in orthotics and prosthetics who seek and receive funding. And by serving on grant review panels—reviewing abstracts for presentations and articles for publication, particularly in her role as editor for Archives of Physical Medicine and Rehabilitation—Fatone plays a part in ensuring the quality of research proposed and reported.

But she recognizes that it’s not just her own mentees who will carry the research torch forward. “It is possible for everyone to support research in ways big and small,” Fatone says. Current O&P clinicians “can help recruit subjects for a study or make a donation to OPERF to fund research projects in orthotics and prosthetics,” she suggests.

“You can contribute as a reviewer of journal articles or serve on a committee

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Advanced O&P Solutions

By DEBORAH CONN

Friendly Fabrication C-fab leverages clinical partnerships and digital platforms to meet clients' complex needs

C

ENTRAL FABRICATION COMPANY Advanced O&P

Solutions (AOPS), situated in a 10,000-square-foot facility in Hickory Hills, Illinois, prides itself on balancing the need to provide comprehensive services with pushing the technology envelope.

AOPS is owned by Chicagobased clinical O&P provider Scheck & Siress. Scheck & Siress founded the company in 2005 to serve the fabrication needs of its clinical locations, but the lab soon expanded and now draws 30 percent of its revenue from outside customers throughout the country.

Advanced O&P Solutions staff member April works on digital capture to begin CAD manufacturing.

COMPANY: Advanced O&P Solutions LOCATION: Hickory Hills, Illinois OWNER: Scheck & Siress HISTORY: 13 years

Advanced O&P Solutions staff members Mario and Tony work on thermoforming plastic for fabrication of a CROW.

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AUGUST 2018 | O&P ALMANAC

Finished molded leather ankle gauntlet

Advanced O&P Solutions staff member Mike makes a postproduction modification.

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

1 year HISTORY: LP, CPO(SA) John Hattingh, CP, OWNER: Leesburg, Virginia LOCATION: FACILITY:

PHOTOS: Advanced O&P Solutions

“We make everything,” says Michael Oros, CPO, LPO, FAAOP, who is chief executive officer and president of Scheck & Siress. “Because of our clinical practice, we can manufacture every aspect of complex O&P devices—from pediatric to geriatric, upper-extremity, lower-extremity, and spinal.”

This translates into having virtually every type of O&P tool and piece of equipment—including a seven-axis carver—on hand at the Hickory Hills facility, which is overseen by General Manager Ron Bystrom and Quality Control

Manager Tony Kapechuck. AOPS has a team of 40 technicians, many of whom have more than 20 years of experience in O&P. Organization is key at the facility, where the French cooking phrase “mise en place”—everything in its place—applies. Each work station is arranged so technicians can move and work efficiently throughout the day, Oros explains. “We want to embed that approach into our culture.”

Oros believes that central fabrication make sense for O&P practitioners, particularly when it comes to devices needed by patients only sporadically. “We believe most facilities struggle to do things they don’t do repeatedly,” he says. “We can take on complicated prosthetic jobs that it’s hard to have the expertise to do because most clinicians are limited in the number of experiences they have with certain devices.”

AOPS recently launched a new digital manufacturing platform for scoliosis management under the direction of Christopher Mowrer, CPO, director of digital manufacturing. The program began in conjunction with Scheck & Siress clinical locations and has rolled

out to other O&P providers. AOPS staff will go to clinicians and walk them through how to capture specifications digitally with a scanner, Oros explains, as well as how to access the finished device.

Plans are underway to extend this approach to other types of orthoses, according to Oros.

Everyone at AOPS, explains Oros, plays an important role in meeting customer expectations for responsiveness and quality.

Because AOPS shares space with a Scheck & Siress clinical facility, the staff can answer questions and concerns from the perspectives of different practitioners.

“There is a dialogue, an exchange of ideas between clinical and technical staff every day,” Oros says. “We all benefit from the closeness of that relationship.”

AOPS actively markets through social media, and salesperson Mike Angelico regularly attends regional and national trade shows.

Still, one-on-one contact is usually the most effective sales technique, according to Oros. Angelico often identifies facilities with an interest in AOPS services, such as digital scanning, then arranges for an in-house educational program on how to work successfully with a central fabrication lab.

For the future, the company plans to continue expanding its digital platform and service offerings. “That’s our goal,” says Oros.

“We still have too many processes that we do the way we did when I was in school 25 or 30 years ago.”

