January 2015 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

JAN UARY 2015

E! QU IZ M EARN

BUSINESS CE

CREDITS

PPS Billing Exemptions

P.20 & 47

P.18

The Master’s Program That Could Shake Up O&P Training P.32

Leadership Conference P.40

Contemplating an O&P Patient Registry P.44

Proper Documentation Policies P.46

Winter’s Effect on Materials

WOMEN ARE PURSUING CAREERS IN THE INDUSTRY IN GREATER NUMBERS THAN EVER BEFORE P.24

WWW.AOPANET.ORG

P.48

This Just In: New Year, New Congress P.21

YOUR CONNECTION TO

EVERYTHING O&P

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

Save the Date

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

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

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JAN UARY 2015 | VOL. 64, NO. 1

contents

FEATURES 24 | Putting the ‘She’ in O&P

COVER STORY

The number of female O&P practitioners in the United States has increased 152 percent in the past decade, offering hope for an even more gender-balanced workplace in the next 10 to 20 years. But disparities still exist, say experts.

P. 21

By Christine Umbrell

21 | This Just In

P. 40

New Year, New Congress With a Republican majority in the U.S. Senate, will the 114th Congress have a big impact on O&P-related legislation? By Thomas F. Fise, JD

P. 32

32 | Education Fast Track O&P leaders have their eyes on the Baylor College of Medicine new 30-month O&P master’s degree. Could this accelerated program change the training model for educators, students, and residencies? By Adam Stone

P. 36

36 | Minding the Science O&P Almanac recently spoke with Jason Highsmith, PT, DPT, PhD, CP, FAAOP, about his new position at the Extremity Trauma and Amputation Center of Excellence and the changing world of O&P research.

40 | Brainstorming

the Future

Industry leaders meet to discuss strategies for advancing the O&P industry during inaugural AOPA Leadership Conference this month.

44 | Contemplating an

O&P Patient Registry The O&P profession could follow the lead of the American Joint Replacement Registry to design a repository for patient information.

By Adam Stone

Advertise with Us! For advertising information, contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

O&P ALMANAC | JANUARY 2015

contents P.48

COLUMNS Reimbursement Page..........................18

PPS Billing Exemptions

Learn the rules for Medicare patients in an inpatient facility that uses prospective payment systems

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

CREDITS

P.50

Compliance Corner...............................46

Documentation: The Key to Maintaining Compliance

Polish your company policies to reduce claim denials

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

CREDITS

P.68

Tech Tutor................................................. 48

The Polar Vortex of Fabrication

How extreme temperatures can affect raw materials

Member Spotlight................................ 50 n n

Optec USA Walkabout Orthotics & Prosthetics

P. 52

DEPARTMENTS Presidentâ&#x20AC;&#x2122;s View........................................6

Insights from AOPA President Charles Dankmeyer Jr., CPO

AOPA Contacts........................................... 8 How to reach staff

Numbers..................................................... 10

At-a-glance statistics and data

Happenings................................................ 12

Research, updates, and industry news

People & Places........................................ 16

Transitions in the profession

AOPA News................................................ 54

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 59 O&P PAC Supporters................... 60 Marketplace.............................................. 62 Careers.........................................................64

Professional opportunities

Ad Index.......................................................64 Calendar......................................................66

Upcoming meetings and events

Ask AOPA...................................................68 Expert answers to your questions about surety bonds, office hours, and more

JANUARY 2015 | O&P ALMANAC

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PRESIDENT’S VIEW

Share Your Thoughts, Get Involved

ANUARY IS ONE BUSY month for AOPA and its staff. It kicks off with the January 9-11 O&P Leadership Conference in Palm Beach, where more than 100 of our leading O&P executives will participate in a program format that many helped devise. This conference was built around the responses from invited O&P executives to questions AOPA posed about the future of the profession. One executive from each AOPA member company received the questionnaire and an invitation to the conference. What impressed me about the questionnaire results was the thoughtful involvement that produced some really great program ideas. These resulted in a wide range of topics and speakers that do indeed address the key concerns affecting our future. What impressed me even more was the participation level. We received an overwhelming response to our questionnaire! AOPA members shared some of their very best thinking, and that’s one of the goals I think we should embrace in the year ahead—greater member involvement. Let’s start with the O&P Almanac. It’s been a favorite read of mine for years. It has good clinical information, excellent management ideas, solid “how-to” guidance, and, of course, the latest on rules, regulations, and legislation that affect our daily business. But there’s one more thing that in my mind would add a certain pizzazz factor to the magazine. And that would be to stir up a little controversy—something to incite members to speak up and share their thoughts on controversial questions via our mainstay information piece for O&P—the O&P Almanac. Here are a couple subjects that come to mind: • What do you think of the way our two certifying bodies handle facility accreditation? One body’s surveyors reviewing a facility’s application for only prosthetic accreditation might note an ankle-foot orthosis being delivered as part of the practice. Bingo—that immediately disqualifies the facility for prosthetic accreditation. That accrediting agency requires that you apply for all services you provide. The other accrediting body performing the same application review and noticing the ankle-foot orthosis does not consider it. The surveyor completes the process and, since all things prosthetic are in compliance, issues the accreditation. Is that a good thing? Two different standards? What would make the services of the accrediting organizations more valuable to you? • Here’s a touchy one. There is an inherent advantage to being large when it comes to recovery audit contractor audits and other intrusive reviews based on CMS policy. That policy limits the number of audits to no more than 10 every 45 days per tax identification number (TIN). A single unit provider with one TIN is much more vulnerable to audits than a multi-unit provider with one TIN. Is that fair?

Of course, there are dozens of other issues that may raise a few hackles, but let’s start with these two. Let us know what you’re thinking on these issues. Just email your thoughts to me at info@AOPAnet.org. We will publish the debate in an upcoming issue. Let’s get it going!

Charles H. Dankmeyer Jr., CPO AOPA President

JANUARY 2015 | O&P ALMANAC

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

Board of Directors OFFICERS

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

AOPA CONTACTS

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

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

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

JANUARY 2015 | O&P ALMANAC

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

Advertise with Us! Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopa14media for advertising options!

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NUMBERS

Female Faces Gaining Ground in O&P

Based on the numbers of students in O&P schools and new certified practitioners, women are choosing to become practitioners in record numbers Data is supplied by the National Commission on Orthotic and Prosthetic Education (NCOPE), the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), and the Board of Certification (BOC).

CERTIFIED PRACTITIONERS IN 2014

WOMEN COMPLETING NCOPE RESIDENCIES

APPLICANTS TO O&P MASTER’S PROGRAMS

1,163

206

Number of female ABC-certified practitioners.

38%

In 2012, less than four out of 10 practitioners completing NCOPE residencies were women.

43%

Number of female BOC-certified www.bocusa.org practitioners.

2012-2013 School Year

49% of applicants to a selected variety of O&P master’s programs* were women.

2013-2014 School Year

In 2013, more than 40% of practitioners completing residencies were women.

51% of applicants were women.

44%

In 2014, the percentage of female practitioners completing residencies was 44%.

“It’s very encouraging to see this shift in our female population.”

2014-2015 School Year

—Arlene Gillis, CP, LPO, FAAOP, chair of the NCOPE board of directors

46% of applicants were women.

FEMALE PRACTITIONERS OVER THE PAST 10 YEARS Women Now Comprise 20 Percent of ABC-Certified Practitioners Total Number of Practitioners

YEAR

Number of Female Practitioners

www.bocusa.org

Percentage Female

2009

1,161

149 13%

2004

2,014

262 13%

2009

4,560

703 15%

2004

3,701

461 12%

JANUARY 2015 | O&P ALMANAC

Percentage Female

206 15%

2014

•Numbers are for NCOPE-accredited schools that participated in NCOPE’s centralized application service.

