December 2017 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

D E C E M B E R 2017

HCPCS Coding and Fee Changes Coming in 2018 P. 14

The Rise of Integrated Health Care P. 30

MAJOR GAINS in

OUTCOMES DATA NEW STUDIES SUPPORT THE EFFICACY AND VALUE OF O&P INTERVENTION P.20

Ottobock's Hans Georg Näder on the Future of O&P P.38

Meet AOPA's 2017 Lifetime Achievement Award Winner P.42

E! QU IZ M EARN

2

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.16

Exclusive: How Proposed Rules From the VA and CMS Could Alter O&P Care P.18

YOUR CONNECTION TO

EVERYTHING O&P

THE PR EM I ER M E E T IN G F OR ORT H OT IC, PROSTH ETIC, A N D PED ORTH IC PROFESSION A LS.

e c n e i r e p Ex

September 26-29, 2018

VANCOUVER CALL FOR PAPERS NOW OPEN! AOPA is accepting clinical, technician,symposia/instructional course, business, and pedorthic abstracts.

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contents

DECE M B E R 2017 | VOL. 66, NO. 12

2

COVER STORY

FEATURES

20 | Major Gains in Outcomes Data O&P stakeholders are stepping up to the challenge of demonstrating that O&P intervention is a value proposition, leading to better outcomes for patients as well as economic benefits. New reports, such as the recently released RAND Corp. simulation study on advanced transfemoral prostheses, are contributing to a deeper well of O&P research that may be referenced by payors in reimbursement decisions in a fee-for-value model of care. But more evidence-based research is needed from both clinicians and manufacturers.

By Christine Umbrell

18 | This Just In

Projecting the Impact of Two Proposed Rules The O&P community may soon face changes stemming from two proposed rules that could affect how clinicians provide patient care.

Find out what CMS has suggested concerning custom diabetic inserts, and learn how the U.S. Department of Veterans Affairs would limit veterans’ choice in selecting O&P providers.

DECEMBER 2017 | O&P ALMANAC

30 | Better, Faster, Stronger Health-care providers of all specialties are increasingly adopting an integrated approach to patient care, which involves working directly with other medical professionals. O&P experts who have hired or partnered with surgeons, therapists, and others to provide integrated care share their experiences and discuss both the clinical benefits for patients and the strategic benefits for O&P facilities.

By Lia K. Dangelico

contents

SPECIAL SECTION

DEPARTMENTS Views From AOPA Leadership......... 4

AOPA’S 100TH ANNIVERSARY

Insights from AOPA President Jim Weber, MBA

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

36 | Then & Now

How to reach staff

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

A new generation of products and services

At-a-glance statistics and data

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

38 | Bridge to the Future

Research, updates, and industry news

Ottobock CEO discusses innovation and globalization

42 | The Global Professional Q&A with London’s Saeed Zahedi, OBE, FREng, BSc, PhD, FIMechE, CEng

P.10

z

People & Places........................................12 Transitions in the profession

AOPA News.............................................. 50 AOPA meetings, announcements, member benefits, and more

COLUMNS Reimbursement Page.......................... 14

Proper Preparation

Coding and fee schedule changes for 2018

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

CREDITS

P.14

Member Spotlight.................................46 n

Grace Prosthetic Fabrication

n

J&J Artificial Limb and Brace

P.48

Welcome New Members ................... 51 PAC Update...............................................52 Marketplace..............................................54 Careers.........................................................56 Professional opportunities

Calendar......................................................58 Upcoming meetings and events

Ad Index......................................................59 Ask AOPA.................................................. 60 Prescriptions for repairs, emergency room billing, and more

O&P ALMANAC | DECEMBER 2017

3

VIEWS FROM AOPA LEADERSHIP

The Future Is Now

T

Leadership Conference O&P

HREE YEARS AGO, AOPA planned and hosted the inaugural O&P Leadership Conference, held in Florida in January of 2015. The meeting—billed as the “O&P, Its Leadership and Its Future” Conference—was designed to bring together chief executive officers, chief operating officers, owners, and other key senior management leaders of the O&P industry for a weekend conference to address the many challenges facing AOPA members in a dramatically changing healthcare environment. The planning of this meeting evolved from discussions among industry leaders around AOPA’s development of a series of Strategic Initiatives and Survival Imperatives over the course of the previous three years.

The program included presentations from many influential individuals, including a report on the changing U.S. health landscape by Michael Lovdal, PhD; a discussion of key perspectives on the future of O&P by Vinit Asar, Professor Hans Georg Näder, Stephen Blatchford, and Paul Prusakowski, CPO; and a focus on the future regulatory environment for O&P from Colin Roskey, Esq. Participants contemplated and predicted the future, escalating U.S. health-care costs, the changing reimbursement models, new unexpected players entering the health-care market, and the need to expand research to prove the cost effectiveness of O&P services. The initial Leadership Conference inherently raised a collective awareness of the need to expand advocacy, research, and education for the industry as a whole. Following the conference, in early 2015, the Prosthetics 2020 initiative was organized and launched as a collaborative industry effort to prove through an evidenced-based medicine approach that timely prosthetic services save lives and money. The conference better prepared the O&P profession to respond to the aggressive introduction of the proposed Local Coverage of Determination (LCD) change in August of 2015.

In the social media communication world of emails, text messages, Facebook, LinkedIn, and Twitter, actually meeting face-to-face and talking about the most pressing issues by which our industry is challenged was and is almost a novel idea.

Each of us, in our own roles within our companies, can get lost in isolation when encountering the changing landscape of health-care today: fee-for-value-based pricing, outcome-measured services, rate-reducing contract amendments, LCD policy changes, postpayment audit clawbacks, prepayment audit holdouts, competitive bidding, accountable care organizations, bundled payments, physician documentation, and more. Sitting in your home office, you seriously start to consider survival!

Organizing a meeting of leaders in our industry to meet and discuss these all-encompassing issues is a Strategic Initiative in itself. Today we are planning the third Leadership Conference, which will take place January 5-7 in Florida, and have invited presentations from Allison Cernich, PhD, director of the National Center for Medical Rehabilitation Research, where she oversees research programs aimed at improving the care of individuals with physical disabilities who require medical rehabilitation, and from Jason Altmire, former three-term member of Congress (D-Pennsylvania) and a nationally recognized leader on health-care policy. Change is constant, the future is now, and we must continue to collaboratively pursue advocacy, research, and education to improve patient access to quality orthotic and prosthetic care.

Jim Weber, MBA, is president of AOPA.

4

DECEMBER 2017 | O&P ALMANAC

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

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

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AOPA CONTACTS

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

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

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Don DeBolt, chief financial officer, 571/431-0814, ddebolt@AOPAnet.org Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org MEMBERSHIP & MEETINGS Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

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 Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

6

DECEMBER 2017 | O&P ALMANAC

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

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

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

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

Copyright © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 12,500 subscribers.

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

Visit bit.ly/almanac17 for advertising options!

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NUMBERS

$

Financial Benefits Linked to O&P Care Final report from Dobson-DaVanzo study demonstrates economic value of orthotic and prosthetic intervention

—“The Economic Value of O&P Care to the Medicare Program,” Dobson-DaVanzo

LOWER MEDICARE 18-MONTH EPISODE PAYMENTS FOR LOWER-LIMB ORTHOTICS

LOWER MEDICARE 18-MONTH EPISODE PAYMENTS FOR SPINAL ORTHOTICS

$1,939

$2,094

Fewer overall health-care dollars spent by lower-extremity orthosis users versus nonusers.

$572

Fewer dollars spent by spinal orthosis users versus nonusers.

$381

SIMILAR TOTAL MEDICARE PAYMENTS FOR LOWER-LIMB PROSTHESES

~$68,800

Approximate medical costs for both prosthetic users and nonusers.

$4,321

Fewer dollars spent on acute care hospital and other inpatient care center visits by orthotic users versus nonusers.

Fewer dollars spent on acute care hospital and other inpatient care center visits by orthotic users versus nonusers.

Fewer dollars spent on acute care hospital and other inpatient care center visits by prosthetic users versus nonusers.

$1,759

$840

$508

Fewer dollars spent on total Part D costs by orthotic users versus nonusers.

Fewer dollars spent on total Part D costs by orthotic users versus nonusers.

$449

$279

Fewer dollars spent on physician office visits by orthotic users versus nonusers.

8

“Across all O&P services … the reduction in health-care utilization exceeded the cost of the O&P services, increasing quality of life for the patient and reducing the cost to Medicare.”

DECEMBER 2017 | O&P ALMANAC

Fewer dollars spent on physician office visits by orthotic users versus nonusers.

Fewer dollars spent on total Part D costs by prosthetic users versus nonusers.

$1,649

Fewer dollars spent on physician office visits by prosthetic users versus nonusers.

SOURCE: “The Economic Value of Orthotics and Prosthetics Care to the Medicare Program, 2011-2014 Update: Final Report Findings,” Dobson-DaVanzo, 2017.

Representatives from Dobson-DaVanzo presented a final report findings update of “The Economic Value of O&P Care to the Medicare Program” at the AOPA World Congress and Centennial Celebration in September. The objective of the research was to determine the financial benefit to government and private payors when a person with spinal injury or lower-limb loss or impairment attains restored mobility through O&P services. Analysis was based on a dataset capturing four years of Medicare claims for a custom cohort of O&P users and comparison group of patients (nonusers) with comparable etiological diagnoses.

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Happenings RESEARCH ROUNDUP

NIH Creates Pediatric Exoskeleton for Cerebral Palsy Patients child while they wear it,” said lead researcher Thomas Bulea, PhD. “The exciting part is that the children’s muscle activity was preserved when they walked in this new way with the exoskeleton, suggesting that long-term use of this device might be a viable way to train a new walking pattern in this population.”

The team is planning additional studies in children with more severe gait deficits from cerebral palsy who are therefore at elevated risk for declining mobility, as well in children with other disorders, such as spina bifida and muscular dystrophy, according to Bulea. The study was published in August in Science Translational Medicine.

Electronic skin that can mimic the full range of biological skin’s sensitivity is under development by researchers at China’s Huazhong University of Science and Technology.

The design of the skin has been inspired by jellyfish, and glows when the pressure against it is significant enough to potentially cause an injury. The skin is intended for use with both prostheses and robots.

Led by Bin Hu, PhD, the research team started their work recognizing that current electronic skin technologies can detect light touches and breezes but do not respond effectively to harmful blows. The researchers studied the concept of 10

DECEMBER 2017 | O&P ALMANAC

a visual warning in replication to a visual threat, and looked for inspiration from the Atolla jellyfish, which can feel changes in environmental pressure and exhibit bioluminescence when threatened.

Hu’s team combined electric and optical systems in an electronic skin to detect both slight and high-pressure forces. The skin consists of two layers of stretchy polydimethylsiloxane (PDMS) film embedded with silver nanowires, plus an additional PDMS layer embedded with phosphors sandwiched in between. The phosphor layer glows with growing intensity as physical force increases.

“Mimicking the pressure-sensing behavior of biological skins using electronic devices has profound implications for prosthetics and medicine,” the researchers wrote in their study, published in the ACS Applied Materials and Interfaces journal. “Its mechanically robust and stretchable properties may find a wide range of applications in intelligent robots.”

PHOTO: Edith A. Widder, Operation Deep Scope 2005 Exploration, NOAA-OE

Scientists Develop Electronic Skin That ‘Glows’ When Damaged

PHOTO: National Institutes of Health Clinical Center

Researchers at the National Institutes of Health Clinical Center have created a robotic exoskeleton to assist children with cerebral palsy with walking. The exoskeleton features a motor, sensors, and electronic-powered braces, and is designed for patients who walk with excessive bending of the knees, or “crouch gait.”

Developed specifically to treat crouch gait, the exoskeleton tracks the natural movement patterns of the user’s limbs and supplies motorized assistance for knee extension at the appropriate times of the walking cycle, according to the researchers.

Several patients, ages 5 to 19, recently took part in a clinical trial of the device. The majority of the children were able to improve their knee extension up to 37 degrees while wearing the brace. The researchers also found that improvements in walking with the exoskeleton increased over time as the children continued to use the exoskeleton.

“Our results show that the exoskeleton can safely and effectively change the posture of a

HAPPENINGS

Ultrasound Technology May Aid in Prosthetic Control

PHOTO: Courtesy of George Mason University

Ultrasound technology is being investigated by researchers at George Mason University in Fairfax, Virginia, to assist amputees in improving their control over prosthetic arms, hands, and legs. Led

by Siddhartha Sikdar, PhD, an assistant professor with joint appointments in the Department of Bioengineering and the Department of Electrical and Computer Engineering, a research team has been investigating a new way of operating prostheses by using ultrasound waves to sense muscle activity.

The team is designing and evaluating miniaturized ultrasound transducers— compact devices worn as a small band on the forearm or embedded under a prosthetic shell. The technology allows sound waves to be sent into the body, which are “sensed” by the transducers.

Computer algorithms have been developed to analyze the signals to recognize muscle activity. This methodology

allows for the recognition of muscle activity deep inside the tissue, and it can differentiate between different muscle groups, according to the researchers.

The research team has found that the ultrasound method allows for great dexterity in controlling upper-extremity prostheses, including fine-tuned motor control of fingers, according to Sikdar.

The team has demonstrated that computer algorithms can use this ultrasound method to learn to differentiate between 15 distinct hand and wrist movements and ultimately exhibit a high degree of control in partial movements, Sikdar says.

“Our goal is to help amputees go about their daily lives with improved function,” Sikdar says. The research is being funding by grants totaling $2 million from the National Science Foundation and the U.S. Department of Defense.

AOPA Purchases

O&P News

AOPA has purchased O&P News magazine from SLACK Inc. AOPA plans to look at continued publication of O&P News, beginning with the January edition.

The mission of O&P News will be to educate and inform health professionals who serve the greater limb-loss community and those using orthotic devices. O&P News will target the extended community of health professionals serving the mobility challenged and will be their connection to relevant news from the world of orthotics and prosthetics. Each issue will feature clinical insights from top minds in patient care, research summaries, product news, and more.

Vol. 26 • No. 12 | December 2017

OandPNews.com THE O&P COMMUNITY’S NEWS SOURCE

A SLACK Incorporated® Publication

INSURANCE INSIGHTS

NCQA Names States With Highest Rated Health Insurance Plans

International African American Prosthetic and Orthotic Coalition Annual Meeting Also in This Issue

COVER O&P’s Virtual STORY

Present and Future

Experts Discuss the Future of Exoskeletons, Neuro-rehabilitation Study: O&P Services Provide Value to Medicare, Patients

10 NJAAOP Annual Meeting

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28 Tired of Hearing ‘No’

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38 Haste Makes Waste

OPN1217_1-5.indd 1

11/27/2017 8:59:53 AM

DID YOU KNOW? Approximately

5of O&Ppercent facilities have The top 10 states with the highest rated health plans are the following: Massachusetts, Rhode Island, Maine, New Hampshire, Wisconsin, Minnesota, Hawaii, New York, Vermont, and Iowa.

business hours on Saturdays.

O&P ALMANAC | DECEMBER 2017

SOURCE: 2017 AOPA Operating Performance Report

The National Committee for Quality Assurance (NCQA) has published its 2017-2018 Health Insurance Plan Ratings.

The ratings compare the quality and services of more than 1,000 U.S. health plans using a system similar to the CMS Star Ratings of Medicare Advantage plans, which emphasizes health outcomes and consumer satisfaction.

NCQA studied and rated 498 commercial plans, 386 Medicare plans, and 178 Medicaid plans. Of the 1,062 rated plans, 103 (10 percent) received a top rating of 4.5 or 5.0 out of 5. Twenty-three (2 percent) earned ratings of 1.0 to 2.0.

HIGHLIGHTS FROM

11

PEOPLE & PLACES PROFESSIONALS

2017-2018 AOPA Board Launches AOPA’s Second Century As AOPA concludes the centennial celebration that lasted throughout 2017, the 2017-2018 leadership team begins its work this month. The transition to the new board, elected during the 2017 AOPA World Congress and Centennial Celebration, comes at an important time for AOPA, as the association

looks to the future and its 101st year of leadership.

As the association sets a tone for the next century, Jim Weber, MBA, takes the helm as president. A full list of officers and AOPA Board of Directors members who are experienced O&P professionals take on their roles for the next year.

