December 2018 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

D E C E M B E R 2018

HCPCS Code and Fee Updates for 2019

This Just In: How Will Recent Policy Changes Impact O&P Patient Care? P.20

P.16

Exploring WHO's Global O&P Standards P.30

Developing and Validating Health Outcome Measures P.35

When To Use the KX Modifier P.52

E! QU IZ M EARN

The Gift of

Giving

O&P TRAVELERS SHARE EXPERIENCES AND OFFER TIPS FOR VOLUNTEERING OVERSEAS

P.22

2

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.18

YOUR CONNECTION TO

EVERYTHING O&P

TH E P R E MI ER M EE TIN G FOR ORTHOTIC, PROSTHETIC, AND P EDO RTHIC PRO FESSIO NALS.

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

#AOPA2019

Join AOPA next year in San Diego, known for incredible panoramic views. Located in the downtown Marina district, the San Diego Convention Centre has many top attractions within walking distance.

ADVANCE YOUR CAREER BY SUBMITTING A PAPER. Learn more at:

bit.ly/AOPACallForPapers

SOUTHERN CALIFORNIA

San Diego’s unbeatable location makes it the perfect gateway providing you with outstanding opportunities for pre- and post-conference travel.

AOPAnet.org

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contents

DECE M B E R 2018 | VOL. 67, NO. 12

COVER STORY

FEATURES

22 | The Gift of Giving This holiday season and every day, U.S. practitioners are heeding the call to help individuals in need of O&P care in less advantaged locations across the globe. Meet O&P clinicians who have traveled to Guatemala, Ghana, Mexico, Haiti, and other areas to volunteer their time and expertise to aid locals in need of O&P intervention, and learn how to network with colleagues and research the various international organizations to determine how to get involved.

By Meghan Holohan

20 | This Just In

Gaining Perspective on Policy Changes What effect will recent policy announcements have on O&P businesses? Find out what the publication of the recently revised “Dear Physician” letter and the November announcement regarding inclusion of off-the-shelf orthoses in competitive bidding will mean for O&P stakeholders.

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DECEMBER 2018 | O&P ALMANAC

30 | Common Practice O&P professionals in the United States can enhance their global understanding of care by reading this primer on the newly established “Global Standards for Prosthetics and Orthotics.”

The standards, published by the World Health Organization, focus on O&P policy, products, personnel, and provision of services and are designed to assist nations in improving their delivery systems to ensure appropriate O&P care.

By Christine Umbrell

contents

PRINCIPAL INVESTIGATOR Brian J. Hafner, PhD ...................................... 35 Meet a University of Washington faculty member who has dedicated his professional life to the development and validation of health outcome measures, the study of contemporary prosthetic technologies, and more.

DEPARTMENTS Views From AOPA Leadership......... 4 AOPA President Jim Weber, MBA, introduces the newcomers on AOPA’s Board of Directors

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

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

COLUMNS

P.16

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

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

The Road Ahead

New codes for 2019 and more changes on the horizon CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Member Spotlight................................. 39 n

KLM Laboratories

n

LeTourneau Prosthetics

P.10 People & Places........................................14

P.39

Transitions in the profession

AOPA News.............................................. 42 AOPA meetings, announcements, member benefits, and more

PAC Update.............................................. 44 Careers........................................................ 46 Professional opportunities

Marketplace............................................. 48 Ad Index..................................................... 49 P.40

Calendar..................................................... 50 Upcoming meetings and events

Ask AOPA...................................................52 Know the rules for the KX modifier

O&P ALMANAC | DECEMBER 2018

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VIEWS FROM AOPA LEADERSHIP

Welcome New Board Members

A

of AOPA’s Board of Directors, who officially take office Dec. 1, 2018, and serve through Nov. 30, 2019. I am honored and excited to continue to represent AOPA as its president for the 2018-2019 term. With this upcoming year, we welcome four new board members who are ready and determined to serve and advocate for our members.

J. Douglas Call, CP, joins the board in the position of director, 6-30 facilities, a two-year term vacated by Jeffrey Brandt, CPO, our new treasurer for the upcoming year. Call serves as president of Virginia Prosthetics & Orthotics Inc. His company, purchased in 1991, has more than 64 employees in seven clinics across Virginia. Call was the leading proponent in the successful effort to pass a bill in Virginia protecting an amputee’s right to obtain adequate health insurance coverage. In addition to his efforts in patient advocacy, Call is the founding member of the Virginia Orthotic and Prosthetic Association. He looks forward to extending his advocacy for the O&P community.

Linda Wise joins AOPA’s Board of Directors in the position of supplier 1 director for a three-year term. Since joining WillowWood in 2009, she has expanded its global distributorships, developed an outside sales staff, participated in a company rebranding, ushered the company through a website upgrade and redesign, and implemented the company’s first CRM system. In 2015, Wise assumed the role of chief marketing officer and currently oversees all sales, customer service, marketing, and product strategy. She personally manages U.S. distributor relations and continues to expand the company’s sales and distributor network in Latin America.

Wise is passionate about seeing individuals with limb loss presented with opportunities, service, and devices to improve their quality of life.

Kimberly Hanson, CPRH, joins the board as a director at-large for a three-year term. She is a director of reimbursement at Ottobock. Hanson and her team manage all coding, coverage, and reimbursement strategies for new and existing products at Ottobock, which include orthotics and prosthetics. Hanson also is a member of the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Advisory Councils for all four regions and recently became certified as a consultant for policy and reimbursement for health care. Hanson understands the pressures of reimbursement and the current climate and seeks to help AOPA members through these tough challenges.

Elizabeth Ginzel, MHA, CPO, joins the board in the position of director at-large for a one-year term vacated by Traci Dralle, CFM, AOPA’s new vice president.

Ginzel currently serves as regional director of operations for NovaCare P&O and is a licensed prosthetist/orthotist in the state of Texas. While practicing in orthotics, she completed the MS-HAIL program from the University of California—San Francisco.

In her current position at NovaCare, she enjoys having the ability to collaborate with other health-care professionals within the organization. Ginzel is no stranger to AOPA’s members, having served on AOPA’s Operational Performance and Compensation Survey Committee and the 2018 Assembly Business Workgroup.

Michael Oros, CPO, LPO, FAAOP, will serve a consecutive term as immediate past president, and Jeffrey Lutz, CPO, will assume the position of president-elect.

We will continue to benefit from the guidance of current board members Mitchell Dobson, CPO, FAAOP; Teri Kuffel, JD; Rick Riley; and David Boone, MPH, PhD. Together we welcome the addition of these experienced individuals to create a very talented and diverse board of directors. We look forward to leading AOPA into the new year. It is a true honor to serve our members and the O&P community.

Jim Weber, MBA, is president of AOPA.

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

S WE PREPARE TO bid 2018 farewell, I’d like to introduce the new members

DECEMBER 2018 | O&P ALMANAC

Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Vice President Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Immediate Past President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Executive Director/Secretary Eve Humphreys, MBA, CAE AOPA, Alexandria, VA DIRECTORS David A. Boone, BSPO, MPH, PhD Orthocare Innovations LLC, Edmonds, WA J. Douglas Call, CP Virginia Prosthetics & Orthotics Inc., Roanoke, VA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Elizabeth Ginzel, MHA, CPO NovaCare P&O, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Spring Lake Park, MN Rick Riley Thuasne USA, Bakersfield, CA Linda Wise WillowWood, Mount Sterling, OH

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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 Eve Humphreys, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC

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

Printing Sheridan

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

Eve Humphreys, MBA, CAE, executive director, 571/431-0807, ehumphreys@AOPAnet.org

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

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

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

Copyright © 2018 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

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

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.

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, kelly.oneill@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

SPECIAL PROJECTS Ashlie White, MA, manager of advocacy, outreach, and special projects 571/431-0812, awhite@AOPAnet.org

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

O&P ALMANAC

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

Eve Humphreys, MBA, CAE, executive director, 571/431-0807, ehumphreys@AOPAnet.org

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

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

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

6

Design & Production Marinoff Design LLC

DECEMBER 2018 | O&P ALMANAC

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

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers.

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

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NUMBERS

Geography Matters

O&P companies vary by size and business practices according to the types of communities they serve

AOPA’s “2018 Operating Performance Report” found that responses regarding facility size and typical business practices were sometimes dependent on the geographical locations of the responding O&P companies. The report breaks down survey responses by three community sizes: facilities located in major metropolitan areas (called “metropolitan areas” below); facilities located in moderate size cities; and facilities located in small cities, towns, or rural areas (called “more rural areas” below).

MEDIAN TOTAL SQUARE FOOTAGE

ACCRUAL VS. CASH BASIS ACCOUNTING

CENTRAL FABRICATION (C-FAB)

62/38

10,800

10,032

Facilities in metropolitan areas

Facilities in moderate size cities

Square Feet

Square Feet

72.2 Percent

Ratio of accrual to cash basis accounting in metropolitan areas

60/40

Percentage of facilities in metropolitan areas that use c-fab

89.7 Percent

Ratio of accrual to cash basis accounting in moderate size cities

36/64

Percentage of facilities in moderate size cities that use c-fab

75.0 Percent

Ratio of accrual to cash basis accounting in more rural areas

Percentage of facilities in more rural areas that use c-fab

TYPES OF PATIENT VISITS, BY COMMUNITY SIZE*

Metropolitan Area Moderate Size City More Rural Area

In-Office Visit

63.5% 78.9% 83.5%

Hospital Visit

12.1% 9.9% 8.0%

Home/Mobile Visit

12.7% 4.5% 2.7%

Skilled Nursing Facility

9.6% 4.3% 4.8%

Other

2.1% 2.5% 1.0%

*Due to rounding, numbers may not add to 100 percent.

SOURCE: AOPA’s “2018 Operating Performance Report.”

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DECEMBER 2018 | O&P ALMANAC

6,025

Square Feet Facilities in more rural areas

M&A ACTIVITY

22.9 Percent

Percentage of facilities in metropolitan areas that have been involved in M&A activity

27.0 Percent

Percentage of facilities in moderate size cities that have been involved in M&A activity

45.5 Percent

Percentage of facilities in more rural areas that have been involved in M&A activity

EDITOR’S NOTE: AOPA’s “2018 Operating Performance Report,” based on 2017 data, captured the financial facts from 90 companies representing 1,022 full-time facilities and 191 part-time facilities. The report is now available through the AOPA bookstore. Visit www.aopanet.org.

Happenings RESEARCH ROUNDUP

Hong Kong Researchers Design Robotic Arm for Stroke Patients Scientists at the Hong Kong Polytechnic University (PolyU) have developed a “mobile exo-neuro-musculo-skeleton,” a robotic arm designed to enable patients to engage in intensive and effective self-help rehabilitation exercise after they are discharged from the hospital.

10

DECEMBER 2018 | O&P ALMANAC

PHOTO: PolyU

The robotic arm developed at PolyU is an integration of exoskeleton, soft robot, and exo-nerve stimulation technologies.

A research team led by Xiao-ling Hu, PhD, in the Department of Biomedical Engineering of PolyU, designed the device to be lightweight and low-power and incorporate sportswear features. The robotic arm consists of components for wrist/hand, elbow, and fingers, which can be worn separately or together for different functional training needs. The sportswear design features washable fabric with ultraviolet protection and appropriate ventilation. The device provides a flexible, mobile tool for patients to supplement their rehabilitation sessions at the clinic.

The impetus behind the project was to create a device that would improve access to outpatient rehabilitation services for stroke patients. While research studies indicate that intensive, repeated, and long-term rehabilitation training are critical for enhancing the physical mobility of stroke patients, patients in Hong Kong who are discharged from the hospital often face challenges in receiving the regular and intensive rehabilitation training crucial for limb recovery, with long wait times for follow-up care.

The new device, which combines both exoskeleton and soft robot (made of air-filled or liquid-filled pipes) features, also integrates external mechanical force design using neuromuscular electrical stimulation (NMES) technology.

Upon detecting the electromyography signals at the user’s muscles, the device will respond by applying NMES to contract the muscles, as well as exert external mechanical forces to assist the joint’s desired voluntary movement.

An initial trial of the robotic arm on 10 stroke patients indicated improved muscle coordination and wrist and finger functions, and lower muscle spasticity in all subjects after completing 20 two-hour training sessions. Further clinical trials will be carried out in collaboration with hospitals and clinics.

The device connects to a mobile application to aid users in controlling their own training. The app records real-time training data for improved monitoring of the rehabilitation progress by both health-care practitioners and the patients themselves. It can also serve as a social network platform for stroke patients to communicate online for mutual support.

“We are confident that with our mobile exo-neuromusculo-skeleton, stroke patients can conduct rehabilitation training anytime and anywhere, turning the training into part of their daily activities,” said Hu. “We hope such flexible self-help training can well supplement traditional outpatient rehabilitation services, helping stroke patients achieve a much better rehabilitation progress.” Her team anticipates the robotic arm to be commercialized in two years.