Number of Female Practitioners

1,392

1,163 20%

Total Number of Practitioners

YEAR

5,860

2014

Women Now Comprise 15 Percent of BOC-Certified Practitioners

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Happenings FAST FACTS

RESEARCH ROUNDUP

U.S. Health Insurance Fast Facts

Robot Control Theory Improves Amputee Gait

$5,615

Average cost of health insurance in the United States, single coverage

$15,745

Average cost of health insurance in the United States, family coverage

$$$$$$ Alaska State with the highest cost of health insurance, single coverage: $6,180

$ Utah State with the lowest cost of health insurance, single coverage: $4,281

Source: Kaiser Family Foundation, National Conference of State Legislatures 12

JANUARY 2015 | O&P ALMANAC

Researchers at University of Texas— Dallas are seeking to improve gait for amputees who use powered leg prostheses. While some newer prostheses are designed with multiple motors to produce motion, they frequently cause awkward movements over unusual terrain or on stairs. A research team at the university has begun incorporating techniques used to control walking robots for use in powered prostheses, with the goal of producing a natural and speedy walking gait regardless of terrain. “We borrowed from robot control theory to create a simple, effective new way to analyze the human gait cycle,” says Robert Gregg, PhD, a faculty member in the Erik Jonsson School of Engineering and Computer Science. “Our approach resulted in a method for controlling powered prostheses for amputees to help them move in a more stable, natural way than current prostheses.” The researchers focused on a

single variable to adjust the motor activity of a prosthetic leg: the center of pressure that the body applies to the foot as a person is walking. This spot moves from the back to the front of the foot as an individual steps on the heel and shifts the body to move the weight toward the toes. The investigators developed control software that records an amputee’s height and weight as well as the measurements of his or her residual limb. The software was tested on three above-knee amputees at the Rehabilitation Institute of Chicago. After customizing the software with each patient’s information, the researchers asked the patients to walk on the ground and then use a treadmill. The test subjects were able to walk nearly as fast as nonamputees and reported having to exert themselves less than when using traditional control software. For more information, see the December issue of IEEE Transactions on Robotics.

#ICYMI

2015 DMEPOS Fee Schedule Takes Effect CMS has released the 2015 Medicare fee schedule for durable medical equipment, prosthetics, orthotics, and services (DMEPOS), effective for claims with a date of service on or after Jan. 1, 2015. The net Medicare fee increase for O&P services for 2015 is 1.5 percent. This is based on a 2.1

percent increase in the consumer pricing index for urban areas from June 2013 through June 2014, minus the annual productivity adjustment, set at 0.6 percent for 2015. The complete 2015 DMEPOS fee schedule may be downloaded from the AOPA website at www.AOPAnet.org.

HAPPENINGS

RESEARCH ROUNDUP

Doctor Designs Whole-Body Exoskeleton

PHOTOS: Dr. Miguel Nicolelis, Duke University

Duke University’s Miguel Nicolelis, MD, has created a “whole-body” exoskeleton designed as a wearable prosthetic suit for individuals who are paralyzed. The exoskeleton is equipped with a brain-machine interface and is controlled by brain-derived signals. Weighing 165 pounds, the exoskeleton supports the weight of the person inside and is operated by an electroencephalography cap. During the 44th Annual Meeting of the Society for Neuroscience in Washington, DC, Nicolelis described a clinical trial involving eight participants wearing the exoskeleton. The patients followed a training regimen that started with visualization coaching and progressed to dictating specific movements to the system, including walking and kicking. In June 2014, one of the participants used the system to deliver the inaugural kick during the opening ceremony of the FIFA World Cup in Brazil.

Nicolelis says the system allows paralyzed users to move again. One of the main components is artificial skin, which is a flexible, printed circuit board that can be put together in a mesh and distributed to key locations of the exoskeleton—such as the surface of the foot, knees, or hip. “We…fool the brain of the subjects to a point in which they feel that it’s not a machine that is carrying them, but [that] they are actually walking by themselves,” says Nicolelis.

South Korean Scientists Develop ‘Smart Skin’ A team of researchers from South Korea’s Seoul National University has created stretchable smart skin to attach to prostheses. The material is designed to restore a sense of touch to prosthesis wearers. The smart skin is equipped with ultrathin single crystalline silicon nanoribbon (SiNR) strain, pressure, and temperature arrays. The SiNR sensor arrays have geometries that are designed to stretch, which allow the material to be stretched out over an entire prosthesis.

The material also integrates stretchable humidity sensors and heaters that enable the wearer to feel the sensation of skin moistures to regulate body temperatures, according to the researchers. The goal of the smart skin is to replicate mechanical and thermal sensation in artificial skin and prostheses. Read more in the article titled “Stretchable Silicon Nanoribbon Electronics for Skin Prosthesis,” published in the Dec. 9, 2014, issue of Nature Communications.

O&P BOOKSHELF

Answer Your Patients’ Insurance Questions With New Publication

Insurance Coverage & Reimbursement: How To Be Your Own Advocate is the latest publication from the Amputee Coalition’s National Limb Loss Information Center. The 100-page book is designed to assist O&P consumers in advocating for themselves or a family member. Included is information on private insurance and government programs and details on the appeals process. Several O&P industry experts contributed to this publication, including AOPA Executive Director Thomas Fise, JD, and Joseph McTernan, AOPA’s director of coding and reimbursement. Practitioners can purchase single copies or boxes of 50, to distribute to patients, by contacting the Amputee Coalition, www.amputeecoalition.org

O&P ALMANAC | JANUARY 2015

HAPPENINGS

PATIENT PROGRESS

Quadruple Amputee Receives Double Arm Transplant A 40-year-old quadruple amputee underwent transplant surgery in Boston to receive two new arm transplants in November. Will Lautzenheiser, a patient at United Prosthetics Inc., lost his limbs in 2011 after coming down with a severe streptococcal infection. Lautzenheiser’s new arms came from an anonymous donor through the New England Organ Bank. Though doctors say it may take years before he can move his hands in complex ways, Lautzenheiser already has made progress and is able to stretch one of his arms.

DIABETES DOWNLOAD

Inhibiting Hormone Production Helps Combat Diabetes Diabetes researchers have discovered that levels of brown adipose tissue—known as “brown fat”—are diminished in obese people, contributing to obesity and diabetes by inhibiting brown fat activity. Obese people have less of the tissue, which is located around the collarbone and burns calories. Researchers at McMaster University have discovered that peripheral serotonin, which circulates in the blood, reduces brown fat activity and “dials down” the body’s metabolic furnace. In a study published recently in Nature Medicine, researchers found that blocking the production of peripheral serotonin makes the body’s brown fat more active. The results indicate that inhibiting production of the hormone may be effective

for reversing obesity and related metabolic diseases, including diabetes, according to Gregory Steinberg, the lead author of the study. “Too much of this serotonin acts like the parking brake on your brown fat,” he says. “You can step on the gas of the brown fat, but it doesn’t go anywhere.” The researchers said they also may have identified the environmental cue responsible for elevated levels of peripheral serotonin—the typical high-fat western diet. Eating a more balanced diet could help reduce levels of peripheral serotonin. The scientists advocate increasing energy expenditure instead of decreasing the appetite to combat obesity and prevent diabetes.

VA VIEWPOINT

1 in 4

One in four veterans has been diagnosed with diabetes.