2018 AOPA Officers

Jim Weber, MBA, President

Chris Nolan, President-Elect

Jeffrey Lutz, CPO, Vice President

Michael Oros, CPO, FAAOP, Immediate Past President

Jeff Collins, CPA, Treasurer

2018 AOPA Board Members

CONTINUING

David A. Boone, PhD, MPH Traci Dralle, CFM

12

Dave McGill

Rick Riley

Brad Ruhl

RETIRING Special Thanks

NEW

Jeffrey M. Brandt, CPO

Teri Kuffel, JD

Mitchell Dobson, CPO, FAAOP

DECEMBER 2017 | O&P ALMANAC

James Campbell, PhD, CO, FAAOP

Pam Lupo, CO

2017-2018

PEOPLE & PLACES

BUSINESSES

THE LIGHTER SIDE

ANNOUNCEMENTS AND TRANSITIONS

Hanger Clinic has announced that Courtney Rogers from Mooresville, North Carolina, is the winner of its #AmputeeLifeHacks contest. Rogers was one of more than 100 contest entrants—individuals with limb loss or limb difference—who submitted short videos showcasing a “life hack,” or a tip or trick that helps them conquer everyday tasks. Rogers’ winning video featured tips that have helped her return to her job after the loss of her left arm above the elbow.

The goal of the contest was to connect the limb loss and limb difference community online, providing opportunities to learn from one another and receive encouragement. As the contest winner, Rogers and a guest will receive a trip to meet movie star and amputee Winter the dolphin, who resides at the Clearwater Marine Aquarium in Florida. Videos from all of the contest finalists can be viewed at www.hangerclinic.com/amputeelifehacks.

Hanger Inc. has announced its board of directors has elected Thomas C. Freyman and John T. Fox as directors, effective Nov. 14, 2017.

The company also announced the retirements of Thomas P. Cooper, MD, current chairman of the board, and Cynthia L. Feldmann, a director, and the appointment of current director Christopher B. Begley as its nonexecutive chairman, effective Jan. 1, 2018.

Leadership Conference O&P

CORRECTION

In the November O&P Almanac article, “Pain, Opioids, & Your Patients,” the American Physical Therapy Association’s MoveFowardPT website was listed incorrectly under the sidebar, “Pain Resources for Clinicians and Patients” on page 34. The correct web address is www.moveforwardpt.com.

A N E X C L U S I V E , B Y I N V I TAT I O N O N LY E V E N T

JAN. 5-7, 2016 • PALM BEACH, FL THE BREAKERS

AOPA invites our top level executives from AOPA member companies to join us at our third O&P Leadership Conference.

—Featured Speakers— Alison Cernich, PhD is the Director

of the National Center for Medical Rehabilitation Research (NCMRR) in the National Institute for Child Health and Human Development at the National Institutes of Health. As Director of NCMRR, Dr. Cernich oversees a varied portfolio of research projects, training programs, and rehabilitation research infrastructure network sites aimed at improving the care of individuals with physical disability who require medical rehabilitation.

Bill Stainton is a multiple Emmy Award-winning TV producer, writer, and performer; an author; a business humorist; and an internationallyrecognized Beatles expert. He blends the business smarts he learned from twenty years in corporate management with the show biz sparks he garnered from working with people like Jerry Seinfeld, Ellen DeGeneres, and Bill Nye the Science Guy to create entertaining and enlightening presentations enjoyed by audiences around the world!

Jason Altmire served three terms

as Representative for Pennsylvania’s 4th district (Democrat). He was a bipartisan centrist known for working with both sides of the aisle. He has been profiled by numerous national publications and has appeared on a wide variety of news programs. In his business career, he has served in senior executive positions in the healthcare industry, and as an adjunct professor at George Washington University, focusing on politics and policy.

This event is invitation only—contact landerson@aopanet.org to request another copy of your invitation.

www.AOPAnet.org O&P ALMANAC | DECEMBER 2017

13

REIMBURSEMENT PAGE

By DEVON BERNARD

E! QU IZ M

Proper Preparation

EARN

2

BUSINESS CE

CREDITS P.16

Get ready for the coding and fee schedule changes coming in 2018

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

After reading this column, simply scan the QR code or use the link on page 16 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

CREDITS

A

S WE WIND DOWN 2017, we

consider whether there will be new codes and how much fee schedules will increase or decrease in January. Now also is the time of year when we show thanks and gratitude to patients and referral sources by offering them gifts.

This month’s Reimbursement Page takes a look at the recently released Health-Care Common Procedure Coding System (HCPCS) code set changes and anticipated fee schedule release and provides a recap of the rules for providing gifts to referral sources and patients.

New and Updated Codes

In early November 2017, CMS released its annual update to the HCPCS code set. The update did not contain any massive upheavals or surprises.

However, there were a few changes: One code had its official descriptor corrected, no codes were deleted, and two new codes were added to the HCPCS code set.

These changes are effective for all claims submitted on or after Jan. 1, 2018.

Code L3760 has an updated code descriptor for next year. The current code descriptor for L3760 is, “Elbow orthosis, with adjustable position

14

DECEMBER 2017 | O&P ALMANAC

locking joint(s), prefabricated, includes fitting and adjustment, any type.” The new code descriptor for 2018 will read, “Elbow orthosis, with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.” Code L3760 will now be considered a custom-fitted brace and will have to meet the requirements established in 2014 with the creation of split codes for custom-fitted and offthe-shelf (OTS) prefabricated braces.

If L3760 is to be considered the custom-fit version of an elbow orthosis with position locking joints, then there must be an OTS version.

The newly created code L3761 is the corresponding OTS version, and its official descriptor is, “Elbow orthosis, with adjustable position locking joint(s), prefabricated, off-the-shelf.”

Since the L3761 code is used to describe an OTS brace, the device should require minimal self-adjustment for fitting at the time of delivery.

According to policy and CMS, “minimal self-adjustment” refers to an adjustment the patient or his or her representative, or the supplier of the brace, can perform and that does not require the services of a certified orthotist. If the elbow orthosis you are providing requires substantial modifications—those beyond minimal self-adjustment—be sure to use the appropriate custom-fitted code, L3760.

The second new code introduced into the 2018 HCPCS code set is L7700. This code is used to describe a component added to a prosthetic liner to create a sealing feature to aid in the suspension of the prosthesis.

REIMBURSEMENT PAGE

The full official descriptor for L7700 is, “Gasket or seal, for use with prosthetic socket insert, any type, each.” The code descriptor would indicate that code L7700 may be used for any upper- or lower-extremity liner. However, at this time, there is no additional published guidance or coverage rules for L7700.

Based on the preliminary reviews of the CMS HCPCS Panel, it is believed that L7700 will be a covered service/item.

Fee Schedule Changes

As O&P Almanac went to press, the 2018 durable medical equipment prosthetics, orthotics, and prosthetics (DMEPOS) fee schedule had not been released. It is expected that the 2018 fee schedule will be slightly higher than the 2017 DMEPOS fee schedule, with a possible overall increase in the neighborhood of 1.1 percent. The DMEPOS fee schedule is calculated using two figures, and at the moment only one is known and verified.

All increases or decreases in the DMEPOS fee schedule are legislatively tied to the increases and decreases in the Consumer Pricing Index for All Urban Consumers (CPI-U). The CPI-U is the average change over time in the prices paid by urban consumers for certain goods and services (e.g., food, housing, clothes, transportation, medical care, etc.) and is calculated by the Bureau of Labor and Statistics (BLS). This year’s CPI-U was calculated using data collected between June 2016 and June 2017.

Since the CPI-U calculation period ended in June, we know with certainty that the CPI-U adjustment will be 1.6 percent; however, the unknown is the second component of the equation: the annual legislatively mandated reduction to the DMEPOS fee schedule or the productivity adjustment. The productivity adjustment also is calculated by BLS but is based on a 10-year rolling average of changes in annual economywide private nonfarm business, or a multifactor productivity. Since it is based on a rolling average, the final productivity adjustment has not been released.

While the 2018 productivity adjustment for DMEPOS has not been

published, the productivity adjustment for such things as ambulance services has been published and is set at -0.5 percent. Traditionally, the DMEPOS productivity adjustment has been similar to these other services since it is based on the same calculation as the ambulance fee schedule. It is safe to say that the adjustment for DMEPOS suppliers and providers will be -0.5 percent as well.

When you take the 1.6 percent CPI-U increase and subtract the anticipated productivity adjustment of -0.5 percent, you will see an overall increase in the 2018 fee schedule of 1.1 percent.

In addition to the impending increase in the DMEPOS fee schedule, you may be wondering about sequestration—the mandatory 2 percent reduction, applied after the Medicare allowable amount, based on the fee schedule. As you may recall, sequestration was the result of the Budget Control Act of 2011 and became effective for claims with a date of service on or after April 1, 2013.

For the foreseeable future, sequestration will remain in effect for 2018.

As a reminder, other insurers, including Medicare Advantage plans, may not automatically reduce their reimbursement by 2 percent as a result of sequestration unless it is specifically written into your current contracts.

Annual Gift-Giving Restrictions With the holidays here, we are thinking about presents. Providing gifts to patients and referral sources is acceptable, but there are some restrictions. These restrictions mainly relate to providing a gift as a way to encourage or increase your business.

Keep the following tips in mind when shopping for and providing gifts to patients: • Gifts of cash or cash equivalents (gift certificates or gift cards) of any type are strictly prohibited.

• The use of nonmonetary gifts is acceptable as long as they are of nominal value. The value of gifts should not exceed $15 per gift, with a $75 aggregate per calendar year, according to the Office of Inspector General (OIG). These limits were increased from $10 and $50, respectively, last year to keep up with inflation. This means that you can offer Medicare patients a maximum of five gifts valued at $15 each in any calendar year.

• There may not be terms associated with the gifts you give. For example, you cannot require that a patient come in for an evaluation in order to receive a gift, or allow a patient to receive a gift only if he or she chooses to receive a particular service or item.

O&P ALMANAC | DECEMBER 2017

15

REIMBURSEMENT PAGE

When shopping for and providing gifts to referral sources, consider the following: • As with gifts to beneficiaries, gifts of cash or cash equivalents of any kind (gift certificates, gift cards, and even free samples of products) are prohibited, but nonmonetary gifts are allowed, under very limited circumstances.

• The value of a gift may not be tied to the volume of referrals received from a physician’s office. For example, you cannot provide a gift of higher value to your regular referral sources than you do to practices that only refer patients periodically. While you are not required to offer the same gift to all of your referral sources, you cannot base your decision on the number of referrals you receive.

• Gifts may not be directly solicited by referral sources. If a referral source requests a specific gift and you provide it, this could be construed as an inducement and a violation of federal antikickback statutes.

• There is a limit to the amount of money that may be spent on referral source gifts. For 2017, there is an aggregate limit of $398, so any gift or gifts provided to a referral source in 2017 may not exceed $398.

Friendly Reminders

Now is a good time to review any coding announcements, policy changes, and form changes, such as the new advanced beneficiary notice form, released by Medicare.

Make sure you have incorporated all of the changes into your facility’s policies and procedures.

In addition, as a Medicare supplier, you are required to submit claims at least once within four consecutive quarters, or at least one claim a year, to keep your Supplier Number and associated billing privileges active.

Since each location where you see Medicare beneficiaries is required to be enrolled separately and have its own Provider Transaction Access Number/Supplier Number, be sure

each office has submitted at least one claim this year. If you do not submit at least one claim from each of your locations, your Medicare billing privileges could be deactivated.

There’s a lot to do to get ready for the new year. Following all of the coding changes and Medicare rules and regulations will ensure your facility is prepared for a successful 2018.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming.

Reach him at dbernard@AOPAnet.org.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz.

Earn CE credits accepted by certifying boards:

www.bocusa.org

Wishing you Happy Holidays & Much Success in the New Year!

Our holiday gift to the O&P community we serve are donations to two programs serving individuals who are physically challenged, aligning with our mission of “Support for Better Life” Creating Unforgettable Days

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DECEMBER 2017 | O&P ALMANAC

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This Just In

Projecting the Impact of Two Proposed Rules O&P professionals should be aware of suggested changes from CMS and the U.S. Department of Veterans Affairs

C

HANGE MAY BE ON THE HORIZON

in the form of two proposed rules— one from CMS and another from the U.S. Department of Veterans Affairs (VA). While the CMS proposal would include the use of digital or virtual models to direct mill custom diabetic inserts as an acceptable method to meet the definition of “molded to patient model” contained in the code language for A5513, it also would reduce the fee schedule amount for inserts made this way. The VA proposal would limit veterans’ choice in selecting an O&P provider. It’s important that all O&P stakeholders understand these proposed rules and voice opinions on these potential changes.

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DECEMBER 2017 | O&P ALMANAC

Custom-Fabricated Diabetic Shoe Inserts CMS has proposed a change to the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Quality Standards that address AOPA’s concern regarding the recent interpretation of the term “molded to patient model” when used to describe custom-fabricated diabetic shoe inserts by the durable medical equipment Medicare administrative contractor (DME MAC) and the pricing, data analysis, and coding (PDAC) contractor.

The proposed change to the Quality Standards allows for the creation of a digital model of a patient’s foot using CAD/CAM technology that is then used to direct mill a custom-fabricated insert based on the digital model. The original DME MAC interpretation required that in order to be considered “molded to patient model,” a physical model of the patient’s foot must be created in order to serve as the model for fabrication of the insert.

In July 2017, the DME MACs and PDAC issued a joint bulletin stating that in order to meet the definition of “molded to patient model” contained in the descriptor for A5513, diabetic inserts must be fabricated over a physical model of the patient’s foot. The

This Just In

bulletin went on to state that digital or virtual models that were used to direct mill custom inserts are not considered a positive model, and inserts fabricated using this technique do not meet the code requirements of A5513 and therefore must be billed as A9270, a statutorily noncovered Health-Care Common Procedure Coding System (HCPCS) code.

On Sept. 28, 2017, AOPA and the American Podiatric Medical Association (APMA) submitted a joint letter to CMS expressing their concern over this bulletin as it represented a significant threat to the use of advanced technology to provide optimal clinical service. In addition to partnering with APMA, AOPA worked closely with the O&P Alliance, the office and staff of Rep. Brad Wenstrup (R-Ohio), and the House VA Subcommittee on Health to make sure that this issue remained at the forefront of discussions.

On Nov. 2, 2017, CMS announced a proposed change to the DMEPOS Quality Standards that would include the use of digital or virtual models to direct mill custom diabetic inserts as an acceptable method to meet the definition of “molded to patient model” contained in the code language for A5513. AOPA generally supports the proposed changes to the DMEPOS Quality Standards; however, AOPA takes issue with the 2018 fee schedule amount that would be reduced from $43.09 to $38.67. AOPA is concerned that by establishing a lower fee schedule amount for direct milled, custom-fabricated diabetic inserts than for molded-to-patientmodel inserts that are fabricated using more traditional techniques, CMS is essentially creating a “toll” for providers who use modern technology to fabricate inserts that are of equal or better quality than those that are fabricated using more traditional methods. This could create a dangerous precedent that will discourage innovation due to concerns about reduced reimbursement.

AOPA will be submitting comments

in regulation that this administrative business decision is made solely by VA to eliminate any possible confusion as to whether a veteran has a right to request items or services generally, or to request specific items or services from a provider other than VA, and to clarify for the benefit of VA-authorized vendors that VA retains this discretion as part of our duty to administer this program in a legally sufficient, fiscally responsible manner."

by the Dec. 11, 2017, deadline expressing these concerns, and is sending a joint letter with APMA to CMS. CMS has indicated that it intends to finalize the proposed changes by Jan. 1, 2018.

Proposed VA Rule

The Oct. 16, 2017, Federal Register included a proposed rule published by the VA that intends to “reorganize and update the current regulations related to prosthetic and rehabilitative items, primarily to clarify eligibility for prosthetic and other rehabilitative items and services, and to define the types of items and services available to eligible veterans.”

There is a provision in the proposed rule that significantly threatens longstanding VA policy that allows veterans to decide whether they receive O&P services directly from the VA or from a VA-contracted provider. The proposed language states the following: “VA will determine whether VA or a VA-authorized vendor will furnish authorized items and services under § 17.3230 to eligible veterans. When VA has the capacity or inventory, VA directly provides items and services to veterans. However, VA also may use, on a case-by case basis, VA-authorized vendors to provide greater access, lower cost, and/or a wider range of items and services. We would clarify

This language, if finalized, is in direct conflict with the current VA policy as well as the Veteran’s Access, Choice, and Accountability Act of 2014 and will significantly restrict the ability of a veteran to see the VA-contracted provider of his or her choice for prosthetic and orthotic care.

AOPA has established a convenient pathway that will allow you to quickly express your concern regarding the VA proposed rule. Visit www.AOPAVotes.org and enter some basic information, then a customized letter will be generated and sent to the VA to express your concern over the unnecessary and unreasonable provisions of the proposed rule.