Oros is confident that advances in materials science and new technology, such as 3-D printing, can play a key role in achieving new, more efficient processes that result in improved definitive devices. And where does he see AOPS’s place in this era of innovation? Right in front.

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Blue Sky Orthotics and Prosthetics

Equipping Athletes Texas facility serves challenged athletes and a wide array of O&P patients

A

ARON FOREMAN, MSPT, CPO,

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AUGUST 2018 | O&P ALMANAC

Aaron Foreman, MSPT, CPO, (center) with two athletes sports prostheses for athletes and activity-minded people at every level of proficiency, says Foreman, whether they want to run a marathon, ride a bike, hike LOCATION: a trail, or just get out and around Austin, Bryan-College town. Blue Sky’s clinicians fit many patients with specialized Station, and sports prostheses, and many Temple, Texas of them use microprocessorcontrolled prosthetic knees.

OWNER: “We try to cover everything,” Aaron Foreman, Foreman says. “We recently fit MSPT, CPO a little 8-year-old with a motorcross hand that has been a huge HISTORY: benefit to her when she rides her Three years motorcross bike. We fit the world 1,500-meter record holder [with a flex foot], and we also built an artificial hand for a mountain biker who does downhill racing.”

The company also fits tennis players who require specifically designed prostheses to accommodate the cutting and twisting demanded in the sport.

Aaron Foreman, MSPT, CPO, builds a mountain Most of Blue Sky’s marketing bike prosthesis. is conducted via word of mouth,

FACILITY: Blue Sky Orthotics and Prosthetics

although the company is developing a presence on social media.

Foreman visits physical therapists, physicians, nurses, and other referral sources as often as possible, and the company is involved in a wide range of athletic events—attending or sending athletes to the Endeavor Games and the Texas regional games in San Antonio.

Blue Sky maintains an active educational program. The company regularly trains interns and is planning to bring an O&P resident on board later this year. Foreman, who also is a physical therapist, helps teach the prosthetics sections to the physical therapy (PT) program at Texas State University in San Marcos. He recalls that working in PT in a rehab setting really set him on his professional course, leading him to become a CPO with an emphasis on prosthetics. “The PT component has been a really big help with training new amputees,” he comments.

Looking ahead, Foreman hopes to continue to expand Blue Sky’s presence in Texas. Like other practitioners, his main challenge is dealing with insurance. “A lot of insurance companies won’t pay for technology that patients could really benefit from. One great thing is that a lot of O&P manufacturers are stepping up to the plate for patients,” he says.

Foreman encourages O&P practitioners to promote their work to attract new students to pursue the O&P profession. “It’s a really gratifying and rewarding profession, and we need to let people know about it,” he says.

“It’s pretty cool to be able to get people moving and get them to achieve goals they didn’t think they could possibly do.”

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

PHOTOS: Blue Sky Orthotics and Prosthetics

has found striking similarities between his prior work manufacturing mountain bikes and his current role as founder and chief executive officer of Blue Sky Orthotics and Prosthetics.

“Our mission then was to help challenged athletes return to or begin mountain biking,” he says.

“Now we’re helping challenged athletes in many sports, including mountain biking, running, wakeboarding, and tennis. That’s been my focus over the last 10 years,” says Foreman, who owned another O&P facility before entering the mountain bike manufacturing space.

Blue Sky, which started in Bryan-College Station, Texas, now has two additional offices, in Austin and Temple. “Central Texas is a large area, and we tried to set up clinics to cover many of the counties in the area,” Foreman says. Each serves a distinctive demographic, including an older population in Bryan, veterans in the Temple office, and a wide range of ages in the Austin clinic.

Across all three offices, Blue Sky employs three clinicians, in addition to patient-care coordinators, two patient amputee advocates, a technician, and billing and accounting staff.

Blue Sky’s main office in Austin, at approximately 4,000 square feet, includes a central lab of 1,500 square feet that handles most of the company’s fabrication work.

The company offers state-ofthe-art myoelectric and adaptive

By DEBORAH CONN

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AOPA NEWS

AOPAversity Webinars AUGUST 8

SEPTEMBER 12

Outcomes & Patient Satisfaction Surveys

Medicare as Secondary Payor: Knowing the Rules

These days, data of all types is essential to running a successful and profitable O&P company. Learn more about designing and administering surveys at your facility so you can aggregate information to help you serve your patients better. Take part in the August 8 webinar, when AOPA experts will address these topics: • What is the importance of conducting patient satisfaction surveys?

