February 2022 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

F E B R UARY 2022

Billing Under the MSP Provisions P.14

Transitioning to Value-Based Care P.30

BEIJING BOUND

ATHLETES AND THEIR PROSTHETISTS PREPARE FOR THE WINTER PARALYMPIC GAMES P.20

New! O&P Advocate Column Highlights Advocacy Efforts and Wins P.38

Quiz Me!

EARN 2 BU SI NE SS CE CREDITS

WWW.AOPANET.ORG

P.18

YOUR CONNECTION TO

EVERYTHING O&P

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WHAT IS IT? • A comprehensive certificate program that offers a series of business and management courses that provide an opportunity to explore crucial business challenges. • Administered by AOPA and the University of Hartford • Topics addressed include finance, sales and marketing, business operations, reimbursement policies, and management. • Similar to non-degree continuing education programs that universities offer in conjunction with their MBA programs. • Courses will be offered online, at the AOPA National Assembly, and at targeted seminars throughout the country.

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PUTTING YOUR BEST FOOT FORWARD

CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES

One size does not fit all. At Hersco, our team of professionals works to fabricate orthotics from your scans and casts to match your patients’ specific needs. Customer service is at the heart of everything we do and we work endlessly to help you be as effective and efficient as possible. When you want the job done quickly and accurately, Hersco is here to help.

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FE B RAU RY 2022 | VOL. 71, NO. 2

contents

FEATURES COVER STORY

DEPARTMENTS | COLUMNS Views From AOPA Leadership......... 4 What’s next for O&P

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 12

Transitions in the profession

20 | Beijing Bound Several prosthetists are working closely with Paralympic patientathletes, optimizing their prostheses and contributing to their training as they prepare to travel to Beijing for the Winter Paralympic Games March 4-13. Meet clinicians who work with a snowboarder, a skier, and a sled hockey player, and find out what they do to ensure athletes are ready for the long trip and elite-level competition. By Christine Umbrell

30 |

Setting the Stage for Value-Based Healthcare

Value-based healthcare is coming, and O&P facilities should explore partnerships that bring together clinical teams, health plans, and community patients, according to healthcare expert Ceci Connolly, who spoke to O&P executives during the Leadership Conference in January. Find out what Connolly identified as the most significant trends, challenges, and opportunities facing providers.

O&P ADVOCATE

NEW

Teri Kuffel, JD............................................................................ 38 What does it take to successfully champion O&P on legislative and regulatory fronts? Teri Kuffel, JD, explains how she combines her legal background with her O&P business expertise to advocate on behalf of the profession and its patients.

FEBRUARY 2022 | O&P ALMANAC

P.12 Reimbursement Page.......................... 14

Secondary Scenarios

Billing when Medicare is the secondary payor

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

Member Spotlight.................................42 n n

Renew Prosthetics & Orthotics Point Designs

AOPA News................................................46

AOPA advocacy, announcements, member benefits, and more

Welcome New Members................... 47 O&P PAC Update................................... 48 Marketplace.............................................. 49 Careers......................................................... 53

Professional opportunities

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

Upcoming meetings and events

Ad Index....................................................... 55 State By State........................................... 56

California, Colorado, and Texas

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VIEWS FROM AOPA LEADERSHIP

What Got Us Here Will Not Get Us There … The Future Starts Today

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

Ltogether a diverse group

AST MONTH, AOPA HOSTED its 2022 Leadership Conference, which brought of leaders from AOPA member companies. I felt particularly strongly about one session, “What Got Us Here Will Not Get Us There,” and not just because I was a panelist for that discussion. The topic interests me on multiple levels: as AOPA’s president, as an individual with limb loss/difference, as someone focused on reimbursement-related issues for a manufacturer, and as someone responsible for patientcare facilities. Joining me in this discussion were Traci Dralle, CFm; Jack Steele, CO, FAAOP; and Glenn Matsushima, CPO, to discuss several issues confronting the O&P field. Talent Acquisition and Retention. Replacing people is hard. Almost everyone in O&P is facing talent shortfalls. We are not immune to the so-called Great Resignation, which impacts all parts of our companies’ respective functional areas—clinical, administrative, manufacturing, etc. The panel discussed the following opportunities we have to address this issue: • Attracting talent by improving how we tell the O&P story/giving employees value and meaning that goes beyond a salary • Being open to technology to make people more productive and expanding use of care extenders and medical assistants to support certified/licensed clinicians • Adopting a continuous-improvement mindset when openings do occur • Investing in students—not only O&P residents, but high school or college students who may be interested in interning for you. Operational Efficiency. COVID-19 has forced us to operate in different (and sometimes leaner) ways. With inflation and reimbursement pressure, learning to run our businesses more efficiently will be critical in the coming years. Opportunities include the following: • Revisiting our materials costs: finding ways to reduce them • Performing “360” reviews of key leaders and being open to changing your organizational structure to exploit those results • Exploring central fabrication, CAD, and new socket fabrication technologies. They’re Ba-aack. Both government and commercial payors have significantly ramped up their audit activities in the past year. We can address that challenge in the following ways: • Reexamine your audit processes and make sure the right people and resources are committed to them; if you’re large enough, consider centralizing your audit response efforts • Engage in continuous, ongoing education of employees regarding both audit issues and how to bullet-proof your claims against clawbacks • Don’t skimp on the resources needed to fight audits. Outcomes. Value-based care—which multiple speakers at the Leadership Conference reminded us is coming—requires us to be documenting outcomes. How do we adapt our businesses to that new reality? • Work to make it part of your organization’s care processes • Remind staff why it’s important—there are several compelling reasons to collect outcomes • Be open to new ways of collecting outcomes (e.g., can other healthcare providers or external entities support your data collection efforts?) • Develop products that have data capture integrated into their function • Measure patient satisfaction. Speaking as someone who became an amputee in 1996, it’s indisputable that the O&P profession is vastly different today than it was then. And I think there’s a compelling argument that the profession is materially different today than it was even three years ago. In these fast changing times, AOPA will 1) continue to provide members a forum to discuss the most important topics and trends, 2) educate and advocate for the profession’s long-term wellbeing, and 3) with all of you, build a sustainable and patient-centric future that allows us all to flourish. AOPA looks forward to planning this with you in 2022 and beyond!

Dave McGill is president of AOPA.

FEBRUARY 2022 | O&P ALMANAC

Board of Directors OFFICERS President Dave McGill Össur Americas, Foothill Ranch, CA President-Elect Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Vice President Mitchell Dobson, CPO Hanger, Austin, TX Immediate Past President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS Jeffrey M. Brandt, CPO Ottobock, Exton, PA Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY Jim Kingsley Hanger Clinic, Oakbrook Terrace, IL Linda Wise WillowWood, Mount Sterling, OH Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair, Hanger Clinic, Houston Medical Center, Houston, TX James O. Young Jr., CP, LP, FAAOP Amputee Prosthetic Clinic, Tifton, GA

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AOPA CONTACTS

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

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Our Mission Statement A trusted partner, advocating for and serving the orthotic and prosthetic community by: • Fostering relationships with decision makers to ensure equitable access • Providing education that promotes professional excellence • Supporting research that informs innovative care • Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.

Our Vision A world where orthotic and prosthetic care transforms lives. EXECUTIVE OFFICES

MEMBERSHIP & COMMUNICATIONS

Eve Lee, MBA, CAE, executive director, 571/431-0807, elee@AOPAnet.org

Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org HEALTH POLICY & STRATEGIC ALLIANCES Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, awhite@AOPAnet.org

Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Nicole Ver Kuilen, manager of public engagement, 571/431-0836, nverkuilen@aopanet.org AOPA Bookstore: 571/431-0876 REIMBURSEMENT SERVICES

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

MEETINGS & EDUCATION Tina Carlson, CMP, senior director, education and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, senior manager of meetings and exhibition, 571/431-0852, kelly.oneill@AOPAnet.org Kristen Bean, digital meetings specialist, 571/431-0876, kbean@AOPAnet.org

O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/520-9632 , bob.rhmedia@comcast.net

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

FEBRUARY 2022 | O&P ALMANAC

Publisher Eve Lee, MBA, CAE

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

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, 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 info@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 © 2022 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 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2022 for advertising options!

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NUMBERS

2022 Paralympic Games Hundreds of athletes to compete in the Winter Games in Beijing

SNOWBOARD

ALPINE SKIING

Medal events

Disciplines: snowboard cross, banked slalom, and giant slalom

FEBRUARY 2022 | O&P ALMANAC

3 Feet

Length of sticks used by players to push themselves, shoot, and pass

15 Minutes

Duration of each period; three periods per game

Consecutive gold medals for Team USA, in 2010, 2014, 2018

Medal events

TECHNICAL REPAIR STATIONS Ottobock will once again serve as the Official Technical Service Provider for the Paralympic Games. Three technical repair service centers staffed by 42 team members will be located across the Paralympic Villages—Beijing, Yanqiing, and Zhangjiakou— so that athletes may access free maintenance and repair service. Ottobock expects to make about 500 repairs in Beijing.

Technical disciplines: slalom and giant slalom

PHOTO: Getty Images for Ottobock

Third

Appearance at Paralympic Games; first contested in 2014

Shuey Rhon Rhon, the Beijing 2022 mascot, is a Chinese lantern child, which represents harvest, celebration, warmth, and light.

SLED HOCKEY

Players per team at a time, including the goalie

MEET THE MASCOT

Speed disciplines: downhill, super-G, and super combined

SOURCES: International Paralympic Committee; paralympic.org; www.teamusa.org; https://www.nbcolympics.com/news/2022-paralympic-winter-games-what-you-need-know; ottobock.com.

Competitors will travel to Beijing, China, March 4-13, for the 2022 Paralympic Games. A maximum of 736 of athletes will compete in six sports—alpine skiing, biathlon, cross-country skiing, sled hockey, snowboarding, and wheelchair curling—for 78 medal events. For details about several of the competitors and their clinicians, read “Beijing Bound” on page 20.

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Happenings INSURANCE INSIGHTS

RESEARCH ROUNDUP

Record Enrollment in ACA Marketplaces

Researchers To Develop Measure of Prosthesis Awareness

More than 14.5 million

SOURCE: “Marketplace 2022 Open Enrollment Period Report,” CMS.gov.

lower-limb loss need to “pay attention” to their prosthesis during activities, as well as how much they need to pay attention to changes when using a microprocessorcontrolled knee. Darter and his team are in the initial stages of developing a measurement tool to assess elements of function and to understand how technological advances benefit prosthesis users. The measure will be designed to assist clinicians in their ability to understand the walking abilities of patients with lower-limb loss, to ultimately improve mobility.

PHOTO: Getty Images

Americans signed up or were automatically reenrolled in 2022 individual market health insurance coverage through the Affordable Care Act marketplaces during the open enrollment period. Approximately 11.5 million returning consumers and 3 million new consumers will be covered by ACA plans this year.

The Department of Defense has awarded a $1.97 million grant to Benjamin Darter, PhD, to study the impact of microprocessorcontrolled knees on prosthesis awareness and overall health. Darter, an associate professor at Virginia Commonwealth University’s College of Health Professions, will collaborate with the University of Washington and Hanger Institute for Clinical Research and Education to develop a measure assessing how much individuals with

Scientists Create Anthropomorphic Robotic Hand

FEBRUARY 2022 | O&P ALMANAC

PHOTO: Uikyum Kim, PhD

South Korean researchers Uikyum Kim, PhD, from Ajou University and Dawoon Jung from Korea University have developed the ILDA hand, an integrated linkage-driven dexterous anthropomorphic robotic hand. The prosthesis has been designed to be dexterous, with a high degree of control, while remaining low cost and low maintenance, according to the researchers. The compact design features 15 degrees of freedom in 20 joints and a fingertip force of 24 newtons. Five fingers with fingertip sensors are integrated with 15 motors. Kim and Jung led experiments demonstrating that the hand can hold an egg without cracking it, pour drinks, cut paper using scissors, and manipulate tweezers. “Existing prosthetic hands have implemented the simple function of grasping objects. The ILDA hand is capable of delicately or strongly grasping objects of various shapes, as well as manipulating complex tools used in daily life,” said Kim. “It is expected that future prosthetic hands will be developed in such a way that most of the tasks currently performed by human hands are possible.” Kim and his team plan to expand this project by developing a flexible, artificial skin to cover the current prototype. Details were published in December in Nature Communications.

