February 2015 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

F E B R UARY 2015

Big Change to Medicare RAC Program P.16

Security Strategies for Photographic Documentation P.32

Practitioners’ Role in Cutting-Edge R&D P. 36

Opinions on Fee Schedules P.53

S D N E R T R U O F h c t a W o t d e You Ne DATA AND INSIGHTS

HEALTH-CARE INESS— S U B R U O Y E G N A THAT WILL CH THINK U O Y N A H T R E N O SO

E! QU IZ M EARN

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.17

This Just In: AOPA Announces Research and Registry Funding P.18

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FE B R UARY 2015 | VOL. 64, NO. 2

FEATURES COVER STORY

DEPARTMENTS | COLUMNS Presidentâ&#x20AC;&#x2122;s View....................................... 4

Insights from AOPA President Charles Dankmeyer, Jr., CPO

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

22 | The Changing Health-Care Landscape: Four Trends You Need To Watch

People & Places........................................ 14

Transitions in the profession

Big changes are coming in the way Americans receive and pay for health care. Find out how O&P patient care will be affected by an increased number of insured patients, the rise of value-based care and accountable care organizations, savvier consumers, and more. By Christine Umbrell

18 | This Just In

P. 18

RAC Changes Begin a New Chapter

Learn how recent changes to the Medicare Recovery Audit Contractor program will affect your billing practices.

CE Opportunity to earn up to 2 CE credits by taking the online quiz.

AOPA Futures Leadership Conference Spurs Additional Research Funding

CREDITS

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

After senior-level O&P professionals identified a dire need for increased O&P research, the AOPA Board of Directors responded with commitments of nearly $300,000 to fund directed research efforts and the initial phase of a patient registry.

Freedom Innovations Mobility Solutions Prosthetics & Orthotics

P. 32 AOPA News............................................... 48

32 | Visual Documentation:

AOPA meetings, announcements, member benefits, and more

Keeping Security in Focus

Before diving head-first into video and photo-taking strategies in support of your documentation, understand the guidelines youâ&#x20AC;&#x2122;ll need to follow to ensure patient privacy and HIPAA compliance.

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

Welcome New Members .................. 53

Member Milestones............................. 54

P. 36

Marketplace.............................................. 56

Ad Index....................................................... 58

Careers........................................................ 60

By Cara Negri, BSME, CP; Jim Lawson; and Steven B. Fletcher, CPO/LPO

Professional opportunities

36 | Part of the Experiment

Upcoming meetings and events

As prosthetic limbs become more advanced and enter the realm of robotics and mind control, research teams are turning to prosthetists to ensure well-fitting devices, proper training, and patient compliance.

Calendar...................................................... 62

Ask AOPA...................................................64 Expert answers to your questions about shoe repairs, compression garments, and more

By Meghan Holohan O&P ALMANAC | FEBRUARY 2015

PRESIDENT’S VIEW

Using the Leadership Conference as a Launch Pad

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

AST MONTH, AOPA ORGANIZED the first-ever gathering

of senior-level O&P professionals designed to help leaders anticipate the future of our health-care world, and the threats and opportunities facing O&P companies and the profession as a whole. The January 10-11 Futures Leadership Conference at the Eau Resort in Palm Beach, Florida, certainly lived up to my expectations. It was unique in that the program content flowed from the ideas and observations of the people planning to attend. The top executive of every AOPA member company received an invitation to this conference, and 150 accepted. AOPA asked registrants to consider four questions ahead of the meeting. These questions related to pressing challenges; promising areas of growth, advancement, and profit opportunities; predictions for how O&P and health care will look five years from now; and which talents, skills, and expertise will be needed in the future (and how to ensure that qualified persons fill those needs). Here are three observations among the dozens of “Ah-ha!” moments that were the reward for spending a weekend seriously examining the world we occupy now and how O&P might fit in this world tomorrow: • Mike Lovdal, PhD, and Allen Dobson, PhD, provoked a serious inquiry about how O&P is going to look in a few years by identifying some of the greatest challenges in the fast-changing, cost-driven health-care world, and most importantly how we’re going to deal with it. • Colin Roskey, Esq., gave a real eye-opening presentation on what reimbursements and regulations may hold for O&P—the triple target of patient satisfaction, better patient outcomes, and reduced reimbursements—and the payors’ push for risk sharing, and how we can prepare for our best chances of survival. • Charles Birmingham, PhD, zeroed in on the insurer and offered advice regarding the payor world of tomorrow, which will be based on cost effectiveness and outcomes. We’ve got to go there, and research is imperative. It was encouraging to see the dedication shown by the very top minds in O&P taking a weekend in January, right after the holidays, to share their thoughts, ideas, and often terrific solutions about O&P’s future. There was plenty of spirited discussion and absolutely no apathy in this conference. Ten breakout sessions resulted in a collection of great ideas and tools that attendees took home to their businesses. These ideas also were sent to the AOPA board to include on its agenda for its meeting eight days after the conference. There will be a lot more in the O&P Almanac pages in future issues to bring you up to date on how we can all benefit from the thinking that came out of the Futures Leadership Conference. As a final note on the conference, participants agreed that all conference attendees, and all AOPA members, should mark their calendars for the March 23-25, 2015, AOPA Policy Forum at the Renaissance Hotel in Washington, D.C. I learned a very simple lesson from a good friend who worked as a lobbyist: “If you don’t tell them what you want, you won’t get it.” Get in there, tell your story, and tell them what you need. No one else can do that as effectively as you. The need for you to get involved and participate in the Policy Forum has never been greater.

Charles H. Dankmeyer Jr., CPO AOPA President

FEBRUARY 2015 | O&P ALMANAC

Turn to page 53 to find out how you can share your thoughts on industry hot topics

Board of Directors OFFICERS

President Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD President-Elect James Campbell, PhD, CO, FAAOP Becker Orthopedic Appliance Co., Troy, MI Vice President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Immediate Past President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis Inc., Rochester Hills, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

AOPA CONTACTS

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

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

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org

MEMBERSHIP & MEETINGS Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

FEBRUARY 2015 | O&P ALMANAC

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, cumbrell@contentcommunicators.com

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2015 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise with Us! Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options!

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NUMBERS

When Off the Shelf Is Not the Answer Report finds that nearly one in five Medicare patients who receive off-the-shelf orthoses subsequently require custom-fitted or custom-fabricated devices

MEDICARE STUDY PERIOD

A new study conducted by Dobson DaVanzo & Associates analyzed the outcomes of patients who received several types of Medicarereimbursed off-the-shelf (OTS) orthoses. The report found that 19 percent later required custom-fitted or custom-fabricated devices. While some of the data reflect instances in which OTS devices are fitted out of necessity in the acute or emergent setting or on patients with progressive disorders, such instances likely account for a relatively small portion of the 19 percent, although further study will be needed to better pinpoint the portions of this that may represent appropriate clinical care.

2008-2010

The study examined data for patients receiving O&P services from Jan. 1 to Dec. 31, 2008.

18 Months

The study followed each patient for 18 months from receipt of initial orthosis.

NEARLY HALF A MILLION ORTHOTIC PATIENTS STUDIED

1,519

More than 1,500 patients initially received OTS thoracolumbosacral orthoses (TLSOs).

56,959

Nearly 20,000 patients initially received OTS lumbosacral orthoses (LSOs).

Close to 80,000 total patients initially received OTS orthoses.

Received OTS as Subsequently Received TYPE First Orthotic Device Custom-Fitted/Fabricated Device TLSOs 7.4%

10.7%

LSOs 10.1%

16.9%

AFOs 21.2%

19.9%

TOTAL 16.1%

19.0%

FEBRUARY 2015 | O&P ALMANAC

10.7 percent of OTS TLSO patients subsequently needed custom-fitted or custom-fabricated orthoses. 16.9 percent of OTS LSO patients subsequently needed custom-fitted or custom-fabricated orthoses.

19.9 Percent

19.9 percent of OTS AFO patients subsequently needed custom-fitted or custom-fabricated orthoses.

78,395

Incidence of Medicare Patients Receiving Custom Orthoses After Initially Receiving Off-the-Shelf Devices

10.7 Percent

More than 56,000 patients initially received OTS anklefoot orthoses (AFOs).

19,917

CUSTOM-FITTED AND CUSTOM-FABRICATED SUBSEQUENT DEVICES

“While the clinical implication of receiving both OTS and custom devices does not in itself demonstrate an adverse patient outcome, this finding likely indicates that a sizeable proportion of beneficiaries are not receiving the appropriate device initially.” —“Summary of Key Findings: Use of OTS and Custom Orthotics Among Medicare Beneficiaries,” Dobson-DaVanzo Report

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Happenings CMS UPDATE

Tavenner Resigns as CMS Administrator website in fall 2013, and subseCMS Administrator Marilyn Tavenner quently apologized to Congress announced on January for the site’s faulty performance. 16 that she will resign Andy Slavitt, the current CMS at the end of February. principal deputy administrator, Tavenner, 63, a key will become acting administrator Obama administration when Tavenner leaves at the end health official who of February. Slavitt was hired by the has been with CMS administration last summer after since 2010, did not he helped salvage healthvare.gov CMS Administrator offer an explanation and other state exchange websites. Marilyn Tavenner for her resignation. While the resignation is a Tavenner had been acting adminissignificant event, it is not expected to bring fundamental change to CMS trator of CMS since late 2011, and she or how it operates. “The tenure of was confirmed by the Senate in May Administrator Tavenner has been 2013. She played a major role in the dominated by the worst period of implementation the Affordable Care excessive regulation of Medicare and Act (ACA). Under her leadership, CMS Medicaid providers, including the wrote many of the new rules putting implementation of over-aggressive the ACA in place and oversaw the audit practices against O&P providers health insurance exchanges created by by both the durable medical equipment the law. Tavenner was at the center of Medicare administrative contactors the troubled rollout of healthcare.gov RESEARCH ROUNDUP

Study Finds Orthoses and Insoles Improve Outcomes for Metatarsalgia Patients Researchers studied two treatment protocols designed to improve outcomes in forefoot involvement in rheumatoid arthritis and osteoarthritis patients. The scientists treated patients in two groups with polypropylene terephthalate (PPT) insoles and custom silicone toe orthoses. One group wore the PPT insoles for 30 days, followed by 30 days of toe orthoses in addition to the insoles. The second group wore the toe orthoses the first 30 days, then PPT insoles alone for the next 30 days. The researchers found the synergic 10

FEBRUARY 2015 | O&P ALMANAC

action of silicone toe orthoses and PPT insoles led to improved Foot Function Index numbers, a reduction in foot plantar pressures, and an increase in foot plantar contact areas. The first group—insoles followed by toe orthoses and insoles—had slightly better outcomes than the second group. The study, titled “A Comparison of Two Podiatric Protocols for Metatarsalgia in Patients with Rheumatoid Arthritis and Osteoarthritis,” was published in the November/December issue of Clinical and Experimental Rheumatology.

and recovery audit contractors,” says Joe McTernan, AOPA’s director of coding and reimbursement services, education, and programming. “In addition, the problems surrounding the initial rollout of the healthcare.gov website resulted in an immediate shift in CMS’ focus to address and correct these problems that were highly visible to the public. This shift made it virtually impossible to address the need for fundamental change in other areas such as audit reform and fair treatment of O&P providers.” AOPA plans to engage Slavitt to continue a dialogue with the O&P community. “Recognizing the complexity and sheer size of a government agency as large as CMS, however, it is unlikely that a significant shift in CMS policies or actions will occur as a result of Administrator Tavenner’s resignation,” says McTernan.

HAPPENINGS

DIABETES DOWNLOAD

Researchers Develop Skin Patch for Diabetic Ulcers Scientists at the Stanford University School of Medicine have developed a skin patch to boost the healing of and prevent future diabetes-related ulcers. The patch delivers deferoxamine (DFO), a drug that has been used to treat hemochromatosis. The Stanford researchers investigated the best way to administer DFO for ulcers, to prevent overexposure since the drug is toxic if used

for too long. The researchers then developed the patch, which can provide local delivery of just enough medication directly to an ulcer. The researchers have tested the patch with mice, who tolerated it well. Plans are underway for clinical trials with humans. Research results were published online in the Dec. 22, 2014, Proceedings of the National Academy of Sciences.

UK Study Probes Limb Salvage Versus Amputation of Diabetic Feet Determining whether to amputate the feet of patients with diabetic foot gangrene is a challenging decision, but a recently published study may assist health-care professionals in making a successful determination. Researchers Jang Hyun Lee, Seung Bae Jeon, and Matthew Seung Choi evaluated 154 patients with distal diabetic foot gangrene who underwent limb salvage surgery between April 2004 and July 2013. They studied the patients in two groups: patients with primary success of limb salvage, and patients who did not heal postsurgery. The researchers found that the five-year survival rate was 81.6 percent for the limb salvage success group and 36.4 percent for the limb salvage failure group. The researchers also found several factors that contributed to whether limb salvage surgery would be successful. These factors included limited activity before surgery, underlying renal disease, a high C-reactive protein level, high white blood cell count, and damage to vessels on a preoperative CT angiogram. The researchers suggest that surgeons study these predictive factors

Survival Rate of Limb Salvage Surgery Patients

82% 82% of patients with successful limb salvage surgery have a survival rate of 5+ years

36% 36% of patients with unsuccessful limb salvage surgery have a survival rate of 5+ years to help establish the appropriate amputation level for a case of diabetic foot and help prevent consecutive operations. The full study, “Predictive Factors for Successful Limb Salvage Surgery in Diabetic Foot Patients,” was published in the Dec. 14, 2014, issue of the British journal BMS Surgery.

PATIENT PROGRESS

Voltage Therapy Helps Paralyzed Man Move His Legs University of Louisville researchers have developed a therapy using electricity that is designed to help paralyzed individuals regain movement in their legs. Calvin Goza, paralyzed from the chest down for more than two years after an accident with a drunk driver, recently underwent a procedure in which researchers implanted electrodes in his spine. After the surgery, a ring with a string attached was placed on Goza’s toe, and he was asked to try to pull the string with his toe when the researchers sent jolts of electricity to the receptors surgically implanted in his spine. The scientiststs tested different combinations of voltage, adjusting currency and polarity. Goza eventually responded to a high voltage, and moved the string with his toe. After additional voltage adjustments, Goza bent his knee. Researchers will continue to test the therapy in several more patients this year, and will examine the impact on patients’ cardiovascular systems.

O&P ALMANAC | FEBRUARY 2015

HAPPENINGS

TAX TALK

Rep. Erik Paulsen (R-Minnesota)

Congressman Moves To Repeal Medical Device Tax Rep. Erik Paulsen (R-Minnesota) has introduced legislation in the 114th Congress that would repeal the medical device tax. The Protect Medical Innovation Act has broad bipartisan support, with 254 co-sponsors—including 27 Democrats—as of January 7. The legislation repeals the 2.3 percent excise tax included in the Affordable Care Act that applies to the sale of medical device products. Similar legislation introduced by Paulsen in the 113th Congress passed the House of Representatives on two different occasions but was not brought up for a vote in the Senate. While AOPA supports repeal of the medical device excise tax, this tax does not have a direct impact on O&P because AOPA secured an exemption from the tax for both manufacturers and patient-care facilities of O&P.

