December 2016 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

D E C E M B E R 2016

E! QU IZ M EARN

Possible Reimbursement Changes in 2017

2

BUSINESS CE

CREDITS P.21

P.18

Scoliosis Care Evolved P.30

Can Private Payors Apply the Medicare Sequestration Reduction to Your Payments?

P.52

PROCESS PEOPLE PRODUCTS

Maximizing

Opportunities in

ORTHOTICS WWW.AOPANET.ORG

Tips for growing your business in 2017

P.24

This Just In: O&P in the Trump Era P.XX P.22

YOUR CONNECTION TO

EVERYTHING O&P

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

SE PTE M B E R

6-9,

2017

LAS VEGAS EXCELLENCE in EDUCATION

Mark your calendars September 6-9, 2017, for an ideal combination of top-notch education and entertainment at the combined 100th AOPA National Assembly and World Congress Meeting in Las Vegas. We look forward to seeing you in 2017!

#AOPA2017

AOPAnet.org

DECE M B E R 2016 | VOL. 65, NO. 12

contents

FEATURES

DEPARTMENTS | COLUMNS

COVER STORY

Views From AOPA Leadership......... 4 Insights from AOPA President Michael Oros, CPO, FAAOP

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 16

Transitions in the profession

24 | Maximizing Opportunities in Orthotics Implementing strategies to grow the orthotics business at your O&P facility could lead to a higher volume and frequency of patient visits and more patient referrals. Find out how improving business processes, hiring appropriate staff, and offering revenue-driving devices could boost business and increase profits.

By Lia K. Dangelico

22 | This Just In

Reimbursement Page..........................18

What's In Store for O&P in 2017?

Preparing your facility for the new RAC contractor, prior authorization, and more

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

CREDITS

Member Spotlight................................. 38 n

P. 22

O&P in the Trump Era The election of Donald Trump and the Republican majority in Congress mean the U.S. health-care arena will see major transformation in the coming year.

The likely repeal of the Affordable Care Act and the changes proposed by Trump during the election could have a significant impact on U.S. health care—and the O&P profession.

n

Seacoast Orthotics & Prosthetics thyssenkrupp Engineered Plastics

AOPA News................................................42

AOPA meetings, announcements, member benefits, and more

Welcome New Members ................. 44

Marketplace.............................................. 45

30 | Bending Convention Scoliosis care is evolving, with many orthotists taking a more individualized approach to care. Clinicians are evaluating and treating patients from a 3-D perspective, looking beyond X-rays to consider flexibility and long-term repercussions in formulating a care plan.

By Christine Umbrell

P. 30

Careers........................................................ 48

Professional opportunities

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

Upcoming meetings and events

Ad Index....................................................... 49 Ask AOPA................................................... 52 Billing for missed appointments, repairs, and more

O&P ALMANAC | DECEMBER 2016

3

VIEWS FROM AOPA LEADERSHIP

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

Embrace All Levels of O&P Advocacy

H

AVING RECENTLY ATTENDED THE Orthotic and

Prosthetic Innovation & Technology Conference, presented by the California Orthotic Prosthetic Association and the University of California—San Francisco (UCSF) , I’m reminded of the tremendous value state and regional associations can hold for the O&P provider community. What came as a surprise to me is that, according to AOPA records, there are currently only 23 such O&P state or regional societies or associations.

Perhaps there aren’t more because that value isn’t fully understood to motivate a core group of leaders to action?

With that in mind, I offer the following for consideration: If you practice in a state without a local association, or you have an association but it’s not well supported, it’s more important now than ever to reach out to your colleagues and breathe some life into a local effort.

Here’s why: In 2014 it was estimated that nearly 50 percent of all insured lives were covered by plans that are regulated at the state—versus federal—level. Noted healthcare futurist Michael Lovdal, PhD, has spoken of the likely progression (increase) of the role of state and city in health-care regulation because of the flexibility individual states have been granted in the enactment of the Affordable Care Act. So while I believe in the expression, “So goes Medicare, so follow all other plans,” and AOPA’s advocacy role with Medicare, there will likely be important coverage and reimbursement distinctions in state commercial and federally funded plans.

So who’s monitoring the regulatory language that governs the orthotic and prosthetic benefits in your state? More importantly, who’s leading the advocacy campaign to ensure access and reimbursement are appropriate to foster quality patient-care outcomes? An engaged state association can be the eyes and ears looking out for the best interests of both the patients we serve and our clinical practices. I’ve personally witnessed misguided language being introduced into state legislation that would have terrible consequences for pediatric O&P patients. Because an alert lobbyist reached out to our society, collectively we were able to gather information and stave off this bill from gaining legislative traction—once it was made clear to the appropriate people how very different custom O&P is from durable medical equipment.

Every year, AOPA hosts a state representatives meeting at the AOPA National Assembly (in 2017, the AOPA World Congress and AOPA Centennial) as well as the annual AOPA Policy Forum. These meetings are prime opportunities to share what’s happening from a regulatory perspective, to discuss strategies to communicate the value of O&P to state payor groups, and to learn from one another.

The AOPA Google Plus community is a great way to connect with colleagues in other states. We’re also developing a reimbursement and regulation exchange portal that will allow state groups access to important information in real time. AOPA is working to put tools in place to help its member practices thrive; let’s make 2017 a year of growth for both our state societies and AOPA. Michael Oros, CPO, FAAOP, is president of AOPA. 4

DECEMBER 2016 | O&P ALMANAC

Board of Directors OFFICERS President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL President-Elect James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Vice President Chris Nolan Ottobock North America, Austin, TX Immediate Past President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Mountain Lake Terrace, WA Traci Dralle Fillauer Companies Inc., Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Townsend Design, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

AOPA CONTACTS

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

Editorial Management Content Communicators LLC

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org SPECIAL PROJECTS Ashlie White, MA, manager of projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

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

Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org

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

Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

AOPA Bookstore: 571/431-0865

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

6

DECEMBER 2016 | O&P ALMANAC

Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org.

Yearly subscription rates: $59 domestic, $99 foreign.

All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Copyright © 2016 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 13,000 subscribers.

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

Visit bit.ly/2017almanac for advertising options!

NUMBERS

Health Coverages and Expenditures in 2016 Reviewing current U.S. health-care statistics as the country prepares for change

OVERALL U.S. HEALTH EXPENDITURES

With the election of Donald Trump as president, there are many questions about the future of the Affordable Care Act and how the policies put into place under President Barack Obama will change once the new administration takes over in January. As we prepare for change, here’s a look at the most recent data on health-care expenditures and insurance trends in the United States.

Average per capita spending on health.

$3 Trillion

32.1 Percent

Percent of U.S. health spending devoted to hospital care.

Percent of U.S. health spending devoted to physician and clinical services.

9.8 Percent

Percent of U.S. health spending devoted to prescription drugs.

5.1 Percent

Percent of U.S. health spending devoted to nursing care facilities and continuing care retirement communities.

8

DECEMBER 2016 | O&P ALMANAC

$

Total national health expenditures.

UNINSURED

Percentage of Americans in 2015 Who Failed To Obtain Needed Medical Care Due to Cost During Past 12 Months

AGES 18-64

25.1 million uninsured.

AGES 17 AND UNDER 3.3 million uninsured.

19.9 Percent

Health expenditures as percent of gross domestic product.

PRIVATE INSURANCE

65.6 PERCENT

Percent of people under age 65 with private insurance.

69.7

PERCENT

Percent of adults ages 18-64 with private insurance.

54.7

PERCENT 8%

6%

PERCENT

Percent of children under 18 with private insurance.

PUBLIC INSURANCE

4%

2%

25.3 PERCENT

PERCENT

18.9

42.2 PERCENT

Percent of people under age 65 with public insurance.

Percent of adults ages 18-64 with public insurance.

Percent of children under 18 with public insurance.

0%

All Ages Total

Male

Female

SOURCES: Centers for Disease Control and Prevention: “National Health Interview Survey’s Early Release Program,” and “Health, United States, 2015.”

National health expenditures are measured by annual health spending in the United States by type of good or service delivered (hospital care, physician and clinical services, prescriptions, etc.) and source of funding for those services (private health insurance, Medicare, Medicaid, out-of-pocket spending, etc.).

TOP NATIONAL HEALTH EXPENDITURES

BY CATEGORY

17.5 Percent

$9,523

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Provides active amputees a great degree of control

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Happenings RESEARCH ROUNDUP

Researchers To Study Amputee Exercise for Osteoarthritis Prevention

A Cal Poly research team—led by Professor Stephen Klisch, left, with student leaders Nina Yadlowsky and Greg Orekhov—is studying how best to minimize impacts for amputees using prosthetic limbs.

one part of the body to compensate for that injury. But the goal is for prosthetics to act in a completely natural way.”

The study will provide information and data to assist amputees in determining a best course of action for exercise habits, movements, and exertion, as well as to prevent future surgery or injury. “There is very little information in this area about the impacts of riding a bike and none about elliptical machines. We want to help people to live better lives, both vet and nonvet amputees,” said Klisch.

Primate Regains Control of Paralyzed Limb Via Brain Implant Neuroscientists in Switzerland have reported that a monkey has regained control of a paralyzed limb after they implanted a brainspine interface into the primate’s brain. The study, led by Gregoire Courtine at the Ecole Polytechnique Federale de Lausanne, was conducted in collaboration with researchers at Medtronic, Brown University, and Fraunhofer ICT-IMM. The brain-spine interface was designed to repair the damage caused during a spinal cord injury, when the motor cortex stops sending signals down the spine to a neural network in the lumbar region, which activates the leg muscles. The new interface allows the implant to pick up brain activity, send it to a computer that decodes signals, and relay walking instructions to a spinal cord simulator embedded in the lumbar region.

“The link between the decoding of the brain and the stimulation of the spinal cord—to make this communication 10

DECEMBER 2016 | O&P ALMANAC

exist—is completely new,” said Jocelyne Bloch, MD, a neurosurgeon at the Lausanne University Hospital and the doctor who surgically affixed the implants. “For the first time, I can imagine a completely paralyzed patient able to move their legs through this brain-spine interface.”

The new implant has not yet been tested on humans, and it remains unclear whether the technology would work on people with severe spinal cord damage. The monkey in the study had a small lesion and would have eventually regained its motor functions on its own.

But the technology may have practical applications for rehabilitating injured patients. Whereas many injured patients must relearn how to walk during physical therapy, the monkey implanted with the interface was able to move with a natural fluidity immediately. Details of the study were published in the November issue of the journal Nature.

PHOTO: Joe Johnston jjohnston@thetribunenews.com

The U.S. Department of Defense has awarded California Polytechnic State University (Cal Poly) a $513,000 grant to study the impacts of different forms of weight-bearing exercises on the bodies of below-knee amputees. The goal of the grant, which was awarded through the U.S. Army Medical Research Acquisition Activity program, is to help prevent the onset of osteoarthritis.

The three-year study will compare the impacts of cycling, elliptical, and walking exercise using motion analysis and computer modeling. The Cal Poly team, composed of engineers and kinesiologists as well as local doctors, will evaluate the knee biomechanics for two groups between the ages of 18 and 50—a group of 10 amputee subjects, and a control group of 10 nonamputee subjects.

The research will help the O&P community better understand the biomechanics of an amputee, whose movements can load more weight on certain parts of the body than a nonamputee. “Amputees who have one amputated prosthetic leg and one unaffected, intact leg tend to have a higher risk of osteoarthritis in their intact leg,” said Stephen Klisch, mechanical engineering professor and principal investigator. “It’s comparable to having an injury and favoring

HAPPENINGS

MEETING MASHUP

O&P Innovators Convene at California Technology Conference

A discussion on the UCSF Osseointegraton Project was paneled by UCSF’s Rickard Brannemark, MD, PhD (far left), Rami Weinberg, DPT, Matthew Garibaldi, MS, CPO, and Richard O’Donnell, MD.