AOPA placed this ad in Roll Call, a Capitol Hill "must read" newspaper, to inform policy makers.

O&P ALMANAC | DECEMBER 2017

19

COVER STORY

Major Gains in Outcomes Data New comprehensive studies support the efficacy and value of O&P intervention—and demonstrate the urgent need for more evidence-based research

By CHRISTINE UMBRELL

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DECEMBER 2017 | O&P ALMANAC

COVER STORY

NEED TO KNOW ■■ As the U.S. health-care environment transitions toward fee-for-valuebased care, more health-care professionals—including O&P clinicians and manufacturers—should be providing outcomes data and engaging in evidence-based research to demonstrate the efficacy and value of specific health services.

■■ The O&P profession is beginning to make bigger contributions to the research arena. Most recently, the value of prosthetic intervention was demonstrated in the RAND Corp.’s “Economic Value of Advanced Transfemoral Prosthetics” and in Dobson-DaVanzo’s updated “Medicare Services” data reports.

■■ The RAND report found that microprocessor knees are associated with improvements in physical function and reductions in falls and osteoarthritis, and that the economic benefits are in line with commonly accepted criteria for value for money by U.S. payors.

■■ As more stakeholders become involved in outcomes and research efforts, there will be more objective data for payors to look to when deciding where to allocate their health-care dollars, as well as a greater understanding of how advanced technology contributes to improved health and long-term economic savings.

■■ While the most recent studies provide important information for O&P professionals to share with patients and payors, it’s what comes next—in terms of continued research and outcomes measurement data—that will be even more important to the future of the profession and O&P patients.

O

&P STAKEHOLDERS CAN AND

should become masters of their own fate by providing evidence-based research regarding all aspects of orthotic and prosthetic care, say O&P experts. The movement toward fee-for-value-based care in the United States will require all health-care professionals to provide outcomes data regarding their services. While other fields have been providing such research for decades, O&P is relatively new to the game.

“Achieving high value for patients is becoming the overarching goal of health-care delivery, with value defined as the health outcomes achieved per dollar spent,” says Kenton R. Kaufman, PhD, who works at the Department of Biomedical Engineering at the Mayo Clinic in Rochester, Minnesota. “Health outcomes in O&P can be defined in terms of improved

patient function and better quality of life. These outcomes will need to be collected on a routine basis in order to justify payments received.”

Fortunately, more and more O&P stakeholders are beginning to understand the significance of—and contribute to—the O&P research pool.

The value of orthotic and prosthetic intervention has been proven in several new studies published during the past few months. The RAND Corp.’s “Economic Value of Advanced Transfemoral Prosthetics” demonstrates how microprocessor-controlled knees help prevent falls and osteoarthritis, and Dobson-DaVanzo’s updated “Medicare Services” data report shows patients who use spinal and lower-limb orthoses as well as lower-limb prostheses gain greater mobility while experiencing lower or equivalent Medicare costs.

O&P ALMANAC | DECEMBER 2017

21

COVER STORY

With the recent RAND and DobsonDaVanzo studies and similar research initiatives, including those funded

by AOPA in partnership with the Center for O&P Learning Outcomes/ Evidence-Based Practice (COPL), O&P professionals are building a repository of data that shows what orthotists and prosthetists have always known— that O&P intervention keeps patients mobile and enjoying an improved quality of life, ultimately promoting health and saving money. While these groundbreaking studies provide important information for O&P professionals to share with patients and payors, it’s what comes next—in terms of continued research and outcomes measurement data—that will be even more important to the future of the profession and O&P patients.

Soeren Mattke, MD, at the AOPA 2017 World Congress

Keeping Pace With Payors

The findings of the RAND Corp. study on the value of microprocessor knees were shared for the first time during the AOPA World Congress in September 2017, then reiterated during a press event in October at the National Press Club in Washington, DC. At both events, Soeren Mattke, MD, presented the results of that research, which showed that microprocessor knees are associated with improvements in physical function and reductions in falls and osteoarthritis, and that the economic benefits are in line with commonly accepted criteria for value for money by U.S. payors (see sidebar, “RAND Study By the Numbers”).

Data such as that provided in the RAND study is extremely important to justify the use of advanced technologies and ensure future reimbursement for such devices.

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DECEMBER 2017 | O&P ALMANAC

RAND Study By the Numbers RAND’s simulation, published in “Economic Value of Advanced Transfemoral Prosthetics,” shows the following results when comparing microprocessor knees (MPKs) with nonmicroprocessor knees (NMPKs): ■■ For every 1,000 people, MPKs result in 82 fewer major injurious falls and 62 fewer minor injurious falls, and save 11 lives over a one-year period.

■■ Similarly, MPKs result in significantly fewer instances of osteoarthritis.

■■ On a per-person-per-year basis, MPKs reduce direct health-care costs by $3,676 and indirect costs by $909, but increase device acquisition and repair costs by $6,287 and total costs by $1,702.

■■ On a per-person basis, MPKs are associated with an incremental total cost of $10,604.

■■ On a per-person basis, MPKs increase the number of life years by 0.11 and qualityadjusted life years by 0.91.

■■ MPKs have an incremental cost-effectiveness ratio of $11,606 per quality-adjusted life year.

■■ The economic benefits of MPKs are robust in various sensitivity analyses.

Injurious Falls and Fall-Related Deaths Among MPK and NMPK Users Injurious falls per 10,000 person years Major Injury Minor Injury

22 16

MPK

104

NMPK 0

Fall-related deaths per 10,000 person years

78

50

100

150

200

16 14 12 10 8 6 4 2 0

11

Lives Saved

by MPK

14

3 MPK

NMPK

Savings Derived from the Use of MPKs in Direct Health-Care Costs and Indirect Costs* 2016 U.S. dollars

$

12,000 10,000

A reduction of $4,585 per person per year Indirect

8,000

5,177

6,000 4,000 2,000 0

4,268

4,814

Direct

1,503 MPK

NMPK

SOURCE: "Economic Value of Advanced Transfemoral Prosthetics," RAND Corp., 2017. *Excluding the incrementally high cost of the MPK device itself

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COVER STORY

“Payors have to manage access to all these technologies, and make trade of what they can and cannot cover since, ultimately, we will not be able to cover everything that is available,” Mattke said during the press event.

“So, that shift in sort of a more cautious attitude toward progress means that payors are actually looking more and more into evidence.”

This shift in the way payors consider reimbursement forces manufacturers, as well as clinicians, to measure and communicate the value of innovation in a new way. “They have to measure the safety, the efficacy, the quality of life, and the cost of care of technovations, rather than the traditional measure of biomechanical properties,” explained Mattke. “And the problem is, by not doing that, payors usually equate absence of evidence with evidence of absence.”

The RAND study was prompted by the launch of the Prosthetics 2020 initiative in 2015, which united the O&P industry in generating and compiling evidence of the value of advanced prosthetics. “The problem was that there was … no direct evidence for the superiority of the

microprocessor-controlled knees,” said Mattke. “That’s not as unusual for medical devices as you might think because, traditionally, device manufacturers weren’t really forced to produce such comparative evidence in contrast to pharmaceutical manufacturers because device innovation is engineering.” But now payors are digging deeper to determine what value these advanced devices actually provide to patients.

Seeking Objective Data

Microprocessor technology is one of the most important innovations to enter the O&P marketplace and many amputees currently use it; however, large sectors of the amputee population are not benefitting from the technology because they cannot receive reimbursement or cannot afford copays. Given the benefits the technology offers amputees—in terms of more sophisticated control, increased stability, and more efficient gait—this is one area where objective research has been needed.

The RAND study, financed by AOPA in support of the Prosthetics 2020 initiative, sought to project

Fall-Related Transitional Probabilities and Associated Cost Outcomes

SOURCE: "Economic Value of Advanced Transfemoral Prosthetics," RAND Corp., 2017.

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DECEMBER 2017 | O&P ALMANAC

Katy Sullivan, actress and Paralympic track and fielder, is a bilateral above knee amputee, using MPK knees on both legs (pictured with Jonathan Cowley at the 2017 World Congress). outcomes for higher-functioning amputees—Levels K3 and K4—over a 10-year period and analyze the associated incremental costs. The notion of incremental costs was important: “The idea is, is that extra cost in line with other things that we commonly found?

And that’s important because we rarely ever see new technology, or new drugs, or new devices being cheaper in terms of cost per quality of life,” explained Mattke.

RAND looked at data for patients using microprocessor-controlled prostheses compared to patients using nonmicroprocessor-controlled prostheses. Ultimately, the RAND analysts were able to quantify several benefits of microprocessor technology.

“The big impact is with respect to falls,” said Mattke. “Amputees have a much lower probability of falling and injuring themselves with the microprocessor-controlled knee than the nonmicroprocessor-controlled knee.

And then that translates into follow-up on cost and quality of life for the patients,” he said. In addition, microprocessor-controlled devices generate

COVER STORY

value by offering a more stable gait.

“So, you get a lower probability of osteoarthritis in the quadrilateral knee because you just walk,” Mattke said.

In fact, the study found almost an 80 percent relative risk reduction in injurious falls—“not just falls where you trip and catch yourself, but falls where you really have an injury, either a minor injury or a major injury, that requires hospital admission,” Mattke continued. “As a consequence, you also have about an 80 percent risk reduction in fall-related deaths that is basically a consequence of these major injuries of falling. These are pretty impressive effects.” The RAND study also identified a 30 percent relative risk reduction in osteoarthritis. The combined benefits of fewer falls and reduced incidence of osteoarthritis “translate into a 13 percent to 37 percent improvement in quality of life,” said Mattke. “You get a pretty significant improvement.”

Looking at all of the data compiled

by RAND, the microprocessor knee, on a pure health-care cost, without cost of the device, saves about $4,000 per person per year, according to the study. “If you count the direct medical costs, the cost of care for falls, for treating osteoarthritis, and the indirect cost of caregiving, lost wages, and transportation expenses that are higher in a less functional amputee, the modern device saves a lot for $1,200 per year,” said Mattke.

“This is an initial attempt to quantify the health and economic benefits of the microprocessor controlled knee, and it does show promising results.

Better health, better quality of life, and incremental costs that are in line with established thresholds and covered technologies,” Mattke said. But he noted there are limits to how much one study can do. “There’s going to be the need for further research to actually generate direct evidence for the impact as opposed to a simulation study,” he said.

“It’s a good start, it’s a first attempt to quantify the benefits, and it underscores how important AOPA’s research agenda is to guide the industry and the profession to further evidence generation.”

PATIENT Perspectives While research is key to ensuring future reimbursement of orthotic and prosthetic devices, stories of patient satisfaction also resonate.

Two O&P consumers spoke out during the October 2017 AOPA press event, sharing with the media how microprocessor technology has added significant value to their lives: “[When I became a below-knee amputee], even simple tasks like walking and holding a conversation became very laborious because I was always looking down, I was always worried about the next step. Was I going to trip over the nut, was I going to miss that curb, do I want to take the incline or do I want to take the stairs? … At the time I was a K2. [My prosthetist] fought because he knew that I had the potential to become a K3. He fought for me to get a microprocessor ankle, so that when I was walking the foot would actually swing up.

“I got the microprocessor ankle and … my life completely changed. I lost 100 pounds just walking with my son. I became more active, I no longer take muscle relaxers, I no longer take pain medication because my leg isn’t off balance anymore. When my gait normalized and I no longer had to think as much when I was walking, I became a safer person. I no longer trip and stumble, I now have an 11-year-old and a 3-year-old, and I can keep up with both of them. I’m no longer the mom at the playground watching the kids play. I’m the mom going up and down the slides with the kids. I’m the mom out in the field kicking the soccer ball, and it’s because I can do that. And I can do that because I have the technology to be able to do that.”

—PEGGY CHENOWETH, BLOGGER AT AMPUTEEMOMMY.COM, GAINESVILLE, VIRGINIA

“I’ve been an above-the-knee amputee for 23 years.

I lost my leg due to trauma; I was hit by a car when I was 19. I’ve been on every type leg you can think of.

I have a microprocessor-motorized knee now, but I started on just a normal swing knee. … I fell three, four, five times a month. That kept up for 10 years, until I got on a microprocessor knee. Now I rarely fall, maybe once a year. And it’s usually my own fault because I’m not paying attention. It’s just good technology, and I hope we can get it for more people.”

—CHRISTOPHER ALLEN, TAX ATTORNEY, ASHBURN, VIRGINIA

O&P ALMANAC | DECEMBER 2017

25

COVER STORY

Advocating for O&P Patients

Microprocessor Technology and Fall Prevention One of the most important findings from RAND’s study on “Economic Value of Advanced Transfemoral Prosthetics” was that microprocessor-controlled knees result in fewer falls. Kenton Kaufman, PhD, shared additional information about the risks of falls for amputees during the October 2017 AOPA press event, when he explained the findings of a recent study by the Mayo Clinic published in Prosthetics and Orthotics International. The study, titled “Direct Medical Costs of Accidental Falls for Adults With Transfemoral Amputations,” which was supported in part by an AOPA grant funded through the Center for O&P Learning (COPL), was a retrospective cohort study of adults who underwent transfemoral amputations between 2000 and 2014, and found benefits for Level K2 amputees who were transitioned to microprocessor knees.

“Even if an amputee [without microprocessor technology] avoids death due to a fall, he or she may suffer very serious consequences from a fall-related injury,” said Kaufman. “The average additional cost in the six months following a fall can be substantial. The cost for individuals requiring an emergency department visit is about $18,000.

For patients who had to be hospitalized, this extra expense is over $25,000.” These dollar amounts are thought to be underestimates of the actual total costs because the Mayo Clinic researchers did not include indirect costs, such as lost wages, caregiving expenses, and transportation costs, in their calculations.

Kaufman and his colleagues found that there was a significant reduction in falls when individuals at Level K2 were converted from nonmicroprocessor knees to the more advanced microprocessor devices—and there were many other health benefits. “The individuals were more active on the microprocessor knee. They went from 60 percent of the time sitting on the nonmicroprocessor knee to 50 percent on the microprocessor knee,” said Kaufman. “And then, when they went back to the nonmicroprocessor knee, they actually had less confidence so the amount of time sitting was 65 percent.”

The researchers quantified the quality of study participants’ gait and found that the quality of their gait more than doubled on the microprocessor knee. “And, not surprisingly, they reported an improved quality of life when using the microprocessor knee,” Kaufman said.

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DECEMBER 2017 | O&P ALMANAC

Research that builds on the RAND study, as well as the recent DobsonDaVanzo study (see Numbers on page 8), will continue to be needed. O&P clinicians and manufacturers from all corners of the United States should determine how they can contribute to O&P research to ensure their patients are not forgotten by payors that are focusing on other health-care fields.

“You see areas in medicine where money is no object, like cancer care.

We spend an enormous amount for gaining one week, one month, of life in a cancer patient. We are not willing to spend the same amount of money for reducing heart attacks, and we are certainly not willing to spend the same amount of money to improve an amputee’s life,” said Mattke. “We need more research to put these things in perspective and put coverage decisions on a more rational level.”

Michael Oros, CPO, LPO, FAAOP, at the AOPA 2017 World Congress AOPA Past President Michael Oros, CPO, LPO, FAAOP, spoke during the press event of a growing “technology gap” that puts U.S. amputees at greater risk of injury, and potentially even death, because of the medical policies that govern coverage and access to contemporary prosthetic technology.

“These policies haven’t been updated in consideration of the value this technology brings to these patients,” said Oros. “You always hear that the big advantage of U.S. health care compared to other developed nations is that people have the option of the best available care and treatment. That is currently not true for all American amputees. The current operating environment for coverage is outdated and needs to change.”

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COVER STORY

Adding to reimbursement challenges, there is a lack of a coordinated care system in many parts of the United States, according to Oros. “I’ve practiced in three or four areas of the country, and there’s a high degree of variability when a patient has an amputation of what the process that follows will look like,” he said. “In major metropolitan areas, sometimes there [are] better clinics to make sure

those patients return and that care is provided and delivered, but … in areas that are sometimes more rural, there are a surgery and the patient is kind of left to fend for themselves to some degree.” More outcomes-based research would lead to more standardized levels of care across the nation.

Copays and deductibles pose another problem for those amputees who do have insurance coverage but

cannot afford out-of-pocket costs.