JANUARY 2015 | O&P ALMANAC

National Hypoglycemic Safety Initiative Designed for Diabetic Veterans The Department of Veteran Affairs (VA) has launched a national Hypoglycemic Safety Initiative to encourage veterans with diabetes to seek support to lower the risk of hypoglycemia. Veterans are being encouraged to work more closely with their VA clinicians to set personal health goals and focus on self-management of their disease. One in four veterans has been diagnosed with diabetes, according to the VA. The key elements of the new initiative emphasize shared decision making and universal health literacy to ensure VA patients understand the health information provided by their health-care practitioners. “Hypoglycemia has only recently been prioritized as a national public health issue, but federal agencies are taking a leadership role in addressing the problem,” says Carolyn Clancy, MD, interim undersecretary for health. “Our objective is to change how diabetes is managed in VA and in the United States, and to help patients improve their personal well-being, not just their numbers.”

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

OPAF, the Orthotic & Prosthetic Activities Foundation, has welcomed new officers and board members for fiscal year 2014-2015. Sue Borondy is president; Karen Lundquist is vice president; Reggie Showers is treasurer; and Scott Williamson is immediate past president.

IN MEMORIAM

William L. “Bill” Meanwell William L. “Bill” Meanwell, a practicing pedorthist for many years with the International School of Pedorthics, passed away Nov. 19, 2014. A resident of Broken Arrow, Oklahoma, Meanwell helped plan and participate in the Pedorthic Footcare Association’s continuing education program. He was a pedorthist at Oklahoma State University and taught at the International School of Pedorthics. Meanwell recently owned and operated Corethotics in Tulsa, Oklahoma.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Paul Prusakowski, CPO, FAAOP, of OPIE Software, is traveling across the United States in the OPIE Mobile 2.0 RV, working with individual O&P facilities. Prusakowski says his goal is to better people’s lives: “My interest has always been to further the O&P profession with the goal of improving patient care. This profession is my passion, my life’s work, and I will continue to look for ways to help. It is my belief that there is power in numbers and knowledge, and this tour is a means for ramping up collaboration and practice management skill development throughout the profession.” So far, Prusakowski has travelled the Eastern Seaboard and parts of the Northeast—and he even stopped by AOPA headquarters to visit with staff. Visit www.facebook.com/opiesoftware for more information.

American Prosthetics & Orthotics, which has patientcare offices throughout Iowa and Illinois, has opened a new office in Ames, Iowa. The office is staffed by Ric Volk, CO; Laurie Barr-Cronin, CPO; Steve Galluzzo, CPO; and Nick Ackerman, CP, director of prosthetics. The Amputee Coalition and the American Academy of Orthotists and Prosthetists have released “Working Together for a Successful Outcome,” a new tool to improve communication among amputees, their families, and care givers when working with health-care professionals. The resource is available on both organizations’ websites. Cascade Orthopedic Supply Inc. has announced a strategic distribution agreement with Ability Dynamics. Customers are now able to purchase Ability Dynamics’ prosthetic devices, including the RUSH product line, through Cascade. Hanger Clinic has announced that one of its patients, 9-year-old Ezra French, was featured on the Ellen television show in December. French was born with a rare congenital disorder called femur-fibula-ulna complex and underwent surgery at age 2 to amputate his nonfunctioning leg above the knee and reconstruct his hand. Under the supervision of Hanger Clinic Manager Ryan Russell, CP, BOCO, French has been able to participate in sports and a variety of other activities. Today, French is the starting quarterback of his school’s football team and was a finalist for the 2014 Sports Illustrated Kids “SportsKid of the Year” contest.

JANUARY 2015 | O&P ALMANAC

PEOPLE & PLACES

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Ottobock has announced the winner of the September and October competitions for the company’s C-Leg 15-Year Anniversary Photo Contest. The contest asks users of C-legs or other prostheses to submit photos or videos showing how their devices have changed their lives. Anthony Phillips of California was named the September winner. Phillips’ photo shows him crossing the finish line of a 5K charity run in San Diego two years after his amputation. Phillips underwent six months of chemotherapy following his amputation and had a long recovery time before he could run again. He has finally recovered to the point where he is preparing for a half marathon next summer. The October winner, Patrick Ward of Fort Lauderdale, Florida, underwent 47 surgeries to treat complications from a military service-related injury before his amputation. He received his C-leg about a year ago and was able to walk again for the first time in 12 years. He has chronicled in photographs the various activities he has returned to since receiving his prosthesis, including enjoying the marina. Ryan Wallace of South Lake Tahoe, California, was named the November photo contest winner. He received his C-leg after his 10-year-old prosthetic leg broke and his sound foot was injured. His practitioners at Anchor Orthotics and Prosthetics in Sacramento spearheaded a fundraiser, the proceeds of which were used to purchase the C-leg. “Anchor also designed my socket, which has the names of my supporters inscribed on it,” says Wallace. “It’s a daily motivator and reminder of the kindness and generosity that was bestowed upon me. As a result, I intend to get the most out of every day.” Due to his injury, Wallace is on leave from his job as a wrestling coach but is taking online classes to finish his degree.

Anthony Phillips, September Winner

Patrick Ward, October Winner

Ryan Wallace, November Winner

O&P ALMANAC | JANUARY 2015

REIMBURSEMENT PAGE

By DEVON BERNARD

PPS Billing Exemptions Learn the rules—and exceptions—for Medicare patients in an inpatient facility that uses prospective payment systems

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.20

JANUARY 2015 | O&P ALMANAC

PROSPECTIVE PAYMENT SYSTEM (PPS) is a system of reimbursement

where Medicare makes a daily payment, or a per diem, to a facility to provide and cover all medically necessary care for its inpatients under the Medicare Part A Hospital Insurance benefit. Medicare uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospices, hospital outpatients, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, etc. The PPS payment amount is different for each type of facility and covers different types of services. Regardless of the amount of each facility’s per diem and the type of services the per diem covers, one thing is certain: The payment is the same whether the facility provides the services through its own internal resources or through a vendor relationship with an outside provider, and the facility has the right to use the vendor of its choice. If a facility uses an outside provider/supplier, it must pay the outside supplier/ provider for its services since that facility already has received payment in full for the patient’s care under the PPS. Billing for items or services provided to a patient in an inpatient setting is rather straightforward: Bill the facility where the item was delivered and not Medicare, because the facility has received payment for the service or item under its PPS. This billing procedure is accurate most of the time, but there are some exemptions to this PPS standard—which can trip you up or cause you some headaches. This month’s Reimbursement Page examines some of the instances

where the PPS standard can stray, causing other facilities, Medicare, or individuals to be responsible for payment.

Home Health Exemptions

Section 1842 of the Social Security Act mandated that all services being provided to a patient under a home health episode must be paid under a consolidated billing format, or a Home Health PPS (HH PPS) system. However, the law established by Section 1842 clearly exempts, as of Oct. 1, 2000, prosthetics and orthotics from the HH PPS. This means that if you are treating a patient who is under home health care, you may still bill Medicare, and you are not required to seek payment from the home health agency (HHA). Just remember that even if your patient is in a home health episode and orthotics and prosthetics are exempt from the HH PPS, the HHA has the ability to provide and bill for O&P on its own or through a preferred provider. Be sure to verify with the HHA that it is okay for you to provide and bill for the items you intend to deliver to the patient.

Hospice Exemptions

When a Medicare beneficiary elects hospice care, he or she is declining treatment for a specific terminal illness and is electing to receive only palliative care. Any item or service that is being provided to the patient to meet those means are generally going to be included in the PPS payment to the hospice provider and cannot be billed separately to Medicare. With the election of hospice care, the patient is not forfeiting his or her rights for care of other illnesses

REIMBURSEMENT PAGE

or injuries not associated with their terminal illness. So, if the orthotic and/ or prosthetic items or services you are providing to the patient are provided to the patient for treatment of a condition or illness not related to the patient’s terminal illness, then those devices are eligible for payment by Medicare and may be billed to the durable medical equipment Medicare administrative contractors (DME MACs). To ensure Medicare knows the items you provided are not related to the terminal illness and the hospice stay, and are eligible for separate payment, be sure to include the GW-modifier in your claim.