HAPPENINGS

Study Finds MPKs Reduce Injurious Falls Among Individuals With Diabetes Researchers from Hanger Institute for Clinical Research and Education completed the Stability and Falls Evaluation After Amputation (SAFE-AMP) 1 study to evaluate the impact of microprocessorcontrolled knees (MPKs) on rates of injurious falls among diabetic and dysvascular people with above-knee amputations. Results were published in January in Assistive Technology Journal. The researchers—Shane Wurdeman, MSPO, PhD, CP, FAAOP(D); Taavy A. Miller, PhD; Phillip M. Stevens, MEd; and James Campbell, PhD—analyzed data associated with nearly 900 diabetic prosthesis users with above-knee amputations who were eligible for MPKs, and studied their gender, age, time since amputation, and body mass index adjusted for limb loss. They concluded that an MPK can decrease odds of an injurious fall by 250% for individuals

with amputation due to diabetes or dysvascular disease. In addition, not providing a diabetic patient with an MPK increases their risk of falling, more than the risk associated with aging. The study is anticipated to be the first in a series that will examine the need for greater access to appropriate rehabilitation solutions for below- and above-knee amputees in the diabetes community. “Hanger is committed to conducting innovative research to advance clinical care for patients relying on orthoses and prostheses,” said Campbell, who is Hanger chief clinical officer. “Our SAFE-AMP findings illustrate that further work is warranted to better understand how all possible orthotic and prosthetic care solutions can help improve clinical outcomes and quality of life for the diabetic patient population.”

RAISING AWARENESS

Celebrate Patients in April The O&P community is preparing to celebrate Limb Loss Awareness Month. Started by the Amputee Coalition in 2010, Limb Loss and Limb Difference Awareness Month takes place each year in April. The Amputee Coalition is asking that individuals with limb loss share their “moments that matter” by writing a story, recording a video, or talking about a time in their life when they felt strong, scared, confident, in pain, or happy. Encourage patients to visit amputee-coaliton. org to participate this year.

FAST FACT

Amputation Causes

DIABETES DOWNLOAD

Children With COVID-19 at Increased Risk for Diabetes Patients younger than 18 with COVID-19 were more likely to receive a new diabetes diagnosis 30 days or longer after infection than were individuals without COVID-19 and those with prepandemic acute respiratory infections, according to a study released in January by CDC. CDC researchers estimated diabetes incidence among patients younger than 18 with diagnosed COVID-19 from retrospective cohorts constructed from two sources: IQVIA healthcare claims between March 1, 2020, and Feb. 26, 2021, and data from HealthVerity that included patients who had any health encounter related to COVID-19 between March 1, 2020, and June 28, 2021. Among these patients, diabetes incidence was 166% higher among those with COVID-19 than among

those without in the IQVIA database, and 31% higher among those with COVID-19 in the HealthVerity data. The researchers noted the findings were consistent with previous research demonstrating an association between COVID-19 infection and diabetes in adults. The observed association between diabetes and COVID-19 “might be attributed to the effects of SARS-CoV-2 infection on organ systems involved in diabetes risk,” according to the researchers. They suggest that healthcare providers should screen for diabetes symptoms in individuals younger than 18. “SARS-CoV-2 infection might lead to type 1 or type 2 diabetes through complex and different mechanisms,” they concluded. The full study was published in Morbidity and Mortality Weekly Report.

More than half of amputations in the United States are caused by vascular disease, which includes diabetes and peripheral arterial disease. 54%

45%

2% Vascular disease

Trauma

Cancer

SOURCE: “Limb Loss in the U.S.,” Amputee Coalition

O&P ALMANAC | FEBRUARY 2022

HAPPENINGS

ATHLETIC ENDEAVORS

Runner Sets World Record

progressing toward his goal of completing a marathon in less than two hours. Several additional Team Össur athletes completed the New York Marathon with impressive times, including Paralympic athletes Richard Whitehead from the United Kingdom and Rudy Garcia-Tolson from the United States, who also ran in the bilateral amputee athlete category. In addition, eight-time South African Paralympian Ernst van Dyk Africa competed in the wheelchair division.

Marko Cheseto set a world record among bilateral limb loss athletes at the 2021 New York Marathon with a time of 2:35:55.

PEOPLE & PLACES PROFESSIONALS IN MEMORIAM

Daryl William (Bill) Sandberg passed away in Mountain Home, Arkansas, January 4. Sandberg, who grew up in Minnesota, worked in the O&P profession for 45 years. Sandberg became a certified prosthetist in 1974 Daryl William after completing programs at New York University and (Bill) Sandberg Northwestern University. Early in his career, he worked for Otto Bock and Winkley Orthopedic Laboratories in Twin Cities. In 1978, he founded Sandberg Prosthetic Services, a company dedicated to the central fabrication of upper- and lower-limb prostheses. In 1997, Sandberg launched SPT Technology Inc., focusing on the manufacture and distribution of products that support the O&P industry. He grew the business into a global company, serving customers domestically and in 20 countries. He became known for his innovative techniques, components, and materials design. Sandberg also was a prominent figure in O&P education. In 1974, he was among the first of three instructors that founded Century College’s O&P technician program. He also was heavily involved in AOPA and the American Academy of Orthotists and Prosthetists. Sandberg retired from O&P in 2011 and split time in residences in Priest River, Idaho, and Mountain Home, Arkansas. He is survived by his wife Mary and sons Don and Tom, as well as several grandchildren. In remembrance of his life, the family asks that any charitable donations be made in his name to the Animal Humane Society or Shriner’s Hospital.

FEBRUARY 2022 | O&P ALMANAC

ANNOUNCEMENTS AND TRANSITIONS

Adriane Griffen, DrPH, MPH, MCHES®, CNED, has been appointed executive director of the American Academy of Orthotists and Prosthetists. Prior to joining the Adriane Griffen, Academy, Griffen served as senior DrPH, MPH, director of public health and leadership MCHES®, CNED for the Association of University Centers on Disabilities for five years; as director for the National Center on Disability in Public Health for four years; and in various health promotion and partnership development leadership roles. “I am honored to serve the O&P profession as executive director of the Academy,” said Griffen. “O&P professionals provide a valuable service to an ever-growing and diverse patient population. I look forward to growing the profession by aligning the Academy with other public health organizations to ensure that O&P professionals are seen as valued members of the healthcare team.” “The Academy board and I are thrilled to have Adriane as the organization’s new executive director,” said Sarah Thomas, CPO, FAAOP, Academy president. “Her experience in the public health space is valuable, as is her ability to lead us into the future with the Academy’s core pillars as a guide.”

PHOTO: Courtesy of ÖSSUR

Marko Cheseto set a world record among bilateral amputee athletes when he completed the 2021 New York Marathon in 2:35:55. Cheseto, a Team Össur member, was born in Kenya and came to the United States on an athletic scholarship at the University of Alaska. He set several collegiate track-and-field records before losing both legs below the knee in 2011, due to an accident that resulted in severe frostbite. In the 10 years since his amputation, he has completed six marathons, and has continued

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REIMBURSEMENT PAGE

By DEVON BERNARD

Secondary Scenarios Tips for billing correctly when Medicare is the secondary payor

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80%, and AOPA will transmit the information to the certifying boards.

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OME OF THE MORE confusing

billing scenarios are those involving multiple payors. When there is more than one payor, questions arise regarding who needs to be billed first, how much each payor will pay, and what happens if the primary payor fails to pay a claim. Fortunately, when one of the payors involved is Medicare, the answers to those questions can be easily found by examining the Medicare as Secondary Payor (MSP) provisions and regulations. Several MSP scenarios always render Medicare the secondary payor, meaning that the patient’s other insurance must be billed, and an explanation of benefits acquired, before you may bill Medicare. These situations involve the working aged, workers’ compensation, no-fault and liability insurance, end-stage renal disease (ESRD), and disabled beneficiaries. This month’s Reimbursement Page examines each of these situations and offers insight into how each program operates, as well as how each program affects Medicare’s payment status.

Working Aged

FEBRUARY 2022 | O&P ALMANAC

PHOTO: Adobe Stock

The most common scenario that makes Medicare the secondary payor is the MSP Working Aged program. Individuals involved in this program have become entitled to Medicare benefits, based on age, but have not yet retired. For

patients to be considered working aged, they must be at least 65 years old and enrolled in their employer’s group health plan (EGHP); the employer must have at least 20 employees. The EGHP also may cover the patient’s spouse, who would be considered working aged, even if they are currently retired. For the purpose of the MSP Working Aged provision, a “spouse” is defined as “a person whose marriage is valid in the jurisdiction in which it was performed, including one of the 50 states, the District of Columbia, or a U.S. territory, or a foreign country, so long as that marriage would also be recognized by a U.S. jurisdiction.” In addition, any time an employer, insurer, third-party administrator, group health plan, etc., has a more inclusive definition of spouse, it may assume primary payment responsibility for the individual in question; and if the individual is reported as a spouse, Medicare will pay accordingly. Keep in mind that if the patient has a retirement plan through their employer and they are 65 or older, the retirement plan will always be secondary to Medicare. In addition, if the patient chooses not to be covered by the EGHP and wants Medicare as their primary insurer, they cannot also receive benefits from the EGHP; it may only be one or the other.

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will expire 12 months after their last dialysis treatment or 36 months after a successful kidney treatment. So, if you have a patient who has Medicare coverage due to ESRD, you should routinely check their coverage or status, because who is primary and secondary can shift, and they may no longer have Medicare coverage.

Disabled Beneficiaries

Workers’ Compensation

Another common scenario involves workers’ compensation claims—claims that are the result of an injury that occurred on the job. Medicare normally will not make payments on a workers’ compensation claim, but there are times when you may send a worker’s compensation claim to Medicare. If you don’t agree to accept the workers’ compensation payment as your payment in full, and your state allows you to collect your full charge, you may then submit the workers’ compensation claim to Medicare for secondary payment.

No-Fault and Liability Insurance

FEBRUARY 2022 | O&P ALMANAC

End-Stage Renal Disease

If a patient is diagnosed with ESRD, they are entitled to receive Medicare benefits, even if they are under the age of 65. If ESRD is the only reason a patient has Medicare benefits, and they are covered by an EGHP, then Medicare will be secondary to the EGHP. The ESRD program is a little more complicated than some of the other provisions or scenarios because there are certain situations when Medicare will retain its primary payor status when a patient has ESRD. Medicare will be secondary for ESRD patients for a total of 30 months, which is called the ESRD coordination period. The coordination period begins when the patient first becomes eligible for Medicare benefits. After the coordination period ends, Medicare will become the primary payor. If the patient is under 65 and is eligible for Medicare benefits solely because of ESRD, the patient also is entitled to all Medicare benefit categories, not just those related to the treatment of the ESRD. However, their entitlement to Medicare benefits

Determining If Your Patient Has Insurance Primary to Medicare Medicare and the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have created a questionnaire that your office may use to determine if a patient has insurance primary to Medicare. The questionnaire is lengthy and extremely thorough.

PHOTO: Adobe Stock

No-fault and liability insurance programs involve coverage by an insurance company, typically involving some type of accident that does not occur at work. No-fault insurance, also known as personal injury protection or medical expense coverage, covers expenses due to injuries that occurred on the insured’s property, or in the use of the insured’s vehicle, regardless of who is responsible for the accident. Liability insurance applies when someone is found to be at fault for causing an injury, and payment is

based on the policyholder’s legal liability for injury. The two most common types of liability insurance are auto and malpractice insurance.

