February 2016 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

F E B R UARY 2016

E! QU IZ M EARN

Medicare Prior Authorization Update

2

BUSINESS CE

CREDITS P.18

P.16

Takeaways From the O&P Leadership Conference P.34

Tapping Data for Business Management P.38

Secure DIGITAL AGE SAFE AND

IN THE

WWW.AOPANET.ORG

BIG BUSINESSES AREN’T THE ONLY ONES THAT NEED TO PROTECT THEIR DATA P.24

This Just In: Top 10 Health-Care Predictions for 2020 P.20

YOUR CONNECTION TO

EVERYTHING O&P

NEW!

AOPA 2016

POLICY

FORUM

You can make a difference!

AOPA O&P Legislation Writing Congress and Policy Forum

APRIL 26-27, 2016

Join us for a new Policy Forum experience!

Former Senator Bob Kerrey will preside over a special session to write a simple one-to-two page piece of legislation to take to the Hill to educate your lawmakers. This is your opportunity to make your voice heard and participate in a landmark event.

Why should you attend?

Educate lawmakers on the issues that are important to YOU: • Participate in the 2016 O&P Legislation Writing Congress • Ensure O&P has fair representation in any O&P LCDs • Make sure Prior Authorization is administered fairly • Help curb RAC audit practices that harm honest providers and don’t prevent fraud • Prevent the expansion of off-the-shelf orthoses and competitive bidding

The 2016 AOPA O&P Legislation Writing Congress and Policy Forum will be held April 26-27 in Washington, DC. Visit bit.ly/aopapolicyforum for more information. Your appointments with your legislators will be arranged by AOPA staff and lobbying team.

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

Support your profession!

Make your plans now to attend the 2016 AOPA O&P Legislation Writing Congress and Policy Forum.

American Orthotic & Prosthetic Association

www.AOPAnet.org

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contents

FE B R UARY 2016 | VOL. 64, NO. 2

FEATURES

DEPARTMENTS | COLUMNS Views From AOPA Leadership......... 4

COVER STORY

AOPA Treasurer Jeff Collins, CPA, on the value of AOPA membership

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

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

At-a-glance statistics and data

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

24 | Safe and Secure in the Digital Age Today’s O&P facilities are leveraging advanced digital business technologies for record keeping, communications, and marketing, but use of these technologies requires adherence to security guidelines to protect patient privacy and prevent breaches. Experienced O&P professionals share tips for maintaining compliance when using EMR systems, texting, emailing, posting on social media, and more.

By Christine Umbrell

20 | This Just In

Research, updates, and industry news

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

Transitions in the profession

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

Medicare Prior Authorization

Questions and answers on the final rule published December 30

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

CREDITS

P. 20

Evaluating the Top 10 Health-Care Predictions for 2020 When senior O&P executives were asked to evaluate predictions on the future health-care climate, they shared their thoughts concerning the potential impact of those predictions and how prepared their businesses are for the changes to come. Find out what O&P professionals think about the influence of precision medicine, information technology, P. 34 consumerism, the regulatory environment, and much more.

34 | Leadership Learning The 2016 AOPA Leadership Conference brought together the best minds in the profession. We talked to several participants about the big ideas that resonated the most and how they are rethinking O&P business management and advocacy.

38 | Leveraging Data for O&P

Business Management

In the first of a three-part series on the financial aspects of running an O&P facility, the O&P Almanac delves into the topic of data. Learn how to find relevant data and put it to use in managing successful O&P facilities.

By Mark Ford

Member Spotlight................................ 40 n n

M-Power Prosthetics & Orthotics PROTEOR

AOPA News............................................... 44

AOPA meetings, announcements, member benefits, and more

Welcome New Members ..................46

P. 38

Marketplace............................................. 48

Careers......................................................... 52

Professional opportunities

Ad Index....................................................... 53

Calendar...................................................... 54

Upcoming meetings and events

Ask AOPA................................................... 56 Orthopedic shoes, diabetic inserts, and more

O&P ALMANAC | FEBRUARY 2016

3

VIEWS FROM AOPA LEADERSHIP

The ROI of Membership

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

By JEFF COLLINS, CPA

A

S WITH ANY PROFESSIONAL association, AOPA provides basic member benefits, including valuable publications—such as this monthly O&P Almanac magazine—and member discounts to attend conferences, webinars, and coding and billing seminars. Did you know that in 2015, AOPA hosted four coding and billing seminars across the United States, led 12 reimbursement webinars plus a special advocacy webinar, and held the annual National Assembly, drawing together more than 2,200 participants? Access to these staff development opportunities is a significant membership benefit. Further, AOPA’s relationship with Cailor Fleming Insurance allows members to take advantage of group rates on insurance programs designed for O&P professionals. These fundamental benefits serve as measurable contributors to return on investment (ROI) from your membership dues each year.

In terms of reimbursement support, AOPA maintains a coding and reimbursement committee that regularly reviews products and makes recommendations regarding the applicable reimbursement codes. The committee also provides information regarding trends in reimbursement. The coding and billing experts answer all kinds of questions related to coding, reimbursement, and compliance, and offer unlimited support to members. They also assist with compliance related to the Health Insurance Portability and Accountability Act as well as navigating the audit and appeals process.

Operationally, AOPA provides many tools to support running your practice, including the recently debuted ICD-10 conversion tool, LCodeSearch.com, discounts with UPS, the annual Operating Performance Report, and the Business Optimization Analysis Tool.

In terms of legislative and regulatory monitoring, AOPA provides a first line of defense on all matters that may impact our profession. AOPA has the resources in place to ensure we are aware of any proposed changes, to sound the alarms when changes come, and to provide leadership in rallying the profession to provide appropriate input and guidance to make our voices heard. As CMS accelerates its efforts to stem health-care spending, it is essential to have a watchdog on potential changes that will impact O&P. Recent examples of AOPA leadership in this area are numerous, including the CMS Recovery Audit Contractor program and related changes and interpretation of documentation standards—AOPA was there to challenge CMS and its contractors. What’s more, when the proposed changes to the Local Coverage Determination for lower-limb prosthetics were announced, AOPA spearheaded industrywide opposition. And AOPA was instrumental in communicating the changes regarding the new prepayment review requirements, including potential downfalls, and gathered and provided comments back to the agency to ensure that O&P’s concerns were considered as this new rule came about.

And AOPA isn’t just playing defense. Take, for example, the new Medical Advisory Board, the Prosthetics 2020 initiative, the AOPA Leadership Summit, the initial stages of a prosthetic registry, significant investments made with Dobson-Davanzo to establish cost efficacy of O&P interventions, and grant funding for research studies and literature reviews. Operating in a health-care system under pressure, AOPA is on the offense working to ensure that the essential work that our profession provides is well documented, is supported by research, and stands up to scrutiny.

I hope you’ll consider these thoughts, and I welcome you to learn more and participate with AOPA to get a terrific ROI from your membership this year.

Jeff Collins, CPA, is president at Cascade Orthopedic Supply Inc. in Chico, California, and is treasurer of AOPA.

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FEBRUARY 2016 | O&P ALMANAC

Board of Directors OFFICERS

President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX President-Elect Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Vice President James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President Charles H. Dankmeyer Jr., CPO Arnold, MD Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Mountain Lake Terrace, WA Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Bradley N. Ruhl Ottobock, Austin, TX

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Connect with us

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-Carlson, 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

6

FEBRUARY 2016 | 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 © 2016 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

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

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers.

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

Visit bit.ly/aopamediakit for advertising options!

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NUMBERS

Insurance Coverage in the United States Insurance plans governed by state regulations are on the rise

DIRECT-PURCHASE PLANS

15 Percent

Approximately 46 million individuals are covered by direct-purchase plans.

12 Million

Of those, 26 percent have ACA/exchange plans covered by the state department of insurance or benchmark plans.

34 Million

The other 74 percent are covered by other individual plans, governed by the state department of insurance or insurance commissioner.

EMPLOYMENT-BASED PLANS Of those, roughly 37 percent are covered by employment-based plans governed by the states.

55 Percent

More than half of the U.S. population— approximately 175 million—is covered to some extent by employment-based plans.

GOVERNMENT PLANS

37 Percent

Approximately 115 million individuals are covered by government plans.

50.5 Million

62 Million

14 Million

Medicare, governed by FEDERAL GOVERNMENT, covers approximately 16 percent of the total population.

Medicaid, governed

by STATES, covers nearly 20 percent of the population.

The military, governed by FEDERAL INSTITUTIONS, covers close to 5 percent of the population.

50.3 PERCENT

175 Million

Covered by insurance plans governed by federal regulators.

49.7 PERCENT

173 Million

Covered by insurance plans governed by state regulators.

SOURCE: Collins, Jeff, “Health Insurance Coverage in the U.S., 2014,” AOPA Leadership Conference 2016.

FEBRUARY 2016 | O&P ALMANAC

MILLION

MILLION

The other 63 percent are covered by employers’ self-insured plans, governed by federal ERISA Guidelines.

“About 50 percent of Americans participate in plans governed by the state. What are you doing to protect and promote O&P benefits in your state? I would encourage you to support, join, or create a state association, and to ask for AOPA’s involvement to help in your state advocacy efforts.”

—Jeff Collins, CPA, speaking at the AOPA Leadership Conference Jan. 10, 2016

State Versus Federal Governance of Insured

8

110

65

SOURCES: Kaiser Family Foundation, “2015 Employer Health Benefits Survey”; U.S. Census Bureau, “Health Insurance Coverage in the United States, 2014” Collins, Jeff, “How State O&P Groups Can Be Effective at Both State and Federal Level,” AOPA Leadership Conference 2016.

There has been significant growth in the number of individuals covered by insurance plans that are directed by state—as opposed to federal—regulation. Between 2013 and 2014, the number of uninsured dropped by nearly 9 million individuals to 33 million. A similar increase is noted in Medicaid—and to a lesser degree Medicare—plans. Experts anticipate more uninsured people to obtain coverage in these programs with the rollout of the Affordable Care Act, pushing more of the population into plans generally governed and regulated by the states. As this trend continues, O&P professionals will need to become more involved in advocacy at the state level to ensure favorable decisions regarding documentation requirements, prior authorization rules, and reimbursement levels.

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Happenings RESEARCH ROUNDUP

FAST FACT

Millions of Americans Delay or Do Not Receive Medical Care Due to Costs Approximately 7 percent of people in the United States, or 22.3 million Americans, delayed medical care during the preceding year because of worry about the cost, based on 2014 data compiled by the Centers for Disease Control and Prevention (CDC).

Additionally, 16.5 million, or 5 percent, did not receive medical care because they could not afford it. Those individuals whose health was assessed as “fair or poor” were much more likely to delay or fail to receive care due to cost.

Percentages of Individuals Who Delayed or Did Not Receive Care, By Health Status

25%

n Total n Fair or poor n Good n Excellent or very good

15%

10%

5%

0% Delayed seeking medical care because of worry about cost

Did not receive medical care because of cost

Source: CDC

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FEBRUARY 2016 | O&P ALMANAC

Researchers at the Johns Hopkins University’s Applied Physics Laboratory (APL) have announced that a patient recently completed osseointegration surgery and is now able to attach APL’s modular prosthetic limb directly to his residual limb. This advance is a “first in the field of prosthetics,” says Michael McLoughlin, chief engineer in APL’s research and exploratory development department. The osseointegration procedure, which was performed on amputee Johnny Matheny, eliminates the need for a socket and may allow a greater range of motion and comfort.

Matheny lost his left arm in 2008 due to cancer. Several years ago, he was the first patient at the Johns Hopkins Hospital to undergo targeted muscle reinnervation (TMR), a procedure that reassigns nerves that once controlled the arm or hand. TMR makes it possible for upper-extremity amputees to better use and control advanced prostheses.

In spring 2015, Matheny elected to undergo osseointegration, a procedure during which a fixture (a threaded titanium implant) is inserted into the marrow space of the bone of the residual limb. The fixture eventually becomes part of the bone. Several weeks after the first surgery, an abutment made of titanium is attached to the fixture and brought out through soft tissues and skin. A prosthesis can be directly attached to the abutment.

Four months after the successful osseointegration procedure, Matheny was able to attach the modular prosthetic limb developed by APL directly to his body for the first time. He completed a series of exercises to determine the

Johnny Matheny tests the modular prosthetic limb attached to a new titanium implant.

limits of his control and range of motion.

Matheny demonstrated individual finger control, simultaneous finger control, two degrees of freedom at the wrist, and multiple grasps, and worked through simulated activities of daily living.

“Before, the only way I could put the prosthesis on was by this harness with suction and straps; but now, with osseointegration, the implant does away with all that,” says Matheny. “It’s all natural now. Nothing is holding me down.

Before, I had limited range; I couldn’t reach over my head and behind my back.

Now, boom, that limitation is gone.”

The achievement “moves the whole field forward, and not just a small step,” says McLoughlin. “The challenge for us next is to really figure out how to get this technology out of the laboratory and into the hands of people who need it.”

PHOTO: Johns Hopkins University’s Applied Physics Laboratory

PERCENTAGE

20%

Amputee Attaches Prosthesis Directly to Residual Limb After Osseointegration Procedure

HAPPENINGS

REGULATORY UPDATE

Orthosis Monitoring Shown To Improve Outcomes in Scoliosis Patients

PHOTO: iStock.com/antila

A new study published in the January issue of Journal of Bone and Joint Surgery found that scoliosis patients who were aware of sensors embedded in their orthoses to monitor use were more likely to wear their braces for longer periods of time and less likely to require surgery.

The research was spearheaded by Lori Karol, MD, staff orthopedist at UT Southwestern Medical Center and medical director of performance improvement and the Movement Science Lab at Texas Scottish Rite Hospital for Children.

Karol’s team embedded sensors in the braces of adolescent scoliosis patients, then divided the patients into two groups. The 93 patients in the “counseled” group were told about the existence and purpose of the monitors, and they discussed the data collected by the sensors and the time spent wearing the orthosis during follow-up visits. The 78 patients in the “noncounseled” group were not told about the purpose of the monitors and did not receive data on brace compliance.

The patients were studied during the course of a 180-day period. Curve

magnitude at the start of bracing was comparable for both groups. The patients in the counseled group, who understood the purpose of the monitors, “wore their brace, on average, an additional three hours each day,” says Karol. In addition, these patients were 11 percent less likely to require surgery due to spinal progression.

Overall, counseled patients who completed bracing averaged 13.8 hours per day of orthotic wear during the entire course of bracing, compared with 10.8 hours per day for noncounseled patients. In addition, the spinal curve did not progress more than 6 degrees between the start of bracing and brace termination in 59 percent of patients in the counseled group, and 36 percent of patients in the noncounseled group.

“Shared information between the teen, parents, orthotist, and physician resulted in improved brace compliance,” says Karol. “These findings emphasize the role that open doctor-patient communication plays in encouraging treatment effectiveness in the adolescent age group.”

Legislators Introduce Two Bills of Significance to O&P The long-awaited Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) bill has been introduced by Sen. Orrin Hatch (R-Utah), chair of the Senate Finance Committee, as S. 2368. This bill has a potential companion discussion draft; a series of additional steps is being advanced for the consideration of the Senate committee, and this discussion draft includes a number of provisions that are of particular interest to the O&P community. The AFIRM bill and discussion draft include orthotist/prosthetist notes language, the separation of O&P from durable medical equipment, and the minimal self-adjustment language in the discussion draft (but not presently in S. 2368). As to S. 2368 itself, there is clearly less there that would be a plus for the O&P community, but the provisions from the discussion draft could be beneficial.

In addition, Rep. Tom Price (R-Georgia) has introduced H.R. 4185, the Protecting Access Through Competitive Pricing Transition Act. Price, an orthopedic surgeon, is on the House Ways & Means Committee and is chair of the House Budget Committee.

In H.R. 4185, Price articulates his vision for a pricing model alternative to competitive bidding. The last two pages of the bill include language of importance to O&P with respect to clarifying the meaning of “minimal self adjustment” for off-the-shelf orthoses.