PHOTOS: Kathleen Jay/UCSF

Hundreds of orthotists, prosthetists, and related health-care professionals travelled to Millberry Union Event & Meeting Center at the University of California— San Francisco (UCSF) in October for the Orthotic and Prosthetic Innovation & Technology Conference , held in conjunction with the California Orthotic Prosthetic Association. The conference was designed to help drive the development of new technologies and innovations in the O&P profession by uniting innovators and investors in a diverse and collaborative educational setting.

The two-day event, which focused on “educating, stimulating, and unity,” featured sessions dedicated to advanced O&P topics such as neural prosthetics, osseointegration, 3-D printing, pattern recognition, virtual reality, outcomes measurements, and big data. AOPA President Michael Oros, CPO, FAAOP, presented a session on “Evidence and Data To Secure the Future of O&P.” Participants also browsed exhibits during breaks.

“The buzz in the crowd and the excitement this year was palpable,” said Matthew Garibaldi, MS, CPO, conference chair and assistant clinical professor and director of orthotic

and prosthetic centers at UCSF. “The concept of merging innovators with investors to help improve technology is foreign to health-care professionals, but I think attendees really embraced the concept and understood the vision and purpose of the event.”

Speaker Andrew Schwartz, PhD, (University of Pittsburgh) confers with UCSF's Rickard Brannemark, MD, PhD, during the conference.

Due to the success of the UCSF O&P Innovation and Technology conference over the past two years, AOPA has invited UCSF to join the planning committee for the AOPA World Congress Assembly in Las Vegas in 2017. Garibaldi will help to develop the Technology Transfer Session, highlighting new technologies from around the globe that have direct applicability to the O&P profession.

E-HEALTH HABITS

Health Literacy Linked With Digital Health Use

People with low health literacy were less likely to use digital health tools like patient portals, wearable technology, and mobile apps, according to researchers at the University of Texas at Austin.

“Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to app adoption and usage,” the researchers concluded.

The researchers studied the responses of 5,000 participants to a 20-minute survey, which included items to assess health literacy, participants’ use and perceptions of four different types of digital health tools, and demographic information. Participants with lower health literacy were not as likely to use fitness and nutrition apps, activity trackers, and patient portals, according to the researchers. High health literacy was found to be significantly associated with greater perceived use and usefulness across all digital health tools.

“Our results suggest that the actual design of apps, ranging from wearable technology to patient portals, has room for improvement so that lower health-literate audiences will perceive the apps as more useful and easy to use,” the researchers concluded.

O&P ALMANAC | DECEMBER 2016

11

HAPPENINGS

CODING CORNER

RAC ACTIVITY

CMS Releases New HCPCS Codes for 2017

CMS Announces New RAC Contractors

CMS has released the new Health-Care Common Procedure Coding System (HCPCS) codes for 2017. The biggest change was the deletion of the temporary K codes (K0901 and K0902), which became effective on Oct. 1, 2014, to describe off-the-shelf (OTS) versions of custom-fitted knee orthoses described by L1843 and L1845, and their subsequent crosswalk to new permanent L codes (L1851 and L1852).

Below is a complete breakdown of the code changes, which will be effective for claims with a date of service on or after Jan. 1, 2017.

CMS placed the activities of the four existing recovery audit contractors (RACs) on hiatus as a result of the upcoming awarding of new RAC contracts. The intention of the hiatus is to allow for a smooth transition to the new RAC contractors, including the new single, national RAC contractor that will focus on claims for durable medical equipment, prosthetics, orthotics, and services (DMEPOS), home health, and hospice services.

CMS announced the recipients of the new contracts on October 31. The Region 5 contract, the new single RAC for DMEPOS, home health, and hospice, was awarded to Performant Recovery Inc. Performant Recovery previously served as the RAC contractor for Jurisdiction A. The full announcement of the contract awards may is available at CMS.gov.

New Codes Descriptor

A4467

Belt, strap, sleeve, garment, or covering, any type

A9285

Inversion/eversion correction device

L1851

Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/ valgus adjustment, prefabricated, off-the-shelf

L1852

Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf

Changes in Code Descriptors Code

New Descriptor

Old Descriptor

L1906

Ankle-foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf

AFO, multiligamentus ankle support, prefabricated, off-the-shelf

Deleted Codes

CORRECTION New Options Sports

Made in the USA

Texas manufacturer offers orthopedic and sports medicine braces as well as liners and covers

J

OHN SCOTT REALIZED

the potential of neoprene in 1977, when his longtime friend Jim Pelletier, a certified orthotic fitter, showed him a basic knee sleeve made of neoprene, which was then more commonly used to make wetsuits. Scott founded a company, Sport Supports Inc., building it from the ground up.

Before long, he was providing braces to the Dallas Cowboys, the U.S. Olympic team, the Association of Tennis Professionals, and a number of orthopedic and physical therapy clinics in the Dallas area.

Scott sold Sport Supports in 1990 and launched New Options Sports in 1993. Soon after, the facility, with its made-in-America products, landed a contract with the U.S. Department of Veterans Affairs (VA). A veteran himself, Scott is particularly proud of the VA contract, which is in its 16th year.

Today New Options occupies a 3,200-square-foot facility in Farmers Branch, Texas, a suburb of Dallas. The company has 80 employees, including manufacturing, sales, and administrative staff. It sells its products through distributors, sales reps, and original equipment manufacturer accounts in the United States, Canada, and Mexico.

The company manufactures knee, lumbar/spine, ankle, wrist, elbow, and shoulder braces, prosthetic suspension liners, and the recently introduced JAFO Freedom covers for prosthetic limbs. New Options is one of the few manufacturing companies to fabricate custom

New Options occupies a 32,000-squarefoot facility, including a fabrication room.

COMPANY: New Options Sports OWNER: John Scott

LOCATION: Dallas, Texas HISTORY: 23 years

John Scott

products, says Scott.

“We recently built a custom product for a veteran with severe loss of buttocks tissue due to a roadside bomb,” says Scott. “Scar tissue covered the area, and he was unable to sit down without a special pad.

We customized a pair of lycraspandex pants and padded all the areas of pain and pressure points, along with additional padding so he looks normal in pants.

“The veteran called me later, crying, saying he could sit normally, he could drive, and he looked normal in clothes. He told me no one was able to do that for him in the eight years since his injury. I think that was the most important thing we ever did.”

The JAFO Freedom cover, just one of a number of products for which New Options holds patents, is a new product that covers and protects prosthetic legs. The cover not only protects the prosthesis from the elements; it also fills out and replicates the calf muscle of the patient’s healthy limb. “Under long pants, both legs look the same,” he says. Freedom covers are available in a number of colors, including digital camo.

34 NOVEMBER 2016 | O&P ALMANAC

DECEMBER 2016 | O&P ALMANAC

Code

By DEBORAH CONN

The company also offers a full line of pediatric soft bracing.

Scott created his first pediatric brace 18 years ago when his young son sprained his ankle playing soccer. When the rehabilitation doctor saw the device, he said, “This brace doesn’t exist. Where did you get it?”

Scott explained, and the doctor immediately placed an order.

Today, the Kids’ Stuff Line offers the same products available in New Options’ adult line, but tailored to children and available in multiple colors.

Scott believes his company has two attributes that set it apart from others. The first is its commitment to providing completely American-made products. “Since the beginning, we have never wavered as far as going to another country to manufacture our products,” he says.

The second is New Options Sports’ two-day turnaround time for custom braces. “No one else offers this,” says Scott. Many people don’t fit in a standard size, so Scott hand-cuts the devices for adults or children who need specialized treatment.

“We probably lose money on this, because we have to do it by hand, but we take pride in meeting our customers’ needs, whatever they are,” he says.

Scott, an art major in college, enjoys doing the custom work, as well as creating his own drawings for the patent process.

The company consults with orthotists and prosthetists in developing and refining its products. “We never set up our own patient-care division, because we have no interest in competing with O&P providers,” he says.

“We make it, and they fit it.”

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

afe!

Be Sower A4466 Just

like

Descriptor Patent Pending

re

befo

Sh ith w ce on ! n legs fide con own 2 r you

K0901 Shower Seal

TM

”Anti-slip”

Waterproof Be it... in the shower bathing by the pool PHOTOS: New Options Sports

The article “Made in the USA” in the November issue of the O&P Almanac incorrectly identified New Options Sports as a 3,200-sqare-foot facility. New Options Sports is actually a 32,000-square-foot facility. We regret the error.

MEMBER SPOTLIGHT

12

Code

Orders (800) 252-2828

safety and Enjoy the ing on ease of standlegs. both your

www.daw-usa.com © Copyright 2016, Daw Industries. San Diego CA. All rights reserved.

K0902

Garment, belt, sleeve, or other covering, elastic or similar stretchable material, any type, each Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf

2016 marks our 25th year as a leader in Custom Orthotic & Prosthetic fabrication. We'd like to thank all of our loyal practitioners that have helped us grow over the years.

We work for you, the practitioner.

Your service is our priority.

As we've done for the past 25 years, we'll do everything in our power to get you what you need when you need it.

Call us.

800 253 7868

Thank you for 25 years of growth.

Spinal Technology, Inc. 191 Mid Tech Drive West Yarmouth, MA 02673 spinaltech.com

1991

2016

Dedicated to supporting the O&P industry since 1991.

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR

NASHVILLE

EARN

JAN. 23-24 | 2017

AOPA Coding Experts Are Coming to Nashville, TN The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The January 23-24 Coding & Billing Seminar at the Holiday Inn Express Nashville Downtown, Nashville, TN, will teach you the most up-to-date information to advance the coding knowledge of O&P practitioners and billing staff.

The seminar features hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments.

Breakouts are tailored specifically for practitioners and billing staff.

Take part in this seminar and to better your business, your staff, and your patients!

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2017billing.

In this audit-heavy climate, can you afford not to attend?

14 CEs

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.

Mark your calendar for the next seminar:

APRIL 10-11 Denver, CO

The Westin Denver Downtown, 1672 Lawrence Street, Denver, CO 80202 Find the best practices to help you manage your business.

Participate in the 2017 Coding & Billing Seminar!

Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

HAPPENINGS

New AOPA Board Prepares for Centennial Celebration As we prepare for 2017 and the 100-year anniversary of AOPA, the 2016-2017 leadership team begins its work this month. The transition to the new board, elected during the AOPA National Assembly Annual Meeting in Boston, comes at an important time for AOPA, with a combined 100th AOPA National Assembly and World Congress Meeting planned for September 2017 in Las Vegas. Leading the association through this seminal

MONEY MATTERS

2017 Amounts in Controversy Released

year is AOPA President Michael Oros, CPO, FAAOP, along with a full list of officers and Board of Directors members who are experienced O&P professionals well-prepared to guide the profession through a benchmark year.

2017 AOPA Officers

Michael Oros, CPO, FAAOP, President

James Weber, MBA, President-Elect

Chris Nolan, Vice President

Jeff Collins, CPA, Treasurer

James Campbell, PhD, CO, FAAOP, Immediate Past President

Medicare has released the amounts in controversy (AIC) for the 2017 calendar year. The AIC is the monetary threshold that must be met in order to file an appeal with the administrative law judge (ALJ), third level of appeal; and with the federal district court, fifth level of appeal.

The 2017 AIC for the ALJ is $160 and represents a $10 increase over the 2016 AIC. The AIC for the federal district court is $1,560 and represents a $60 increase over the 2016 AIC. The new AICs will be effective for all appeal requests filed on or after Jan. 1, 2017.