Researchers Design NeuralEnabled Prosthetic Hand Led by Arizona State University (ASU) researcher James Abbas, PhD, a multiinstitutional group of researchers has developed the first neural-enabled prosthetic hand (NEPH). The system requires the user to receive a neural implant that enables the brain and the prosthesis to produce sensations of touch in the hand in a “bidirectional” approach.

The implant was built off of the common experience of phantom limb, a phenomenon that allows amputees to feel sensations from an amputated limb, according to Abbas, the director of the Center for Adaptive Neural Systems and an associate professor in the School of Biological and Health Systems Engineering at ASU. “Our system is the first one that is wearable for long-term use beyond the laboratory setting,” said Abbas. “All of the components are either mounted on the prosthesis or implanted in the body.”

ASU researchers are working with a team at Florida International University (FIU) on the device, which is being tested by amputee Jason Little, the first owner of the NEPH system. Little underwent implant surgery several months ago and has been successfully using the system—a wirelessly controlled neurostimulator and prosthetic hand—both in the FIU lab and at home.

“The participant has reported enhanced

confidence in performing daily tasks,” said Ranu Jung, professor and chair of the Department of Biomedical Engineering at FIU. “He is able to interact with objects around him and determine the answers to questions surrounding sensation, such as, ‘Have I touched it? How hard am I squeezing it? How large and soft is it?’”

Abbas presented the research during the annual meeting of the Society for Neuroscience in November. The project has received an investigational device exemption for human trials from the U.S. Food and Drug Administration (FDA) to test the product on six people, according to Abbas. If initial tests are successful, the research team will seek further approval from the FDA and continue the development process.

FAST FACTS

Diabetes Risks Across the Globe An estimated 415 million people worldwide were reported to have diabetes in 2015, and this figure is expected to rise to 642 million in 2040. As 60–70 percent of people with diabetes lose sensation in their feet, they are at risk for injury. Furthermore, 12–15 percent of people with diabetes will develop a foot ulcer, which increases their risks for infection, amputation, or even premature death.

SOURCE: “Standards for Prosthetics and Orthotics, Part 1: Standards,” World Health Organization, 2018.

POLICY PROVISIONS

DME MACs Announce Minor Revision to LCD for Lower-Limb Prostheses On November 1, the four durable medical equipment Medicare administrative contractors (DME MACs) released an updated Local Coverage Determination (LCD) for lower-limb prostheses. Since the changes to the LCD were minimal and do not restrict coverage, the notice and comment period required by the 21st Century Cures Act did not apply to the revision.

The only change to the LCD was the removal of the patient weight range (110 pounds to 275 pounds) for coverage of L5859—Addition to lower-extremity prosthesis, endoskeletal knee shin system, powered and programmable flexion/extension assist control, includes any type motor(s). All other requirements for coverage of L5859 remain the same.

O&P ALMANAC | DECEMBER 2018

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MEDICARE MATTERS

Premium and Deductible Rates See Slight Rise for 2019

CMS Introduces Documentation Lookup Service Initiative

Changes in Medicare premium and deductible rates for 2019 have been published by CMS. The monthly Medicare Part B premium will begin at $135.50. This is slightly higher than the 2018 amount of $134. The Medicare Part B deductible for 2019 has increased by $2 and will be set at $185; the Medicare Part B co-insurance remains at 20 percent of the Medicare allowed charge.

The Medicare Part A deductible for 2019 is set at $1,364; the daily co-insurance amount for days 61-90 is $341, and the lifetime reserve day’s rate is set at $682.

Lastly, the Skilled Nursing Facility (SNF) Part A extended care day’s co-insurance (days 21-100) has been set at $170.50 for 2019.

CMS held an Open-Door Forum conference call in October to educate the public about a new initiative to develop an online resource where providers and suppliers can look up the documentation requirements necessary for Medicare to cover a service or item.

The goals of the Documentation Requirement Lookup Service prototype are to reduce provider burden, reduce improper payments and appeals, and improve “provider-topayor” information exchange. CMS is currently recruiting providers and suppliers to pilot the prototype system. The initial pilot project will be populated with the following information: • Whether Medicare fee-for-services require prior authorization for a given item or service; and • Documentation requirements for oxygen and continuous positive airway pressure devices.

Formal Telephone Discussion Demonstration Project Expands to Jurisdictions A and B CMS has expanded the Qualified Independent Contractor (QIC) Telephone Discussion Demonstration project to include Jurisdictions A and B, effective Nov. 1, 2018.

The QIC Telephone Discussion Demonstration project was launched

by CMS on Jan. 1, 2016, to determine if engagement between suppliers and the QIC could improve the understanding of the cause of appeal denials and result in increased proper claim submissions. The project was originally limited to certain durable medical equipment (DME) claims; however, the project was expanded in October 2016 to all DME claim types, including orthotics and prosthetics—but only in Jurisdictions C and D. Participation in the Telephone Discussion Demonstration is voluntary; 12

DECEMBER 2018 | O&P ALMANAC

however, there is no way for providers to “sign up” to take part in this program.

Representatives from QIC select the claims for review; currently, the QIC contractor is C2C solutions. C2C Solutions reviews reconsideration requests to identify appeals that may benefit from participation in the process, then offers eligible suppliers the opportunity to engage in a telephone discussion with QIC prior to the issuance of the reconsideration decision.

This extra step allows suppliers to discuss the facts of an appeal directly with C2C medical review staff and to submit any missing documentation that may have been identified by C2C. Early results of the initial phases of the demonstration project have proven to be successful, with a denial overturn rate approaching 86 percent.

Medicare Sets 2019 Amounts in Controversy Medicare has released the amounts in controversy (AIC) for the 2019 calendar year, effective for all appeal requests filed on or after Jan. 1, 2019. The AIC is the monetary threshold that must be met to file an appeal with the administrative law judge (ALJ), third level of appeal, and with the federal district court, fifth level of appeal. The 2019 AIC for the ALJ is $160, and the AIC for the federal district court is $1,630.

COMPANY CULTURE

AOPA Board Adopts Workplace Nondiscrimination and Antiharassment Policy During a meeting at the 2018 AOPA National Assembly in Vancouver, the AOPA Board of Directors unanimously adopted a statement to advance nondiscriminatory and antiharassment practices in O&P workplaces. The board determined to include the following statement in the “AOPA Code of Interactions With Health-Care Professionals” and to recommend the policy to all AOPA members: Nondiscrimination/Antiharassment in the Workplace AOPA member companies, as assembled groups of health-care professionals, must operate in full compliance with all federal and state laws, including those that govern discriminatory practices. Title VII of the Civil Rights Act of 1964 prohibits employers from discriminating against employees on the basis of sex, race, color, national origin, and religion. By way of accreditation, it is established that O&P facility owners operate with compliance plans that adhere to these tenets and condemn any form of discriminatory practices in the workplace. Every employee is entitled to fair treatment in the workplace. Any violation of these conditions is not consistent with the standing of AOPA member companies as assembled groups of health-care professionals and is not consistent with this Code. More importantly, any violation of these conditions is almost certainly illegal, and punishable under state or federal laws.

AOPA is currently considering education programming in support of this statement. The association also provided input on this issue to the O&P Alliance at its meeting in Vancouver, which resulted in establishment of an Alliance Workgroup on this topic. AOPA has since submitted suggested language for an open letter from the O&P Alliance which has now been adopted. See the AOPA website for full version of the letter.

AMPUTEE ATHLETICS

O&P Facilities Host First Clinics

First Climb event hosted by Wright & Filippis and the Filippis Foundation

Several O&P groups recently hosted instructional athletic events in conjunction with the Orthotic & Prosthetics Assistance Fund (OPAF) and The First Clinics.

Wright & Filippis and the Filippis Foundation hosted a pediatric First Climb clinic in Madison Heights, Michigan. The event was held at the local Planet Rock gym and led

by Tommy Lyons, a below-knee amputee and national paraclimber.

Lyons was assisted by the staff of Planet Rock, volunteers from Wright & Filippis, friends from College Park Industries, and O&P students from Eastern Michigan University.

The MSOP students of the University of Texas (UT)—Southwestern recently hosted First Kick and First Swim clinics at Bachman Therapeutic Recreation Center in Dallas. First Kick, an introduction to amputee soccer, was led by Craig Till and Robert Maldy, members of a U.S. amputee soccer team, assisted by representatives from a Haitian amputee soccer team. Attendees and participants were given a quick course in amputee soccer and took part in a series of soccer skills and drills, including some competitive play.

During the First Swim event hosted by the UT MSOP students, First Swim Director Mabio Costa led participants into the pool to work on balance, floating, and swim skills. Costa was assisted by Bob Welty with the U.S. Masters Swim program, who works regularly with amputees in the Dallas area. Several of the Haitian soccer

team members assisted in the pool.

A separate First Swim event was held in Greenville, South Carolina, and hosted by Shriners Hospital for Children, Sure Step, CP Now Foundation, and Greenville Healthcare Systems—Roger C. Peace Rehab. Adults and children received instruction from Costa and First Swim instructor Rob Hendry during the clinic. Participants worked on water basics such as floating and feeling comfortable both in and around the pool. Therapists from Shriners Hospital were paired up with participants during the event.

First Kick and Swim event hosted by MSOP students at the University of Texas—Southwestern

OPAF & The First Clinics, along with the First Swim Training and Clinic program, was recently awarded a grant from U.S. Masters Swim and its Adult Learn-To-Swim Program. “These grant dollars will help us to grow the First Swim program in two specific cities where we have close ties with local YMCAs and other aquatic facilities,” said OPAF Executive Director Robin Burton. OPAF plans to use the funds in two pilot programs of adaptive swim instruction: one in Orlando and one in Bay City, Michigan.

O&P ALMANAC | DECEMBER 2018

13

PEOPLE & PLACES PROFESSIONALS

AOPA Board of Directors Sets the Stage for 2019

With the start of December comes the transition of AOPA to the 2018-2019 Board of Directors, whose members were elected during the 2018 AOPA National Assembly in Vancouver. Jim Weber, MBA, will lead the association as president in the new year.

Weber served as president for the 2017-2018 time period.

Under customary circumstances, the president-elect automatically succeeds to the office of president, and the president automatically succeeds to the office of immediate past president. Due to the resignation of 2017-2018

President-Elect Chris Nolan, the AOPA Nominating Committee proposed, and members supported during the election, a continuance for Weber, who has been re-installed as AOPA president, and Michael Oros, CPO, LPO, FAAOP, who has been re-installed as immediate past president, each for an additional one-year term.

Below is the full list of current AOPA board members, who took office Dec. 1, 2018, and will serve through Nov. 30, 2019. These board members will be supported by AOPA’s new executive director, Eve Humphreys, MBA, CAE.

2019 AOPA Officers

Jim Weber, MBA, President

Traci Dralle, CFM, Vice President

Jeffrey Lutz, CPO, President-Elect

Michael Oros, CPO, LPO, FAAOP, Jeffrey M. Brandt, CPO, Immediate Past President Treasurer

Eve Humphreys, MBA, CAE, Secretary

2018-2019

2019 AOPA Board Members

14

CONTINUING

David Boone, MPH, PhD

RETIRING

Special Thanks

Mitchell Dobson, CPO, FAAOP

Teri Kuffel, JD

Elizabeth Ginzel, MHA, CPO

Kimberly Hanson, CPRH

Rick Riley

NEW

J. Douglas Call, CP

DECEMBER 2018 | O&P ALMANAC

Linda Wise

Jeff Collins

Dave McGill

Chris Nolan

Brad Ruhl

PEOPLE & PLACES

PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Asar was joined on the NYSE podium by Medal of Honor recipient and former Nebraska governor and U.S. senator Bob Kerrey, a Hanger Clinic patient and U.S. Navy SEAL officer who became an amputee as the result of injuries sustained during the Vietnam War.

Thomas Hartman, Hanger’s senior vice president and general counsel, has been awarded the Magna Stella Award from the Texas General Counsel Forum. The award recognizes in-house general counsel Thomas Hartman excellence in Texas corporations.

Hartman, who joined Hanger as general counsel in 2009 and was appointed senior vice president in 2015 and secretary in 2014, works closely with fellow members of Hanger’s senior leadership team, board of directors, and functions across the company.

IN MEMORIAM

Barry Townsend, CPO Barry Townsend, CPO, passed away in Bakersfield, California, on November 9. Townsend attended University of California, Los Angeles (UCLA), on a full athletic scholarship. While at UCLA, he was ranked in the top four swimmers in the nation each year and was a nine-event All-American swimmer.

He earned a bachelor’s degree in kinesiology and a postgraduate degree in prosthetics and orthotics.