O&P ALMANAC | FEBRUARY 2016

11

HAPPENINGS

#ICYMI

HISTORICAL O&P

Archaeologists Uncover Sixth Century Prosthesis CMS Publishes 2016 Medicare Premiums and Deductibles CMS has announced the Medicare premium and deductible rates for 2016. The monthly Medicare Part B premium will begin at $104.90, which is unchanged from 2015.

The Medicare Part B deductible for 2016 has increased by $19 and will be set at $166; the Medicare Part B coinsurance remains at 20 percent of the Medicare allowed charge.

The Medicare Part A deductible for 2016 is set at $1,288, which represents a $28 increase over the 2015 amount. The daily co-insurance amount for days 61-90 is $322, and the lifetime reserve day’s rate is set at $644. In addition, the skilled nursing facility Part A extended care days (days 21-100) will be $161 for 2016.

FEBRUARY 2016 | O&P ALMANAC

tibia and fibula of the individual may have derived from a leather pouch or wooden construction used to strap the prosthesis to the remaining leg.”

Researchers analyzed the bony evidence and X-rayed the remains. The left foot and the ends of the left tibia and fibula were missing entirely, offering evidence of amputation. There were small circular holes that indicated an infection of the remaining lower leg bones, according to the researchers.

Binder and her team noted that the man’s amputation differs from other medical amputations of that time, since those were usually done at the joint and not mid-bone. They believe it is more likely this amputation was the result of either accidental or violent trauma, and have hypothesized that he may have been a high-status cavalryman, injured in a skirmish.

It is significant that “this man kept his elite status and importance within the community” postamputation, and his disability did not make him a social outcast, say the researchers. A full analysis of the skeleton will be published in the March 2016 issue of the International Journal of Paleopathology.

PHOTO: Courtesy of Austrian Archaeological Institute

12

Archaeologists excavating a cemetery in Hemmaberg, Austria, have uncovered the remains of a middle-aged man with a unique foot prosthesis.

Researchers are investigating whether the man’s left foot had been amputated for medical reasons, in an accident, or as punishment for a crime.

The grave where the remains were found was situated near the Church of St. Hemma and Dorothea. The amputee had been buried with a short sword and ornate brooch and was determined to have died during the mid to late sixth century. Archaeologists believe he may have ridden horseback because there was evidence of overused muscles in his hips and spine, and he was found to have suffered from osteoarthritis.

The excavation revealed a skeleton with an iron band near where the man’s foot would have been. “Remnants of wood, together with the position of the iron ring in the grave, suggest that the prosthesis may have consisted of a wooden peg reinforced with an iron band on the bottom,” says bioarchaeologist Michaela Binder of the Austrian Archaeological Institute. “The dark staining covering the remaining left

HAPPENINGS

CODING CORNER

Jurisdiction B Releases Prepayment Review Results for Spinal Orthoses National Government Services, the Jurisdiction B durable medical equipment Medicare administrative contractor (DME MAC), has released results of its ongoing widespread prepayment review for spinal orthoses.

Between July 1, 2015, and Sept.

30, 2015, a total of 289 claims were reviewed. Sixty claims were allowed and 229 claims were denied, resulting in a claim error rate of 79.24 percent.

The majority of the claim denials were denied due to a lack of medical necessity documentation or missing proof of delivery documentation.

Many of the proof of delivery denials were due to complete lack of proof of delivery, as opposed to an incomplete or noncompliant proof of delivery.

While the overall claim denial rate of 79.24 percent represents a significant reduction from previous quarters, where denial rates were as high as 97 percent, the denial rate is still too high to consider reducing or eliminating prepayment audits for spinal orthoses.

AOPA reminds members of the importance of obtaining and maintaining Medicare-compliant documentation to support Medicare claims.

Jurisdiction A Publishes Prepayment Audit Results NHIC Corp., the Jurisdiction A DME MAC contractor, has published results of two widespread prepayment reviews involving claims for L4360 (custom-fitted pneumatic walking boot) and L1940 (custom-fabricated plastic ankle-foot orthosis).

The prepayment review for L4360 involved 156 claims, with an overall claim denial rate of 96.7 percent. The overwhelming reason for claim denial (97 percent) was lack of documentation supporting the medical need for a customfitted device instead of an off-the-shelf device. In addition, for 39 percent of the claims, no response to the additional documentation request (ADR) was received, resulting in an automatic denial.

While Medicare claims data shows that the majority of devices described by L4360 were provided by podiatrists (30.9 percent) and orthopedic surgeons (25.9 percent), O&P professionals provided approximately 20 percent of the devices described by this code in 2013. The extremely high denial rate should serve as a reminder to ensure that all documentation, including the referring physician’s

documentation, not only supports the general medical need for a walking boot, but also supports the need to customize the walking boot to meet the individual clinical needs of the patient.

The prepayment review for L1940 included 114 claims, with an overall claim denial rate of 78.5 percent. While this claim denial rate is not as high as the claim denial rate for L4360, three of every four claims were denied. Significant factors contributing to the claim denial rate were a lack of clinical documentation (23 percent), no detailed written order (13 percent), and missing proof of delivery documentation (18 percent).

While AOPA members do not have any direct control over the clinical records of referral sources, they do have the ability to control both detailed written orders and proof of delivery documentation. Making sure that these two vital pieces of documentation are complete and compliant could reduce the claim denial rate by as much as 30 percent. AOPA will continue to monitor prepayment review results for both of these codes going forward.

PDAC Announces Coding Verification Review for Ankle Gauntlets The Pricing Data Analysis and Coding (PDAC) contractor has announced that due to a change in the 2016 descriptor verbiage for L1902 and L1904, it will initiate a new coding verification for any ankle gauntlet style devices that contain joints that are currently listed on the PDAC site under L2999.

PDAC coding verification for products described by L1902 and L1904 is not mandatory under current Medicare policy guidelines.

The coding verification review applies only to products that have been voluntarily submitted to the PDAC for coding verification in the past, and applies only to ankle gauntlet style devices that contain joints and were previously verified as L2999 through the PDAC coding verification process. Ankle gauntlet style devices that do not contain joints and have been voluntarily submitted and verified by PDAC as coded as L1902 or L1904 in the past should not be affected.

O&P ALMANAC | FEBRUARY 2016

13

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

The Amputee Coalition has announced its 2016 officers and board of directors: • Chairman of the board: Jack Richmond, CPOA, director of sales for Fillauer, of Cleveland, Tennessee • Chair-elect: Michael Estrada of Statesville, North Carolina • Vice chair: John “Mo” Kenney of Lexington, Kentucky • Treasurer: Dennis Fields of Vienna, Virginia • Secretary: David Sanders of Washington, D.C. • Immediate past chair: Dan Berschinski of Stanford, California Continuing on the Amputee Coalition board are Brandon Dale of Paradise Valley, Arizona; Leslie Pitt Schneider of Phoenix, Arizona; Dennis Strickland of Atlanta; Ron Drach of Potomac, Maryland; and the Amputee Coalition’s medical director, Terrence Sheehan, MD, of Rockville, Maryland.

The Board of Certification/Accreditation has announced the results of its 2016 elections. L. Bradley “Brad” Watson, BOCO, BOCP, LPO, was elected chair. Watson is an owner/practitioner at Clarksville Limb & Brace and Rehab Inc. in Clarksville, Tennessee. Joining Watson on the board’s Executive Committee are the following: • Vice Chair: Rod Borkowski, CDME, general manager of health essentials DME, Costa Mesa, California • Secretary: Wayne R. Rosen, BOCP, BOCO, FAAOP, former owner of W.R. Rosen Inc., Fort Lauderdale, Florida • Treasurer: Shane Ryley, BOCP, BOCO, area clinic manager at Hanger Orthopedic Group, Torrance, California • Re-elected as Member-at-Large: William J. Powers, MBA, LFACHE, retired chief operating officer of the American Nurses Association and Colonel, Retired, U.S. Air Force, Medical Service Corp., Midlothian, Virginia • Immediate Past Chair: James L. Hewlett, BOCO, who has owned, operated, and served as a consultant for both DME and O&P facilities, Redding, California.

James Button has been appointed chief executive officer of Allard USA. He assumed responsibilities in January as successor to Carol Hiemstra-Paez, who is continuing with the company as a corporate advisor. Since 2013 Button has served on the board of Allard USA’s Dralla Foundation, which supports programs for children and adults with physical challenges. During his time on the board, the foundation has awarded grants to dozens of such programs throughout the United States.

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FEBRUARY 2016 | O&P ALMANAC

IN MEMORIAM Jerome Voisin, who owned a successful prosthetic practice in Houma, Louisiana, for more than 30 years, passed away in December at age 62. An amputee himself, Voisin became a prosthetist out of his desire to help others renew their ability. Voisin had several inventions, innovations, and patents to his credit. He is survived by his wife Bobbie Harlow Voisin, and two sons.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Ability Prosthetics & Orthotics, Penn State Hershey’s physical medicine and rehabilitation department, and Penn State Rehabilitation Hospital sponsored an adaptive ski day with Two Top Mountain Adaptive Sports Foundation on January 22. Patients and their families from Ability’s locations and from Penn State Hershey attended the event at Whitetail Ski Resort in Mercersburg, Pennsylvania.

Birmingham Limb & Brace has been selected for the 2015 Best of Birmingham Award in the Prosthetic Appliances category by the Birmingham Award Program. Each year, the Birmingham Award Program identifies companies that have achieved exceptional marketing success in their local community and business category.

The Hanger Charitable Foundation is supporting the Sepsis Alliance in its production of a series of public service announcements (PSAs) called KNOW SEPSIS. According to Sepsis Alliance, more than 250,000 American die every year from sepsis, and a significant number of individuals undergo amputations as a result of the condition. The KNOW SEPSIS PSA series aims to ensure those who are infected with sepsis seek help earlier to ensure more effective treatments.

“The Hanger Charitable Foundation is dedicated to the well-being of those with physical challenges in the communities that we serve,” says Vinit Asar, president and CEO of Hanger Inc. and chair of the Hanger Charitable Foundation. “Sepsis is a stealth disease that adversely impacts the physical abilities of many people.

We are proud to help support Sepsis Alliance.”

Visit http://sepsis.org/resources/psa to view the videos.

PEOPLE & PLACES

Dienen Inc., the parent company to Midwest Orthotic Services and Surestep in South Bend, Indiana, recently transitioned to a 100 percent employee stock ownership plan (ESOP) for its 170 employees. Owners Bernie Veldman, CO, and his wife Pam announced in January that employees of Midwest Orthotic Services and Surestep have been made participants in a qualified retirement benefit that holds company stock. The dayto-day operations and individual jobs do not change, but employees have become part owners, and their future financial benefits are tied to the company’s success. Bernie Veldman remains president, and Pam Veldman will continue to serve as vice president, under the new arrangement.

LIM Innovations has released a video showcasing customers using their socket to celebrate a milestone: 200 people are now using the company’s socket with their prostheses. The video can be seen at www.liminnovations.com.

The Ohio State Department of Health and the Healthy Ohio Business Council recently honored WillowWood with a Healthy Ohio Healthy Worksite Award. WillowWood was recognized at the bronze level during a luncheon at the Health Action Council’s 2016 Annual Conference in January. The award recognizes employers that demonstrate a commitment to employee health through comprehensive worksite health promotion and wellness programs. WillowWood offers numerous health and wellness programs for its staff, including an employee health fair, tobacco cessation program, walking challenges, community gardening, weight loss, and fitness training.

The O&P Almanac has been honored with a Bronze Award in the Association TRENDS’ 2015 All Media Contest for the monthly trade association publication category. The All Media Contest is an annual competition held exclusively for associations, recognizing the most creative and effective communication vehicles of the previous year.

The 2015 competition included 400 entries in 22 categories of association communications. Winners will be honored at the 37th Annual Salute to Association Excellence, to be held March 4, 2016, at the Capital Hilton in Washington, D.C.

Get Ahead of the Curve ONLINE! CHARLESTON BENDING BRACE CERTIFICATION COURSE Upon completion of this 3 hour online course, participants will receive CBB Certification and have ability to order the Charleston Bending Brace.

Course Includes: Background information on scoliosis.

Review of the types of scoliotic curves.

Indications and contradictions for each type of curve.

Unlike most braces used to treat scoliosis, the Charleston Bending Brace offers a major revolutionary approach. Patients wear this nocturnal (nighttime) orthosis only eight to ten hours at night; they therefore may participate in normal daytime activities, including sports.

C. Ralph Hooper, Jr., CPO will be hosting the course.

Registration fee is $350 Course Dates are March 11th, April 8th, May 27th, and June 24th.

The number of participants is limited so please register early at CBB.org.

For more information please contact Natasha Hardina at 843-577-9577 or email her at nhardina@carolinaop.com

O&P ALMANAC | FEBRUARY 2016

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REIMBURSEMENT PAGE

By JOE MCTERNAN

Medicare Prior Authorization

E! QU IZ M EARN

CREDITS

The final rule published December 30 offers some helpful information but leaves many questions unanswered 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 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

Medicare Fee EXECUTIVE

-For-Service

er Payments

2013 Improp

Report

SUMMARY

Rate ntage of Compliance e rate – the perce s submitted claim (FFS) complianc fee-for-service nt. This calculation included Medicare paid 1 s that 2013 Medicare perce The estimated paid correctly – was 89.9 2012. This mean rs through June dolla 2011 icare July Med onth period from this time. during the 12-m .4 billion correctly during $321 an estimated dollars ent Rate e of Medicare Improper Paym – the percentag ated $36.0 billion 10.1 Percent payment rate oper impr paid an estim ent FFS 2013 Medicare nt. This means that Medicare adjusted the improper paym of The estimated CMS the effect y - was 10.1 perce June 2012. For 2013, to account for nt and paid incorrectl perce 2011 for 10.1 een July odology percent to A. The meth incorrectly betw ($2.2 billion) from 10.7 nt r Medicare Part . rate by 0.6 perce hospital claims denied unde was unchanged from 2012 rate ient oper payment rebilling inpat 2013 FFS impr calculating the r Payments (accounting for ses of Imprope report period or Common Cau during the 2013 ort the services oper payments of documentation to supp impr of e caus on was lack The most comm oper payments) impr total of atient, 56.8 percent icare. h, hospital outp Med to healt e d hom bille supplies hetics ent rate were improper paym ble medical equipment prost driving the 2013 , dura The service types ity, physician/lab/ambulance hospital services. facil S),and inpatient skilled nursing EPO (DM supplies rt orthotics and Payments Repo S) ice Improper an Services (HH Fee-For-Serv Health and Hum (IPIA) of 2002, The Medicare Department of mation in the Information Act of 2010 requires lements infor oper Payments Act (IPERA) This report supp Report (AFR). The Impr very Reco on and ents Eliminati Agency Financial Paym oper Impr amended by the

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nson Daniel R. Levi eral Inspector Gen August 2011 170 OEI-02-10-00

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FEBRUARY 2016 | O&P ALMANAC

O

N DEC. 30, 2015, CMS published the final rule that set the parameters for implementation of Medicare prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items, including most lower-limb prosthetic Health-Care Common Procedure Coding System (HCPCS) codes. The final rule was published in the Dec. 30, 2015, issue of the Federal Register.

While the final rule provided some information regarding the eventual implementation of Medicare prior authorization, it left many questions unanswered. This month’s Reimbursement Page provides an overview of the aspects of prior authorization that were established by the final rule, as well as an explanation of the aspects that remain ambiguous or unanswered.

What the Final Rule Tells Us

The prior authorization final rule established the final list of HCPCS codes that are eligible for inclusion in prior authorization. This list consists of 135 HCPCS codes, 84 of which represent HCPCS codes that describe lower-limb prostheses.