David A. Boone, PhD, MPH Pam Lupo, CO

Jeffrey Lutz, CPO

Dave McGill

Brad Ruhl

Traci Dralle

Teri Kuffel, JD

Rick Riley

2016-2017

RETIRING

Special Thanks

NEW

CONTINUING

2017 AOPA Board Members

Maynard Carkhuff

Charles H. Dankmeyer Jr., CPO

Eileen Levis

O&P ALMANAC | DECEMBER 2016

15

PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

ANNOUNCEMENTS AND TRANSITIONS

Maynard Carkhuff, vice chairman and chief innovation officer of Freedom Innovations, has been elected to the California Orthotic & Prosthetic Association’s (COPA’s) Board of Directors. Carkhuff’s appointment was Maynard Carkhuff voted upon and made official at COPA’s annual meeting in San Francisco. “It’s an honor to represent Freedom Innovations while stepping into a leadership role alongside my industry colleagues at COPA,” said Carkhuff, who also has served on AOPA’s Board of Directors. “COPA does essential work promoting the art and science of orthotics and prosthetics to create and communicate innovative solutions for positive patient experiences.”

Liberating Technologies (LTI), a College Park Company, has been selected as a finalist in the Department of Defense (DoD) Velociter Program™. The program was created to support the transition and commercialization of the DoD Small Business Technology Transfer and Small Business Innovation Research (SBIR) technology through guidance, training, and fostering of key relationships. The LTI grant project selected for this program was for the development of new technologies to train upper-limb myoelectric prosthesis users, awarded by the DoD SBIR program in 2015.

Liberating Technologies also has been awarded two additional grants, totaling approximately $2 million, from the National Institutes of Health to work on a fingertip terminal device and an advanced EMG controller.

Ottobock has named Matt Swiggum regional president and chief executive officer of North America. Swiggum started his nearly 20-year career with Ottobock in 1997 as a sales representative in the Ohio territory and has held Matt Swiggum numerous leadership positions across all Ottobock business units as director of sales for technical orthopedics, business unit director for mobility solutions, vice president of mobility solutions, and, most recently, executive vice president of sales and marketing for North America. In his new role, Swiggum will lead prosthetic, orthotic, mobility solutions, and business services activities across North America with the goal of bringing world-class innovative products and services to market and ensuring a customer-centric approach.

IN MEMORIAM

Charles Woodley Wright Charles Woodley Wright, 96, of Taylors Island, Maryland, passed away on March 28, 2016, at his home.

After graduating from high school in Alexandria, Virginia, Wright served as a Charles Woodley Merchant Marine during World War II, and Wright joined J.E. Hanger, a prosthetics manufacturer. After moving to Philadelphia, Wright opened a branch office for J.E. Hanger, where he worked until retiring in 1985. Wright enjoyed boating and fishing, and he was a member of Coast Guard Auxiliary. He also was a long-time member of the Taylors Island Volunteer Fire Company.

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DECEMBER 2016 | O&P ALMANAC

Paceline Inc., a medical products and solutions provider, has relocated its headquarters and manufacturing operation from Monroe, North Carolina, to a 50,000-square-foot facility in Matthews, North Carolina. “Our business has grown of late with the acquisition of SPT Technology, and more recently Acsys Orthopedic. With these acquisitions, along with an increased industry awareness of existing and new products, demand has risen,” said Paceline President and Chief Executive Officer Joe Davant. Multiple plant sites have been combined into one large facility.

Phoenix Molded Shoes, Inserts, and Braces has opened in Sebring, Florida. The new company, owned by Keith Brewer, CPed, LPed, offers functional custom footwear and orthotic devices, and aims to work with practitioners to provide optimal customer service and turnaround times.

Virginia Prosthetics & Orthotics Inc., founded in 1966, has been awarded the Legacy Award (Operating Continuously for 50+ Years) from the Roanoke, Virginia, Regional Chamber Small Business Awards. The company was recognized during the 30th Annual Small Business of the Year Awards Ceremony in October.

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3D Casting

REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

What’s In Store for O&P in 2017?

E! QU IZ M EARN

CREDITS

Changes in the RAC contractor, prior authorization, and more may impact your facility next year 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 21 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

L

AST MONTH’S Reimbursement Page

covered issues that O&P professionals should consider as the year comes to a close—such as reviewing your Medicare participation status and rules governing gifts to referral sources and patients.

Following that theme, this month’s Reimbursement Page looks into the future to prepare you for situations that may occur in 2017—situations that could have a major impact on your business.

While some of the scenarios discussed in this article may not come to fruition in 2017, they are all things that will come to pass eventually. Preparation now is the key to success in the future.

Renewed RAC Audits

On Oct. 31, 2016, CMS announced the award of the new single, national recovery audit contractor (RAC) contract for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), home health, and hospice claims to Performant Recovery Inc., which previously served as the Jurisdiction A RAC contractor. While the announcement did not offer any details of the contract award—such as a timeline for implementation—it is expected that Performant will begin RAC activity in the very near future since the infrastructure for performing claim audits is already in place.

O&P providers enjoyed a temporary hiatus in RAC audits while the new contract arrangements were being made; however, the contract award to Performant Recovery clears the way for resumption of RAC audits. With Performant focused on a much smaller universe of Medicare claims (DMEPOS, home health, and hospice), the hope 18

DECEMBER 2016 | O&P ALMANAC

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BUSINESS CE

P.21

is that its auditors will be better versed in Medicare coverage and payment rules for O&P devices, resulting in more educated decisions on claim reviews.

While the new contract narrows the focus of Performant Recovery to a smaller universe of claims, the same limits on additional documentation requests (ADRs) that existed under the previous RAC contract exist under the new RAC contract. The RAC contractor may audit 10 percent of the claims submitted by a supplier (under each tax identification number) in the previous year, divided by eight, every 45 days. For O&P suppliers, the ADR limit is subject to a cap of 10 claims every 45 days. It is important to note that ADRs are only issued when performing complex medical reviews. The cap does not apply to automated reviews that do not require specific review for medical necessity.

While nobody is looking forward to facing the challenge of RAC audits, the hiatus that has been in place was always a temporary one. RAC audits are a fact of life, and preparation today is the key to success tomorrow.

Prior Authorization for Lower-Limb Prostheses

While there are no signs of imminent implementation of a prior authorization program for lower-limb prostheses, the final rule authorizing the program has been in place for almost a year now.

CMS has indicated that it will continue to take a cautious approach in implementing a DMEPOS prior authorization program, but it may be implemented at some point in the next 12 months.

Medicare prior authorization is a subject that has divided the O&P

EXTRAORDINARILY SIGNIFICANT FINDINGS:

Medicare data proves the economic value of an O&P intervention.

O&P CARE is COST EFFECTIVE

5

Reasons to visit MobilitySaves.org

Learn about the study proving orthotic and prosthetic care saves money

1.

Find ads and videos on Medicare’ costcutting to share on your website or social media

See healthy lives affected

by O&P care

2.

Find resources to share with your patients

3.

4.

Learn how much Medicare has saved this year by providing O&P care

5.

The Study that Started MobilitySaves.org

The Results

A major study, commissioned by the Amputee Coalition with support from the American Orthotic & Prosthetic Association, shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. O&P professionals have learned the positive outcomes from the Dobson DaVanzo study, which proves that timely O&P intervention results in fewer co-morbidities and lower total healthcare costs for both patients and payers. Share this significant news by using the educational tools provided at MobilitySaves.org. Mobility Saves Lives And Money!

The lower limb prosthetic patients could experience better quality of life and increased independence compared to patients who did not receive the prosthesis at essentially no additional cost to Medicare (or other payers), and patients using spinal orthoses and lower limb orthoses had lower overall costs.

O&P CARE IS A SAVER, NOT AN EXPENSE TO INSURERS! Visit MobilitySaves.org.

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REIMBURSEMENT PAGE

community. While some see it as a program that reduces provider financial liability by rendering a preliminary payment decision prior to delivery of the prosthesis, others believe that the program in its current form will lead to unacceptable delays in the delivery of clinically appropriate prosthetic care for Medicare beneficiaries. AOPA has worked closely with CMS, and will continue to do so, to ensure that any Medicare prior authorization program for lower-limb prostheses does not hinder the patient’s ability to receive appropriate prosthetic care in a timely manner.

While the debate continues over whether prior authorization is beneficial or harmful to the Medicare community, the fact is that it will eventually be implemented. Preparation for its implementation will help avoid unnecessary delays when it becomes reality.

Lower-Limb Prosthesis LCD PHOTO: iStock.com/uschools

While AOPA was successful in convincing CMS to reconsider the draft Local Coverage of Determination (LCD) for lower-limb prostheses that was published by the durable medical equipment Medicare administrative contractors (DME MACs) in August 2015, the draft LCD was not rescinded.

The draft remains available on the DME MAC websites as a published document. What AOPA did achieve was a recognition that the draft LCD, in its current format, may not represent the best interests of lower-limb amputees covered by Medicare.

Rather than rescind the document completely, CMS announced that it would convene an interagency task force to review the available literature and provide input on what the final LCD for lower-limb prostheses should look like. Unfortunately, creation of the interagency task force did not allow for the involvement of individuals who are not direct employees of the federal government so the process has been less than transparent.

While AOPA is aware that the task force has been formed and has had several meetings, there has been no indication of any preliminary findings by the task force and no indication of when the task force expects to complete its work. While AOPA does not expect a revised draft LCD for lower-limb prostheses in the near future, it may occur at some point in 2017. AOPA continues to monitor this situation closely and will report any new developments immediately.

Changes to the Political Environment

Following the results of the recent election season, the House, the Senate, and the executive branch of the U.S. government will be under the control of the same party for the first time in

recent years. While AOPA has always been and remains politically neutral, the impact of the election will be significant, not only in the health-care arena, but across the board. It is still too early to understand the true impact of the recent changes to the political environment, but AOPA will continue to push for legislation that is favorable to AOPA members and their patients.

While accurately predicting the future is difficult at best, it is a safe assumption that each of the issues discussed above will somehow impact your business during 2017. AOPA will continue to diligently monitor any activities related to these issues and provide analysis and guidance to its members as they develop.

As 2016 comes to a close, AOPA would like to thank its members for their continued support in helping the association best represent its members and their patients. May 2017 bring continued success to the O&P industry.

Joe 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 | DECEMBER 2016

21

This Just In

O&P in the

Trump Era

How will health care be affected by the election of Donald Trump and the GOP’s continued control of Congress?

I

N AN ELECTION UNPRECEDENTED

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DECEMBER 2016 | O&P ALMANAC

President-Elect Donald Trump with Governor Mike Pence addresses his supporters at an election night event at the New York Hilton Midtown Nov. 8, 2016, in New York City.

President-Elect Trump’s Health-Care Proposals

The key issues discussed by Trump in regard to health care include health insurance coverage and costs; Medicaid; Medicare; opioids; prescription drugs; women’s reproductive health; mental health; and Zika funding. Below are Trump’s proposals in these areas; remember that almost any significant change could face challenges in Congress.

Health insurance coverage and costs: Trump’s proposals would repeal the ACA and eliminate the individual mandate; allow insurance to be sold across state lines; and allow taxpayers to deduct their entire health premium.

They also would allow people to enroll in tax-free health savings accounts, which could be used by all family members and would be inheritable

without tax penalties. Trump has said he would require transparency from all health-care providers to enable individuals to shop for the best prices on health-care procedures. In addition, Trump has proposed protecting individuals from premium increases or exclusions due to pre-existing conditions; enforcing immigration laws and restricting visas to reduce health-care costs; and working with the states to establish high-risk pools to ensure access for individuals who have not maintained continuous coverage.