After graduation, Townsend and his brother founded Valley Institute of Prosthetics and Orthotics (VIPO) in Bakersfield in 1980. In 1982, Townsend became the sole owner and manager of the business, which he led for 30 years until his retirement. His son, Trevor John Townsend, CPO, is a current co-owner and president of VIPO. Townsend also created a second business, BioQuest Prosthetics, for which he designed high-functioning prostheses.

The New York Stock Exchange welcomed Hanger Inc. (NYSE: HNGR) in celebration of Veterans Day. President and Chief Executive Officer Vinit Asar, joined by Chris Taylor, vice president, NYSE Listings and Services, and Hanger employees and patients, rang The Opening Bell®.

Steeper USA has moved its headquarters to Leeds, United Kingdom. The new state-of-the-art facility houses the company’s Leeds-based manufacturing and office operations. The move will allow Steeper to continue to provide its products and services while improving efficiencies, according to company represeentatives.

THE LIGHTER SIDE

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Hanger Inc. rang the opening bell of the New York Stock Exchange (NYSE) on November 12 in celebration of Veterans Day. “We are honored to pay tribute and express gratitude, along with the entire nation, to all those who have served our country,” said Hanger President and Chief Executive Officer Vinit Asar. “We consider it a privilege to provide care to our nation’s heroes, and give back to those who have given so much to us.”

O&P ALMANAC | DECEMBER 2018

15

REIMBURSEMENT PAGE

By JOE MCTERNAN

The Road Ahead Competitive bidding, new codes, and O&P notes may dominate reimbursement discussions in 2019

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

After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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DECEMBER 2018 | O&P ALMANAC

A

S 2018 COMES TO a close, it’s

natural to ask, “What is O&P going to look like in 2019? What issues will dominate conversations during industry meetings at the national, state, and local levels?” This month’s Reimbursement Page takes a crystal-ball look to help you understand the issues that will rise to the top next year.

Competitive Bidding for OTS Orthoses

Since Medicare competitive bidding first hit the radar with the passage of the Medicare Modernization Act in 2003, the inclusion of off-the-shelf (OTS) orthoses as a competitive bidding product category has always been a possibility. For years, however, CMS chose not to include OTS orthoses in the Medicare competitive bidding program.

That all changed on Nov. 1, 2018, when CMS announced it is soliciting comments on the proposed inclusion of OTS spinal orthoses and OTS knee orthoses as product categories in the next round of Medicare competitive bidding.

This announcement was made on the same day that the final rule on changes to the competitive bidding program was announced, including a provision announcing a delay in the implementation of future rounds of competitive bidding until at least Jan. 1, 2021. Thus, it will be at least two years until the O&P community feels the impact of the inclusion of OTS spinal and knee orthoses in competitive bidding—but now we are seeing an indication that some types of OTS orthoses will one day be affected by competitive bidding.

CMS proposed a total of 16 OTS spinal orthoses and eight OTS knee orthoses for inclusion in the competitive bidding program. AOPA analysis on the codes included in the proposal indicates that traditional O&P providers are responsible for less than 15 percent of overall claims submitted to Medicare for the codes in question. These codes do not represent a significant portion of a typical facility’s business; however, it is AOPA’s position that no orthosis should be subject to competitive bidding. AOPA has submitted comments to CMS indicating that competitive bidding for OTS orthoses is not in the best interest of patients or the Medicare program.

Despite the various arguments that AOPA has presented, both historically and in its recent comments to CMS, the reality is that the 24 codes proposed for inclusion in competitive bidding will most likely be included in the next round. While implementation will not happen until 2021 at the earliest, there is little doubt that competitive bidding of OTS spinal and OTS knee orthoses will be a hot topic next year.

New Codes and Fees

Every year, in late October or early November, the AOPA reimbursement staff begins an annual ritual of constant checking and rechecking the Medicare website for the annual announcement of new Health-Care Common Procedure Coding System (HCPCS) codes and fees. This year was no different; on November 5, CMS released the 2019 HCPCS update.

REIMBURSEMENT PAGE

Three new O&P HCPCS codes have been added for implementation for dates of service on or after Jan. 1, 2019.

The new HCPCS codes are as follows:

A5514

For diabetics only, multiple-density inserts, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient’s foot, including arch, base layer minimum of 3/16-inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each.

A5514 is a direct crosswalk of K0903, a temporary HCPCS code that was released in 2018 to describe customfabricated, direct-milled, diabetic inserts. K0903 has subsequently been deleted from the HCPCS file.

L8701

L8702

Powered upper-extremity range-of-motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.

Powered upperextremity range-ofmotion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.

L8701 and L8702 were issued as a result of a new code application submitted by a manufacturer that has developed a microprocessor-controlled upper-extremity orthosis that helps 18

DECEMBER 2018 | O&P ALMANAC

patients with upper-extremity weakness or paralysis to regain adequate function to perform activities of daily living. L8701 represents a version that does not include the fingers, and L8702 represents a version that includes the fingers in the design of the orthosis.

In addition to new codes, AOPA staff is diligent about tracking the release of updated fees for O&P services.

While the official release of the 2019 Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule has not occurred as of the writing of this column, AOPA is confident that it can provide a reasonable estimate of the Medicare DMEPOS fee schedule for 2019.

The annual increase in the Medicare O&P fee schedule is determined by two factors: the change in the consumer pricing index for urban areas (CPI-U) from June to June of the previous year, and the annual Multi-Factor Productivity Adjustment (MFPA), which was enacted by the Affordable Care Act in 2011. AOPA has confirmed that the increase in the CPI-U from June 2017 to June 2018 was 2.9 percent. The MFPA for O&P for 2019 has not yet been released, but the MFPA for other areas that typically trend in line with O&P is 0.8 percent. While the MFPA may change slightly when it is released for O&P, AOPA expects the 2019 Medicare O&P fee schedule to be approximately 2.1 percent, assuming there is no significant change in the MFPA.

Increased Value on O&P Practitioner Notes

The year 2018 saw a major legislative shift with the enactment of an amendment to the Social Security Act that stated the following: “(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS. For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals described in section 1848(k)(3)(B).”

This legislation acknowledged the role of the orthotist and prosthetist as allied health professionals whose clinical documentation must be considered as part of the medical record for purposes of medical review.

While the law was passed in early 2018, the impact of the law will be seen as we move into 2019. The durable medical equipment Medicare administrative contractors (DME MACs) finally acknowledged the change with the release of a revised “Dear Physician” letter for O&P documentation on Nov. 13, 2018. In this letter, the DME MACs acknowledged that O&P practitioner documentation will be considered as part of the medical record and will be used to corroborate and expand on documentation by the referring physician. While the revised Dear Physician letter is far from perfect (AOPA plans to provide feedback to the DME MACs outlining concerns about language used in the letter), it is a step forward in acknowledging the orthotist and prosthetist as allied health professionals, not simply suppliers. The discussion on the impact of this legislative change will surely continue in the coming months.

Is That All?

The issues above provide a quick snapshot of issues that will top the list for discussion in 2019.

As usual, there will certainly be issues that seem to come out of the blue that will dominate discussion, either briefly or long term, but 2019 will not be boring. The O&P profession is constantly changing, and changes bring dialogue—which is always healthy.

Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org.

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This Just In

Gaining Perspective on Policy Changes A closer look at the revised ‘Dear Physician’ letter and competitive bidding for O&P

R

ECENT ACTIONS BY CMS and

the durable medical equipment Medicare administrative contractors (DME MACs) could affect how O&P professionals perform their duties.

Delving more deeply into the publication of the recently revised “Dear Physician” letter as well as the possible inclusion of off-the-shelf (OTS) orthoses in competitive bidding will help O&P stakeholders understand how changes could affect their businesses.

Recognition of O&P Notes

Last month, the DME MACs published a revised Dear Physician letter that addresses the Medicare requirements for documentation within the referring 20

DECEMBER 2018 | O&P ALMANAC

physician’s medical records that support the medical necessity of orthotic and prosthetic services provided to Medicare beneficiaries. This letter replaces an earlier Dear Physician letter, issued in August 2011, that was retired early in 2018 as a result of the passage of legislation that AOPA had promoted and lobbied for (Section 50402 of the Bipartisan Budget Act of 2018), which requires Medicare to consider the medical records of orthotists and prosthetists as a legitimate part of the medical record for purposes of claims payment and medical necessity review/determinations.

The newly released letter acknowledges the legislative change that was passed in February 2018 and reminds physicians that while orthotists’ and prosthetists’ notes are now part of the patient’s medical record for purposes of medical necessity review, there is a continued need for referring physicians to document the medical need for the O&P devices they prescribe.

The letter stresses that O&P practitioner notes must “corroborate and provide details consistent with the physician’s records,” and that conflicting information in the physician’s notes and O&P practitioner notes may result in claim denial.

The letter also discusses the importance of physician documentation of

the patient’s overall health to support the assigned functional level, including the following: • Symptoms limiting ambulation or dexterity • Ambulatory assistance used by the patient, either prior to amputation or postamputation in addition to a prosthesis • Comorbidities affecting ambulation and the ability to use a prosthesis • A summary of the patient’s activities of daily living • A physical examination that is relevant to functional deficits.

AOPA is encouraged by the continued acknowledgement of a patient’s potential as a factor when establishing his or her appropriate functional level as well as the reminder that bilateral amputees cannot always be strictly bound by functional level classifications.

With the DME MAC medical directors acknowledging the legislative change that requires the recognition of O&P practitioner notes as part of the medical record, there clearly has been progress. However, the legislative change does not and was not intended to remove or diminish the role of the physician as a vital partner in the rehab team. In this respect, the legislation generally returns documentation

This Just In

requirements back to where they stood in July 2011, before the original Dear Physician letter sought to eliminate all consideration of the O&P professional’s notes and records: O&P clinical records are legitimate as consistent with, as corroborative of, and to fill in details in addition to the physician’s prescription and clinical findings submitted to CMS. This recognition is in alignment with the intent of the legislation to acknowledge and recognize the role of the O&P practitioner as a health professional with valuable clinical input on the overall health and prosthetic needs of the Medicare beneficiary.

One concern regarding this latest Dear Physician letter is its assertion that prior and concurrent patient use of ambulatory aids—such as canes, walkers, crutches, and wheelchairs—is in any sense a significant consideration in determining a patient’s functional level. This was a central tenet of the July 2015 proposed Local Coverage Determination (LCD) for lower-limb prosthetics, which

lacked scientific justification and was universally criticized by more than 80 witnesses at a public hearing, and which was rejected earlier this year by the CMS Interagency Workgroup’s repudiation of that draft LCD and has since been “retired.” Further, multiple scientific studies have shown that ambulatory aids are not necessarily an impediment to function and often improve a patient’s ability to effectively use a prosthesis.

OTS Orthoses and Competitive Bidding

CMS announced on Nov. 1, 2018, that it is soliciting comments on its proposed inclusion of OTS spinal orthoses and OTS knee orthoses as product categories in the next round of Medicare competitive bidding. This announcement came on the same day that the final rule on changes to the competitive bidding program was announced. Ironically, a provision of the final rule was the announcement of a delay in the implementation of future rounds of competitive bidding until

at least Jan. 1, 2021. While the impact of inclusion of OTS spinal and knee orthoses will not be felt for at least two years, the recent CMS announcement represents the first indication that OTS orthoses of any kind will be included in competitive bidding.

Sixteen OTS spinal orthoses and eight OTS knee orthoses have been identified for inclusion in the competitive bidding program. AOPA has performed preliminary analysis on the codes included in the proposal and found that traditional O&P providers are responsible for less than 15 percent of overall claims submitted to Medicare for the codes in question.

While these codes do not represent a large portion of a typical O&P practice’s business, AOPA continues to believe that no orthosis should be subject to competitive bidding and will be submitting comments to CMS indicating that competitive bidding for OTS orthoses is not in the best interest of patients or the Medicare program.

AOPA will continue to engage in dialogue with CMS on this issue.

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https://jobs.aopanet.org O&P ALMANAC | DECEMBER 2018

21

COVER STORY

The Gift of

Giving

How O&P professionals find and create opportunities to donate their time and talent in underserved areas

By MEGHAN HOLOHAN

22

DECEMBER 2018 | O&P ALMANAC

COVER STORY

NEED TO KNOW • For those O&P professionals seeking to share their skills and expertise with patients in under-served areas, there are many ways to get involved and opportunities to consider.

• Several international organizations are dedicated to facilitating O&P care in underprivileged areas where there are few properly trained clinicians, such as Haiti, Guatemala, Mexico, Ghana, and the Dominican Republic.

• Some O&P professionals discover volunteering opportunities through friends or co-workers in the health-care industry, and others find mentors who help them acclimate to the volunteer experience.

• These experiences allow practitioners to “give back,” but they also lead to growth experiences. Volunteers are exposed to unique prosthetic and orthotic challenges and gain a different perspective when giving care overseas.