To be considered eligible for inclusion in Medicare prior authorization, HCPCS codes must be included in the DMEPOS fee schedule, have an average purchase price of $1,000 or more or an average monthly rental rate of $100 or more, and meet one of the following qualifying criteria: • The item is identified in a report from the U.S. Government Accountability Office or the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) that

2

BUSINESS CE

P.18

is national in scope and published in 2007 or later as having a high rate of fraud or unnecessary utilization; or • The item is listed in the 2011 or later version of the Comprehensive Error Rate Testing (CERT) program’s annual Medicare Fee-for-Service Improper Payment Rate Report in the appendix on “Service-Specific Overpayment Rates: DME.” The 84 lower-limb prosthesis HCPCS codes included in the list in the final rule all meet the $1,000 average purchase price threshold and were included in the OIG report published in August of 2011 titled Questionable Billing by Suppliers of Lower-Limb Prostheses. The final rule did remove five prosthetic codes that were included in the proposed rule that did not meet the minimum average purchase price threshold of $1,000.

These codes included two prosthetic cover codes (L5705 and L5706), two exoskeletal knee/shin system codes (L5718 and L5722), and one endoskeletal knee/shin system code (L5816).

The prior authorization final rule also announced that while there are currently 135 HCPCS codes that are eligible for inclusion in prior authorization, CMS will not include all of these codes in the initial implementation of any prior authorization program. CMS will publish a subset of the 135 HCPCS codes that will be subject to prior authorization initially; CMS referred to this list as the “requires prior authorization” list. The final rule announced that following any announcement on the “requires prior authorization” list, there will be a 60-day notice period prior to implementation.

In the prior authorization final rule,

REIMBURSEMENT PAGE

The final rule does state that the response limits will only be lowered and will not increase beyond the 10-day/20-day timeframe in the proposed rule.

IMAGE: iStock.com/Diane Labombarbe

CMS acknowledged that the 10-day response limit for initial prior authorization requests and 20-day response limit for resubmitted prior authorization requests may create beneficiary access-to-care issues. For this reason, CMS elected to not finalize the response limits in the proposed rule and will issue further guidance through subregulatory channels that will potentially lower the response time for specific items. The final rule does state that the response limits will only be lowered and will not increase beyond the 10-day/20-day timeframe in the proposed rule.

In addition, the final rule announced that implementation of the Medicare prior authorization program may occur on a local or regional level instead of nationally. The final rule established CMS’s authority to implement prior authorization on a local or regional level; however, there was no indication in the final rule that CMS would be exercising this authority.

While the final rule confirms that claims that receive a preliminary affirmation decision are afforded some protection from future audits, it still allows for claim denial based on technical issues such as invalid proof of delivery, or through CERT audits, Zone Program Integrity Contractor (ZPIC) audits, or other audits where fraud and/or abuse is a concern, so there is no absolute assurance that a claim that received provisional affirmation for medical necessity

will not subsequently be subject to a postpayment Recovery Audit Contractor (RAC), CERT, or ZPIC audit examining the same issue of medical necessity.

What the Final Rule Does Not Tell Us

While the prior authorization final rule answered many general questions regarding how Medicare prior authorization will work, many questions remain unanswered and will be clarified at a later date.

First, the prior authorization final rule indicated that implementation of the prior authorization program will be implemented 60 days after the Federal Register publication date of Dec. 30, 2015. What the final rule did not clarify were the dates of publication and implementation for the “requires prior authorization” list.

While the prior authorization program will be officially implemented on or around March 1, 2016, until the first phase of “required” codes is published and the 60-day notice period is triggered, there is no firm effective date when claims must be submitted for prior authorization as a condition of Medicare payment.

Second, while it is encouraging that CMS has acknowledged that for certain services, the time periods of 10 days for an initial prior authorization decision and 20 days for a resubmission decision are too long and may result in patient access-to-care issues, the final rule did not establish alternate timeframes.

Instead, the final rule indicated that the timeframes would be addressed through subregulatory guidance.

Unfortunately, no timeframe for when this guidance would be issued was provided, and there was no discussion regarding the ability for the public to provide any input on the appropriateness of the response timeframes.

Finally, the prior authorization final rule did not provide any significant clarification as to what protection an affirmative prior authorization decision provides on the eventual payment of a claim or the exposure of that claim to future audit. While the final rule does state that a positive prior authorization affirmation will provide some assurance of eventual payment, the claim may still be denied for technical reasons. In addition, the final rule indicated that while a positive prior authorization affirmation will provide some protection from further audit activity, exposure of a prior authorized claim to CERT audits and fraud and abuse based audits does not change as a direct result of a positive prior authorization affirmation.

What Happens Next?

The next several months will hopefully provide more details regarding when and how Medicare prior authorization will be implemented. The most probable action that will occur next will be the publication of the initial list of HCPCS codes that will require prior authorization as part of the first phase of implementation. As discussed in the final rule, CMS will provide a 60-day notice period between the publication of this list and implementation of the prior authorization process as a condition of claim payment for those codes.

AOPA is troubled by, and will raise two key points with CMS relating to, implementation: 1) 2010-2014 Medicare data shows a remarkable reduction in the frequency and Medicare payments as to many of the 84 prosthetic codes, particularly sharp reductions in frequency, in the range of 20 to 35 percent in advanced technology prosthetic codes—where data shows such dramatic recent reductions, these codes clearly are not evidencing either excessive or O&P ALMANAC | FEBRUARY 2016

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REIMBURSEMENT PAGE

understand the prior authorization process and develop strategies that best meet the needs of the individual O&P practice. Finally, AOPA will facilitate a separate session during the 2016 AOPA Policy Forum that will discuss the details of the prior authorization process, its impact on your business, and how you can best prepare for its implementation.

Learn more about AOPA’s educational efforts at bit.ly/priorauthorization.

unnecessary utilization, and so do not quality for, and should not be subject to, prior authorization; and 2) the list(s) CMS intends to publish of items requiring prior authorization should be announced in a manner permitting stakeholder input via a notice and comment process.

AOPA will immediately notify its members of any new developments regarding further implementation of Medicare prior authorization. In addition, AOPA will be offering a free webinar,

held on two separate dates in February, where AOPA members can learn more about the final rule and its potential impact on the provision of prosthetic services. As more details emerge regarding the actual implementation of prior authorization, AOPA will be offering additional webinars, for a nominal fee, that will help attendees prepare for implementation of prior authorization.

AOPA also will develop a reference guide that will help O&P professionals

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

EXTRAORDINARILY SIGNIFICANT FINDINGS: Medicare data proves the economic value of an O&P intervention.

O&P CARE is COST EFFECTIVE The Study that Started MobilitySaves.org

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Reasons to visit MobilitySaves.org

Learn about the study proving orthotic and prosthetic care saves money

1.

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

A major study, commissioned by the Amputee Coalition with support from the American Orthotic & Prosthetic Association, shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. Mobility Saves Lives And Money!

See healthy lives affected

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Follow us on social media!

FEBRUARY 2016 | O&P ALMANAC

3.

Visit MobilitySaves.org.

“Search Mobility Saves” on Facebook, Twitter, and LinkedIn

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Find resources to share with your patients

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

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This Just In

Evaluating the Top 10 Health-Care Predictions for 2020 O&P leaders share their perspective on the predictions from health-care expert Michael Lovdal, PhD, during AOPA’s Leadership Conference

Leadership Conference O&P

A N E XC L U S I V E , BY I N V I TAT I O N O N LY E V E N T

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HEN THE TOP THOUGHT

leaders in O&P gathered in Palm Beach, Florida, in January during AOPA’s Leadership Conference, there was an unprecedented level of information sharing and brainstorming. (Read more about the attendees’ takeaways, on page 34.) However, everyone likes predictions, so in this month’s This Just In, we are sharing a special component of the presentation given by Michael Lovdal, PhD, a health-care expert and emeritus partner at Oliver Wyman.

During his presentation, Lovdal took the room’s temperature to determine how people feel regarding his “10 Predictions About U.S. Health Care in 2020.” Here, we share Lovdal’s predictions on what the health-care climate will look like, as well as attendees’ responses. For each prediction, attendees were asked three questions: • What impact will this prediction have on your organization?

• How prepared is your organization

to deal with the changes that come with this prediction?

• How high of a priority should AOPA place on this prediction?

The responses given by attendees may help you rethink your five-year business plan.

Prediction 1: The structure of health care will radically change.

Almost nine in 10 attendees—89 percent—said this prediction concerning the structure of health care would have a high impact on their O&P company.

Twenty percent feel somewhat or well prepared to deal with the changes that come about from structural changes, 37 percent said they are somewhat prepared, and 43 percent acknowledged being poorly prepared. When asked to rank how high a priority AOPA should place on this possible structural shift, 81 percent of attendees said it should be a high priority, 10 percent a medium priority, and 9 percent a low priority.

R

This Just In

U.S. HEALTH CARE 2020—

Mike Lovdal’s 10 Predictions

10

2020

9

Health-care pricing will become transparent

4

$2 trillion will migrate to value-based health care

8

Consumer-centric business models will be essential to survival

3

Newly sculpted provider networks will emerge as winners

7

6

Thirty-nine percent said a shift to precision medicine would have a high impact on O&P businesses, while 34 percent feel it would have a moderate impact, and 27 percent are in the low-impact camp. Seventeen percent feel well prepared to deal with precision medicine becoming more commonplace, 43 percent feel somewhat prepared, and 40 percent feel poorly prepared. When asked about how high AOPA should place this prediction on its list of priorities, 36 percent believe it should be a high priority, 32 percent a medium priority, and 32 percent a low priority.

PREDICTION 3: Health care will become an information technology business.

Three quarters of attendees said this prediction would have a fairly high impact on their business, with another FEBRUARY 2016 | O&P ALMANAC

Health care will become an information technology business

2

Public health and health care will increasingly merge

PREDICTION 2: Precision medicine will become commonplace.

22

5

State and local initiatives will trump federal impact

200 million Americans will become healthcare consumers

20 percent believing it would have a moderate impact and 5 percent sensing a low impact. In terms of readiness for such a shift, only 14 percent feel well prepared, 56 percent feel somewhat prepared, and 30 percent What impact will this prediction have on your organization: Health care will become an information technology business.

Low impact Moderate impact

5%

20%

75% High impact

Precision medicine will become commonplace

1

The structure of the health-care industry will radically change

poorly prepared. Seventy-one percent feel this prediction should be a high priority for AOPA, with 15 percent giving it a medium priority and 14 percent, low priority.

PREDICTION 4: Consumercentric business models will be essential to survival.

Nearly two thirds of attendees—65 percent—said this prediction would have a somewhat to high impact on their business. Another 27 percent said it would have a moderate impact, and 8 percent a low impact. Forty-four percent of attendees feel somewhat or well prepared to deal with this healthcare phenomenon, 34 percent somewhat prepared, and 22 percent poorly to somewhat prepared. Nearly half of attendees feel this business model should be a high priority for AOPA, with 39 percent ranking it as a medium priority, and the rest ranking it a low to medium priority.

This Just In

PREDICTION 5: Health-care pricing will become transparent.

Sixty-three percent of attendees reported that health-care pricing transparency would have a high impact, with 35 percent ranking it a low to moderate impact and just 2 percent citing low impact. Nearly one third—32 percent—feel somewhat or well prepared to deal with transparency, with 38 percent feeling somewhat prepared and 30 percent feeling poorly to somewhat prepared. Fifty-four percent believe preparing for transparency should be a high priority for AOPA, with 32 percent labelling it a medium priority and 14 percent a low priority.

PREDICTION 6: Two hundred million Americans will become health-care consumers.

Attendees were in agreement that the impending high number of health-care consumers would have an impact on the O&P profession: 85 percent of the respondents rated this as high impact and 15 percent as moderate impact.

No one ranked it low impact. As for readiness for the additional patients, 36 percent feel somewhat to well prepared, 43 percent feel somewhat prepared, and 21 percent feel poorly to somewhat prepared. Fifty-six percent said this should be a high priority for AOPA, 29 percent a medium priority, and the remaining 15 percent a low to medium priority.

PREDICTION 7: Public health and health care will increasingly merge.

While 39 percent believe the public health/health-care merger prediction will have a high impact, another 39 percent view it as moderate impact, and 22 percent view it as low to moderate impact. Attendees do not feel overwhelming prepared for such a shift: Only 16 percent said they are somewhat to well prepared, 36 percent are somewhat prepared, and the remaining 48 percent are poorly to somewhat prepared. Nearly half (47 percent) said AOPA should treat this as a high priority, with 38 percent labelling it a medium priority and the remaining 18 percent a low to medium priority.

PREDICTION 8: Newly sculpted provider networks will emerge as winners.

The prediction concerning new provider networks was rated as having a high impact on O&P businesses, according to 69 percent of attendees; 25 percent feel it will have a moderate impact, and 6 percent a low impact. Few feel well prepared for such a transition: Only 13 percent are somewhat or well prepared, 43 percent somewhat prepared, and 44 percent poorly to somewhat prepared.

More than half (56 percent) feel AOPA should address it as a high priority; another 31 believe it should be a medium priority, and 14 percent a low priority.

PREDICTION 9: $2 trillion will migrate to value-based health care.

More than three quarters of attendees (78 percent) believe a transition to valuebased care will have a high impact.

Another 18 percent think it will have a moderate impact, and only 4 percent a moderate to low impact. Approximately 31 percent feel well prepared to respond How high of a priority should AOPA place on the prediction that $2 trillion will migrate to value-based health care?

Medium priority

2% Low to medium priority

9%

89% High priority

to this migration; 27 percent feel somewhat prepared, and the remaining 42 percent are poorly to somewhat prepared. Nine out of 10 attendees (89 percent) believe this prediction should be a high priority for AOPA; just 9 percent call it a medium priority and 2 percent a low to medium priority.

PREDICTION 10: State and local initiatives will trump federal impact.

Here’s where the road gets really muddy—Lovdal’s prediction that state

How prepared are you for a change in which state and local initiatives trump federal impact?

Somewhat or well prepared Somewhat prepared

16%

46% 38% Poorly to somewhat prepared

and local initiatives will trump federal impact was a very bold statement.

Wow! If this is true, there could be 50 mini CMS authorities; 50 pricing, data analysis, and coding contractors; and 50 durable medical equipment Medicare administrative contractors.

It’s no surprise that 68 percent ranked this prediction as having a moderate to high impact, 24 percent a moderate impact, and 8 percent low to moderate impact. Only 16 percent feel somewhat or well prepared for such a change; 46 percent feel somewhat prepared, and 38 percent poorly to somewhat prepared. Two thirds of attendees (66 percent) believe this should be a medium to high priority for AOPA, 24 percent a medium priority, and 10 percent a low to medium priority.

Getting a sense of what O&P leaders think about 10 key predictions made by a veteran health-care consultant helps focus attention on where individual businesses and AOPA should consider positioning their respective roles. Clinical health-care providers, manufacturers, distributors, and AOPA should consider how these changes may alter the way business will be conducted in 2020 and beyond. The AOPA Board will look at these predictions and how they are viewed by members as building blocks for future AOPA advocacy and member services agendas.

O&P ALMANAC | FEBRUARY 2016

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COVER STORY

SAFE and

SECURE

in the Digital Age How O&P facilities are protecting patient data while leveraging new business technologies

By CHRISTINE UMBRELL

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FEBRUARY 2016 | O&P ALMANAC

COVER STORY

NEED TO KNOW • In leveraging digital business technologies, O&P professionals must implement safeguards to prevent data breaches and comply with the rules set forth by the Health Insurance Portability and Accountability Act (HIPAA).

• O&P professionals should check that their electronic medical record systems are designed to keep patient data secure and are HIPAA compliant, and should investigate whether the systems allow secure messaging with patients.

• Practitioners should consider encryption technologies and password protections for mobile devices that are used for professional purposes, and should avoid storing patient photos, videos, or signatures on smartphones.

• Facilities can take advantage of social media tools, apps, and videos to communicate patient use and care information, but must be sure that no patient data is disclosed, and that permissions have been signed for any patient photos or videos.

• Ongoing employee education on information technology and data security is key to ensuring that protected health information remains secure.

T

HE ART OF PATIENT communications has undergone an overhaul as a result of new technologies. Today’s O&P practitioners regularly use laptops, smartphones, tablets, electronic medical record (EMR) systems, and social media to complete documentation and interact with patients. Those who have kept up with the technological advancements benefit from faster and more accurate communications as well as more engaged patients with easier access to their practitioners.