Skilled Nursing Facility Exemptions

Several different exceptions may apply to PPS billing at skilled nursing facilities (SNFs). Depletion of Part A Benefits: The 100 Days. A SNF benefit period, or when the PPS is active and most items/services must be billed to the SNF, begins immediately after a patient is admitted to the SNF following a mandatory hospital admission of at least three days. Each SNF benefit period is capped at 100 days; after those 100 days, Medicare Part A will no longer cover any aspect of the SNF stay.

If the patient remains in the SNF past those 100 days, he or she must pay for the room, board, and nursing expenses through personal funds or other insurance, including Medicare Part B supplemental coverage. Medicare Part B will cover any orthotic and prosthetic care that the patient needs. When this is the case, you may submit your claim

directly to the DME MAC for payment. However, do not get stuck counting the days on a calendar to determine if the 100 days have passed and whether it is okay to bill Medicare. The 100 days is the benefit limit and not an entitlement. It is possible for a patient to be in a SNF for less than 100 days and not have Part A coverage, and it is possible for the patient to be in a SNF for more than 100 days and still have Part A coverage. When determining whether the facility or Medicare is responsible for payment, it is always best to confirm the patient’s status, Part A or Part B, with the facility business office—do not rely solely on the word of the patient, his or her family, or the physician. The buck stops with the business office, and a staff member there will know the status of any patient at any given time. Consider asking for status verification in writing, in case there is a dispute later concerning who is responsible for payment. SNF PPS Exempt Codes: The Prosthetic Exclusion. Most prosthetic items and services are considered to be high-dollar, low-volume items (not provided on a routine basis in a SNF setting). As such, they have been legislatively excluded from the SNF’s PPS per diem, eliminating a substantial financial burden. Because prosthetic items/services are excluded from a SNF’s PPS, you are allowed to bill Medicare directly instead of looking to the SNF for payment. However, not all prosthetic services/ items have been excluded from the SNF PPS system. Certain services, such as prosthetic socks, shrinkers, partial hand and partial feet prostheses, and immediate postsurgical prostheses and parts and labor (L7510 and L7520), continue to be included in the SNF PPS payment. More importantly there are two highdollar prosthetic items that have not been excluded from the SNF’s PPS: prosthetic foot codes L5969 and L5987. These items, as well as all orthoses, must be paid for by the SNF when a patient is in a Medicare Part A-covered stay. A full list of codes excluded from a SNF’s PPS may be found on the CMS website, www.cms.gov, by searching “SNF Consolidated Billing.”

Device Ordered Before Admission to the SNF: Custom Device Exemption. Another exemption to the traditional SNF PPS billing rules occurs when a patient is being transferred from a hospital to a SNF. Who pays for the device when a custom-fabricated brace or prosthesis was ordered for the patient while he or she was still in the hospital, but due to the fabrication time associated with a custom item, it is not delivered until after that patient is admitted to the SNF?

In this case, the hospital remains responsible for payment of the item because the medical necessity for the custom device was established while the patient was in the hospital, not in the SNF, so the SNF should not be billed. In addition, if the medical necessity for a custom device occurs while the patient is at home, but delivery does not occur until after a SNF-covered admission, the item may be billed to the DME MACs. To avoid receiving a denial in this situation—because the patient is currently in a SNF—make sure you use your start date as the date of service and not the actual delivery date. Just remember this exemption applies only to custom-fabricated orthoses and prostheses and does not apply to prefabricated (off-the-shelf or customfitted) items or to any type of therapeutic shoes or inserts. To read more about this exemption or to have a document to support you position when seeking payment from a hospital or Medicare, visit the CMS website and search for “Medlearns Matter Article SE0507.” O&P ALMANAC | JANUARY 2015

REIMBURSEMENT PAGE

Emergency Room Exemptions

Emergency room (ER) visits are unique in the PPS realm because they are not considered to be a Part A benefit. In other words, emergency room visits are not covered under the Medicare hospital insurance program, even though the patient is being seen in a hospital setting, because typically a patient is not admitted into the hospital. Most ER services will, however, be covered under Medicare Part B, or the supplemental insurance program.

In 2000 Medicare created an Outpatient Prospective Payment System (OPPS) to cover ER services including, but not limited to, hospital outpatient services (including partial hospitalization services), certain Part B services furnished to hospital inpatients that have no Part A coverage, and splints, casts, and antigens provided to hospice patients for treatment of nonterminal illness. Since orthotics and prosthetics were being paid under an existing fee schedule, Medicare decided to exclude O&P care from the OPPS. Therefore, any service you provide in an ER setting should be billed to Medicare and not the hospital in which the ER is located. Be aware that if you provide a device to a patient in an ER setting, and the patient is subsequently admitted to a hospital, the hospital could become responsible for payment of the item provided. 20

JANUARY 2015 | O&P ALMANAC

The Standard PPS Exemption— The Two-Day Rule

The two-day rule is the one exception that is consistently applied and is in play at any facility being paid under a PPS (acute care hospital, SNF, hospice, longterm care hospital, rehab hospital, etc.). The two-day rule states that you may deliver a completed device to a Medicare beneficiary during a Part A stay within 48 hours (two days) of his or her anticipated discharge date. As long as the device is not medically necessary during the last two days of his or her stay, and the patient is being discharged home and not discharged to a different hospital or facility, then you may bill the DME MACs directly for the device. However, you must be delivering the item only for fitting and training purposes, and this doesn’t mean the patient uses the item during therapy. If the item is required as part of the patient’s recovery or rehabilitation in the facility, it must be paid for by the facility regardless of when it was delivered. If you deliver an item to a patient during a Medicare Part A stay and all of the two-day rule criteria have been met, then you may bill the DME MACs. When billing under the two-day rule, use the discharge date as your date of service.

Incarcerated Patients

Though technically not covered or paid under a PPS system, billing for incarcerated patients is a unique delivery situation that changes who is responsible for payment. For terms of this article and for Medicare, the terms “incarcerated” and “in custody” mean any person who at the time of delivery or date of service is under arrest, imprisoned, escaped from confinement, under supervised release, on medical furlough, required to reside in mental health facilities, required to reside in halfway houses, required to live under home detention, or confined completely/partially in any way under a penal statute or rule. Typically, Medicare will not make a payment for anyone who is incarcerated, and the claim must not be submitted to Medicare. However, there is one exception to the rule when it is acceptable for you to

bill Medicare. For this exception to be met, two criteria must be fulfilled. First, the state/local laws require those individuals who are incarcerated to repay the cost of medical care they receive while in custody. Second, the state/ local government actively enforces the requirement to pay by billing and seeking payment from all those in custody with the same legal, whether insured or uninsured. The state/local government also must pursue collection of the amounts owed (this includes the collection of any Medicare deductible and coinsurance amounts and the costs of items and services that are not covered by Medicare) in the same way it collects all other debts. If these criteria have been met and it can be shown that they are met, then you may bill Medicare using the QJ-modifier. While this month’s Reimbursement Page covers some of the examples of when the PPS billing rules for Medicare are flipped and turned upside down, these are not the only exceptions. Be aware of the rules for inpatient settings when seeing patients outside of your facility. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org. Editor’s Note: To learn more about unique inpatient billing situations and other coding, billing, and reimbursement issues, attend an AOPA Coding & Billing Seminar. The first seminar of 2015 is scheduled for February 9-10 in Savannah, Georgia. Visit www.aopanet.org for details. 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

This Just In

New Year, New Congress Will new faces in the 114th Congress have a big impact on O&P-related legislation?