• Many volunteers find they return to the same locations year after year, treating some of the same patients and helping to train local health-care professionals to aid in building sustainable O&P programs.

• Practitioners who are willing to adapt to ill-equipped working environments and who are able to cover their own travel costs are always in demand in these types of programs. Many organizations provide food and housing for volunteers.

• O&P professionals who cannot commit the time needed to travel can contribute by organizing equipment donations for individuals who cannot afford commercial prosthetic devices.

I

N 2006, ZACH HARVEY, CPO, was in

Guatemala City, Guatemala, fitting patients with prosthetic limbs as part of volunteer trip with the Range of Motion Project (ROMP). After fitting a prosthetic leg on a young man, Harvey walked away to find a tool so he could adjust and align the new limb. When he returned, the man was gone. After searching the clinic, Harvey walked outside and spotted the man getting into his car. He was so excited to finally walk that he simply left the clinic.

“He waited two years to get a leg, and that was [as long as] he was going to wait,” Harvey, managing CPO of Creative Technology Orthotic &

Prosthetic Solutions, says. “For him, a leg probably meant he was able to get back to work and support his family.

There is definitely an economical aspect to these kinds of problems.”

While Harvey laughs as he remembers the story, it highlights one of the reasons he decided to become a prosthetist: He wanted to help people not just in his own community but also around the world. He knew the need was great, and he could have a lasting impact on people’s lives. “I heard a statistic that only 10 percent of the need worldwide was met,” he says.

“I wanted to volunteer. It took a little while to find the right opportunity.”

O&P ALMANAC | DECEMBER 2018

23

COVER STORY

When Zach Harvey, CPO, travelled to Guatemala with ROMP, he gained invaluable experience fitting prostheses on individuals with complex lower-limb amputations.

Harvey first volunteered with Physicians for Peace. At the time, his then-employer, Hanger Clinic, had a relationship with the organization, and he was given time off to volunteer.

He went to the Dominican Republic and Guatemala with Physicians for Peace, learning a lot about complex prosthetic fittings and gaining loads of experience. When a friend started a grassroots project in Guatemala, Harvey offered to help. He joined for a few fact-finding missions and helped develop the project before eventually volunteering with ROMP. His various international travels taught Harvey what it means to find a fulfilling volunteer experience.

“I think finding a good fit is finding a country you want to travel to and reaching out to a program there,” he says. “It is really good to get an experience with an existing program instead of going out and doing things on your own.”

Many international organizations are dedicated to facilitating O&P care in underprivileged areas. Programs such as Physicians for Peace, ROMP, the Sustainable Therapy and New 24

DECEMBER 2018 | O&P ALMANAC

Development (STAND) Haiti Project, CRIMAL (the Total Rehabilitation Center for the Mobility Impaired), and LIMBS International—to name a few— need certified prosthetists to work overseas. O&P professionals seeking more information about opportunities with established organizations can look up these organizations online and contact representatives for details; there is usually a significant demand for O&P professionals.

PHOTOS: Zach Harvey, CPO

Knowing the Fundamentals

Harvey has spent time in the Dominican Republic and Guatemala fitting people with prostheses and fulfilling his desire to help others in need.

“We are working in countries where there are few certified prosthetists,” explains Oscar Gonzalez-Montoya, president of LIMBS International.

“Our focus is [aiding] people in developing countries who cannot afford commercial prosthetic devices.”

While LIMBS International has a stable of volunteers who regularly help with trips to eight locations in Mexico, South America, and Indonesia, the organization is always seeking new recruits—particularly certified prosthetists who are willing to go with the flow. While being fluent in the local language is helpful, the organization provides translation assistance when necessary.

“When we think about volunteers, people should be able and willing to adapt. They are going to be working in environments they are not used to,” Gonzalez-Montoya says. “When you travel overseas, you have to be able to adapt and find your way with things on hand.”

While many prosthetists agree that international volunteer trips are an important part of their professional— and personal—development, finances must be considered. Volunteers

COVER STORY

Volunteers with CRIMAL in Queretaro, Mexico, work collaboratively to provide appropriate care for clinic patients.

PHOTOS: John “Mo” Kenney, CPO, LPO, FAAOP. PHOTO of Querataro: Getty Images

typically cover their own travel costs and other incidentals, such as recommended vaccinations.

“Normally, they pay for their plane tickets” when volunteering with LIMBS International, Gonzalez-Montoya says.

“We provide all the equipment and components for the patients.”

Harvey notes that the organizations often help offset daily living expenses, too. “The programs I have been involved with, there is a sponsor with lodging and food,” he says. He suggests that, because of the personal expenses involved, volunteers should consider taking extra time for themselves to travel and explore while overseas.

Teaming Up for the Greater Good

While some orthotists and prosthetists find programs that are well suited to their needs by conducting research ahead of time, others discover volunteer matches through colleagues.

That’s how Pam Lupo, CO, a consultant in Michigan, began working in Ghana. A physician with whom she often collaborated traveled to the country and performed spinal surgery on people with advanced scoliosis. While the surgeries

Querataro State, Mexico

certainly improved the outlook for many patients, they often lacked quality orthoses. When the physician asked if Lupo would consider joining a trip, she agreed—and was stunned by what she witnessed. She recalls her first trip as “an experience of a lifetime. There were hundreds of patients in line waiting to be seen, and I just couldn’t stop trying to help,” she says.

Since that trip, Lupo has returned more than 15 times, joined on many occasions by her husband and her son. While she knows other areas also need assistance, she feels committed to Ghana and is motivated to making the program sustainable when she is not there. This became extremely important over the past four years as Ebola has made return trips extremely risky for international practitioners.

“It expanded from orthotics, to really handling needs on the ground, and then partnering with people who are there full time,” she says. “You also need to be sure you are working with the right authorities or structure while you are there.”

For 23 years, John "Mo" Kenney, CPO, LPO, FAAOP, (in white coat), has volunteered with CRIMAL in Queretaro, Mexico.

O&P ALMANAC | DECEMBER 2018

25

COVER STORY

Before jumping in to volunteer, Lupo suggests practitioners consider where they want to visit, examine their resources, decide what they would like to learn, and figure out how they can help when selecting a program.

“Where do you want to go, and what are you hoping to accomplish?” she asks. “Do you want to experience a variety of opportunities and communities, or do you want to contribute to something that is sustainable?”

By returning to the same location on a regular basis, Lupo was able to provide ongoing care to some of her patients, and she now sees how her interventions affected their entire lives. She recalls a young woman from her first trip, Paschalina, who had a greater-than-90-degree curve in her spine. When she was at the clinic for her surgery, she was alone because none of her family members could afford to miss work and travel with her.

Lupo stayed with Paschalina overnight as she recovered. Since then, Lupo learned that the surgery and orthoses she provided helped the woman live a fulfilling life; Paschalina went on to graduate from college, find a full-time job, marry, and have children.

26

DECEMBER 2018 | O&P ALMANAC

Pam Lupo, CO “The biggest impact is providing [patients in] an under-served community [with] the ability to change their life so they are a productive member of their society and culture,” she says.

Finding a Mentor

Like Lupo, John “Mo” Kenney, CPO, LPO, FAAOP, of Kenney Orthopedics, was motivated to volunteer by a colleague. Twenty-three years ago, Kenney met Junior Odom, CP, the outgoing manager of a clinic in Kentucky where Kenney was taking a job. Odom told Kenney about a clinic he had started in Queretaro, Mexico, with another certified prosthetist and an orthopedic surgeon. While Kenney had volunteered on previous trips to China and the Ukraine, he felt drawn to Mexico in a way that he had not previously experienced.

“Mexico, you kind of fall in love with it,” he says. “I had been trying to find something for my life fulfillment … and one of those desires was to [get involved in] a full-time giving-back humanitarian cause.”

Kenney says he has been able to volunteer for a week each fall for CRIMAL because of the connection he feels with the program and the community. He recommends that people look for programs that have a collaborative spirit. And, he thinks it is easier to participate if you work closely with a mentor. “I kind of lucked out through a mentor,” he says.

He also thinks volunteering has helped him grow as a prosthetist and a person, and he urges other clinicians to seek out similar opportunities.

“Volunteering will make them better

and more well-rounded practitioners.

You will see a perspective that is entirely different than what you see in the United States. It will make you a better person,” he explains. “It will hone your skills. You will see some prosthetic challenges that are unique.”

Filling Sudden Needs

Another way to make a positive impact on a global scale is by volunteering for organizations that serve in countries that have experienced recent natural disasters, such as earthquakes. The need for qualified prosthetists increases after an earthquake as many people survive the disaster but lose a limb in the process, says Ryan Spill, CP, LP, owner of R.J. Rosenberg Orthopedic Lab.

PHOTO: Getty Images

PHOTO: John “Mo” Kenney, CPO, LPO, FAAOP

Kenney believes that volunteering internationally helped him become both a better person and a better prosthetist.

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COVER STORY

Early in his career, Spill considered volunteering with an international organization but was unable to find an opportunity that fit. After the earthquake in Haiti in 2010, he tried to find an organization looking for volunteers. Initially he found the country was inundated with people trying to help. But soon, he received an email

from an Australian prosthetist looking for volunteers to travel to Haiti.

After a few chats, he had found his perfect fit.

Spill first visited Haiti in 2014, where he helped about 25 patients who had amputations and provided five devices. “It was awesome,” he says.

“I was the only prosthetist.”

O&P Resources

He returned two years later, but with a different organization, STAND: The Haiti Project. While the first organization was great, he says, he enjoys working with STAND because it aims to build a sustainable program so that Haitians and people who live in the country can provide ongoing treatment to patients. “If there is no follow-up, you are not really doing a service. You are doing a really temporary service,” he says. “This organization with the commitment to training of locals … is a win-win for everyone.”

Several organizations aid in funding O&P devices AOPA is currently sourcing information about charitable funding entities that help individuals pay for prostheses. The following organizations have been identified as aiding in these efforts:

The Given Limb Foundation

The Prosthetic Foundation MISSION: Helping under-served amputees throughout Texas obtain quality prosthetics, and comprehensive aftercare, and to generate public awareness about limb loss. http://www.theprostheticfoundation.org/

MISSION: The Given Limb Foundation aims to support programs, adaptive accommodations, and outreach for those who are facing or have had limb amputations or diminished use of their limbs, particularly the wounded military population. https://givenlimb.org/

Limbs for Life

http://limbsforlife.org/

Steps of Faith MISSION: Steps of Faith is a nonprofit public charity dedicated to providing prosthetic care, hope, and comfort to amputees needing financial support.

We help uninsured and underinsured amputees get the prosthetic limbs they need. http://www.stepsoffaithfoundation.org/

To add an organization to AOPA’s list, email suggestions to co-op@aopanet.org.

28

DECEMBER 2018 | O&P ALMANAC

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

PHOTO: Getty Images

MISSION: Limbs for Life Foundation is a global nonprofit organization dedicated to providing fully functional prosthetic care for individuals who cannot otherwise afford it and raising awareness of the challenges facing amputees.

When Spill visits, he brings prosthetic devices donated by his patients and the community. This is another way that people can become involved in helping out overseas. Lupo, with the help of Wright & Filippis, has has sent donated devices to Ghana.

“Not everyone has the resources to travel internationally. We sent four 40-foot containers to Ghana. It took a lot of coordination, effort, and commitment to provide that level and care and devices,” she says. “People can provide it locally and partner with someone [without having] to go overseas to contribute to international efforts.”

Wherever they choose to work, O&P professionals devote their careers to helping others by returning them to an improved quality of life via orthotic and prosthetic intervention. But many also choose to cross international boundaries to provide care for those in dire need of care. For those clinicians seeking volunteer opportunities, there are many avenues to pursue, organizations to research, colleagues to partner with, and experiences to share.

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By CHRISTINE UMBRELL

COMMON

PRACTICE What you need to know about the recently published “Global Standards for Prosthetics and Orthotics” NEED TO KNOW •

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The “Global Standards for Prosthetics and Orthotics” have been published by the World Health Organization (WHO) in partnership with the International Society for Prosthetics and Orthotics (ISPO). These are the first international O&P standards and are designed to assist nations in setting up, improving, or transforming their systems to ensure appropriate O&P care.

Sixty total standards are categorized in four key areas related to O&P care: policy, products, personnel, and provision of services.

WHO also has published an “Implementation Manual” to assist countries in their compliance efforts.

DECEMBER 2018 | O&P ALMANAC

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The 15 policy standards require Member States to promote the availability and use of O&P devices at affordable costs and suggest that governments should work cooperatively with O&P stakeholders to develop a national O&P strategy.

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The nine product standards call for an appropriate range of O&P products to be available in countries to suit local needs and realities. All materials should be reliable and meet the accepted international standards set forth by the International Organization for Standardization.

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The 12 personnel standards identify the requirements to be considered in planning, developing, and promoting professional recognition of the O&P workforce. Complying with ISPO’s newly updated educational guidelines can help achieve compliance with the WHO personnel standards.