Medicare provides benefits and coverage to anyone who has a permanent disability regardless of their age. If someone is receiving Medicare benefits because of a disability, Medicare will usually be primary. However, it is possible for Medicare to become the secondary payor when certain criteria are met. First, the patient must be under 65, receiving Medicare benefits solely because of a disability, and have other healthcare coverage under a large group health plan (LGHP). The coverage from the LGHP may be through the patient’s current employment or the current employment of a family member, such as a parent or a spouse. An LGHP is slightly different than an EGHP discussed in relation to the MSP Working Aged provision above. In order for a group health plan to be considered an LGHP, at least 100 people must be employed by the sponsoring company, or in the case of a plan that covers multiple employers, at least one employer in the group must have at least 100 employees. For example, if Mr. Jones is covered by an LGHP and he has a disabled son who has qualified for Medicare due to his disability, the LGHP would be billed as the primary and Medicare as the secondary for any of the child’s medical expenses— not just those related to the disability.

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If you don’t want to use the questionnaire, you may instead use it as a guide to create a questionnaire of your own. You also may contact the Benefits Coordination & Recovery Center, the contractor responsible for maintaining and reporting insurance coverage for Medicare patients, at 855/798-2627. If you call, they will only be able to inform you that the patient has an insurer primary to Medicare, but they cannot provide you with any other information; you must obtain all other information from the patient.

Calculating Medicare’s Payment

When dealing with the MSP provisions, one of the biggest questions is: What will Medicare pay? Medicare will never pay more than its allowable, so the most Medicare will pay in an MSP claim is its allowable. The exact amount Medicare will pay is determined using a set of three calculations; Medicare will pay the lesser of the amounts derived from the three calculations: • Calculation 1: Medicare determines the amount they would pay if they were primary, or if they were the only payor. • Calculation 2: Medicare calculates its liability with regard to the primary insurer’s payment. This calculation is done by subtracting the primary insurer’s payment (what it actually pays) from either the Medicare allowable or insurer’s allowable (how much it could pay). • Calculation 3: Subtract the submitted charge minus the payment made by the primary insurer. These calculations can get confusing. Fortunately, each of the DME MAC websites features aids or calculators to help you determine Medicare’s liability in MSP scenarios.

What happens if the primary payor does not or cannot pay you in a timely manner? Will Medicare make a payment or default to the primary payor? 18

FEBRUARY 2022 | O&P ALMANAC

responsibility for medicals (ORM). These are defined as “an administrative mechanism used to allocate a portion of a settlement, judgment, or award for future medical and/or future prescription drug expenses.” In situations when a set-aside arrangement or an ORM has been put in place, you may not bill Medicare until you can provide evidence that the money in the set-aside agreement or ORM has been exhausted and the money was spent on appropriate medical expenses. This may include getting documentation from the patient and/or their attorney, or the insurance company. Once the set-aside amount is exhausted and accurately accounted for, Medicare will pay primary for future Medicare-covered medical and/or prescription drug expenses related to the injury or illness or disease. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: www.bocusa.org

PHOTO: Adobe Stock

Set-Aside Arrangements and Conditional Payments

Typically, under the MSP provisions, Medicare will not pay primary for items when payment has been or is expected to be made. However, with liability insurance, no-fault insurance, and workers’ compensation insurance claims—and to some extent claims involving group health plans—you have the ability to seek a conditional payment. Medicare may make a primary payment when there is evidence that the primary payor will not or cannot pay the claim promptly. This payment will only be made on the condition that upon final reimbursement by the primary payor, Medicare will recover their payment, and this will typically be directly from the payor. If you believe the primary insurer will not pay your claim in a prompt manner, defined as more than 120 days, you may submit the claim to Medicare. However, if it is determined that someone else should have paid first or you eventually receive payment from the primary insurer, you must refund Medicare. Keep in mind that you may not seek primary payment from two insurers at the same time. If you choose to seek a conditional payment from Medicare, you must withdraw any claims you have with the primary insurer and drop any liens or collections you may have placed on the beneficiary. In some claims involving workers’ compensation, or no-fault or liability insurance, the claim may involve a “set-aside arrangement,” an ongoing

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Beijing Bound

Paralympic athletes prepare for the Winter Games—with a little help from their committed prosthetists By CHRISTINE UMBRELL

NEED TO KNOW • Elite-level athletes from across the country will travel to Beijing to compete in the 2022 Winter Paralympic Games, March 4-13. • Athletes with limb loss form close connections with their prosthetists, relying on their expertise with their devices as well as their understanding of their sport and training requirements. • Some prosthetists are athletes themselves, and may display a competitive spirit in seeking to design the most appropriate and efficient prostheses for patients. • Most athletes look to their prosthetists to help them understand the mechanical aspects of their devices—and some go a step further, learning to replace their own sleeves, change valves, and more. • Prosthetists emphasize an individualized approach to patient care and open lines of communication, with both elite athletes and less active prosthesis users, to ensure optimal outcomes. 20

FEBRUARY 2022 | O&P ALMANAC

COVER STORY

HO BETTER TO understand

the unique prosthetic needs of a highly active, elite-level athlete than another highly active, elite-level athlete? For Paralympic snowboarder Evan Strong, having his prosthetic needs met by friend and prosthetist Ronnie Dickson, CP, has been a formula for success. Dickson, founder of the Chattanooga, Tennessee, branch of Prosthetic & Orthotic Associates (POA) and winner of several national adaptive climbing competitions, met Strong when they two men were just 19 years old, and formed a friendship that predates their professional relationship. Strong will compete in the Beijing Winter Games as a member of the U.S. Paralympics Snowboarding National Team, having earned a roster spot after winning two gold medals in the men’s SB-LL2 class in the Austria World Cup late last year. Eight years ago, Strong became the first man to win a Paralympic gold medal in snowboarding when he won the inaugural snowboard-cross event in Sochi. He went on to win a silver medal in 2018 in banked slalom. Strong turned to snowboarding after losing his left leg below the knee in a motorcycle accident right before his 18th birthday. A former child competitive skateboarder, he was immediately drawn to adaptive athletics postamputation—an interest he shares with Dickson. Dickson’s left leg was amputated above the knee when he was 17, after years of congenital pain. For three years postamputation, Dickson experienced problematic prosthetic pain and discomfort, until he met Stan Patterson, CP, LP, founder of POA, who provided his first well-fitting prosthesis.

O&P ALMANAC | FEBRUARY 2022

COVER STORY

Dickson first met Strong when both participated in the 2007 Extremity Games. “I was competing in rock climbing, and [Strong] was competing in rock climbing and skateboarding,” Dickson recalls. “With both of us being right around the same age, we hit it off with a friendship.” The following year, they roomed together at the 2008 Extremity Games.

Paralympic

Snowboarding Events Evan Strong hopes to compete in

only one rider at a time with their

both snowboard-cross and banked

best run determining their placement

slalom at the 2022 Winter Paralympics.

for head-to-head brackets. Finals

Snowboard-cross (also known as snowboarder X, SBX, boarder cross, boarder-X, or BX) is a snowboard

consist of two competitors per heat, fastest rider to the finish advances. In banked slalom, each athlete

competition that first consists of a

gets three runs down the course,

time-trial; three runs down a course,

with their best run determining the final results based on ascending time. There is only one rider on the course at a time. The course may be a medium pitched slope. It may be preferably a naturally varying terrain, with plenty of bumps and dips, and preferably a U-shape/natural valley.

Evan Strong (center) took gold at the Austria World Cup late last year.

FEBRUARY 2022 | O&P ALMANAC

Ronnie Dickson, CP, was a national champion in adaptive rock climbing in 2021—in addition to serving as Strong’s prosthetist.

PHOTOS: Courtesy of Ronnie Dickson, CP

PHOTOS: Courtesy of Evan Strong

Two years later, their friendship evolved when Dickson—who continued to compete in adaptive rock-climbing—began his prosthetics residency, under the supervision of Patterson. Dickson saw Strong at the Challenged Athletes Foundation San Diego Triathlon Challenge, and noticed his prosthesis was well-worn and needed some adjustments. Dickson brought Strong Strong and Dickson to the Southern first met 15 years California ago, when both combranch of peted in the 2007 POA, were he Extremity Games. helped “tidy up” Strong’s prosthesis, with Patterson’s guidance and generosity. “That’s where things went from a friendship to a working relationship, when I started working with Evan on his prosthesis.” Dickson continues to serve as Strong’s prosthetist today. Strong himself truly appreciates being cared for by another athlete. Dickson “doesn’t just hear what I’m saying; he gets what I’m saying,” Strong explains. “I’ve really been pushing my prosthesis to the extreme. I need a bunch of range of motion to move on my snowboard, but I also need a lot of control. It really becomes a limb,” a concept that Dickson intimately understands.

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COVER STORY

Going for Gold

Guillermo “Will” Castillo, captain of the USA Para Bobsled Team, trains at Prosthetic & Orthotic Associates in Orlando, under the supervision of Stan Patterson, CP.

Bobsled Athlete Hopes to

Compete in Future Paralympics Not all winter sports have been

Prosthetic & Orthotic Associates (POA)

recognized as official sports at the

in Orlando, overseen by his prosthetist,

Paralympic Games, so some athletes

Stan Patterson, CP. The POA facility

who compete at high levels must

features a full gym and trainers who

demonstrate their skills at alternate

are experienced in running, agility

competitions.

training, and functional movements,

Guillermo “Will” Castillo, for example, Team, but bobsled is not yet an event

allowing Castillo to train and prepare for upcoming competitions. Castillo remains hopeful that he

in the Paralympic Games. Castillo, who

will one day be able to compete in

lost his leg above the knee in combat

the Paralympic Games. It was recently

while serving in the U.S. Army, is ranked

announced that bobsled will not be an

No. 1 in the United States for seated

event in the 2026 Games in Milan and

para bobsled, and No. 7 in the world.

Cortina d’Ampezzo, Italy, but Castillo

Castillo trains almost every day at

and others plan to appeal that decision.

FEBRUARY 2022 | O&P ALMANAC

PHOTO: Prosthetic & Orthotic Associates

is captain of the USA Para Bobsled

Working with elite athletes means “executing at a really high level,” according to Dickson. “As a professional, you put your best foot forward to make somebody the best possible device that you can craft. So there’s a little bit of that challenge, because you know that if your skill level [at designing prostheses] combines with that individual’s skill level [at their chosen sport], it’s going to be a recipe for success.” Dickson was a national champion in 2021 in adaptive rock climbing, has participated in five U.S. teams, and was awarded a silver medal twice in international competitions. Being an athlete has taught him to work closely with patients and to listen to their ideas when selecting and fitting a prosthesis. In working with Strong, Dickson seeks to ensure the snowboarder understands all aspects of his prosthesis. Strong uses a Biodapt Versa foot, created by Mike Schultz, paired with “a pretty standard total-surface bearing suction socket,” says Dickson. The prosthesis features an upgraded shock linkage system and heel strike dampener, which provide stability and control for Strong, as well as a barefoot Vibram sole plate. “We have it set up very simply, so it’s all serviceable in the field,” he adds. Dickson works with Strong to tune his prosthesis and snowboard in his office in Chattanooga, “but then he’s going off to Colorado to train, or Austria to compete, and each one of those racecourses is going to be a little bit different. In some of these situations, his needs are going to change, and I’m not going to be there to be able to help him with that,” says Dickson. “So I have to make sure, as we go through these fittings, that I’m keeping him involved in everything we’re doing together, so that he ultimately has the knowledge necessary to do what he needs to do when the time comes,” for example, replace his own sleeve, change a valve, or adjust toe-in/toe-out.