Mitch McConnell (R-Kentucky)

By THOMAS F. FISE, JD

Sen.-Elect James Lankford (R-Oklahoma)

Sen.-Elect Bill Cassidy (R-Louisiana)

HE NOVEMBER 4 MIDTERM

Tom Harkin (D-Iowa)

election featured a Republican rout that impressively “flipped” the U.S. Senate: from a 55/45 Democratic majority in the 113th Congress, to what looks to be a 54/44 Republican majority in the 114th Congress, with two Independents. Everyone is thankful the election is over so none of us has to watch another attack ad, or receive still another fundraising email. If we measure the impact of the election on O&P in terms of how our O&P PAC contributions were deployed, then the news is very good. The O&P PAC supported 28 candidates—19 Republicans and nine Democrats, we were right on 26 of those “bets,” or 90 percent. We made a strong commitment to new Majority Leader Mitch McConnell (R-Kentucky), and we are hopeful his election will have positive implications for O&P. The O&P PAC also provided strong support to two prospective new members of the U.S. Senate:

Sen. Ron Wyden (D-Oregon)

Sen.-Elect Bill Cassidy (R-Louisiana), a physician, a member of the House, a former AOPA Policy Forum speaker, and the winner of the run-off against Sen. Mary Landrieu (D-Louisiana); and Sen.-Elect James Lankford (R-Oklahoma) who, in his former capacity as chair of the House Oversight and Government Reform Health Subcommittee, was helpful in focusing attention on the perils of recovery audit contractor (RAC) audits and administrative law judge (ALJ) delays impacting O&P professionals. Probably the biggest loss for O&P resulting from the 2014 election relates to a diminished presence of two senators, both Democrats, whom O&P has counted as friends. Sen. Tom Harkin (D-Iowa), long a leading voice for the disability community and co-signer on a recent important letter on off-the-shelf orthoses, has retired, which also means we lost the lead sponsor of the Insurance Fairness to Amputees bill. Sen. Ron Wyden (D-Oregon) is no longer chair of the O&P ALMANAC | JANUARY 2015

This Just In

O&P Professionals Weigh In

The O&P Almanac asked two O&P industry experts to answer questions about how the legislative environment will change with the 114th Congress. Below, Tom Watson, CP, owner and president of Tom Watson’s Prosthetics and Orthotics Lab, and Rick Fleetwood, MPA, chief executive officer of Snell Prosthetic and Orthotic Lab—Arkansas, offer their insights. 1. With a Republican majority in both houses of Congress and a Democratic president, do you expect we’ll see less gridlock and more being accomplished? WATSON: “Historically, divided government can work if there is a willingness on both sides. Former President Bill Clinton and former Speaker of the House Newt Gingrich (R-Georgia) balanced the budget, worked on welfare reform, and created a surplus.”

Tom Watson, CP

FLEETWOOD: “I would love to say yes, but unfortunately I believe we will continue to see gridlock because of promises made by the newly elected officials and the veto power of the president. The president is trying to work on his legacy, and Republicans are trying to appeal to their base. However, I do believe that the majority of Americans are becoming much less supportive of a ‘do nothing’ attitude.”

FLEETWOOD: “Probably not, but it will be modified. To yank the program out would indeed cause chaos in all aspects of government. It has gone too far and is engrained into our process now. With nothing to replace care, the best option would be to modify it— and this is why O&P needs to be at the table.” 3. Do you see any significant changes in Medicare or health care generally in the next two legislative years, or can we look for more of the same? WATSON: “There will be little done with Medicare. I think they will work to improve the mess at the Department of Veterans Affairs instead—working on that is easier and may see some real results before the 2016 presidential election.”

FLEETWOOD: “Yes, I see significant changes in all aspects. We have not solved the problem in health care—we have only begun to address it! Coverage, technolRick Fleetwood, MPA ogy, scope of practice, and fair compensation will continue 2. Will Obamacare be to be on the table every year. It will be repealed? even more important that we, as private providers and as an organization, be able WATSON: “I think the Supreme Court to address those challenges and issues will decide the fate of Obamacare in in a strong position, with strong leaders June. and in a timely fashion that will test our Those who won election on repealabilities.” ing it will be loud to satisfy their constituents. There are some good things in it, but the funding vehicle will implode if the court rules against the medical device tax and the individual mandate.”

JANUARY 2015 | O&P ALMANAC

Senate Finance Committee, so we lost a committed O&P advocate in a high place. His likely successor, Sen. Orrin Hatch (R-Utah), has been sensitive to O&P issues, and Hatch’s staff is both knowledgeable and responsive. Sen. Dick Durbin (D-Illinois), who championed our Department of Defense (DoD) outcomes research funding, won re-election, and we hope to continue to work with him in his likely new role in the minority leadership.

Dick Durbin (D-Illinois)

Tammy Duckworth (D-Illinois)

Our House champion, Tammy Duckworth (D-Illinois), won re-election, with our solid PAC support. We are confident she will continue to draw focus on O&P issues. Both of the cosponsors of our Medicare bill—Glenn Thompson (R-Pennsylvania) and Mike Thompson (D-California)—won re-election. We will continue to rely on their support, as well as the support of the 17 other returning House members supported by our PAC. Here’s a prognostication on two frequent questions. First, will the results of the election break the current Washington gridlock? Both parties always promise to work together, but now we have the legislative branch concentrated in the Republican party and the executive branch still in the Democratic party. They may work together in essential areas, but since gridlock reflects an ideological divide within the country itself, I think odds are that President Obama will veto a substantial number of bills passed by the House and Senate, and that Senate Democrats will be a barrier to overriding most of those vetoes— so gridlock is likely to continue.

This Just In

Second, will Obamacare be repealed? Depending on the precise Senate rules, Democrats may be able to block by filibuster any votes on bills to repeal Obamacare. Of course, the president will veto any bill enacted by both houses, and Senate Democrats can unite to sustain such vetoes. For these reasons, repeal seems unlikely; however, there could finally be incremental efforts to amend aspects of the Affordable Care Act, and such bipartisan efforts do have a chance to succeed. The $1.1 trillion combined continuing resolution and omnibus appropriations bill (the “cromnibus” bill) includes a DoD section with an additional $10 million for O&P outcomes research funding. This funding also was included in last year’s budget. We are especially grateful for AOPA lobbyist Catriona Macdonald, who has done a spectacular job in transitioning this from a one-time item to a multiyear accomplishment—and hopefully a mainstay of the federal budget. This is another good win for AOPA and its members, and was particularly impressive given the large number of cuts to other programs that were squeezed out of the DoD portion of the bill. In addition, the 113th Congress signaled that the efforts of AOPA and many others have been successful in raising very significant concerns regarding the Medicare RAC audits, and the unconscionably long (and illegal) delays in allowing providers to access an ALJ hearing. Although there is no substantive fix included,

an additional $5 million was added to ALJ funding in the omnibus appropriations bill. Greater help, while by no means certain, could come in new Medicare legislation in 2015. The good news is that Congress did “put down a marker” on its concern in the following language included in the bill: “Recovery Audit Contractors (RACs). There is concern that the CMS RAC program has created incentives for RACs to take overly aggressive actions. Information received from the Office of Medicare Hearings and Appeals (OMHA) indicates that about 50 percent of the estimated 43,000 appeals were fully or partially overturned at its level. The fiscal year 2015 budget request should include a plan with a timeline, goals, and measurable objectives to improve the RAC process. In addition, CMS is expected to

work with Congress and stakeholders to identify challenges and additional reforms. Further, CMS should establish a systematic feedback process with OMHA, the CMS programs, and the RACs to prevent the appearance that RACs are selecting determinations to increase their fees. The CMS is urged to stay focused on improvements to all ‘operations’ that prevent improper payments in lieu of chasing dollars after the fact.” Once the 114th Congress is sworn in, we’ll have a new look to our legislative interactions. When Congress sets its calendar, AOPA will set dates for the 2015 AOPA Policy Forum— watch for it, and come meet your new representatives. Thomas F. Fise, JD, is executive director of AOPA.