Peggy Chenoweth, an amputee blogger, spoke during the press event of her experiences in speaking with other amputees. “I receive hundreds of emails every month from amputees who want to get a prosthetic device and don’t have the funds to be able to do it,” she said. “If they have a 20 percent copay, ... not everybody has [the amount of money required as a

K-Level Analysis for Lower Extremity Prostheses: Spending and Utilization by K-Level Cohort** (2008-2010 and 2012–2014)

Care Setting

2007–2010 K1 - K2 (n = 173)

K3 - K4 (n = 173)

2011–2014 Difference

K1 - K2 (n = 137)

K3 - K4 (n = 183)

Difference

Physician

$8,550

$8,640

-$90

$9,957

$7,222

$2,735

DME

$17,295

$24,900

-$7,605*

$11,871

$18,346

-$6,474*

—

—

—

$7,561

$11,226

-$3,665*

$21,000

$16,995

$4,005

$21,242

$12,411

$8,831*

Long Term Care Hospital

$2,250

$1,740

$510

$1,008

$1,183

-$175

Inpatient Rehabilitation Facility

$2,325

$2,490

-$165

$4,201

$3,178

$1,023

Outpatient

$9,375

$11,400

-$2,025*

$10,251

$7,537

$2,714

Skilled Nursing Facility

$12,255

$6,240

$6,015*

$7,687

$3,596

$4,091*

Home Health

$8,220

$5,565

$2,655*

$7,161

$3,735

$3,426*

$615

$525

$90

$133

$115

$19

Total Part D Drug Spending

—

—

—

$5,804

$5,228

$576

Total Part D Drug Spending among Part D Users Only

—

—

—

$6,796

$6,598

$198

Total Part D Drug Spending for Pain Medicine among Part D Users Only

—

—

—

$638

$1,216

-$578

$81,900

$78,495

$3,405

$79,314

$62,549

$16,765*

68.39

40.31

28.08*

34.99

20.78

14.21*

Average Number of Fractures and Falls

0.83

0.86

-0.03

0.87

0.30

0.57*

Average Number of ER Admissions

1.69

1.51

0.18

2.88

1.70

1.18*

Average Number of Inpatient Admissions

1.25

1.12

0.13

1.69

0.87

0.82*

Average Number of IRF Admissions

1.54

1.39

0.14

0.20

0.16

0.05

Prosthetics Only: L5000 - L5999 Acute Care Hospital / Other Inpatient

Hospice

TOTAL Average Number of Therapy Visits

Source: Dobson | DaVanzo analysis of custom cohort Standard Analytic Files (2007–2010 and 2011–2014) for Medicare beneficiaries who received O&P services from January 1, 2008 through June 30, 2009 (and matched comparisons), or January 1, 2012 through June 30, 2013 (and matched comparisons) according to custom cohort database definition. * Statistically significant at p< 0.05 ** Analysis does not include all lower extremity prostheses study group patients as not all prostheses were billed with a K-level.

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DECEMBER 2017 | O&P ALMANAC

COVER STORY

copay] to be able to spend for a prosthetic device, especially when they just had the amputation, so they’re being hit with all the medical bills and then time off of work,” said Chenoweth.

“And unfortunately, there are many people who are in a situation where they have the desire to ambulate and the desire to move forward, but they’re lacking the funds to be able to do so.”

It also is hoped that research will support coverage of advanced technology for lower-level ambulators.

Current reimbursement for microprocessor-controlled knees is, in many cases, limited to Level K3 and K4 patients. “This absolute definition between K2 and K3 happens on a continuum. So, someone who’s at the very high end of K2—but is not quite K3—that is so marginally different, and to deny access to that based on what may be a very, very small difference is just a shame,” said Oros.

Gait training with first generation microprocessor knee technology in the early 2000s. technology, for example, providing a microprocessor-controlled knee instead of a mechanical knee.” (See sidebar, “Microprocessor Technology and Fall Prevention.”)

Doing Your Part

Kenton R. Kaufman, PhD, at the AOPA 2017 World Congress During the press event, Kaufman shared information about a separate study conducted at the Mayo Clinic that offers justification for covering microprocessor technology for K2 ambulators. “Several studies have demonstrated that patients with transfemoral amputations who receive microprocessor knees have reduced fall rates. This study is the first report of the direct cost of falls among individuals with transfemoral amputation,” said Kaufman. “Quantifying the costs of falls for individuals with transfemoral amputation provides a comparison for payors who are evaluating the value of more expensive health-care

Microprocessor technology is just one area where research is needed to demonstrate the efficacy of O&P intervention. There are many ways that both clinicians and manufacturers can contribute to the O&P research pool.

Individual facilities can commit to objectively measuring outcomes data as often as possible—capturing both pre- and post-intervention.

“Each O&P clinician should look at the measures that are typically used to document outcomes and decide which ones could be easily implemented in their clinical practice,” suggested Kaufman. “Ideally, they should select one that is validated, only takes a few minutes to complete, and will demonstrate changes in patient function over time. In a short time, having this data will enable them to demonstrate the effectiveness of their clinical practice.”

Combining such data with similar data from other clinicians will build a base of data that can be shared with payors.

“Value for patients is revealed over time and is manifested in longer-term

outcomes such as improved function,” Kaufman said. “The only way to accurately measure value, then, is to track patient outcomes and costs longitudinally. The entire O&P profession will need to unite with researchers in order to achieve this goal.”

Manufacturers also will need to play a part in demonstrating the usefulness and cost-effectiveness of the O&P devices they bring to market. “In the past, manufacturers launched a new product into the marketplace with essentially no research to document efficacy or effectiveness. Payors are now requiring evidence that the new product—which is usually more expensive—provides value,” explained Kaufman. “Manufacturers will need to partner with the O&P profession to provide the evidence required by the payors.”

As O&P stakeholders maneuver a health-care climate that is transitioning to a fee-for-value-based payment system, all are called to provide evidence of the health and economic benefits that come from optimal orthotic and prosthetic care.

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

O&P ALMANAC | DECEMBER 2017

29

By LIA K. DANGELICO

BETTER, FASTER, STRONGER ORTHOTISTS AND PROSTHETISTS CAN UP THEIR GAME AND PROVIDE MORE COMPREHENSIVE PATIENT CARE WHEN THEY ADOPT AN INTEGRATED APPROACH

NEED TO KNOW • O&P professionals should consider adopting an integrated approach to health care, which involves bringing conventional and complementary health- and patient-care approaches together in a coordinated way. Integrated care can lead to better patient outcomes and a distinct business advantage.

• When O&P professionals work directly with therapists, orthopedic surgeons, and other members of the health-care team, patients get a full and complete care plan and avoid inconsistent suggestions from siloed care providers.

• Fostering a culture of trust is essential to making the team approach work. All of the members of an integrated team should believe in the “collective intellect,” respecting each other’s opinions and working together to develop optimal solutions for patients.

• Hiring the right staff is key to a successful integrated care approach. Employees should be willing to work collaboratively with others and to continuously educate themselves on all aspects of patient care.

• An integrated approach to health care also can extend to the business aspects of O&P, as facilities embrace efficiencies to help coordinate the front and back office with clinical care, improve workflows, and capture outcomes data.

• Collaborative and secure IT software systems and outcomes data collection processes help ensure all parties on an integrated team share patient information and create a complete record of each step of the patient-care and reimbursement process.

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I

T HAS LONG BEEN said that a team

is more productive than the sum of its parts. In health care, teamwork—in the form of an integrated approach to care—can mean an improved patientcare experience as well as a more efficient health-care facility.

Integrated care, also called comprehensive or coordinated care, involves bringing conventional and complementary health- and patient-care approaches together in a coordinated way. In O&P, it often means incorporating other care providers—such as orthopedic surgeons, psychologists, physical and occupational therapists, and others who specialize in a particular area of the patient’s condition—into the orthotic and prosthetic treatment process. It also may relate to embracing efficiencies that help to improve workflow and lead to stronger, more collaborative teams. There are many different ways to approach integrated or interdisciplinary care, but the essential goals remain the same: to improve patient care to drive better outcomes and to adopt agile business practices that help businesses thrive.

Increasingly, integrated care approaches are proving to be good for business, which is more important than ever given the current climate of unprecedented economic and technological change and innovation. Many industries, including O&P, remain vulnerable to the threats of automation and computerization. So, how do we provide ever better, faster patient care without throwing all profits out the window?

During a symposium at the 2017 World Congress in Las Vegas this past September, “Implementing an Integrated Care Model Into Your Practice,” panelists addressed that very question. They shared their experiences and insight on how integrated care models can work in everyday clinical practice, and how these approaches have helped to create excellent outcomes for patients while also providing a distinct business advantage for the company. Each touched on balance—the importance of finding the right balance between the

clinical, technical, and business aspects make money, you don’t get paid, your in order to be successful. employees don’t get paid, your patients Essentially, integrated care is a don’t get the care they need,” she says. notion that “solutions are better and An integrated care model also can problems are solved faster when you be a differentiator for your business, have others help you with other skill helping you to stand out—both among sets,” says Silvia Raschke, your competition and by PhD, project leader with the industry’s top talent. the MAKE+ Research “Not very many O&P busiGroup at the British nesses look at and provide Columbia Institute of resources for a psychologTechnology and the ical evaluation, prosthetic panel moderator. “It also intervention, prosthetic requires a self-awarefabrication, therapeutic training, return to work, and ness that, no matter Silvia Raschke, PhD return to social activities, how clever you are, you so it’s all under one roof,” cannot know and do says John Miguelez, CP, FAAOP(D), everything yourself.” Finally, it forces president and senior clinical director O&P clinicians to find a comfort level of Advanced Arm Dynamics. The in—and, for some, be energized by— company boasts a multidisciplinary doing things well outside the comfort team of full-time prosthetists, physzone of a typical practice model. ical and occupational therapists, and technicians working together onsite, Improving the Bottom Line Change may not be easy, but O&P prac- who collaborate to determine the best prosthetic fit for patients in the most tices that don’t adapt their business efficient way possible. The program models to embrace efficiencies and “integrates prosthetic training guided improve outcomes will be left behind. by a therapist into every phase of “Change is happening whether we care,” says Miguelez. “Our expedited actively engage with it or not,” says care model optimizes the patient’s Raschke. And while the care and skill comfort and function, providing an of O&P clinicians is incredibly important, O&P professionals cannot forget to initial prosthetic solution with baseline training within one week.” be business people first. “If you don’t O&P ALMANAC | DECEMBER 2017

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4 Steps for Successfully Integrating Care Andrea Giovanni Cutti, MEng, PhD, applied research manager at INAIL Prostheses Centre in Italy, offers the following suggestions for a successful approach to integrated care:

Find professionals you trust and try to open a dialog with them.

Be open-minded and listen to what other professionals have to say.

Be comfortable explaining what you do and how, adjusting your communication to the person who is listening.

Build well-documented treatment pathways.

how to manage situations.”

Over the years, Miguelez Another positive result and his colleagues also of a tight clinical chain is have been able to find that it helps with employee efficiencies in how they retention and recruitment. do business. For example, “I believe one of the biggest administrative services— things that threatens the such as billing, human O&P industry is that we resources, marketing, have a limited number etc.—have been sectioned John Miguelez, of clinicians,” he says. off from the clinical team CP, FAAOP(D) “Those businesses that are so that the experts in those successful tend to attract and retain areas can tackle those tasks and the the best clinicians. So I think it’s clinical team’s time can be maximized always looking for ways to pull your with patient care. Despite the delinteam closer together, which [results in eation, the company has worked to increased] retention.” build well-connected teams that don’t function in silos, or situations where certain departments or sectors do not Increasing Clinical Value wish to share information with others Closer, more tight-knit front office in the same company. “We have a very and clinical teams result in a more close team,” which is not so easy when streamlined patient experience; better your company is spread out across the documentation and, thus, reimburseUnited States, he says. “We want our ment; and improved clinical care. seven centers to work together “Everybody’s working together for the patient’s best interests, and at some to harness the collective intellect point, when insurance companies of our whole team. … We have the start to make that turn, what they’re opportunity to share successes and looking at is, are they getting the most challenges, not just as case studies, bang for their dollar?” says Miguelez. but really how to manage patients, 32

DECEMBER 2017 | O&P ALMANAC

“The integrated model is far superior because it gives the patient a much larger opportunity to adapt to wearing and using a prosthesis. If the patient is functional, they’re integrated back into their social and work activities, and to me, that’s the definition of good rehabilitation.”

That definition aligns with the company’s greater philosophy to treat the whole patient. Advanced Arm Dynamics’ clinical model is based on a comprehensive team approach to collaborative care, via a team of experienced rehabilitation therapists on staff, innovative prosthetic intervention, and individualized treatment plans. As a result, the facility also conducts comprehensive multidisciplinary patient assessments and works to ensure the patient stays at the center of—and remains the most important part of—the care team.

Part of that initial assessment is the “Wellness Inventory,” a proprietary screening tool developed by the company in partnership with an outside licensed psychotherapist. The tool helps “address issues in psychological domains known to negatively affect people who have experienced trauma,” and is administered to each new patient by his or her therapist.

Once the assessment is complete, therapists determine if additional psychological support is needed and help to connect and refer patients to the appropriate care provider in their communities. Additionally, full-time on-staff physical and occupational therapists create customized therapeutic plans tailored to each patient’s needs and goals—whether they relate to self-care and activities of daily living or returning to work and recreational activities. As such, the company offers a lifetime commitment to care, a promise that it will provide therapy for the life of the prosthesis. “Over the course of a patient’s lifetime, we are responsive to individual shifts in lifestyle and health, providing therapeutic support and optimizing the prosthesis to meet the patient’s changing needs,” says Miguelez.

Integrated Care Simply put, an integrated in Action care model can help to create and demonstrate Each practice is unique, value, both for patients with a different makeup of and for your business as employees, patient demoa whole. “It’s the only graphics, resources, and way to go,” says Andrea more, so there are many Giovanni Cutti, MEng, PhD, ways to make integrated Andrea Giovanni applied research manager care work. But there are Cutti, MEng, PhD at INAIL Prostheses a number of components Centre in Vigorso di Budrio, Italy. that can help to make any program The Centre has used an integrated stronger. care model for decades, and boasts an At INAIL Prostheses Centre, the multidisciplinary group of physicians, team approach begins with the initial engineers, CPOs, physical therapists, medical evaluation. Each week, social workers, nurses, and others who Tuesday mornings are dedicated to work together to tailor their services patients with upper-limb amputations around the needs of patients and who are coming to the facility for the their families, whether for inpatient first time; Wednesdays are dedicated to or outpatient treatment. “The simple lower-limb patients; and Thursdays are reason is that you want patients to for patients seeking advanced bionic come to you with a problem and leave components, as well as those in need with one comprehensive, reliable, of lower-limb or orthoses. Regardless evidence-based solution. If you can of the level of amputation, patients sit provide quality, patients will come down with an interdisciplinary team back and will spread positive opinions that includes a physician specializing [and feedback about you]. If you base in physical medicine and rehabiliyour plan on evidence and you track tation, an orthopedic surgeon with outcomes reliably, you will experience specific expertise in upper- or lowerfewer problems with reimbursement.” limb traumatology, a physician with

specialization in ultrasound imaging for the lower limb, the technical director of production, the chief CPO for the patient’s amputation level, a nurse, a psychologist, and a social worker. Together with the patient, they discuss his or her needs and the necessary prosthetic, surgical, and rehabilitation plan.

“The important point here is that patients leave the room with a full picture of what they can do, and they do not need to move from one specialist to the other looking for separate and sometimes inconsistent suggestions,” says Cutti. Patients also are provided with all relevant technical information, in writing, before leaving their appointment, so they know what their care plan will be and can review with family members on their own. “We know that patients can become anxious and might not remember exactly what’s supposed to happen next.”

Additionally, prosthetic fittings always include a training period, performed by specialized physical therapists on the INAIL team. After that, every time a major change in prosthetic technology is undertaken, a training period follows, so that the prosthetic and rehabilitation teams are constantly working in tandem to provide the best, most integrated services and solutions.

Over the years, Miguelez has found that fostering a culture of trust is essential to making the team approach work. His team works to build and maintain trust by avoiding a clinical hierarchy, where this person or that is the guru on one topic or another. “We use a technique called ‘experiential learning,’” he says. “The idea is that … we don’t want to have anybody who is seen as the ‘most expert.’ We want everybody to be experts.” He thinks of it this way: “We have seven centers across the country, and regardless of how much experience you have as a clinician, it’s not as powerful as having seven sets of clinical perspective to draw from. We really believe in the collective intellect—that we can do more together than separately.”