Just as important as ensuring successful digital records and communications is protecting patient privacy. O&P professionals must follow the rules set forth by the Health Insurance Portability and Accountability Act (HIPAA), which require that covered entities implement reasonable safeguards to limit incidental, and avoid prohibited, uses and disclosure of protected health information (PHI).

Those orthotists and prosthetists who can leverage new digital opportunities while managing patient privacy concerns are the most likely to succeed in a technology-focused environment.

Data That’s Ripe for the Picking

Cyberthieves are constantly innovating, say experts, and news of retail breaches continually make headlines. But health-care companies— such as O&P facilities—house data that has significant resale value on the black market. Whereas credit card information stolen from retail businesses has a short shelf life, with new cards being issued on a regular basis, the PHI taken from health-care companies often contains Social Security numbers and medical data that is much more difficult to change. That makes data stolen from medical facilities attractive to criminals involved in traditional financial crimes as well as medical insurance fraud schemes.

O&P ALMANAC | FEBRUARY 2016

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COVER STORY

During 2015, there were 253 health-care breaches, according to the Department of Health and Human Services’ Office for Civil Rights (OCR).

Each of those breaches affected 500 individuals or more, with a combined loss of more than 112 million records.

The top 10 health-care data breaches accounted for more than 111 million records that were lost, stolen, or inappropriately disclosed.

Thirty-eight percent of the breaches occurred due to “unauthorized access/disclosure.” However, 90 percent of the top 10 breaches resulted from a “hacking/IT incident.” Such incidents can be extremely costly for the companies that are breached: The average loss for a breach of 1,000 records is between $52,000 and $87,000, according to Verizon’s “2015 Data Breach Investigations Report.”

Companies that fail to comply with HIPAA regulations are subject to steep fines, as set forth by the Health Information Technology for Economic and Clinical Health (HITECH) Act. “Health-care organizations need to make data security central to how they manage their information systems and to be vigilant in assessing and addressing the risks to data on a regular basis,” says Rachel Seeger, a spokesperson for OCR. “We are certainly seeing a rise in the number of individuals affected by hacking/IT incidents. These incidents have the potential to affect very large numbers of health-care consumers.”

Securing O&P Patient Data

As the potential for costly data breaches grows, O&P facilities must ensure they are protecting patient data when leveraging new technologies.

Most O&P facilities have transitioned to EMR systems for record keeping and are making use of messaging, email, and texting to interact with patients. “This increased access is a two-way street that provides a direct link to patients for improving care and sharing information,” says Chrysta Irolla, MS, MSPO, CPO, who works at the University of California, San Francisco’s (UCSF) Mission Bay Hospital.

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The ABCs of HIPAA and the HITECH Act

A

ny health-care organization that stores, processes, or transmits protected health information (PHI) is required to comply with the Health Insurance Portability and Accountability Act (HIPAA) and safeguard all protected data. HIPAA mandates standards-based implementations of security controls by all health-care organizations that create, store, or transmit electronic PHI. The HIPAA Security Rule governs protection of PHI. Organizations must certify their security programs via self-certification or by a private accreditation entity. Noncompliance can trigger various civil penalties, including fines and/or imprisonment.

The Health Information Technology for Economic and Clinical Health (HITECH) Act brings additional compliance standards to health-care organizations. It is directly related to HIPAA and was part of the American Recovery and Reinvestment Act of 2009. HITECH requires health-care organizations to apply “meaningful use” of security technology to ensure the confidentiality, integrity, and availability of protected data. The HITECH Act also prescribes stiff penalties for organizations that fail to secure EHRs. Compliance entails deployment of security controls and processes to fulfill the laws.

Penalties for noncompliance with HIPAA /HITECH can be substantial. In cases of “willful neglect,” a HITECH penalty can be at least $50,000 per violation, up to a total of $1.5 million in a calendar year. Other breach-related costs will be incurred for discovery and containment, investigation of the incident, remediation expenses, attorney and legal fees, loss of customer confidence, lost sales and revenue, and brand degradation. Compliance is a serious responsibility for all health-care organizations.

COVER STORY

HIPAA Email and Texting Guidelines

T

he Privacy and Security Rules set forth in the Health Insurance Portability and Accountability Act (HIPAA) require covered entities, such as O&P providers, and their business associates to implement safeguards when emailing or texting electronic protected health information (e-PHI) to patients or others. When it comes to communicating with nonpatients, the covered entity or business associate must generally ensure that its email or texts comply with relevant Privacy and Security Rule standards.

Below, Kim Stanger, a partner at legal firm Holland & Hart, offers an analysis of the emailing and texting rules for HIPAA compliance.

• Emails and Texts to Patients: The HIPAA Privacy Rule not only allows but requires covered entities to communicate with patients via email or text if requested by the patient.

However, covered entities must implement appropriate safeguards. To communicate e-PHI to patients, the covered entity must either secure the transmission using encryption technology or other appropriate means, or warn the patient if the network or means of communication is not secure or the e-PHI is not encrypted.

• Emails and Texts From Patients: The Security Rule does not apply to patients. A patient may send health information to a health-care provider using email or texting that is not secure.

That health information becomes protected by the HIPAA rules when a provider receives it. The health-care provider can then assume, unless stated otherwise, that email communications are acceptable to the patient, but should ensure the patient is aware of the possible risks of using unencrypted email.

• Emails and Texts to Other Providers, Employees, or Third Parties: The HIPAA Privacy and Security Rules also apply to emails and texts to persons or entities other than patients. Unlike communications with patients, simply warning the third party that the communication may not be secure is not enough. Providers generally should not communicate e-PHI with their staff or other providers via unencrypted e-mail or text unless they have implemented appropriate safeguards consistent with Security Rule requirements.

Source: Stanger, Kim. “HIPAA, Emails, and Texts to Patients or Others,” Holland & Hart website, June 8, 2015.

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FEBRUARY 2016 | O&P ALMANAC

Chrysta Irolla, MS, MSPO, CPO

Many EMR systems, when used correctly, can facilitate secure interactions. OPIE and Futura, two of the most commonly used EMR systems designed for O&P businesses, are both HIPAA compliant and encrypted, says Mark Ford, president of The OPIE Choice Network. “Anyone in an office with OPIE or Futura can message from within the system to others within the system and remain HIPAA compliant, and the information becomes part of the patient record,” says Ford. But external communications must be closely monitored.

“A lot of EMR systems have patient logins that comply with HIPAA, so this is a good service if available,” says Irolla. Many EMRs “allow patients to send secure messages to practitioners through a patient login,” she says.

“For example, EPIC, which is the EMR program used by a lot of hospital systems, has MyChart as a way for patients to access their medical information online and message their practitioners.”

Mark Ford

But many practitioners must work to some extent outside of EMR systems and rely on smartphones and tablets to take pictures and videos, and collect patient signatures, all of which must be placed in patients’ records. It is illegal to store those types of files on personal devices. “If a practitioner is storing photos on his personal smartphone, without appropriate device security in place, that behavior is not compliant with HIPAA regulations,” says Ford.

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COVER STORY

Tips for Securing PHI and Payments Data

N

ot only are health-care facilities required to secure electronic protected health information (e-PHI); they also must protect data associated with payments, such as patients’ credit and debit cards. O&P Almanac recently spoke with Marc Punzirudu, senior security consultant for ControlScan, a company that offers managed security and compliance solutions for health-care and other types of companies. Below, he offers advice on how to foster compliance with both Health Insurance Portability and Accountability Act (HIPAA) and payments regulations.

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O&P ALMANAC: What is ‘PCI’ and how does it relate to HIPAA compliance?

O&P ALMANAC: What types of violations do you typically see in smaller health-care facilities?

MARC PUNZIRUDU: The Payment Card Industry Data Security Standard (PCI DSS) applies to any business that processes, transmits, or stores cardholder data (CHD). If your business accepts credit cards for payment, then you are subject to PCI. PCI and HIPAA follow a few of the same principles: 1) if you don’t need it, don’t store it; 2) if you do store it, store it securely and check on it from time to time; 3) if you need to get rid of it, destroy it; 4) protect the data you handle (CHD or e-PHI) from unauthorized parties; and 5) monitor access to the data. How a business goes about these activities, however, is not the same.

HIPAA focuses on availability and maturity of processes. PCI is prescriptive; the controls can be interpreted at times like a bullet list for CHD security. HIPAA doesn’t contain any security prescriptions; however, it ensures that processes are in place and mature enough to lessen risk.

PCI permits almost every single requirement to be “addressable,” in that it permits a compensating control.

HIPAA contains some requirements that are not addressable and must be in place.

PUNZIRUDU: I see a number of different types of violations: • Clean desk policy violations—no paper on desk, electronic workstations only, shredders, locking screens upon completion of task, ensuring that monitors face away from public areas, etc.

• Shared user authentication methods • Clear text and/or weak passwords/authentication methods • Verbal conversation in public resulting in an information disclosure • Open, guest, or other Wi-Fi service connected to the sensitive network and not used for business purposes only.

FEBRUARY 2016 | O&P ALMANAC

O&P ALMANAC: What types of technologies are available to help O&P facilities maintaining compliance?

PUNZIRUDU: Firewalls ensure the integrity and confidentiality of e-PHI environment by controlling incoming and outgoing network traffic. To do their job, though, firewalls have to be properly installed and configured as well as regularly updated and monitored. Managed firewall service providers have expertise in this area and also can monitor the security device for unauthorized activity, plus ensure that segmentation properly protects the systems as well as the data. Those who provide managed firewall services also sometimes perform data loss prevention, which will further harden the e-PHI environment.

Another important technology involves secure messaging.

Look for applications that permit secure, encrypted messaging to authorized parties for email, chat, etc. Data confidentiality and the least-privilege access control model are key to HIPAA compliance.

A number of EMR systems, including OPIE and Futura, feature applications that allow safe uploading of images into patients’ records. At UCSF, Irolla regularly uses an EPIC app called Haiku to securely upload patient images to medical records. These tools are useful to ensure patient documentation is complete in a HIPAAcompliant manner.

At Wright & Filippis, staff use an EMR that is HIPAA compliant and designed to keep all information secure, says Paul Turek, director of information services for the company.

However, practitioners are encouraged to work within the on-site EMR system for patient documentation because the system “is not entirely compatible with mobile devices at this point,” says Turek. “It is browser-specific, and it can only be accessed from within our network or at another facility where it has been approved for use.”

Paul Turek

Direct Patient Communications

Many practitioners and patients want to communicate via email and text when they have quick questions that need to be addressed. “The HIPAA omnibus rule does allow nonsecure email communication if a patient has consented.

Otherwise, there are services that can be used to encrypt emails so that they comply with HIPAA standards,” says Irolla. (See sidebar, HIPAA Email and Texting Guidelines, on page 28.)

At Wright & Filippis, mobile devices are uploaded with mobile device management (MDM) software that complies with HIPAA and personal health information regulations. The software enforces encryption, requires passwords, and allows the information systems staff to wipe devices remotely if they are lost. “As an ancillary benefit, if a clinician contacts me and tells me he

cannot locate his phone, I can turn on the GPS, and I can turn on an alarm that will sound even if the phone is on silent,” says Turek. The MDM system also automatically connects the company’s mobile devices with Wi-Fi in all 25 facilities.

In addition, smartphones at Wright & Filippis ensure email is passed through a heuristic encryption tool.

That app automatically encrypts any personal information—for example, a Social Security number—to keep the email HIPAA compliant.

To prevent misuse of personal devices, some O&P businesses are providing their employees with companyowned smartphones for professional use only, while others are purchasing software that siloes professional files from personal files on mobile devices— but such systems can be confusing and may not be entirely compliant with all government regulations, says Ford.

With any texts, emails, or digital communications that might contain personal patient information, Ford cautions that practitioners must consider the destination of the message— and whether that entity is subject to HIPAA compliance rules. “Are you sending patient information when you are sending data to a supplier or a central fabrication site?” he asks. “If I provide information about a patient so

a c-fab can make a prosthetic socket, I’ve just released patient information,” says Ford.

“Some c-fabs have set up HIPAAcompliant email systems, but others may not be compliant,” says Ford.

He notes that practitioners should consider putting business associate agreements in place, which may offer some flexibility and protection when conducting business with these types of companies.

O&P ALMANAC | FEBRUARY 2016

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COVER STORY

make sure there are no computer screens open to patient PHI in the background,” says Turek.

Security Training

Videos, Apps, and Social Media

“The greatest advantage of these new communication tools is that they make it easier for patients to access practitioners, and vice versa,” says Irolla.

But maintaining patient privacy in all communications is critical—even when sharing patient educational information.

“One barrier is maintaining HIPAA compliance while also providing access to information,” says Irolla. “This is best balanced by diversifying which tools are used for different tasks so that you can avoid situations where HIPAA is even an issue.” For example, rather than emailing care and use information to a patient, facilities can post videos to their websites. “The new instructional manual is videos,” says Irolla. “Facility websites and YouTube can be a great way to share care and use videos for specific devices or outline treatment protocols.”

A few facilities are developing apps to offer patient information. Hanger Clinic has created an O&P mobile reference app that features, among other things, searchable O&P device information, including photos and descriptions, and a “find-the-nearest” Hanger Clinic location function.

At UCSF, the digital health and innovation department is working with orthopaedic surgery and O&P “to develop a series of apps to guide patients through different treatments,” says Irolla. “One of the first is called Backmeup, which is designed to provide information for scoliosis patients undergoing spinal surgery. I 32

FEBRUARY 2016 | O&P ALMANAC

am helping to develop the TLSO care and use information for the app, so patients requiring orthotic treatment after surgery have all the information they need in one place.”

Another venue for information sharing—both informational and promotional—is social media sites, which allow patients to download information without getting overloaded by direct communications. “You want to be careful not to flood your patient’s email in-box, but rather use a social networking tool like Facebook or Twitter to share information in a less intrusive way,” says Irolla.

“These sites and others like them can be used to market events, highlight patient success stories (with consent), and share news stories,” says Irolla.

Of course, all digital strategies must be continuously monitored. Wright & Filippis has Facebook, Twitter, and LinkedIn accounts, but “we don’t allow patient data on the sites,” says Turek.

Instructional videos that contain photos or videos of patients cannot be posted until patients have given their written permission. Even staff training videos, intended for employees only, must adhere to HIPAA guidelines, says Turek. “If we make any videos for internal training purposes, we have patients sign permission forms,” he says.

What’s more, seemingly innocent social media posts must be monitored to protect patient privacy. “Employees may want to post a selfie while they’re sitting in the office, but you need to

Training all employees on digital technologies and the related government regulations is one way to help promote compliance. O&P facilities should task a staff member with the responsibility of maintaining patient data security—especially considering “it’s not a matter of if, but when, someone will try to breach your data,” says Turek.

Smaller facilities may choose to outsource that duty. “There are several off-the-shelf products and organizations” that can help small O&P companies in their security efforts and HIPAA adherence measures.

Turek says all new hires at Wright & Filippis are required to take part in an employee orientation session focused on company information technology (IT) processes. “We set aside time for the IT department to talk about the computer system and data security,” he says. Turek also participates in periodic in-services on the topic and sends out company-wide emails on phishing and data breach prevention.

Ultimately, every staff member has an obligation to ensure security. Just as criminals are continually testing new methods and programs to steal data, O&P businesses must implement the proper programs and update them regularly to ensure their technologies remain secure and patient data remains protected.

EDITOR’S NOTE: Visit www. healthit.gov for additional guidance on securing data at health-care facilities, including information on health information privacy and security when using mobile devices, and a “Guide to Privacy and Security of Electronic Health Information.”

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

By JOSEPHINE ROSSI

Leadership Conference O&P

A N E XC L U S I V E , BY I N V I TAT I O N O N LY E V E N T

LEADERSHIP LEARNING Several participants weigh in on discussions and takeaways from the 2016 O&P Leadership Conference

N

OW IN ITS SECOND year, the O&P Leadership Conference has become a seminal event to bring together the most innovative thought leaders in the O&P community. This year, the conference was held at the Eau Palm Beach Resort and Spa, January 8 to 10. It featured a host of big-picture topics—from the impact of research and education on clinical practice and communication strategies to clinical service trends and perspectives on prosthetic payments—all with the goal of identifying and debating the trends that will shape the O&P profession as a whole as well as individual businesses.