FEBRUARY 2015 | O&P ALMANAC

LATEST LEGISLATION

Cromnibus Bill Includes $10 Million for O&P Outcomes Research In a “win” for O&P outcomes research, the $1.1 trillion combined continuing resolution and omnibus appropriations bill (the “cromnibus” bill) enacted Dec. 13, 2014, to keep the government running includes a Department of Defense (DoD) section with an additional $10 million for O&P outcomes research funding. This funding also was included in last year’s budget. AOPA lobbyist Catriona Macdonald has been instrumental in transitioning these funds from a one-time item to a multiyear budget item, and hopefully a mainstay of the federal budget. The news was especially impressive given the high number of

cuts in the DoD portion of the bill. Legislators also signaled that the efforts of AOPA and many others have been successful in raising significant concern regarding the Medicare Recovery Audit Contractor (RAC) audits, and the unconscionably long delays in allowing providers to access an administrative law judge (ALJ) hearing. Although there is no substantive fix included, an additional $5 million was added to ALJ funding. Greater help, while by no means certain, could come in new Medicare legislation in 2015. Congress included the following language in the bill:

Recovery A udit Contr is concern actors (RA that the CM Cs). There S RAC prog incentives ram has cre for RACs to ated take overly Informatio aggressive n received a c tions. from the O Hearings an ffice of Me d Appeals (O dicare MHA) indic 50 percent of the estim a ated 43,000 tes that about fully or part appeals we ially overtu re rned at its le year 2015 b vel. The fisc udget requ a l est should with a time include a p line, goals, lan and measu to improve rable objec the RAC pro tives cess. In add expected to ition, CMS work with C is ongress and ers to identi stakeholdfy challeng es and add Further, CM itional refo S should est rms. ablish a syst process wit ematic feed h the OMH back A, CMS pro RACs to pre grams, and vent the ap th e pearance th selecting d at RACs are eterminatio ns to increa The CMS is se their fee urged to sta s. y focused o ments to all n improve“operations” that preven payments in t improper lieu of chasi ng dollars a fter the fac t.

HAPPENINGS

#ICYMI

CMS Awards Single DMEPOS RAC Contract to Connolly LLC In February 2014, as the initial Recovery Audit Contractor (RAC) contracts were reaching the end of their term, CMS announced it would be consolidating the RAC contracts for durable medical equipment, prosthetic, orthotics, and supplies (DMEPOS), home health, and hospice services into a single RAC contract to provide all RAC services nationwide for these three benefit categories. Previously these services were performed by four independent RAC contractors, one for each Medicare jurisdiction. On Dec. 30, 2014, CMS named Connolly LLC as the new single RAC contractor for all DMEPOS, home health, and hospice services. Connolly previously handled the RAC duties for Jurisdiction C. As part of the new contract, CMS also planned to address some of the

concerns raised about the RAC program, including reducing provider/supplier burden, increasing CMS oversight of its contractors, and increasing the transparency of the RAC program. To see a summary of how CMS is addressing these concerns with the new Connolly contract, visit bit.ly/racimprovements. Editor’s Note: Another CMS contractor has filed a protest, so final award has been delayed.

OTS Orthoses Left Out of DMEPOS Competitive Bidding Round 2 Recompete

CMS has announced the bidding timeline for the Round 2 competitive bidding recompete and the national mail-order recompete of the Medicare DMEPOS Competitive Bidding Program. Off-the-shelf (OTS) orthoses were not included as a product category in this round of competitive bidding.

AOPA is encouraged by this announcement: The organization has been educating lawmakers of the harm that could come from inclusion of OTS orthoses in competitive bidding, and has been lobbying against CMS’s attempts to broaden the definition of OTS to include devices that are currently delivered under the care of an orthotist. AOPA has orchestrated several initiatives, including an effort for members and patients to submit comments to CMS refuting the improperly defined “minimal self-adjustment” definition proposed by CMS that is contrary to the congressional statute.

MEETING MASHUP

China To Host International Rehab Meeting The 2015 Multidiscipline Rehab Treatment+Rehacare & Orthopedic (MDRT+R&OC) will take place at the Poly World Trade Centre, Guangzhou, China, March 27-29. Held concurrently will be the International Rehabilitation Canton Forum, which has been organized by the International Society of Physical and Rehabilitation Medicine. MDRT+R&OC, the latest event for the development of Chinese rehab industry, will feature the latest technologies and products in the medical equipment field. The event is being marketed as an optimal trading and dialogue platform for traders, manufacturers, prosthetists and orthotists, doctors, therapists, managements of medical institutions, medical educational staff, innovative newcomers, social workers, and other professionals. Visit http://en.cantonrehacare.com/ for more information.

O&P ALMANAC | FEBRUARY 2015

PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Terri Bragdon has been promoted to chief administrative officer of New England Orthotic and Prosthetic Systems LLC.

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc. (ABC) has released the Accreditation Compliance Kit, a new resource for its accredited facilities. The kit is designed to help facility owners and business managers maintain compliance with ABC accreditation throughout the year. The kit includes a 12-month calendar with ABC advice and tips for the most critical standards and an online resource pack with form and document templates as well as ABC’s comprehensive Facility Accreditation Guide. Each month includes highlights and tips for the most significant standards to help facility owners and managers stay on track with the annual compliance requirements.

Brandon Dale, CPO

Kathleen DeLawrence

Dennis Fields

Brandon Dale, CPO, has been named to the board of directors of the Amputee Coalition. Dale works for Hanger managing some of the company’s business operations. He also is active on the state level, advocating for Arizona and California, and is a member of the board of directors for the California Orthotic and Prosthetic Association. Kathleen DeLawrence has been hired as chief operating officer at Ability Prosthetics & Orthotics Inc. DeLawrence, who previously served on Ability’s board of directors, brings senior management, operational expertise, and business building skills to the company. Dennis Fields has been named to the board of directors of the Amputee Coalition. Fields is chief operating officer of SourceAmerica, a nonprofit organization that creates employment opportunities for people with disabilities.

Kevin W. Hershberger has been named chief financial officer of ReWalk Robotics, an Israeli company that makes wearable robotic exoskeletons. Hershberger is the former controller and chief accounting officer at NxStage Medical Inc. John “Mo” Kenney, CPO, LPO, FAAOP, has been named to the board of directors of the Amputee Coalition. Kenney, a below-knee amputee, owns and manages Kenney Orthopedics, an O&P facility John “Mo” Kenney with nine locations in Kentucky and Indiana. He also is the clinical director of the National Commission on Orthotic and Prosthetic Education. David Mahler, CPO, has been promoted to chief operating officer for New England Orthotic and Prosthetic Systems LLC. Jack Swan has joined Hanger Clinic’s Columbus, Ohio, patient-care facility.

FEBRUARY 2015 | O&P ALMANAC

The Amputee Coalition has announced its 2015 National Conference will take place July 23-25 in Tucson, Arizona. BCP Holdings LLC has announced that it has formed Bulow Clinic Partners Group (BCP Group) to make ownership investments in O&P practices with reputations for clinical excellence using BCP Group’s partnership model. BCP Group provides practice management services to strengthen and grow its independent O&P clinic partners while enabling clinician owners to maintain meaningful ownership interest and leadership positions within the organization. Matt Bulow, CP, is BCP Group’s chief executive officer and founding partner. Correction: In the January 2015 issue, we inadvertently placed the logo of Cascade Dafo Inc. rather than the logo of Cascade Orthopedic Supply Inc. We regret the error. To note, the two businesses are not affiliated. Cascade Orthopedic Supply is based in Chico, California, and is a comprehensive distributor of prosthetic, orthotic, and related supplies and services for certified, independent providers of prosthetic and orthotic care in North America. The correct logo and announcement are as follows: Cascade Orthopedic Supply Inc. has announced a strategic distribution agreement with Ability Dynamics. Customers are now able to purchase Ability Dynamics’ prosthetic devices, including the RUSH product line, through Cascade.

Four of the Most Common

fall risk factors

are within Podiatristsâ&#x20AC;&#x2122; scope of practice1

Muscle Weakness, Gait Deficits, Balance Deficits, Arthritis. Podiatrists typically see patients with one or more of these common fall risk factors every day, yet few practices have established formal fall risk management programs. We can help. By making fall risk a top priority, not only will you help your at-risk patients remain safe and independent, you may even save their lives. The Moore Balance Brace, as part of a comprehensive fall risk management protocol, can play an important role. Weâ&#x20AC;&#x2122;re prepared to arm both you and your patients with all the information necessary to get started right away on a path to fewer falls, a healthier life and significant practice growth.

Find out how the Moore Balance Brace along with a fall risk assessment play an integral role in any comprehensive fall risk protocol

Call today for a free fall Risk Management starter kit

(877) 780-8382 1 Guideline for the Prevention of Falls in Older Persons American Geriatrics Society, British Geriatrics Society, and the American Academy of Orthopedic Panel on Falls Prevention: JAGS, 49;664-672, 2001

www.MooreBalanceBrace.com

REIMBURSEMENT PAGE

By JOE MCTERNAN

RAC Changes Begin a New Chapter Modifications include a single RAC contractor for O&P Medicare audits, plus measures designed to promote fairness Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

EARN

BUSINESS CE

CREDITS P.17

FEBRUARY 2015 | O&P ALMANAC

ET’S FACE IT. The Medicare Recov-

ery Audit Contractor (RAC) program has fundamentally changed the way health-care services are provided to Medicare beneficiaries. Whether we are discussing inpatient hospital services, home health services, durable medical equipment, or prosthetics and orthotics, recovery audits have had a tremendous impact on Medicare reimbursement during the past decade. The RAC program began as a limited, three-year demonstration project in 2005 that was designed to determine if the use of independent auditors, through postpayment review of Medicare claims, would save the Medicare program money. It has ballooned into a national recovery audit program that claims to have returned approximately $3 billion to the Medicare trust fund in 2013 alone. Depending on your perspective, the RAC program is either an efficient and useful way to protect taxpayers from unnecessary spending or a glaring example of lack of government oversight resulting in predatory audit practices by government contractors who collect a percentage of every dollar they return to the Medicare trust fund. Determining which perspective is correct will continue to be the subject of significant debate for many years to come. This month’s Reimbursement Page focuses on some recent changes to the Medicare RAC program that may have a significant impact on O&P businesses. While some of the changes are good and some are not, change is definitely in the air.

From Four to One

The biggest change that will affect O&P providers is the reduction in the number of RAC contractors, with responsibility for auditing O&P claims transitioning from four regional RAC contractors to a single national RAC contractor.

RAC

}

E! QU IZ M

RAC

When the RAC program was expanded into a permanent, national program in 2009 and 2010, the initial contracts awarded by the government established four regional RAC contractors along the same geographic divisions as the existing durable medical equipment Medicare administrative contractors (DME MACs). Each RAC contractor had responsibility to perform recovery audits for all providers within its jurisdiction, including Medicare Part A claims, Medicare Part B claims, and claims for DME, home health, hospice, and O&P. As these contracts reached the end of their original four-year term, CMS looked to make improvements that would allow the RAC contractors to work more efficiently, resulting in the potential for additional savings for the

REIMBURSEMENT PAGE

Medicare program. The decision was made to create a single, national RAC that would focus only on Medicare claims for DME, O&P, home health, and hospice services. Due to the relatively low number of Medicare claims for these services compared to other services, CMS believes that using a single contractor to perform RAC reviews for only these types of claims will allow for a more efficient program. On Dec. 30, 2014, after several delays due to protests surrounding the award of the contract, CMS announced that the contract to serve as the DMEPOS, home health, and hospice RAC contractor had been awarded to Connolly LLC, based in Wilton, Connecticut.

Changes to the RAC Program

In addition to transitioning from four regional RAC contractors to a single RAC contractor for DMEPOS, home health, and hospice claims, CMS has announced several refinements to the RAC program that will be implemented as part of the new contractual agreements between CMS and its RAC contractors. While not all of the changes will have a direct impact on O&P claims, several of them will have a positive impact and make the RAC process a bit fairer to O&P providers.

The Devil You Know

Connolly LLC is not a new player in the RAC audit game. Providers in the Southeast United States should be very familiar with the Connolly name as it has held the Jurisdiction C RAC contract since it was first awarded in 2010. What is different about Connollyâ&#x20AC;&#x2122;s new role is that instead of serving as the RAC auditor for all Medicare claims for the Southeast region, it will now focus only on DMEPOS, home health, and hospice claims but will have audit responsibility for these claims for the entire country. This is not necessarily a bad thing. Since Connolly will focus on a relatively small subset of the Medicare claims universe, it should have better educated and trained auditors who are more familiar with the specific medical policies that govern Medicare coverage of DMEPOS, home health, and hospice services. A potential downside of the selection of Connolly as the DMEPOS, home health, and hospice RAC contractor is that, in its previous role as the Jurisdiction C RAC contractor, Connolly was particularly aggressive in auditing O&P claims. While CMS has established specific limits on the number of additional documentation requests (ADRs) that any supplier can receive from a RAC auditor, which should prevent Connolly from being overly aggressive in the number of audits it performs on O&P claims, O&P will most likely continue to be an attractive target for Connolly.

One positive change is that ADR requests will be adjusted to reflect an individual providerâ&#x20AC;&#x2122;s compliance with Medicare rules. This means providers that establish strong success rates on RAC audits may have their audit limits reduced as a result. This is a strong incentive for providers to make sure they are meeting all of the Medicare policy requirements prior to submitting a claim to Medicare. Another positive change involves a shift in when RACs may collect their contingency fees. Under the previous RAC contracts, the RACs received their contingency fee immediately upon denial and recoupment of the claim. Under the new contracts, RACs may not collect their contingency fee until after the second level of appeal, known as reconsideration, is exhausted. While this does not prevent immediate recoupment of monies for the denied claim, it does make the RAC contractor wait to collect its share of the recoupment and may discourage RAC contractors from pursuing claims that will most likely be overturned on appeal. AOPA continues to support further expansion of this provision so that contingency fees may not be collected until after

the third level of appeal, known as an administrative law judge hearing. CMS also has implemented several measures that will encourage responsible auditing by RAC contractors. There are provisions in the new RAC contracts that create consequences for individual RAC contractors who have more than 10 percent of their audits overturned at the first level of appeal or do not maintain an overall success rate of 95 percent on audits. If RAC contractors do not meet these thresholds, they will be subject to a corrective action plan that may result in reduced limits on the number of ADR requests they may generate. This change is significant as it creates accountability for RAC auditors who may be tempted to audit frivolously to collect higher contingency fees. While several other changes have been made to the Medicare RAC program under the new contracts, the three changes above are of the most significance for O&P providers.