O&P ALMANAC | JANUARY 2015

COVER STORY

‘She’

Putting the in

O&P

Women are pursuing careers in the industry in greater numbers than ever before By CHRISTINE UMBRELL

Need to Know: • The number of female O&P practitioners in the U.S. has increased 152 percent in 10 years, and women now comprise 20 percent of practitioners certified by ABC. Still, an imbalance in leadership roles at O&P companies remains. • Two major changes in the profession have led to this evolution: a move toward a less manually-driven profession and an increase in the education level required for practitioners. • Women may approach problem solving from a slightly different angle, which can lead to unique solutions in treatment plans. The combined skills of women and men can be the best aspect of a diverse workplace. • Small and mid-sized companies seeking to attract a more diverse workplace can look to larger, women-friendly organizations for guidance. Össur and Hanger are just two of the companies that have implemented programs to advance women in leadership roles.

JANUARY 2015 | O&P ALMANAC

COVER STORY

OR NEW PRACTITIONERS, SEEING women in the O&P

workplace is nothing out of the ordinary—especially in larger O&P companies and practices affiliated with universities. But a lack of female faces in some of the smaller, more rural O&P businesses continues. In addition, a large percentage of O&P managers and owners still tend to be male. The number of female O&P practitioners in the United States has increased 152 percent in 10 years, and women now comprise 20 percent of practitioners certified by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. While the disparity in management positions is noticeable, the numbers of female students choosing the O&P profession is promising. And it offers hope for an even more gender-balanced workplace in the next 10 to 20 years.

Trending Female

Historically a male-dominated profession, the numbers of female practitioners have risen dramatically during the past 20 years (see “Numbers” on page 10). Two major changes in the profession have led to this evolution: a move toward a less manually-driven profession (with lighter materials and more devices being made via central fabrication) and an increase in the education level required for practitioners. These two factors, along with an increased awareness of the profession through media coverage, have led to more women choosing a career in O&P. In the United States, the O&P profession started out as a series of mom-and-pop shops, with fathers passing down the family business to sons. There was limited exposure to the profession as a career choice. O&P ALMANAC | JANUARY 2015

COVER STORY

“Up until we had the schools and the bachelor’s degree became required for certification, you learned the profession from your family,” says Anita LibermanLampear, MA, immediate past president of AOPA and the administrative director of the University of Michigan Orthotics and Prosthetics Center (UMOPC). “It was a craft, and there was little encouragement for women. But with the schools and the degrees, women began to see that this was a choice,” she says. “Historically, there was not enough awareness,” agrees Arlene Gillis, MEd, CP, LPO, FAAOP, chair of the board of directors at the National Commission on Orthotic and Prosthetic Education (NCOPE). “It used to be considered more of a men’s profession because there was so much metal-bending and working with hands,” she says.

“Up until we had the schools and the bachelor’s

St. Petersburg College Program Director Arlene Gillis, MEd, CP, LPO, FAAOP, reviews the anatomy of the spine with students and faculty

“Since the educational requirements have grown, and since there is greater awareness of the profession, more women are choosing O&P.” Gillis came to the profession by choice, not by family. She was the only female in her class at her O&P program at Florida International University (FIU) in 1994—a scenario that was “challenging, but it was fine. The climate was that if you were able to perform well, and complete the task, it really wasn’t a problem.” Gillis has a unique perspective on the profession, having practiced in multiple settings. After working in private practice and for the Department of Health, she settled at St. Petersburg College, where she is program director of the College of O&P. Each year Gillis sees more diversity in the schools: Women comprise 52 percent of the O&P student population overall, with even higher percentages in some programs.

degree became required for certification, you learned the profession from your family.” —Anita Liberman-Lampear, MA Arlene Gillis, MEd, CP, LPO, FAAOP, and St. Petersburg/College Florida State University Consortium students 26

JANUARY 2015 | O&P ALMANAC

“Since the educational requirements have grown, and since there is greater awareness of the profession, more women are choosing O&P.” —Arlene Gillis, MEd, CP, LPO, FAAOP

The Value of Women Practitioners

Businesses that include and promote women have a strategic advantage because “women bring some different things to the table,” says LibermanLampear, who has extensive expertise in helping organizations achieve success. She led the revitalization of the UMOPC program when she first came on board, turning it from an underperforming 18-person department into a 56-employee unit that is an integral part of the university health system. Women may approach problem solving from a slightly different angle, which can lead to unique solutions in treatment plans. The combined skills of women and men can be the best aspect of a diverse workplace, says Dana Johnson, regional vice president, Hanger Clinic. “Some women excel at communication skills, and some men may have great engineering skills.

COVER STORY

Female Pioneers

NE OF THE TRAILBLAZERS who showed the histori-

cally male-dominated O&P community that women can be successful in the profession was Mary Dorsch, CPO, one of the first women O&P business owners and a past president of AOPA (1971-1972). In 1934, when Dorsch became a below-knee amputee at age 20, she went to Dorsch Prosthetics for her prosthesis, where she met her future husband, Charles Dorsch. After marrying Charles, she started working at the facility, eventually taking over the company and becoming its president. She was the first woman to earn certification from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC). “I was born into O&P,” recalls Marita Dorsch Carozza, CP, FAAOP, Dorsch’s daughter. “As a child, I played with wood ankle blocks and swung on the parallel bars in the office. O&P patients were an everyday part of my life.” In 1963, upon high school graduation, she started working in the business, eventually becoming a manager, then an owner. She went to school to earn her certification in prosthetics, attending New York University and graduating from Northwestern University. She continues to serve the profession as a consultant for the facility accreditation program and its surveyors for ABC. For Dorsch Carozza, being a woman in a male-dominated field was simply a way of life. “I never saw it as an obstacle, and my mother never presented it as an obstacle,” she says. “My mother had laid the groundwork for me.” But she notes that it was important to prove herself to other practitioners. “I may have felt extra pressure being Marita Dorsch Carozza, CP, FAAOP in the minority—but it pushed me to try harder. You didn’t want it to ever be said that you couldn’t do what the man next to you could do.” Back in the 1950s and ‘60s, the scope of practice of the O&P profession involved more manual labor than it does today. The standard fabrication techniques, combined with heavy machinery and components, lent themselves to a male-dominated profession. “Decades ago, fabrication was 75 to 90 percent of the job,” recalls

Dorsch Carozza. In addition, treating male patients 40 years ago was a challenge for women prosthetists and orthotists, whose patients were not accustomed to female O&P practitioners. “There was a possible modesty issue with male patients that was not shared by male practitioners treating female patients. [Male clinicians] were the accepted norm,” she says. Lucia Klemmt Nezelek, CO(E), CPed, is another female O&P professional who prevailed during a time when very few women chose the profession. Born in Rotterdam, Holland, Klemmt Nezelek moved to Germany at age 7 and spent a portion of her childhood living in war-torn areas. She married an orthotist in Lucia Klemmt Nezelek, 1951. The couple immigrated to CO (E), CPed Canada in 1957, then moved to the United States two years later. In 1965, Klemmt Nezelek and her husband started Klemmt Orthopaedic Services in Vestal, New York. After studying orthotics at NYU and Northwestern, she earned her ABC certification. “There was definitely some discrimination,” Klemmt Nezelek recalls of her early years in the profession. “I didn’t recognize it at the time. I thought it was just my lack of experience, which made me work harder to gain acceptance.” Klemmt Nezelek enjoyed a gratifying career in O&P. She took great pleasure in the relationships she formed with patients, doctors, nurses, and suppliers. Outside of the office, she served as an examiner in orthotics for certification programs at two universities. She also was a long-time member of the O&P Auxiliary and an avid fundraiser for the Academy and the O&P PAC. At age 87, Klemmt Nezelek is retired but still interested in the profession: “Looking back, we have come a long way, haven’t we?” she says.