Medicaid and Medicare: Trump’s proposals would move Medicaid to a system of block grants for the states.

Regarding Medicare, Trump has said he would guarantee enrollees have an income-adjusted contribution toward a plan of their choice with catastrophic protection.

PHOTOS: Top right: iStock.com/LPettet. Center: Ricky Carioti /The Washington Post via Getty Images

in American history, Donald Trump defied the polls, conventional wisdom, and notions of political correctness for a convincing win of the U.S. presidency in the Electoral College, despite losing the popular vote. What does it mean for orthotics and prosthetics, and health care in general?

It is clear that the Affordable Care Act (ACA) is likely to be repealed.

There will need to be a replacement, and it may have several consistent features—for example, no exclusions for pre-existing conditions and maintaining kids on parents’ coverage until age 26. But expect the medical device excise tax to be history, as will major subsidies, and any tax on uninsureds.

Medicaid will likely be addressed by offering block grants to states to use as they deem appropriate. Similarly, expect a movement toward vouchers in Medicare. Next year, we will have new CMS leadership. In addition, large amounts set aside for innovations, accountable care organizations, and similar features may go away.

Aside from discussions of the ACA, health care was not heavily debated during the election. Beyond the broad issues, it is unclear what the Trump administration’s health-care agenda will look like. AOPA’s counsel, Alston & Bird, published a general overview that included the following information, which we provide below with attribution to our counsel’s authorship.

This Just In

Opioids: Stopping the inflow of opioids and investing in heroin addiction treatment would be priorities under Trump’s proposals.

Prescription drugs: Trump has said he would allow drug importation and allow Medicare to negotiate drug prices.

Women’s reproductive health: Trump has proposed allowing abortion only to save the life of the woman or in cases of rape and incest; limiting access to later-term abortions; and making permanent the Hyde Amendment, which bars the use of certain federal funds to pay for abortion, except to save the life of the mother or cases of rape and incest.

Zika funding: Trump has said he would provide funding for Zika research.

Repercussions for O&P

In terms of the specific impact these proposals would have on O&P once in place, perhaps three comments are noteworthy: • Senator-Elect Tammy Duckworth (D-Illinois), a double amputee Iraq

war hero who has been a major champion for O&P, was one of only two Democratic candidates for the Senate who succeeded in defeating a seated Republican.

• Trump has emphasized a commitment to improve care for veterans, and some predict that could lead to a greater role for private-sector contractors and lessen movement toward more O&P care by prosthetists and orthotists employed by the U.S. Department of Veterans Affairs.

• The threat for competitive bidding being errantly applied to O&P, and the strong reliance on data-driven decisions and emphasis on quality and cost effectiveness of care, are concepts largely embraced on both sides of the aisle, so we can expect these efforts—as well as some battles around these issues—to continue.

There will almost certainly be a lame duck session of the 114th Congress, likely a short one with many remaining issues simply pushed forward to the new president and Congress. However,

AOPA has laid a good bipartisan foundation for possible action on issues around both S. 829/H.R. 1530, the Medicare O&P Improvements Act, and the proposed Local Coverage of Determination for lower-limb prosthetics during that lame duck session—the timing and duration of the session permitting.

As with any new administration, it will take time for presidential cabinet and agency appointments to play out, as well as for new health-related committees in the House and Senate to be settled. In short, it will take awhile to determine the key players in the executive branch and in the 115th Congress will be. AOPA will continue to be a strong advocate for O&P professionals and their patients.

The 2017 AOPA Policy Forum is slated for May 2017, with events tentatively scheduled for May 24-25.

The coming year promises to usher in a brave new world in Washington— mark your calendars for the AOPA Policy Forum, and plan to be part of it.

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23

COVER STORY

Maximizing Opportunities in

Orthotics

Tips for growing your business in 2017 with the right processes, people, and products

By LIA K. DANGELICO

PROCESS PEOPLE

NEED TO KNOW • Growing the orthotics side of your O&P facility offers many benefits, including higher volume and frequency of patient visits, increased opportunities for patient referrals, and a greater spectrum of device options.

• In today’s fast-moving, consumer-driven health-care climate, focusing on processes, people, and products is the key to running a successful orthotics facility.

• Improving orthosis turnaround times, educating patients about the value of orthotic intervention, and scheduling follow-up appointments can help streamline processes at your facility.

• Staffing appropriately can lead to more referrals: Orthotists should be up-to-date on new technologies and devices, managers should be trained to successfully navigate the reimbursement climate, and marketing staff should lead the facility’s web and social presence.

• Exploring which types of devices may drive revenue can lead to increased profit margins. Scoliosis braces, unloader hips, fracture bracing, and stance-control knee braces are examples of devices that may fit this category.

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DECEMBER 2016 | O&P ALMANAC

PRODUCTS

COVER STORY

A

OPA’S 2016 NATIONAL ASSEMBLY, held in Boston,

September 8-11, featured an unprecedented amount of business management programming.

One popular session was “Growing Your Orthotic Practice,” presented by Eric Burns, CO, regional director at Hanger Inc.; Eric Weber, CPO, LPO, FAAOP, national orthopedic specialist at Hanger Inc.; and Bret Bostock, CO, global manager, medical, for Boa Technology. Together, they discussed challenges facing orthotic practices in today’s world—where the big prosthetic stories make the headlines, and consumers are demanding products ever faster, cheaper, and better.

In this environment, focusing on processes, people, and products is the key to running a successful orthotics facility, according to the Assembly speakers. Taking this approach, even the smallest practice can gain a foothold in the market and find success.

Processes

These days, it’s easy for the orthotic side to be overlooked—but that would be a critical mistake, according to Eric Burns, CO. “Growing your orthotic program—or, your ‘O’—has a lot of benefits.

You have a lot higher volume. You get a lot more touches with the referrals for patients. You have a higher frequency, and the volume itself is what keeps your practice more consistent and full,” he said. “You look at the pathologies, the devices, the variety—you have a greater

spectrum of things that you can treat with a greater spectrum of devices.”

To maximize these opportunities, orthotic facilities must have the right processes in place. Burns highlighted three key areas that can have the biggest impact: turnaround, education, and follow-up.

TURNAROUND: We’re living in an instant-feedback, “Amazon” world, and customers don’t expect to wait weeks or months for their device. “In the past, you could focus on one area and be successful,” said Burns, “but today, you have to focus on three areas to be successful in health care and orthotics: speed, quality, and price. You want to get the highest quality device on, as fast as you can, at a competitive price.”

Obviously, there’s a fine line between quality and overnight delivery. Burns said it is crucial for facility managers to examine how quickly an item can be produced before quality drops.

Another area for improvement is scheduling. “If someone comes in for an ankle-foot orthosis (AFO), they need to walk; wouldn’t they like to walk… or get involved in therapy… right away?”

Burns asked. “So look at your lab, your central fab, etc.,” and determine how the process might be expedited. For example, by notifying manufacturing partners that you have an AFO evaluation on Monday, they may be able to set aside time on their Tuesday schedule and turn a device around quickly, without extra charges.

O&P ALMANAC | DECEMBER 2016

25

COVER STORY

Examining shelf stock also may improve overall turnaround time. The ideal situation is to be able to pull any item off the shelf at any time, but that’s not realistic for most bottom lines.

Instead, “look at when your patients come in, look at your business mix, and see what you actually need in stock,” Burns said. “If you have to order an item, you’re delaying patient care.

You’re doubling your cost [to provide] that service. If you can get it right away, the patient walks out satisfied and happy with your practice.”

One last way to streamline the production process and drive home the value of orthotic services is to embrace technology, such as CAD/CAM. “We can start the fabrication process before the patient leaves,” Burns said. “You can have the patient involved in the modification process. You can actually have an AFO modified while they’re in the room, and send it off before they leave.” As a result, the patient is likely to leave the facility as an advocate for the business.

EDUCATION: The orthotic business is about more than delivering devices.

Physicians and physical therapists are relied on for the medicine they practice and the knowledge they provide.

26

DECEMBER 2016 | O&P ALMANAC

Similarly, orthotists must embrace the roles of educators and researchers, according to Burns. “Educated patients have the best outcomes,” he said. “They’re also your biggest advocate. If we can have patients walk in the door and leave the most educated they can be… it will be unbelievable what it can do to your business and growth.”

Burns advised practitioners to explain more than the basics to patients when fitting a device. Discuss how and why an AFO, splint, or back brace helps them, for example. “When you go into a room, make sure you’re the foremost expert on the device you’re providing,” he said. “If something’s coming in that you’re not familiar with, make sure you are the expert before you go in. And when you fit a device, make sure you understand the alternatives to what you’re providing.”

Burns also suggests practitioners offer patients written documentation they can share with their loved ones and caregivers, who can help keep them accountable for wear and compliance issues.

FOLLOW-UP: “Everybody knows it’s

much, much more efficient to retain a patient than it is to grab a new one,” Burns said. “They’re already in your

network…. so, if they have a great experience, they’re going to come back to you.”

Burns shared several tactics for improving follow-ups. First, be sure to schedule annual follow-ups for diabetic shoe patients, who qualify for new shoes annually through Medicare.

Similarly, young patients grow quickly and may need larger AFOs or braces to accommodate their growth; explain to these patients that they will need to return annually. Schedule regular appointments for patients who wear knee or sport braces, AFOs, or other custom devices to assess normal wear and tear and account for changes in the patients’ physique. The same goes for postsurgical patients, whose bodies can change drastically after being discharged. For example, Burns said, “you put a thoracolumbosacral orthosis on a patient at the hospital, then [he or she gets] home, the fluid passes, and it no longer fits. Imagine if we followed up with that person, made minor adjustments, or provided a stepdown brace that better fits their needs” as their function changes.

“When we fit a patient in orthotics, it should be the beginning of a relationship,” Burns said. The first step is getting that patient a great device quickly. The second is giving him or her an incredible experience. From there, it’s essential to set the expectation that he or she will need to return for a second visit, and “then we have a formalized follow-up to keep them engaged in our process,” said Burns.

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COVER STORY

brace is appropriate postsurgery and be completely unaware that the term “orthotist” even exists. All of these are opportunities to engage and educate patients, and therein drive business, said Weber.

To drive these efforts, O&P facilities should designate, or hire, a media/ marketing point person on staff, who can field media requests and head the facility’s web and social presence.

Products

People

Because relationships are key, it’s easy to see how big a role the “people factor” can play in orthotic businesses. Eric Weber, CPO, LPO, FAAOP, addressed the recent decrease in orthotic referrals across the country: Although many attribute those losses to product failures and aging populations, Weber pointed to the people factor.

To be successful, orthotists must constantly be up-to-date—and become experts, even—on new and current technologies and devices available for their patients. Orthotists who are behind the curve run the risk of “putting a technology or a certain device on a patient and that has a detrimental effect…and then you’ve been unable to accurately or concisely deploy that treatment,” said Weber.

Failures also come about when members of the patient’s care team are not on the same page. “The relationship between the orthotist and the physician is huge in discussing some of those points and making sure that we are bracing for function and outcome and not just for safety,” he said.

Having the right staff in place to navigate the difficult reimbursement climate is equally important. Facility managers should empower their staff to be proactive about their client base, regularly breaking down and analyzing its make-up by age and other demographic data. “This data can help your team assess where you need to focus and reassess your efforts moving forward,” Weber said. For example, 28

DECEMBER 2016 | O&P ALMANAC

when bringing in a patient from the pediatric or adolescent population, the staff can prequalify that individual and start to prepare him or her now for necessary future treatments.

Orthotic business managers should not underestimate the power of connecting with people—current and potential clients and even employees—online. The first step is to have an updated and easy-to-navigate website, preferably one is that is Google-certified, where keyword searches can link browsers to your facility, said Weber. That way, when a potential patient in the area does a search on “foot drop,” your clinic may come up as a related local business.