Moving Forward

The existence of RAC audits is an unfortunate reality that will continue into the foreseeable future. It is hard to argue against a program that saves the Medicare program billions of dollars each year. While RACs are part of the new reality for O&P and other providers, the creation of the single RAC for Medicare DMEPOS, home health, and hospice claims, along with significant improvements to the RAC program designed to ensure fairness and consistency, should make the RACs slightly more palatable. Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

www.bocusa.org

O&P ALMANAC | FEBRUARY 2015

This Just In

AOPA Futures Leadership Conference Spurs Additional Research Funding AOPA Board of Directors announces plans to grant nearly $300,000 to further O&P research and begin building a patient registry

AOPA President Charles H. Dankmeyer Jr., CPO

Al Dobson, PhD 18

FEBRUARY 2015 | O&P ALMANAC

N JANUARY 10 AND 11, 150 O&P senior leaders from global patient-care and manufacturing companies gathered in Palm Beach, Florida, for an exclusive discussion on the O&P profession and its priorities for the future. During the two-day event, attendees participated in open dialog that included international perspectives on technology, marketdominating health-care trends, regulatory limitations, and more in an effort to determine strategies for evolving the profession and their businesses. More specifically, leaders shared their thoughts on the important role research will play in securing the future of the profession. The O&P industry will need to play “heavy-duty catch-up to make O&P much more data-driven and outcomes-responsive,” says AOPA President Charles H. Dankmeyer Jr., CPO. As a follow-up to the discussions held during the conference, the AOPA Board of Directors considered several recommendations from conference participants during its meeting on January 19. The board subsequently voted to make major extensions of three research-oriented “Survival Imperatives” established more than two years ago: establishing a longitudinal database for O&P patients and

services; developing evidence-based best practices derived from systematic literature reviews and establishing levels of evidence for various O&P clinical research findings; and compiling all available data on cost effectiveness of O&P care and commissioning new prospective comparative effectiveness studies, particularly around newer O&P treatment modalities. After much discussion and consideration of the recommendations from conference participants, AOPA has announced plans to deploy AOPA resources in three important areas: • A total of $50,000 has been committed to launch initial work on compiling patient information and demographics toward an AOPA registry initiative for prosthetic care. The long-term goal is to create registries for both prosthetics and orthotics. “We will be starting with prosthetics first because the number of patients, predisposing conditions, and treatments are more tightly circumscribed,” says Dankmeyer. An AOPA working group will report back on progress and next steps by the end of June. • A total of $120,000 has been committed to support two new

This Just In

systematic reviews—the first step toward defining evidence-based best practices. The board established several conditions/treatments to focus on and will publish request for proposals (RFPs) in the following areas: cost efficacy for transtibial interventions; adolescent idiopathic scoliosis; alternate assessment tools or category systems—candidacy for prosthetic technology; and partial foot in the diabetic population (is transitibial amputation a better and more viable option?). AOPA will determine which two areas to study first based on the RFP responses. • A total of $120,000 was committed to support up to two new comparative effectiveness studies. The format for these studies involves

funding partnerships between AOPA and multiple companies with an interest or products in one of the several specific areas. Based on the viability of securing additional support from companies in the profession, AOPA will issue RFPs for the topics that look most promising from among the following: prosthetic feet, emphasis on lower function; cranial remolding; economic studies of custom-fit and custommade versus off the shelf (OTS); and OTS versus custom-fit and custommade ankle-foot orthoses. “These are major, very important commitments of resources by AOPA, but these grants are not nearly enough,” explains Dankmeyer. “It is a good start toward new, badly needed projects. Much, much more will be

needed to actually catch up with the demands for data and research in our current health-care/clinical care environment.” In light of AOPA’s renewed commitments to advancing the profession, the organization is asking individual O&P professionals and businesses to find ways to participate. AOPA welcomes members’ thoughts on prioritizing the topics for evidence-based best practices and new comparative effectiveness studies. “We won’t get unanimity, but we will weigh carefully the input of O&P leaders,” says Dankmeyer. AOPA also is seeking volunteers with specific areas of expertise to take part in targeted working groups. In addition, the organization will be asking O&P companies to provide support to advance the comparative effectiveness studies.

O&P ALMANAC | FEBRUARY 2015

This Just In

Outdoor breakfast during the AOPA Futures Leadership Conference

Jason Highsmith, PT, DPT, PhD, CP, FAAOP

Building on Current Research

Al Dobson, PhD

Vinit Asar, Hans Georg Näder, and Stephen Blatchford 20

FEBRUARY 2015 | O&P ALMANAC

During the Futures Leadership Conference, AOPA announced it is making portions of the data from the Dobson-DaVanzo Medicare studies available to AOPA members in a new compendium on the AOPA website. The home page of the site now contains valuable Medicare data on O&P services, payments, and market share. Conference participants also heard from Al Dobson, PhD, about some new data from Dobson-DaVanzo on K2/K3 patients. The base study concluded that total health-care expenditures for patients receiving K2 prostheses were actually slightly higher than the total health-care expenditures for patients who received K3 devices, despite the fact that the cost of the prosthesis itself was higher for the latter. AOPA charged Dobson-DaVanzo with further analyzing the K2/K3 data. Dobson-DaVanzo has isolated patients where Medicare’s own data records the patient’s functional level as being lower or higher than that which describes the actual prosthesis the patient received (and Medicare paid for). The economics show that, for example, if the prosthetist, based on his or her clinical judgment, provided a K2 patient, according to Medicare’s administrative claims data, with a K3 device, that group of patients who received a device of a higher functional

level than Medicare would typically pay for had lower total health-care expenditures than did the comparable group of Medicare-recorded K2 patients where the prosthetist ended up providing a K2 device. The research essentially demonstrates that providing K3 devices to K2 patients saves money. Patients were recorded as having reported more falls (perhaps attributable to greater ambulation) but no increase in emergency room admissions. To further validate the DobsonDaVanzo findings, actual prospective clinical studies will need to be conducted. AOPA is looking at a special priority effort to do so and will work with member companies on this project, called “Prosthetics 2020.” “This is a time of both peril and challenge, as well as some real opportunities for O&P,” says Dankmeyer. “It is a time for all of us to pull together for our profession, our patients, and our businesses.” Editor’s Note: Look to future issues of the O&P Almanac for our new exclusive Leadership Series, which will investigate targeted information garnered during the AOPA Futures Leadership Conference, including competitive bidding, boutique and niche O&P services, hospital and institution networks, consolidation, and much more.

ce! fferen i d a e n mak

a You c

5 1 0 2 AOPA

M U R O F Y C LI

MARCH 23-24, 2015 Special Extended Program March 24-25

Meet your Members of Congress in Washington, DC with AOPA!

The Policy Forum is your best opportunity to learn the latest legislative and regulatory details and how they will affect you, your business, and your patients. Once you are armed with the facts, we as a profession will educate our Members of Congress to offer common sense solutions and share how the O&P profession restores lives and puts people back to work. Your Congressional appointments will be organized by AOPA staff and lobbyists.

The 2015 AOPA Policy Forum will be held March 23-24, 2015 with post-conference events being held March 24-25 at the Renaissance Hotel in Washington, DC.

TENTATIVE SCHEDULE MONDAY March 23 12:45 – 4:40 PM

Policy Forum General Session

• Briefings and updates from Senators and Representatives, the AOPA lobbying team, and other experts on critical issues confronting the O&P community 4:45 – 5:45 PM

O&P PAC Fundraiser (optional event)

6:30 PM

Reception and Dinner (included)

TUESDAY March 24 Breakfast and General Session

7:30 AM

• Review of Talking Points • Mock Congressional Visit 8:00 AM – 4:00 PM Congressional Visits Noon

Lunch

4:00 – 4:30 PM

Debriefing Session

OPTIONAL ADD-ON PROGRAM

Stay an extra day to participate in post-forum education modules and earn up to 10.5 CE Credits. These high-level executive meetings will provide the business information and Washington insider focus you need to continue to run your highly successful business. TUESDAY March 24 5:00 – 8:00 PM Extended Education (Module 1) with Dinner

WEDNESDAY March 25 8:30 AM – 1:00 PM Extended Education (Module II) with Breakfast and Lunch 8:30 AM – 1 PM

General Session

Hotel Reservations

Noon

Lunch

AOPA has reserved accommodations at the Renaissance Hotel for your convenience. All hotel reservations must be made by attendees directly through the hotel by utilizing the online link at https://resweb.passkey.com/ go/AOPA15 or calling (202) 898-9000. When calling, be sure to indicate that you would like the AOPA room block to receive our preferred group rate of $299 per night. RESERVE EARLY, AS THE HOTEL WILL LIKELY SELL OUT OVER THE DATES OF THE POLICY FORUM.

Module I

$200

Module II

$300

BIG VALUE EARN UP TO

10.5 CE CREDITS!

Entire Program $575 (save $75!)

American Orthotic & Prosthetic Association

www.AOPAnet.org

Discover our historic city and enjoy easy access to all the attractions of our nation’s capital from this ideal location. Walk to Congressional Office buildings, the Smithsonian and the National Mall, visit monuments and museums—all just minutes from this Capitol Hill hotel.

Breakfast

Policy Forum $150

Make your plans now to attend the 2015 AOPA Policy Forum.

Renaissance Hotel 999 Ninth St., NW Washington, DC

8:00 AM

Registration Fees

Support your profession!

Location

Registration is open.

Meet your member of Congress and tell them how, through orthotics and prosthetics:

COVER STORY

S D N E R T R U FO h c t a W to

The Changing Health-Care Landscape:

d e e N Yo u

Health-care industry expert Michael Lovdal, PhD, shares data and industry insights that will change your businessâ&#x20AC;&#x201D;sooner than you think By CHRISTINE UMBRELL

al, PhD

Michael Lovd

FEBRUARY 2015 | O&P ALMANAC

COVER STORY

EALTH CARE IS BIG BUSINESS in the United Sates. This $2.8 trillion sector of the economy comprises nearly 18 percent of the country’s gross domestic product—up from just 5 percent in 1960, according to CMS data. But consumers “are not getting a good return on our investment,” says Michael Lovdal, PhD. Lovdal, an emeritus partner at Oliver Wyman with 25 years of experience providing strategic planning and alignment assistance to clients in health care and other fields, shared his thoughts on how the healthcare industry will evolve over the next few years during a keynote address at AOPA’s Futures Leadership Conference in Palm Beach, Florida, last month, and during an exclusive follow-up interview with the O&P Almanac. “The state of the U.S. health-care system, by most measures, no matter where you are, is not good,” said Lovdal. Despite rampant spending, people in this country are at the second-highest risk of dying from noncommunicable diseases and at fourth-highest risk of dying from communicable diseases compared to 16 other high-income countries, according to a study conducted by

the National Research Council and Institute of Medicine. Shockingly, the United States was found to rank last among males and second-to-last among females for life expectancy, and had the highest infant mortality rate of the 17 peer countries examined including Australia, Canada, France, Japan, Italy, and the United Kingdom, among others. The expensive U.S. health-care system is broken—and a fix is needed. A number of factors are converging to force change in the fundamental structures and models of health-care delivery and reimbursement—change that will likely have a profound effect on O&P facilities. “Health care is being reformed,” said Lovdal. “You’re being reformed, and therefore totally restructured and redesigned, with all kinds of new models.” While there is no crystal ball that can guarantee what changes will have the greatest impact on the health-care industry in general and the O&P profession specifically, Lovdal offered a glimpse at four trends that he believes will have a tremendous impact on health-related businesses in the coming years.

NEED TO KNOW • As a direct result of the ACA, O&P business owners may see an increase in insured patients as well as in health spending over the next 10 years. O&P practitioners may see more individuals seeking treatment due to the number of first-time insured via state and federal exchanges and expanded Medicaid programs. • A transition to more patientcentered care will play out via a two-fold approach: Health-care entities will need to adopt a patients-first philosophy and then implement the technologies necessary to follow through on patient personalization, predictive care, and centralized record keeping. • One third of the current health-care expenditures will move to some kind of value-based care by 2017. The transition already is underway, with more than 500 ACOs currently in the market, some of which are private and some of which are affiliated with CMS/Medicare/Medicaid.

U.S. health spending: 5% of GDP in 1960, 17.5% in 2013 U.S. Health Spending, 5% of GDP in 1960, 17.5% in 2013

• With a move to defined contribution plans, consumers will likely seek transparency in their health-care interactions. Some legislators are advocating moving to Medicare vouchers or Medicaid block grants. If they take hold, the Medicare and/or Medicaid populations may have more choices.

U.S. Healthcare Expenditures Percent of GDP 20% 18% New medical and therapeutic technologies

16% Percentage (%)

14% 12% 10% 8%

Demographic age wave

Sense of health entitlement Fee-for-service payment systems

Declining population health status and attitudes

User = payor

$2.81T

$1.56T $1.25T

Private

Projected

0% 1960

• As more information about individual health becomes available, health-care practitioners should expect to see a greater demand for preventive care.

Total

Public

1970

1980

1990

2000

2010

Year Source: Centers for Medicare and Medicaid Services, 2013

O&P ALMANAC | FEBRUARY 2015

TREND 1

COVER STORY

More Uninsured Americans Will Become Insured as the ACA Takes Effect

O&P business owners may see an increase in insured patients as a direct result of the Affordable Care Act (ACA). Though still a hot topic in Congress, with some seeking to repeal or counteract the ACA, the initial numbers indicate that the law has led millions of previously uninsured people to seek health coverage. “The ACA in a nutshell is all about insurance reform and expanding access,” explained Lovdal. Once ACA coverage became available, approximately 8 million people signed up for coverage through either state-based exchanges or federally-facilitated exchanges. Lovdal believes there will continue to be a decrease in the number of uninsured—which was at 40 million in the United States pre-ACA. He points to Massachusetts, which implemented “Romneycare” eight years ago, as a good benchmark for how the ACA may play out. “PreRomneycare, Massachusetts had

surance status of 319M Americans

Insurance status of 319M Americans Individual 16 M 5% Public Employer 37M

Medicare 51 M 16%

12% 17%

Medicaid 54 M

13% Private Employer

37%

121 M

Source: Oliver Wyman analysis based on multiple surveys

ER WYMAN

FEBRUARY 2015 | O&P ALMANAC

Uninsured 40 M

10 percent uninsured. It is now (less than) 2 percent (1.9 percent). Romneycare is exactly the same structure as Obamacare: Use the tax system to encourage/incent/penalize individual participation in insurance. In Massachusetts, the biggest incentive for individual compliance is not the monetary penalty, it’s the fear of running afoul of the tax authority,” he said. “So I don’t know if we’re going to see the percentage of uninsured go down five times like Massachusetts did, but if it’s any indication, it will have an impact, and it will bring people into the system. We will see that 40 million uninsured cut at least in half, is my guess, at least in the next three or four years. It will incent cooperation and compliance.” The implementation of the ACA will be a contributing factor to increases in health spending over the next 10 years, according to a National Health Expenditure Projection study conducted by CMS. This could be good news for O&P practitioners, who may see more individuals seeking prosthetic or orthotic treatment due to the number of first-time insured via state and federal exchanges and expanded Medicaid programs. Lovdal recommends that O&P professionals keep a close eye on regulatory activity at both the federal and state levels in the coming months, particularly because each state varies in how it chooses to implement the ACA. “Know where you are, and know what your state is doing,” he said. “In states that set up their own exchange—in New York for example— it opens up a whole lot of competition. Some states don’t want the one-size-fits-all Medicaid answer, so what’s happening is a private option in Arkansas, coordinated care organizations in Oregon. States are saying, ‘I’m going to innovate a different approach here. I’m going to tailor it to my people, and my needs, and my environment,’” said Lovdal. “A lot of intriguing things are going to be happening, particularly in the Medicaid 29 field, over the next year or so.”