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The 24 standards focused on provision of services emphasize the importance of people-centered O&P services. O&P consumers should be regarded as equal members of the treatment team, and the service delivery model should be designed to facilitate accessibility and ongoing maintenance.

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While the United States may already be in compliance with many of the WHO standards, O&P stakeholders should review the standards to identify areas in need of improvement and educate policymakers and payors on relevant aspects of the new document—including the need for a national committee.

I

T’S A GLOBAL WORLD TODAY.

Technological advances transcend geographic borders, and international health initiatives enable healthcare professionals to interact with colleagues across the globe to learn about their medical systems and innovations and share best practices.

Adopting a global perspective of O&P may enhance your company’s understanding of why and how patient care differs around the world—and could ultimately improve the way your facility provides care. The first step in gaining an international understanding of O&P is to look at the inaugural “Global Standards for Prosthetics and Orthotics,” published a few months ago by the World Health Organization (WHO) in partnership with the International Society for Prosthetics and Orthotics (ISPO). These new standards have been designed to assist complying countries, called “Member States,” in setting up, improving, or transforming their systems to ensure appropriate O&P care.

Terry J. Supan, CPO

A Need for Global Agreement

As the world has become more interconnected, interest in and need for global health has increased—but until last year, no international standards specific to O&P care existed.

About 10 years ago, more than 170 countries ratified the Convention on the Rights of Persons With Disabilities (CRPD), and WHO implemented the “WHO Global Disability Action Plan, 2014-2021”—a broad agreement to be applied to the care of individuals who could benefit from assistive technology. But it wasn’t until the past 18 months that a consensus conference was held to develop the “Global Standards for Prosthetics

SOURCE: “Global Standards for Prosthetics and Orthotics,” World Health Organization

and Orthotics.” In May 2018, those standards, which align with WHO’s international goals, were endorsed at the World Health Assembly.

“These are the first standards that internationally apply not only to the education of orthotists and prosthetists but also to products and policies,” says Terry J. Supan, CPO, treasurer of ISPO and president and chief executive officer of Supan Prosthetic Orthotic Consultants. “They are in place for all of the developing world.” They serve as a benchmark to all 177 Member States, including the United States, that have signed on to the CRPD. There are a total of 60 standards, categorized in four key areas related to O&P care: policy (15 standards), products (nine standards), personnel (12 standards), and provision of services (24 standards). WHO also has published an “Implementation Manual” to assist countries in their compliance efforts.

The standards are “of global relevance” and were created in such a manner that they can be implemented by any country—regardless of its technological capabilities, according to Edward Lemaire, PhD, president-elect of ISPO and professor at the University of Ottawa. Lemaire explains that the standards are set at

a high level to ensure all countries are aiming for optimal patient care.

For U.S. practitioners, that means it’s important to be aware of the standards and make sure their facilities are complying, and to advocate for compliance from local and national legislators and payors. “If you come from a top economically successful country, you might think you automatically live up to the standards—but not necessarily,” says Lemaire.

Policy Standards

The first section of the WHO standards addresses policy issues. These standards require Member States to promote the availability and use of O&P devices at an affordable cost.

They also suggest that governments should assume a leading role in or delegate responsibility for the oversight of nationwide O&P services and should involve a range of stakeholders in planning, developing, and monitoring services. Each Member State should develop and institute a “national guiding framework” for O&P service provision that outlines legal acts, policies, strategic plans, standards, and rules and regulations to “guide the design of affordable, accessible, effective, efficient, safe services of high quality.”

O&P ALMANAC | DECEMBER 2018

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SOURCE: “Global Standards for Prosthetics and Orthotics,” World Health Organization

The standards also advocate for the establishment of “a national O&P committee or similar entity, with a wide range of stakeholders … for the coordination and development of national O&P service provision” in each country, says Lemaire. “This idea of national policies and strategies goes beyond just having billing codes,” Lemaire explains. The national committees could help ensure quality of care throughout larger nations. In Canada, for example, “things vary from province to province,” he says. “What qualifies as ‘quality’? What is ‘appropriate’?” Similarly, in the United States, a national committee could ultimately result in an improved standard of patient care countrywide.

Supan recommends that O&P professionals reference the WHO standards as a tool when advocating to CMS, the U.S. Department of Veterans Affairs (VA), or Congress and should remind policymakers that the WHO standards are established international guidelines. At present, the United States is “not always in alignment—but we should be,” he says. “Make sure [policymakers] understand that, internationally, things are changing, and the 32

DECEMBER 2018 | O&P ALMANAC

standards are starting to surpass [the policies and requirements] we’ve had in the U.S.,” says Supan.

In addition, U.S. O&P professionals should consider sharing the WHO standards at the state level, suggests Supan—for example, when communicating with paying agencies in the states to ensure O&P care is affordable.

Even in low-income countries, O&P consumers should be receiving, at a minimum, a “middle-class” level of components, rather than cheaply made devices, says Lemaire. This recommendation supports WHO’s GATE initiative, which is designed to improve access to high-quality, affordable assistive products globally. “The standards are built on the idea that a device should not bankrupt a family and should not be an excessive financial hardship,” says Lemaire.

Regarding 3-D printing, Supan notes that this fabrication process has come a long way and could—in the future—play an important role as one type of O&P product offering. “The stuff being done early on to meet kids’ needs … really didn’t meet any standards,” he says. “But the materials and durability have changed. Using 3-D printing properly and incorporating it into the service model,” provided by appropriately qualified health-care professionals, may be an important part of the O&P products evolution.

Edward Lemaire, PhD

Product Standards

The product section of the “Global Standards for Prosthetics and Orthotics” calls for an appropriate range of O&P products to be available in countries to suit local needs and realities. O&P products and working methods should be appropriate to the setting in which the products are fabricated, fitted, and funded. The standards also recommend that each country develop a national list of priority O&P products.

Supan explains that all materials should be reliable and meet the accepted international standards set forth by the International Organization for Standardization (ISO). “It’s important to make sure materials are durable in third-world countries—but also accessible,” says Supan.

Although the standards do not specify materials to use, Supan says it’s becoming more important to consider materials in light of new technologies.

“For generations, we had to look at the kind of wood and materials we used” to make prostheses, he explains.

Now, technology has evolved to the point that “we’re making devices that are permanently attached to a person’s femur” with the advent of osseointegration procedures. With some of the earliest osseointegration patients reaching a 10-year mark with their implants, “we’re finding that components need to be adjusted,” and we may need to explore materials choices, Supan suggests. “A traditional ankle/knee/hip prosthesis may need

ISPO Occupation Classification ISPO Occupation Classification

Short Description

Prosthetist/Orthotist

Training level aimed at the full breadth of clinical service, leadership, advancing models and/or methods of service delivery

Associate Prosthetist/Orthotist

Training level aimed at general clinical service delivery

Prosthetic/Orthotic Technician

Training level aimed at technical design and fabrication of devices without providing clinical intervention

SOURCE: “Global Standards for Prosthetics and Orthotics,” World Health Organization

to be built differently since it’s being built into a bone,” he says. When a prosthesis breaks, it’s “a lot easier to replace a prosthesis that’s in a socket than to go into surgery to replace” an osseointegrated device.

Supan also notes that the standards call for product research and development to be suitable to the geographic setting. “Remember that you can’t always take technology from the developed world into the developing world,” he says.

Of course, proper data collection on O&P patient care will help professionals understand which products are currently being supplied for different types of O&P patients in various countries. The recent announcement of a U.S. Limb Loss and Preservation Registry, developed by the Mayo Clinic and National Institutes of Health, is a good starting point for American data collection, Supan says, “but it needs to be expanded upon on an international basis.”

Personnel Standards

The personnel-focused standards identify the requirements to be considered in planning, developing, and promoting professional recognition of the O&P workforce. These standards emphasize the importance of training various types of O&P personnel to meet national demand and call for Member States to develop regulations to ensure that O&P patients are protected from malpractice and poor-quality services. The standards also mandate that complicated O&P treatment and care of complex cases

should be provided by a multidisciplinary team of professionals with complementary skills.

The WHO standards state that “training according to international and national standards, such as those of ISPO, equips students with the minimum competence required for safe, effective practice in each professional category, although more work is needed to determine the exact influence of training and education on the quality of prosthetic and orthotic services.”

Robin Seabrook

Thus, the WHO personnel standards can be met by compliance with ISPO’s educational guidelines for O&P professionals, which standardize three “levels of care” associated with the profession: orthotists/prosthetists who are credentialed clinicians, associate orthotists/prosthetists (commonly called “assistants” in the United States), and technicians. The ISPO educational standards were developed by the ISPO Standards Committee in 2017 and became “live and active” in September 2018, according to Robin Seabrook, executive director of the National Commission on Orthotic and Prosthetic Education (NCOPE) and a member of the ISPO Standards Committee. The committee

“formalized the accreditation process,” she explains.

In the United States, an orthotist or prosthetist will likely be in compliance with the requirements for the top “level” of O&P health-care professional described in the ISPO educational guidelines—and the WHO personnel guidelines—if he or she has completed an O&P education program accredited by the Commission on Accreditation of Allied Health Education Programs, completed a residency at an NCOPE-approved site, and earned certification from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), according to both ISPO and WHO. “If you’re meeting ABC standards, you are in alignment with the [WHO] standards,” says Supan.

Regarding the standards advocating for a multidisciplinary team of professionals, the U.S. has some work to do. “A multidisciplinary approach is a sporadic occurrence in the United States,” says Supan. He notes that after World War II, much of the world adopted a team approach for O&P care, and multidisciplinary care has now become routine in some countries—but O&P care is still siloed in many parts of the United States.

But Supan also notes that, because there is less multidisciplinary care, many U.S. O&P practitioners are more highly trained than in some other areas.

“In the ’60s, the orthopedic surgeon was in charge of the rehabilitation process [in the United States]. But now, rather than orthopedic surgeons, vascular surgeons or general surgeons O&P ALMANAC | DECEMBER 2018

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SOURCE: “Global Standards for Prosthetics and Orthotics,” World Health Organization

are taking on more amputations; these individuals are not as well-trained in O&P medicine, so U.S. orthotists and prosthetists have to be highly trained” in all aspects of amputation rehabilitation and care, says Supan.

In addition, O&P technology has advanced so much that therapists are not as familiar with some of the newer devices, says Supan. So, prosthetists “have to step it up—and educate surgeons and therapists.”

the following questions: How are O&P professionals presented? Does the facility project a level of professionalism? Are you going into a “shop” or a clinical facility? Do you have a clinical assessment area? Lemaire believes that most accredited facilities in North America already adhere to many of the provision of services standards—“but now it’s also recognized within the global standards.”

Provision of Services Standards

U.S. O&P professionals should, at a minimum, know that the new WHO standards exist and that their overall goal is to provide a standard level of care to O&P patients worldwide, according to Lemaire. “People being well-versed in what’s expected is a good thing. Knowing the way the world is moving is very important for any profession,” he says. “A CPO doesn’t need to read the whole document in detail, but should take time to review and look at the different recommendations.” The full “Global Standards for Prosthetics and Orthotics” document is available on the WHO International website, www.who.int.

Being an active participant in the greater O&P community requires awareness of global standards, says Seabrook. While the standards may not have a specific impact in the U.S. in terms of reimbursement, “we don’t want to be isolationists or work in a vacuum,” she says. “And we want to be recognized as working at a high level.”

Awareness of the standards also gives U.S. clinicians who travel to

The final area of the new WHO standards emphasizes the importance of people- or user-centered O&P services.

O&P consumers should be regarded as “equal members of the treatment team and be given the necessary information to empower them to make decisions about their care and final selection of a product,” according to the “Global Standards for Prosthetics and Orthotics.”

The standards recommend that service delivery models be designed to facilitate accessibility, be part of a health system, and consider maintenance and repair as part of the service, according to Supan. “Service delivery” is defined as assessment, fabrication and fitting, user training and product delivery, and follow-up. The standards position O&P services as an integral part of health services.

Part of complying with the provision of services standards means presenting O&P facilities and providers in a professional manner, says Lemaire.

To determine how well a facility is complying, he recommends answering 34

DECEMBER 2018 | O&P ALMANAC

Embracing the New Standards

other countries an understanding of the minimum guidelines to be adhered to by the 177 participating Member States. “It gives an opportunity for our students to go globally and participate at the highest level,” Seabrook says. “We are participating and representing the interests of the U.S. at a global level” via exchange programs, information sharing across borders, and other joint endeavors.

“Ultimately, extending viewpoints across borders has a positive impact on patient care.”

Of course, the WHO standards are brand new, so full compliance, for any country, is probably not possible yet.

In the future, ISPO plans to conduct an international survey to see how individual countries are living up to the standards, says Lemaire, but it’s important to give Member States time to adapt to the new requirements.