Second, recognize that most patients are already active and connected on

various social media platforms, such as Facebook and Instagram. They’re sharing their good stories and their bad experiences, both of which can have a major influence on referrals.

A patient might watch a YouTube video of a polio survivor walking up a mountain and ask, “Why can’t I do that?” Or a patient facing surgery may be searching for answers as to what

Moving from people in the clinic to products in hand, Bret Bostock, CO, presented a snapshot of the following revenue-driving devices: SCOLIOSIS BRACES: Broadly, scoliosis

braces are used to stop the progression of the spinal curve. “When we think scoliosis, we think of adolescent scoliosis,” said Bostock. “We think of the idiopathic, younger population, but do we think about the adult population with scoliosis?” Braces that treat adult scoliosis are not only codable, they also can be very helpful for a specific population—one that could offer new revenue streams and growth.

UNLOADER HIPS: Unloader knee braces have been used for years, and now there is a device that addresses the common problem of osteoarthritis in the hip. According to Bostock, orthotists should become familiar with unloader hips and incorporate them into their practices, “so that when that patient comes in and says, ‘My hip is killing me,’ you can talk to them about an option that’s not surgical. Or something to give them another year, another two years… I encourage you to find them, educate yourselves on them, and bring them out.”

FRACTURE BRACING: These braces

have a new code for an upper-extremity orthotic devices and a design that borrows from the unloader knee.

Using these braces in cooperation with the physician gives the clinician an opportunity to align a fracture within a brace as an alternative to complicated, high-risk surgery. “This is a device that

has not quite taken off because I don’t think people are aware of it,” Bostock said. Orthotists who take the time to learn about these products and share them with physicians are presented with “a codable opportunity that eliminates risk, saves money, and prevents the patient from having surgery.”

STANCE-CONTROL KNEE BRACES:

While these braces are not new, they are codable and readily available, and provide great outcomes. Bostock urged attendees to familiarize themselves with these products, which react to the patient’s movement, locking and unlocking the knee joint to make walking easier. He noted that this type of brace could be beneficial for postpolio syndrome patients who struggle with walking. “It only takes one patient’s great experience to multiply into referrals for years to come,” said Bostock.

EXOSKELETONS: According to

Bostock, this is an area where orthotic businesses should be looking more

closely. It’s unlikely anyone will invest in getting these items coded because they’re simply not being used, Bostock said. “So patients are going to look for other products and outlets that are successful,” such as therapy or directto-patient. If orthotists demonstrate that patients can be successful with exoskeletal devices, demand will increase and could lead to growth at orthotic facilities, he reasoned.

While it can be financially beneficial to offer certain products, Bostock

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argued that reimbursement shouldn’t be the sole business focus for orthotic practices. It is more important to offer the product that’s most appropriate for the patient—even if it is a device that the orthotist does not have much experience with or can’t code for, he said.

Bostock suggested that orthotic businesses follow the lead of prosthetists, who over the past few years “did a great job in this industry of fighting for microprocessor knees, getting codes, and making them significant,” he said. “But 10 years ago, most of this room would’ve been outraged at talk of microprocessor knees for the K-2 level patient.”

Similarly, orthotists should embrace a forward-thinking attitude regarding new technology and developments, said Bostock. “We have to push for what’s best for our client today—and in the future.”

Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

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

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

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

The unit is waterproof and has a traction base pad.

O&P ALMANAC | DECEMBER 2016

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By CHRISTINE UMBRELL

BENDING

CONVENTION

Looking beyond traditional X-rays and considering flexibility factors, orthotists are taking a more individualized approach to improve outcomes for scoliosis patients NEED TO KNOW • While X-rays continue to be instrumental in documenting curve severity, pattern, and progression, new technologies such as CAD systems, scanning equipment, and digital X-rays are being leveraged to assess curvatures and determine bracing protocols for scoliosis patients.

• Many orthotists advocate a team approach to scoliosis care, involving physicians, physical therapists, and family members in treatment decisions.

• Studied approaches to in-orthosis correction can allow orthotists to determine more specific design parameters and measure outcomes in scoliosis patients.

• In addition to studying the coronal plane, many orthotists are taking the sagittal and transverse planes into consideration to prevent new problems when treating the original curvature.

• Follow-up care at regular appointments, and open lines of communication between orthotists and their patients, can help improve patient compliance with orthosis wearing and fitting guidelines.

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DECEMBER 2016 | O&P ALMANAC

A

FFECTING 7 MILLION AMERICANS of all

PHOTO: Keith M. Smith, CO, LO, FAAOP, Orthotic & Prosthetic Lab Inc.

ages, scoliosis remains a bit of a “mystery” condition, with a full 85 percent of cases defined as idiopathic.

Scoliosis is most commonly diagnosed between the ages of 10 and 15, with females being eight times more likely than males to have a curve progress to a stage that requires treatment. Each year, 30,000 children are fitted for a brace for scoliosis, and 38,000 people with scoliosis diagnoses under spinal fusion surgery.

Curvatures of the spine are traditionally measured by Keith M. Smith, CO, LO, FAAOP (left) works with Laura Hartung, CO, and Glenn Schmidt, CO, the “Cobb method” and diagto mold for an asymmetrical TLSO for a right thoracic left lumbar curve on the Risser table. nosed in terms of severity by the number of degrees. Studies have indicated that braces, when used Evolving Diagnostic Tools structures actuwith full compliance, may successScoliosis is typically confirmed ally are in space,” through a physical examination, an says Tom Gavin, fully stop curve progression in about X-ray, spinal radiograph, CT scan, or CO, LO, national 80 percent of children with scoliosis.

MRI. But as new technologies come orthotic specialist For optimal effectiveness, the brace to market, the tools available to assess at Hanger Clinic’s should be checked regularly to ensure new cases of scoliosis are expanding, National Orthotic a proper fit, and in many cases may and clinicians have more options than Program. “In the need to be worn 16 to 23 hours every Tom Gavin, CO, LO operating room, ever at their disposal when making day until growth stops. their evaluations and treatment they look very Effectiveness of orthotic intervenrecommendations.

“The means of different.”

Gavin designed the tion was demonstrated in a widely capturing images have changed, with Rosenberger thoracolumbosacral read study published an October 2013 CAD systems, scanning equipment, orthosis (TLSO) in 1983 to apply issue of the New England Journal of and digital X-rays allowing for 3-D Milwaukee brace forces without a Medicine. Titled “Effects of Bracing in metal superstructure and neck ring, Adolescents With Idiopathic Scoliosis,” imaging,” says Debra Auten, CPO, LPO, who works at Cook Children’s Hospital and has updated that design to be the research concluded that “bracing in Fort Worth, Texas.

CAD-based, now called the ProSpine significantly decreased the progression Using advanced CAD/CAM and scoliosis orthosis. When training of high-risk curves to the threshold computer technologies allows for more orthotists, Gavin makes sure that all for surgery in patients with adolescent specific placement of pads, for “more residents he works with observe and idiopathic scoliosis. Longer hours intense pressure in braces that aren’t report on at least one spinal fusion, of brace wear were associated with symmetrical,” says C. Ralph Hooper Jr., for a fuller understanding of the greater benefit.”

CPO, president of Carolina Orthotics & human spine.

While these findings are important, Prosthetics.

Gavin advocates for a studied some of today’s orthotists are delving Today’s orthotists are learning to approach to scoliosis patient care: “I deeper into bracing protocols for look beyond the X-ray to formulate can help many more people with an patients, looking beyond the coronal the ideal treatment plan for each orthosis by being meticulous with the plane and assessing patients’ flexibility individual scoliosis patient. “X-rays application of biomechanical princito determine optimal orthotic interare our current, most precise way to vention on a case-by-case basis. These ples of treatment, combined with a document curve severity, pattern, clinicians, while sometimes differing kind clinical approach,” he says. “Most and progression, and to diagnose any in their approaches to treatment, all importantly, I believe in what we do, co-morbidities, but are a poor depicemphasize the importance of treating and I believe that patients and families the patient, and not just the X-ray. can sense if you believe in your work.” tion of what these three-dimensional O&P ALMANAC | DECEMBER 2016

31

Gavin also says that conveying his strong belief in the value of orthotic intervention helps with patient compliance issues.

Optimal patient care begins with a long conversation, before any discussion of bracing or treatment options, says Gavin. “I want to know what they know about scoliosis, what the doctor told them about orthotic treatment, and what their concerns are, and I try to derive my clinical information during the conversation.”

Involving the patient and his or her family in a team approach to scoliosis care also is a priority for Hooper. “An integrated, team approach, where physicians work with orthotists, physical therapists, radiologists, and the patient” in formalizing a treatment plan, results in better outcomes, he says.

Frequent Follow-Up

The goal of scoliosis bracing is to correct the curve and prevent surgery— and Gavin has found that this goal is most often achieved when patients wear their braces for most of the day, and when the orthoses are adjusted properly at regular office visits.

He cites a Rosenberger study 32

DECEMBER 2016 | O&P ALMANAC

he took part in where two groups had similar curvature rates and similar orthoses. Group 1, which was prescribed orthotic treatment for 16 to 18 hours a day and whose pads were not routinely tightened at follow-up appointments, had a 30 percent postsurgical rate—meaning three out of 10 eventually required surgery. Group 2, which was prescribed orthotic treatment for 23 hours a day and who engaged in meticulous follow-up and tightening, had an 18 percent postsurgical rate. This study showed “the physician and the orthotist should be meticulous to achieve the best results,” says Gavin.

Keith M. Smith, CO, LO, FAAOP, also believes in the value of progressive in-orthosis correction, and, throughout his 21-year career in treating scoliosis, has evolved his treatment methods accordingly. “Originally, we began increasing pad thicknesses due to the known issue of pad compression as time goes on during wearing months— in other words, recognizing that foams compress under load,” says Smith, who works at Orthotic & Prosthetic Lab Inc. in St. Louis, Missouri.

According to Smith, orthotists first began increasing the pad thickness

in an attempt to maintain the magnitude of force that was present at the time of initial fitting. “As we noticed patients tolerating the increases well, we then evolved to question the ability of increasing the magnitude of the force of the pushes on the kids that are young and very flexible, such as the juvenile group of scoliosis patients,” he explains. Ultimately, it was recognized that young patients’ flexibility “allows us to increase in-orthosis correction as time goes on by increasing the magnitude of force on the curves, and oftentimes axillary as well as gluteus pushes.”

Smith advocates a team approach to care to address “the two gold standards of Cobb angle and decompensation, but we also look at the Coronal Balance Summation (CBS).”

While Smith started out his career following the traditional approach of evaluating “symmetrical modules ordered from taking four measurements,” he eventually adopted the Wilmington approach, in which the patient is molded on the Risser table, allowing for “shifting curves manually in the molds back toward the central sacral line (CSL),” he says. Taking this approach increased patient comfort and improved in-orthosis corrections, overall decompensations, and trunk imbalances. But Smith also sought a way to measure “the dramatic improvement we were seeing to the overall balance of the spine in relation to the CSL.” To better quantify outcomes, Smith began to measure the lateral displacement from the midline (LDM), from the CSL of the centroid of every vertebral body throughout the spine in and out of orthosis, and assign those to the right a positive sign and those to the left of the CSL a negative sign.