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Proving O&P’s Worth Going forward, all O&P professionals will need to get involved in the movement to provide data and research demonstrating the value and cost-effectiveness of quality O&P care. Such information will be critical to earning the trust of regulatory agencies, payors, accountable care organizations, and even patients as the four trends mentioned by Michael Lovdal, PhD, take hold. During the Leadership Conference, Sam Liang, MBA, president of Hanger Clinic (Patient Care), offered a presentation on “Research and Outcomes: Sam Liang, MBA Why Are They Important to O&P?” Liang, who previously worked at Bayer and Johnson & Johnson, emphasized the necessity of research to elevate the profession in the eyes of payors and prove that O&P care improves patients’ quality of life and lowers overall health-care costs. “How do we know that the markets reward innovation, outcomes, and research? Our health-care system is predicated upon very standardized care patterns, and clinical practice guidelines, and all of them have a translation into some health economic benefit,” said Liang. That health economic benefit needs to demonstrate that O&P treatment will lower the cost of care somewhere down the line. “Our paucity of clinical practice guidelines and outcomes data—this is what raises questions in the minds of the payors,” Liang said. “Why are we facing all of these challenges with RAC audits and payments? It’s because all of these other markets, they have a bunch of data, and standardized guidelines, and we don’t. We’re in our infancy in terms of developing them.” Liang called on O&P professionals to transition from a defensive to an offensive position, asking the community to “define and provide outcomes data to CMS, and to protect and grow the $4 billion-plus O&P market, while also differentiating O&P from the DME markets in the minds of the payors.” Specifically, Liang said the profession will need to conduct systematic literature and data reviews and build upon the work of Dobson-DaVanzo/Mobility Saves program in demonstrating O&P’s cost-effectiveness. “If our data, based upon these end points, doesn’t exist, then we have to do prospective studies, whether they’re randomized clinical trials, or objective performance criteria—there’s a number of different study designs the industry and profession can utilize to collect that data. “We need to define as a profession what data we want to collect. We’ve already seen the first look, with Dobson-DaVanzo. But imagine if we, with thought, start treating patients in a certain way and start driving certain outcomes: What do you think that’s going to reflect within the Medicare/Medicaid data? It’s going to be very valuable to us.” Liang also suggested that lower-extremity prosthetics should be the first area where O&P focuses its research efforts. He noted the increased number of RAC prepayment and certification audits specifically targeting lower-extremity prosthetics—50 to 75 percent, in his estimation. “These lower-limb devices are very high-dollar items, and we don’t have a lot of evidence, so this is an easy target for the payors,” he said. Liang concluded his presentation by emphasizing the need to ramp up O&P research efforts quickly: “We’ve got to go now—our patients are waiting.”

TREND 2

COVER STORY

Look for a Transition From Fee-for-Service to Patient-Centered Value-Based Care

“Patient-centricity is second nature for O&P practitioners— putting patients front and center is what O&P practitioners do really well,” said Lovdal. “The move to patient-centricity, however, for all parts of the health-care system is not a particularly natural one or easy one.” A transition to more patient-centered care will play out via a two-fold approach: Health-care entities will need to adopt a patients-first philosophy and then implement the technologies necessary to follow through on patient personalization, predictive care, and centralized record keeping. “We’ve got to get better at making this a seamless process,” said Lovdal. By combining patient-centered care with IT interoperability, “you trigger a whole set of possibilities about how you treat patients, and about how things begin to work together, in terms of analytics, and predictive care, and personalization, in real time.” Once the appropriate technologies are in place, Lovdal predicts the emergence of “smart care teams”—groups of health-care professionals with specific expertise assembled to treat populations of patients, with particular sorts of needs, supported by the appropriate technologies. Smart care teams will be “the cornerstone of the move to value,” he explained.

Michael Lovdal, PhD 26

FEBRUARY 2015 | O&P ALMANAC

We are pleased to announce the formation of BCP Group, a partnership of high-quality O&P practices.

12 Clinics 6 Markets 4 States 1 Partnership

Member Clinics:

Equity Partners: Matt Bulow, CP

Bulow OPS

Nashville, Tenn.

Gordon Stevens, CPO

Baker O&P

Fort Worth, Texas

Eric Neufeld, CPO

Bulow OPS

Denver, Colo.

Zach Harvey, CPO

Bulow OPS

Denver, Colo.

Grant Rutledge

BCP Group

Nashville, Tenn.

Brad Gardner

BCP Group

Nashville, Tenn.

Rawls Butler

Frist Capital

Nashville, Tenn.

BCP Group is an O&P management company based in Nashville, Tenn., dedicated to enhancing the viability of the independent, clinician-driven O&P practice model. We make ownership investments in high-quality clinical practices and then provide behind-the-scenes business support and resources that enable our partners to focus on patient care and practice growth.

www.bcpgroup.net

COVER STORY

The transition is already underway, with 500+ ACOs currently in the market and hundreds of additional pilots on the way

Legend Medicare / Medicaid Private Both Prep activity only

Updated as of January 2014. Sources: News releases, company websites, Dartmouth Atlas PCSAs, Claritas, Oliver Wyman analysis 1. ACOs defined as providers participating in Pioneer ACO, Medicare Shared Savings, a Medicaid ACO, PGP Transition, or in a shared savings/risk arrangement with a commercial payer; Prep activity defined as participation in a learning collaborative or providers preparing to become an ACO © OLIVER WYMAN

$1T to value-based health care (in some form) by 2017

FEBRUARY 2015 | O&P ALMANAC

The current health-care system is largely a fee-for-service transactional model, with most doctor visits, procedures, and facility visits being reimbursed on a per-transaction basis. But Lovdal believes we will move toward a fee-for-value world: “Right now, if someone injures a knee, the insurer cuts multiple checks” for each type of health-care provider, for hospitals, and for various procedures. But in a fee-for-value world, “they cut one check—to cover the whole treatment of the knee,” he explained. And someone will be responsible for deciding how each entity gets paid—“how that check gets divided up,” he said. Lovdal predicts that one third of the current health-care expenditures—roughly $1 trillion—will move to some kind of value-based care by 2017: “Some of them will be accountable care organizations (ACOs), which are springing up all over the place,” he said. The transition already is underway, with more than 500 ACOs currently in the market, some of which are private and some of which are affiliated with CMS/Medicare/Medicaid. Lovdal recommends that O&P business owners start now to build relationships with ACOs or similar organizations in their territories. “Try to get experience, whether via partnership or a vendor relationship, with these types or organizations sooner rather than later,” he said. In addition to researching ACOs, forward-thinking O&P professionals should be aware of population health managers (PHMs) as well. “They’re popping up all over the place. They say they’ve got the data and want to serve as ‘disintermediators’ to dole out the ACO money to the different parties,” he explained. The bottom line: Lovdal encourages O&P business owners to watch what’s happening in this value-based world. “It’s changing literally by the month in terms of the strategic players and the positioning they’re taking, and the impact they’re having on health care.”

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TREND 3

COVER STORY

Patients Will Become Consumers

Consumer engagement and empowerment will have an enormous impact on health-care entities going forward. In addition to becoming more educated about their health and their options for health care, patients are gaining flexibility in terms of how and when to spend their health-care dollars. Consumers increasingly will choose their own health-care plans as employers move away from traditional insurance coverage for employees and adopt “defined contribution” (DC) plans instead. Several large companies such as Sears, Walgreens, and TimeWarner already have adopted these plans for either their active or retired employees. Ultimately, “about half of all employers will move to some type of a defined contribution plan,” Lovdal said. With DC plans, employers give each employee a fixed dollar amount he or she may choose how to spend on health care. Typically, employees are allowed to use their DC plans to reimburse themselves for individual health insurance costs. Instead of pursuing treatment purely based on the coverage offered by an assigned insurance company at a facility under that insurer’s umbrella, patients with DC plans will have unlimited choices— but limited dollars. That should lead to much savvier consumers considering their health-care choices. What’s more, some legislators are advocating a movement to Medicare vouchers or Medicaid block grant approaches. If some of these

FEBRUARY 2015 | O&P ALMANAC

New World: Consumer-centricity

“fundamental structural changes” take hold, the Medicare and/or Medicaid populations may have more choices. To attract and retain patients once these shifts take hold, O&P businesses will need to “start thinking like most other consumer businesses,” Lovdal said. “We’ve got to think about how our consumers are different, and tailor offerings to the needs of those consumers.” Consumers will likely seek transparency in their health-care interactions. Lovdal cited the recent outrage when CMS released data on the vast differences in the costs of the highest- versus lowest-cost knee replacements, with no difference in quality. “How much tolerance are we going

to have as a society for these kinds of surprises?” He noted that when consumers begin tracking where each of their health-care dollars go, they will demand value for their money, and they will expect to know exactly how much each aspect of their care costs. As a result, health-care facilities will need to reconsider how they market to consumers. Maintaining an online presence and increasing awareness of advances in technologies will be critical. “Websites are the number one source of health information for consumers today,” he said. “And look what’s happening with apps—all of the apps now available to help you with your health.” What’s more, Lovdal predicts that social media will help redefine health care, connecting patients with others sharing similar diagnoses. These same online communities have the power to recommend practitioners—or not. Lovdal’s advice to O&P professionals? “Recognize that consumers have a fair amount of discretion in how they spend their money,” he said. “Start building consumer loyalty— especially with younger patients”—so they choose your facility as their options open up.

TREND 4

COVER STORY

Advances in the Science of Diagnosis Will Spur a Culture of Prevention

As more information about individual health becomes available, health-care practitioners should expect to see a greater demand for preventive care. Lovdal points to the example of human genomes. Currently, it costs between $1,000 and $2,000 to sequence a human genome. For certain types of rare diseases, genome sequencing— which can help predict changes in the level or structure of key proteins—has become “a fairly useful and highly predictive technology, that’s incorporated into practice and protocols on a fairly regular basis,” he said. “The big question is, what happens when we get down to the level of $100 [for costs of human genome sequencing]? Then you may have a baby, and about an hour later they walk back in with a printout that says, with a highly degree of statistical probability, here’s your kid’s life history, and the expectations, statistically, of what his or her medical risks are. “Increasingly, we’re going to have to ask ourselves, as a society, do we want that data, what are we going to do with it, what are the legal and ethical and moral implications, who ought to have access to it, etc.?” Increased access to predictive health-care information in the form of genome sequencing and other genetic tests will move the United States from a reactive health-care arena to a more proactive and preventive mindset. “We will transition to a world that’s basically prevention, intervention, and health management. We want to prevent in the first place,” said Lovdal. “If we can’t prevent, we want to intervene very quickly, to minimize the cost and minimize the personal agony, and we want to manage your health, as a group and a population,” he said. “That’s not 20 years away. This is a matter of years where it changes pretty radically.”

Putting It All Together

An increased number of insured patients. Value-based care and more

accountable care organizations. Educated consumers with more choices, and more accountability for health-care providers. A rising demand for preventive care. These trends will redefine the rules. O&P business owners need to look toward these trends today, and prepare for inevitable changes, like it or not. “Ask yourself and ask your colleagues, ‘Who’s not in our business now, and who could be in two years?” said Lovdal. “Who could upset and redefine

the game for us, in a major way?’ “We have to consider these things while we’re trying to keep the lights on, and do the reimbursement, and run our business on a day-to-day business,” Lovdal concluded. “We’re talking about unprecedented change.” Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.

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By CARA NEGRI, BSME, CP; JIM LAWSON; AND STEVEN B. FLETCHER, CPO/LPO

Visual Documentation:

Keeping Security in FOCUS

When practitioners at your facility take photos or video of patients, follow these tips for compliance with ABC and HIPAA guidelines

FEBRUARY 2015 | O&P ALMANAC

ITH MEDICARE AUDITS STILL looming, O&P facilities are taking advantage of technology and utilizing video and images to help paint the portrait of a patient’s rehabilitation and progress. These tools can serve as a “common language” for the insurer to visualize the improvement that the orthotic or prosthetic intervention has served. Mobile devices have become the newest technology for video and imagery in O&P facilities. The good news is that smartphones and tablets are very easy to use, and take little knowledge of advanced camera settings. The bad news is that they are not standalone devices that serve the sole purpose of capturing video or images, and then are locked away every night. Mobile devices give us the ability to capture our patients’ progress in their homes, in a park, or on a track with very little equipment. Cameras are another tool in our clinical toolbox to aid in decision making. Video and images allow us to see things that are difficult for the human eye to see in real time. With our smartphones’ camera capabilities to adjust automatically, there is no question that we should be using these tools in daily practice.

ABC Offers Guidelines for Maintaining Security in Patient Records The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) offers the following relevant Facility Accreditation Standards: TIP: ALL PATIENT RECORDS MUST BE CONSISTENT. If you use photographic documentation, you will have a policy that describes how, when, and under what circumstances photographic documentation is used.

PR.6.1

Your patient records must include: 1. Patient evaluation/assessment that contains diagnosis, prescription or valid order, relevant patient history, and medical necessity 2. Pretreatment photographic documentation as appropriate for the item 3. Patient education 4. The name of the patient-care provider, his or her findings, recommendations, treatment plan and follow-up schedule

The ABC Code of Professional Responsibility also addresses this subject. The Code states the following:

C3.1 Confidential Information

All patient information derived in a workplace from a working relationship relating to any patient shall be held and always remain confidential by all parties unless there is written permission to release the information.2

Ensuring Clarity and Security in Patient Records

As mobile devices become a part of daily practice, mobile device security is an obligation: It’s imperative to protect your patients’ health information. O&P business owners and practitioners must evaluate the risk associated with using mobile devices to capture video and pictures—but should not avoid using mobile devices simply because they are unsure of the facts. These tools can capture valuable health-care information if used properly. A simple video-based system could document the fitting process, reduce a certain amount of trial and error, facilitate treatment planning, provide video feedback for training, and act as a communicative tool among the orthotist/prosthetist, the rehabilitation team, the patient, and the insurer. Some O&P professionals have voiced concerns about the question of safely implementing the use of smartphones into clinical practice.1 The biggest concern relates to emailing

photos and videos: Some practitioners caution against using unencrypted email servers to send information such as photos and videos. But there are other avenues available for sharing photos and videos. By learning about these options for safe image capture and storage and putting relevant policies into place at your facility, you can protect your patients. O&P professionals can look to guidance from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) for assistance in determining the rules for patient documentation safety. (See sidebar on this page.) Then office owners and managers can follow the ABC guidance in implementing facility policies for visual documentation. It’s important to be consistent when developing guidelines for capturing and storing patient photos and videos. Start by determining the purpose for the visual documentation, and determine to what extent the information will be used. Will you create a process to take O&P ALMANAC | FEBRUARY 2015

a video or picture of a device and/or residual limb every time a patient walks through the door? If so, where will the videos and images be stored? Will they be used as a part of the patient’s medical record in electronic medical records, such as OPIE software? These questions must be answered before anyone at your facility starts to capture videos or images. Why? If you simply start taking a lot of video and images and you do not have a systematic approach to the storage, you will soon have too many to thumb through when you need them for documentation or justification purposes. Start off with a sound process that immediately puts the images into the record.