“Countries are in the early stages of getting to know the breadth and potential of using standards to effect change,” he says. “The ‘operational’ parts are still unknown,” including whether U.S. stakeholders will form a task force related to the standards.

The first step will be to “make sure governments realize the standards are in place,” says Supan. O&P professionals can do their part by educating themselves, their payors, and their legislators on the new WHO O&P standards.

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

PRINCIPAL INVESTIGATOR

From Rocket Science to O&P Before becoming a prominent O&P researcher, Brian J. Hafner, PhD, trained as an aerospace engineer

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

O

&P MAY NOT BE rocket science,

PHOTO: Brian J. Hafner, PhD

but the science behind the profession comes close. Recent orthotic and prosthetic research is elevating the profession to new heights, with prominent academics conducting studies that demonstrate the value of O&P interventions. One such researcher—Brian J. Hafner, PhD, a faculty member at the University of Washington (UW)—found the O&P field to be so important that he transitioned from undergraduate studies in aerospace engineering to graduate and doctoral studies in prosthetics.

“I originally trained as a mechanical (aerospace) engineer but was drawn to the medical field after my grandfather was diagnosed with amyotrophic lateral sclerosis,” Hafner recalls. He witnessed firsthand the debilitating effects of an adverse health condition, and “the incredible impact that assistive technology could have on the lives of the individual and their family.”

Hafner completed his undergraduate studies in engineering but pursued graduate training in bioengineering, planning to apply his engineering skills to pertinent clinical problems. “My first exposure to O&P research was as a research assistant in graduate school,” Hafner explains. He joined a research lab in the Department of Bioengineering at UW that studied the interface stresses present between the residual limb and prosthetic socket in people with transtibial amputation.

“In that role, I helped to conduct a variety of research experiments intended to improve our understanding of residual limb health and injury associated with wearing a prosthesis.”

During his initial interactions with amputee subjects, Hafner was “inspired by the selflessness of the research participants who each—despite their own challenges—found the capacity to give of their time so that we could learn from their experiences.” In the years that followed, he began to work more and more with allied health professionals in the UW Department of Rehabilitation Medicine, who showed him “the remarkable impact that specialists, like prosthetists and orthotists, can have on the patients they treat,” he says. He soon became fascinated with the challenge of trying to measure the effects of prostheses and orthoses on the lives of their users.

Hafner also was inspired by the time he spent working at Prosthetics Research Study (PRS), a nonprofit research organization in Seattle. “PRS worked extensively with the American Academy of Orthotists and Prosthetists (AAOP) on educational projects funded by a grant from the U.S. Department of Education,” he says. While working with PRS, Hafner collaborated with renowned clinicians, educators, and researchers on several State of the Science Conferences and other grant-related activities.

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PRINCIPAL INVESTIGATOR

“Involvement in these activities inspired me to pursue my prosthetics training and return to academia,” he says. He soon earned a certificate in prosthetics from Northwestern University and assumed a position in the UW Division of Prosthetics & Orthotics.

Today, Hafner is a professor in the Department Rehabilitation Medicine and an adjunct professor in the Department of Bioengineering Engineering at UW, where he spends the majority of his time focused on O&P research. He also teaches students in the university’s master’s in prosthetics and orthotics (MPO) and rehabilitation sciences doctorial programs.

Filling the O&P Research Well

Over the past two decades, Hafner has authored or co-authored more than 60 peer-reviewed scientific publications and more than 150 presentations at local, national, and international scientific meetings. His research projects have generally fallen into three primary areas of focus: development and validation of health outcome measures, application of sensing technologies to study prosthetic health and related behaviors, and comparative effectiveness of contemporary prosthetic technologies.

Hafner’s current research focuses on the Prosthetic Limb Users Survey of Mobility (PLUS-M), a standardized

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DECEMBER 2018 | O&P ALMANAC

survey instrument he and his team developed that is used regularly to evaluate prosthetic outcomes in lowerlimb prosthesis users. “Last year, we received a grant from the Department of Defense (DoD) to enhance PLUS-M to be able to better measure highly active individuals with lower-limb amputation,” such as military service members, active veterans, and civilian athletes, Hafner explains. “We expect to have a revised version of PLUS-M based on this work ready for use as soon as next year.”

Another current project involves

a collaboration with Andrew Sawers, PhD, CPO, at the University of Illinois at Chicago, to develop the Narrowing Beam Walking Test (NBWT), a clinical balance test to assess fall risk in people with lower-limb amputation. This project, which was initiated with funding from the Orthotic and Prosthetic Education and Research Foundation (OPERF) and is subsequently being funded by the DoD, is intended to determine whether the NBWT can predict who may be at risk for falls.

Hafner and his research team also are working with investigators from the University of Miami to develop the PROsthetic Mobility Performance Test, an individualized performance-based test of mobility that is designed for fast, in-clinic administration. “We’ve just started a large data collection effort and will be travelling around the country to collect performance data from a large number of prosthesis users so that we can calibrate the instrument and prepare it for administration in clinical practice and research,” he says. “We’re very excited about this project, as we envision it will help us to create a system of measures—both self-report and performance-based— that can be administered quickly and provide practitioners and researchers with valuable information about an individual’s functional abilities.”

PHOTOS: Mariana Kajlich

Paper version of the PLUS-M instrument

Electronic version of the PLUS-M instrument

PRINCIPAL INVESTIGATOR

In addition to his instrument development research, Hafner and his team are studying advanced prosthetic foot technologies. They recently concluded a three-year, DoD-funded crossover study to compare the effectiveness of crossover and energy-storing feet. Crossover feet are “a new type of prosthetic feet, developed by one of our local clinical collaborators and recently commercialized by Össur and Fillauer,” explains Hafner. These feet combine features of both high-performance running feet (an extended keel and posterior socket attachment) and traditional energy-storing feet (carbon fiber heel and foot cosmesis). According to Hafner, “The unique, hybrid design of the crossover foot allows users to achieve a greater range of function, from walking to running to sporting activities, with a single prosthesis.” He recently conducted a study to assess how well the hybrid design performed, relative to traditional energy-storing feet, using both laboratory testing methods and in real

use. “Results of our study showed that the crossover foot performed as well or better than traditional feet in laboratory tests, and that users reported significantly better performance when the foot was used daily over an extended period,” he reports. Next, he and his team will study whether the crossover foot can provide performance similar to a running foot in more aggressive activities.

Outside Influencers

Throughout the years, Hafner’s research has been funded by a variety of agencies and organizations, including UW, AOPA, DoD, OPERF, AAOP, the National Institutes of Health, the National Science Foundation, and various O&P companies.

He has collaborated with dozens of “inspiring and amazing” individuals, he says, including physicians, prosthetists, orthotists, physical therapists, engineers, instrument developers, and prosthetic limb users. Several of his research collaborations are with former students

Ferrier Coupler Options!

who have gone on to be successful researchers at UW or other institutions.

Among his many current collaborations, Hafner is partnering with Sara Morgan, PhD, CPO, on a pilot randomized control trial to assess outcomes associated with use of microprocessor-controlled prosthetic knees in the early phases of postamputation rehabilitation.

“The goal of this study is to determine whether users’ health, safety, and quality of life can be improved by providing a microprocessor-controlled knee (MPK) in a user’s first prosthesis, rather than the traditional approach of only providing an MPK after the user has demonstrated mastery of a nonmicroprocessor-controlled knee,” he says.

In addition to “researcher” and “research collaborator,” Hafner takes pride is his role as “educator.” As a professor in UW’s MPO program, Hafner helps prepare future clinicians to better assess and document their patient outcomes. He is the primary instructor for a course called

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PHOTO: Greg Davidson, CPO

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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 2018

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PRINCIPAL INVESTIGATOR

“Outcome Measures for the Prosthetics & Orthotics Clinic,” which trains students to select, administer, score, interpret, and disseminate the results from standardized outcome measures.

Hafner also mentors doctorial students from the university’s Departments of Rehabilitation Medicine, Mechanical Engineering, and Bioengineering, training the next generation of O&P educators and researchers.

When he’s not conducting research or teaching class, Hafner devotes much of his spare time to his scientific writing.

“I believe that an author has the opportunity—if not the responsibility—to tell

a story that is interesting and engaging to the reader,” he says. “I revel in the challenge of creating the story, even if it does not always come easy. I often spend hours, or even days, trying to get a key paragraph or section just right, but I think that, ultimately, the work benefits and the end result shows that extra effort that goes into creating it.”

O&P Priorities

Looking to the future, Hafner believes there is one pressing question around which O&P research should be focused: How do we define, measure, and justify a successful prosthetic or orthotic

Notable Works Brian J. Hafner, PhD, has been involved in the publication of many important articles and papers over the course of his education and career. Some of his most impactful articles include the following: • Hafner B.J., Willingham L.L., Buell N.C., Allyn K.J., and Smith D.G. “Evaluation of Function, Performance, and Preference as Transfemoral Amputees Transition From Mechanical to Microprocessor Control of the Prosthetic Knee.” Arch Phys Med Rehabil 2007; 88(2): 207-17. PMID: 17270519.

• Hafner B.J., Gaunaurd I.A., Morgan S.J., Amtmann D., Salem R., Gailey R.S. “Construct Validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M) in Adults With Lower-Limb Amputation.”

Arch Phys Med Rehabil 2017; 98(2): 277-85. PMID: 27590443.

• Morgan S.J., McDonald C.L., Halsne E.G., Cheever S.M., Salem R., Kramer P.A., Hafner B.J. “Laboratory- and Community-Based Health Outcomes in People With Transtibial Amputation Using Crossover and Energy-Storing Prosthetic Feet: A Randomized Crossover Trial.” PLOS One 2018; 13(2): e0189652. PMID: 29414988.

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outcome? “To me, this question lies at the center of our field’s current struggles with research and reimbursement,” he says. “This question is so challenging to address because rehabilitation interventions, like prosthetics and orthotics, are individualized to the priorities and needs of each user.

Therefore, ‘success’ for one individual may not be the same as another.”

Selecting outcome measures for patients in a clinic or participants in a research study is a challenging undertaking, says Hafner, who seeks better ways to identify each user’s priorities and customize assessments to that individual “in order to fully understand the broad impact O&P interventions can have each individual’s life.” It is his hope that the instruments developed through his many research initiatives will allow for the collection of outcomes data “more accurately, efficiently, and on a larger scale than has been possible in the past,” Hafner says. “While the current funding environment has certainly contributed to the profession’s need for better outcomes data, I would also like to think that practitioners are increasingly interested in measuring the success they have with each patient. It is my goal to create tools that are easy to use and that provide information that is relevant to patients and providers, and are readily accepted by clinicians, researchers, and payors.”

What Hafner enjoys most about his work is learning that the research he is involved in “matters,” he says.

“From time to time, we receive notes, letters, or emails from former research participants or professionals thanking us for our work. These are small gestures, but [they] remind us that the research we do has the potential to positively affect the lives of many.”

A lot has changed since Hafner’s undergraduate days as an aerospace engineer. And while it is possible that he may have made a significant impact on the field of rocket science had he not made the fateful decision to study prosthetics, it is clear that he has made truly important contributions to the O&P community, benefitting not only clinicians but O&P consumers and their families as well.

MEMBER SPOTLIGHT

KLM Laboratories

By DEBORAH CONN

Inserting New Technologies California company welcomes digital scanning and traditional methods in providing orthoses

A

S IN SO MANY origin

PHOTOS: KLM Laboratories

stories, KLM Laboratories got its start in a garage. Or, in this case, a backyard shed where podiatrist Howard Marshall, DPM, and his sons, Kirk, Scott, and Kent, made orthotic inserts for Howard’s patients.

At the time—the early 1970s—new plastics were being introduced to the orthotics industry, and non-weight-bearing, neutral-position casting techniques were starting to be used to capture the shape of the foot.

With few custom foot orthosis labs in the United States, Howard Marshall decided to launch KLM Laboratories in 1973.

Forty-five years and six locations later, KLM has about 75 employees and occupies a 35,000-square-foot facility in Valencia, California, manufacturing orthotic shoe inserts, orthotic sandals, and custom and over-the-counter braces, including Richie Braces, gauntlets, and ankle-foot orthoses.

The company’s diabetic orthotics are approved to be used for codes A5513 and K0903, according to Melinda Dawson, the company’s marketing manager, and “we also have a full line of sport, functional, and geriatric products,” she says.

“We offer a variety of materials and supplies as well.”

KLM serves a broad range of podiatrists, orthotists, pedorthists, and physicians. The company accommodates traditional plaster casts and foam impression casts, as well as digital scans. “Many practitioners are eager to embrace technology, like using a tablet

The KLM working lab

COMPANY: KLM Laboratories OWNERS: Kirk Marshall, Scott Marshall, and Kent Marshall LOCATION: Valencia, California

to create digital scans,” says Dawson. “But if a practitioner is reluctant, we gladly accept traditional casting methods because we strive to satisfy the needs of all of our customers.”