• How should the results of patient satisfaction surveys be analyzed?

• Why is it important to track outcomes?

• How can tracking outcomes help you provide better care to your patients?

Your source for advanced learning EARN CE CREDITS 44

AUGUST 2018 | O&P ALMANAC

There is a lot to know and understand when Medicare is a secondary payor. Take part in the September 12 webinar, and have all of your questions answered.

• Find out which payors are primary to Medicare.

• Learn to determine if Medicare is a secondary payor or a primary payor.

• Find out how to calculate your payments from Medicare when it is a secondary payor.

• Get educated about conditional payments.

• Learn about set-aside arrangements.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2018webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0836 with questions.

Sign up for the entire series and get two webinars free. All webinars that you missed will be sent as a recording. Register at bit.ly/2018webinars.

O&P PAC UPDATE

T

HE O&P PAC UPDATE provides infor-

mation on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC would like to thank the following AOPA members for their recent contributions to the PAC:

W E CO RDIALLY INVITE Y O U TO ATTEND

• Lisa Arbogast • Edward De La Torre • Scott Sabolich, CP

Enjoy a night of ’70s soulful tunes, dinner, a silent auction, a disco dance off, and

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community.

The O&P PAC achieves this goal by working closely with members of the U.S. House of Representatives and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/pacauth.

much more. Be there or be square.

You are not required to wear your best ’70s threads, but we hope you will!

6:30-9:30 PM

September 27

2018

That Seventies Bar a.k.a. Convention Center Level 3-Summit

This is a special event and will require a separate registration fee.

Certain rules and restrictions may apply. For additional information about Party With A Purpose or to register, visit AOPA Booth #302.

www.AOPAnet.org

NEW MEMBERS

T

HE OFFICERS AND DIRECTORS of

the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company.

Supplier levels are based on annual gross sales volume.

Barber Prosthetics Clinic 540 SE Marine Drive Vancouver, BC V5X 2T4 Canada 604/321-1115 Patient-Care Facility David Moe, CP(C)

Braceman P&O Inc. 2830 W. Cermak Road Chicago, IL 60623 847/736-6686 Patient-Care Facility Amir Sheikh Holmes Prosthetic Center 8998 Kirby Drive Houston, TX 77054 713/432-9949 Patient-Care Facility Jon B. Holmes

O&P ALMANAC | AUGUST 2018

45

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

North Central

CO, CPO, or Board-Eligible Practitioner and Certified Pedorthist

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

Madison, Wisconsin The Aljan Company in Madison, Wisconsin, has immediate full-time openings for a certified orthotist or orthotist/ prosthetist and certified pedorthist. Patient-care experience preferred. Applicants must be able to work independently, be highly motivated, and possess excellent communication, time management, and organizational skills and the ability to work with patients of all ages. Applying applicant will need to be available to work on-call weekends once a month.

We are a well-established privately owned O&P company in south central Wisconsin that prides ourselves on providing excellent patient care. We offer competitive salary and benefits package.

For additional information, contact:

ALJAN CO.

ORTHOTICS-PROSTHETICS PEDORTHICS A Division of Burke Labs Inc.

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

Member $482 $634

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

Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word

Nonmember $678 $830

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

Job Board

Alan Burke, BOCO 608/257-4256 Email: arbblinc@msn.com Website: www.aljan.com

Member Nonmember $85 $150

For more opportunities, visit: http://jobs.aopanet.org.

Inter-Mountain

Certified Prosthetic/Orthotic Clinicians

Albuquerque and Santa Fe, New Mexico Advanced Prosthetics and Orthotics is currently seeking skilled, dedicated, and hard-working ABC-certified prosthetic/orthotic clinicians for our Albuquerque and Santa Fe offices. CPOs and COs must possess a strong clinical background as well as provide quality and compassionate care. We offer competitive salary; medical, dental, vision, and retirement options are available.

SUBSCRIBE

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

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AUGUST 2018 | O&P ALMANAC

Email: rocket4464@gmail.com

CAREERS Mid-Atlantic Certified Prosthetist/Orthotist (CPO) Certified Prosthetist (CP) Certified Orthotist (CO) Certified Pedorthist (CPed)

Pittsburgh, Pennsylvania De La Torre Orthotics and Prosthetics is seeking certified clinicians to join our ever-growing practice in southwestern Pennsylvania. The qualified candidate will see patients in our local clinical offices, various physical therapy departments, and rehab facilities in the greater Pittsburgh area.