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COVER STORY

Dickson tries to help each patient achieve their goals at every clinical encounter. “It comes down to attention to detail. With the athletes, what you learn is that you really need to optimize every bit of percentage of that prosthesis, because they’re going to actually be able to tap into it and use it,” Dickson says. “You get to hone in on that part of your craft.” He approaches all clinical encounters with that mindset. “Even if they’re not going to be able to tap into it 100%, I still want to make sure I paid attention to all those little details, to put my best game forward every time,” he says. “Whenever I put a device out, it’s a reflection of who I am, and I want it to be as excellent as I can make it.”

Being a Team Player

FEBRUARY 2022 | O&P ALMANAC

caliber. I was inspired by her eagerness to be as active as possible.” Doederlein, a bilateral above-knee amputee who plays sled hockey for the San Diego Ducks and hopes to compete for Team USA as a skier in Beijing, doesn’t wear her prosthetic legs while competing, but she relies on them to get to practice, when traveling, and throughout her daily activities. When she became Baril’s patient, Doederlein was in ischial containment sockets that worked well, “but with how much pressure she was putting through her ischium during training, she was getting skin breakdown,” recalls Baril. “We took a leap together and changed the design to subischial, which relieved the skin and allowed for more hip range of motion.” Doederlein uses microprocessor knees, which allow her to have a more energy-efficient gait than with nonmicroprocessor knees, according to Baril. “This means she can use that extra energy she has saved when she’s at the gym training for her next competition.” When it comes to treating elite-level

athletes, “we need to keep additional factors in mind when designing the prosthesis and selecting the componentry, because their activity levels are significantly higher than most of our other patients,” says Baril. “We need to be on the top of our game, in regard to new designs and technology, so they can be at the top of their game.” Baril enjoys the close relationship she has formed with Doederlein. “Lera has invited me to practice sled hockey with her,” she says. “Once her 2022 Paralympics journey is complete, I’m looking forward to getting out on the ice and observing her in that environment—even though she has promised to ‘check me.’”

Prosthetic Problem-Solving

Fred Schaumburg, CP, has been working with Josh Pauls, captain of the Team USA sled hockey team, for more than a decade. Pauls, who was born without tibia bones and had both legs amputated at 10 months old, is a threetime Paralympic gold medalist, and hopes to win a fourth gold in Beijing.

PHOTO: Hanger Clinic/Lera Doederlein

Strong and Dickson share a unique history, but many other prosthetists have formed strong bonds with their athlete-patients. Danielle Baril, MSPO, CPO, says she and Lera Doederlein, a Nordic skiing Paralympic hopeful, “immediately clicked” when Doederlein became her patient. “I was extremely lucky to meet Lera when she moved to San Diego from Arizona in 2018,” says Baril, clinic manager at Hanger Clinic in San Diego. “She was in need of a new prosthetist, and I was looking to expand my knowledge and skills. I’ve worked with other athletic patients, but none of her

Lera Doederlein plays sled hockey for the San Diego Ducks and hopes to compete for Team USA as a skier in Beijing.

PHOTO: International Paralympic Committee

COVER STORY

Schaumburg, a Hanger Clinic national upper-limb specialist based in St. Louis, has played an important part in helping Pauls train for competition. He recalls the first time he worked with Pauls, right after the athlete moved to the St. Louis area for college more than 10 years ago. “He was having issues with the bilateral above-knee prostheses he was wearing at that time,” says Schaumburg. “After some discussion with Josh, we decided to try traditional suction transfemoral sockets instead of the thick cushion gel liner sockets that he was wearing. He was happy the first time he walked with this style of socket, immediately noticing the lack of bulk and improved suspension and prosthetic control the sockets offered.” While Pauls competes without prostheses—as is the rule for sled hockey—his devices are critical for training off the ice, including in the gym and during everyday activities.

OP_almanac_Feb2022.indd 2

Josh Pauls of USA (left) and Billy Bridges of Canada in action during the world para ice hockey championship match between Canada and the United States in Ostrava, Czech Republic, April 27, 2019. “I see Josh for traditional follow-up appointments to adjust for optimal function and fit, to ensure his legs are operating well for his day-to-day mobility, as well as the training and travel being an athlete of his caliber requires,” Schaumburg says. “I’ve

also supplied belts for secondary suspension during Josh’s weight and cardio training.” Schaumburg emphasizes the importance of an individualized approach to care—with both elite athletes and less active prosthesis

1/13/2022 3:03:52 PM O&P ALMANAC | FEBRUARY 2022

COVER STORY

Dickson says he competes with himself to provide the most optimal prosthesis for each patient, regardless of age or ability.

Tips for Treating

Patient-Athletes Experienced prosthetists share their advice for best results when working with athletic patients:

“Be a sponge,” says Ronnie Dickson, CP, founder of the Chattanooga, Tennessee, branch of Prosthetic & Orthotic Associates. “Listen to what the patient’s experience has been—what’s worked well, what hasn’t worked well. And then, as you’re formulating that treatment plan, you can provide some counterpoints to their feedback, and see how, within your skill set and within what that individual wants—where that middle ground is. How can you help this person meet their goals while still utilizing the best things that you have to offer out of your skill set?”

“Be open to new ideas, components, and designs,” says Danielle Baril, MSPO, CPO, clinic manager at Hanger Clinic in San Diego. “What wouldn’t work for most patients can work for these highly active patients. Don’t be afraid to reach out to other practitioners and seek advice. Our patients rely on our devices to succeed. These patients might have a coach/trainer and a physical therapist; we need to be another supporting figure in this ‘pit crew.’”

“Listen to your patient’s feedback,”

FEBRUARY 2022 | O&P ALMANAC

Mutual Wins

For Dickson, Baril, and Schaumburg, working with elite-level athletes has pushed them to sharpen their prosthetic skills while empowering their patients to excel in their sports. Says Dickson, “What’s been so incredible for me is the fact that [Strong and I] met when we were both so young, and here we are now in our mid-30s and have so much amazing life experience under our belts, through adaptive sports. It’s been a lot of fun.” After all of the preparations, training, and prosthetic fine-tuning, Strong, Doederlein, and Pauls are ready to compete at the highest level in Beijing. “I head into competition with the goal to give my best performance to date, to showcase myself and good snowboarding,” says Strong. “It’s an adventure!” Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

PHOTO: Ronnie Dickson, CP

says Fred Schaumburg, CP, a Hanger Clinic national upper-limb specialist. “A prosthesis that may work well for general community use often does not perform up to the requirements of high-activity tasks. Teamwork is critical in achieving the optimal outcome. Ask for assistance from other prosthetists, athletic trainers, physical therapists, etc. Don’t forget to include the patient, as he or she is the most valuable team member and is the one who has to use the devices that we make. Highly active patients often have an idea of what they need before they even come in to see their prosthetist. They have researched online what others are utilizing and can form opinions even before coming into our offices. It is important to establish the team mentality early, encouraging different ideas and discussing treatment options openly. Through this open team discussion, the best prosthetic outcomes are often achieved.”

users. “Each person has their own unique set of requirements, goals, and challenges,” he says. “A newly amputated diabetic may have frequent volume fluctuations, weaknesses, and range-of-motion restrictions that we need to accommodate for, while a Paralympic athlete generally does not have these restrictions. Rather, an athlete may require enhanced socket flexibility, secondary methods of suspension for security during high stress activities, or environmental considerations. Each patient that we see has their own set of unique challenges that we must meet, regardless of their athletic prowess.” He also notes the importance of new and emerging technologies. When working with more active patients, Schaumburg has incorporated adjustable socket technology, as well as silicone interfaces and a unique modification to the traditional ischial containment design. These advancements have improved both comfort and function for athletes, according to Schaumburg.

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Setting the Stage for

Value-Based Healthcare Healthcare expert Ceci Connolly discusses healthcare trends, challenges, and opportunities that may impact O&P facilities

FEBRUARY 2022 | O&P ALMANAC

.S. HEALTHCARE IS slowly transi-

tioning away from fee-for-service and toward a value-based model, which offers benefits for patients and providers alike, according to Ceci Connolly, president and CEO of the Alliance of Community Health Plans and former Washington Post reporter. Connolly shared her perspective and offered her thoughts on the challenges, trends, and opportunities facing healthcare providers when she spoke on “Reimagining the Future of O&P: Harnessing the Intersection of Humanity and Technology” during AOPA’s Leadership Conference in January. During her presentation to O&P executives and business owners, Connolly emphasized the benefits of a partnership model, which brings together clinical teams, health plans, and community patients, “preferably in some sort of value-based arrangement,” so that the financial incentives favor the patient and their health outcomes. “Personalized, targeted medicine for the individual that suits them, that is proven, that is not unnecessary or inappropriate,” should lead to improved patient outcomes and more costeffective healthcare, Connolly said.

Current Challenges Highlight Need for Change

One of the most challenging aspects of the current U.S. healthcare climate is cost, compared to outcomes. Connolly pointed out that even though U.S. per capita healthcare spending exceeds comparable countries, it ranks “No. 1” at chronic disease burden and obesity and has the highest number of hospitalizations from preventable causes, as well as the highest rate of avoidable deaths, compared to similar industrialized nations. She noted that the

“If you want to improve the health of a community, just getting people fed can be one of the quickest ways to bump up the health of that population.” United States is “great at a lot of things in medicine,” such as cancer detection and treatment as well as development of COVID-19 vaccines, “but when you look at some of these very basic measures across the entire population, like mortality rates, many of our citizens are dying younger now than they were just a few years ago.” In addition, disparities in coverage of care as well as health inequities are longstanding issues that were “brought out into the forefront” during the COVID-19 pandemic, according to Connolly. She pointed to studies demonstrating that the life expectancy, health, and socioeconomic status of people of color, as well as marginalized communities and individuals in rural areas, are not comparable to the health and well-being of others. “Very little has changed in decades,” she said, adding that these communities often experience a lower quality of care, as well as bias. Connolly also cited recent studies highlighting how race and socioeconomic status impact the O&P patient population. “Black Americans are four times more likely to experience amputation for any reason than white Americans,” she said. “Latinx Americans are almost two times more likely to experience amputation.”

She also noted that hunger and housing issues are hurdles to improving healthcare. “Social determinants of health, the connections between food or hunger and your health status, your health and wellbeing, are breathtaking,” she said. “If you want to improve the health of a community, just getting people fed can be one of the quickest ways to bump up the health of that population.” She noted that some healthcare companies are starting to study the housing issue, including UPMC, headquartered in Pittsburgh. “They are doing some really cutting-edge work in the area of housing and then incorporating medical services, including behavioral health interventions,” she said. “It’s phenomenal, but … it takes capital. It takes labor, and you kind of are doing it one family at a time. So getting to scale is hard.” Connolly emphasized the need to curate targeted, actionable data to help address inequities problems. “There are some people that have transportation problems. There are some people that are hungry. You need to know the difference, or you’re going to waste a whole bunch of time and money on something that is not targeting one of the root causes of those disparities,” she said. O&P ALMANAC | FEBRUARY 2022

She anticipated that the federal government will take a leading role, but suggested that the healthcare sector should be informing “what the federal government is going to say about data collection monitoring, and then in short order, incentives.” CMS will start to build in quality measures, “maybe even tied to payments,” predicted Connolly. State Medicaid procurement bids are sometimes requiring healthcare providers to use data to show they plan to close gaps within certain populations, and to improve quality in certain populations,

something, every time they write a prescription, take an X-ray, perform a surgery, put you in a hospital bed, do tests, do more tests, write another prescription,” she said. This fee-for-service model has resulted in “phenomenal waste in the system,” according to Connolly, by means of errors, duplication, and unnecessary care. “Economists will tell you, everybody is doing exactly what you would expect them to do” given the fee-for-service model, Connolly said. “It’s rational behavior, so we need to change the incentives.”

is here to stay, and that many seniors are “choosing” the plans. Among minority populations, “50% of African American seniors are in Medicare Advantage, and 60% of Latinx seniors are in Medicare Advantage, as well as the lowest income seniors in the country,” Connolly said. Those who have chosen Medicare Advantage are benefiting from coordinated care for seniors, which results in positive outcomes, including 33% fewer emergency department visits and 23% fewer hospital admissions, according to Connolly.