O&P ALMANAC | DECEMBER 2017

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WHEN DISASTER STRIKES,

‘IT TAKES A TEAM’

There is perhaps no occasion where a team approach—and all of its key components of communication, compromise, and trust—matters more than after a natural or human-induced disaster. Following the horrific Boston Marathon bombing on April 15, 2013, publishers of The Journal of Bone & Joint Surgery and the Journal of Orthopaedic & Sports Physical Therapy produced a special report entitled, “It Takes a Team: The 2013 Boston Marathon: Preparing for and Recovering From a Mass-Casualty Event.”

The special report explores what took place before and immediately after the incident at hospitals across the Boston region, when first responders, physicians, therapists, and other health-care workers sprung into action to help victims in need. It also outlines what others can and should learn from that experience to be better prepared for a variety of disasters and traumatic incidents. Here are just a few of the meaningful takeaways relating to teamwork from the report: Streamline the patient experience.

As victims of the Boston Marathon bombing were being discharged from the hospital, the medical team realized patients would be juggling five or more specialists throughout their recovery. So they created a multidisciplinary clinic for marathon outpatients, where all the various clinicians came to the patient in one convenient visit. “This system enabled most patients to be seen by all their care providers in about an hour.

It also facilitated face-to-face, clinician-to-clinician consults, and enabled one dressing takedown instead of repeated ones,” according to the report.

• Welcome all voices on the care team, says Cara Brickley, DPT, director of the Comprehensive Rehabilitation Program at Spaulding Rehabilitation Hospital, in the report. “Get everyone’s input on problems and solutions. There are more parts to a truly interdisciplinary team than most people imagine.”

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DECEMBER 2017 | O&P ALMANAC

Set clear goals then “work to reach a consensus on how to achieve them. Don’t dictate from the top down,” Brickley adds.

Find ways to improve communication. “Improvements in team-based communication are always possible, especially around discharge planning,” Brickley advises in the report. “Don’t let the communication challenges that come with interdisciplinary activities deter you from going the interdisciplinary-team route.

It is the best approach to quality patient care.”

Simulate for success. At Brigham and Women’s Hospital, all trauma teams take part in its medical simulation exercises to learn specific interventional techniques and to learn how to work as a team in all situations, but especially in extraordinary cases, such as a natural disaster. Senior residents in surgery and emergency medicine must successfully lead at least one team through a simulation before they are considered qualified to lead a trauma team in caring for a real patient.

Each month, Miguelez hosts a call with his clinical team of prothestists, CPOs, and therapists, which is structured to help achieve openness and collaboration. The calls feature a different presenter, moderator, and coach within the clinical team, who can present case studies or simply pose a question or situation they’re struggling with. For example, they might discuss how best to manage the overly-involved-but-well-meaning family that is doing too much for a patient and limiting his or her ability to optimize independence, or how to best fit an interscapular thoracic patient who has nerve damage. Once on the call, participants are presented with the challenge or the idea and take a moment to consider it and ask clarifying questions. But here’s the catch: The rule is that other members on the call are not allowed to give advice; all they can do is share their

experiences. “No one is allowed to say ‘Hey, you need to do X, Y, and Z,’” he says. Instead, “what they do is share their experience with similar cases, sharing successes and failures. And when you multiply that by the clinical team, it’s not just the individual that’s asking for input, it’s everyone on the clinical team who grows.” That format “forces everybody on the call to be super-engaged, because they’re going to be the next one up, having to share an experience,” Miguelez says.

The Advanced Arm Dynamics team also conducts a Plus/Delta of each case, looking at what the team did well and what it could have done better to optimize care. “That allows us to keep getting better,” says Miguelez, and it also leads to more creative solutions.

“It creates this vibe within the team of really trying to get to the bottom of what patients need and how we can achieve that.”

And it’s important for O&P clinicians to be able to adapt what they provide to meet patients’ needs, says Cutti. “We need to be flexible enough to customize to the best treatment that we can provide, and keep the pace.

Keep following up with patients and keep them engaged. If the patient is engaged and part of the team, we can really deliver the best results in a very reasonable time.”

measure of the patient to see how they’re doing.” It’s also important to provide that information back to the patients, to motivate them to continue on with their rehabilitation. That way, “they know where they are, and they know they’re making progress—because sometimes you’re making progress, but it doesn’t really feel like it.” The company has developed two upperlimb-specific outcome measures—a survey to gather direct patient feedback, and a performance-based assessment of the fit of the prosthesis and the function of the patient—and

Hurdles and Tools

is working on getting these measures validated and published.

While the clinical calls and consultations detailed above are great ways to encourage collaboration and communication, they may not be realistic for all. “Communication among professionals can be a challenge,” says Cutti. “Information must flow rapidly, correctly, and in a nonambiguous way.

The benefit of everybody’s work [and contributions] must be recognized.”

It also can be difficult to streamline communication with the patient. “I think that the patient should always perceive that one single, understandable voice is being spoken by the team,” he says. Often, a patient’s engagement is dictated by how well-coordinated the team is.

For Miguelez, the people who make up his team make all the difference, so hiring the right people is key. “We go out of our way to attract clinicians who are hungry for knowledge and looking to grow,” he says. One of his favorite sayings to use around the clinic is,

Even the most well-connected care teams require tools and resources in order to overcome the challenges of implementing an integrated care program. Cutti stresses the importance of having collaborative IT software and systems in place that can “help considerably to streamline the communication process, because if you don’t track information, you lose control.”

Software and other digital tools also can help track and manage data, which can be used to drive outcomes, and enable clinicians to better connect and communicate with outside specialists.

Miguelez’s team has been using outcome measures for eight years.

To date, one of the most meaningful outcomes they have developed is the patient’s perception of how his or her care is progressing. The facility obtains this data through client feedback and surveys. It’s great to look at the aggregate data and results, he says, but “the most important thing with outcome measures is to look at the individual

“If you’re not growing, you’re shrinking.” And as a result, all of the clinicians on his team live and work that way. Cutti also emphasizes a strong team that participates in highlevel training courses and conferences to better understand what’s going on in the industry and beyond and have a firm grasp of new operative models.

A Hard Truth

Perhaps the greatest challenge for O&P practitioners in adopting a more progressive and collaborative care model is letting go of outdated expectations, says Raschke. The O&P landscape is changing more rapidly with every given day, and practitioners are finding their roles are evolving, too. In a health-care environment filled with ever-advancing technology and a challenging reimbursement climate, good business sense is just as important as optimal clinical care.

Some days, O&P professionals may find they’re spending more time on paperwork than being hands-on with patients, or they may be forced to forge new relationships and foundations of trust both with their internal teams as well as outside care providers. But clinicians and facility managers need to be realistic about who the final gatekeeper of their business is, says Raschke. “At the end of the day, that’s the insurance company… you really have to take a hard, honest look at how [you and your practice] look through their lens. Because the truth is, only their lens counts.” For many, that’s a tough pill to swallow.

But once you let go of the past and accept today’s health-care climate, “it’s actually an exciting world out there,” Raschke says. She’s inspired by those in the industry who embrace this change and are willing to adapt to new technologies and approaches—including integrated care. “I see a bright future for people who are willing to sort of let go of their old self-image and say, ‘I’ve got to reinvent myself here.’”

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

O&P ALMANAC | DECEMBER 2017

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& NOW

THEN

The Latest AOPA Products and Services As AOPA concludes the yearlong Centennial Celebration, the association unveils new member benefits

Then & Now is a monthly department for 2017. As part of AOPA’s centennial celebration, O&P Almanac discusses how the orthotics and prosthetics profession has evolved over the years.

This month, we focus on current and future products and services.

W

AY BACK IN 1917, AOPA got

its start as a member organization—originally called the Association of Limb Makers of America (ALMA)— with just 12 representative member companies. The association has come a long way over the past century, growing its staff, developing innovative and much-needed products and services, and building an advocacy arm that helps steer discussions on O&P-related regulations and legislation.

THEN

During ALMA’s earliest years, the association did not have a central office or staff. “The major value of ALMA was that it permitted the free exchange of ideas between limb manufacturers. At its meetings, some attempts were made to present technical papers, and, from time to time, the organization published a newsletter or magazine called the ALMAnac,” reports the History of Prosthetic-Orthotic Education. One of 36

DECEMBER 2017 | O&P ALMANAC

the earliest gatherings of association members occurred when 33 members assembled at the 1918 Annual Convention in Indianapolis. Between the years of 1917 and 1922, ALMA held eight meetings in different states, had regional offices throughout the country, and developed a code of ethics.

Since those inaugural years, membership has grown exponentially and now exceeds 2,000 companies, suppliers, and affiliates.

The AOPA National Assembly has become a must-attend event, with thousands venturing each year to a carefully selected location for education, networking, and a trade show. Products and services span a full spectrum, and members can choose from a variety of educational opportunities via webinars, Coding & Billing seminars, and online options.

Research has become a pillar of the organization, with several important research initiatives underway. And AOPA has become a central voice in advocating on behalf of the O&P profession.

century of membership benefits, these initiatives will be critical in advancing both the profession and individual O&P clinicians and business owners.

NOW

Last month, AOPA partnered with the Health-Care Compliance Association to celebrate Health-Care Compliance and Ethics Week, Nov. 5-11, 2017. While AOPA encourages members to make ethical choices throughout the year,

In addition to the well-known activities AOPA offers, several new initiatives AOPA is working on are greatly affecting the O&P profession. As the association heads into 2018 and a new

The AOPA Co-OP

Launched just this year, the AOPA Co-OP is a “compendium of O&P” that serves as an online reimbursement, coding, and policy resource. The site features a collection of detailed information with links to supporting documentation for topics essential to AOPA members. Much like a “Wikipedia” of all things O&P, the Co-OP features a crowd-sourcing component—vetted

by AOPA staff—to provide information that’s easily accessible. Members can access the Co-OP online or via an app.

Health-Care Compliance and Ethics Week

New and Improved AOPA Operating and Performance Report

this week-long celebration was a way to demonstrate to staff and patients that O&P facilities are doing what is right. AOPA member companies participated with free webinars and CE opportunities focused on compliance, ethics, and professionalism; and leveraged AOPA’s resources to craft their companies’ unique celebrations.

Companies could sign the “Celebrating Wall” on AOPA’s website and use AOPA’s sample press release to let the community know they were celebrating. During the week-long event, AOPA sent out a daily compliance tip and a question so members could win prizes. AOPA also published a revised compliance guide, which is an update of the former guide—but still based on information from the Office of the Inspector General.

Orthotics 2020

During the 2017 AOPA World Congress and Centennial Celebration in September, key O&P stakeholders held the first face-to-face meeting to launch a new initiative to establish the value and favorable patient outcomes for orthotic intervention. Meeting participants established five central research topics to focus on in conducting critical appraisals of the available scientific literature: osteoarthritis, stroke, scoliosis, traumatic spinal injuries, and plagiocephaly. In the coming months, there will be follow-up telephone conferences around each of these five topics to get the discussions and research initiatives started. The funding aspect of Orthotics 2020 will resemble the Prosthetics 2020 model, with companies invited to provide research dollars and financial support for the Medical Advisory Board or boards that may be needed to move the topic areas forward.

AOPA’s Operating and Performance Report has been a seminal AOPA publication for more than 40 years, capturing real-time financial information from member companies each year and documenting findings based on company size and location. Next year, AOPA will begin revising the survey used to capture financial information as well as the report itself. An AOPA committee will consider including questions relating to outcomes measures and clinical management practices and comparing those results.

It is hoped that the new process will result in more accurate forecasts of work in progress, outcomes measures being used at various facilities, data on administrative law judge and audit success rates, and more.

Presidential Papers

In 2017, the AOPA World Congress Clinical Content Committee arranged to have a select number of scientific submissions published in the Journal of NeuroEngineering and Rehabilitation. These submissions, designated the “Presidential Papers,” were presented during the 2017 World Congress and were sponsored by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics.

The selected papers were required to consist of original research backed by a full manuscript.

Ongoing EvidenceBased Research

The 2017 World Congress and Centennial Celebration served as the venue for the presentation and release of the RAND Corp.’s “Economic Value of Advanced Transfemoral Prosthetics” research report and Dobson-DaVanzo’s updated “Medicare Services” data report. The 10-year value simulation RAND report, which was conducted by the RAND Corp. and commissioned

by AOPA through the Prosthetics 2020 Project, analyzed the impact of drug and other medical costs plus earnings, related health risks (such as falls and osteoarthritis), and other elements demonstrating the value of increased mobility experienced by amputees.

Dobson-DaVanzo’s cost-effectiveness research used Medicare’s own services data from 2011 to 2014 to demonstrate the economic value of orthoses and prostheses. In addition, AOPA plans to continue its partnership with Center for O&P Learning Outcomes/EvidenceBased Practice (COPL). Thirty-three small grants have been funded since the 2009 inception of COPL, including seven funded for 2017-2018.

AOPA President Jim Weber, MBA

New Mission Statement

With AOPA concluding its first century of service, the organization is pivoting to the future and plans to lead the profession in 2018 and beyond committed to a new mission statement: “Through advocacy, education, and research, AOPA improves patient access to quality orthotic and prosthetic care.”

As AOPA President Jim Weber, MBA, noted in the Views From AOPA Leadership column on page 4, “Change is constant, the future is now, and we must continue to collaboratively pursue advocacy, research, and education to improve patient access to quality orthotic and prosthetic care.” With so many new and ongoing products and services, AOPA is well prepared to lead O&P professionals through the changes to come.

O&P ALMANAC | DECEMBER 2017

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BRIDGE TO THE FUTURE: THE INTERVIEWS

The Future Is Bright Ottobock CEO discusses how globalization and education will drive O&P manufacturing and improve patient outcomes

By JOSEPHINE ROSSI

Bridge to the Future: The Interviews is a monthly column for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will look to the next 100 years—by interviewing noted experts in the O&P field to learn their vision for the future of O&P. This month, we speak with Professor Hans Georg Näder, president and chief executive officer of the Otto Bock Group, about globalization, consolidation, manufacturing and technology trends, and more.

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DECEMBER 2017 | O&P ALMANAC

HE CONCEPT OF GLOBALIZATION

in general and its impact on the O&P field is nothing new for Professor Hans Georg Näder. For the past 30 years, Näder has led the Otto Bock Group, overseeing transformations in not only the way O&P devices are made, but also in how they are provided to patients. From his unique vantage point, Näder has seen the effects of globalization on countries big and small, noting how innovations on one side of the world can ultimately impact the quality of life for O&P users thousands of miles away.

O&P Almanac spoke with Näder during the 2017 AOPA World Congress in Las Vegas. He shared his perspective on the evolution of O&P over the past several decades, with new technologies driving more intellectual and philosophical discussions of how the O&P industry will advance in the coming years. Below, Näder shares his insights on globalization, education, evolutions in manufacturing and patient care, new technologies, and outcomes and socioeconomic benefits. Responses have been edited for length and clarity.

PHOTO: Ottobock

Hans Georg Näder

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O&P ALMANAC: Could you talk a

little bit about globalization and the impact you’re seeing it have on O&P and/or health care in general?

HANS GEORG NÄDER: Globalization is just the moment where the world becomes more unified, becomes more connected through the digital world.

With globalization for O&P, technologies on the whole [are] transmitted throughout the world.

For many decades, next to Germany and Europe, the U.S. and North America has been the driver for innovation for new products and new services, so globalization has, I think, a limited impact on this market. But on the other hand, global consolidation has an impact and is a serious trend on the product side, and also on the patient-care side.

If you look on the patient-care side, globally, our partner Hanger is the number one [largest provider] in patient care, but Ottobock is number two in patient care. Many people in North America do not know that Ottobock has been active for several years in patient care, and the only market where we are not active in patient care is the U.S., where we have long-term old-standing relations with our key accounts like Hanger.

O&P ALMANAC: Are there specific

ways that Ottobock is embracing globalization?

NÄDER: For me, a globalized O&P

PHOTO: Getty Images/MATJAZ SLANIC

approach is quite normal. We are in more than 50 countries, and there are Ottobock companies on six continents, so we are already totally global, and we supply our products and services to all the countries of the world.

Today we have a full reach in South and Latin America, we have a full reach in Eastern Europe, full reach in Africa, and a full reach in Asia Pacific.

And looking on the globe, the biggest differentiation is the level of education. In many, many countries of the world, there’s a big lack of educated technicians.

Education is key for the future. Not only here in North America but also in Europe, and also even more in a globalized world.

O&P ALMANAC: Does any of

Ottobock’s research or other activities have ties to globalization?

NÄDER: All our research and our R&D projects are connected globally. If you look into Ottobock, we have contacts with more than 50 global research institutions, including contacts with MIT [the Massachusetts Institute of Technology], the Rehabilitation Institute of Chicago, the Mayo Clinic, and many others. Our research and development network is connected all over the globe, and these research institutions also are connected to each other—we have programs that MIT is running with Harvard, for example.