Requirements: • ABC-certified is preferred • A minimum of two years of recent, successful patient-based experience • Must work well in a team environment • Excellent oral communication skills with patients and referral sources • Ability to learn and use an EMR system is necessary.

De La Torre O&P offers competitive compensation and benefit packages, including 401(k), medical, disability policies, and certification reimbursement, and is an AAP employer.

DOWNLOAD the

“AOPA 365” App on your iPhone, Android or iPad

Download the

Mobile App! Download the app by either scanning the QR code or by searching the keyword AOPA365 in the Apple or Google stores.

Email résumé to: drew@delatorreop.com Subject line: job opportunity

Thank you to Our Supplier Plus Members

AOPA Supplier Plus Partners

Thank You to Our AOPA Supplier Plus Partners

O&P ALMANAC | AUGUST 2018

47

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac18 for advertising options.

ALPS High Density Gel The High Density (HD) Gel product line is ideal for those patients transitioning from silicone to gel liners. The firm nature of the gel provides active amputees with a great degree of control while still providing superior comfort. Alps HD Gel is available in several of our liners and sleeves.

Please contact us for a sample of our Gel Strips to experience it for yourself! Call us or visit www.easyliner.com for more details.

Huge Price Reduction on Coyote Composite

Motion Control Named Exclusive U.S. Distributor of TASKA® Prosthetic Hand Taska, the world’s first heavyduty, water-resistant, multiarticulating prosthetic hand, is available now from Motion Control Inc., a leader in myoelectric upper-extremity prosthetics.

Taska features 23 grip patterns with flexible compliant fingers, breakaway and user-resettable knuckles, high-speed thumb rotation, grip cycle buttons, and an integrated flexion wrist. Motion Control provides sales and service for Taska hands in the U.S. For more information, contact Motion Control, a division of Fillauer, at 801/326-3434, email MotionInfo@ fillauer.com, or visit www.UtahArm.com.

HUGE Price Reduction on Coyote Composite

“Itching” for a new material?

• Nontoxic, noncarcinogenic, and inert alternative to carbon fiber • Has little to no itch • Made from basalt (lava rock), a 100 percent natural fiber • We found you can save at least 31 percent by using Coyote Composite compared to carbon fiber.

For a list price and a more comprehensive list of reasons why you should switch to Coyote Composite, go to www.coyotedesign.com.

For more information, contact Coyote Design at 208/429-0026.

Make More Possible With the New 2018 ‘Crossover’ Knee The world’s first hybrid prosthetic knee that is user adaptable for walking, running, or sports.

• Walking knee transforms into an activity knee • Mimics natural muscle function • Adjustable tendon durometers • Adjustable flexion range requiring no tools • Adjustable dampening and rebound • 275 lbs K2-K4+ activity • Use in any environment • Light and strong • Hybrid design.

Call us about our evaluation program! Call 800/322-8324 or visit www.fabtechsystems.com.

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AUGUST 2018 | O&P ALMANAC

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

For more information, call 800/301-8275 or visit www.hersco.com.

Pro-Flex®—Less Load, More Dynamics™ Introducing Pro-Flex LP Align, which couples up to 2 3/4 inches of heel height adjustability with the mechanical power of the three-blade Pro-Flex design—so users can maintain proper alignment across a variety of everyday footwear, from sandals to sneakers to dress shoes.

Visit ossur.com/pro-flex-family or ask your Össur representative about a Pro-Flex demo today.

MARKETPLACE Ottobock’s ProFlex™ Plus Sealing Sleeve Countdown to flexibility for you and your patients with Ottobock’s ProFlex™ Plus Sealing Sleeve • Three colors and sizes • Two lengths • Number one choice.

ProFlex Sleeves—delivering proven performance for the last 10 years.

This soft, yet tough, sealing sleeve is designed with a more flexible fabric and smoother proximal seam. It features 15 degrees of flexion for easier bending and less bunching behind the knee; a preformed knee cap for lower stress on the patella; and a conical shape proximal for improved thigh fit and tighter distal shape for enhanced sealing on socket.

Check out professionals.ottobockus.com for details.

Ottobock’s WalkOn® Carbon-Fiber AFO WalkOn ankle-foot orthoses (AFOs) are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally.

WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical

gait, offering fluid rollover and excellent energy return.

WalkOn offers a full range of AFO sizes and designs, including the WalkOn Reaction Junior pediatric sizes.