After presenting his work, and being awarded the Thranhardt Honorarium at the 2004 Academy of Orthotists and Prosthetists Annual Meeting, Smith partnered with Marty Carlson, CO, to retrospectively study past radiographs to determine what the measurements meant to the practitioner. They then created a simpler and more efficient

Honesty and Education: The Keys to Patient Compliance Patient compliance with wearing orthoses is perhaps the biggest challenge in scoliosis care. Adolescents and teenagers “don’t want to wear braces. It makes them different, and a target for bullying, so noncompliance is a big issue,” says C. Ralph Hooper Jr., CPO. Communicating to patients the importance of wearing their brace for the indicated number of hours each day is an important task for orthotists treating scoliosis patients.

Encouraging compliance begins with education, says Tom Gavin, CO, LO: “An uneducated patient in the hands of a tentative clinic team may adopt the posture of, ‘Why should I wear this if I’ll need surgery anyhow?’” He also notes that physicians should communicate the value of orthotic intervention to patients. He recommends that doctors and physicians explain to patients that approximately 80 percent of kids who should be braced but do not wear orthoses will eventually need surgery, but proper bracing reduces that probability to 30 percent or less.

It’s also important that patients learn to put on their braces correctly and wear them as advised.

Scoliosis orthoses should be “donned in the supine position and worn to maximal, tolerable tightness and under the clothes,” says Gavin. “For my last 25 clinical years, I resolved this by letting the patient know that the tighter you wear it, the better your clothes will hide it.”

Open communication with not only the patient, but his or her family as well, is mandatory, says Keith M. Smith, CO, LO, FAAOP. “With the internet, it can be very difficult for parents to siphon through the large amounts of information out there to determine, first, what is true and scientific, and then, second, what is best for their child,” says Smith. “We try to educate patients and their parents on how to monitor growth and how to determine how the brace is fitting.

We encourage them to email pictures of their child in the orthosis with questions on fit. Ultimately, we stay available to our patients.”

Smith informs patients “that we have a chance, as a team, to stop this scoliosis in its tracks right now, and that they are in the driver’s seat,” he says. “We get one chance, as if it progresses to a certain level, then we can’t go back and try to recover what we have lost.”

Occasionally, Smith will encounter patients who, despite his best efforts, will not wear their orthoses. In that case, “we then move to a nocturnal program and use the Charleston and Providence nocturnal systems.”

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DECEMBER 2016 | O&P ALMANAC

Keith M. Smith, CO, LO, FAAOP

way that orthotists could use this tool in a clinical setting—the CBS. “With the CBS system in place, our goal was to measure quantitatively the effectiveness of the asymmetrical design in scoliosis.”

Using CAD/CAM technology, Smith realized that the modules themselves could add trunk shifts and reliefs opposite the curve pushes and be made to multiple measurements to better fit the patient. Ultimately, according to Smith, the goals of using the CBS system are improved in-orthosis correction to the Cobb angles, decreased decompensation, and improved overall balance of the spine.

Smith says the best advice he can offer orthotists treating scoliosis is to recognize the Cobb angles and decompensation but monitor the overall balance of the patient. “Use the CSL and the lateral deviations from the midline to guide this with the CBS. Use technologies available today such as asymmetrical TLSO designs to treat the patient—and ensure best fit and function.”

Smith’s approach incorporates the use of radiographs as one part of an overall treatment strategy. “Monitoring the curves ensures that we meet our ultimate goal of preventing any progression,” says Smith. X-rays also are important when orthotists measure in relation to the CSL: “It wasn’t until I started using the CSL that I truly understood scoliosis and the impact an orthosis was having, and how to determine my design parameters such as where and how much magnitude of force I should be using,” says Smith.

”Hanger has been there for me and always has my best interest at heart.”

Curt A. Bertram, CPO, FAAOP Director, National Residency Program National Orthotics Specialist

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Technological Advances May Alter Treatment Protocols New technologies will contribute to treatment decisions and compliance for scoliosis care, according to scoliosis experts: • Compliance monitors: Some clinicians are experimenting with “compliance monitors” that may enable monitoring of temperature and force applied to the patient’s body to indicate how often and how tightly the brace is worn, says Debra Auten, CPO, LPO. Some orthotists are hopeful that increased monitoring will improve patient compliance and provide clinicians with useful information about patient’s brace-wearing habits. But not all are convinced that the new technology will produce optimal outcomes, and are concerned that compliance monitors may place “too much of a psychological burden on the bracing,” says C. Ralph Hooper Jr., CPO. He believes that monitors could cause family strife C. Ralph Hooper for some patients, if a monitor becomes “a big stick” for Jr., CPO parents to leverage during discussions with their children regarding bracing compliance.

• Blood tests: Researchers are working on a blood test that will help medical professionals identify which patients are good candidates for orthoses, says Hooper. “About 20 percent of scoliosis patients will need surgery, regardless of bracing, and another 20 percent have curves that will not progress, so they will not need braces,” he says.

Researchers are working on ways to “identify, physiologically, markers to determine who won’t progress and who will definitely need surgery—then we will not need to brace those individuals.” Such testing will ensure that those patients who are prescribed orthotic intervention are most likely to benefit from bracing.

Preventing New Problems

Miguel Gomez, MD, LO, is a vocal advocate for considering Many of today’s orthotists the sagittal and transverse have taken a closer look at all planes. “An X-ray puts the three planes involved in scolideformity in too simple a view, osis evaluations. Studying the with only the coronal plane sagittal and transverse planes, showing,” he says. This can in addition to the coronal lead to too much force being plane, can help prevent new used in one plane without problems when treating the Miguel Gomez, considering the consequences original curvature.

MD, LO for the sagittal and transverse “Sagittal plane alignment planes. Gomez, who was a trauma is important so we do not create a forward list and hypo lordosis or hypo- surgeon in Colombia before training as an orthotist in the United States, has kyphosis,” says Gavin. “Our job begins developed the Gomez Orthotic Spinal with keeping or restoring balance and System (GOSS) approach to orthotic then correcting deformity. We are evaluation and treatment. “The GOSS there to help with deformities, not system takes good pictures of the create new ones.”

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DECEMBER 2016 | O&P ALMANAC

patient using a grid and lasers, so we will understand balance, alignment, and stability.”

Gomez recommends using CAD/ CAM and then following the GOSS approach, which involves photo documentation of the deformity (coronal plane frontal view and posterior views, sagittal plane left and right views, Adam’s test anterior and posterior views, and proximal to distal views applying the ML gauge anatomical measuring tool), photo documentation of flexibility and correctability, and X-rays when warranted.

Gomez’s methodology is a mathematical approach to the deformities: “We measure everything, from the foot up. We can’t just treat the X-ray—we have to control the three dimensions.” Gomez believes there are some patients in braces whose curves continue to progress because some clinicians fail to score patients’ flexibility correctly. “Patients need to be measured correctly—you need to measure every segment. We need to make sure we are not creating another deformity.”

Personalized Care

While no two scoliosis patients are alike, advances in technology and new approaches to evaluating patients and measuring outcomes mean that orthotists have a number of tools to choose from when treating this population. The most important strategy, say scoliosis experts, is to consider the individual patient and formulate a plan according to his or her particular curvature, and remain open to new strategies and new ways of thinking.

“Learn, learn, learn, so you will believe” in the efficacy of what you are doing in treating scoliosis patients, says Gavin. “Be sure that in 20 years, you have 20 years of experience—and not one year of experience repeated 20 times.”

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

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MEMBER SPOTLIGHT

Seacoast Orthotics & Prosthetics

By DEBORAH CONN

New Hampshire’s Newcomer Three-year-old facility focuses on sports orthoses and lower-limb prostheses

A

FTER WORKING FOR A

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DECEMBER 2016 | O&P ALMANAC

Chris Phillips, CPO, works in the on-site lab at Seacoast Orthotics and Prosthetics.

FACILITY: Seacoast Orthotics & Prosthetics OWNERS: Chris Phillips, CPO, and Chris Croasdale, CP LOCATION: Portsmouth, New Hampshire HISTORY: Three years

Chris Phillips, CPO, (right), works with a patient.

The Portsmouth area has a large young and fit population, says Phillips, so the facility’s patient base trends toward sports medicine patients, usually requiring braces and ankle-foot orthoses. In addition, about 45 percent of the facility’s work involves prosthetics, and patients range from young adults to seniors. Seacoast provides acute care services to patients at several local hospitals, including one that recently became a Level 2 trauma center.

“We don’t see many upper-extremity prosthetic cases,” says Phillips, “although I lecture on that topic to occupational therapy students at the University of New Hampshire.”

The area subscribes to a “buy local, stay local” philosophy, and Seacoast O&P is the only locally owned practice within 40 to 50 miles, according to Phillips, who promotes that attribute in marketing the facility.

In addition to clinicians Phillips and Croasdale, Seacoast has one part-time and two full-time office employees. Although the facility has a small lab, it outsources

its fabrication to a number of suppliers, including Mountain View Prosthetics in New York, Spinal Tech in Massachusetts, and WillowWood in Ohio.

It uses both digital scanning and casting methods.

Seacoast O&P has a strong community presence, sponsoring a number of local events and organizations such as Northeast Passage, a group that offers adaptive sports and recreation programs in affiliation with the University of New Hampshire. Each year Seacoast sponsors the Banff Mountain Film Festival’s fundraiser for a local community health center as well as the Vets Count Pack-n-Boots 5K in cooperation with Easter Seals.

Seacoast hired a public relations specialist to assist with its marketing efforts, including a revamped website that features patient stories. “We also have an active presence on social media,” says Phillips, who notes that posts involving local stories get a lot of attention.

Looking ahead, Phillips says Seacoast will likely expand into the region. He plans to hire another practitioner this year and expects at some point to open a branch to extend the facility’s reach by 30 or 40 miles.

“It’s been a wild three years,” says Phillips. “But we are doing well and look forward to many more years of serving our patients.”

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

PHOTOS: Seacoast Orthotics & Prosthetics

large O&P facility, Chris Phillips, CPO, and Chris Croasdale, CP, decided in 2013 to launch their own business, Seacoast Orthotics & Prosthetics, in Portsmouth, New Hampshire.

Phillips was born without a left leg below the knee, a condition that exposed him from the start to the field of prosthetics and gave him insight and empathy for others with limb loss.

“I had a great family that didn’t hold me back,” Phillips says, “so I did a lot of sports and was very active. I got a new prosthesis every year or two, so I saw many different facilities, from large, hospital-based clinics to smaller private practices. I felt a real calling to be a part of that.”

Phillips started his O&P career as a technician with a Virginia facility. He earned a degree in biology and then attended Northwestern University for his O&P education.

Launching a new facility allowed Phillips and Croasdale to start fresh, says Phillips. “We avoided a lot of history and baggage from Recovery Audit Contractor (RAC) audits. We were able to learn from the trials and tribulations of other companies, and we pride ourselves on having done it right, from the beginning.”

The facility uses office management software and focuses on obtaining appropriate physician documentation up front. “We try to use best practice guidelines and bill cleanly,” says Phillips. “I think that’s one of the keys to our success: We started the right way.”

MEMBER SPOTLIGHT

thyssenkrupp Engineered Plastics

By DEBORAH CONN

Provisioning the Profession Materials supplier offers products tailored to O&P market

D

ISTRIBUTOR THYSSENKRUPP ENGINEERED PLASTICS (formerly AIN Plastics)

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DECEMBER 2016 | O&P ALMANAC

Or-Pro Stiff check socket

COMPANY: thyssenkrupp Engineered Plastics OWNER: thyssenkrupp Materials AG LOCATION: 11 offices in the United States HISTORY: 40 years

Scott Moore

needed a socket that would withstand full weight-bearing tests.”

In response, tkEP developed the Or-Pro Stiff, a clear, unbreakable material for check sockets.

The clarity of the plastic allows clinicians to see problems and make adjustments, and the material is strong enough to accommodate a person’s full weight without cracking or breaking, says Moore.