So the future in research is already connected globally, like a spider.

And then we have connections to companies. We have cooperations with Saudi Arabia in human mobility, we have cooperations with Utah, and companies like Adidas and Volkswagen in Germany. We have a lot of connections with companies working on specific projects.

O&P ALMANAC: Regarding your new

partnership with global investment firm EQT, what are the benefits of this new relationship?

NÄDER: So, our deal with EQT is a reverse IPO. We were thinking about going public for many, many years, and we think it’s the right moment to take such a step. But instead of selling shares to a bunch of people, we sold a 20 percent stake to one of the most prominent private equity firms in Europe. EQT is founded by the Wallenberg family, it’s one of the oldest Swedish industrial families, and they are heavily invested in medtech [medical technology]. They own Lima, which is an Italian exoskeleton/endoprosthetic company. They are involved in digital manufacturing, and we feel that this step enables us to invest now into technology, and into growth. Then we may do a potential IPO later. Let us say in five to seven years.

O&P ALMANAC: So we’re talking

about partnerships ... do you see any new partnerships emerging in the next five or 10 years that maybe we’re not thinking about right now?

And what impact might they have on the profession?

NÄDER: I think that the partner-

ships of those who focus on quality, and outcomes, and quality for life, and socioeconomic benefits will be strengthened. In many markets, many people who are really qualified focus on the quality of the outcome. And a good outcome also means a good socioeconomic benefit.

O&P ALMANAC | DECEMBER 2017

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Good socioeconomic benefit, in line with quality of life of the patient, is important. We need to get the payors to talk to the politicians, underlined by clinical studies, to say we not only improve quality of life, but we also create so much socioeconomic benefit because people who feel better internally come back to work in their social environment. So I think O&P has a huge opportunity. And talking to the key players in the market, we all see this opportunity.

I think relations between manufacturers and patient-care companies will be much stronger in the future, and I think the outcomes studies will be so much more important in the future than the [coding-based payment systems] we have today. In five to 10 years we will see so much more outcomes-driven payment.

To give you one example: The C-leg is now 20 years on the market, and I think there’s no product in O&P that has so many outcomes studies.

Altogether we have more than 66 clinical studies just for the C-leg. So I love this kind of market influence because it really can prove what we promise.

O&P ALMANAC: Are there any

barriers or challenges to achieving outcomes-driven performance?

NÄDER: I think it will depend a lot on the U.S. health-care system and changes in the health-care system. But the good news is all the media we are creating, and all these things that help to educate people on O&P. And looking into O&P and the future of O&P, we’re talking about managing interfaces, and, regarding the near future, even cyborgs.

We also will be talking about some new methods of payment. When I buy a new motorcycle, I can pay off the motorcycle over five years. Why shouldn’t I [be able to] pay off some devices over a period of time?

But the government has to allow us to do so. So it will be interesting, and the key is really communication.

What we promise and what we present must be really honest, and I think the connection, or let’s say the ability of 40

DECEMBER 2017 | O&P ALMANAC

the industry to get an open ear, in the highest circles of politics, has never been as good as it is today. Because there are the veterans, and there’s technology—if you look into National Geographic, a lot of bionic stuff is going on there.

O&P ALMANAC: Ottobock’s acqui-

sition of Freedom Innovations in September marks a global consolidation on the product side. What are the challenges and opportunities for O&P due to global consolidation of manufacturers, and how will the O&P field benefit from Ottobock’s acquisition of Freedom?

NÄDER: Ottobock and Freedom Innovations, together with professionals and patients, will benefit from their combined sales power and portfolios. Integrating the company into the global Ottobock family offers significant advantages; we will be able to generate synergies and take Freedom Innovations to the next level thanks to the strength of our global sales network. Users will benefit from an even broader spectrum of innovative systems in prosthetics and a full pipeline of new products, thanks to our combined development expertise.

Employees at Freedom Innovations will become part of a large, successful company. And our growth strategy will be bolstered by a great brand that will also further strengthen our product offerings in North America.

O&P ALMANAC: What technology or

what technological concepts are you most excited about?

NÄDER: If you ask me, it’s man-machine interfaces, it’s cyborgs using components we have today and we might have tomorrow. It’s digital manufacturing, which will play a huge role in the future. It’s robotics, it’s post-automotive human mobility. It’s all this bunch of technology where you have to spend time to sit and to think and to reflect with people who are involved.

Thirty years ago we were looking to present the next foot or the next knee,

and today it’s so much more about technological concepts. It’s much more intellectual and philosophical than it was before.

Talking this morning to a patient, a young lady who is wearing a C-brace, she told me that she was sitting as semiparaplegic. I am looking at what we can do with the second generation of the C-brace, which we will present next year, for patients suffering from stroke, or suffering from MS, or semiparaplegia. If you think about the applications for O&P devices, and if you can imagine what it means to be able to stand up and walk, to have safety and stability for an MS patient or a patient suffering a stroke—if you compare [the opportunities to help these types of patients] with the [relatively small] number of amputees, I think O&P is shaping a market of future opportunity that might be 10 times bigger than O&P today. But it will take joint efforts to establish reimbursement, or other ways of funding.

Many people are scared. But the future in this case is bright, and it’s a great opportunity. You have to invest in your own education. You know, I'm now 56 years old, and I was born into day-to-day discussions about O&P, and it never was as interesting as it is today.

And the huge opportunities never have been so great.

In health care, politics and the pay scale are always changing. There’s Medicare reform in the U.S., and these changes will continue. But for the industry, the role Big Data can play, and the role outcomes studies can play—it’s amazing.

The market opportunities are there. And I know a lot of key partners here who are focusing on quality, who are focusing on outcomes, who are focusing on happy patients, on increased quality of life—and all of them say the future is bright.

These interactions at the AOPA World Congress, at ISPO, and at these conferences really help the O&P dialogue—they’re really important. So are the discussions at Leipzig [where OT World takes place] every year.

I'd love to see more Americans come to Leipzig and be involved in the dialogue there.

O&P ALMANAC: Is there anything

else you feel is important for our readers to know?

NÄDER: I think sometimes people are afraid of consolidation. But I see [some good things] on both sides. On the patient-care side, as more consolidation goes on, I also see more startup companies come up, and they are really specialized on a specific sector. I see many really successful startups.

And on the product side, we always see consolidation here. Every year you see new companies popping up and new companies creating new companies, so I think that’s also the normal cycle. So if the cycle prizes innovation, and prizes quality of life and the socioeconomic benefit, then it’s healthy. It’s really healthy because people are competing in a sporting way. Competition [promotes] a healthy marketplace.

Looking back 30 years ago when I came the first time with my father to the convention—I think it was in Houston—there were more and smaller players. In the past 30 years, the market has consolidated. But that has helped fund more innovation and spurred innovation by new firms, which is good.

One thing is clear: This industry never has been as interesting from a scientific point of view, and from an empathic, emotional point of view, creating quality of life for people with disabilities. For me, after the C-leg and after body-mind interfaces, the next phase is we need to get people out of wheelchairs, to let them stand and walk, and also to get people with MS or patients after stroke mobilized again. That will change this industry in a positive way.

I think the next decade will be driven by mechatronic orthotic devices, which is just another name for exoskeletals. That will be the big boom in O&P. It’s a cycle of technology. You start first, and then you

The Source for Orthotic & Prosthetic Coding

optimize and optimize and optimize.

Big Data is another important innovation as it can help with proving outcomes. What we are aiming for is really to collect data, to prove outcomes. Because the best, best signals in our talking about an orthotic device is that you can prove through education that it works, and it improves the application process. I think Big Data in our case is really a supportive device.

Also, next year at Leipzig, [Ottobock] will present our first big steps in digital manufacturing, with orthotics scanned and 3-D printed.

I think this … evolution will start in orthotics. Many people look at the moment as [significant for] prosthetics, but I think orthotics will be the first.

Overall, I think the future is bright; we shouldn’t be scared. I’m fully convinced.

Josephine Rossi is editor of O&P Almanac. Reach her at jrossi@ contentcommunicators.com.

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O&P ALMANAC | DECEMBER 2017

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THE GLOBAL PROFESSIONAL

Saeed Zahedi, OBE, FREng, BSc, PhD, FIMechE, CEng, RDI London

S

AEED ZAHEDI, OBE, FREng, BSc,

In honor of the Second O&P World Congress, held in conjunction with AOPA’s 100th anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a question-and-answer section with international O&P experts.

Each month, we spotlight an O&P professional from a different part of the world to find out how O&P is practiced across the globe.

Saeed Zahedi, OBE, FREng, BSc, PhD, FIMechE, CEng, RDI

London

PhD, FIMechE, CEng, is the technical director of Chas A. Blatchford & Sons and manages research and development; he also is a visiting professor of biomedical engineering.

In September, Zahedi was awarded AOPA’s 2017 Lifetime Achievement Award. He was named in the Queen’s Birthday Honors list earlier this year for Services to Engineering and Innovation. He received a Special Commendation in the Prince Philip Designer prize in 2011, and was honored with the British Health Trade Association Lifetime Achievement Award for nearly 40 years of service in prosthetics and orthotics in 2013.

Zahedi has received several prizes for scientific papers and numerous additional awards. He has served as chair of the U.K. International Society for Prosthetics and Orthotics (ISPO) and as a member of protocol and scientific committees. He has authored or co-authored more than 125 scientific papers and 35 patents.

O&P ALMANAC: Please tell us a little

about your company, your position and responsibilities there, and how your company contributes to O&P innovation.

SAEED ZAHEDI, OBE, FRENG, BSC, PHD, FIMECHE, CENG, RDI: Chas A.

Blatchford and Sons Ltd. was formed 128 years ago, and from the onset,

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DECEMBER 2017 | O&P ALMANAC

innovation was the mantra. Today Blatchford employs over 300 clinicians (CPOs) and cares for more than 15,000 amputees and 40,000 orthotic patents.

Forty years ago, Brian Blatchford (father of current Executive Chairman Stephen Blatchford) made a resolution to change and improve for the better what was offered to amputees as he thought they could be doing more. He set about studying engineering, and the first application of engineering in prosthetics led to the creation of the first modular assembly prosthesis (MAP), enabling the introduction of amputee lifechanging functional design. This also led to the divergence of our industry into products and services and the creation of today’s prosthetist profession. The MAP system, although highly functional, was heavy, and with the first introduction of carbon fiber composite over 30 years ago, it was possible to reduce the weight of below-knee prostheses to 1 kg (2.2 pounds) and above-knee prostheses to 1.5k g (3.3 pounds). This was the birth of the Endolite system from Blatchford, the first endoskeletal lightweight prosthesis.

I started my career in the evaluation of various MAP systems in Scotland for the U.K. government and joined Blatchford at the right time to be part of the team that achieved the goals of the Endolite product range, as we showcased the full range in

Japan in 1989. Over the last 28 years, Blatchford has continuously raised the innovation bar. This has been driven to a large extent by the demands and needs of U.S. amputees. Most recently, the company has released the first Integrated Prosthesis, Linx, allowing ankles and knees to continuously talk to each other. Today’s O&P world is dominated by advanced technology, concurrently leading the health economic justification for these devices for payors as well as all other stakeholders.

O&P ALMANAC: Please tell us a little

about your university position and your responsibilities there.

ZAHEDI: I started my career in Scotland as a research assistant at the University of Strathclyde and was responsible for the study of alignment of lower-limb prostheses as well as the supervision of students in O&P and postgraduate biomedical engineers.

Later I worked for the health service, responsible for introducing the first clinical gait analysis services for amputees, stroke adults, and cerebral palsied children. I was responsible for postgraduate research at the University of Dundee in orthopedic engineering.

When I joined Blatchford in England, I became visiting staff at

University of Surrey in biomedical engineering, responsible for O&P research projects and teaching, and, until recently, served as a visiting professor supporting the department.

Now I am a visiting professor at Bournemouth University and Hertfordshire University, and I will try to help as much as I can in advancing their research programs. With a number of other universities, I have additional responsibilities, including as an external examiner for master’s and doctorate degrees; teaching, lecturing, and mentoring students; and spinoffs to extensive collaborative research on specifying the needs through validation, outcome measures, and developments of future technologies that will impact the O&P industry in the coming years.

O&P ALMANAC: Can you explain the

types of O&P research that you are involved in? What are you studying, and what are your expectations for future research projects?

ZAHEDI: There are two trends in current research driven by a common objective—namely, reduction in healthcare costs while addressing the aging population, the increased number of individuals with disabilities, the reduced number of care professionals,

the increased expectations of users, and the need to enhance their mobility.

The first trend, in lower-limb mobility, is the integration of lowerlimb joints and segments. The Linx paved the way in prosthetics, and the next version will provide additional enhancement. The road map is full of greater and closer integration with body interfaces and sensors. This platform technology is based on the new underlying science of biomechanics and biomimetics, which is common in lower-limb orthotics, too. So this trend of research promises future integrated highly functional products, which will be full of sensors and actuators linked through artificial intelligent microprocessor control, ready to accommodate and receive external power to enhance independence and activities by many users.

Another trend is the use of smarter products, integrated to a smarter supply chain, and smarter manufactured—mass-produced knowledge-based customization of products made to suit and fit the individual. This will effectively integrate the products and the services—the so-called servitization—which will transform the future offerings of O&P through advance scanning, intelligent knowledge-based rectification, 3-D additive manufacture of soft interfaces with integrated sensors locally made, housed in structural modules made at that district level.

With closed-loop sensory feedback linked into the supply chain, with increased self-sensing, the more accurate prescription and fitting of devices promises more cost-effective and enhanced solutions to mobility of disabled people in future O&P. I think in the next five years, we should see changes as these two trends come together and define the next phase of renaissance in O&P that we are witnessing. The integration of products and services has the potential to break the walls, and the falling walls will provide access and openness for the birth of new solutions to enhance amputee life, which will bring new standards in care and rehabilitation.

O&P ALMANAC | DECEMBER 2017

43

O&P ALMANAC: Please tell us a little

about the inventions that you have patented and your work in developing the Linx.

ZAHEDI: With Linx, we replaced the fundamental building blocks of a microprocessor-controlled ankle joint and a microprocessor knee joint with a new controller that also required new hardware. A central control unit linking the ankle and knee control systems has a Bluetooth communication link between the Linx central controller and a remote programming device such as a PC or apps. The mechanical hardware integrates with a molded frame to house a battery pack, flexi PCB, user operational button interface, charging point, and power switch controlling the electronic hardware.

The flexi PCB technology enables us to optimize for available space by reducing the number of connectors. These required a single power source and charging point, as the user required extended battery life through using lithium ion battery technology, which required additional safety circuitry when compared to previous battery technologies. Specialist cabling to transfer power and signals between the ankle and knee within a confined space was one of many challenges the team faced.

The patent is about the inter-relation of the ankle and knee damping simulating muscles in walking, standing, sitting, going up and down a ramp, ascending and descending stairs, and moving from sit to stand and stand to sit, all aimed at producing equal loading on both limbs on all terrains.

The firmware control the hydraulic valve in the knee for the high- to low-resistance direction at high speed, enhanced communication protocols between the central processor unit and knee, and also between the central processor unit and ankle to facilitate the additional information being transferred with higher throughput aggregation between centralized control and local joint control to provide synchronized operation while also ensuring that safety critical tasks are not compromised.

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DECEMBER 2017 | O&P ALMANAC

Additional calibration algorithms for self-calibration and automatic adjustment are core parts of Linx technology. This patent complements a family of other patents on a hydraulic ankle that provides continuous ground compliance and its microprocessor version, which provides assistance and brakes on slope, combined with an augmented vacuum connected to a natural vacuum dry skin liner suspension as an integrated patented device enhances the suspension and paves the way for total integration and total connectivity, total feedback, total adjustability, and total control that amputees have over their prosthesis.

ISPO and the World Health Organization have reviewed the standards to help education and training aimed at paving the way for wider educational offerings.

O&P ALMANAC: How are new

orthotists and prosthetists being educated in your country? What are some of the new techniques or processes they are studying?

ZAHEDI: O&P education in the U.K. has been, until recently, enjoying the benefits of additional funding by the government as well as being concentrated around biomedical engineering research centers of excellence. This is in the form of Strathclyde and Salford Universities in the U.K. With changes in funding and the possible reduction of O&P research

in associated biomedical engineering groups, we as the main U.K. industry have tried to fill possible gaps with other O&P collaborative research with a large number of other universities.

This is not, in my view, to the scale of U.S. Department of Defense research funds, but in relative scale to U.K. size, which has produced great results with tremendous support of U.K. academia for the training and research of O&P professionals, and keeping O&P topics at the top of the agenda for research fund managers.