“In the very near future, this administration is going to work very hard to tie reimbursement dollars to quality for specific populations to see that we are really [helping] everyone in this country, not just some.”

according to Connolly. “It’s not going to be enough in the future to just say, ‘Hey, here’s our quality score for everybody we take care of,’” she said. “In the very near future, this administration is going to work very hard to tie reimbursement dollars to quality for specific populations to see that we are really [helping] everyone in this country, not just some.”

Fee-for-Service Incentivizes Volume Over Value

The COVID-19 pandemic demonstrated “why fee-for-service medicine is not serving us well as a country,” said Connolly. “It is basically like paying a factory worker per piece. You get paid every time you do a thing; you don’t get paid to have healthy patients, healthy productive communities,” she said, adding that the current system incentivizes volume, not value. Under the fee-for-service model, too many doctors, nurses, and hospitals are “paid every time they do 32

FEBRUARY 2022 | O&P ALMANAC

Connolly also noted that looking at the country’s health outcomes demonstrates why “we’re not getting our money’s worth” out of the $3.8 trillion we’re spending on healthcare as a nation each year. “As a whole, our country is not incredibly healthy,” she said. She lauded those O&P facilities that are already partnering with other healthcare companies in a bundled payment approach and are facilitating a full complement of care, “meeting the patient where they are.” According to Connolly, “That’s really what value needs to be about.”

Rising Senior Population Drives Change

Connolly pointed to Medicare Advantage as a good example of a value-based arrangement. “First and foremost, 42% of our senior population is in Medicare Advantage, and that’s going to very rapidly exceed more than half of the senior population,” she said, explaining that Medicare Advantage

Medicare Advantage equates to $1,600 less in out-of-pocket costs and premiums compared to original Medicare, according to Connolly, including reduced prescription drug coverage. “Medicare Advantage plans incentivize going to the primary care doctor often” and appointing the primary care provider as the “quarterback” of the healthcare team who coordinates care. She believes Medicare Advantage is here to stay, although “it’s due for a refresh.” Some O&P professionals are concerned about the Medicare Advantage trend, specifically because many of these plans ask patients to pay large upfront fees and high deductibles. Connolly encouraged O&P facilities to share relevant data that makes the case for reduced out-ofpocket expenses and lower deductibles to both CMS and Medicare Advantage administrators. “If you’re able to demonstrate that by bringing [costs] down, bringing them access to the full complement of care and services that

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they need to ultimately be healthier and not have those longer-term costs, then I think that’s a compelling case,” she said.

Future Patients Will Demand ‘Care Anywhere’

Connolly also discussed the need for “portable healthcare products” to accommodate the growing trend among baby boomers who choose to live part of the year in their hometowns and part of the year in warmer climates, like Arizona and Florida. Seniors will want easy information sharing among healthcare providers in different geographic areas, as well as virtual care options. She believes Medicare Advantage must transform to adapt to this trend, “and it’s also going to have to raise its quality measures, because they have tended to focus

such as some pneumonia cases, patients can choose to be admitted to the hospital for monitoring or to stay home for remote monitoring and home nurse visits. The remote monitoring option offers savings, monitored outcomes, and patient satisfaction. Connolly hopes that the current administration and Congress will choose to extend flexible telehealth options after the public health emergency is over, “in order for all of us to keep collecting data and be able to show exactly how telehealth has served the population,” she said. While some question the security of new virtual care options, Connolly noted that HIPAA is due for a refresh, and providers will have to watch the transparency regulations and restrict healthcare data access when warranted.

She cited studies carried out since the ACA took effect that demonstrate how “having health insurance coverage—just simply having coverage, no matter if it’s good or mediocre, or where it is or which doctors—people that got coverage started to have better health outcomes,” she said. “Things like screening, having a primary care doctor who serves as your hub, maybe it’s prescription drug coverage—any of those elements that come with insurance coverage helped those individuals live healthier lives, and the outcomes and the data are there.” Higher numbers of insured Americans lead to lower healthcare costs, she added, because fewer people will wait to get care until it becomes an emergency, and emergency department visits will decrease.

Implementing “care anywhere” strategies, such as permanent telehealth flexibilities, value-based benefit designs that support telehealth, and “hospital-at-home” programs, could lead to expanded access, improved care coordination, and an improved and more convenient patient experience.

on process instead of outcomes—but that’s coming.” While she believes the concept of portable healthcare may be disruptive for many in the industry, it could also be a net positive for patients and healthcare professionals alike. Implementing “care anywhere” strategies, such as permanent telehealth flexibilities, value-based benefit designs that support telehealth, and “hospital-at-home” programs, could lead to expanded access, improved care coordination, and an improved and more convenient patient experience, Connolly explained. She pointed to the example of an innovative pilot “hospital-at-home” program in Marshfield, Wisconsin; for hundreds of diagnoses, 34

FEBRUARY 2022 | O&P ALMANAC

Many Americans Remain Uninsured or Underinsured

Despite the new marketplaces put in place via the Affordable Care Act (ACA), 31 million Americans remain uninsured, which is problematic for patients as well as providers. “Obviously, somebody who is uninsured is not going to have the same access—not only the equipment, but the critical care that you are delivering to individuals,” Connolly said. She is concerned that the uninsured population will grow once the COVID-19 public health emergency ends and some states disenroll some individuals from Medicaid.

Several avenues are available to improve healthcare coverage in the United States, according to Connolly, including permanently extending ACA subsidies; closing the Medicaid gap in nonexpansion states; and providing 12 months of continuous eligibility for the Children’s Health Insurance Program and Medicaid programs. These steps would help provide consistent coverage, lower overall costs, improve patient outcomes through coordinated, preventative care; and improve equity and social determinants of health, according to Connolly.

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Moving from the current healthcare climate to one that emphasizes valuebased care will take some time—but there are steps O&P facilities can take to help move the needle. Connolly encourages O&P stakeholders to engage on the policy level, specifically the CMS Innovation Center (CMMI) and its director, Elizabeth Fowler, PhD, JD, who is interested in value and value-based arrangements. “She has a very open door right now,” said Connolly. “Her goal is to do a much smaller number of pilots and demonstrations but at a much larger scale, involving more players” than in years past. In addition to engaging with CMMI, Connolly noted that healthcare companies such as O&P facilities should push for value-based care and seek out partnerships with

Despite the new marketplaces put in place via the ACA, 31 million Americans remain uninsured … [that] population [could] grow once the COVID-19 public health emergency ends and some states disenroll some individuals from Medicaid.

like-minded healthcare companies. “A lot of it is going to have to occur within the industry,” she said, noting that some of the member companies at the Alliance of Community Health Plans are now involved in value-based arrangements. “Some of them are starting to reach that tipping point where it will affect the entire region

because they are now more heavily in value-based arrangements,” she said. “And so, in your communities, I think you want to find those willing partners. You need to be a willing provider as well, and it’s a little bit scary,” she said. “The change is hard, and it will be bumpy and challenging, but it is going to be the future.”

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O&P ADVOCATE

Championing O&P Teri Kuffel, JD, combines her legal background with her business acumen to advocate on behalf of the profession

This month, O&P Almanac debuts a new column focusing on individuals who go above and beyond to advocate on behalf of the O&P profession. Here, you will get to know colleagues and O&P stakeholders who champion issues of importance to O&P practitioners, business owners, and patients, and who foster relationships with decision-makers to ensure equitable access for individuals with limb loss and limb impairment.

ERI KUFFEL, JD, EMBRACED

O&P advocacy to unite her two professional interests—law and her family business. Kuffel is vice president of Arise Orthotics & Prosthetics Inc. in Spring Lake Park, Minnesota, which she founded with her husband, Charles Kuffel, MSM, CPO, LPO, FAAOP, but she began her career as an attorney and worked at a law firm for several years after graduation. Then she switched focus, using her legal skills to help her brother build an O&P practice in

Arizona before moving to Minnesota to open Arise O&P. Since Arise launched in 2007, Kuffel has overseen the contract, human resources, and organizational management of the facility, and has become extremely involved in advocating on behalf of both O&P patients and the profession itself. “My interest in advocacy grew out of an organic need to do more than just run an O&P business,” says Kuffel, who is president-elect of AOPA and a long-time board member. “It’s an incredible field, so I felt an incredible desire to help.” She now dedicates part of her time to studying O&P policy issues and honing her skills at effectively communicating with legislators. “No one asked me to be an advocate,” she says, “but I felt compelled to do so.”

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FEBRUARY 2022 | O&P ALMANAC

PHOTO: Teri Kuffel, JD

Teri Kuffel, JD, brought patient Nick Nelson (seated in wheelchair) to the first AOPA Policy Forum she attended in 2011. Also pictured are Charles Kuffel, MSM, CPO, LPO, FAAOP, Rep. Erik Paulsen, Nick’s mom, and two of Kuffel’s children.

Kuffel began advocating for the profession on a national front more than 10 years ago, when she attended her first AOPA Policy Forum in 2011. Since then, she hasn’t missed the annual event, where O&P stakeholders from across the nation convene in Washington, D.C., to attend legislative-focused educational sessions, then meet with their members of Congress to encourage them to support O&P-friendly bills.

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O&P ADVOCATE

Kuffel (far right) brought a large contingent of clinicians and patients from Minnesota to the 2015 patient rally at HHS headquarters.

FEBRUARY 2022 | O&P ALMANAC

husband, Charlie, accompanies her on these visits to lend his extensive clinical expertise to the discussions. Kuffel has taken on more important roles at the annual Policy Forum in recent years, frequently educating others how best to conduct one-on-one meetings with legislators. (See “Advocating for Patients During the Policy Forum—and Beyond” in the May 2021 O&P Almanac.) After last year’s event was virtual, due to the COVID-19 pandemic, she is looking forward to traveling to Capitol Hill for the in-person 2022 AOPA Policy Forum and encouraging senators and representatives to support the Medicare O&P PatientCentered Care Act, S 2556 and HR 1990.