She estimates that the company works with traditional methods about 90 percent of the time.

An example of the scanning process

HISTORY: 45 years

Designing an orthotic sole

The company is excited to embrace new technology, including robotics and 3-D printing. “Our use of tech has changed a lot in the 14 years I’ve been here, and we want to stay ahead of the curve,” Dawson notes. “The Marshalls understand that to stay ahead, we have to employ tech-savvy individuals—including a third generation of Marshalls.”

KLM uses three different methods of cast correction: traditional hand correction; a proprietary computerized technique called System-Rx,

which generates a positive mold to which a custom foot orthosis is pressed; and Value Rx, which replaces hand pressing the orthosis to a positive mold with one of 99 shapes of injection-molded shells available in four rigidities. Both computerized systems can help reduce costs without sacrificing accuracy, Dawson says.

The company markets its products and services via trade shows and digital and print advertising. The owners emphasize education. “We travel extensively for residency summits, where we conduct workshops on biomechanics and digital scanning technology,” adds Dawson.

KLM also works with PRESENT e-Learning Systems, which offers online lectures and CME credits to users. The KLM website features instructional videos, including casting techniques, as well as articles, a blog, and an e-newsletter.

KLM customers can set up online accounts to place, track, and manage their orders through the website, as well as request a pickup.

The Marshall brothers continue to develop new methods for evaluating biomechanical foot deformities, says Dawson. “They work with doctors to find new ways of assessing and accommodating any type of foot deformity.

KLM also helps practices privately label custom or over-the-counter products. We are a one-stop shop doing whatever doctors or O&P practitioners need.”

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

O&P ALMANAC | DECEMBER 2018

39

MEMBER SPOTLIGHT

LeTourneau Prosthetics

By DEBORAH CONN

Texas Hospitality Family-owned facility prioritizes customer service and innovations

I

N ITS CURRENT FORM,

LeTourneau Prosthetics is only two years old, but the business dates back to 1989. That’s when Tom LeTourneau, CPO, FAAOP, started selling braces to hospitals, using the back of his car as his warehouse.

LeTourneau’s business grew quickly. At first he partnered with durable medical equipment (DME) shops, using their facilities to fabricate orthoses and prostheses, but he soon realized that DME, with its focus on sales, was not a good fit for O&P, which emphasizes service. Instead, he began to share offices with physical therapists. As business grew at each location, LeTourneau would open his own facility in the area. At one point, LeTourneau Orthotics and Prosthetics had 13 offices in Texas and Louisiana, with 39 employees. LeTourneau credits his team for the success of his business, both then and now.

Tom LeTourneau, CPO, FAAOP, fitting a socket

FACILITY: LeTourneau Prosthetics OWNERS: Tom LeTourneau, CPO, FAAOP, and Sandra LeTourneau, CO LOCATIONS: Jasper, Beaumont, and Port Arthur, Texas HISTORY: 27 years

Over the years, LeTourneau rejected buyout offers from several companies. He eventually received an offer he “couldn’t refuse.”

After acquiring LeTourneau’s business, the buyer ended up closing most of the offices and 40

DECEMBER 2018 | O&P ALMANAC

Tom and Sandra LeTourneau with great-granddaughter Matilda Rice

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

PHOTOS: LeTourneau Prosthetics

(Left to right) Matilda Rice; Dori Waugh, prosthetic assistant; Samantha Rice, head of accounts receivable; Shawn Rice, COF, CPed; and Brenna Rice

then failed to meet a contractual obligation, allowing LeTourneau to take back the remaining facilities in 2016. “I decided to keep just the Jasper, Beaumont, and Port Arthur offices,” he says. Today, the three offices employ nine staff members.

LeTourneau Prosthetics is definitely a family concern. Tom’s wife, Sandra, is a certified orthotist; she sees some patients and handles much of the business side of operations. Their daughter, Shawn Rice, COF, CPed, is chief financial officer of the company, and his granddaughters, Samantha Rice and Brenna Rice, tend to billing and customer service, respectively. LeTourneau’s 4-year-old great-granddaughter is often at the office, perhaps paving the way for a fourth generation of family.

LeTourneau uses a 3-D scanning system he regards as “amazingly accurate.” He says, “The really nice part is that you have accurate shapes and images and measurements all at one time. You can do overlays that

demonstrate progress, which is great for documentation. When an insurance company asks for notes, you’ve got it right there.”

The company markets itself through a robust website and several social media platforms.

LeTourneau also advertises on television, a medium he believes is critical for momand-pops and smaller facilities.

The engaging 30-second spots feature candid testimonials from patients, including Anthony Quinn, a high-profile amputee runner who is training for the 2020 Paralympics. All videos are accessible from the website and on Facebook, as well.

In addition to his roles as owner and clinician, LeTourneau is an innovator, with several new products to his name. He designed a prosthetic covering process called Perfect Skin that gives a lifelike look to upper- and lower-extremity prostheses with natural-looking joints, skin, nails, and hair. Another new product, the Neutralizer knee brace, takes pressure off certain areas of the knee, easing the pain and preventing further deterioration from osteoarthritis, he notes.

In all of his endeavors, LeTourneau places customer service at the top of his priorities.

“You can write all kinds of books and articles on prosthetics, but no matter who you are or how you started, when you are in this career you have to base everything on customer service,” he says.

“They don’t train you in school on this. The focus is on physiological changes, gait analysis, the technical aspects of O&P. But new practitioners have to learn service. The customer is always right—they are the ones who have to wear the device. And whatever they need, you do it.”

Who is an innovator?

Who is held to the highest O&P standards?

Who is committed to life-long learning?

I AM. I am a big part of great possibilities.

I AM ABC. Visit abcop.org today to find out what ABC can do for you.

703.836-7114

AOPA NEWS

AOPAversity: Webinar Series Subscription During the one-hour monthly webinars, AOPA experts provide the most up-to-date information on a specific topic.

Webinars are held the second Wednesday of each month at 1 p.m. EST. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits, so you can still take advantage of the series discount and the valuable learning opportunities.

JANUARY 9

Sign Up for the 2019 Full Year Series & Save!

Registration Fee

AOPA Members Nonmembers

Price Per Seminar

$99.00* $199.00*

Price for Full Year

$990.00 $1,990.00

* Includes an unlimited number of participants per telephone line. AOPA members may use code “member” when registering for the $99 price.

Earn 1.5 Business CEs each by returning the provided quiz within 30 days and scoring at least 80 percent. All webinars begin at 1 p.m. EST. Webinar registration fees are nonrefundable. AOPA can provide the webinar recording if registrants cannot make the scheduled webinar.

FEBRUARY 13

Patient Outcomes: Best Practices & How To Use Them Understanding the Knee Orthosis Policy Up your game by ensuring you understand all aspects of the Knee Orthosis Policy. Take part in the January 9 webinar, when AOPA experts will provide an in-depth review of the policy and will: • Examine which additional codes can be used with each base code • Determine what documentation is needed for each type of knee orthosis • Determine when you may use the KX modifier on a KO claim • Review the Reasonable Useful Lifetime of all knee orthoses • Review all other pertinent information found in the Local Coverage Determination and Policy Article.

42

DECEMBER 2018 | O&P ALMANAC

The February 13 webinar will focus on the principles of developing and using patient outcomes in your practice.

AOPA experts will address the following questions: • • • •

What exactly are “patient outcomes”?

Why should you pay attention to patient outcomes?

What are best practices for tracking patient outcomes?

How can you leverage patient outcomes to improve care and your business?

AOPA NEWS

2019 WEBINARS

2019 Webinar Topics Announced

NOW AVAILABLE:

‘2018 Operating Performance Report’ AOPA Releases Results From Member Benchmarking Survey

Mark your calendars for AOPA’s 2019 monthly webinars. These informative sessions take place on the second Wednesday of each month at 1 p.m. EST. 2019 Webinars • January 9: Understanding the Knee Orthosis Policy • February 13: Patient Outcomes: Best Practices & How To Use Them • March 13: Advanced Beneficiary Notice (ABN): Get To Know the ABN Form • April 10: Shoes, External Breast Prostheses, Surgical Dressings, and Other Policies • May 8: Are You Compliant? Know the Supplier Standards • June 12: Documentation—Understanding Your Role • July 10: Target, Probe, Educate—Get To Know the Program & What the Results Are Telling You • August 14: Are You Ready for the Worst? Contingency Planning • September 11: Veterans Affairs Updates: Contracting, Special Reports, and Other News • October 9: Performance Reviews: How Is Your Staff Doing?

• November 13: The Holiday Season— How To Provide Compliant Gifts • December 11: New Codes for 2020, Other Updates, and Yearly Roundup 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.

Are you curious about how your O&P business is performing compared to others? Have you been asking questions like these: • How does our spending on materials, advertising, or other expenses compare with other companies similar to ours?

• Is our gross margin better or worse than other facilities of the same size?

• Are our employees generating enough sales?

Copies of the “2018 Operating Performance Report” are now available. The annual report provides a comprehensive financial profile of the O&P industry, including balance sheet, income statement, and payor information organized by total revenue size, community size, and profitability. This year’s data was submitted by more than 90 patient-care companies representing 1,022 full-time facilities and 191 part-time facilities.

Copies of the “2018 Operating Performance Report” are available electronically or print in AOPA’s bookstore: • “2018 Operating Performance Report” (Electronic)—Member/Nonmember: $185/$325

Entire Series ($990 Members/$1,990 Nonmembers).

Register at bit.ly/2019webinars.

O&P ALMANAC | DECEMBER 2018

43

AOPA NEWS

AOPA Announces 2019 Call for Papers Submissions Due March 25

AOPA is seeking high-quality educational and research content for the 2019 AOPA National Assembly, which will be held September 25-28, 2019, in San Diego, California. All submissions are due March 25, 2019.

Your submissions will set the stage for a broad curriculum of high-value clinical and scientific offerings at the National Assembly. All free paper abstracts must be submitted electronically. Abstracts submitted by email or fax will not be considered. All abstracts will be considered for both podium and poster presentations. The review committee

will grade each submission via a blind review process and reach a decision regarding acceptance of abstracts.

AOPA is seeking submissions for the clinical free paper sessions, symposia/instructional courses, technician program, or business education program. Contact AOPA Headquarters at 571/431-0876 or rgleeson@AOPAnet.org with questions about the submission process or the AOPA National Assembly in general.

Visit the AOPA website for more information and to see full submission guidelines for the 2019 AOPA National Assembly.

O&P PAC UPDATE

T

HE O&P PAC UPDATE

provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported.

The O&P PAC would like to thank the following AOPA members for their contributions to the O&P PAC: • David Boone, PhD, MPH, BSPO • Jeffrey Lutz, CPO

• • • •

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the U.S. House of

AOPA Supplier Plus Partners

44

DECEMBER 2018 | O&P ALMANAC

Brian Mayle Rick Riley Scott Schneider Chris Snell, BOCP

Representatives and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

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

Thank You to Our AOPA Supplier Plus Partners

www.bocusa.org

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

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

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

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

Learn & Earn TOP QUALITY

orthotic, prosthetic and pedorthic education and CE credits from the organization that knows O&P.

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

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

Start earning your credits today!

Visit www.aopanetonline.org/aopaversity.

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

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

Include your company logo with your listing free of charge.

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

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

Member $482 $634

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

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

Nonmember $678 $830

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

Member Nonmember $85 $150

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

SUBSCRIBE

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

46

Certified Prosthetist Orthotist (CPO)

Job location key:

Job Board

Mid-Atlantic

DECEMBER 2018 | O&P ALMANAC

Central Virginia The Prosthetics and Orthotics Division in the University of Virginia’s School of Medicine seeks a certified prosthetist and orthotist (CPO) to consult, provide, and fabricate orthotic and prosthetic devices for adults and children with musculoskeletal impairments throughout Central Virginia.

The successful candidate will be responsible for managing comprehensive orthotic and/or prosthetic patient care. This includes patient assessment, formulation of a treatment plan, implementation of the treatment plan, and follow-up care and practice management.

Candidates for the position should have either a bachelor’s degree with completion of an NCOPE-affiliated certificate program and completion of NCOPE-affiliated residency program; or an associate degree with at least 10 years of direct P&O experience. Qualified candidates must be certified through the American Board for Certification in Orthotics, Prosthetics, and Pedorthics and have one year of postcertification experience.

Some experience with foot/ankle and pediatrics is required.

Also, candidates should be knowledgeable with durable medical equipment billing codes, insurance compliance, and current trends in the prosthetic and orthotic industry.

Successful candidates for the position should also possess interpersonal skills to help build referral bases. A history of prior practice management is preferred, and supervisory and office management skills are a plus.