Leaders left the conference stimulated and feeling positive about how they can evolve their organizations to adapt to the changing health-care landscape, according to several O&P executives who attended.

“We began shifting our view of where we need to go years ago.

Following the 2015 Leadership

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Conference, that focus evolved and became a little clearer,” says Rob Yates, CPO, FAAOP, president and chief executive officer of JP&O Labs. “The 2016 conference has helped bring things into a little more focus. We recognize that the environment is changing around us, and we are working now to prepare to respond to these changes.”

Rob Yates, CPO, FAAOP

Value Predictions

For the second year, analyst Michael Lovdal, PhD, kicked off the event by forecasting the future of the U.S. health-care market. His goal was to

Teri Kuffel, Esq.

the business aspects of our industry.

Apparently, that is becoming more and more important to survive.”

“I am extremely excited about the Prosthetics 2020 initiative and am very eager to have the opportunity to participate in the lower-extremity prosthetics registry,” says Yates. “If we, as a field and as individual organizations, cannot show the value and effectiveness of our work in terms of outcomes for patients, we will continue to face ever-increasing challenges in the environment that is fast-changing around us.”

Shifting Power

help participants assess the changing market’s effect on their business models. (Read more about participants’ reactions on page 20.) The migration of $2 trillion to value-based health care was among his first predictions. He advised O&P leaders to think about bundled-care payments and where O&P services fall.

“In a fee-for-value world, there is episodic care, there’s condition care, and there’s population care,” he said. “[Knowing which care category best describes O&P services] is going to be a very important call when you think about value.”

Health economist and consultant Alan Dobson, PhD, co-founder of Dobson-DaVanzo, took a deeper dive into CMS’s goal of shifting half of Medicare payments away from the traditional fee-for-service model by 2018.

“They are going as hard as they can… this is serious enterprise,” he said of the effort. “I would submit to you that whoever comes in the next administration is going to look around, they are going to see this amazing bit of activity that has taken place the last few years, they’re not going to like all of it, but they’re going to use a lot of it because it will be the only tools they

will have to reduce health-care utilization and take a whack at preserving the Medicare program.”

The complexity and overlapping nature of government-led programs to date will demand stakeholders—including O&P providers— demonstrate their value, Dobson said. This means describing how they improve population-based health, explaining their clinical prowess, and proving functional outcomes.

Participants also recognized this need for a differentiated value proposition.

Michael Lovdal, PhD

“This was my second year attending the conference, and I think both years have provided business owners with an incredible insight as to the future of O&P. That not only helps us prepare for the future, but it helps us plan our individual course for our unique businesses,” says Teri Kuffel, Esq., vice president of Arise Orthotics & Prosthetics Inc., who also presented during the event. “Because I am not a clinician, I have a different perspective— now more-valued than in the past—on

Another prediction from Lovdal is that power will shift from the federal level to states and cities as a result of exchanges, Medicaid expansion, and other factors. As a result, involvement at the state and local levels is going to become more important. This shift was echoed in presentations from Kuffel; Jeff Collins, chief financial officer for Cascade Orthopedic Supply Inc. and treasurer of the AOPA Board; and others during the conference.

Lovdal pointed to several factors that should be carefully tracked in terms of local initiatives trumping federal impact: the uninsured rate among the nonelderly; Medicare Advantage contracts with four or more stars; state health-care practice restrictions; current status of exchanges and Medicaid expansion; and cities with health innovation initiatives. “[State and local dominance] worked very well in certain big sectors of the U.S. economy, like agriculture,” he said. “If we let it work in health care, we actually may be beneficiaries of it.”

“Because of my role as the government affairs director for the North Carolina Orthotics and Prosthetics Trade Association (NCOPTA), I have felt this change coming in a very real way for some time now,” says Ashlie White, director of operations for Beacon P&O, who attended the event.

“I believe that business owners and practitioners are going to have to look more carefully at the local and state government activities. Lovdal suggested that we do a better job self-regulating as a profession, to identify the waste, fraud, and abuse, in a concerted effort to O&P ALMANAC | FEBRUARY 2016

35

Political Expert Weighs In on the

Presidential Primaries Charlie Cook

“T

HIS ELECTION CAMPAIGN SO far has

been one of the most unusual that we have seen in our lifetime,” said Charlie Cook, political analyst and editor and publisher of “The Cook Report,” who opened his discussion at the 2016 O&P Leadership Conference with an explanation of how politics in America has changed since the 1970s.

Several factors, he said, are responsible for the rise of unorthodox presidential candidates real-estate tycoon Donald Trump and Sen. Bernie Sanders (D-Vermont): growing ideology and political polarization on both sides; anxiety about the economy; the rise of populism on both sides; terrorism and national security concerns; distrust and anger at the Washington establishment, particularly among Republicans; and perceived threats to the American way of life.

So who will win the parties’ nominaDonald Trump tions? On the Republican side, Cook said Trump’s popularity is deceiving because the vote is split among 12 candidates [at the time of his presentation]. He expects that support to wane into the spring as the field of candidates narrows. “Thirty percent of the vote means that 70 percent is not for you,” he said. And of those who do support him, many still doubt his temperament PHOTO: iStock.com/andykatz and judgment, according to focus groups.

“I think these people are angry, alienated—they feel like outsiders. They will look for an angrier, more plausible candidate, and I think you will see a fair number of those people gravitating over to [Sen.] Ted Cruz” (R-Texas). Cook said it will be possible to see a contested primary election in July between Cruz and Sen. Marco Rubio (R-Florida), who will evolve into the more moderate of the two.

On the other side of the aisle, Cook was much Sen. Bernie Sanders more confident in his prediction that former (D-Vermont) Secretary of State Hillary Clinton would earn the Democratic nomination—and it comes down to a matter of numbers. Although Sanders is rising in the polls, the states with the largest concentration of delegate votes lean toward Clinton. “If something catastrophic happens to Hillary Clinton, they’re just going to call Joe [Biden]. … This Bernie thing is just not going to happen.” Still, he questions Clinton’s PHOTO: iStock.com/andykatz viability in a general election, particularly because her approval rate among independents has gone down significantly over the past year. “If she were a stock, you’d say she has a very narrow trading range…it’s really unlikely that she could ever win big, it’s unlikely she could lose big.”

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FEBRUARY 2016 | O&P ALMANAC

take control of our own future. This is absolutely one of the initiatives I plan to bring back to our board at NCOPTA.” For Kuffel, the power-shift discussions reinforced her strong belief that advocating on behalf of patients is essential: “We have come to realize that being part of state O&P groups can help effectuate change at both the state and federal levels. Establishing and maintaining relationships with our legislators helps us tell the story of our patients who continue to need us to care for them in a specific way.”

Other Insights

Conference participants also left Florida with several other topics top of mind. One was increased consumer involvement as patients become more aware of the transparency available surrounding quality and cost of care.

“These trends will significantly influence consumer choices in the new health-care economy. Health-care organizations will need to be ahead of these trends in order to remain viable,” says Yates.

Kuffel agrees, emphasizing the importance of mitigating consumer issues and requesting patient feedback on the care experience and device delivery. “Comments to Yelp and Health Grades will help determine the values of care and add much to future business success,” she says.

For White, the concept of mobility as a public health initiative soundly resonates. Several presenters touched on the topic, including Saeed Zahedi, PhD, technical director of Blatchford and visiting professor at the University of Surrey, who presented on the World Health Organization’s global initiative to increase access to mobility devices and O&P care.

“As a profession, for a very long time, we’ve been emphasizing the importance of the O&P practitioner’s role in providing services that allow patients to achieve mobility—the mobility of our patients it at the center of our mission,” says White. “It is also at the center of public health initiatives across the globe, but we are constantly fighting a battle on the

other side, trying to prove that the services we provide, as health-care professionals, are important and necessary. The contrast between one government agency making mobility the top health initiative and another agency bringing forth a draft LCD [Local Coverage Determination] that limits a patient’s access to the services that provide mobility is striking. I am interested to see how we will use the broader focus on mobility to support our mission as a profession.”

As a result of attending the Leadership Conference, Yates says his organization will be assessing the data it has and improving its data gaps. His team also will be developing and implementing outcomes measurement protocols.

“We are working to develop systems that lead to increased consistency in performance across the organization in terms of quality and patient experience, clinical outcomes, and of course compliance with documentation requirements,” Yates says. “We

Saeed Zahedi, PhD

are looking outside the organization to develop important partnerships and relationships where we can both give and gain value.”

The prediction that the health-care industry will radically change and become an information-technology business is the single biggest takeaway from the event for Kuffel.

“O&P businesses will need to make a commitment to further educate and retain staff to meet the challenges that will come along with such industry change,” she says.

Meanwhile, Beacon P&O is establishing and enforcing compliance standards—“a hard, but necessary,

decision,” says White. The standards “not only make us audit-proof, but ultimately set us up to better serve our patients.” She adds, “I know that our team is always looking at what we can be doing to refine this process and make it easier for our patients and our employees. Hearing about my colleagues’ experiences helps guide me to make better informed decisions for our company.”

Ultimately, the O&P executives who convened in Florida are in agreement that many changes will have a significant impact on the practice of O&P in the very near future. Those companies that anticipate those changes and prepare for a shifting business environment—by attending events such as the AOPA Leadership Conference and building on the experiences of others— will be best positioned for success in the coming years.

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

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37

By MARK FORD

Leveraging Data for O&P Business Management Learn to engage in benchmarking to make data work for you

“

This article is the first in a three-part series written by members of AOPA’s Operating Performance Committee focusing on the financial aspects of running an O&P facility. This month, we discuss how comparing your facility’s numbers to data provided in the AOPA Operating Performance Report can teach you to benchmark and identify areas of strength and areas of improvement for your facility.

In God we trust, all others must

”

bring data.

—W. EDWARDS DEMING

FEBRUARY 2016 | O&P ALMANAC

importance of data in the healthcare world is highlighted in a medical journal, written up in an online article about the price of insurance company stocks, included in a newspaper article about the Affordable Care Act, or published in a report from the Office of the Inspector General. In the vast majority of these sources, there are repeated indications about how data is changing health care today and how the future for everyone in health care is dependent on data.

All of these articles are exactly right about the rapidly growing importance of health-care data. You cannot underestimate the importance of focusing your practice on understanding the significance of data to the future success of your business, on deciding which systems to utilize to gather your data, and on making a serious commitment to gathering clean data. However, in their rush to highlight how data is changing the entire health-care field, the vast majority of these articles neglect to include the real value of this amazing new pool of knowledge that

is being created. At the end of the day, having good data is important, but the really important part of having data is using it.

As an essential part of the medical profession, it is critical that the owners of O&P practices push themselves into the brave new world of health-care data. Yes, it’s a different way of managing your business, and yes, it will require you to stretch your brain. But this change in how you view your business through the eyes of data is possible, and there is a great tool to helping you make the transition to a user of data from your current role as an owner of a practice, as a clinician, or both. That unique tool is benchmarking.

Benchmarking is the process of comparing one’s business processes and performance metrics to industry bests or best practices from other companies. What this means in real life is that benchmarks are a great way to make data more than just about the numbers and actually link the data to your everyday work. You connect the data to information that has an

IMAGE: iStock.com/jodiecoston

38

E

VERY DAY, A NEW article about the

impact on your business. So consider this example: How do you know if you are paying too much for the products?

Sure, you can track your practice’s cost of goods and then compare those expenses to your revenue so that you find your cost of goods percentage.

But what does that number mean? Is it good or is it bad?

One good place to figure out the answers to some of these questions is the annually published AOPA Operating Performance Report, which aggregates self-reported data from AOPA members. This unique report presents a wide range of business data in many different formats to allow practice owners of all sizes to see how their own business compares to other practices in our field.

By using the 2015 AOPA Operating Performance Report, you can begin to benchmark key financial metrics from your practice with those same details from more than 100 other O&P practices. As you compare these numbers,

benchmark – n. a standard of excellence, achievement, etc., against which similar things must be measured or judged

look for the places where your financials have the biggest differences from the various data metrics, and then dig into your own financial data in these areas to figure out why your numbers are different. Just like that, you will be benchmarking and really using the data that everyone is talking about!

Mark Ford is president of The OPIE Choice Network in Gainesville, Florida.

Reach him at mark.ford@oandp.com.

Ferrier Coupler Options!

EDITOR’S NOTE: Contact bleppin@aopanet.org to participate in the 2016 Operating Performance Survey. Participation is free, and participants receive a copy of the final published report ($325 value) and a personalized company report ($1,000-plus value) free of charge comparing their business to other O&P facilities of similar size and location.

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 2016

39

MEMBER SPOTLIGHT

M-Power Prosthetics & Orthotics

Small Facility, Big Voice Dallas facility emphasizes advocacy, education

A

MY MEHARY first encountered

40

FEBRUARY 2016 | O&P ALMANAC

Amy Mehary, CP/LP, FAAOP, works with a patient.

FACILITY: M-Power Prosthetics & Orthotics OWNERS: Amy Mehary, CP/LP, FAAOP, and Chris Mehary LOCATION: Dallas, Texas HISTORY: 11 years

longevity, she says, are two administrative employees and a highly skilled O&P technician who fabricates devices in the facility’s in-house lab.

Being an O&P business owner in today’s marketplace is not for the faint of heart, says Mehary.

“You have to be well prepared, continually educating clinicians and colleagues to ensure all medical records are cohesive and complete. We and every other O&P facility are battling to stay on top of health-care changes and adapt to remain competitive.”

M-Power maintains a continuous process of self-monitoring to pinpoint and resolve problem areas. The company has updated its policies and procedures to stay on top of regulatory requirements, and it recently adopted new administrative and compliance software.

“It really hit home for us, when justifying a new prosthesis for a long-time patient necessitated working with his physician on a 32-page document followed by

endless calls with his insurance company,” says Mehary.

Mehary and the M-Power marketing team launched an “Advocacy in Action” program that helped spearhead a local call-toaction campaign to block Medicare changes. In addition to providing community briefings, M-Power began a unique service for patients’ medical teams, says Mehary: medical clinical sessions, where representatives of the patient’s medical team can directly participate in patient-care sessions.

“Doctors have said that walking out the door knowing there was a completed and compliant medical necessity and outcome measures write-up truly made their lives easier,” she notes.

M-Power sees a wide range of patients, specializing in lowerand upper-limb devices, including, most recently, the i-limb from Touch Bionics.

Patient education is important to Mehary, and M-Power’s website includes a section that explains to patients what to expect after an amputation and the process of being fitted for a prosthesis.

The website also features a section for professionals, where clinicians can access research documents, view videos of outcome measures, and read presentations on the C Leg and gait deviations, as well as an overview of prosthetic interfaces.

Physical therapists can browse a selection of presentations that offer continuing education credits and arrange to set up on-site sessions.

M-Power’s marketing efforts focus on word of mouth and maintaining a presence in the community. The facility supports the Dallas Amputee Network and sponsors an annual “Leggapalooza” fundraiser. Mehary says, “The best marketing is a satisfied customer.

Our work always has and always will be about patient care.”

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

PHOTOS: Amy Mehary, CP/LP, FAAOP

the field of prosthetics in 1995. A recent business graduate, she interviewed for a job at an O&P facility converting paper patient files into electronic medical records. Mehary was hesitant to accept the position.

“I was intimidated by the thought of being around new amputees and all the emotions that would entail. I thought it would be depressing,” she says. The facility owner asked her to try it for a month. That month changed Mehary’s life.

“I saw an amputee who had thought her life was over walk out of that facility. It was amazing.

That’s when I knew I wanted to be a prosthetist,” she says.

Mehary went back to school to take the required science courses and in 1998 graduated from Northwestern University’s Prosthetic and Orthotic Center.