Fast and easy to fit, the WalkOn footplate is trimmable and can be shaped with scissors, often requiring only one office visit. Contact us at 800/328-4058 or professionals. ottobockus.com for details.

Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lowerlimb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry.

Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses.

For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

AD INDEX

Advertisers Index Company Alps South LLC Amfit BCP Group ComfortFit Orthotic Labs Inc. Coyote Design Fabtech Systems LLC Ferrier Coupler Inc. Fillauer Hanger Clinic Hersco Naked Prosthetics Össur Ottobock Spinal Technology Inc.

Page 3 41 7 19 23 9 29 15 35 1 27 25 C4 39

Phone

Website

800/574-5426 800/356-3668 615/550-8774 888/523-1600 800/819-5980 1-800-FABTECH 810/688-4292 800/251-6398 512/777-3814 800/301-8275 888/977-6693 800/233-6263 800/328-4058 800/253-7868

www.easyliner.com www.amfit.com www.bcpgroup.net www.comfortfitlabs.com www.coyotedesign.com www.fabtechsystems.com www.ferrier.coupler.com www.fillauer.com www.hanger.com www.hersco.com www.npdevices.copm www.ossur.com www.professionals.ottobockus.com www.spinaltech.com O&P ALMANAC | AUGUST 2018

49

CALENDAR

2018

September 14–15

August 8

Outcomes & Patient Satisfaction Surveys.

Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

ABC: Prosthetic Clinical Patient Management (CPM) Exam, ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@ abcop.org, or visit www.abcop.org/certification.

WEBINAR

August 10–11

The Texas Chapter of the American Academy of Orthotists and Prosthetists 2018 Annual Meeting.

Westin Galleria, Dallas. For information and registration, visit www.txaaop.org.

September 17–22

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

September 26–29

September 1

ABC: Application Deadline for Certification Exams.

Applications must be received by September 1 for individuals seeking to take the November Written and Written Simulation certification exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

September 7–8

ABC: Orthotic Clinical Patient Management (CPM) Exam, ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@ abcop.org, or visit www.abcop.org/certification.

September 12

Medicare As a Secondary Payor: Knowing the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

AOPA National Assembly. Vancouver Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

October 1

ABC: Application Deadline for Winter CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

October 1

ABC: Practitioner Residency Completion Deadline for November Certification Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Apply Anytime!

Apply anytime for COF, CMF, CDME; test when www.bocusa.org ready; receive results instantly. Current BOCO, BOCP, and BOCPD candidates have three years from application date to pass their exam(s). To learn more about our nationally recognized, in-demand credentials, or to apply now, visit www.bocusa.org.

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your next event!

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Cascade Dafo Institute. Cascade Dafo Institute offers eight free ABC-approved online continuing education courses for pediatric practitioners. Earn up to 12.25 CE credits.

Visit cascadedafo.com or call 800/848-7332.

CE For information on continuing education credits, contact the sponsor.

Questions? Email ymazur@AOPAnet.org.

Calendar Rates Let us

Free Online Training

CREDITS

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

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

AUGUST 2018 | O&P ALMANAC

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CALENDAR

October 1

ABC: Application Deadline for ABC/OPERF Student Award for Academic Achievement. Ten exceptional students will be selected to win $1,000 to cover educational expenses. For more info or to apply, go to operf.org.

October 10

November 14

Evaluating Your Compliance Plan & Procedures: How To Audit Your Practice.

Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

November 28–30

Year-End Review: What Should You WEBINAR Do To Wrap Up the Year & Get Ready for the New Year? Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

New England Chapter AAOP. Please join us at Mohegan Sun in Connecticut for an outstanding ABC/ BOC continuing education program. Registration and more information at www.neaaop.org.

October 18–20

December 6–8

International African-American Prosthetic Orthotic Coalition Annual Meeting. Embassy Suites Downtown Medical Center, Oklahoma City. For more information, contact Tony Thaxton Jr. at 404/875-0066, email thaxton.jr@comcast.net, or visit www.iaapoc.org.

Shirley Ryan AbilityLab: Elaine Owen. Pediatric Gait Analysis and Orthotic Management: An Optimal Segment Kinematics and Alignment Approach to Rehabilitation (OSKAR). Chicago.

25.5 ABC credits approved. For more information, contact Melissa Kolski, call 312/238-7731, or visit www.sralab.org/academy/PedsGait18.