Other products include Or-Pro Lean, a polyethylene used in pedorthics, and Or-Pro Flex, a “soft-touch” finish material where shock absorption is needed.

“Each material is in response to what practitioners say they need and something that will make their job easier and more efficient, and their patients more comfortable,” says Moore. tkEP also has a distinctive labeling method that notes the forming direction on all tkEP plastics. “One of the biggest issues we have heard is about plastics that don’t react the same way time after time. At thyssenkrupp, we have done two things. We source materials from specific places so we always know the resin used to make the materials is consistent and of the highest quality. We also know that plastics, like wood, have a direction. The arrow lets

PHOTOS: thyssenkrupp Engineered Plastics

focuses on high-end engineering plastics, ancillary products, and services including fabrication, custom cutting, and inventory solutions. AIN Plastics was founded about 40 years ago and in 1996 became a part of thyssenkrupp Materials NA, changing its name in September to thyssenkrupp Engineered Plastics (tkEP). tkEP places a dedicated focus on special markets, including orthotics and prosthetics. Scott Moore, industry segment manager for tkEP’s O&P program, has worked to build a full line of materials for the industry, including polyolefin sheets, clear plastics, rigid plastic sheets, and flexible plastics, as well as adhesives, antibacterial foams, natural cork, and more.

Moore, a 19-year plastics veteran, began his time at tkEP in business development for the medical/life sciences market when he first encountered the O&P industry by working at the annual AOPA National Assembly.

“I met a great group of people at that show—accommodating and friendly,” he recalls. “I really gravitated to the field and wanted to do more there.”

Moore consults with orthotists and prosthetists in the field to determine their needs. “I was hearing about problems people come across in working with thermoset plastics, like issues with check, or test, sockets cracking or plastics not forming as expected,” he says. “In check sockets, prosthetists wanted to be able to see what they were doing, and they

practitioners know what that direction is when they heat and form their plastic,” says Moore.

“So whether you put it in the oven today or a year from now, it will perform the same way. Our goal is to achieve consistency in all our products so practitioners don’t have to rework the materials.” tkEP also notes full lot and batch traceability on the label so if a problem occurs, the company can trace it all the way back to the batch of resin used to make that plastic.

In addition to supplying materials, tkEP manufactures custom items for the industry—for example, shrinker-sock donning tubes.

“We saw a need for a slightly different donning tube,” explains Moore. “Ours is made from a lightweight material that won’t shatter or chip to create sharp edges. Instead the edge is smooth and rounded so the tight-fitting socks slide on and off easily.”

The tkEP O&P division places a high value on educating the O&P market, and its internal staff as well. Moore recently finished training on forming sockets to gain a better understanding of the issues facing practitioners. tkEP maintains an online presence through the company’s blog, website, and social media, with a LinkedIn page dedicated to the O&P market. “We love questions,” says Scott. “We are always happy to assist customers in any way that we can, and we believe sharing knowledge is a very important aspect of our service.”

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

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• Learn the detailed requirements for your documentation.

• Learn how to avoid common documentation mistakes.

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 and scoring at least 80 percent. Register at bit.ly/2017webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

Mark your calendars for AOPA’s 2017 monthly webinars.

One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits—so you can still take advantage of the series discount and the valuable learning opportunities.

Register for the complete 2017 series and get two free webinars! Members pay $990 and nonmembers pay $1,990, for the series. Register at bit.ly/2017webinars.

2017 Webinars • January 11: O&P Clinical Documentation: Who Needs To Document and What You Need To Document • February 8: LSO/TLSO Policy • March 8: Marketing Your Business • April 12: Grassroots Advocacy • May 10: Modifiers: What Do They Mean and When To Use Them • June 14: Internal Audits: The Why and the How of Conducting Self-Audits • July 12: Know Your Resources: Where To Look To Find the Answers • August 9: What the Medicare Audit Data Tells Us and How To Avoid Common Errors • September 13: ABC Inspections and Accreditation • October 11: AFO/KAFO Policy • November 8: Gift Giving: Show Your Thanks and Remain Compliant • December 13: New Codes and Other Updates for 2018

42

DECEMBER 2016 | O&P ALMANAC

www.bocusa.org

?

Need CE’s

by the end of the year

Learn and earn with the AOPAversity 70+ TOP-QUALITY ORTHOTIC, PROSTHETIC AND PEDORTHIC EDUCATION COURSES.

Online Learning Center

EARN SCIENTIFIC, BUSINESS AND PEDORTHIC CE CREDITS BY STUDYING THE COURSE MATERIAL AND PASSING THE QUIZ.

ACCESS YOUR PERSONAL ACCOUNT, VIEW VIDEOS, PRINT CERTIFICATES, OR REVIEW CE CREDIT HISTORY 24/7.

Learn & Earn New videos added from the 2016 Assembly!

• Osseointegration • Thranhardt Lectures • The Future of Pedorthics

• Human Resources: Performance Appraisal • Marketing: The Value of the Patient Story

It’s as easy as 1-2-3 1. Set up your free personal online account 2. Choose your education and study 3. Take the quiz and print your certificate

Membership has its benefits:

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

Visit www.AOPAnetonline.org/aopaversity for more information.

www.AOPAnetonline.org/AOPAversity

American Orthotic & Prosthetic Association 330 John Carlyle Street, Suite 200 Alexandria, VA 22314

AOPA NEWS WELCOME 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 publiwww.AOPAnet.org cation, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

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

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Alliance Prosthetics & Orthotics 1235 Friendship Road, Bldg. 300 Braselton, GA 30517 770/679-3090 Category: Patient-Care Facility Jason Auyer, CPO, LPO

Arise O&P 8338 Highway 65 NE, Ste. E Spring Lake Park, MN 55432 763/755-9500 Category: Affiliate Parent Company: Arise Orthotics & Prosthetics Inc., Blaine, MN

Boas Surgical Inc. 90 N. Claude A. Lord Blvd.

Pottsville, PA 17901 570/581-8862 Category: Affiliate Parent Company: Boas Surgical Inc., Bethlehem, PA

Boas Surgical Inc. 200 Kelly Road, Unit D Quakertown, PA 18951 267/490-5970 Category: Affiliate Parent Company: Boas Surgical Inc., Bethlehem, PA

Independence ProstheticsOrthotics Inc. 31 Meadowood Drive Newark , DE 19711 302/369-9476 Category: Affiliate Parent Company: Independence ProstheticsOrthotics Inc., Newark, DE

Munger Prosthetics & Orthotics 5701 Lake Otis Parkway, Ste. 400 Anchorage, AK 99507 907/743-9991 Category: Patient-Care Facility Michelle Mitchell New Beginnings O&P 3333 Elvis Presley Blvd., Ste. 203 Memphis, TN 38116 901/396-6221 Category: Patient-Care Facility Mario A. Carver, CPA, CFTS North Shore Orthotics & Prosthetics 591 Bicycle Path, Ste. D Port Jefferson Station, NY 11776 631/928-3040 Category: Affiliate Parent Company: North Shore Orthotics Prosthetics Ltd., Port Jefferson Station, NY

Is Your Facility Celebrating a Special Milestone?

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

The Source for Orthotic & Prosthetic Coding

T

HE O&P CODING EXPERTISE the profession has come to rely on is available online 24/7! LCodeSearch.com allows users to search for information that matches L Codes with products in the orthotic and prosthetic industry. Users rely on it to search for L Codes and manufacturers, and to select appropriate codes for specific products.

This exclusive service is available only for AOPA members.

Log on to LCodeSearch.com and start today.

Need to renew your membership?

Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org. www.AOPAnet.org

44

DECEMBER 2016 | O&P ALMANAC

Manufacturers: AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571/431-0876.

Feature your product or service in Marketplace.

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

Visit bit.ly/2017almanac for advertising options.

ALPS Skin Reliever ENCP The ALPS Skin Reliever eliminates shear forces and friction, and prevents abrasions on the skin of the stump.

It offers both superior comfort and durability while also accommodating for volume fluctuations over the life of the prosthesis. The ALPS Skin Reliever provides superior elongation for very little compression against the skin, reducing shearing and abrasion. There is no need to make a new socket for this product, as the ALPS Skin Reliever can be worn under silicone and gel.

For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Custom Stealth Foot Orthotics Custom carbon fiber foot orthotics—and boy, are they pretty.

And strong. And lightweight. Trusted to protect the feet of our service members, this beauty goes more than skin deep. Fabrication available from foam boxes or Amfit digital files in two rigidities (firm or flex).

Corrections and adjustments are molded into the carbon fiber to eliminate movement of pads and edges during wear. EVA heel counter maintains stability in the shoe or boot.

Contact our customer service team to learn more today. orders@amfit.com or 800/356-FOOT(3668), x250.

FootPrinter Impression Box Program Need a way to order custom foot orthotics without adding technology to your office? Keep it simple with impression foam for your custom foot orthotic orders. FootPrinter Program available for standard EVA, diabetic, carbon fiber, and polypropylene orthotics. No equipment or software necessary, just a quick and easy order form to get you on your way. A5513 PDAC-approved diabetic insert program includes return shipping to the lab and the finished inserts back to your door.

Fabrication time from three to five business days.

Contact our customer service team to learn more today. orders@amfit.com or 800/356-FOOT(3668), x250.

MARKETPLACE

Prefabricated KAFO/Patient Rehabilitative Systems by Anatomical Concepts Inc. This rehabilitative orthotic system provides a unique and cost-effective approach in managing your patient’s lower-extremity needs.

These modular KAFO/AFO systems can be easily adjusted ranging between only three standard sizes (adult, pediatric, and infant). The individual anklefoot and knee sections can be disconnected quickly in the field with or without tools to be used separately if needed.

The versatility and durability of its single posterior jointed design creates a patient-friendly superior sagittal plane support system for ambulatory/recumbent patients that can manage their entire rehabilitative process for an indefinite period of time.

For more information, visit www.PRAFO.com or call 800/837-3888.

Peak Scoliosis Bracing System Winner of the 2015 Spine Technology Award, the Peak Scoliosis Bracing System is a revolutionary new bracing system from Aspen Medical Products. This innovative new concept in bracing is the only brace specifically designed for adults with scoliosis and has been shown to: • Significantly reduce pain • Increase mobility • Promote better posture • Improve the quality of life.

Code L1005 approved. Visit www.aspenmp.com.

O&P ALMANAC | DECEMBER 2016

45

MARKETPLACE THK-5PS10MPK and THK-5PS0MPK-PYR

by DAW Industries The technology for the THK-5PS10MPK and THK-5PS0MPK-PYR works like an ultrafast 3-D gyroscope that instantly detects the knee positioning in space and reacts by providing through its microprocessor the optimum extension flexion resistance while walking down an incline or stairs. Select on the DAW website a predetermined set of parameters from a menu according to patient weight, level of activity, muscle strength, and preferred activities. Then tweak the parameters to reach that perfect natural gait that everyone hopes for but cannot quite reach.

For more information, contact DAW Industries Inc., at 800/252-2828, email info@ daw-usa.com, or visit www.daw-usa.com.

TGK-5PS0SLK and TGK-5PS10SLK

by DAW Industries Welcome to the latest, most advanced world of True Variable Cadence Gait with the electronically controlled TGK-5PS0SLK and TGK-5PS10SLK. This knee unit utilizes the very advanced “Blank Slate Technology.”

This means that the computer is preprogrammed with what gait is, but the parameters of that gait will self-program as the knee walks, constantly learning and changing to your individual patient’s gait pattern. This means that you are required to do very little adjustment and no programming.

For more information, contact DAW Industries Inc., at 800/252-2828, email info@ daw-usa.com, or visit www.daw-usa.com.