Preventing Images From Leaving the Office

Complying With HIPAA

Only use websites that are compliant with the Health Insurance Portability and Accountability Act (HIPAA) when storing photos and videos. HIPAA is an unusual law in that it makes a lot of recommendations (addressable items) and a few assertions (required items), but in the end it is up to each organization to determine for itself what it needs to do to be compliant. This creates a great deal of flexibility, as well as a great deal of uncertainty. In general, to be HIPAA-compliant, a website must at a minimum ensure that all electronic protected health information (ePHI) is kept secure in the following ways: • Transport Encryption: ePHI is always encrypted as it is transmitted over the Internet. • Backup: ePHI is never lost, i.e., should be backed up and can be recovered. • Authorization: ePHI is only accessible by authorized personnel using unique, audited access controls. • Integrity: ePHI is not tampered with or altered. • Storage Encryption: ePHI should be encrypted when it is being stored or archived. • Disposal: ePHI is permanently disposed of when no longer needed. • Omnibus/HITECH: ePHI is located on the web servers of a company with whom you have a HIPAA Business Associate Agreement (or it is hosted in house and the in-house servers are properly secured per the HIPAA security rule requirements).

FEBRUARY 2015 | O&P ALMANAC

Understand and mitigate the chance of visual information being stored on a device that will leave the facility. Mobile devices are an option—but only when used in conjunction with appropriate programs or websites. For example, within the PnO Data Live app, the video and/or image is captured within the software, and the data is never stored on the device. The app uses secure web-based software to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA). Another safe site is BOX. Both of these sites offer security certificates. It also is important to conduct a risk analysis to understand where the risks are with photo/video storage. This is similar to practicing and conducting emergency procedures. If you lay out all of the potential areas for unsafe practices, you know what areas have potential to cause problems, your staff can keep each other in check, and everyone will know what to do in case of an emergency. This process also should include creating a formal video and image release form for patients’ signatures. Once you have identified what the photos and videos will be used for, it should be documented in the video and image release form. The more you explain to patients why this

information is helpful, when it will be used, and who it will be shared with, the better.3 Although templates are a great starting point, each organization is different, and the video and image release form should be designed to represent each facility. Draft your organization’s policy and procedure for mobile device use. Outline how the videos and photos are to be captured, how the information will be kept safe, and what internal audit procedures your organization will undergo to ensure that the process is sound. How will you manage the mobile devices? Will you allow BYOD (bring your own device)? What restrictions will there be on mobile devices? If an employee uses his or her own device and he or she leaves employment, what is the process to make sure his or her device does not have any patient information on it?3 Once you establish a policy and procedure document, remember to revise the policy on a regular basis. Try

a process out for a few weeks, revisit it, and make changes to the workflow documentation.

Communicate Your Policies

After you have developed a procedure for implementing video and image capture into your organization, conduct training for all employees. The training should be similar to office safety training—it should be ongoing and include discussions on risks, security, and avoiding mistakes. Implementing video and image capture in your practice is a great idea. Not only is it beneficial to you and your organization—it also is beneficial to your patients. Videos and images serve as a supplemental documentation source like no other. They can take you back to each patient visit at the end of the day, when documenting patient visits might be difficult. It also can be a fun and interactive way to engage patients during office visits to show them their progress or explain a deviation that may be difficult to put into words.

Ferrier Coupler Options!

References

1. Smartphone discussion, OandP listserve (2014, October 2). Retrieved from http:// www.oandp.com/oandp-l/message. asp?frmmessageid=840b4b92-f6a0-4510b4dd-863ea85c9f6c. 2. ABC Individual Certification Information. Retrieved from https:// www.abcop.org/individual-certification/Documents/Code%20of%20 Professional%20Responsibility.pdf. 3. Your Mobile Device and Health Information Privacy and Security (2015, January 8). Retrieved from http:// healthit.gov/providers-professionals/ your-mobile-device-and-health-information-privacy-and-security.

Cara Negri, BSME, CP, is director at PnO Data Solutions. Reach her at cara@pnodata.com. Jim Lawson is outreach manager at the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC). Steven B. Fletcher, CPO/LPO, is director of clinical resources at ABC.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

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

Model A5

Model F5

Model P5

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

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

Model FA5

Model FF5

Model FP5

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

Model T5

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

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

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

O&P ALMANAC | FEBRUARY 2015

By MEGHAN HOLOHAN

Part

of the

EXPERIMENT Several prosthetists are joining research teams focused on robotics and neural prosthetics— demonstrating the critical role O&P professionals can play in cutting-edge R&D

Need To Know: • Prosthetists throughout the country are making headway into experimental research, playing key roles on teams that develop and test artificial limbs for patients who have undergone targeted muscle reinnervation and other advanced prostheses. • In addition to designing well-fitting sockets and determining where switches should be placed on prostheses, prosthetists involved in advanced research teams can help motivate and train patients in using new devices. • Researchers frequently look to prosthetists to help identify study participants and ensure the appropriate individuals are selected for inclusion in new research.

FEBRUARY 2015 | O&P ALMANAC

ESLIE BAUGH RECENTLY MADE

PHOTOS: Johns Hopkins University Applied Physics Laboratory

national news as the first bilateral shoulder-level amputee to wear and control two modular prosthetic limbs (MPLs) designed at the Johns Hopkins Applied Physics Laboratory (APL). After undergoing a procedure where surgeons reassigned nerves that once controlled his arms and hands, Baugh has learned to operate the new prosthetic system simply by thinking about his limbs. Though the engineers and surgeons at APL who designed the system and led the experiment are receiving most of the accolades associated with this accomplishment, credit also is due to the prosthetist who played a critical role in several stages of the study. Courtney Moran, CP, worked with Baugh after he arrived at APL to test the prostheses. As the clinical lead and certified prosthetist, Moran helped develop the sockets needed for the MPLs. She also serves as a bridge between the patients and engineers to ensure that the MPLs work well for the users. She reaches out to patients between visits to gather feedback. “My job was to work with the whole team … to set a schedule for a clinical objective,” Moran says. She communicates with patients to “see what, if any, progress they make.” In working with Baugh, Moran was impressed by how quickly he learned to complete the tasks assigned to test the MPLs. While waiting for custom sockets to be prepared, Baugh had to learn how to move virtual arms with his mind in a virtual integration environment system. Once his sockets were ready and his training was complete, Moran observed as Baugh completed several assigned tasks using the MPLs. For example, Baugh was tasked with picking up a glass of water. When Baugh grasped that first glass of water, his emotions were tempered. With other patients, emotions flood their faces as they celebrate such an accomplishment. Not Baugh; after picking up the glass, he wanted to move onto the next difficult task.

Leslie Baugh completes a task showcasing his control of the MPL.

APL prosthetist Courtney Moran, CP, looks on as Baugh tests out the MPL.

O&P ALMANAC | FEBRUARY 2015

Robert Armiger observes Baugh handing Albert Chi, MD, a ball.

Courtney Moran, CP 38

FEBRUARY 2015 | O&P ALMANAC

to advance the field of prosthetics. As prosthetic limbs become more advanced and enter the realm of robotics and mind control, it might seem as if the roles of engineers and surgeons will take precedence over the job of prosthetist. But several cutting-edge projects rely heavily on the expertise of trained prosthetists, who contribute to these projects in unique and meaningful ways.

Prosthetists in Research

Robert Armiger, assistant group supervisor of the biological sciences and engineering group in APL’s research and exploratory development department, is one of the individuals with whom Moran works closely. When he says he wants to add a new feature, it is Moran’s job to explain how people might struggle or succeed using a limb with that particular ability. She provides suggestions that would be more intuitive for a patient. “It’s a good kind of push/pull in making sure that … the patient can use it,” he says. When there are additions to the limb—a switch, for example—Moran might advise Armiger where to put it that makes sense for the patient. “We do want to add all those new features and [make sure] they are super intuitive,” Armiger says.

When Moran first joined the team in 2007, she became the lead on socket development. Because the MPL was a new type of limb, it required a different kind of socket. “Primarily we were trying to come up with some novel socket design to best support the limb,” she says. “We had quite a variety of collaborators working on socket attachment or integrated feedback.” The work resulted in the RP2009 socket; she also designed the clinical protocols for its use. Following the success of that project, her role changed. “[I] evolved into a clinical lead for any amputee-related work with the modular prosthetic limb,” she says. This means Moran covers a lot when it comes to patients. After Baugh—who lost his arms 40 years ago in an electrical accident—underwent targeted muscle reinnervation, Moran arranged for him to be cast for a custom socket, which allows connections to the reinnervated nerves. While she can create casts herself, the lab doesn’t have facilities and they outsource fabrication. A well-fitting socket that can hold the MPLs remains important for a patient’s success. “With noninvasive surface control, it was essential to have a well-fitting custom socket,” says Moran.

PHOTO: Johns Hopkins University Applied Physics Laboratory

“He’s not easily impressed with these huge milestones. He’s like, ‘Great … let’s see what we can do next,’” Moran says. “He’s very much focused on mastering it.” In many ways, this makes Baugh a great case study for the MPLs. Because mental training is as important as physical training, patients take home virtual reality programs to practice their skills. Moran is instrumental in making sure that patients are able to complete tasks and improve. That way, when they return to APL to use the MPLs, they are prepared to perform the tasks asked of them and reach important benchmarks in the study. Moran is one of several prosthetists throughout the country who are assisting in research projects designed

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As he waited for the socket, Baugh worked on pattern recognition in a virtual integration environment, which allows people to practice controlling the limbs with their mind before the MPLs are attached. The socket is interchangeable with other limbs so that amputees can practice at home. Moran oversaw how Baugh progressed— within 10 days of practice, he adeptly controlled the arms. Even though he cannot yet take the arms out of the APL lab, Baugh, and other patients, work within the virtual integration environment to practice moving limbs with their minds. “We were able to send him home with a virtual system where he wears the same socket that the limbs were attached to and practices [his motions] with virtual reality limbs,” Moran says. In addition, she knows that Baugh’s regular prosthetist gave him new arms to work with at home. These arms don’t have the same degree of freedom as MPLs, but Baugh can use them to keep his skills sharp so when he returns to APL, he’ll be able to tackle the next big challenge.

Like Moran, Laura Miller, CP, also works as an integral part of a research team focusing on advanced prosthetics. Miller works at the Rehabilitation Institute of Chicago’s Center for Bionic Medicine where she is involved with numerous robotic projects. She’s one of several prosthetists focusing on targeted reinnervation and how patients can control prosthetic limbs after the procedure. Miller, too, often advises the engineers on how to add a switch to a limb that makes sense for patients. Or she might give recommendations on where all of the sensors should go. “Some of the electronics and controllers have to fit inside, and you want it to blend in and look aesthetically pleasing. We help drive some of the development of how it would look and how it might feel in the prosthetic [limb],” she says. Moran and Miller are good examples of the importance of including individuals who have traditional prosthetic backgrounds into advanced prosthetic research and experiments. Both believe that having a prosthetist on the team of

The Source for Orthotic & Prosthetic Coding

advanced limb projects helps the team focus on creating a limb that works well for the patient. “I think it is absolutely essential to be a part of the research project as much as possible,” Moran says.

Prosthetists as Consultants

John Billock, CPO/L, has worked in prosthetics since he started as a technician in 1963. As his career progressed, he became an expert in upper-limb prosthetics and was one of the first people in the country to adopt myoelectric prostheses. With his practice in Warren, Ohio, he currently consults with a team from Case Western Reserve University, led by Dustin Tyler, PhD, an associate professor of biomedical engineering. This project successfully provides the sense of touch to prosthetic limbs. Right now, Tyler isn’t interested in building a new prosthetic limb. He’s adding sensors to existing limbs in the hopes of creating sensation for the patients. The sensors connect to the patients’ myoelectric limbs to stimulate bundles surgically implanted around the major nerves in the arm.

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FEBRUARY 2015 | O&P ALMANAC

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Have you Heard the News That Mobility Saves?

A major new study has proven that prosthetic and orthotic care saves money for payers and improves lives for patients.

The Study A major new study shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. The study was commissioned by the Amputee Coalition and conducted by Dr. Allen Dobson, health economist and former director of the Office of Research at CMS. The study used Medicare data to compare patients with similar conditions who received prosthetics with patients who needed but did not receive prosthetics, over an 18 month period.

The Results

EXHIBIT 4.9 Lower Extremity Prostheses Cumulative Medicare Episode Payment by Cohort (18 Month Episodes from 2008-2010)

Lower Limb Prosthetics

•

The prosthetic patients could experience better quality of life and increased independence compared to patients who did not receive the prosthesis at essentially no additional cost to Medicare or to the patient.

100000

Study Group Average Cumulative Medicare Payments

•

The slope of the cumulative cost curve indicates that had the period of evaluation been longer the break-even would have been reached.

To learn more about the campaign, visit

80000

40000

20000

www.MobilitySaves.org.

Comparison Group

60000

9 10 11 12 13 14 15 16 17 18

Months from Index (Receipt of O&P)

Video and add your own experiences like Queen’s story!

Make Sure the Insurance Companies and Health Care Providers Know This Too! Get Involved and Submit Your Testimony to the Public Relations Campaign Spreading the Word.

Upload your 1-3 minute video or write your story about how your prosthetic has improved your life, like helping you get back to work, take care of your family, rejoin the community, etc. Upload your testimony at bit.ly/yourmobility or scan the QR code on left.

Tyler relies on Billock and other prosthetists to recommend patients who would be well suited for the procedure. Those prosthetists also help modify the limbs as needed and work with the patients so they feel comfortable in an experimental setting. It was through Billock that Tyler first met Igor Spetic, one of the patients taking part in Billock’s study. Spetic, who lost his right hand during a machine accident, currently wears an myoelectric hand. “He was a patient of mine and he still is,” says Billock. “Our goal was not to interfere with the normal use [of study participants’ prostheses] but to enhance, and we didn’t want them to learn a new hand or a new arm,” Tyler says. Aside from knowing what type of devices people needed to qualify for Tyler’s study, Billock really knows the people with whom he works. After more than 50 years in practice and research, Billock understood that Spetic possessed qualities that would make him excel in such a research project. “I just felt that Igor was the kind of individual who could provide them feedback,” he says. “There had to be a willingness. This involves surgery. It’s an invasive type of procedure. He may not see the end benefit of this.” While Tyler’s group is able to give Spetic’s prosthetic arm the sense of touch, it’s still experimental. It could take decades for these capabilities to be commercially available. To add the sense of touch to a prosthesis, Tyler attaches the sensors to the outside of Spetic’s hand, and these connect to contact points on the arm that have been implanted with cuffs that circle the median, radian, and ulna nerves in the arm. The cuffs have eight access points; by using them in different concentrations, Tyler can simulate the sense of touch in the missing limb. When the researchers run a cotton ball over Spetic’s prosthetic hand, he feels it and recognizes what it is. He can even tell the difference between sensations when blindfolded—easily discerning between sandpaper and cotton balls as he did before his amputation.