October 20

Advancements in Conservative Treatments of Scoliosis. San Mateo, CA. Schroth instructors, orthotists, and MDs from around the country will be joining us to discuss topics relating to conservative and surgical scoliosis treatment. Grant Wood, Align Clinic, & Beth Janssen, Scoliosis Rehab. For more information, visit www.align-clinic.com or email evaldez@align-clinic.com.

October 27

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Airport Plaza Hotel, New York. Contact Drew Shreter at 800/946-9170, ext. 101, or email dshreter@pomac.com.

November 4–10

Health-Care Compliance & Ethics Week.

AOPA is celebrating Health-Care Compliance & Ethics Week and is providing resources to help members celebrate.

Learn more at bit.ly/aopaethics.

November 7–9

NJAAOP. Harrah’s, Atlantic City, NJ. For more information, visit www.njaaop.com. Contact Brooke Artesi, CPO, LPO, with questions at Brooke@sunshinepando.com.

November 12–13

2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

Las Vegas. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

December 12

New Codes, Medicare Changes, & Updates. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

2019 September 25–28

AOPA National Assembly. San Diego Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

2020 September 9–12

AOPA National Assembly. Mandalay Bay, Las Vegas.

For general inquiries, contact Ryan Gleeson at 571/4310836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

Coding & Billing Seminar

O&P ALMANAC | AUGUST 2018

51

ASK AOPA CALENDAR

Repair and Replacement Answers to your questions regarding adjustments, RUL determinations, and more

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry.

Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Q

What is the reasonable useful lifetime (RUL) for orthotics and prosthetics?

Q/

The Medicare manuals state that RUL for items is determined through program instructions, such as Medicare policies or regulations, and in the absence of these regulations or policies the RUL is to be set at five years. So, while most O&P items will have a RUL of five years, there are some exemptions.

For example, knee orthoses are an exception because policy has set RUL at between one and three years depending on the style of brace. In addition, prostheses are exempt from the five-year RUL based on regulations set forth by the Benefits Improvement and Protection Act of 2000.

A/

Are new initial orders and detailed written orders required when conducting a repair or adjustment to an orthosis or prosthesis?

Q/

No, a new order is not required because repairs and adjustments are covered under the original order for the lifetime of the item.

However, if you are replacing a major component in order to conduct the repair, then you should obtain a new order for the replacement part or component.

If you were not the original provider of the orthosis or prosthesis and do not have a copy of the original order on file, you should consider obtaining

A/

52

AUGUST 2018 | O&P ALMANAC

an order for the repair or adjustment, just to verify the medical necessity and continued need of the item.

May I submit a claim to Medicare and receive payment if I do not have a physician’s order on file?

Q/

Yes, you may submit a claim if you didn’t receive or if you don’t have a valid physician order on file; however, you must submit the claim using the EY modifier. The EY modifier will indicate that you don’t have an order on file and will cause your claim to be denied. The denial will result in a not medically necessary denial, meaning you have the ability and right to file an appeal and seek payment, if you are able to document the medical necessity of the item or service you provided.

A/

If we are nonparticipating providers with Medicare and we are not accepting assignment on a claim, are we still required to obtain all of the required documentation before we can submit a claim for payment?

Q/

Yes, you are required to adhere to all Medicare policies and procedures, and this includes making sure you have the proper documentation to support medical necessity. The choice of being a participating or nonparticipating provider and accepting or not accepting assignment only relates to how you bill the patient and the amount you may collect from the patient.

A/

Answer Question 1

AOPA Coding Experts Are Coming to

Las Vegas

November 12-13

ATLANTA

FEB. 26-27 | 2018

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA November 12-13 in Las Vegas to advance 14 CEs your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics.

EARN

AOPA experts provide the most up-todate information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group.

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2018billing.

The Tropicana Las Vegas 3801 S Las Vegas Blvd Las Vegas, NV 89109 Book your hotel by October 24 for the $95/night rate by calling 800/648-4462.

Top 10 reasons to attend: 1.

Get your claims paid.

2.

Increase your company’s bottom line.

3.

Stay up-to-date on billing Medicare.

4.

Code complex devices

5.

Earn 14 CE credits.

6.

Learn about audit updates.

7.

Overturn denials.

8.

Submit your specific questions ahead of time.

9.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience.

Find the best practices to help you manage your business.

Participate in the 2018 Coding & Billing Seminar!

Register online at bit.ly/2018billing.

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

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