46

DECEMBER 2016 | O&P ALMANAC

Shower Seal by DAW Industries DAW Industries Inc. just introduced a below-knee prosthetic system allowing amputees to shower, bathe, and enjoy most aquatic activities standing up on both of their legs. It is so unique that a U.S. patent was filed. Its name is Shower Seal.

No need any longer to navigate the dangerous floor of a bathroom (where most serious slip/fall accidents occur) with a walker or hopping around on one leg. Who can properly shower sitting on a chair? Many amputees tell us of the pure enjoyment of showering again standing up with no limitations. This add-on to their every day all-activities prosthesis is a far cry from putting up with a cumbersome and functionally limited “shower-leg.” Enjoy life again in all its aspects, not to mention the time saved every morning in getting ready.

For more information, contact DAW Industries Inc., at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

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

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

MARKETPLACE New 10V41 Robo-Wrist Continuous locking positions provide precise, secure functions to support a wide range of ADLs. The 10V41 Robo-Wrist can rotate the terminal device by 360 degrees and simultaneously flex/extend it at any angle up to 43 degrees. Constructed of titanium, steel, and high-strength aluminum, the Robo-Wrist provides a durable solution without adding unwanted weight (5.8 oz / 165 g). The ball joint is suitable for highly functional body-powered fittings, for instance the Ottobock MovoHook 2Grip1.

For more information on the Robo-Wrist, go to professionals. ottobockus.com or call customer service at 800/328-4058.

Custom Silicone Leg Covers Ottobock’s Custom Silicone Services acts as your extended workbench, fabricating aesthetically pleasing and high-quality silicone covers for leg prostheses. Precise and custom made, each silicone leg cover is designed to your patients’ unique appearance. From skin pigmentation to freckles and hair, each silicone leg is as individual as your patient.

For more information, go to professionals. ottobockus.com or call customer service at 800/665-3327.

design. dexterity. intelligent motion.

•

Smarter: uses simple gestures to change grips

•

Faster: boost digit speed by up to 30 percent

•

Smaller: new form-fitting anatomical design reduces profile in every dimension For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

VQ OrthoCare® Introduces Custom Knee Brace App VQ OrthoCare® introduces its newest custom brace measurement system: the eCast™ app, which uses image capture technology to provide precise anatomical details for a more accurate measurement and fit. The app guides the user to the proper height, distance, and tilt of the iPhone camera and auto-captures a picture when the image is correct. Orders are sent directly from an iPhone to manufacturing, reducing paperwork and eliminating the need for additional measurements. Faster ordering, faster delivery.

Available at the Apple iTunes store. For more information, call VQ OrthoCare at 800/652-1135 or visit www.vqorthocare. com/ecast.

O&P ALMANAC | DECEMBER 2016

47

AOPA NEWS

CAREERS

Opportunities for O&P Professionals Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

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

Include your company logo with your listing free of charge.

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

Mid-Atlantic

Certified Orthotist Boardman, OH Established in 1994, Ankle & Foot Care Centers is comprised of 18 podiatric foot and ankle surgeons with 20 locations in Northeast Ohio. We are seeking a full-time certified orthotist for our practice. This individual will be responsible for evaluation, recommendation, and fitting of custom AFOs, shoes, and foot orthoses. Candidates must be self-directed, possess strong clinical skills, have the ability to code for services rendered, and effectively communicate with physicians.

Competitive salary, benefits, and profit sharing plan offered.

Please send resume to: Email: info@ankleandfootcare.com Michael Vallas Practice Administrator Ankle & Foot Care Centers 8175 Market Street Boardman, OH 44512 Phone: 330/758-6226, ext. 207 Fax: 330/758-4914 www.ankleandfootcare.com

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

Member $482 $634

Nonmember $678 $830

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

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

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

Job Board

Member Nonmember $85 $150

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

SUBSCRIBE

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

48

DECEMBER 2016 | O&P ALMANAC

Southeast

Clinical Educator Chattanooga, TN Fillauer, a global leader in manufacturing orthotic and prosthetic technology, is seeking a clinical educator to provide education and support on all Fillauer divisions’ orthotic and prosthetic-related products and services. The qualified individual will need the clinical skills of a certified prosthetist/orthotist, must be able to fabricate both prosthetic and orthotic devices, must be comfortable communicating to large groups of people, and must have an excellent grasp of Microsoft Office products. Applicants must be certified in prosthetics and orthotics (MSPO preferred), be comfortable with out-of-town travel, and either have or have the ability to obtain a passport. If you feel that you fit this description and are ready to work hard and learn in a fast-paced, rewarding environment, contact us for more details. Please apply at:

Fillauer.com/careers

CAREERS

Career Opportunities...

Oregon

Medford, CPO Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services.

California

Fresno, CP/CPO San Jose, CO Salinas, CO

The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others.

Washington

Richland, CP/CPO

A competitive salary, benefits and profit sharing are offered based on position/experience.

To apply, submit resume to: careers@pacmedical.com

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremast as demonstrated by our positive attitude, teamwork and professionalism.”

ADVERTISERS INDEX

Company

Page Phone

Website

ABCOP—American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc.

41

703/886-7114

www.abcop.org

ALPS South LLC

9

800/574-5426

www.easyliner.com

Amfit

17 800/356-3668

www.amfit.com

Amputee Coalition

C3

800/267-5669

www.amputee-coalition.org

Anatomical Concepts Inc.

39

800/837-3888 / 330/757-3569

www.anatomicalconceptsinc.com

Aspen Medical

37

800/295-2776

www.aspenmp.com

Cailor Fleming Insurance

5

800/796-8495

www.cailorfleming.com

Cascade Dafo Inc.

33

800/848-7332

www.cascadedafo.com

ComfortFit Orthotic Labs Inc.

23

888/523-1600

www.comfortfitlabs.com

Custom Compoite

7

866/273-2230

www.cc-mfg.com

1 800/252-2828

www.daw-usa.com

DAW Ferrier Coupler Inc.

29

810/688-4292

www.ferrier.coupler.com

Hanger Inc.

35

512/777-3800

www.EmpoweredCareers.com

Hersco

2 800/301-8275

www.hersco.com

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

Spinal Technology

13

800/253-7868

www.spinaltech.com

Touch Bionics

27

855/694-5462

www.touchbionics.com

VQ Orthocare

19

800/652-1135

www.vqorthocare.com/ecast O&P ALMANAC | DECEMBER 2016

49

CALENDAR

2016 December 14

New Codes and What Lies Ahead for 2017. Register online at bit.ly/2016webinars.

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

for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians in 250 locations nationwide.

Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Webinar Conference

2017

January 11

O&P Clinical Documentation: Who Needs To Document and What You Need To Document. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

January 23-24

January 1

ABC: Application Deadline for all March Exams.

Applications must be received by January 1 for individuals seeking to take the March ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and technicians. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Nashville, TN. Holiday Inn Express Nashville Downtown, 920 Broadway, Nashville, TN 37203. Book your room by Friday, December 30, for AOPA's special rate of $185. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

February 8

January 6-7

ABC: Orthotic Clinical Patient Management (CPM) Exam. Caruth Health Education Center, St. Petersburg College, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

LSO/TLSO Policy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

March 8

Marketing Your Business. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

January 9-14

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered

Apply Anytime!

Apply anytime for COF, CMF, CDME; test when 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.

www.bocusa.org

SHARE

your next event!

50

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

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

Questions? Email landerson@AOPAnet.org.

Calendar Rates Let us

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 landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

DECEMBER 2016 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR

April 10-11

2017 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars.

Denver. The Westin Denver Downtown, 1672 Lawrence Street, Denver, CO 80202. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

September 6-9

100th AOPA National Assembly and Second World Congress. Las Vegas. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

April 12

Grassroots Advocacy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

September 13

ABC Inspections and Accreditation.

Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

May 10

Modifiers: What Do They Mean and When To Use Them. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

June 14

Internal Audits: The Why and the How Webinar Conference of Conducting Self-Audits. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

July 17-18

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

Pittsburgh. The DoubleTree by Hilton Hotel and Suites Pittsburgh Downtown, One Bigelow Square, Pittsburgh, PA. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

October 11

AFO/KAFO Policy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

November 6-7

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

Phoenix. Sheraton Grand Phoenix, 340 N. 3rd Street, Phoenix, AZ. Book by October 13 for the $179 rate by calling 800/325-3535 or by calling the hotel directly at 602/262-2500. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

November 8

Gift Giving: Show Your Thanks and Remain Compliant. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

June 21-23

New York State Chapter of AAOP Educational Program. Albany Marriott Hotel, Albany, NY. Visit www.NYSAAOP.org or contact Joann Marx, CPO, FAAOP, at Marx4nysaaop@aol.com.

December 13

New Codes and Other Updates for 2018.

Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

July 12

Know Your Resources: Where To Look To Find the Answers. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

August 9

What the Medicare Audit Data Tells Webinar Conference Us and How To Avoid Common Errors.

Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

BUILD A

Better BUSINESS WITH AOPA

AOPA membership has its benefits.

Visit www.AOPAnet.org/join today!

O&P ALMANAC | DECEMBER 2016

51

ASK AOPA CALENDAR

Lost Time Billing for missed appointments, VA patients, and more

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

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

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

Q/

May I bill for missed appointments?

Yes and no. You may not bill Medicare for a missed appointment, but you may bill the patient directly.

While Medicare regulations do not preclude you from directly billing the patient for a missed appointment, there are some caveats. For example, you may not discriminate against Medicare patients. This means it is not acceptable to charge only Medicare patients—and not patients with other coverages—for missed appointments. You also may not charge Medicare patients a higher fee for missed appointments than you do for other types of other patients.

A/

Can private payors or Medicare Advantage plans apply the mandated 2 percent Medicare sequestration reduction to our payments?

Q/

No. The 2 percent sequestration reduction will typically only apply to traditional Medicare fee-for-service payments, and Section 1854(a)(6)(B)(iii) of the Social Security Act prohibits CMS from interfering in the payment arrangements between Medicare Advantage plans and their providers/suppliers.

However, if your contracts with the Medicare Advantage organization allow for the sequestration reduction, or for any other similar reduction, then they are allowed to apply the sequestration reduction.

A/

Can we bill a claim to both Medicare and the Veterans Administration (VA) if the patient is eligible to receive benefits from both?

Q/

It is possible for a patient to be eligible to have coverage from both the VA and Medicare, and use both insurances for different aspects of his or her care. However, the patient must choose one of the agencies to handle his or her orthotic and prosthetic services, and he or she may not use both insurances at the same time. A claim may not be submitted to both agencies for the same date of service and for the same items; this includes any potential balance billing.

A/

52

DECEMBER 2016 | O&P ALMANAC

Is a new prescription required in order to repair or adjust a patient’s prosthesis or orthosis?

Q/

No. A new prescription is not required because all repairs and adjustments are covered under the original prescription for the lifetime of the device. A new prescription would be required only if you are replacing a major component in order to facilitate the repair.

A/

Still #NotaLuxury Speak out.

Advocate.

Donate.

Volunteer.

For 30 years, the Amputee Coalition has led the way in empowering people affected by limb loss and limb difference.

With our focus on education, advocacy, and support, we work hard to make sure every time someone reaches out, they can feel someone reaching back.

This work is possible through your support, whether it is adding your voice to the fight for appropriate coverage, making a donation, or sharing your time and talents. amputee-coalition.org 888.267.5669

C-LegÂŽ 4

Clinically proven outcomes

C-Leg studies have shown improved quality of life* and satisfaction*, and up to 88% preference over non-microprocessor knees.*

The C-Leg has been shown to reduce falls by up to 80% in the K2 population when compared to mechanical knees.*

*Please reference bit.ly/ClinicalEvidence

#KnowTheDifference professionals.ottobockus.com