But more importantly, when Spetic has the sensors working on his hand, it feels like it belongs to him. It’s not simply a tool. “It’s not really replacing their hands … [it’s] just giving the sensation,” Tyler says. Once in the lab, Tyler asked Spetic to shake his hand when Spetic’s thumb, index, and middle fingers had sensation. At first, Spetic reported feeling a little pressure. Then Tyler turned on all of the sensation, and asked Spetic to try again. “Now it feels like someone squeezing his hand, and that is the human element,” said Tyler. One unexpected benefit of Tyler’s project is that Spetic no longer experiences phantom limb pain. At first Tyler thought that Spetic would need more regular stimulation for the feeling to subside, but that’s not the case. “Phantom pain is very traumatic,” says Tyler. Billock is excited to be a part of Tyler’s project, and he knows that patients benefit from such experimentation. Billock believes prosthetists can play an important role as the devices become more advanced. He says

prosthetists have the unique position of “providing personal input, advice, and support with regard to the direction and potential benefits of such research to their patients. “I love what I do and share my knowledge with folks who want feedback,” he says. But he also worries that the cost will be prohibitive. “I am very concerned with the advancing costs of new prosthetic technologies and the effectiveness of how prosthetic practitioners are trained and educated in the properly applying new and advanced technologies,” he says. Ultimately, Billock believes that prosthetists can provide unique insight into advanced projects designed to help improve patients’ functioning and well-being. “Do I think this is something worthwhile? I certainly do. I’ve always been an advocate of technology.” Meghan Holohan is a contributing writer to O&P Almanac. Reach her at meghan.e.holohan@gmail.com.

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O&P ALMANAC | FEBRUARY 2015

MEMBER SPOTLIGHT

Freedom Innovations

By DEBORAH CONN

Eyeing Expansion The company’s production facility, located in Gunnison, Utah.

REEDOM INNOVATIONS IS SOMEWHAT of a second act

FEBRUARY 2015 | O&P ALMANAC

Freedom Innovations’ headquarters in Irvine, California.

COMPANY: Freedom Innovations OWNERS: Majority owned by private equity firm, Health Evolution Partners, located in San Francisco, California LOCATION: Headquartered in Irvine, California, with manufacturing facility in Gunnison, Utah, and distribution office in The Netherlands HISTORY: 14 years

providing Freedom Innovations with additional resources to develop and market its products. Among those products is the Plié microprocessor knee, first introduced in 2006, with a third version released in October 2014. The knee offers protection from stumbles and falls and allows users to move at their own pace. The latest iteration includes programming upgrades and increased durability—including water resistance that allows it to be safely submerged for up to 30 minutes. The Plié also offers a gait and cadence analysis to validate that the patient is variable-speed ambulatory for purposes of reimbursement. On the horizon is the Kinnex, a new microprocessor-controlled hydraulic ankle. “The microprocessor will function during the swing and stance phase,” says Cripe, “increasing stability, creating more comfort going up and down slopes, and allowing for an electronically adjustable heel height.” Users will be able to make some adjustments through a smartphone app. The device, water resistant to the same

standard as the Plié, is entering beta trials in the first quarter of 2015 and is scheduled for release by the end of the year. “We’re also working on powered devices using technology licensed from Vanderbilt to develop a knee and ankle developed on the same platform,” he says. “We hope eventually to offer the first fully powered leg on the market. That’s where we’re headed with the higher end of technology, as we continue to develop foot and knee products to fill gaps in our current portfolio.” Freedom Innovations uses a variety of vehicles to educate its customers, including seminars, trade shows, and free monthly webinars. “We try to provide a higher level of education,” says Cripe. The hour-long webinars deal with a range of topics, including fitting, microprocessor troubleshooting, socket technologies, and coding and reimbursement. Experts also discuss documentation compliance and how to address Recovery Audit Contractor (RAC) program requirements. “RAC audits are a major issue in the industry,” Cripe says, “and we want to help our customers learn more about how to survive in this new environment.” Freedom Innovations is surviving well, says Cripe, with strong growth in spite of the effects of RAC audits on its clients. “And we expect that growth to carry into 2015.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Freedom Innovations

for its chairman and chief executive officer, Maynard Carkhuff, who was formerly president and chief executive officer of FlexFoot Inc. and Össur Prosthetics. In 2000, Carkhuff led the sale of Flex-Foot, the first company to produce carbon-fiber prosthetic foot products, to Össur. Today, Freedom Innovations takes that carbon-fiber technology and prosthetic innovation to the next level, says Rob Cripe, executive vice president of global marketing for the company. Freedom Innovations currently has 145 employees and has plans to expand to 175 employees by year’s end. The company distributes its lower-extremity prosthetics in more than 40 countries. Its three primary locations include corporate headquarters in Irvine, California; a facility in Gunnison, Utah, that manufactures the company’s carbon-fiber products; and a sales, marketing, and distribution center in The Netherlands. Recently, Freedom Innovations received a minority investment from Parker Hannifin, an Ohiobased company that specializes in motion and control technologies. Parker Hannifin used technology licensed from Vanderbilt University to develop Indego, a powered lower-limb orthosis, or exoskeleton, that has a commercial launch scheduled for later this year. The investment, which gives Parker Hannifin a seat on the board, will expand on the partnership between the two companies that began in July 2013 with a technology collaboration,

Freedom Innovations leverages partnerships and innovation to foster growth

The new Skeo silicone liner family A better connection starts here

Choose a liner that works with your patient rather than against them. Designed from the inside out, Skeo liners feature a textured inner surface for enhanced feel and connection. Each liner includes an internal matrix to reduce pistoning that can strain a patient’s limb. Patients will also appreciate the slick outer surface that makes donning/doffing easier. Choose from a variety of options that include SkinGuard anti-bacterial protection, an anatomically pre-flexed liner, or a clear liner to help evaluate limb health. Our newest option is the 6Y87 Skeo 3D TF! Call your Sales Representative at 800 328 4058 to give your patients a better connection with the new Skeo silicone liner family. Ottobock US · P 800 328 4058 · F 800 962 2549 · www.ottobockus.com Ottobock Canada · P 800 665 3327 · F 800 463 3659 · www.ottobock.ca

NEW

MEMBER SPOTLIGHT

Mobility Solutions Prosthetics & Orthotics

By DEBORAH CONN

One-Woman Show Solo practitioner relies on referral sources and thorough patient evaluation techniques to grow patient base

HANNON LEVIN, AT 28,

FEBRUARY 2015 | O&P ALMANAC

Shannon Levin, CPO, works with a patient in the casting room.

experience,” she says, “but it wasn’t as hard as people told me.” She relied on colleagues in other market areas to share their expertise, and she visited local FACILITY: referral sources to generate busiMobility Solutions ness. While launching Mobility Solutions was easier than she Prosthetics & had expected, there were—and Orthotics are—challenges, most notably in negotiating contracts with OWNER: Shannon Levin, CPO the larger insurance companies and third-party payors. “The patient side is easy!” she says. LOCATION: Levin believes she differentiSalem, Oregon ates herself from other O&P facilities in town by her emphasis HISTORY: on thorough evaluation at the 8 months beginning of the process. “By paying attention to details up front, when patients come in to be fitted, I am able to spend less time fitting and more time training them how to use their device,” she notes. “I’d much Levin works with a rather spend that patient in the gait lab. time educating

my patients and having them practice wearing their device in the facility, where they can get a good feel for it.” Fast turnaround is another hallmark of Mobility Solutions. According to Levin, patients normally receive their devices within one week and no later than two weeks after the initial evaluation. Levin uses the Mobility Solutions website to impart useful information to patients, including slideshows of common devices and links to additional information. Patient forms, including a feedback survey, can be downloaded and printed. It may be early to think about future plans for a facility that’s less than a year old, but Levin is not ruling out expansion at some point. “Some people are interested in possibly joining me in the future,” she says. “But my business model is to stay small. “By being a smaller company, I am able to spend the necessary time with each patient. I have worked for larger corporations in the past, and know that being part of a larger group does not mean that you will be more available to the patients—in fact, it is the opposite. Rather than being rushed and spread thin, my goal is to do quality work in a timely manner. The benefits are better patient outcomes and reduced need for follow-up appointments because I am able to take the time up front.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Mobility Solutions Prosthetics & Orthotics

has a surprisingly full resume. She conducted biomechanical research at the Willamette University in Salem, Oregon, worked as an O&P technician for more than three years, and then attended Northwestern University to become a practitioner. Now an ABC-certified prosthetist/ orthotist, Levin launched her own facility, Mobility Solutions P&O, in Salem in June of last year. Mobility Solutions is a one-person enterprise. Levin is clinician, technician, billing department, and scheduler. “I really like having a good mix of being able to use my hands and being creative, as well as working with patients,” she says. “This arrangement allows me to make my own schedule and be hands-on in creating and fitting devices. Being able to do it all myself has really boosted my enjoyment and satisfaction in my career.” Levin provides orthotic, prosthetic, and pedorthic services to patients ranging from children to adults, with a good number of diabetic patients who need offloading orthoses for foot ulcers. Prostheses include both lower- and upper-limb devices. The Mobility Solutions facility features a comfortable waiting room, a patient-care room, a gait lab with parallel bars and a therapy stair set, a fabrication room, and a casting room. “The lab allows me to do just about everything I need to, although I do use central fabrication when I need it,” she says. Establishing her own business was “definitely a learning

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AOPA NEWS

Introducing AOPA’s Take— Where You Go When You Need To Know! As we begin 2015, AOPA offers a new form of communication to all members of the O&P community, AOPA’s Take. Using a blog style format, AOPA’s Take will keep you in the loop regarding news and information that is vital to the business of O&P. While AOPA has established lines of communication through traditional venues such as the O&P Almanac and the SmartBrief newsletter, AOPA’s Take will follow a different approach that will focus on specific issues that are significant each day. Communication through AOPA’s Take will be immediate, keeping you informed of new information and developments as they happen. AOPA has a long history of leading the way in ensuring that members of the O&P community have the tools to make sound decisions regarding the direction of their businesses. AOPA’s Take will continue this history by quickly becoming the best source for immediate access to breaking news that affects your O&P business. AOPA’s Take is available at no charge to all members of the O&P community, and subscribing is simple. Go to www.aopastake.org and click on the subscribe button. Fill out a few fields, and you’re in!

Register Now: 2015 AOPA Policy Forum March 23-25, 2015 The AOPA Policy Forum provides the best opportunity to learn the latest legislative and regulatory happenings and find out how they will affect you, your business, and your patients. Once you are armed with the facts, you will help educate members of Congress to offer common sense solutions and share how the O&P profession restores lives and puts people back to work. Your congressional appointments will be organized by AOPA staff and lobbyists. Join AOPA March 23-25 at the Renaissance Hotel in Washington, DC. Learn more and register at bit.ly/policyforum2015. 48

FEBRUARY 2015 | O&P ALMANAC

Mastering Medicare Webinar

Find Success: Tips, Strategies, and Understanding the Appeals Process Feb. 11, 2015 Learn the ins and outs of the five levels of the Medicare appeals process, including what type of claims can and cannot be appealed. Find out the best way to craft a successful agreement to ensure success in your appeal. The February webinar will focus on navigating the curves of the appeals process, and explain why it’s an important part of your business operation. An AOPA expert will address the following issues: • The five levels of appeals • Helpful hints on filing appeals • Strategies to achieve a successful appeal • The necessary information to include in an appeal • Information that should and should not be included in an appeal. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register online at bit.ly/aopawebinars. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with registration questions.

AOPA NEWS

Mastering Medicare Essential Coding & Billing Techniques Seminar

AOPA Coding Experts Come to Seattle in April

The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance your O&P practitioners’ and billing staff’s coding knowledge. The seminar includes hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Start the year off right for your business, staff, and patients! Join your colleagues in the Emerald City April 13-14. 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. Learn from AOPA coding and billing experts who have more than 70 years of combined experience. In this audit-heavy climate, can you afford not to attend? Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more, register, or see the rest of the year’s schedule at bit.ly/2015billing.

Virginia Newspaper Features Editorial Citing Dobson-DaVanzo Facts AOPA Immediate Past President Anita Liberman-Lampear, MA, of University of Michigan Orthotics and Prosthetics Center has published an editorial in the Roanoke Times on the Dobson-DaVanzo research. Published Dec. 18, 2014, the editorial, titled “Medicare Denies Too Many Claims for Prosthetics,” explains the findings of the research, which was funded by AOPA and commissioned by the Amputee Coalition. The research used Medicare’s own data to prove that providing orthotics and prosthetics is cost effective. The study was the basis for Mobility Saves, the public relations campaign spreading the word to O&P providers, referral sources, payors, and patients that O&P saves Lives and Money. Read the editorial at bit.ly/editorialop. Please note that at the time the editorial was submitted, Liberman-Lampear was the AOPA president of the board of directors. As of Dec. 1, 2014, Charlie Dankmeyer Jr., CPO, is the current president. SUBSCRIBE

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

O&P ALMANAC | FEBRUARY 2015

AOPA NEWS

Reserve Exhibit Space for the 2015 National Assembly

Call for Papers: Become a Presenter at the 2015 AOPA National Assembly Share Your Expertise• Advance Your Career • Improve Patient Care Henry B. Gonzalez Convention Center, San Antonio, TX

OPA IS SEEKING HIGH-QUALITY education presen-

XPAND YOUR KNOWLEDGE, GROW your market

presence, and advance your career by exhibiting at AOPA’s 2015 National Assembly, the country’s oldest and largest meeting for the orthotic, prosthetic, and pedorthic profession in the United States. • Build your customer base and increase sales by meeting with owners who make the final decisions on purchases. • Experience face-to-face time with existing customers to answer questions and build new relationships. • Enjoy sponsored networking opportunities, including an opening reception in the exhibit hall. • Take advantage of fun traffic-building opportunities. • Take part in education sessions to learn what’s happening with regulatory agencies that affect the success of your product. • Increase visibility for your company/organization in a targeted market. • Host a manufacturer’s workshop and/or product preview theater presentation. • Speak to AOPA reimbursement experts who can answer all of your O&P coding, reimbursement, and compliance questions. • Hear from top researchers and clinicians to learn what products and support are needed from manufacturers. • Participate in key education programs and plenary sessions. • Be a part of the largest exhibit hall in the country for the orthotic, prosthetic, and pedorthic profession, and much more! More information on exhibiting can be found at www. AOPAnet.org under the “Education” tab. Contact Kelly O’Neill at koneill@AOPAnet.org or 571/431-0852 with exhibitor questions.