Applicants should complete a staff application through the Jobs@UVa website, and provide a cover letter, résumé, and a list of three references. To apply for either position, visit https://jobs.virginia.edu, click on University Staff, and search for posting # 0622645 for the Certified Prosthetist Orthotist.

For more information about the division, please visit https:// med.virginia.edu/orthopaedic-surgery/orthopaedic-divisions/ orthotics-and-prosthetics/.

This position is restricted and contingent upon continued funding.

University of Virginia Website: https://jobs.virginia.edu The University of Virginia is an equal opportunity and affirmative action employer. Women, minorities, veterans, and persons with disabilities are encouraged to apply.

CAREERS Northeast

O&P Services

CO/CPO and/or Technician

Prudential Billing and Consulting

Long Island and Queens, New York Wanted: CO/CPO and/or technician for busy Long Island and Queens practice. Excellent pay and comprehensive benefits package. Must be professional, knowledgeable, and caring. Technician must have experience pouring and modifying casts.

An Orthotics and Prosthetics Billing Company A full-service billing company providing initial insurance verification through final payment posting, including any denial management or appeals necessary.

Consultants committed to providing the service you need to be successful!

Apply by email to : Mark Goldberg Prosthetic & Orthotic Labs Email: careers@mgpolabs.com

Pacific

Certified Orthotist (CO) or Certified Prosthetist Orthotist (CPO)

San Diego, California Immediate full time position available for a CO or CPO in a multi-office, ABC-certified, and well-established company in sunny San Diego. Applicant should be experienced in all aspects of the O&P profession with excellent O&P skills and patient care/carry through. We offer competitive salaries and benefits. Send résumés to: BIONICS ORTHOTICS & PROSTHETICS Website: www.bionicsoandp.com Email: bionicsop@gmail.com

Pacific CPO, CPed

Southern California A well-established, privately owned multi-office ABC Accredited Corporation is seeking experienced CPO’s and CPed’s who will support the company’s vision, mission, and values and provide premier prosthetic and orthotic patient care to join our team.

Candidates must be energetic, self-driven, motivated, and knowledgeable individuals who possess strong clinical, technical, and interpersonal interaction skills. They must be patient oriented, innovative, and desire a long-term career with a growing company.

We offer competitive salaries, benefits and a rewarding place to take the next step in establishing a great career and make a difference. Salaries are commensurate with experience. Local ABC-Accredited practitioners are preferred.

Contact: www.prudentialbilling.org Phone: 888/862-9377 Email: info@prudentialbilling.org

WANTED! A few good businesses for sale.

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

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

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

Apply by email to : Email: Box100@AOPAnet.org Reference Job ID: 45402723

O&P ALMANAC | DECEMBER 2018

47

MARKETPLACE

Feature your product or service in Marketplace.

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

Visit bit.ly/almanac18 for advertising options.

ALPS Flex Sleeve ALPS Flex Sleeve (SFX) has a seamless knitted construction with a 30-degree preflexion, which allows for ease of bending and reduces bunching behind the knee. It features our HD Gel, which has a relatively firm nature and provides maximum comfort.

For more information, visit us at www.easyliner.com.

Sutti Bounders Store and Return Energy— Mimicking Normal Muscle Function

Victor Knee Step victoriously. The Victor knee is a single-axis, pneumatic knee joint featuring a friction brake to control stance phase. This knee is the ideal solution for low to moderate activity users, as it can adjust to accommodate both slow and fast paced walking. It also works well for patients looking to increase their activity level after rehabilitation. The Victor is an economical option that instills confidence and freedom in patients.

For more information, contact College Park Industries; visit www.college-park.com.

Coyote® Design Prosthetic Locks

“Itching” for a new material?

• Nontoxic, noncarcinogenic, and inert alternative to carbon fiber.

• Has little to no itch.

• Made from basalt (lava rock), a 100 percent natural fiber.

• We found you can save at least 31 percent by using Coyote Composite compared to carbon fiber.

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

48

DECEMBER 2018 | O&P ALMANAC

New “Sutti Bounders” modular pediatric dynamic elastomers are a patent-pending elastomer technology that offer two progressive solutions. Sutti Bounders store and return energy—mimicking normal muscle function to produce both eccentric and concentric contractions and, if needed, a ground-reaction force. Smart and simple modular design, standardized sizes, and three levels of performance to choose from add up to an easy-to-use, expandable dynamic system to treat your pediatric and young adult patient base.

For more information, contact www.fabtechsystems.com/ bounders or call 800/322-8234.

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.

MARKETPLACE iLimb

WalkOn® Carbon Fiber AFO

The i-limb product range combines functionality with style. Individually motorized digits, stall detection, and the unique software used to control the i-limb hands result in highly versatile prosthetic hands optimized to meet the needs of your varied patient population.

Visit ossur.com/touch or ask your Össur representative about i-limb® today.

2019 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2019 AOPA coding products.

Ensure each member of your staff has a 2019 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• 2019 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers

WalkOn ankle-foot orthoses (AFOs) are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally.

WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return. WalkOn offers a full range of AFO sizes and designs, including the WalkOn Reaction Junior pediatric sizes.

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

New DVS Liner for Improved Sealing

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

With real-time control and an unprecedented four-axis design, the Meridium® microprocessor foot has taken a giant step closer to approximating the human foot. Perfect for your low to mid K3 patients that are looking for a more natural gait pattern plus enhanced stability and safety.

Ask your sales representative or visit professionals.ottobockus.com for more details.

AD INDEX

Advertisers Index Company

Page

Phone

Website

ALPS

9 800/574-5426 www.easyliner.com

American Board for Certification in Orthotics, Prosthetics, and Pedorthics

41

Amfit

17 800/356-3668 www.amfit.com

703/836-7114

www.abcop.org

College Park Industries

7

800/728-7950

www.college-park.com

Coyote Design

27

800/819-5980

www.coyotedesign.com

Fabtech Systems LLC

5

1-800-FABTECH

www.fabtechsystems.com

Ferrier Coupler Inc.

37

810/688-4292

www.ferrier.coupler.com

Hersco

1 800/301-8275 www.hersco.com

Naked Prosthetics

19

Össur

29 800/233-6263 www.ossur.com

Ottobock

C4 800/328-4058 www.professionals.ottobockus.com

888/977-6693

www.npdevices.copm

O&P ALMANAC | DECEMBER 2018

49

CALENDAR

2018

January 4–6

DECEMBER BOC Certification. Apply anytime for www.bocusa.org 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.

AOPA 2019 Leadership Conference. The Scott, Scottsdale, AZ. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

January 9

Understanding the Knee Orthosis Policy.

Register online at bit.ly/2019webinars.

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

WEBINAR

January 11–12

December 6–8

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

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

December 9–14

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 abcop.org/ individual-certification.

December 12

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

WEBINAR

Free Online Training

Cascade Dafo Institute offers eight free ABC-approved online continuing education courses for pediatric practitioners.

Earn up to 11.75 CE credits. Visit cascadedafo.com or call 800/848-7332.

2019 January 1

ABC: Practitioner Residency Completion Deadline for February 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 abcop.org/individual-certification.

50

DECEMBER 2018 | O&P ALMANAC

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

January 25–26

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

January 28–29

2019 Mastering Medicare: Essential Coding & Billing Techniques Seminar.

Orlando. Register online at bit.ly/2019billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

February 1

ABC: Application Deadline for Certification Exams.

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

February 1

ABC: Accreditation Renewal Application Deadline for sites expiring June 30, 2019. Submit your renewal application to ABC online before June 30, 2019, to avoid any delays in your accreditation. Contact 703/836-7114, email accreditation@abcop.org, or visit abcop.org/facility-accreditation.

February 13

Patient Outcomes: Best Practices & How To Use Them. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

CALENDAR

NEW DATES: February 15–16

PrimeFare Central Regional Scientific Symposium 2019. Renaissance Hotel, Tulsa, OK. Contact Cathie Pruitt at 901/359-3936, email primecarepruitt@gmail.com; or Jane Edwards at 888/388-5243, email jledwards88@att.net; or visit www.primecareop.com.

August 14

Are You Ready for the Worst?

Contingency Planning. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

September 11

March 13

Advanced Beneficiary Notice (ABN): WEBINAR Get To Know the ABN Form. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Veterans Affairs Updates: Contracting, Special Reports, and Other News.

Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

September 25–28

April 10

Shoes, External Breast Prostheses, WEBINAR Surgical Dressings, and Other Policies.

Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

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

October 9

April 15–16

2019 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminar.

Chicago. Register online at bit.ly/2019billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Performance Reviews: How Is Your Staff Doing? Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

November 3–9

May 8

Are You Compliant? Know the Supplier WEBINAR Standards. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@ AOPAnet.org.

Health-Care Compliance & Ethics Week.

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

Learn more at bit.ly/aopaethics.

November 13

June 12

Documentation—Understanding Your WEBINAR Role. Register online at bit.ly/2019webinars.

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

The Holiday Season—How To Provide Compliant Gifts. Register online at bit. ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

July 10

Target, Probe, Educate—Get To Know WEBINAR the Program & What the Results Are Telling You. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

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

Questions? Email ymazur@AOPAnet.org.

CREDITS

December 11

New Codes for 2020, Other Updates, and Yearly Roundup. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

Let us share your next event!

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

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

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O&P ALMANAC | DECEMBER 2018

51

ASK AOPA CALENDAR

KX Questions Know the rules for including the modifier on claims for shoes and orthoses

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

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

Q

L3649 KX

AFO

52

DECEMBER 2018 | O&P ALMANAC

If the KX modifier indicates that the proper documentation is on file, should I include it on all claims?

If I did not provide diabetic shoes for a patient, may I provide inserts for that individual?

You should have all documentation on file to support medical necessity of the items or services you are providing, but the KX is not required for all claims. The answer is found in the full Medicare definition of the KX modifier: “The requirements specified in the medical policy have been met.” This means that if a medical policy has set forth special documentation criteria for billing, you must meet all of the criteria to bill, and that is when you use the KX. There are currently four O&P medical policies that require the use of a KX modifier: • Ankle-Foot Orthosis/KneeAnkle-Foot Orthosis Policy • Knee Orthosis Policy • Orthopedic Footwear Policy • Therapeutic Shoes for Persons With Diabetes Policy.

Yes, but you may only provide the inserts in limited circumstances.

For Medicare to cover inserts provided independently of therapeutic shoes, the provider of the inserts must obtain a written statement from the provider of the shoes that the patient has appropriate footwear into which the insert may be placed.

You also should verify if the patient has already received any inserts during the year since a beneficiary is only eligible to receive up to three pairs of inserts per calendar year.

Q/ A/

How do I bill for a shoe attached to a brace that is not an oxfordstyle shoe?

Q/

If the shoe is not an oxfordstyle shoe (i.e., high-top shoe, depth-inlay shoe, athletic shoe, etc.), the Orthopedic Footwear Policy states that you should bill the claim using L3649 (orthopedic shoe, modification, addition or transfer, not otherwise specified) and the KX modifier.

When billing with the L3649, you must include information on your claim to describe the L3649—in other words, what type of shoe it is.

A/

Q/ A/

3

r Year

Pairs of Inserts pe

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

Q/

Yes, you are still required to adhere to all Medicare policies and procedures, and this includes ensuring you have the proper documentation to support medical necessity.

The choice of being a participating or nonparticipating provider and accepting or not accepting assignment only relates to how you bill the patient and how much you may collect from the patient.

A/

AOPA Coding Experts Are Coming to

Orlando

January 28-29, 2019

ATLANTA

FEB. 26-27 | 2018

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA January 28-29, 2019, in Orlando 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 at bit.ly/2019billing.

The DoubleTree by Hilton Orlando at SeaWorld 10100 International Drive Orlando, Florida 32821 Cutoff Date: January 11, 2019 Room Rate: $149 Individuals can book their room by calling (407) 352–1100 and requesting the AOPA rate.

Top 10 reasons to attend: 1.

Get your claims paid.

2.

Increase your company’s bottom line.

3.

Stay up-to-date on billing Medicare.

4.

Code complex devices.

5.

Earn 14 CE credits.

6.

Learn about audit updates.

7.

Overturn denials.

8.

Submit your specific questions ahead of time.

9.

Advance your career.

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

Find the best practices to help you manage your business.

Participate in the 2019 Coding & Billing Seminar!

Register online at bit.ly/2019billing.

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

www.AOPAnet.org

YOUR GOAL

Help patients improve their quality of life OUR COMMITMENT To never stop improving the safety and performance of the world’s most advanced ankle – Empower®. To deliver an active ankle joint that gives power, even on ramps, stairs and hills. And security with real-time adjustments to terrain. To work with you to help patients like Rob and others return to their daily life at work and at home. Because when your patients succeed, we have all reached our goals.

ottobockus.com/forward-together

11/18 ©2018 Ottobock HealthCare LP. All rights reserved.

We all move forward, together.