She served her residency at the University of Texas Health Science Center at San Antonio, and earned CP and LP credentials.

After working at other facilities for several years, Mehary wanted more flexibility and autonomy.

“I wanted to be able to focus more on patients than on the bottom line, to provide patient care the way I thought it should be provided,” she says. She and her husband, Chris, launched M-Power Prosthetics & Orthotics in 2005—the same year their second child was born.

The facility remains small, intentionally, with seven employees. Mehary shares clinical duties with orthotist Pam Byers, LO/ BOCO, and a registered O&P assistant. Key to the practice’s

By DEBORAH CONN

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PROTEOR

By DEBORAH CONN

French Connection Dijon-based O&P manufacturer recently expanded into the United States

P

ROTEOR MANUFACTURES ORTHOTIC AND prosthetic

42

FEBRUARY 2016 | O&P ALMANAC

COMPANY: PROTEOR OWNERS: The Pierron family LOCATIONS: Headquarters in Dijon, France, with subsidiaries in seven countries HISTORY: 103 years

The athlete Eric Dargent, fitted with the ALLUX, the newest MPC knee crafted by Nabtesco. Eric Dargent is fitted by BTC Orthopédie.

patient care allows PROTEOR to understand the market and innovate to serve it better, according to Desprez. PROTEOR directs 3 to 4 percent of its profits to research and development. The company works with the biomechanic laboratory of the Arts et Métiers ParisTech, a research center focused on orthotic and prosthetic fitting, and the University of Burgundy—Franche-Comté, an association of institutions of higher education and research.

Among those innovations is the OdrA, or osteo-distraction rotation arthrosis, an orthosis designed to relieve pain caused by osteoarthritis of the knee. The device’s medial joint provides distraction and the lateral join rotation, together lowering pressure in the medial knee compartment, according to the company.

PROTEOR’s central fabrication facility supplies its network for 50 fitting centers in France with prostheses, CAD/CAM-produced orthoses, and the OdrA orthosis.

The company offers clinicians a tool on its website that outlines a fitting scenario.

Called “Synopsis,” the tool’s diagrams present flowcharts of

PHOTOS: PROTEOR

components, materials, and workshop equipment. It also operates a network of fitting centers; in France alone, 100 certified prosthetist/ orthotists fit 26,000 patients each year, according to Frédéric Desprez, PROTEOR’s director of sales.

PROTEOR dates back to 1913 in Burgundy, France, when it was a workshop that made wooden parts from nearby willow trees for orthoses and prostheses. It was taken over in 1943 by the Pierron family and renamed PROTEOR in 1949. The company’s current CEO is Michel Pierron, who represents the fourth generation of the family.

Today, the PROTEOR Group comprises subsidiaries in China, Japan, the Czech Republic, Luxembourg, Morocco, Canada, and now the United States. The company has 700 employees, including 600 in France. Its production site remains in Burgundy with headquarters in Dijon. In 2012, PROTEOR joined forces with its Japanese partner, Nabtesco, which develops microprocessor knees, to expand jointly in the United States. In January, in an effort improve and speed service, Nabtesco and PROTEOR decided to maintain an inventory of PROTEOR O&P components, as well as materials for manufacturing, in Muskego, Wisconsin.

PROTEOR supplies the company’s own fitting centers as well as customers worldwide, including certified prosthetist/ orthotists, rehabilitation centers, and hospitals. The interplay between manufacturing and

PROTEOR’s manufacturing plant in Burgundy, France

components that work together.

“We have been providing this tool for almost 10 years now,” explains Desprez. “It is designed to help CPOs find the best solution for the patient and make sure they do not forget any component. Professionals appreciate this and find it helpful.

In 2015, we offered it as a poster in the annual magazine we distribute in the United States.”

Like many O&P manufacturers, PROTEOR develops partnerships with elite athletes who provide feedback on new products and those under development. Eric Dargent, who won the first French adaptive surfing competition in October, wears the Nabtesco ALLUX MPC knee, a polycentric microprocessor stance-and-swing-phase controlled knee that was released at the end of December.

“We also support a German mountain biker who won several gold medals at the Extremity Games, and we have a partnership with a French woman who competed in a 137-mile paddleboard race on rivers in the Netherlands,” says Desprez.

“In her daily life, she’s fitted with a Nabtesco MPC knee, as well, which adds pneumatic control to the hydraulic system.”

PROTEOR offers a variety of educational offerings to providers, including training sessions and digital tutorials to help CPOs fit such products as the Hydracadence knee, says Desprez.

In the United States, a clinical manager offers continuing education seminars on PROTEOR and Nabtesco products.

Desprez says the company hopes to soon bring innovations to the U.S. market—“original products to provide value and cost-effective solutions to CPOs in the United States.”

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

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Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers Illustrated Guide: $185 AOPA members, $425 nonmembers Quick Coder: $30 AOPA members, $80 nonmembers Preorder now at bit.ly/aopastore.

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FEBRUARY 2016 | O&P ALMANAC

Register for the February 10 Webinar Reimbursement for skilled nursing facilities is complex.

Make sure you understand when and how to bill so you can get paid. Mark your calendar to take part in the February 10 webinar, when AOPA experts will discuss the following topics: • How to get paid when a patient is in a skilled nursing facility • When to bill the skilled nursing facility versus when to bill Medicare • Breakdown of the 100-day benefit period • Detailed discussion of skilled nursing facility consolidated billing AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given terminal.

Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2016webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

IMAGE: iStock.com/Neustockimages, iStock.com/skynesher

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Webinar Wednesdays Register for AOPA’s 2016 Webinar Series and earn 1.5 credits each month. During the one-hour monthly Webinars, AOPA experts provide the most up-to-date information on a specific topic. Webinars are held the second Wednesday of each month at 1:00 PM EST. One registration is all it takes to provide the most reliable business information and CE Credits for your entire staff. If you’ve missed a Webinar, AOPA will send you a recording of the webinar and quiz for CE credits, so you can still take advantage of the series discount and the valuable learning opportunities.

Register for the complete 2016 series and get two free webinars! Members pay $990 and nonmembers pay $1,990, for the series. Register at bit.ly/2016webinars.

Upcoming 2016 Webinar Topics • February 10: SNF Billing: Beyond the Basics (The Ins and Outs) • March 9: Shift the Liability: The Proper Use of the Advanced Beneficiary Notice Form • April 13: Understanding Shoes, Mastectomy, & Other Policies • May 11: When Things Go Wrong: Making Lemonade Out of Lemons • June 8: Physician Documentation: How To Get It & How To Use It • July 13: Strategies and Levels: How To Play the Appeals Game • August 10: The Supplier Standards: Are You Compliant?

• September 14: Fill in the Blanks: Know Your Forms • October 12: Knee Orthosis Policy: The ABCs of the LCD and Policy Article IMAGE: iStock.com/Warchi

• November 9: Don’t Miss Out: Are You Billing for Everything You Can? • December 14: New Codes and What Lies Ahead for 2017

Have You Read the O&P Almanac’s Leadership Series?

Find out what senior-level O&P professionals have to say about the most critical issues facing the O&P profession.

Several 2015 issues of the O&P Almanac featured a new Leadership Series, showcasing Q&As with O&P experts on targeted topics of importance to the profession. Visit www.aopanet.org/publications/op-almanac-magazine to access past issues of the magazine and read what executives have shared, in their own words, on these important topics: HOSPITALS—WHAT’S THE HYPE? Andrew Meyers, CPO; Jim Kingsley; and Rebecca Hast detail their success strategies. June 2015 O&P Almanac, page 34 TECHNOLOGY SMARTS David Boone, PhD, MPH; Jan Saunders, CPO; and Stephen Blatchford share their insights.

July 2015 O&P Almanac, page 36

LEADERSHIP SERIES

LEADERSHIP SERIES

O&P ALMANAC: What is the difference between consolidation and vertical integration?

A Place in the

CONSOLIDATION Continuum?

Experts weigh in on the future of independent O&P facilities amid evolving economics

A

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession.

This month, we investigate the topic of consolidation and vertical integration.

S O&P PROFESSIONALS GRAPPLE with reimbursement challenges and dwindling profit margins, it’s impossible to ignore the industry consolidation trends taking place within the greater health-care arena. The number of “independent” health-care providers across medical specialties is falling. In fact, the number of U.S. physicians in independent practice has dropped significantly, from 57 percent in 2000 down to 37 percent in 2013, with a predicted decline to 33 percent by the end of 2016, according to data published by Accenture.

The same report finds that those independent physicians who have sold their practices or sought employment directly with health systems have done so largely due to disruptive market conditions, such as reimbursement pressures. Some of the independent physicians who have kept their practices are coping by experimenting with other models to remain competitive—for example, 17 percent of U.S. independent physicians are participating in accountable care organizations (ACOs).

Today’s O&P practitioners are facing similar reimbursement challenges and increasing costs. Several independent O&P facilities have recently consolidated with larger O&P practices, or have aligned themselves with suppliers or distributors on the O&P production pathway.

What do these consolidation and vertical integration trends mean for today’s typical O&P provider and the outlook for the O&P profession? O&P Almanac recently spoke with three O&P experts, who shared their insights on the current business climate and the pros and cons of industry consolidation.

Meet Our Contributors

Mike Sotak is president and chief executive officer of PEL in Cleveland, Ohio. Sotak acquired PEL two years ago, after a diverse business career managing distribution and manufacturing businesses in pharmaceuticals, wound care, durable medical equipment, and related health fields.

Pam Filippis Lupo, CO/LO, is a member of the board of directors at Wright & Filippis and at Carolina O&P. She also is a surveyor for the facility accreditation program of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, and an industry consultant.

Rick Riley is chief executive officer of Townsend Design in Bakersfield, California, a company with more than 150 employees. He worked in hospital administration before joining Townsend in 1995 as vice president of marketing, then took on duties as the company’s vice president of sales and marketing in 1997.

He assumed the role of CEO in 2003.

PAM FILIPPIS LUPO, CO/LO:

Consolidation is a merger or acquisition of smaller companies into a larger company. Vertical integration is when the supply chain or manufacturer owns the company to which it supplies products.

MIKE SOTAK: Consolidation is gener-

ally driven by the need or objective to realize economies of scale; it’s fewer companies getting bigger to leverage costs and gain efficiencies. With vertical integration, the goal is usually different—diversification, to spread risk, or to gain control upstream or downstream across the continuum of care. Examples of vertical integration include aligning with referral sources and partnering with physical therapists or other service providers, such as ACOs. Many O&P facilities right now are vertically integrated with c-fabs, which are technically custom manufacturing operations.

O&P ALMANAC: What types of

consolidation and/or vertical integration are occurring in O&P right now?

LUPO: There are a number of differ-

ent ways O&P facilities are consolidating and being integrated into larger companies. For example, O&P companies are buying other O&P companies. Several O&P companies have made acquisitions, including Hanger, Wright & Filippis, Level Four O&P, and New England Orthotics and Prosthetics.

Some O&P companies are combining with physical therapy. Some hospitals are buying O&P and durable medical equipment (DME) facilities.

Some physician groups are acquiring prosthetists.

On the manufacturing side, some manufacturers are working together,

or are working together with O&P as a provider, potentially under competitive bidding. There are numerous configurations.

SOTAK: We’re seeing some consolidation on the patient-care side. Some larger regional players are looking to acquire other practices—facilities that are looking to get bigger for efficiencies of scale. For example, many organizations are feeling a need to hire compliance officers—but how can you afford to hire someone on staff as a compliance officer if you’re a two-person staff? So they’re looking to consolidate to justify hiring professionals necessary to consistently meet regulatory requirements.

We’re also seeing consolidation at the manufacturer level, and I think we will see a lot more as manufacturers face new challenges in meeting expected financial performance.

RICK RILEY: There is an emerging

model, especially in larger markets, where hospitals, physician clinics, and ancillary services—including

38 SEPTEMBER 2015 | O&P ALMANAC

O&P—are vertically integrated to create increased synergy and efficiency. In some cases, a local O&P facility is purchased by a large medical provider, and in other cases the network is hiring in-house orthotists and prosthetists.

Among suppliers and manufacturers, there is also increasing consolidation. The companies that have the financial capital to make acquisitions can amass a vast range of products.

This creates a strategic advantage in terms of offering one-stop-shopping to group purchasing organizations and integrated provider networks.

O&P ALMANAC: What types of opportunities do these mergers present for the O&P profession and its patients?

LUPO: Mergers and acquisitions can

lead to decreased costs due to the consolidation of redundancies. They may also allow O&P companies to expand into different scopes of practice—for example, foot care or DME. O&P ALMANAC | SEPTEMBER 2015

39

A PLACE IN THE CONSOLIDATION CONTINUUM. Pam Filippis Lupo, CO/LO; Mike Sotak; and Rick Riley weigh in. September 2015 O&P Almanac, page 36

DISSECTING DISEASE TRENDS Thomas DiBello, CO, FAAOP; Phil Stevens, MEd, CPO, FAAOP; and Rudolf B. Becker offer their thoughts.

October 2015 O&P Almanac, page 48

LEADERSHIP SERIES

Understanding disease prevalence and forecasts can help O&P professionals adapt their practices

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of disease trends.

Meet Our Contributors

LEADERSHIP SERIES

BROADENING

Our Scope

Providing ancillary services may offer benefits for both O&P facilities and patients

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of ancillary services.

Meet Our Contributors

Ivan Sabel, CPO, is chief executive officer of Orthotic Holdings Inc. in Hauppage, New York, a company that specializes in technologies and treatment options for health-care providers who treat conditions associated with the lower extremities.

He previously served as chairman and CEO of Hanger.

30 NOVEMBER 2015 | O&P ALMANAC

T

O EXPAND OR NOT TO EXPAND into the world of ancillary services?

That was the question posed to four senior-level O&P executives for this month’s Leadership Series article. While some practitioners may believe it’s important to adhere to the core competency inherent in O&P—strictly defined orthotic and prosthetic services—others trust that tremendous opportunities are available to O&P business owners who broaden their scope of practice. Disciplines such as durable medical equipment, physical therapy, foot care, mastectomy services, and home remodeling are all possible areas of growth.

Here, our experts share their personal thoughts and experiences related to offering additional services at traditional O&P practices, emphasizing that the only expansions that will succeed are those that are well researched, properly staffed, and reimbursable.

Anthony Filippis, CPO, is chief executive officer of Wright & Filippis, a patientcare company focused on prosthetics, orthotics, and custom mobility products and accessibility solutions headquartered in Rochester Hills, Michigan.

Michael Tillges, CPO, is co-vice president at Tillges Certified Orthotic Prosthetic Inc., where he has worked since 2004. The company has facilities throughout Minnesota and western Wisconsin.

Jeff Lutz, CPO, is zone vice president of Hanger Clinic and currently serves on the AOPA and Amputee Coalition boards of directors. He has been a practicing CPO for the past 30 years.

O&P ALMANAC: Why should O&P professionals consider including ancillary services as part of their practice?

IVAN SABEL, CPO: As the landscape for O&P continues to evolve and change, it’s becoming more and more difficult to look at it as a pure orthotic or pure prosthetic business. Some people are navigating well around the headwinds that are affecting the profession; others are not faring as well.

A pure O&P practice, which I define as a facility that solely offers custom orthotics and/or prosthetics, will continue to face reimbursement challenges as well as challenges with the orthotic and prosthetic codes. In this environment, ancillary services can be leveraged as bottom-line contributions to offset these challenges and the changes in the headwinds.

ANTHONY FILIPPIS, CPO: There are a lot of synergies of products that patients need. O&P patients are coming into our facilities anyway, so we need to consider the items they may need as rehabilitative—when they can’t use an orthosis or prosthesis, or to use as additional support. For example, items such as canes, grab bars, bathroom aids, and raised toilet seats are examples of things that can make our patients’ lives better and easier. We need to be thinking: “What are the things that are going to help improve our patients’ lives?”

MICHAEL TILLGES, CPO: Ancillary services provide the patients and referral sources a full-service facility—in essence, a “one-stop shop.” They also allow a facility to become better diversified, and to tap into different revenue streams and markets to increase profitability.