FEBRUARY 2015 | O&P ALMANAC

tations for the 98th Annual AOPA National Assembly. Share your expertise and advance your career by being part of the country’s oldest and largest meeting for the orthotic, prosthetic, and pedorthic profession. Your submissions, based on sound research and strong empirical data, will set the stage for a broad curriculum of highly valued clinical and scientific offerings at the 2015 AOPA National Assembly. All free paper abstracts for the 2015 AOPA National Assembly 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, based on the criteria below, and reach a decision regarding acceptance of abstracts. • Relevance, level of interest in topic • Quality of scientific content • Quality of clinical content. All papers should be submitted at bit.ly/presentin2015. AOPA is accepting submissions for the following topics: • Clinical Free Papers: The top-scoring papers will compete for the prestigious Thranhardt Award. • Technician Program • Business Education Program: The top papers will be considered for the prestigious Sam E. Hamontree, CP (E), Business Education Award. • Symposia • Student Poster Submissions • Technical Fabrication Contest Submissions Contact AOPA Headquarters at 571/431-0876 or TMoran@AOPAnet.org with questions about the submission process or the National Assembly.

AOPA NEWS

AOPA’s 2015 Mastering Medicare Webinars Announced

ARK YOUR CALENDAR NOW for the 2015 AOPA Webi-

nars. These one-hour sessions come to you in the comfort of your office on the second Wednesday of each month at 1 p.m. EST. This series provides an outstanding opportunity for you and your staff to stay up-to-date with the latest hot topics in O&P, as well as gain clarification and ask questions on topics that you may not understand as fully as you would like to. You may access the webinars by phone or computer.

Buy the Series and Get Two FREE! • January 14: Fill In the Blanks: VA Contracting and the New Template • February 11: Find Success: Tips, Strategies, and Understanding the Appeals Process • March 11: Who Gets the Bill: A Complete Look at Medicare Inpatient Billing • April 8: Lower-Limb Prostheses Policy: Learn the Policy Inside and Out • May 13: The New Player in Town: Understand How the RAC Contract Works • June 10: Stay Out of Trouble: Building a Medicare-Approved Compliance Plan • July 8: Who’s on First? Medicare as a Secondary Payer • August 12: Off-the-Shelf vs. Custom Fit: The True Story • September 9: Prior Authorization, How Does It Work? • October 14: Understanding the LSO/TLSO Policy • November 11: How To Make a Good Impression: Marketing Yourself to Your Referrals • December 9: Bringing in the New Year: New Codes and Changes for 2016 Visit the AOPA website, buy the series, and get two free. Members pay just $990 and nonmembers pay $1,990. If you purchase all of the conferences, all conferences from months prior to your purchase of the set will be sent to you to access online. Seminars are priced at just $99 per line for members ($199 for nonmembers). Questions? Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876. Learn more and register at bit.ly/aopawebinars.

Earn CE Credits by Reading the O&P Almanac!

E! QU IZ M EARN

BUSINESS CE

CREDITS P. 17

BECAUSE OF THE HIGHLY EDUCATIONAL content of the O&P Almanac’s Reimbursement Page and Compliance Corner columns, O&P Almanac readers can now earn two business continuing education (CE) credits each time you read the content and pass the accompanying quizzes. It’s easy, and it’s free. Simply read the Reimbursement Page column (appearing in each issue) and Compliance Corner column (appearing quarterly), take the quizzes, and score a grade of at least 80 percent. AOPA will automatically transmit the information to the certifying boards on a quarterly basis. Find the digital edition of O&P Almanac at: • www.AOPAnet.org/publications/digital-edition/ Be sure to read the Reimbursement Page article in this issue and take the February 2015 quiz. Access February’s quiz and previous monthly quizzes at: • bit.ly/OPalmanacQuiz

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

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O&P ALMANAC | FEBRUARY 2015

AOPA NEWS

Coding Questions Answered 24/7

AOPA members can take advantage of a “click-ofthe-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways—by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

AOPA Media on Facebook and Twitter— Follow us and we follow you!

OPA IS ON FACEBOOK and Twitter. Follow us to keep

you and your office on top of the O&P community happenings! Signal your commitment to quality, accessibility, and accountability. Strengthen your association with AOPA by helping us build these online communities. • Like us on Facebook at: http://www.facebook.com/ AmericanOandP with your personal and your organization’s account. • Follow us on Twitter: @americanoandp and we’ll follow you too.

UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa! Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster. AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air® All this with the peace of mind that comes from using the carrier that delivers outstanding reliability, greater speed, more service, and innovative technology. UPS guarantees delivery of more packages around the world than anyone, and delivers more packages overnight on time in the US than any other carrier. Simple shipping! Special savings! It’s that easy! www.savewithups.com/aopa

FEBRUARY 2015 | O&P ALMANAC

Top 5 Reasons to Follow Us: 1. Be the first to find out about training opportunities, jobs and news from the field. 2. Build relationships with others working in the O&P field. 3. Stay in touch with the latest research, legislative issues, guides, blogs, and articles that are hot topics in the community. 4. Hear from leaders and experts. 5. Receive special social media follower discounts, perks, and giveaways!

COMMENTS

Seeking Your Opinion...on Fee Schedules

AST MONTH I ASKED O&P Almanac readers to share

your thoughts about some of the jagged edges that hang around the O&P community. I am looking for you to comment back to me about these topics. This column is written one month before it is published. As I write this, it is fee schedule season in my area. CMS publishes its fees, and other insurers do the same. One local commercial insurer published O&P rates so outrageously low that I cannot believe anyone can provide the service without losing significant amounts of money. This same insurer requires providers to be accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, or by the Board of Certification, so the playing field should be pretty level. One of the advantages of being in the same business in the same area for a long time is the alliances you make. I have a trusted person at this particular insurer with whom I have worked for many years.

So I called to ask what the insurance company was thinking when it put the new fee schedule together. His answer was that the O&P community set the fees—not the insurance company. Huh, how did those of us in O&P do that? My friend explained that the insurance office responsible for the state of Maryland had mailed out a fee schedule to O&P professionals. Those who chose to participate filled out the appropriate contract paperwork and sent it back. Enough qualified suppliers accepted the fees stated on that contract to meet the geographic coverage needs. My friend tells me that means those fees I characterized as outrageously low are the market rate for Maryland. And as far as my friend is concerned, we did it ourselves. Any thoughts? Email info@AOPAnet.org. —Charles H. Dankmeyer Jr., CPO AOPA President

WELCOME NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants www.AOPAnet.org for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume:

Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million. Baker O&P Enterprises Inc. 1311 Record Crossing Road Dallas, TX 75235-6003 972/348-5295 Category: Affiliate Member Parent Company: Baker O&P Enterprises Inc.

Center for Orthotic Prosthetic Care 4975 Alben Barkley Drive Paducah, KY 42001 270/558-4704 Category: Affiliate Member Parent Company: Center for Orthotic & Prosthetic Care

Cumberland Foot Health Solutions 117 Tradepark Drive Somerset, KY 42503 606/679-2773 Category: Patient-Care Facility Kevin Scribner John Callan Orthotic Services 1729 N. Weber Street Colorado Springs, CO 80907 719/799-6529 Category: Patient-Care Facility John Callan Pacific Medical P&O Salem 1344 Liberty Street SE Salem, OR 97302 503/385-1702 Category: Affiliate Member Parent Company: Pacific Medical P&O, Tracy, CA

San Francisco Prosthetic Orthotic Service Inc. Redwood City 617 Veterans Blvd., Ste. 101 Redwood City, CA 94063 650/364-3080 Category: Affiliate Member Parent Company: San Francisco Prosthetic Orthotic Service Inc., San Francisco, CA Texas Prosthetic Center Inc. 4242 Medical Drive, Ste. 2100 San Antonio, TX 78229 210/949-0011 Category: Patient-Care Facility Sara McDonald

Is Your Facility Celebrating a Special Milestone in 2015? O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@contentcommunicators.com.

O&P ALMANAC | FEBRUARY 2015

MILESTONES

Congratulations to AOPA members

25-Year Anniversary: Tamarack Habilitation Technologies Inc. O&P Almanac celebrates the important milestones being celebrated by established AOPA members in 2015

Company History

Tamarack Habilitation Technologies was incorporated in January 1990 by Marty Carlson, CPO, and Peggy Carlson. Tamarack opened its doors as a full-service orthotics, prosthetics, and rehabilitation engineering facility in October of that year. The founding professional staff consisted of Mark Payette, CO; Katie Voss, CO; Dave Harris, CP; Diane Goodwin, rehabilitation engineer; and Adelle North, office manager.

J. Martin “Marty” Carlson , CPO, and Peggy Carlson

ShearBan products

FEBRUARY 2015 | O&P ALMANAC

20 OWNERS: J. Martin “Marty” and Peg Carlson

What Makes This Company Successful?

During its years as a clinical service facility, Tamarack attracted the most complex cases as well as practitioners of great talent. That combination of complex cases, close listening, and talented practitioners resulted in a number of breakthrough solutions/designs. Currently, we put our experience to use developing products to provide our professional colleagues access to more efficient and effective care options. We try to understand and intervene at the

most fundamental level. We live our business values rather than talk about them.

How Will the Company Thrive in the Future?

We will continue to innovate, bringing forth authentically new solutions and products for O&P caregivers. Preserving our collaborative, curious culture also is important as we move into the future. We hope to continue to attract excellent, motivated employees and to make the kind of difference that justifies our business success.

MILESTONES Is Your Facility Celebrating a Special Milestone in 2015? The O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@ contentcommunicators.com.

PHOTOS: Tamarack Habilitation Technologies Inc.

In 1993, Tamarack began development of an advanced flexure-type orthotic joint, which was introduced to the field in cooperation with Becker Orthopedic in the spring of 1995. In 1999, Tamarack and Becker introduced ShearBan to the O&P industry. Both products were developed and manufactured by Tamarack in Minnesota. In 1999, Marty and Peg gifted the patient-care division of the company to Fairview Hospital. The remaining product manufacturing

part of Tamarack was moved to Blaine, Minnesota, in 2000, where it is presently located. The Tamarack staff has been 25-YEAR active academically: teaching, ANNIVERSARY: presenting at meetings, conductTamarack Habilitation ing seminars, and writing for journal publications. They have Technologies Inc. been invited to conduct 16 multiHEADQUARTERS: day workshops in 12 countries. In 2009 Becker Orthopedic partMinneapolis, nered with Tamarack to continue Minnesota those Tamarack style workshops. Tamarack is currently engaged ADDITIONAL in licensing and commercializing LOCATION: several internationally patented Manufacturing technologies that will be utilized facility located in in hospitals, rehab care, and wheelchair function. The products Mora, Minnesota relate to wound healing and prevention. EMPLOYEES:

E-Mail: kingsley@oandp.com

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Aqualeg with New Soft Shell Technology The Aqualeg soft shell cover has an exact fit and is self-supporting without the need for foam underneath. This allows the cover to be used in and around water. It has flexibility modeled after real limbs and is available in a precise 3D custom fabrication. Every cover is produced to fit perfectly on the socket. The covers are intended to be used everyday and provide a solution for active people who have lifestyles that include getting into water or harsh environments. They offer the perfect solution for prosthetic devices that are traditionally difficult to cover, including those with electronic components or vacuum assistance. For more information, contact Aqualeg Inc. at 855/955AQUA (855/955-2782) or visit www.aqualeg.com.

Introducing the Stronger, Smarter, Submersible Plié® 3 MPC Knee

Freedom Foot Products Just Got Better

Now, with the broadest range of sandal-toe options available anywhere, you can focus first on performance and rest assured that your patient’s desire to wear sandals can be easily satisfied. Achieve improved clinical outcomes by delivering a product designed to meet your functional objectives. Whether it’s shock absorption, hydraulic ankle motion, heel height adjustability, or multiaxial ground compliance, the new sandal-toe product line delivers form and function—unrestricted. Choose from 13 high-performance designs: • Highlander® • Kinterra® • Pacifica® & Pacifica® LP • Renegade® & • Runway® & Runway® HX Renegade® LP • Thrive® • Agilix™ • WalkTek® • DynAdapt™ • Sandal-Toe Foot Shell • Sierra® Our second-generation Sandal-Toe Foot Shell is available in sizes 22-28 cm and in three different skin tones (light, medium, and dark). For additional information, contact customer service at 888/818-6777 or email us at info@freedom-innovations.com.

Slope Strips Now Available From Acor

Stronger construction makes the new Plié 3 Microprocessor Controlled (MPC) Knee both submersible and more rugged than ever. Yet it’s still the fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees. With the most responsive stumble and fall protection, users can instinctively move at their own pace in any direction...even if it’s taking small short steps or pivoting in confined spaces. And with a more streamlined, intuitive set-up, the Plié 3 MPC knee makes it even easier for prosthetists to help patients expand their freedom. To learn more about the Plié 3 MPC knee, contact Freedom Innovations at 888/818-6777 or visit www.freedom-innovations.com.

FEBRUARY 2015 | O&P ALMANAC

Slope strips are now available from Acor! This newly designed EVA slope strip is 37” x 17” and has a thickness of 1.25” in the heel, which tapers down to .25” in the forefoot. Custom sizes are available on request and can be made to fit any mill. This new size and shape allows for reduced material waste and faster milling times. Each slope strip will yield at least three pairs of orthotics and has quickly become the industry standard for milling. See our ad in this issue and call today to try one! For more information, contact Acor Orthopaedic Inc. at 800/237-2267 or visit www.acor.com.

MARKETPLACE New From Coyote Design: Dynamic AFO Strut Our new posterior dynamic strut AFO combines the fit and comfort of a custom AFO with a posterior-mounted dynamic strut for optimal ambulation. The strut can mount to either a custom thermoformed or laminated AFO. Purchase struts and tooling from Coyote and fabricate in your own facility, or we can make the entire custom brace for you. These AFOs are great for drop foot; they improve gait and are designed with affordability and adjustability in mind. To learn more about Coyote Design’s Dynamic AFO Strut check out the video testimonials at www.coyotedesign.com.

Coyote Design’s Two Lightweight, Airtight, Water-Resistant Pin Locks

Ottobock ProCarve ProCarve provides you targeted support to take on the challenge of snow skiing, waterskiing, and snowboarding. It also meets the highest demands of performance you require on the slopes. It has been specially designed for skiing and snowboarding with extreme carving. Integrated, high-performance dampers control the flexion and extension movements for users with a transtibial or transfemoral amputation. To learn more, log onto professionals.ottobockus.com or call your local sales representative at 800/328-4058.

Silicone, Urethane, and Copolymer Liners

The Air-Lock and Small Air-Lock dual suspension pin systems are designed to combine suction suspension comfort with pin suspension safety and security. The airtight seal of the Air-Locks prevents air from entering the bottom of the socket by creating negative pressure inside the socket (suction), which reduces pistoning even without a sleeve. The Easy-Off Lock, similar to the Air-Lock, stays airtight. The Easy-Off Lock creates suction in the socket and can also work with elevated vacuum mechanisms. Its patent pending lever design makes doffing easy for amputees with hand strength issues. For more information, contact Coyote Design at www.coyotedesign.com.