Up for a Challenge

One of the most difficult-yet-rewarding advocacy initiatives Kuffel has been involved in was working with AOPA in 2015 when the four DME MACs published a draft Local Coverage Determination (LCD) and Policy Article governing Medicare coverage of lower-limb prostheses. The policy would have dramatically and adversely impacted care for U.S. amputees, effectively reverting to the standard of care and limb technology of the 1970s. AOPA responded immediately, mobilizing members, allies, and advisers to work on multiple strategies, with the goal of requesting that the draft policy be rescinded. AOPA spearheaded an initiative that generated more than 5,000 comments from patients, practitioners, and other interested parties, which were included in the

Additional Involvement

In addition to her work with AOPA, Kuffel takes part in other initiatives to advance care for O&P patients and support the work of prosthetists and orthotists. She has attended every Amputee Coalition Hill Day for the past five years. “The goal of these efforts is to advocate for and

PHOTO: Teri Kuffel, JD

In 2011, Kuffel and her team “were the only ones who brought patients” to the Policy Forum, she recalls. “We brought 11-year-old Nick Nelson and his mom, Greta, to D.C. to meet with Minnesota legislators. It was an amazing trip.” Kuffel and the Nelsons had face time with almost all the Minnesota senators and representatives. That first Policy Forum experience inspired Kuffel to “tell Nick’s story, and to tell more stories to be effective in this environment.” Kuffel encouraged other O&P professionals to invite patients to advocacy events, and the number of Policy Forum attendees who are accompanied by limb loss patients on their legislative visits has grown. Now, “I couldn’t imagine walking into meetings without patients,” says Kuffel. “Their stories are incredibly impactful, and they tell them like no one else can.” In recent years, she has brought Aaron Holm and Rob Rieckenberg on her trips to Washington. Both men are individuals with limb loss who are involved in the amputee advocacy group Wiggle Your Toes—an organization where Kuffel also holds a board member position. “Aaron and Rob have been on this journey with me,” she says. “They’re part of the ‘Minnesota Dream Team,’ and we’re usually the largest group from any state” at events such as the Policy Forum. She suggests that advocacy teams from other states consider including at least one policy person, one practitioner, and one patient in each legislative visit, for maximum impact. More often than not, Kuffel’s

official record for LCD rulemaking. The association also submitted 43 pages of comments regarding the draft policy; conducted a data analysis demonstrating that the data used by CMS contractors to support their proposed policy was based on outdated information; and published a series of print and television advertising campaigns, as well as a series of patient vignettes communicating the personal impact of the proposed LCD on patient care. On Aug. 26, 2015, AOPA arranged for five speakers at the DME MAC public meeting in Linthicum, Maryland, then organized a patient rally at U.S. Department of Health and Human Services headquarters. Kuffel brought several clinicians and patients from Minnesota and played a key role in these meetings. At the rally’s conclusion, representatives from AOPA, the O&P Alliance, and the Amputee Coalition met with high-ranking CMS officials who said they would work with the regional contactors’ medical directors. CMS later announced that it would not finalize the draft LCD, and that the LCD would not be implemented in anything close to its original form. CMS subsequently convened a multidisciplinary workgroup to develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower-limb prostheses. The decision to halt the progress of the proposed LCD was a clear win for AOPA and the profession. “It was an empowering experience to walk and stand with so many in our industry,” Kuffel says, “to advocate for policy to support reasonable access to care and devices for those with limb loss and limb impairment.”

O&P ADVOCATE

hobby-lobbyists to bring the bills to our legislators in offices and committee hearings, and ultimately to the governor for signature into law,” says Kuffel. She also plays a role in educating the next generation of O&P advocates in her position as an associate professor at Concordia University St. Paul. “I talk to my students about advocating for and with” limb loss patients, “and I encourage them to take that next step now. Don’t wait to be asked—do what you can.”

PHOTO: Teri Kuffel, JD

Kuffel with Aaron Holm, Sen. John McCain, and Rob Rieckenberg with the population we serve to provide education that results in access to care and devices for these individuals, our patients, friends, family members.” Kuffel also works closely on state-specific programs and has forged relationships with both private payors and the administrators of Minnesota’s Medicaid program. She has “helped facilitate small and large groups in submitting policy drafts and fee schedule requests, which have resulted in changes to both private payor medical policy and fee schedules concerning O&P claims,” she says. Kuffel frequently unites clinicians, patients, and clinical research experts to help effect change—most notably with Minnesota Medicaid and BCBS of Minnesota. For the past 10 years, Kuffel has been on the Board of the Minnesota Society of Orthotists, Prosthetists, & Pedorthists, which has been active in prompting two new laws. The Minnesota State Orthotist, Prosthetist, and Pedorthist Licensure Act, passed in 2016, mandates that only licensed, qualified O&P professionals engage in O&P care in the state. The second law, passed in 2020, expands the scope of prescribers of O&P in Minnesota to match those individuals who are approved to do so, per CMS. “Together with representatives from the limb loss and impairment community of Minnesota, we effectively drafted bills and became grassroots advocates and

Planning for an Impactful Future

Kuffel will continue her advocacy journey over the next year, by attending the Policy Forum and by supporting “any and all policy initiatives put forth by the leadership in our extended O&P community,” she says. “It is truly what I am called to do—to help bridge the gap between patients and legislators to help restore, maintain, and provide access to care.”

She encourages other O&P professionals to consider serving in a similar capacity. “The basic needs of our patients know no political agenda and cross both party lines,” Kuffel adds. “We need to motivate practitioners to help their patients beyond the exam room. This journey is great, and the numbers of those who serve are too few.” Kuffel also encourages others to engage in local and state-level efforts. “It is just as important to get to know administrators in state Medicaid programs because they have the power to control the O&P care for a population in arguably the greatest need,” she explains. “If there’s a flame flickering in your belly that is telling you to help, then help,” Kuffel says. “Don’t wait to be asked, do the asking. Take the first step and start the journey to help others. Be an advocate. Help educate. Be purposeful in your actions to help provide access to care and devices.”

O&P ALMANAC | FEBRUARY 2022

MEMBER SPOTLIGHT

Point Designs

By DEBORAH CONN

Hand Mobility Colorado startup creates durable prosthetic fingers

OINT DESIGNS, A COMPANY

FEBRUARY 2022 | O&P ALMANAC

Point Designs founders (left to right) Levin Sliker, PhD; Jacob Segil, PhD; Richard Weir, PhD; and Stephen Huddle, MS not to take on outside investors. So we had to be creative with our suppliers, and we were scrambling to fill orders,” recalls Sliker. “I OWNERS: think a lot of startups face that Levin Sliker, PhD; issue as they learn to scale up.” Richard Weir, Since then, they have refined the PhD; Jacob Segil, device and added other product PhD; and Stephen lines. Their offerings include the Point Digit and Point Digit mini, Huddle, MS both full-finger prostheses, as well as the Point Partial, a partial finger LOCATION: device, and the Point Thumb. Lafayette, Colorado The company occupies a 4,400-square-foot facility in HISTORY: Lafayette, Colorado, that holds 15 Five years employees evenly divided among sales, production, and research and development. The company welcomes feedback from prosthetists —and in fact made several adjustments to the original Point Digit based on their comments. “We switched from steel to titanium, so the finger is 30% lighter, and we added grippy surfaces on portions of the finger,” Sliker notes. All Point prostheses have a load rating of 150 pounds, integrated compliant fingertip pads that are CEO and Co-Founder Levin Sliker, PhD touch-screen compatible and can

COMPANY: Point Designs

Point Designs markets both to prosthetists and to their referral sources, including therapists and physicians. They meet with customers at trade shows and other venues, both virtually and in person. The company has developed relationships with some end users as well, says Sliker. “We host a monthly gathering where recent amputees and people who use our products can get together to share advice, experiences, and support, as well as feedback to help us continue to improve our products,” he says. “We started with a few people who made a good connection with one another, and the group kept growing. These days it is virtual, but we hope to return to in-person meetings at some point.” While Sliker acknowledges that myoelectric advances are the wave of the future, he believes the field will always have a place for mechanical products. “There will always be a need for simple, durable, robust prostheses—I don’t think there’s a replacement for that, no matter how good myoelectric devices get.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Point Designs

that develops and manufactures prosthetic fingers, began as a spinoff from research conducted at the Biomechatronics Development Laboratory at the University of Colorado Denver. One of the company’s founders, Richard Weir, PhD, has a long history in prosthetics research, and was involved in inventing the Implantable Myoelectric Sensor (IMES) system for use in the control of advanced prosthetic limb systems. While working in the biomechatronics lab, Weir also was extensively involved in the design and development of the prosthetic arm systems built under DARPA’s Revolutionizing Prosthetics initiatives. In addition, he completed the training required to become a clinical prosthetist at Northwestern University Prosthetics-Orthotics Center, where he later became an instructor. Fellow Point Designs founders Jacob Segil, PhD; Levin Sliker, PhD; and Stephen Huddle, MS, all worked under Weir’s guidance at the university. The impetus for designing a new prosthetic finger came from the field. “We were hearing a constant need from the prosthetists we knew,” explains Sliker, CEO of the company. “They wanted a prosthetic finger that was robust and durable, and so we set out to design it.” The four researchers founded Point Designs in 2016 and introduced their first prosthetic finger in 2017. The Point Digit was an immediate success, which created a challenge as the company struggled to keep up with demand. “We had limited resources in the early days, because we decided

be replaced by the prosthetist, and a patented ratcheting mechanism with auto spring-back that allows users to position the fingers without using their opposite hand. “The durability of our fingers is the primary feature,” says Sliker, “but we did a good job designing something functional, yet elegant in appearance. It works, and it is aesthetically pleasing.”

AOPA MEMBER BENEFIT

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WHY THE AOPA AFFINITY HEALTH PROGRAM? • A Nationwide network of doctors and pharmacies for complete coverage • Prosthetics and Orthotics coverage • Dental and Vision coverage • Multiple plan designs make it easy for you to find the right fit for your business • Cost savings of level-funding, without added risk • All AOPA-established benefit plans meet minimal essential coverage as mandated by the Affordable Care Act • An experienced, trusted team is always ready to provide expertise before and after you’ve chosen your plan

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MEMBER SPOTLIGHT

Renew Prosthetics & Orthotics

Personalizing Care Clinician-owner aims to return patients to activities they enjoy

OLLIE MATTHEWS, CPO, RECALLS one of her most

memorable patients, a 58-yearold man who had multiple breaks in his leg after falling from a porch. He chose to have the leg amputated above the knee after multiple surgeries failed to repair the damage. “The doctors wanted to fuse the entire leg, and he decided to amputate,” she explains. Matthews fit him with a transfemoral prosthesis featuring an X3 knee. “He was an active man and wanted to get back to sports he enjoyed,” she says. “He was very motivated and put a lot of hours into physical therapy.” Within eight months, the patient was once again boating, jet skiing, and playing golf.

Staff at Renew Prosthetics & Orthotics

FACILITY: Renew Prosthetics & Orthotics

FEBRUARY 2022 | O&P ALMANAC

HISTORY: Two years LOCATIONS: Mooresville and Concord, North Carolina

Mollie Matthews, CPO

She continues to visit referral sources regularly. She posts on social media, including Facebook and Instagram, and frequently updates the company website to keep it fresh. Renew organizes the Lake Norman Limb Loss Support Group, with meetings about every six weeks. “One of our patients runs the show,” says Matthews. “We usually hold the meetings at a local hotel and include physicians, therapists, and dietitians. All amputees are welcome, not just our patients.” The facility recently held a walking clinic, with a guest certified prosthetist-orthotist, to aid clinicians in helping patients achieve a better gait. Matthews hopes to hold similar events a couple of times a year. Renew prides itself on its extremely personalized service, which includes being on call 24/7, weekend appointments if necessary, and house calls when patients are unable to come into the office. “We make sure our patients know when their appointments are with physicians and therapists, and at that time we will advocate for them to get the most appropriate componentry for their activity level,” says Matthews. “We also have excellent administrative staff, Terry Godwin and Laurie Favaloro, who really go to bat with the insurance companies” to get approvals for the orthotic and prosthetic devices. “It’s been a great experience building a business and having a career in O&P,” she notes. “Some of my patients have been with me from the beginning, and having them by my side through this journey has been really nice. We plan to continue to grow and serve our community as best we can.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Renew Prosthetics & Orthotics

This type of success story is what keeps Matthews motivated at Renew Prosthetics & Orthotics, a facility she launched in North Carolina a little over two years ago. Matthews had spent several years working for, and then partnering with, Tim Owens, CO. The partners decided to separate into two businesses, and in 2019, Matthews became sole owner of the facility and renamed it Renew Prosthetics & Orthotics. The facility, with locations in Mooresville and Concord, has seven employees, including one other clinician, Scott Meyer, CO. Meyer serves orthotic patients, while Matthews focuses on

OWNER: Mollie Matthews, CPO

prosthetics, and they allocate their time between both locations. The business’s split and transition, while planned, were challenging, Matthews says. “Trying to separate the two companies was a difficult process, but having the right people who helped so much along the way made that process much easier. And when all was done, the effort was worth it. The fun part has been rebuilding, getting the word out, and becoming known in the area as Renew.” Matthews relied on Outsource Marketing Solutions to help her grow the business. “I started offering a variety of continuing education courses through Clinical Education Concepts,” she says. She taught more than 200 classes to therapists in the area, which boosted the facility’s visibility. Matthews had to pause that form of outreach in the face of the COVID-19 pandemic, but she hopes to return to continuing education at some point.