JEFF LUTZ, CPO: Consider is the key word in this question. The possibility of adding services or product lines to an existing O&P practice is intriguing to many. However, owners will need to carefully consider the impacts the addition may have on their core business.

To assist, AOPA has recently formed an Ancillary Service Committee to identify services and products that are related to O&P but not typically provided in an O&P practice. The concept is to be able to provide practices with alternative income and identify what is required to participate, as well as the potential profit. It should be noted that we are also looking at potential value-adds that may not be a traditional revenue stream, but add to the practice’s value proposition to the patient and referral communities, driving our current core competency, O&P. O&P ALMANAC: How can the O&P profession leverage our core competency and core asset to broaden our scope?

SABEL: O&P’s greatest asset is our

ability to identify and provide services to our patient population in a way that traditional business models outside of O&P don’t necessarily provide.

Our referral sources come to us with one specific request—an orthotic or prosthetic device. But we need to look at patients in a much more holistic way; our patients need other services and products to continue to live their lives to the fullest. They come into our

facilities requesting just an orthosis or prosthesis, but they have a number of other needs in their treatment modality.

By offering ancillary services, you’re contributing to a better quality of life for your patients, and you may make a profit to help offset some of the reimbursement and other recent challenges impacting O&P. FILIPPIS: I think it all ties to patient management. Sometimes we get tunnel vision and focus only on orthotics or only on prosthetics. But we have to look at the activities of the patient before and after they arrive at our facilities. We can meet some of their needs—either with ancillary services, or by serving as a resource.

TILLGES: O&P’s core competency includes crafting and fitting of orthotic and prosthetic devices, as well as assessing the needs of the patient to provide appropriate products and services to better their life.

O&P’s core asset includes the patients we take care of, our referral sources, third-party payors, and employees and staff members.

By focusing holistically on the patients’ needs and providing them with the highest quality products and services, we enhance the quality of life for the patients we serve.

O&P ALMANAC | NOVEMBER 2015

31

A

S THE O&P PROFESSION begins to collect patient data to demonstrate the effectiveness of orthotic and prosthetic intervention in restoring function— data that is increasingly important to payors—it’s a good time for O&P practitioners to take a look at those disease trends that are emerging from data generated by other health-care sectors.

Many medical disciplines already have a vast array of patient information—data that could prove useful to orthotists and prosthetists as they consider patient demographics and set business plans. With reimbursement challenges on the rise and profit margins on the decline, it has become more important than ever for O&P businesses to understand which types of patients may be in greatest need of services in the near- and long-term future. Those O&P business managers and clinicians who follow disease trends will be best positioned to treat the patients most likely to visit their offices in the coming years.

Here, O&P experts share their thoughts on the importance of following disease trends, such as diabetes and cerebral palsy, and offer suggestions for staying current on relevant medical advances.

Thomas DiBello, CO, FAAOP, is clinic regional director at Hanger Clinic; honorary adjunct faculty at Texas Women’s University; and chairman of the Advisory Committee of the Baylor College of Medicine Masters Program on Orthotics and Prosthetics. He is past president of both AOPA and the Academy of Orthotists and Prosthetists.

48 OCTOBER 2015 | O&P ALMANAC

LEADERSHIP SERIES

LEADERSHIP SERIES

O&P ALMANAC: Why should O&P professionals pay attention to disease trends?

DI SSECTING

DISEASE TRENDS

Phil Stevens, Med, CPO, FAAOP, is immediate past president of the American Academy of Orthotists and Prosthetists and is in clinical practice with Hanger Clinic in Salt Lake City, Utah.

Rudolf B. Becker is chairman and president of Becker Orthopedic, a supplier of orthopedic component parts and central fabrication services located in Troy, Michigan.

THOMAS DIBELLO, CO, FAAOP:

As we evolve as a profession, it’s important that we be very involved in understanding and appreciating the changes occurring in the diseases that we treat.

For instance, if there were an effective way to completely cure diabetes, then there may be a diminished number of amputations for diabetes patients, and that would reduce the need for prosthetic devices for diabetic amputees.

On the orthotics side, if physicians begin performing more prenatal intra-uterine surgeries to repair spinal insults that occur in unborn infants with spina bifida, and research shows that these patients are then more cognitively alert but still have neuromuscular limitations that require bracing, that may have an impact on orthotics treatments—and we would need to be aware that further advances could ultimately eliminate the need for those types of orthoses.

One example of the importance of following disease trends can be seen in the case of a well-known rehabilitation hospital. During the course of a decade during the 1980s and ‘90s, the hospital transitioned from being primarily a spinal cord injury center to a hospital that primarily treats stroke patients. They were watching trends and recognized that the number of spinal cord patients was diminishing—mainly because the majority of spinal cord injuries occurred secondary to motor vehicle injuries. As cars became safer, there were fewer spinal cord injuries. A change in focus to stroke patients helped ensure the hospital’s longevity.

We, as a profession, need to be equally aware of trends that may affect the work we do.

PHIL STEVENS, MED, CPO, FAAOP:

Every industry has to forecast its future. Are the demands for their

services going to increase or decrease?

For orthotics and prosthetics, disease trends constitute a big part of that forecasting.

RUDOLF B. BECKER: It’s important to follow disease trends so the profession and the companies that supply practitioners can prepare for the future needs of patients and offer viable treatments to referral sources.

O&P ALMANAC: What do individual practitioners, or the O&P profession as a whole, need to do to ensure we follow disease trends?

DIBELLO: I know there is a lot of uncertainty in the profession these days related to possible Local Coverage Determination (LCD) changes and downward pressures on reimbursement, but we need to devote human and financial resources within the O&P profession to look at these trends, as so many other professions do.

In the past, we have not studied the changes occurring in general medicine related to our patients whose diagnoses

we encounter the most. At times, we have been caught by surprise.

We have to face this as a profession.

We know very little about these areas of medicine we are most affected by, and we are at risk of being caught in a situation for which we are unprepared.

STEVENS: I think individual practitioners will continue to be dependent on larger entities within the profession to follow disease trends. Individual practitioners don’t have the time or means to access the kinds of data that tell those stories. However, organizations like AOPA and the Academy do.

Journalists within the profession can also do so. Once these entities create secondary knowledge sources that summarize these trends, then it’s up to individual practitioners to consume them and include those findings in their decision making.

BECKER: AOPA does a fine job of publishing data and the appropriate links in its biweekly AOPA in Advance Smart Brief and monthly O&P Almanac. They couldn’t be easier to access, and if you want more data, just use one of the search engines available online.

O&P ALMANAC | OCTOBER 2015

49

BROADENING OUR SCOPE Ivan Sabel, CPO; Anthony Filippis, CPO; Michael Tillges, CPO; and Jeff Lutz, CPO, share their experiences.

November 2015, O&P Almanac, page 30.

O&P ALMANAC | FEBRUARY 2016

45

WELCOME NEW MEMBERS

T

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

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

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

Advanced Prosthetic Research Waco Inc. 2410 Wycon Drive, Ste. 101 Waco, TX 76712 254/235-1477 Category: Affiliate Parent Company: Advanced Prosthetic Research Inc., Plano, TX Apex Foot Health 414 Alfred Avenue Teaneck, NJ 07666 800/252-2739 Category: Supplier Affiliate Parent Company: Orthotic Holdings OHI, Hauppauge, NY Richard Metz Arizona AFO 4825 E. Ingram Street Mesa, AZ 85205 480/222-1599 Category: Supplier Affiliate Parent Company: Orthotic Holdings OHI, Hauppauge, NY

Arnold O&P Lab Inc. 619 Jordan Street Shreveport, LA 71101 318/428-2400 Category: Affiliate Parent Company: Premier Hope Orthotic & Prosthetic Enterprises LLC, Monroe, LA Steve Lindsley, CP, BOCO

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FEBRUARY 2016 | O&P ALMANAC

Buckner Prosthetics and Orthotics 2 Old River Place, Ste. D Jackson, MS 39202 601/944-1130 Category: Patient-Care Facility Stephen Singleton Carolina Orthotics & Prosthetics 1097B Cook Road Orangeburg, SC 29118 843/577-9577 Category: Affiliate Parent Company: Carolina Orthotics & Prosthetics LLC, North Charleston, SC

Carolina Orthotics and Prosthetics 1331 Ashley River Road, Bldg. C Charleston, SC 29407 843/577-9577 Category: Affiliate Parent Company: Carolina Orthotics & Prosthetics LLC, North Charleston, SC

Center for O&P Care 902 Dupont Road, Ste. 100 Louisville, KY 40207 502/899-9221 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

Cranial Technologies 5450 Knoll North Drive, Ste. 340 Columbia, MD 21045 866/362-2263 Category: Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ

Independence ProstheticsOrthotics Inc. 550 S. College Avenue, Ste. 111, STAR Campus Newark, DE 19711 302/894-9476 Category: Affiliate Parent Company: Independence ProstheticsOrthotics Inc., Newark, DE John Horne, CPO, CPed

North Shore Orthotics & Prosthetics 591 Bicycle Path, Ste. D Port Jefferson Station, NY 11776 631/928-3040 Category: Affiliate Parent Company: Long Island Orthotics & Prosthetics, West Babylon, NY

OhioHealth Home Medical Equipment 7708 Green Meadows Drive, Ste. D Lewis Center, OH 43035 614/556-0739 Category: Patient-Care Facility Nick Brown, CO, LO

KLM Laboratories 28280 Alta Vista Avenue Valencia, CA 91355 661/295-2600 Category: Supplier Level 1 Melinda Dawson

Orthotic & Prosthetic Centers at Mission Bay Hospital 1825 4th Street, Ste. M5302 San Francisco, CA 94158 415/476-1788 Category: Affiliate Parent Company: Orthotic & Prosthetic Centers at Parnassus Heights, San Francisco, CA

Orthotic Holdings OHI 1393 Veterans Memorial Hwy. Hauppauge, NY 11788 480/222-1580 Category: Supplier Level 4

Langer Biomechanics 2905 Veterans Memorial Hwy. Ronkonkoma, NY 11779 800/645-5520 Category: Supplier Affiliate Parent Company: Orthotic Holdings OHI, Hauppauge, NY Jonathan Medrano Liberating Technologies Inc. 325 Hopping Brook Road, Ste. A Holliston, MA 01746 508/893-6363 Category: Supplier Affiliate Parent Company: College Park Industries, Warren, MI

Orthotic Prosthetic Solutions LLC 7336 S. Yosemite Street, Ste. 210 Centennial, CO 80122 303/990-0100 Category: Affiliate Parent Company: Orthotic Prosthetic Solutions LLC, Fort Collins, CO Sheila Cynkar

WELCOME NEW MEMBERS

PedAlign 8665 Miralani Drive, Ste. 300B San Diego, CA 92126 866/733-2544 Category: Supplier Affiliate Parent Company: Orthotic Holdings OHI, Hauppauge, NY Jonathan Medrano Prosthetic & Orthotic Group Los Angeles 5837A Uplander Way Culver City, CA 90230 310/348-9090 Category: Affiliate Parent Company: Prosthetic & Orthotic Group Inc., Signal Hill, CA

Prosthetic & Orthotic Group Pediatric Specialists—Colorado 13123 E. 16th Avenue Aurora, CO 80045 303/400-8866 Category: Affiliate Parent Company: Prosthetic & Orthotic Group Inc., Signal Hill, CA

Prosthetic & Orthotic Group San Gabriel Valley 1227 Buena Vista Street, Ste. B Duarte, CA 91010 626/256-1414 Category: Affiliate Parent Company: Prosthetic & Orthotic Group Inc., Signal Hill, CA

Real Life Prosthetics/ Maryland Real Life Designs LLC 300 Biddle Avenue, Ste. 212 Newark, DE 19702 410/569-0606 Category: Affiliate Parent Company: Real Life Prosthetics/ Maryland Real Life Designs LLC, Abingdon, MD Ritchie Limb & Brace LLC 1069 E. Gonzales Seguin, TX 78155 830/433-9188 Category: Affiliate Parent Company: Ritchie Limb & Brace LLC, New Braunfels, TX David Ritchie, CPO, LPO, CPed

What are we doing?

Where are we going?

How do we survive?

Safe Step 414 Alfred Avenue Teaneck, NJ 07666 866/712-7837 Category: Supplier Affiliate Parent Company: Orthotic Holdings OHI, Hauppauge, NY Richard Metz

Scheck & Siress O&P Inc. 12380 Prinston Drive Huntley, IL 60142 847/961-5800 Category: Affiliate Parent Company: Scheck & Siress O&P Inc., Oak Park, IL Brett Kramer, CPO Scheck & Siress O&P Inc. 2401 Kaneville Road, Ste. 2 Geneva, IL 60134 630/845-0445 Category: Affiliate Parent Company: Scheck & Siress O&P Inc., Oak Park, IL Brett Kramer, CPO

The Orthotic Group 160 Markland Street Markham, ON L6C OC6 800/551-3008 Category: Supplier Affiliate Parent Company: Orthotic Holdings OHI, Hauppauge, NY Karolina Korelin

Is Your Facility Celebrating a Special Milestone in 2016?

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.

Products & Services

For Orthotic, Prosthetic & Pedorthic Professionals

2016 OPERATING PERFORMANCE REPORT FREE Find the best practices to help you manage your business. Participate in the annual O&P Operating Performance Survey to chart your course.

for AOPA members

Contact Bleppin@aopanet.org to participate in the 2016 survey coming this spring. www.AOPAnet.org

O&P ALMANAC | FEBRUARY 2016

47

MARKETPLACE

Feature your product or service in Marketplace.

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

Visit bit.ly/aopamedia for advertising options.

ALPS Guardian Suction Liner The Guardian suction liner from ALPS features raised GripGel bands that grip the socket wall to form a secure interface between the socket and the liner to prevent slippage or premature release. These low-modulus GripGel bands stretch against the socket wall, while the inner wall conforms easily to the residual limb, to ensure there is no restriction of blood flow or stiffening to inhibit donning. No seams and a single-piece construction improve durability.

Available in both transfemoral and transtibial models, the Guardian suction liner can be fully inverted for ease of donning.

To accommodate for volume fluctuations, please use the ALPS Skin Reliever (ENCP) for continued use of same socket.

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

Introducing Precise Insoles by Amfit Amfit is proud to announce a prefabricated, functional insole in 24 sizes. Confidently offer a noncustom orthosis with biomechanically engineered arch support built right in. Millions of unique foot shapes formed the basis for designing a ready-towear insole with true functional support and the widest size range on the market. Most high-quality premade insoles offer less than 10 shell sizes. Precise insoles were designed to bridge that gap so you can offer a high-quality, functional orthosis when full custom isn’t an option.

• 24 sizes • Integrated length, width, and arch height • Anatomically correct design • Functional shell with no crack guarantee • Forefoot comfort insert • Stabilizing deep heel cup • Tablet-style digital sizing guide Opt for the Starter Kit (36 pairs, digital sizer, mount, and display materials) or order by the pair.

Ask about introductory specials at sales@amfit.com or 800-356-FOOT (3668) x264.

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FEBRUARY 2016 | O&P ALMANAC

It’s Your Patient; Shouldn’t It Be Your Orthotic Design Too? Take complete control for the ultimate in patient satisfaction with Amfit Lab Services.

• Carbon fiber (flex and firm) • Polypropylene (flex, semiflex, rigid) • Five EVA styles and densities • One- to four-day turnaround • Diabetic-specific program: three pair for $60, includes shipping • Foam box processing • Contact Digitizer 3D digital casting system • Equipment rental and lease programs available.

Thirty years specializing in custom foot orthotics and orthotic technology, we will help move your practice forward while saving time and money. Contact Amfit Inc. today at 800/356-FOOT(3668), email sales@amfit.com, or visit www.amfit.com.

Sidekicks™, the New Multiaxial Stubbie Feet College Park’s Sidekicks are the first adjustable stubbie feet for bilateral, above-knee amputees.