O&P ALMANAC | JANUARY 2015

COVER STORY

That doesn’t mean women can’t be great engineers, and men can’t be great communicators—but it does mean that “if you have both men and women in a clinic, they’re going to learn from each other,” she says. “O&P is a very broad profession. There are certain areas where women tend to migrate toward,” adds Gillis. Cranial, pediatric, and mastectomy subspecialties tend to attract a greater percentage of female practitioners. Leigh Davis, MSPO, CPO, LPO, treats a high percentage of scoliosis patients—usually adolescent girls—at Childrens Healthcare of Atlanta: “The majority prefer female clinicians,” she says. She also suggests that some of the mothers of babies being treated with cranial helmets prefer female practitioners, who “bring the maternal instinct into the interaction.”

“We’ve come a long way in larger institutions, but some of the women I know working in smaller companies still feel they have to work twice as hard to prove themselves.” —Chrysta Irolla, MS, MSPO, CPO

JANUARY 2015 | O&P ALMANAC

Female clinicians also are frequently called on to see female transfemoral patients, says Davis, who earned her MSPO degree from the Georgia Institute of Technology in 2007. “Not all women prefer women practitioners, but [transfemoral fitting] can be a very personal interaction.” Chrysta Irolla, MS, MSPO, CPO, a young practitioner at the University of California, San Francisco, also sees the benefits that female clinicians have to offer: “In my experience, female practitioners are very good at addressing the emotional piece of a patient’s rehabilitation through really listening to their goals and the story beyond the orthosis or prosthesis,” she says. Irolla received her master’s in O&P at Georgia Tech in 2011, and also has a master’s in engineering design and education. “Women are very adept at getting patients to confide in them so they can provide a more holistic therapy.” But, she concedes, “Some male practitioners are Chrysta Irolla, MSPO, CPO, volunteered with a great at that as well.” Range-of-Motion project in Guatemala last year As a newer face in the O&P industry, Irolla never really thought twice about choosing a profes- women, they’ll start infiltrating more and more management roles over the sion that, in past years, was malenext decade.” dominated. She saw a good balance Davis believes it may take 10 to 20 of men and women in her classes, and years for this to happen: “It’s going to only noted a lack of women during take a long time to see totally balanced those rotations she spent at small leadership,” she says. “But there are rural facilities, and at a rotation at the more opportunities today to take on Department of Veterans Affairs hospimanagement roles than in the past.” tals. “I’m lucky I did not have to be a Perhaps more troubling is the pay trailblazer,” she says. “But there’s still a grade inequality between male and lot of work to do.” female practitioners, which many see as a continuing problem. While some Breaking the Glass Ceiling are quick to point out that women may Despite recent advances in a more receive smaller salaries due to mitigatgender-balanced workplace, an imbalance in leadership roles at O&P ing factors such as maternity leave companies remains. absences, shorter workweeks, or more “The lack of women in managewomen in roles that are typically lower paying, “there are still pay discrepanment is probably the biggest hole in our profession right now,” says Irolla. cies when you compare apples to “But since there’s a huge influx of apples,” says Davis.

COVER STORY

O&P Companies Focus on

Female Leadership

S MORE WOMEN EMBRACE the profession, O&P

companies are taking note. Össur and Hanger are just two of the companies that have implemented programs to advance women in leadership roles. In early 2014, Össur initiated an internal women’s leadership group to provide leadership education to the female employees of Össur in the United States and to promote more women in leadership roles within the company. “There are a lot of women pouring into the profession, but it’s still maledominated,” says Karen Edwards, Karen Edwards senior area manager, prosthetics, and director of the Össur Women’s Leadership Initiative (OWLI). To determine how to approach the initiative, she created an online interest survey, to which 135 female practitioners responded. The results included the following: • 93 percent agree the O&P industry needs more women in leadership roles. • 56 percent feel the O&P industry does not encourage gender fairness in the workplace. • 50 percent say their organization does not reward leadership. • 50 percent say their organization does not offer adequate benefits such as paid maternity leave. • 64 percent are under the age of 40.

Edwards created a website, www.Össur.com/OWLI, which went live in November. During 2015, Edwards says the OWLI will publish blogs and send monthly leadership education emails, hold four educational webinars, and host a speaker at one or more of the national O&P meetings. Like Össur, Hanger recently demonstrated its commitment to advancing women in the profession. The company held a “Women in Leadership” course at its 2014 Education Fair & National Meeting and will be hosting the course at the 2015 Education Fair & National Meeting as well. The objective of the session is to connect, engage, and empower women leaders at Hanger. The course features a female keynote speaker as well as a panel discussion showcasing women leaders at Hanger. The panel discussion covers a range of topics, including personal career journeys; behaviors, techniques, and strategies for managing conflict; leadership competencies; work / life balance; and more. The 2015 Women in Leadership course will be extended an hour (totaling four hours). Rebecca Hast, president of Linkia, will serve as keynote speaker. The initiatives at Hanger and Össur are designed to provide women with more avenues to connect, so they will come to support and mentor one another for the good of the profession—and its patients.

Given these findings, Edwards helped set several goals for the OWLI: increase the volume of female leadership within the O&P industry, encourage fairness and equality in the workplace, eliminate conscious or unconscious gender biases, and create a positive, balanced perception of both male and female industry leaders. “A lot of the biases are unintentional, because historically there were not very many women in the profession,” says Edwards. “And women sometimes take subservient roles, or feel like they have to keep quiet until they prove themselves.” She wants to promote the positive qualities that women bring to the profession: “We want to educate the industry; it makes economic sense to attract and retain the strongest practitioners, regardless of gender.”

O&P ALMANAC | JANUARY 2015

COVER STORY

Irolla notes that at some facilities, managers may be afraid to invest in women—to provide continuing education or put them on the path to management—“because they believe a female clinician will have kids and leave whereas their male counterparts won’t. This is a dated assumption and only stands in the way of the best practitioner excelling.” “Women need to be vocal about [equal pay]—and once there are more women in management, we should be able to address this,” Irolla says.

Combatting Discrimination

While most O&P professionals are accepting of both sexes in the O&P workplace, “There are still many men in the field who walk around with the old-school mentality,” says Davis. And though many female practitioners do not see a great deal of gender discrimination in 2014, there have been—and still are—some circumstances where women are treated unfairly. Liberman-Lampear, the second female president of AOPA, recalls how different the industry looked just 20 years ago. In the early 1990s, when she was hired as assistant department

administrator to transform UMOPC, she spent several weeks driving around Michigan, visiting O&P facilities to meet colleagues and get ideas for her own program. There were very few women in her travels. “The majority of the businesses back in the early ‘90s were very small,” Liberman-Lampear recalls. Despite the fact that almost all of the business owners and managers were male, “I was welcomed with open arms … I was always treated respectfully and as part of the group.” But she does recall one early experience: “When I first started at UMOPC, two of the staff told me they didn’t want to work with a woman—so I helped them to the door,” she says. “I’m not one to be intimidated.” Irolla, who is much newer to the industry, agrees that it’s important to stand up for yourself. “I’m lucky I don’t face as many biases as women many years ago,” says Irolla. “But sometimes, an older male clinician will treat a young female practitioner like junior staff, rather than a colleague.” In such situations, Irolla says, “it’s important to make clear that you value their opinion, and will take their

“If you have both men and women in a clinic, they’re going to learn from each other.” —Dana Johnson

points into consideration, but you’re their colleague and will make your own decision,” she says. During her rotations at various facilities, Irolla says she sometimes felt hesitance from older male practitioners in trusting her with technical and fabrication work. “But I never felt hesitance in the patient-care aspect,” she says. “We’ve come a long way in larger institutions, but some of the women I know working in smaller companies still feel they have to work twice as hard to prove themselves,” says Irolla.