The Skeo family of silicone liners includes an internal matrix to reduce pistoning plus a slick outer surface to aid in donning and doffing. Choose from a variety of options that include preflexed for enhanced fit, and SkinGuard protection to reduce odor. Our copolymer liners are ideal for lower activity patients, and our Anatomic 3D Urethane liner is preferred for Harmony vacuum or valve systems. Whether your patients need a silicone, urethane, or copolymer solution, Ottobock can help you find the right fit. Call your local sales rep to find out more.

The S comb with ortho Str K

K Th that o main

Ottobock • 800.328.4058 www.professionals.ottobockus.com

medi USA Introduces the 4Seal TFS Liner

WCASE

The new medi 4Seal TFS Liner combines a revolutionary sealing technology with a unique self-gliding surface, providing extraordinary suspension, comfort, and ease of use for those with transfemoral amputations. Features and benefits include: K Integrated seals for easy inversion and a highly secure fit. O&P ALMANAC | FEBRUARY 2015 57 K Easy Glide PLUS outer surface—no donning aids or sprays required.

Hers custo mate ogy l duro the a absor Plast tive d

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

AirSelect AirSelect puts comfort, control, and healing in the hands of the patient with the most-advanced pneumatic walking boot available. Beneath its sleek appearance are patented technological advances that work together to enhance treatment and improve outcomes. The integrated inflation system lets patients inflate each aircell individually, to maximize comfort and minimize edema. SoftStrike technology absorbs and dissipates shock while the lightweight, lab-tested rocker sole encourages a natural gait, allowing a continuation of everyday activities. AirSelect offers superior comfort and faster healing. Thatâ&#x20AC;&#x2122;s the ultimate combination! For more information, visit www.DJOGlobal.com/airselect.

ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the ground reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the selfleveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

New Sure Stance Knee by DAW This ultra-light, true variable cadence, multiaxis knee is the worldâ&#x20AC;&#x2122;s first 4-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K-3 patients. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

ADVERTISERS INDEX

Company ACOR Orthopedics Inc. Aqualeg Inc. Arizona AFO Inc. ARTech Laboratory Inc. BCP Group ComfortFit Labs Inc. Coyote Design DAW Industries DJO Global Ferrier Coupler Inc. Fillauer Flo-Tech O&P Systems Inc. Freedom Innovations, LLC Hersco Kingsley Manufacturing Ottobock 58

FEBRUARY 2015 | O&P ALMANAC

Page Phone

Website

7, 47 800-237-2276 www.acor.com 25 855-955-2785 www.aqualeg.com 15 877-780-8382 www.arizonaafo.com 39 888-775-5501 www.artechlab-prosthetics.com 27 615-550-8774 www.bcpgroup.com 19 888-523-1600 www.comfortfitlabs.com 9, 41 800-819-5980 www.coyotedesign.com 2, 59 800-252-2828 www.daw-usa.com 31 800-336-6569 www.djoglobal.com 35 810-688-4292 www.ferrier.coupler.com Gatefold 800-251-6398 www.fillauer.com 43 800-356-8324 www.1800flo-tech.com 29 888-818-6777 www.freedom-innovations.com 5 800-301-8275 www.hersco.com 53 800-854-3479 www.kingsleymfg.com 45, C4 800-328-4058 www.professionals.ottobockus.com

MPK with pinpoint programmable gait accuracy Advanced Pneumatics with extremely high exion resistance 5-bar stability, fully adjustable stance exion Full range adjustable geometric stance control

Trouble free low maintenance. Proven durability and dependability Fully programable centrode (PC) Record-able gait data for seamless Bluetooth transfer to another Stealth MP Knee Patient weight: up to 275 lb

This latest New technology detects instantly any change in knee 3-D positioning. The programmable Stealth microprocessor translates the data and provides the optimum extension--exion resistance. Its advanced Pneumatics with unheard of high compression ratio can easily be set to provide the desirable resistance while walking down an incline or stairs.

AOPA NEWS

CAREERS

Southeast

Opportunities for O&P Professionals

CPO or CO

Job location key:

Chattanooga, Tennessee Fillauer Companies Inc. is seeking a CPO or CO to join its team as the director of orthotics at its headquarters in Chattanooga, Tennessee. The qualified candidate will manage the product development and clinical education for Fillauer’s orthotic product lines. Requirements: • The minimum education is a bachelor’s degree in O&P and/or master’s degree in O&P is a plus. • ABC certification is preferred. • A minimum of five years of recent patient-care experience with emphasis on orthotics. • Licensed or ability to be licensed in Tennessee. • If not currently living in Chattanooga or the surrounding area, the candidate must be willing to relocate. • Must work well in a team environment. • Excellent communications skills, including oral and written, are necessary. • Must have the ability to travel up to 30 percent of the time, or as needed. Fillauer Companies Inc. offers a competitive benefits package, including 401K and medical, dental, and vision insurance. Please apply at:

Website: Fillauer.com/careers

Pacific Here We Grow Again… Openings: CPO, CP, and CO

Orange County, Riverside County, San Bernardino County, California A reputable, well-established, multi-office, Southern California O&P company is looking for energetic and motivated individuals who possess strong clinical skills and experience to provide comprehensive patient assessments to determine patient needs, formulate and provide treatments, perform necessary protocols to ultimately deliver the best orthotic/prosthetic services, and provide follow-up patient care. Candidates must have excellent communication, patient-care, and interpersonal interaction skills, and always abide by the Canons of Ethical Conduct instilled by ABC. We offer competitive salaries and benefits. Salary is commensurate with experience. Local candidate preferred. Send resumé to: Attention: Human Resources Inland Artificial Limb & Brace, Inc. Fax: 951/734-1538 60

FEBRUARY 2015 | O&P ALMANAC

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

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

Member Nonmember $80 $140

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

Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Products & Services

For Orthotic, Prosthetic & Pedorthic Professionals

2014 OPERATING PERFORMANCE REPORT AOPA Helps Run

s s e n i s u B r u Yo 2014 OPERATING PERFORMANCE REPORT

AOPA Operating Performance Report

2014

(Reporting on 2013 Results)

Are you curious about how your business compares to others? This updated survey will help you see the big picture. The Operating Performance Report provides a comprehensive financial profile of the O&P industry including balance sheet, income statement and payer information organized by total revenue size, community size and profitability. The data was submitted by more than 98 patient care companies representing 1,011 full time facilities and 62 part-time facilities. The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2012 operations. Electronic Version AOPA Member: $85.00 Non-Members: $185.00

HOW TO ORDER BY FAX: 571/431-0899

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

ONLINE: www.AOPAnet.org BY MAIL: AOPA Bookstore, 330 John Carlyle Street, Suite 200, Alexandria, VA 22314 MORE INFORMATION: For AOPA products and educational opportunities, contact 571/431-0876 or e-mail info@AOPAnet.org.

CALENDAR

2015

March 11

Who Gets the Bill: A Complete Look at Medicare Inpatient Billing. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

February 9-10

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. Embassy Suites, Savannah, GA. Register online at bit.ly/2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

March 14-15

ABC: Orthotic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas, TX. Contact 703/836-7114, certification@abcop.org, or visit www.abcop.org/certification.

February 11

Find Success: Tips, Strategies, and Understanding the Appeals Process. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

February 21-22

Children and Their Feet. Holly Springs, NC. Study pathology-based treatments, orthotics, shoes, and taping while supporting a good cause. 16 credits. Register at FootCentriconline.com.

March 1

ABC: Application Deadline for Certification Exams. Applications must be received by March 1, 2015, for individuals seeking to take the April Practitioner CPM exams or May Written and Written Simulation certification exams. Contact 703/8367114, certification@abcop.org, or visit www.abcop.org/certification.

March 16-21

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 250 locations nationwide. Contact 703/8367114, certification@abcop.org, or visit www.abcop.org/certification.

March 20-21

ABC: Prosthetic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas, TX. Contact 703/836-7114, certification@abcop.org, or visit www.abcop.org/certification.

March 20-21

PrimeFare West Regional Scientific Symposium 2015. Marriott City Center, Denver, CO. Sponsored by ReliaCare Alliance IPA. For more information, visit www.primecareop.com or contact Jane Edwards at 888/388-5243 or jedwards@reliacare.com.

Year-Round Testing

Online Training

BOC Examinations. BOC has year-round testing for all of its exams and no application deadlines. Candidates can apply and test when ready and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

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

www.bocusa.org

Calendar Rates Let us share your upcoming event! Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

FEBRUARY 2015 | O&P ALMANAC

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

CREDITS

BONUS! Listings will be placed free of charge on the â&#x20AC;&#x153;Attend O&P Eventsâ&#x20AC;? section of www.AOPAnet.org.

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less

$40

$50

1/4 page Ad

$482

$678

26-50

$50

$60

1/2 page Ad

$634

$830

51+

$2.25/word $5.00/word

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

CALENDAR

March 23-25

AOPA Policy Forum. Renaissance Hotel, Washington, DC. Come make a difference! Educate Congress on issues affecting your business. For more information, contact Devon Bernard at dbernard@AOPAnet.org or call 571/431-0876.

SUPERCOURSE SPRING 2015 APRIL 8-11, 2015

Motion Control Headquarters, Salt Lake City, UT

April 8

Lower-Limb Prostheses Policy: Learn the Policy Inside and Out. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

April 13-14

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. Grand Hyatt Seattle. Seattle, WA. Register online at bit.ly/ 2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

• In-depth training of Utah Arm 3+ / Hybrid Arm / ProPlus TDs and Wrist

• Latest MC components, integrating with i-limb, bebionic, and others

• Hands-on training with UI software - bring your Windows laptop

• Convenient Wednesday Saturday schedule Plus training in the NEW

• Casting/fitting/socket design F.L.A.G. (Force Limiting Auto for SD/FQ, T-H, T-R levels; Grasp) feature for ETD & Hand patient subjects provided

The 4-day SuperCourse fee is $1,350.00 CEUs: 28 (estimated) ABC/BOC For more information or to register for the SuperCourse, email: info@UtahArm.com

April 24-25

PrimeFare Central Regional Scientific Symposium 2015. Tower Hotel, Oklahoma City, OK. Sponsored by ReliaCare Alliance IPA. For more information, visit www.primecareop.com or contact Jane Edwards at 888/388-5243 or jedwards@reliacare.com.

April 30-May 2

115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801.326.3434 • Fax: 801.978.0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com

2015 International African-American Prosthetic Orthotic Coalition Annual Meeting. Ocean Front Studio Suites, Virginia Beach, VA. Contact Michael Smith at 757/548-5656, email aopcnow@gmail.com, or visit www.iaaopc.org.

May 13

Motion Control

O&P Almanac Calendar Ad SuperCourse Spring 2015.indd 1

The New Player in Town: Understand How the RAC Contract Works. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

June 11-12

12/30/14 10:21 AM

MOPA: Michigan Continuing Education Meeting. DoubleTree by Hilton Bay City-Riverfront. Now offering pedorthic continuing education credits. Contact 517/784-1142 or visit www.mopa.info.

June 19-20 May 14-16

PA Chapter of AAOP Annual Spring Conference. DoubleTree by Hilton Hotel Pittsburgh-Meadow Lands, Pittsburgh, PA. For more information, call Beth or Joe at 814/455-5383.

May 14-16

Western and Midwestern Orthotic & Prosthetic Association (WAMOPA). Peppermill Hotel Resort, Reno, NV. Contact Sharon Gomez at 530/521-4541, or visit www.wamopa.com.

June 10

Stay Out of Trouble: Building a Webinar Conference Medicare-Approved Compliance Plan. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

PrimeFare East Regional Scientific Symposium 2015. National Convention Center, Nashville, TN. Sponsored by ReliaCare Alliance IPA. For more information, visit www.primecareop.com or contact Jane Edwards at 888/388-5243 or jedwards@reliacare.com.

July 8

Who’s on First? Medicare as a Secondary Payer. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

July 13-14

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. Philadelphia, PA. Register online at bit.ly/2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

O&P ALMANAC | FEBRUARY 2015

ASK AOPA

Uncovering Covered Benefits Answers to your questions regarding reimbursement for shoe repairs, compression garments, and more AOPA receives hundreds of queries from readers Q and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Are compression garments a covered benefit under the Medicare program?

Compression garments are typically not considered a benefit under the Medicare program and will be denied as noncovered, meaning that Medicare will not make a payment for the garments and the patient will be held liable. However, there is one occasion when certain compression garments may be covered by Medicare: when they are used in conjunction with a surgical dressing and are being used to treat an open venous stasis ulcer. If the compression garment is used in this rare occasion, the claim must include the AW modifier, and the AW modifier may only be attached to the following codes: A6531, A6532, and A6545.

Is it possible to bill for repairs to a pair of diabetic shoes? If yes, do we use the orthotic parts and labor codes (L4205 and L4210)?

Yes, it is possible to bill for repairs to diabetic shoes and inserts; however, you would not use the L4205 and L4210 codes. When billing for the repair, you would use the code A5507 (for diabetics only, not otherwise specified modification (including fitting) of off-the shelf depth inlay shoe or custom-molded shoe, per shoe). Keep in mind that, according to policy, the use of A5507 counts toward the total number of eligible inserts/modifications that a patient may receive and for which Medicare will reimburse.

FEBRUARY 2015 | O&P ALMANAC

Are there weight limits/ restrictions for the use of heavy-duty knee joints—for example, the L2395 and L2385?

The policy is clear on when the heavy-duty joint codes may be used and when they would be considered medically necessary. The policy states that the codes L2395 and L2385 may only be covered when the patient weighs more than 300 pounds.

Can I bill Medicare for a concentric-style torsion joint provided with a custom or prefabricated orthosis?

Yes, but how you code for it and bill for it will depend on the function of the joint. If the concentric adjustable torsion joint is used solely to provide an assistive function for joint motion, you may use the L2999 for lower-extremity orthoses and L3999 for upper-extremity orthoses. As a reminder, any claim for an L2999 or L3999 must include either a narrative description of the item or the manufacturer name and model name/number. If the concentric-style torsion joint is used for any other purposes and is incorporated into the item you are providing, it is no longer considered an orthosis and is considered to be a durable medical equipment item. It must be coded and billed for using one of the following codes:

• E1800—Dynamic adjustable elbow extension/flexion device • E1802—Dynamic adjustable forearm pronation/supination device • E1805—Dynamic adjustable wrist extension/flexion device • E1810—Dynamic adjustable knee extension/flexion device • E1815—Dynamic adjustable ankle extension/flexion device.

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

Save the Date

OCTOBER 7-10, 2015 Mark your calendars for an ideal combination of top-notch education, exhibits, and entertainment at the 98th AOPA National Assembly in San Antonio, Texas. We look forward to seeing you in 2015!

For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.

Mobility + Stability = 3R62 New K2 Knee

The 3R62 Pheon packs a lot into a small package for your K2 patients. The stability of a polycentric design with added safety features like an optional manual lock and extension assist means it gives your patients the security they need. As patients progress, they’ll appreciate the smooth extension stop and up to 10⁰ of stance flexion the knee provides. You’ll appreciate that this little knee packs so much function into such a small package. To find out more, ask your sales representative or call us at 800 328 4058.