By DEBORAH CONN

AOPA Member Benefit

AOPA’s Co-OP is

THE Compendium of O&P A confluence of coding, billing, and policy information, the AOPA Co-OP provides a cooperative space for collaboration among O&P colleagues. This easily accessible, online resource enables your organization to be successful in today’s everchanging healthcare environment.

Resources include: State-specific insurance policy updates L Code search capability Data and evidence resources, and so much more!

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AOPA NEWS

AOPAversity Webinars

OIN AOPA EXPERTS FOR the most up-to-date informa-

tion on specific topics during these one-hour webinars, held the second Wednesday of each month at 1 p.m. ET. One registration is all it takes to provide the most reliable business information and CE credits for your staff at a single office location. Visit www.AOPAnet.org/education/monthly-webinars for details and registration information.

UPCOMING WEBINARS

February 9 Lower-Limb Prostheses Policy: A Review

The February webinar offers a comprehensive review of the current Lower-Limb Prostheses Local Coverage Determination and Policy Article. Hear about recent changes and updates to the policy, including a breakdown of the coding guidelines; which items require approval from the Pricing, Data Analysis, and Coding contractor; and much more.

March 9 Medicare 101: Get To Know the Basics

Don’t miss the perfect webinar for new hires, and the ideal refresher course for experienced staff. This webinar provides an overview of the Medicare program and explains how it relates to O&P care. Learn about the different parts of Medicare and how certain payment structures are created.

Call For Papers

Submit your proposal for the AOPA 2022 National Assembly

HE 105TH AOPA NATIONAL ASSEMBLY will be held

in San Antonio Sept. 28 to Oct. 1, 2022. In addition to the in-person Assembly, virtual elements are being planned. Attendees will participate in general sessions as well as concurrent breakout tracks, an Expo, patient demonstrations, and workshops. Consider submitting an education proposal in one of these key topic areas: • Clinical Education • Business Education • Postmastectomy Education • Technical Education • Digital O&P Care Submissions are due April 1. For submission instructions and details on where to submit your proposal, visit www.AOPAassembly.org.

FEBRUARY 2022 | O&P ALMANAC

AOPA MEMBERS

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of the American

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

Catdaddy Consulting Services 1800 Gordon Road Jamestown, OH 45335 937/510-2220 www.catdaddyconsulting.com Mark Ford Supplier Member

J. Puente Consulting 10317 Chaucer Street Westches, IL 60154 708/712-5874 Jose Puente Supplier Member

Medical Creations Inc. 1668 N. Lafayette Street Denver, CO 80218 970/429-4203 http://xtremity.com Maynard Carkhuff Supplier Member Pongratz Orthotics & Prosthetics Inc. 730 N. 52nd Street Phoenix, AZ 85008-7986 602/222-3032 www.pongratzop.com Joseph S. Pongratz, CPO, FAAOP Patient-Care Facility

Precision Medical Solutions 119 Market Place Montgomery, AL 36117 334/260-3767 http://precisionmedicalsolutions.com Carey Jinright, LO Patient-Care Facility Restorative Care of America Inc. 12221 33rd Street N. Saint Petersburg, FL 33716 800/627-1595 www.rcai.com Dean Josloff Supplier Member

O&P ALMANAC | FEBRUARY 2022

O&P PAC UPDATE

Special Thanks to the O&P PAC Contributors The O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: Jeffrey Brandt, CPO Russell Cannon Maynard Carkuff Tina Carlson, CMP Traci Dralle, CFm Daryl Farler, CPA

Elizabeth Ginzel, MHA, CPO, LPO Kimberly Hanson, CPRH Dan Ignaszewski Jim Kingsley Charlie Kuffel, CPO, FAAOP

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible

SAVE THE DATE MAY 17-18

Eve Lee, MBA, CAE William Lester, CPO James Liston, CP, FAAOP Joe McTernan Rick Riley Todd Westlake, CPO

Ashlie White, MA Linda Wise James Young, CP, LP, FAAOP

individuals must first sign an authorization form, which may be completed online: bit.ly/aopapac. * Due to publishing deadlines this list was created on Jan. 25, 2022, and includes only donations and contributions made or received between Jan. 1 and Jan. 25, 2022. Any donations or contributions made or received on or after Jan. 25, 2022, will be published in a future issue of O&P Almanac.

SAVE THE DATE MAY 17-18

Use Your Voice. Educate. Advocate. Celebrate. More details on the program to come. FOLLOW US @AmericanOandP

FEBRUARY 2022 | O&P ALMANAC

www.AOPAnet.org

Feature your product or service in Marketplace. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2022 for advertising options.

ToeOFF® 2 ½ & BlueROCKER® 2 ½

Now offering more Allard AFOs with half the heel height. All 2 ½ models include choice of wrap-around or D-ring straps, shorter wings, and a Starter SoftKIT™ included. It is easier to adapt ToeOFF® 2 ½ and BlueROCKER® 2 ½ to shoes with lower heel heights because there is a lower forefoot curvature and more space in the shoe toe box. ToeOFF® 2 ½ addition models available in camouflage, birch, and black. Call 888/678-6548 or email info@allardusa.com to receive your free Product Selection Guide.

MARKETPLACE

Apis

Apis custom programs offer practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words. Call us at 1-888/937-2747.

Boston Orthotics & Prosthetics eLearning Center

Support for Better Life ALPS Flex Sleeve (SFX) ALPS Flex Sleeve (SFX) is a prosthetic suspension sleeve made with seamless knitted construction in high-density gel to provide maximum comfort and control for active amputees. With 30-degree pre-flexion, the SFX effectively allows for ease of bending and reduces bunching behind the knee. The SFX is available in one length and thickness that accommodates most users. Plus, you can choose from two sleek color options—black or beige. For more information, visit www.easyliner.com or call us today at 800/574-5426.

Boston Orthotics & Prosthetics eLearning Center is pleased to offer six online courses. You can take advantage of this new training option from anywhere, including your home. With our new eLearning Center, you can stay connected with the most up-to-date technology and techniques with Boston O&P. Students, residents, certified orthotists, physical therapists, and other allied health professionals are welcome to register for our courses. CEUs are provided upon completion of the course. Questions? Contact Jim Wynne, CPO, FAAOP, at jwynne@bostonoandp.com. To gain access to our eLearning courses, simply use the following link: https://www.bostonoandp.com/ for-providers/education-and-training/online-training.

O&P ALMANAC | FEBRUARY 2022

MARKETPLACE Coyote’s New, Robust Easy-Off Lock Design

Coyote’s Easy-Off Lock is a lever-action airtight pin system giving dual-suspension pin security with the comfort of suction; it also works with elevated vacuum mechanisms. Coyote has improved the Easy-Off Lock with a new robust lock plate and lever design. Its patented lever mechanism makes doffing easy for amputees with hand strength issues. The airtight seal of the Easy-Off Lock prevents air from entering the bottom of the socket by creating negative pressure inside the socket (suction), which reduces pistoning even without a sleeve. This lock is also water-resistant. For more information, contact Coyote 208/429-0026, or visit www.coyote.us.

Coyote QUIK GLUE

50 cc or 220 cc

Now available in 30-, 60-, and 90-second set times. • Great for attaching componentry • Multiple repair uses • Very quick set with no sag. They ship nonhazardous and are safe with no odor. For more information, contact Coyote 208/429-0026, or visit www.coyote.us.

Tillges Technologies Propulsion® Prepreg Partial Foot Prosthesis The Propulsion® prepreg Partial Foot Prosthesis is engineered by our clinical orthotic and prosthetic practitioners for our own patients, so we’re positive that our dynamic, ultra lightweight, adjustable, and modular designs using cutting-edge carbon-fiber materials will provide your patients with the stability, balance, and energy they need in every step. Propulsion braces are built for professionals, by professionals—gain better control and greater comfort. To learn more, visit www.tillgestechnologies.com or call us at 1-855-4TILTEC. 50

FEBRUARY 2022 | O&P ALMANAC

The Original Preflexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement. For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com.

Black Iron Trainer Pivot The TRS Black Iron Trainer is the world’s most popular weight training prosthetic accessory. The Black Iron Trainer Pivot provides 32 degrees of friction-adjustable freedom for added versatility, safety and control over barbells, dumbbells, and other weight training apparatus. For more information, visit www.fillauer.com.

FLO-TECH® “Multipurpose” FLO-TECH-TOR™ FLO-TECH® has redesigned the FLO-TECH-TOR™ by incorporating trim lines into the forming of the transtibial FLO-TECH-TOR™ to allow modifications to be made for a Flexible Inner Socket to be used with the appropriate Universal Frame Outer Socket (UFOS™) and pylon system, for your patient’s preparatory prosthetic needs. Anatomically side specific, 7-in. and 9-in. lengths, soft anterior tibial interface plus pre-tibial band, dynamic size expansion and reduction, result in effective assimilation of actual limb volume reduction. From immediate post-op through preparatory prosthesis needs. Visit www.1800flo-tech.com for additional photos, email info@1800flo-tech.com, or call 800/356-8324.

MARKETPLACE Hersco 3D Printing Hersco is delighted to offer HP’s advanced 3D printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods— reducing landfill waste by 90 percent! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90 percent reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a bio-based renewable material that has been tested and proven in research and industry. Call today, 800/301-8275, for a free sample.

Unique Liners From Ottobock

Ottobock Continues Paralympic Partnership in Beijing Featuring multiple custom material options and a scanning app, the innovative Unique Liners from Ottobock are individually made-to-order to achieve ideal fitting results. This includes the Skeo Unique silicone liners and the Uneo Unique urethane liners. The multitude of choices for these customized solutions include textile covers, suspension options, including DVS Dynamic Vacuum, and fresh scent or Skinguard antibacterial for our Uneo liners. Plus, we offer the free Custom4U iPad app for easy scanning with a structure scanner to reduce mess and save on shipping costs. Choose custom to provide the best protection, stability, and function for your patients. Scan the QR code to learn more.

Freedom ShockWave™ by PROTEOR

Continuing the long-standing partnership with the Paralympic Games since 1988, Ottobock is the Official Technical Service Provider for the Beijing Games, offering free maintenance and repair services for athletes. With a team of 42 team members, comprehensive technical service is offered across the three Paralympic villages in Beijing, Yanqing, and Zhangjiakou. Regardless of manufacturer, Ottobock’s expert technicians assist with all repair services to ensure athletes can perform at their very best. From para snowboarding to para curling, the dedicated service team is ready for anything these world-class athletes need. Learn more about the Technical Service Center by scanning the QR code.

The Freedom ShockWave™ utilizes the industry-leading classic Freedom foot design with its proprietary EnduraCore® hybrid composite technology and incorporates a Spherical Shock Unit (SSU). The SSU provides both vertical shock absorption and axial rotation, giving K3 / K4 patients a shockingly natural and comfortable experience during both everyday and high-impact activities. For more, visit www.FreedomQuattro.com. O&P ALMANAC | FEBRUARY 2022

MARKETPLACE Naked Prosthetics

Spinal Technology Inc.

It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit www.npdevices.com.

PDI 3D Central Fabrication

K TOC IN S The 4th Gen Squirt Shape 3D Printer is now available for purchase! Test sockets, definitive sockets, custom liners, and more! Deliver quicker, with a 24-hour socket turnaround. Have a difficult fit or extreme size? Don’t struggle with fabrication, let us print a check or definitive socket for you. For more information, email fab@prostheticdesign.com or call 800/459-0177 for a quote today!