With natural anatomical ankle motion, Sidekicks flex and plant in real-world environments for the ultimate balance and stability. The feet encourage muscle activity to assist in the rehabilitation process, which can be especially helpful when the goal is a transition to microprocessor knees. Also sold as a single unit and certified safe for water use, the Sidekicks can be used by unilateral amputees for adaptive sports, like surfing or rock-climbing.

The robust multiaxial ankle and small, treaded platform provide unlimited possibilities.

See the Sidekicks in action at www.youtube.com/ CollegeParkInd.

MARKETPLACE New Sure Stance Knee by DAW This ultralight, true-variable cadence, multiaxis knee is the world’s first four-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 K3 patients.

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

DawSkin New Mega Stretch

DawSkin New MegaStretch is the most durable tear-free skin in the world. It is the ideal skin for your patient to shower on both legs (definitely the safer way). DawSkin MegaStretch provides the vertical ankle stretch required for multiaxis feet and energy restitution feet.

“Heat-shrink” skins limit the ankle movement and will tear.

DawSkin New EZ-Access dons on and off just like a sock yet provides all of the benefits of the DawSkin New MegaStretch.

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

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 self-leveling 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.

Introducing the Stronger, Smarter, Submersible Plié® 3 MPC Knee Stronger construction makes the new Plié 3 MicroprocessorControlled (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.

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.

O&P ALMANAC | FEBRUARY 2016

49

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

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

3D Fabrics for High-Quality Lining

The antiperspiration 3D fabrics are suitable for the lining of corsets, braces, and other orthopedic devices. Our Regular (TT381) and Thermoformable (TT501) 3D fabrics allow air circulation and keep skin dry thanks to a breathable structure.

• Thermoformable at 340 degrees Fahrenheit (TT501).

Matches the most complex mold shapes • To be glued or fixed with micro hook • Comfortable and soft to the touch • Washable up to 100 degrees Fahrenheit • Made of several heat-bonded layers, minimizes allergies • Thickness: 2/8 inch • Available in red, black, white, blue, pink, grey, brown, and green.

For more information, contact Nabtesco and PROTEOR in the United States at 855/517-4414 or visit www.nabtescoproteor-usa.com.

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FEBRUARY 2016 | O&P ALMANAC

Socket-less Socket Transfemoral We’ve reinvented sockets from the ground up. No more static socket shape. No more hard ischial seat.

No more loss of suction. Using our NASA-based hammock-fit technology, the Socket-less Socket truly conforms to the user, providing a custom-fit socket every time you put it on. Fitting a socket is now microadjustable in real time, eliminating the need for the antiquated casting, modification, and iterative test socket fitting methods from the past.

View the free Socket-less Socket training at MartinBionics.com.

Contact Martin Bionics at 844-MBIONIC.

Bikini Socket—One Third the Size, One Third the Weight, Three Times the Comfort Instead of encapsulating the pelvis with a bucket, our patented, lightweight Bikini Socket and Iliac Crest Stabilizers provide a direct biomechanical link between the device and its user, resulting in superior control, comfort, and functional outcomes.

Fitting a hip or hemipelvectomy level has never been so simple. The Bikini Socket Hammock Casting Stand allows you to microadjust the socket shape using our NASA-based mesh fabric hammock-eliminating point-specific ischial loading and providing an ultra-comfortable hammock fit. The casting shape becomes the final socket shape. It’s that simple.

View the free Bikini Socket Hammock Casting Stand training at MartinBionics.com. Contact Martin Bionics at 844-MBIONIC.

MARKETPLACE Go Sleeveless With the Unity® Sleeveless Vacuum System by Össur® Elevated vacuum systems typically require a sleeve to maintain vacuum. The problem is, sleeves are bulky. They bunch behind the knee, restricting range of motion. They can also puncture, leading to a loss of vacuum.

Building on established Seal-In® technology, the Unity Sleeveless Vacuum System by Össur is the first elevated vacuum solution to generate 15-22 inHg of vacuum without a sleeve.

Unity Sleeveless Vacuum is compatible with a variety of Flex-Foot® feet, including low-activity, low-profile, and microprocessor solutions.

Visit www.ossur.com/unity2 to learn how to get certified and check out the entire line of Unity-compatible Flex-Foot feet.

New Aluminum Components Our new line of aluminum pylons, adapters, and tube clamps is designed and tested to support up to a 300-lb weight limit while providing you with a cost-effective, high-quality solution. The line includes double adapters at various lengths, a 30-mm pylon, a 30-mm tube clamp, and a pyramid adapter.

For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.

Polycentric Pneumatic Knee The key element of the new 3R106 Pro is the servo-pneumatic control unit. Its powerful dual-chamber pneumatic unit with progressive damping has a flexion valve set for the patient’s normal walking speed. At faster walking speeds, the flexion resistance increases, which prevents too much knee flexion. This helps provide more consistent swing phase even during fast walking. With three options for the proximal connection (pyramid, threaded connector, and lamination anchor) and a 275-lb weight limit, the 3R106 Pro offers you great fitting options.

For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.

i-Limb Quantum: Precision. Power.

Intelligent Motion.

NOW AVAILABLE IN FOUR SIZES! Call us today to learn more about our new i-limb™ quantum.

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

Visit us at AAOP in booths 1120 and 1122.

New Suspension Option for Transfemoral Amputees The WillowWood One System provides transfemoral amputees a choice in suspension methods without sacrificing reliability and security. The WillowWood One System may now be used as a suction system.

Initially released for use with elevated vacuum, WillowWood has clinically tested the system with suction suspension for the past 10 months. The system includes several components, including a fabricless Alpha SmartTemp® Liner, a gel sock, a seal, and a removable brim that work together to deliver secure suspension.

Certification is required to purchase and fit the WillowWood One System. For more information, contact WillowWood at 800/848-4930 or visit willowwoodone.com.

O&P ALMANAC | FEBRUARY 2016

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AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific

Job location key:

Prosthetic and Orthotic Technician

Southern California Inland Artificial Limb and Brace Inc. is currently seeking a prosthetic and orthotic technician for our Southern California central fabrication facility.

We offer competitive pay (commensurate with experience), medical, and retirement benefits. We look forward to speaking with you. Please forward your résumé to:

- 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.

Inland Artificial Limb and Brace Inc. Email: careers@inlandlimbandbrace.com

Mid-Atlantic CPO/BOCPO

Louisville, Kentucky At Center for Orthotic & Prosthetic Care (COPC) our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, New York, and Pennsylvania. Due to an opening at one of our patient-care facilities in Louisville, Kentucky, we are seeking a CPO, or Kentucky-licensed BOCPO, with a minimum of five years’ clinical experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest quality patient care. This position offers a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your résumé, in confidence, to:

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.

52

FEBRUARY 2016 | O&P ALMANAC

Center for Orthotic & Prosthetic Care (COPC) Fax: 502/451-5354 Email: dkoch@centeropcare.com

Morning, noon, or night— LCodeSearch.com allows you access to expert coding advice—24 hours a day, 7 days a week.

The Source for Orthotic & Prosthetic Coding

T

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

Log on to LCodeSearch.com and start today.

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

Need to renew your membership?

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

SPECIA16L! for 20

www.AOPAnet.org

ADVERTISERS INDEX

Company

Page

Phone

Website

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

41

703/886-7114

www.abcop.org

ALPS South LLC

21

800/574-5426

www.easyliner.com

Amfit

29

800/356-3668

www.amfit.com

Amputee Coalition

37

888/267-5669

www.amputee-coalition.org

Board of Certification/Accreditation

43

877/776-2200

www.bocusa.org

Charleston Bending Brace Foundation

15

843/577-9577

www.cbb.org

College Park Industries

9

800/728-7950

www.college-park.com

DAW

1

800/252-2828

www.daw-usa.com

Ferrier Coupler Inc.

39

810/688-4292

www.ferrier.coupler.com

Freedom Innovations LLC

5

888/818-6777

www.freedom-innovations.com

Hersco

2

800/301-8275

www.hersco.com

Martin Bionics

27

844-BIONICS

www.martinbionics.com

Nabtesco & PROTEOR in USA

33

855/517-4414

www.nabtesco-proteor-usa.com

Össur

7

800/233-6263

www.ossur.com

Ottobock

C4

800/328-4058

www.professionals.otobockus.com

Touch Bionics

19

855/694-5462

www.touchbionics.com

WillowWood

Insert

800/848-4930

www.willowwoodco.com O&P ALMANAC | FEBRUARY 2016

53

CALENDAR March 11

2016

Charleston Bending Brace Online Certification Course.

Register online at cbb.org. For more information, contact Natasha Hardina at 843/577-9577 or email nhardina@carolinaop.com.

February 10

SNF Billing: Beyond the Basics (The Ins and Outs). Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

February 25 Webinar Conference bit.ly/priorauthorization.

Introduction to Prior Authorization.

Free for AOPA members. Register at

March 14-19

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

March 18-19

March 1

ABC: Application Deadline for Certification Exams.

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

March 4-5

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

March 9

Shift the Liability: The Proper Use Webinar Conference of the ABN Form. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

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

March 18-19

PrimeFare West Regional Scientific Symposium 2016.

Denver Marriott City Center, Denver. Contact Jane Edwards at 888/388-5243, jledwards88@att.net or visit www.primecareop.com.

March 25 & 31 Webinar Conference

April 8

Charleston Bending Brace Online Certification Course.

Register online at cbb.org. For more information, contact Natasha Hardina at 843/577-9577 or email nhardina@carolinaop.com.

No Application Deadlines BOC offers year-round testing for all of its exams and has no deadlines. Candidates can apply, test when ready, and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at http://my.bocusa.org. To learn more about our nationally recognized, in-demand credentials, visit www.bocusa.org or emailcert@bocusa.org.

www.bocusa.org

SHARE

your next event!

54

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

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

Questions? Email landerson@AOPAnet.org.

Calendar Rates Let us

Prior Authorization Preparation. Register online at bit/ly/priorauthorization.

CREDITS

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

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

FEBRUARY 2016 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR May 27

June 24

Charleston Bending Brace Online Certification Course.

Register online at cbb.org. For more information, contact Natasha Hardina at 843/577-9577 or email nhardina@carolinaop.com.

Charleston Bending Brace Online Certification Course.

Register online at cbb.org. For more information, contact Natasha Hardina at 843/577-9577 or email nhardina@carolinaop.com.

April 7-9

June 24-25

Texas Association of Orthotists & Prosthetists.

Dallas/Addison Marriott Quorum by the Galleria, Dallas.

For more information, visit www.TAOP.org.

April 13

Understanding Shoes, Mastectomy, & Other Policies. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

PrimeFare East Regional Scientific Symposium 2016. Renaissance Hotel & Convention Center, Nashville. Contact Jane Edwards at 888/388-5243, jledwards88@att.net, or visit www.primecareop.com.

July 13

Strategies and Levels: How To Play the Appeals Game. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

August 10

April 22-23

PrimeFare Central Regional Scientific Symposium 2016.

Southern Hills Marriott, Tulsa, OK. Contact Jane Edwards at 888/388-5243, jledwards88@att.net, or visit www.primecareop.com.

April 26-27 AOPA Policy Forum. Washington Marriott at Metro Center, Washington, DC. For more information, visit bit.ly/policyforum2016 or contact Ryan Gleeson at rgleeson@AOPAnet.org.

May 11

When Things Go Wrong: Making Lemonade Out of Lemons. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

May 11- 13

New York State Chapter Annual Meeting. Albany Marriott, Albany, NY. For information, email Marx4NYSAAOP@aol.com, or visit www.NYSAAOP.org

May 19-21

International African American Prosthetic & Orthotic Coalition.

Memphis, TN. For more information, visit www.iaapoc.org.

The Supplier Standards: Are You Compliant? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

August 18-20

Virginia Orthotic & Prosthetic Association. Hyatt Regency Reston, Reston, VA. For more information, visit www.vopainfo.com.

September 8-11

99th AOPA National Assembly. Boston.

For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@ AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

September 14

Fill in the Blanks: Know Your Forms.

Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

October 12

KO Policy: The ABCs of the LCD and Policy Article. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

June 8

Physician Documentation: How To Get Webinar Conference It & How To Use It. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

June 9-10

MOPA: Michigan Continuing Education Meeting.

DoubleTree by Hilton Bay City-Riverfront, Bay City, MI. Now offering pedorthic continuing education credits. Contact 517/784-1142 or visit www.mopa.info.

November 9

Don’t Miss Out: Are You Billing for Everything You Can? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

December 14

New Codes and What Lies Ahead for 2017. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

O&P ALMANAC | FEBRUARY 2016

55

ASK AOPA CALENDAR

Footwear Facts Answers to your questions regarding shoes, inserts, 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.

If I did not provide a patient with his or her diabetic shoes, can I still provide that patient with diabetic inserts?

Q/

Yes, you may provide diabetic inserts for a patient for whom you did not provide shoes. However, you must obtain a written statement from the original provider of the shoes indicating that the shoes meet all of the coverage and coding guidelines found in the diabetic shoe policy. Also, be sure to verify that the patient has not already received his or her allotted inserts and/ or modifications for the year.

A/

If I custom fabricate diabetic inserts in house, must they be verified by the PDAC?

Q/

No, they do not need to be verified by the PDAC. However, you must be able to produce a list of materials used in the fabrication and a description of your fabrication process, if requested.

A/

How do I bill for a custom orthopedic shoe that is attached to a brace?

Q/

The orthopedic footwear policy provides clear guidelines regarding which code should be used to describe custom shoes attached to a brace: L3649. When billing with the L3649 for a custom shoe attached to a brace, your claim must include a brief narrative of why the shoe is custom as well as a brief explanation of why the custom shoe is needed.

A/

Do all diabetic shoes and inserts require coding verification from the Pricing, Data Analysis, and Coding (PDAC) contractor in order to be billed to Medicare?

Q/

No. The only diabetic shoe inserts, modifications, or shoes that require PDAC coding verification are inserts described by codes A5512 (prefabricated inserts) and A5513 (custom-fabricated inserts).

A/

56

FEBRUARY 2016 | O&P ALMANAC

Q/

What is the useful lifetime for an external breast prosthesis?

Typically, the useful lifetime for any item is five years, unless otherwise stated in a policy or piece of legislation.

The external breast prosthesis policy has established the useful lifetimes for certain breast prostheses under five years. For silicone breast prostheses, the useful lifetime is set at two years, and the useful lifetime for a nipple prosthesis is three months. For most other breast prostheses (e.g., fabric, foam, fiber, etc.), the useful lifetime expectancy is set at six months.

A/

The premier meeting for orthotic, prosthetic, and pedorthic professionals.

#AOPA2016

AOPAnet.org

LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON

Earn more than

32 CE

SAVE THE DATE

CREDITS

Join us September 8-11, 2016, for the 2016 AOPA National Assembly at the Hynes Convention Center in Boston, MA.  PLOT A COURSE FOR FUTURE SUCCESS with 5 concurrent sessions for Orthotists, Prosthetists, Pedorthists, Technicians, Business Owners and Managers

The O&P community has experienced stormy seas for the past several years with legislative challenges, rising costs, and reimbursement pressures. If you are looking for a lighthouse in the storm—join us at the 2016 Assembly.

Our goal is to bring our profession together to build a strong future through clinical and business education, networking and the support of a strong supplier community.

 Cruise through the stormy seas of REGULATORY RULES with answers you can only get from AOPA  Navigate the country’s LARGEST O&P EXHIBIT HALL  Sail through spectacular general sessions with inspiring KEYNOTE PRESENTERS

 Partake in FUN NETWORKING EVENTS  Enjoy exciting and HISTORIC BOSTON BACK BAY  Catch up with the ALUMNI CONNECTION  Maneuver your way with CASE STUDIES AND SYMPOSIA  GET ONBOARD with MDs, PhDs, Wound Care Specialists, Research Scientists, Attorneys, Business Experts and Top-Notch Practitioners.

Questions?

Contact AOPA at 571/431-0876 or email at info@AOPAnet.org.

For information about the show, scan the QR code with a code reader on your smartphone

Visit www.AOPAnet.org to learn more, submit a paper, or to exhibit.

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