However, the future outlook is not very great, and our aim now is about encouraging more people to take on the O&P profession with pathways leading to become CPOs. There are also significant shortfalls in the number of technicians to support the clinicians. ISPO and the World Health Organization have reviewed the standards to help education and training aimed at paving the way for wider educational offerings. I hope this will make some impact at a global level, but what is needed for all life sciences subjects is greater and deeper collaboration between all stakeholders, and in my view it needs to be led by small enterprises for sustainability.

Hence, funding should be made available to enable small- to medium-size entities to be freed, enabling them to take on such a role and bring payors, users, academics, educationalists, professionals, and other health-care providers with industry together as a greater O&P family united to meet the challenges and make O&P more attractive and exciting for fresh new entrants.

O&P ALMANAC: If there are any

circumstances where you do see patients, please explain those circumstances, and how you provide O&P solutions for those patients.

ZAHEDI: We are lucky that we have a number of research CPOs to carry out the experimentation within R&D and enable our team of design engineers and scientists to get first-hand feedback. We have some research patients

who are actually a direct part of the R&D team. More importantly, having direct access to a large number of patients and being able to meet them routinely and freely and help to solve some of their issues provides a deeper insight of their needs that they themselves may not be aware of.

We also are obliged to do more with less, which is a real engineering challenge for the 21st century. Hence we need to go under the skin of issues that amputees face, and for that you need to be very close to them, in a way live with them, as they are also the ones who show you the solutions. In my journey, that has been vital in what we have achieved to date.

O&P ALMANAC: Can you share any

information about reimbursement for O&P services in your country: How are the devices you provide paid for?

ZAHEDI: In the United Kingdom, the main services today are offered by the National Health Service (NHS) (95 percent), and some 5 percent by insurance and private care providers.

In recent years, we were able to provide sufficient systematically reviewed evidence to introduce an offering of microprocessor knees under NHS policies. We have decades of practice in providing clinical evidence on the benefit of what we design.

In a way, we also were the first to introduce the underlying science as the reason for prescription and subsequent justification for payment.

This has been the culture of NHS and now extended worldwide. The key issue has been the period of availability of devices for collection of sufficient statistically valid data, which can be scrutinized and is independent of the manufacturer in terms of funding.

I think with the help of AOPA and some other manufacturers, we may have broken this impossible cycle, along with the assistance of the RAND Corp. in coming up with simulation models that can replace and be used for determining the dollar value of the benefit of what is offered and justify

We also are obliged to do more with less, which is a real engineering challenge for the 21st century.

the economics of health care. I am glad that our effort singularly focused on working for amputees’ needs—such as reducing the risk of falls, reducing low back pain, reducing skin dermatological problems, and reducing pain and discomfort as well as abnormal high level of anatomical joint loads through reduced compensation—has paid off and kept us again one step ahead of others.

O&P ALMANAC: Describe your own

educational background and any certifications you have. How do you keep your skills sharp?

ZAHEDI: After high school and A Levels in the United Kingdom, I did a degree in mechanical engineering with final year honors options in biomedical engineering and CNC programming.

My final year project was the study of fluid mechanics in pulsatile flow of synthetic artery. That led me to apply for a master’s in biomedical engineering at Strathclyde, and my project was to develop a device to measure the alignment of lower-limb prostheses for assessment of functionality of the MAP system. I then was employed by the university, and my continuous education started through training and work with amputees.

I completed several other courses to enable me to work as clinical physicist in the NHS and then chartered engineer, innovation management, and more recently diploma for chartered director.

Recently, through activities of participation in major research grants, as well as developing international

global standards in rehabilitation robotics and O&P with advances in technology, I naturally found myself updating my knowledge, as without knowing the latest and how they are inter-related, I could not be as effective in my job.

O&P ALMANAC: What are your

predictions about the future of the orthotics and prosthetics profession?

ZAHEDI: Servitization—the integra-

tion of products and services—is my prediction. Customized bespoke at the price of mass-produced parts fitted precisely to individuals, with self-sensing and self-adjusting, perhaps self-fitting one day, for at least 50 percent of users. There are 10 million amputees (global) presently, and only sufficient CP numbers to fit 4 million of them, in my estimation.

Smarter products, with self-sensing, adjustable interfaces, are already being evaluated. Through a smarter connected supply chain, this dream is already becoming a reality. The cloudbased systems enable reaching much larger populations and open access to provide care for prolonged independent living and restore functions to enable greater social participation.

Naturally, the application of power to prostheses will be, in my view, the standard for the future of lower-limb devices. I am glad the pace of technology is fast enough, and our great O&P family is receptive and motivated enough, for these major developments to take place in my lifetime.

O&P ALMANAC | DECEMBER 2017

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Grace Prosthetic Fabrication

COMPANY: Grace Prosthetic Fabrication OWNERS: Ed Grace and Tony Culver LOCATION: New Port Richey, Florida HISTORY: 27 years

Use of the Grace Plate became so widespread that the company has had to defend its trademark to prevent the name being used to refer to any four-hole plate. “There is only one original,” Culver says.

Twenty-three years ago, Grace Prosthetic Fabrication became one of the first central fabrication facilities to use computer-generated socket design and manufacturing.

“We were always trying to adapt to new industry standards and in 1994 we began using the CAD/ CAM system, which was new to O&P,” says Ed Grace. “It changed the industry and became popular among practitioners. Still, some practitioners today prefer not to use the system, so we work from casts we get in the mail as well as from scans and other digital files.”

Technicians at the facility are experimenting with 3-D printing.

“It’s fascinating what you can do with a piece of plastic string, and I think 3-D printing will eventually have a strong presence within our industry,” Culver says. “Right now, the potential is limited as the materials are only strong enough for upper-extremity devices, but the technology will come.”

In addition to devices, Grace offers custom laminations, a

process that allows technicians to personalize the exterior of an artificial limb. “We feel allowing patients to customize the look of their prosthesis makes them more confident when wearing it, and it becomes an expression of their personality,” says Culver.

Grace offers approximately 1,500 standard patterns, but patients have the option of choosing a customized pattern more reflective of their personality or interests.

Grace markets its products through magazine ads and trade shows, with Culver attending 12 to 15 shows each year. He notes that when the business started, he attended only seven meetings—five regional and two national. “Today, just about every state has an annual meeting,” he says. “There is no way I can attend all of them, so I have to select which states to visit.”

The company has a marketing professional on staff who maintains a presence on social media outlets, including Facebook and Twitter. The company website features downloadable order forms and online payment capabilities.

Customers can access support via a toll-free number or email.

Being an active community member is essential to the foundation and success of any small business, notes Grace, and the company donates both products and services to various organizations in Florida, Puerto Rico, and the Philippines.

Looking ahead, Grace anticipates continued growth and product expansion using new technologies. “We strive to be innovative to keep up with a constantly changing industry,” he says. “At the same time, we want to maintain our foundation as a small business remembering the old way of doing things.”

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

PHOTOS: Grace Prosthetic Fabrication

S A YOUNG MAN, Ed Grace got his start in O&P working in an orthopedic operating room in West Virginia. In that capacity, he met two certified prosthetist/ orthotists from Parmeco Inc. in 1979 and soon went to work for Parmeco himself, remaining there until 1986. Grace later moved to Florida to work in the prosthetics department at Dobi-Symplex and then for a brief time as a partner in another central fabrication facility.

In 1990, he decided to open his own business with his father and younger brother, Tony Culver, joining him.

When Grace Prosthetic Fabrication began, it was all family: Parents Bill and Charlene Grace worked in the office while Ed and Tony worked in fabrication. Today, Grace Prosthetic Fabrication has 12 additional employees and serves customers throughout the United States.

Grace’s 5,000-square-foot facility was built specifically for O&P fabrication, with underground vacuum lines to keep noise levels down within work spaces. The company produces a full range of orthotic and prosthetic devices, as well as spray skins and hydrographic printing.

Its flagship product is the Grace Plate. The plate—now ubiquitous in the industry—was developed out of necessity, explains Culver.

“The standard square four-hole plate had to be placed just right to align with the socket before it was laminated,” says Culver.

“We realized that if the plate was round, we could align it after the socket was made and drill the four holes as a final step when you could see inside the socket.”

By DEBORAH CONN

AOPA Coding Experts Are Coming to

Products & Services

Atlanta

FOR ORTHOTIC, PROSTHETIC & PEDORTHIC PROFESSIONALS

February 26-27, 2018

ATLANTA

FEB. 26-27 | 2018

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA February 26-27, 2018, in Atlanta to advance 14 CEs your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics.

EARN

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

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

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.

Doubletree by Hilton Atlanta Airport 3400 Norman Berry Dr Atlanta, GA, 30344

Book by February 2 for the $119 room rate.

Find the best practices to help you manage your business.

Participate in the 2018 Coding & Billing Seminar!

Register online at bit.ly/2018billing.

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

www.AOPAnet.org

MEMBER SPOTLIGHT

J&J Artificial Limb and Brace

Pediatric O&P Patient base at West Coast facility trends on the youthful side

J

ASON FRIEDMAN, CPO,

started down the O&P path as a student in a Jesuit high school in Detroit, Michigan. As part of his required volunteer service, he worked at a hospital making stretching devices for children recovering from burn injuries, and later orthoses for patients with closed-head injuries. A stint at the Rehabilitation Institute of Michigan and volunteer work at Wright & Filippis ultimately led him to California for his O&P education.

Jason Friedman, CPO, works with a young patient.

Friedman worked for other facilities after gaining his certification, but he knew he wanted to be his own boss. He met and then married his wife, Esperanza, who is a certified orthotist, and the couple decided to open their own practice in 2001.

“I’m a workaholic,” explains Jason Friedman. “I may get paid to work 8 to 5, but I’ll be there until 10 or midnight. I figured if I was going to be doing that, I wanted to be doing it for myself,”

FACILITY: J&J Artificial Limb and Brace OWNERS: Jason Friedman, CPO, and Esperanza Friedman, CO

HISTORY: 16 years

Braces display some of the patterns that can be laminated on orthoses.

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DECEMBER 2017 | O&P ALMANAC

work with amputees as well as patients who have spina bifida, cerebral palsy, scoliosis, muscular dystrophy, plagiocephaly, and certain genetic disorders.

J&J has a fabrication lab in its Poway office, and the facility also uses some central fabrication services. The Oceanside facility is set up for making minor adjustments.

While J&J uses traditional casting methods to fabricate most devices, the facility is dipping a toe into the use of more advanced techniques. “We‘re just playing with some of the computer-aided design and manufacturing techniques,” Friedman says. “We’re also doing some 3-D printing, especially with device covers.”

Friedman markets his practice through social media, visits to referral sources, and general word of mouth. “We use Instagram to show kids and parents what a brace will look like,” he says.

Friedman enjoys drawing images to decorate devices for both children and adults; his work has included a dragonfly with the initials of a patient’s children woven into the design, a panda bear, and funny dog pictures for kids.

J&J maintains a strong presence in the community, participating in events mounted by the San Diego Spina Bifida Foundation, including parties and a summer camp for kids with disabilities.

Looking ahead, Friedman says he eventually would like to expand to three offices in the area, but otherwise, he is content to stay relatively small. “I’m not looking to open 600 facilities,” he says. “You’d lose a lot of control and quality once you got that large. We want to stay nice and small, so we can continue to take all the time we need to get to know our patients and give them the best care possible.”

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

PHOTOS: J&J Artificial Limb and Brace

LOCATION: Poway and Oceanside, California

he says. “Also, I never felt that I had enough time with patients when I worked for someone else.

It was all about the numbers.

“Our philosophy at J&J is that we spend real time with patients—one to two hours is not abnormal. We work a lot with children, so getting to know the families and the child is critical.

They become part of our family.”

J&J’s two offices, in Poway and Oceanside, California, are located about a half-hour’s drive apart and serve San Diego and South Orange County. In addition to the Friedmans, the company has nine employees, including three CPOs and one staff member who is preparing to become a certified orthotic assistant.

Pediatrics accounts for about 85 percent of Friedman’s caseload and about 75 percent of the facility’s overall business. Clinicians

By DEBORAH CONN

amp Sean’s story is an example of a successful fight for access to prosthetic care.

If you and your patients are experiencing Insurance challenges, visit AmplifyYourself.org to tell insurance executives and legislators that no is not an answer.

The Amplify initiative is turning up the volume to make sure everyone has access to the care that they need.

Sean told his insurance company that “No” was not an answer. Read his story at AmplifyYourself.org and share yours today.

AOPA NEWS

AOPAversity Webinars DECEMBER 13

2018 WEBINARS

2018 Webinar Topics Announced Mark your calendars for AOPA’s 2018 monthly webinars.

These informative sessions take place on the second Wednesday of each month at 1 p.m. Eastern Time.

2018 Webinars • January 10: Lower-Limb Prosthesis Policy: A Comprehensive Review • February 14: Inpatient Billing

New Codes and Other Updates for 2018 Prepare for the new year by getting a head-start on the coding changes for 2018. Take part in the December 13 webinar, during which participants will: • Learn about new Health-Care Common Procedure Coding System codes that will take effect Jan. 1, 2018 • Find out which codes will no longer be used as of Jan. 1, 2018 • Discuss verbiage changes to existing codes and how they may affect O&P businesses • Hear AOPA’s interpretation of why the changes are taking place • Look at other pertinent policy and legislative changes that of which O&P facilities should be aware in order to succeed in 2018.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2017webinars.

Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

• March 14: Medicare Coding Guidelines: MUEs, PTPs, PDAC, and More • April 11: Enhancing Cash Flow and Increasing Your Accounts Receivable • May 9: Coding: Understanding the Basics • June 13: Audits: Know the Types, Know the Players, and Know the Rules • July 11: Administrative Documentation • August 8: Outcomes & Patient Satisfaction Surveys • September 12: Medicare as Secondary Payor: Knowing the Rules • October 10: Year-End Review: How To Wrap Up and Get Ready for the New Year • November 14: Evaluating Your Compliance Plan and Procedures: How To Audit Your Practice • December 12: New Codes, Medicare Changes, and Updates During these one-hour sessions, AOPA experts provide the most up-to-date information on a specific topic.

Webinars are perfect for the entire staff—they’re a great team-building, money-saving, and educational experience!

Sign up for the entire series and get two conferences free.

Entire Series ($990 Members/$1,990 Non-Members).

Register at bit.ly/2018webinars.

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DECEMBER 2017 | O&P ALMANAC

NEW MEMBERS

T

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

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

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

Desert Prosthetics & Orthotics 68-860 Perez Road, Ste. G Cathedral City, CA 92234 Member Type: Patient-Care Facility 760/770-4620 Neal Collins, CPO

LeTourneau Lifelike Orthotics & Prosthetics Inc. 2452 Calder Street Beaumont, TX 77702 Member Type: Patient-Care Facility Sandra LeTourneau, LO 409/832-5005

Ferrier Coupler Options!

North Carolina Orthotics & Prosthetics of Goldsboro 1306 Wayne Memorial Drive Goldsboro, NC 27534 Member Type: PatientCare Facility William “Bill” Stauffer, CPO 919/736-1010

MedSupply Corp.

24455 Goddard Road Taylor, MI 48180 Member Type: PatientCare Affiliate Parent Company: MedSupply Corp., Troy, MI 734/992-6975

MedSupply Corp.

7719 Graphics Way, Ste. E-1 Lewis Center, OH 43035 Member Type: Patient-Care Affiliate Parent Company: MedSupply Corp., Troy, MI 740/879-3657

Snell Prosthetic & Orthotic Laboratory 612 Post Office Park Drive Bryant, AR 72055 Member Type: Patient-Care Affiliate Parent Company: Snell Prosthetic & Orthotic Laboratory, Little Rock, AR 501/847-8889 Brant Snell

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

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

Model A5

Model F5

Model P5

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

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

The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

Model FA5

Model FF5

Model FP5

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

Female portion of coupler accepts a pyramid.

Model T5

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

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

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

The unit is waterproof and has a traction base pad.