800/459-0177 | WWW.PROSTHETICDESIGN.COM

FEBRUARY 2022 | O&P ALMANAC

Spinal Technology Inc. is the global leader in the design and fabrication of spinal orthoses, for the stabilization, immobilization, and the correction of various abnormalities of the spine. Our team consists of American Board-Certified orthotists, highly skilled and experienced technicians, and dedicated customer service experts. We’ve proudly maintained expertise in a wide range of proven scoliosis bracing methodologies and have employed the latest technology for treating each patient since 1991. We are the exclusive manufacturer of the Providence Nocturnal Scoliosis® System. Providing unparalleled support 24 hours/day, 365 days/year, for thousands of medical professionals across the USA and around the world. For information call 508/957-8282 or visit Spinal.Tech/Almanac.

The Xtern, a Life-Changing Solution for Foot Drop Patients by Turbomed Orthotics Say goodbye to your painful and stiff in-shoe orthosis! This revolutionary brace, specifically designed for people suffering from foot drop, has one thing in mind: movement. The Xtern sits entirely outside the shoe (and, to add to that, to any shoe!), and is so flexible that it allows maximal range of motion and calf muscle strength. No more rubbing injuries or skin breakdowns: You’ll barely notice it’s there. Walking, running, mountain climbing, skiing? Not a problem! The Xtern will follow you as far and as long as you want. Turbomed’s innovative products are designed in Quebec, Canada, sold in more than 30 countries around the world, and distributed by Cascade in the United States. Visit turbomedusa.com, and think outside the shoe!

CAREERS

WANTED!

Opportunities for O&P Professionals

A few good businesses for sale.

Job Location Key: - Northeast

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

- Mid-Atlantic - Southeast - North Central

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

- Inter-Mountain - Pacific

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge.

AOPA Members are Shaping the Future of O&P

Refer to www.AOPAnet.org for content deadlines. 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. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, 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.

Centered on YOUR success, AOPA provides the tools to build strong O&P businesses that provide excellent patient care.

www.AOPAnet.org

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 $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

ADVOCACY

RESEARCH

We ARE AOPA

EDUCATION

Finding your Finding your next job easiereasier with the AOPA with th

ADVOCACY | RESEARCH | EDUCATION

Finding For Job Seekers:your

Runnin h

next job or hire just got

For Job Seekers: easier with the AOPA Career Center.

Job searching is easy with thejust got Finding your next job orpage. hire pane-view job search Set up Job searching is easy with the easier with the Career Center. job alerts,AOPA upload your resume or Set up pane-view job search page.

ONLINE: O&P Job Board Rates For Job Seekers: Visit the only online job board in the industry at jobs.AOPAnet.org. Job searching is easy with the

create an anonymous career proﬁle or job alerts, upload your resume that leads employers to you.

Job Board 50 or less

For Employers:

pane-view job search page. Set up For Job Seekers: Member Nonmember job alerts, upload your resume or Job searching is easy with thean anonymous career proﬁle create $85 $280 pane-view job search page. upemployers to you. that Set leads job alerts, upload your resume or For more opportunities, visit: http://jobs.AOPAnet.org. create an anonymous career proﬁle For Employers: that leads employers to you.

Reach 4,500+ O&P professionals through the Job Flash™ email. For Employers: Ensure high visibility for your open positions through this highly Reach 4,500+ O&P professionals A large number of O&P Almanac engaging email.

create an anonymous career proﬁle that leads employers to you.

Reach 4,500+ O&P professionals For Employers: through the Job Flash™ email. Ensure high visibility for your open Reach 4,500+ O&P professionals positions through this highly through email. the Job Flash™ email. engaging

Ensure high visibility for your open positions through this highly engaging email.on recruitment options, contact Customer For more information

the Job Flash™ email. readers view through the digital issue— Log in at jobs.ao Ensure high visibility for your open Service at clientserv@communitybrands.com or (727) 497-6565. If you’re missing out, visit positions through this highly issuu.com/americanoandp For more information on recruitment options, contact Customer engaging email. Log in at jobs.aopanet.org to get started! Service at clientserv@communitybrands.com or (727) 497-6565. to view your trusted source For more AOPA_PrintAd.indd 1 information on recruitment options, contact Customer Log Service at clientserv@communitybrands.com or (727) 497-6565. of everything O&P. For more information AOPA_PrintAd.indd on recruitment1 options, contact Customer Service at clientserv@communitybrands.com or (727) 497-6565.

8/19/21 8:02 PM

AOPA_PrintAd.indd 1 AOPA_PrintAd.indd 1

| FEBRUARY 2022 O&P ALMANAC 8/19/21 8:02 PM

CALENDAR May 10–13

OT World. Leipzig, Germany. For more information, visit www.ot-world.com/index-en.html.

May 11 WEBINAR

Supplier Standards & Revalidations. 1 PM ET. Register at www.AOPAnet.org.

May 17–18

AOPA Policy Forum. Hilton Crystal City, VA. Register at www.AOPAnet.org.

May 18–20

2022

New York State Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Rivers Casino & Resort. Schenectady, NY. For more information, visit nysaaop.org/meeting.

February 1–31

ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at ABCop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org or visit ABCop.org/contact-us.

June 8 WEBINAR

at www.AOPAnet.org.

February 9 WEBINAR

visit www.AOPAnet.org.

Lower-Limb Prostheses Policy: A Review. 1 PM ET. For more information,

March 2–5

AAOP. Atlanta. For more information, visit www.oandp.org/events/event_list.asp?DGPCrSrt=&DGPCrPg=2.

June 24–25

Nashville Renaissance Hotel and Conference Center In-Person Meeting. For more information, contact Cathie Pruitt at 901/359-3936, email pruittprimecare@gmail.com, or Jane Edwards at 888/388-5243, email jledwards@attnet. Visit www.primecareop.com.

July 13

Clinicians’ Corner—Orthotics: How To Get Started Into Digital Workflow. From Scanning, to Carving, to 3D Printing, the Next Step for O&P. 1 PM ET. Register at www.AOPAnet.org. WEBINAR

March 9 WEBINAR

Medicare 101: Get To Know the Basics. 1 PM ET. Register at www.AOPAnet.org.

August 10

March 18–19

Ohio O&P Meeting. Columbus Hilton at Easton. Visit ohiooandp.com and ohiochapteraaop.com.

WEBINAR

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@ AOPAnet.org along with VISA or MasterCard number, cardholder name, 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.

AOPA National Assembly. San Antonio, TX. For more information, visit www.AOPAnet.org.

Clinicians’ Corner: Techs and Fitters. 1 PM ET. Register at www.AOPAnet.org.

Calendar Rates

FEBRUARY 2022 | O&P ALMANAC

Prosthetics Clinicians’ Corner. 1 PM ET. Register at www.AOPAnet.org.

September 28–October 1

April 13 WEBINAR

SWOs, PODs, ABNs, AOBs: Your MustHave Documentation. 1 PM ET. Register

Words/Rate 25 or less 26-50 51+

Member $40 $50 $2.25/word

Nonmember $50 $60 $5.00/word

Color Ad Special 1/4 page Ad 1/2 page Ad

$482 $634

$678 $830

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

CALENDAR

Welcome to AOPA Connection, the one-stop-shop for all things AOPA. Logging into AOPA Connection you will instantly have access to all your AOPA benefits, including: • AOPAversity • Your Membership Record • Your Individual Profile • Event Calendar • Bookstore • Co-OP But, it doesn’t stop there! We are pleased to introduce a new benefit accessible through AOPA Connection, My O&P Community. In this online community of your O&P colleagues you can get guidance, share advice, have one-on-one and group conversations, and access resources.

MyAOPAConnection.org

AD INDEX

Advertisers Index Company

Page

Phone

Website

Allard USA Inc.

866/678-6548

www.allardusa.com

ALPS South LLC

800/574-5426

www.easyliner.com

Amfit

800/356-3668

www.amfit.com

Apis Footwear Company

888/937-2747

www.apisfootwear.com

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

Cascade Dafo Inc.

800/848-7332

www.cascadedafo.com

Coyote Prosthetics & Orthotics

23, 25

800/819-5980

www.coyote.us

Danmar Products

800/783-1998

www.danmarcranial.com / www.danmarproducts.com

ESP LLC

888/WEAR-ESP

www.wearesp.com

Ferrier Coupler Inc.

810/688-4292

www.ferrier.coupler.com

Fillauer

800/251-6398

www.fillauer.com

Flo-Tech O&P Systems Inc.

800/356-8324

www.1800flo-tech.com

Hersco

800/301-8275

www.hersco.com

Naked Prosthetics

888/977-6693

www.npdevices.com

Ottobock

800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

855/450-7300

www.proteorusa.com

Spinal Technology Inc.

800/253-7868

www.spinaltech.com

The Bremer Group Company

800/428-2304

www.bremergroup.com

Tillges Technologies

855/484-5832

www.tillgestechnologies.com

TurboMed Orthotics Inc.

888/778-8726

www.turbomedorthotics.com O&P ALMANAC | FEBRUARY 2022

STATE BY STATE

Joining Forces Updates from California, Colorado, and Texas, and a call for volunteers

Each month, State By State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/resources/co-op.

California

The California Orthotic & Prosthetic Association (COPA) continues to pursue a grassroots legislative effort to improve reimbursement rates from California Medicaid. COPA has hosted O&P clinic tours for several key legislators and is pursuing budget proposals and legislation to advance improved reimbursement rates for O&P services. To learn more and get involved in California O&P advocacy, visit COPA’s website at www.californiaoandp.com. 56

FEBRUARY 2022 | O&P ALMANAC

Colorado

The Colorado Department of Healthcare Policy and Financing is seeking additional information to inform rate setting for pediatric custom cranial orthoses, procedure code S1040. AOPA sent a comment letter in response to this request in order to explain the nature of services related to cranial orthoses and articulate their value. For details, visit the Colorado page of the AOPA Co-OP.

Texas

The Texas Department of Licensing and Regulation is seeking to fill two vacancies on its Orthotists and Prosthetists Advisory Board. The purpose of the board is to provide advice and recommendations to the department on technical matters. Members serve unpaid six-year terms upon appointment by the Commission of Licensing and Regulation. Applicants must be either an individual who uses an orthosis, or a licensed prosthetist who has practiced for five years preceding their date of appointment to the board. Interested parties can request an application via email at advisory.boards@tdlr.texas.gov.

Submit Your State News

Become an AOPA State Rep.

If you are interested in participating in the AOPA State Reps network, email awhite@AOPAnet.org.

Become a Liaison to the VISN Network

AOPA is seeking members to serve as liaisons to the Department of Veterans Affairs’ Veterans Integrated Service Network (VISN) to share experiences and facilitate collaboration with the department. The AOPA VISN Network will meet quarterly as a group, and members are encouraged to check in with AOPA staff individually as challenges or issues arise within their respective VISNs. Participation in at least two quarterly meetings each year is required for continued service. If you are interested in serving as a member of the network, contact Sam Miller, AOPA’s state and federal advocacy manager, at smiller@aopanet.org.

Member Resource Alert

AOPA has invested in a resource that allows us to track legislative and regulatory activity related to O&P in every state. We will be updating the state pages on the AOPA Co-OP with alerts as they arise.

To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org.

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

o i n o t n San A SEPTEMBER 28-OCTOBER 1

! s r a d n e l Ca r u o Y k r Ma Join us September 28-October 1, 2022, for

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

an ideal combination of top-notch education and entertainment at the 105th AOPA National Assembly in San Antonio, TX.

www.AOPAassembly.org

C-Brace®

Step into the future.™

professionals.ottobockus.com

February 2022 O&P Almanac

Articles inside

Ad Index

Calendar

State By State

Marketplace

Welcome New Members

AOPA Contacts

O&P PAC Update

People & Places

Happenings

AOPA News

Teri Kuffel, JD

Reimbursement Page