O&P ALMANAC | DECEMBER 2017

51

AOPA O&P PAC

Special Thanks to the 2017* PAC Contributors AOPA would like to thank the following individuals for their contributions in 2017 to the O&P PAC: PRESIDENT’S CIRCLE ($1,000-$5,000) Robert Arbogast David Boone, BSPO, MPH, PhD Jeffrey Brandt, CPO J. Martin Carlson, CP

Rick Fleetwood, MPA Denise Hoffman Aaron Moles, CPO Michael Oros, CPO, LPO, FAAOP

Rick Riley John Roberts Jr., CPO Bradley Ruhl Scott Sabolich, CP Scott Schneider

Mark Smith, CP Bernie Veldman, CO Jim Weber, MBA

Robert Leimkuehler, CPO William Leimkuehler, CPO, LPO Pam Lupo, CO Jeffrey Lutz, CPO Martin McNab, CPO Andrew Meyers, CPO Walter Racette, CPO(E)

Dale Sheen, CO Chris Snell, BOCP Ronald Snell, CP Matt Swiggum Frank Vero, CPO

Arlene Gillis, CP, FAAOP Eddy Gosschalk, CPO Michele Hogan Ralph Hooper, CPO Jack Jones Jr., BOCO, CO James Kaiser, CP, LP Jim Kingsley, COO Alfred Kritter, CPO, FAAOP Eileen Levis Sam Liang Anita LibermanLampear, MA Elizabeth Mansfield

Dave McGill Steve McNamee, CP, BOCO, FAAOP Wendy Miller, BOCO, CDME Catherine Mize, CPO Jonathan Naft, CPO Chris Nolan Curt Patton, CP Ricardo Ramos, CP, LP, CPed Jack Richmond, CPOA Ivan Sabel David Sisson, CP William Snell, CPO

Jack Steele, CO Jay Wendt, MBA Jeff Wensman, CPO Eddie White, CP Shane Wurdeman, MSPO, PhD, CP, FAAOP James Young Jr., CP, LP, FAAOP Pam Young

Don DeBolt Esperanza Friedman, CO Ryan Gleeson Elizabeth Hammer, BOCO, CFO

Steven Herrera, CPO Betty Leppin Brad Mattear, LO, CPA, CFo Yelena Mazur Joseph McTernan

Kelly O’Neill, CEM Don Pierson, CO, CPed Dewain Ritchie Duane Romo, CPO Ashlie White

SENATOR’S TABLE ($500-$999) Jeffrey Alaimo, CP Jim Campbell, PhD, CO, FAAOP Doyle Collier, CP Jeff Collins, CPA Edward De La Torre Thomas DiBello, CO, LO, FAAOP

Ted Drygas, CPO A.J. Filippis, CPO K. Michael Fillauer, CPO Elizabeth Ginzel, CPO, LPO Michael Hamontree John Kenney, CPO, FAAOP Curt Kowalczyk, CO Teri Kuffel, Esq.

CHAIRMAN’S TABLE ($100-$499) Lisa Arbogast Vinit Asar Gerald Bernar Jr., CP, LP Frank Bostock, CO George Breece Erin Cammarata Rod Cheney, CPO, FAAOP Kenneth Cornell, CO Joseph DeLorenzo, CP Mitchell Dobson, CPO, FAAOP Traci Dralle Tom Fise, Esq.

1917 Club (Up to $99) Lauren Anderson Devon Bernard William Carver Tina Carlson, CMP Robert Compton, CPed 52

DECEMBER 2017 | O&P ALMANAC

AOPA O&P PAC

2017 PAC Supporters These individuals have generously contributed directly to a political candidateâ&#x20AC;&#x2122;s fundraiser and/or have donated to an O&P PAC sponsored event.

Lauren Anderson Lisa Arbogast Vinit Asar Rudolf Becker III Tina Carlson, CMP Jeff Collins, PCA Thomas Costin Don DeBolt Traci Dralle, CFm Thomas F. Fise, JD

Rick Fleetwood Ryan Gleeson Lisa Guichet Scott Guichet Maurice Johnson, CO James Kaiser, CP Teri Kuffel, Esq Stephanie Langdon, CPO, FAAOP Betty Leppin

Sam Liang Pam Lupo, CO Jeffrey Lutz, CPO Yelena Mazur Joseph McTernan Kelly Oâ&#x20AC;&#x2122;Neil, CEM Michael Oros, CPO, LPO, FAAOP Rick Riley Scott Schneider

Stephen Schulte, CP, FAAOP Chris Snell, BOCP Clint Snell, CPO Peter Thomas, JD Jim Weber, MBA Ashlie White Shane Wurdeman, MSPO, PhD, CP, FAAOP

In 2017 the O&P PAC made contributions to the following members of Congress: Sen. Tom Carper (D-Delaware) Sen. Bill Cassidy (R-Louisiana) Sen. Jeff Flake (R-Arizona) Rep. Mike Bishop (R-Michigan) Rep. Brian Mast (R-Florida) Rep. Richard Neal (D-Massachusetts) Rep. Dutch Ruppersberger (D-Maryland) Rep. Glenn Thompson (R-Pennsylvania) Rep. Brad Wenstrup (R-Ohio)

AOPA O&P PAC

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate to educate them about O&P issues and to help elect those individuals who support the O&P community.

To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@aopanet.org.

* Due to publishing deadlines, this list was created on Nov. 16, 2017, and includes only donations and contributions made or received between Jan. 1, 2017, and Nov. 16, 2017. Any donations or contributions made or received on or made after Nov. 16, 2017, will be published in the next issue of O&P Almanac.

O&P ALMANAC | DECEMBER 2017

53

MARKETPLACE

Feature your product or service in Marketplace.

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

Visit bit.ly/almanac17 for advertising options.

ALPS Anterior Posterior Tapered Liner ALPS New AP Tapered Liner is gradually tapered from the anterior to the posterior to provide superior comfort.

This liner is available in a pin-and-locks system or suction suspension. The AP Tapered Liner features our black high-performance fabric with gel to assist in reducing bunching in the popliteal region.

For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com.

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.

Foam Box Lab Services for Diabetic, EVA, and Rigid Orthotics FootPrinter allows you to send your own boxes or use ours. Standard EVA orders manufactured in three to four business days; diabetic A5513, carbon fiber, and polypro in three to five days.

PDAC-approved A5513 diabetic pricing includes shipping costs for bi-lam and tri-lam styles. EVA available in soft, medium, dual, firm, and cork blend. Carbon-fiber fabrication offered in flex or firm to best suit your patient. Milled polypropylene available in three widths and thicknesses for excellent fit and wear.

Get started right away by emailing orders@amfit.com for an account form, or call 800/356-FOOT.

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DECEMBER 2017 | O&P ALMANAC

Pediatric V-VAS™ The Pediatric V-VAS™ custom knee-ankle-foot orthosis (KAFO) is fabricated for your young patients who present or require treatment for all lower-limb bowing deformities. The dynamic V-Vas™ joint system allows for sequential correction of the deformity and allows for accommodation of growth with outstanding patient compliance. It is the only system that creates a bending moment that maintains the fourpoint correction throughout the full range of knee motion. The KAFO design is adaptable to incorporate a medial or lateral Step lock or Drop lock joint opposite of the V-VAS joint to simplify straightening adjustment and increase knee stability if needed.

For more information, call 800/837-3888 or visit www.AnatomicalConceptsInc.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 800/301-8275 or visit www.hersco.com.

Ottobock’s ProFlex™ Plus Sealing Sleeve Countdown to flexibility for you and your patients with Ottobock’s ProFlex™ Plus Sealing Sleeve • Three colors and sizes • Two lengths • #1 choice.

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

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

Check out professionals.ottobockus.com for details.

MARKETPLACE precision. power. intelligent motion.

2017 AOPA Coding Products

Now available in four sizes!

Call us today to learn more about our new i-limb™ quantum.

For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

AOPA Compliance Guide CD—Updated This Compliance Handbook helps patient-care facilities follow the fraud and abuse prevention guidelines recommended by the Office of the Inspector General. This product will assist you in developing a compliance plan for your facility, including guidelines for developing a standard of conduct, billing policies and procedures, and much more. With the help of the AOPA Compliance Handbook CD, you will be able to create an effective audit/ quality assurance program to monitor compliance and conduct introductory training sessions for employees.

• AOPA Compliance Guide CD—Updated: $159 AOPA members, $318 nonmembers

Get your facility up to speed, fast, on all of the O&P HealthCare Common Procedure Coding System (HCPCS) code changes with an array of 2017 AOPA coding products. Ensure each member of your staff has a 2017 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

Order at www.AOPAnet.org or call AOPA at 571/431-0876.

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.

O&P ALMANAC | DECEMBER 2017

55

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Southeast

CPO, CO

Job location key:

South Carolina

- 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.

Floyd Brace Company Inc. is currently seeking hard-working, skilled, certified prosthetic/orthotic practitioners for our South Carolina territory. CPOs and COs must possess a strong clinical background. Compassion, quality, and timeliness of care are important aspects to provide our patients. We offer competitive salary, medical, dental, and vision benefits.

Additionally, retirement plan options are available.

Candidates must possess ABC certification and experience for each discipline.

Contact: Human Resource Department Email: niki@floydbrace.com

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

Make Your First Impressions Count

NE

With Customized Polo shirts, Scrub tops and Lab Coats for your O&P staff

Create an attractive business image, promote your brand, and foster team spirit with AOPA’s new Apparel Program.

To order your apparel, go to

iconscrubs.com

AOPA Polo Shirts–Now for Sale

Celebrate AOPA’s Centennial with us by ordering AOPA polo shirts for your office! The shirts are black with a white AOPA logo. Moisture wick, 100 percent polyester. Rib knit collar, hemmed sleeves, and side vents. The polos are unisex but the sizes are men’s M-2XXL. $25 plus shipping. Order in the bookstore at bit.ly/aopastore.

Enter access code: ICON-AOPA Enter your AOPA member id Create your user profile AOPA is partnering with Encompass Group, a leading provider of health care apparel, to offer members special prices on customized polos, scrub tops, and lab coats.

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DECEMBER 2017 | O&P ALMANAC

POLO TS SHIR

B SCRU TOPS

LAB COAT

W

!

NEW RELEASE!

How Does Your Business Measure Up? Use AOPA’s Benchmarking Survey Results to Find

YOUR COMANY’S SCORECARD based on 2016 data:

BENCHMARKING: the process of comparing one’s business processes and performance metrics to industry bests.

Performa

COMPANY REPORT A VALUABLE RESOURCE FOR BUSINESSES IN THE O&P INDUSTRY

erated Sales Gen e ye lo p m Per E oods Sold

Cost of G

tion &

Compensa Benefits

AOPA Products & Services

OPERATING PERFORMANCE

For Orthotic, Prosthetic & Pedorthic Professionals AOPA PRODUCTS

COMPANY REPORT A VALUABLE RESOURCE FOR BUSINESSES IN THE O&P INDUSTRY

REPORT

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

BENEFITS REPORT AOPA COMPENSATION AND

AOPA

Good

rgin

AOPA PRODUCTS

AM ERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Best

ork Needs W

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ARD

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2017

PUBLICATIONS. EDUCATION. SERVICES. Everything you need to manage a successful patient care facility.

2017 Annual Operating Performance Report

2017 Operating Performance Report member/nonmember $185/$325

and

2017 Compensation and Benefits Report member/nonmember $185/$325

2017 Bi-annual Compensation and Benefits Report

ORD

E

DAY O T R

To order, visit www.aopanetonline.org/store. For more information contact bleppin@aopanet.org or call 571-431-0810.

CALENDAR

2017

January 8-13

December 7-9

Shirley Ryan AbilityLab: Elaine Owenâ&#x20AC;&#x201D;Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management.

Chicago. 25.5 ABC credits. For more information, contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/education.

December 13

New Codes and Other Updates for 2018.

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

WEBINAR

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

January 10

Lower-Limb Prosthesis Policy: A Comprehensive Review. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

January 19-20

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

2018 January 1

ABC: Application Deadline for March Written and Written Simulation 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.

Leadership Conference O&P

January 5-7

AOPA Leadership Conference. The Breakers, Palm Beach, FL. Top executives at each AOPA member company are invited to this exclusive event. Contact landerson@AOPAnet.org for more information.

Let us

your next event!

58

February 1

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

Free Online Training

Cascade Dafo Institute. Now offering a series of seven free ABC-approved online courses, designed for pediatric practitioners. Earn up to 10.25 CEUs. Visit cascadedafo.com or call 800/848-7332.

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

Questions? Email landerson@AOPAnet.org.

Calendar Rates

SHARE

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

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

January 26-27

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 2017 | 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 February 1

ABC: Application Deadline for Spring CPM Exams.

Applications must be received by February 1 for individuals seeking to take the May Practitioner CPM exams.

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

April 26-28

New York State Chapter Annual Meeting (NYSAAOP).

Rivers Casino & Resort, Schenectady, NY. For more information, visit www.NYSAAOP.org.

May 9

Coding: Understanding the Basics.

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

WEBINAR

February 14

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

WEBINAR

June 13

Audits: Know the Types, Know the Players, and Know the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

February 23-24

PrimeFare Central Regional Scientific Symposium 2018.

Renaissance Hotel, Tulsa, OK. Contact Cathie Pruitt, 901/359-3936, email primecarepruitt@gmail.com; or Jane Edwards, 888/388-5243, email jledwards88@att.net; or visit www.primecareop.com.

July 11

Administrative Documentation: The Must Haves and the Sometimes Needed. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

February 26-27

2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

Doubletree by Hilton, Atlanta. Register online at bit.ly/2018billing.

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

Coding & Billing Seminar

March 1

August 8

Outcomes & Patient Satisfaction Surveys.

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

WEBINAR

Call for Papers deadline. Deadline to submit your clinical, business, technical papers or symposia at bit.ly/present2018 to present at the 2018 National Assembly.

March 14

September 12

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

WEBINAR

Medicare Coding Guidelines: MUEs, PTPs, PDAC, and More. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

April 11

Enhancing Cash Flow & Increasing Your Accounts Receivable. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

September 26-29

AOPA National Assembly. Vancouver Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0876 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

ADVERTISERS INDEX Company

Page

Phone Website

Allard USA

16

888-678-6548

www.allardusa.com

ALPS South LLC

7

800-574-5426

www.easyliner.com

Amfit

9 800-356-3668

Amputee Coalition

49

800-267-5669

www.amputee-coalition.org

Anatomical Concepts

17

800-837-3888 / 330-757-3569

www.anatomicalconceptsinc.com

Cailor Fleming Insurance

5

800-796-8495

www.cailorfleming.com

Ferrier Coupler Inc.

51

810-688-4292

www.ferrier.coupler.com

Hersco

1 800-301-8275

Ottobock

C4 800-328-4058

Touch Bionics

23

855-694-5462

www.amfit.com

www.hersco.com www.professionals.ottobockus.com

www.touchbionics.com

O&P ALMANAC | DECEMBER 2017

59

ASK AOPA CALENDAR

Prescription and Billing FAQs Answers to your questions on repairs, emergency room billing, and more AOPA receives hundreds Q of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

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

Is a new prescription required 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. The only time a new prescription would be required is when you are replacing a major component to facilitate the repair.

Note that a new prescription is not required when you are providing replacement supply items, as long as they were listed on the original prescription.

A/

Can we have some of our locations/facilities be participating providers and some of our locations/facilities be nonparticipating providers?

Q/

The answer depends on how many Tax Identification (ID) numbers you have. The decision to be a participating provider or nonparticipating provider is tied to the Tax ID of a company and not to its locations or facilities. If you have multiple locations under one Tax ID, you may not have some locations be participating and some locations be nonparticipating providers.

A/

If an item is provided to a patient in the emergency room and the patient is not admitted to the hospital, may we bill Medicare?

What about if the patient is admitted to the hospital?

Q/

Orthotic and prosthetic items and services are excluded from the emergency room prospective payment system (PPS). If a patient visits the emergency room and is not admitted to the hospital, you may bill Medicare for the items provided during that visit.

However, if a patient is admitted to the hospital immediately following an emergency room visit, the hospital must pay for the item because orthotic and prosthetic items are not exempt from the inpatient hospital PPS. Any services or items provided on the day of admittance are covered under the PPS. Keep in mind that the hospital could refuse to pay you if it did not provide a purchase order.

A/

60

DECEMBER 2017 | O&P ALMANAC

What will the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier application fee be set at for 2018?

Q/

The anticipated 2018 Medicare DMEPOS supplier application fee is $569. The 2017 application fee is currently set at $560, and the fee varies from year to year based on adjustments found in the Consumer Price Index for Urban Areas (CPI-U). This year’s CPI-U has been established as 1.6 percent, resulting in an increase of $8.96 in the application fee.

A/

www.bocusa.org

EARN CREDITS AT YOUR OWN PACE www.AOPAnetonline.org/aopaversity

100+ TOP-QUALITY ORTHOTIC, PROSTHETIC, AND PEDORTHIC EDUCATION COURSES.

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14457 - 10/17 ©2017 Ottobock HealthCare, LP, All rights reserved.

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