Taking Some Lessons From Bigger Companies

Some women see advantages in working at larger O&P facilities, with multiple locations and more opportunities, because such companies are obligated to comply with the Family and Medical Leave Act and other regulations that can offer protection for female employees. Small and mid-sized companies seeking to attract a more diverse workplace can look to women-friendly larger facilities to learn what they’ve done to attract female workers. 30

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COVER STORY

“At a bigger company like Hanger, we can offer benefits such as maternity leave, job sharing, and part-time jobs, and have the ability to provide a broader offering of policies and practices designed to assist our employees with balancing their work and personal lives,” says Johnson. With a large staff across multiple locations, Hanger is “inherently more diverse in our employee makeup, resulting in a need and opportunity to match career paths to individualized interests.” Hanger has a greater percentage of women in clinician and management roles than many other companies that Johnson is familiar with. The company also offers a Women in Leadership course at its annual Education Fair (see sidebar), and there is a concerted effort to increase women in leadership roles at the company. “But we’re not trying to promote people just because they’re female,” Johnson says. “Hanger is similar to most other large companies—results are going to get you where you want to be.” She encourages women to “have confidence in their own skills” in order to move forward. And women who are considering jobs at smaller companies should not be afraid to ask for the benefits they are seeking, even if they are not advertised. Some smaller workplaces may be more flexible than you think.

A Bright Future

As more women enter the field, many are choosing to participate in social networks to share their challenges and address gender-specific issues. “It is important for women to mentor each other,” says Gillis. “It can be helpful, especially if there are no other women in an individual woman’s workplace, to have another female to relate to,” she says. Davis is a big advocate of camaraderie among women. In fact, she is a founding member of the Women in O&P Committee of the American Academy of Orthotists and Prosthetists (AAOP), which she helped form while still an MSPO student. Davis and several other Georgia Tech students

started an informal group in 2005 that eventually became an Academy committee. The committee hosts a website, facilitates a mentoring program, and organizes social events and meetings. “O&P is more than just a career for a lot of people,” Davis says. “The more the field becomes a passion for you, the more you want to overcome the challenges in the field and make it part of your life.” Engaging in discussions with other women about career paths and family/work balance can help alleviate some of the stress points.

Irolla believes that mentor programs can be very useful to new practitioners. She notes that her own mentor demonstrated how to manage work/life balance as a clinician and researcher. “Women in O&P are starting to create message boards and share ideas,” she says. She encourages female O&P professionals to find ways

to connect with each other. Some O&P companies have initiated programs to focus on women in leadership (see sidebar). Women-centered alliances should be one part of a larger networking strategy, says Liberman-Lampear. “I don’t think we should be about men versus women. We all need to do this job together as team, regardless of gender or ethnicity.” Look no further than the O&P organizations, and you’ll see a number of women achieving top leadership positions: Liberman-Lampear just finished her tenure as AOPA president; Gillis is chair of NCOPE, and Michelle Hall, CPO, FAAOP, recently served as president of AAOP. Seeing women in these high-level positions demonstrates the level of acceptance of female leadership within the profession, and bodes well for the future of women seeking to succeed in the industry. Irolla sums it up nicely: “Hopefully in 10 or 20 years, no one will care about male versus female—just about quality patient care.” Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com. O&P ALMANAC | JANUARY 2015

By ADAM STONE

Fast

EDUCATION

Can an accelerated master’s degree program change the training model for educators, students, and residencies?

TRACK

Need to Know: • O&P leaders across the United States are watching closely to see how the Baylor College of Medicine first-of-its-kind 30-month O&P master’s degree program performs. • The program delivers all of the standard academic coursework needed to support a master’s degree at a highly accelerated pace—just 12 months in the classroom, roughly half the usual time. • Students also complete six three-month, full-time clinical rotations, which are organized by BCM educators rather than the students themselves. • Rather than be paid as employees during their residencies, students continue to pay tuition. This could encourage providers who could not afford to hire on residents in the past to get involved in training.

• While BCM program organizers are optimistic, they concede that the model will not work for every school. Some may shy away from the logistical burden that comes with maintaining deep involvement with the residency program. Others may not have a suitable financial structure. 32

JANUARY 2015 | O&P ALMANAC

PHOTO: Baylor College of Medicine

• As a final project, students must engage in data collection, conduct research through hands-on work with patients, or else work to define, design, and prototype a clinically relevant product or part related to O&P care.

T CAN BE A LONG AND WINDING ROAD on the way to a career in O&P.

A typical student will spend two years working toward a master’s degree, followed by another 18 months to two years in residencies. While some will call this time a small price to pay for admission into a lifelong profession, others ask whether it’s possible to speed up the process and still graduate high-quality professionals. Administrators at Baylor College of Medicine (BCM) in Houston say they have hit on the answer—one that combines academic work with a rigorously controlled residency experience. Students complete the program in just 30 months, while gaining exposure to residencies in a range of clinical settings. The program will graduate its first class of 18 in December 2015, and O&P leaders across the United States are watching closely to see how this first-of-its-kind education model performs. “We want to take a look at the outcomes, have some conversations with the Baylor faculty, and see if it is plausible,” says Arlene Gillis, MEd, CP, LPO, FAAOP, chair of the National Commission on Orthotic and Prosthetic Education (NCOPE) and program director for the O&P program at St. Petersburg College. If the model proves successful, it could mean dramatic change for students, educators, and those who offer residency opportunities throughout the O&P community.

Baylor College of Medicine is located in the heart of the Texas Medical Center at One Baylor Plaza, Houston.

obligation, applicants participate in multiple-day interviews, talking to three faculty members as well as to a student who can describe firsthand the rigors of the program. “We look for students who are dedicated and who understand what they are getting into.”

PHOTOS: Top right-UTHealth; Center-Baylor College of Medicine

How It Works

The BCM Master of Science in Orthotics and Prosthetics (MSOP) delivers all of the standard academic coursework needed to support a master’s degree, but it does so at a highly accelerated pace—just 12 months in the classroom, roughly half the usual time. To get through, students must carry a heavy workload. “A student can’t have a job during this program. It’s just not feasible,” says Jared Howell, BCM’s program director for O&P. To ensure prospective students understand the

Not everyone shows the academic prowess, or single-mindedness of purpose, needed to make the grade. In its first two years, the program has accepted just 25 to 30 percent of applicants. As with any O&P education, academics are only a starting point. BCM’s didactic, or classroom, learning is followed by hands-on residency experience. But here, the similarities

end. In this tightly integrated model, students don’t simply graduate and go off to their residencies. Rather, the clinical experience is an integral part of the overall learning experience. This means faculty stay involved during the residency phase, which is structured so that students experience a broad range of O&P practice models. It also means that the financial model changes. Rather than be paid as employees during their residencies, students continue to pay tuition during this time. (Tuition and fees run an estimated $24,500 per year.) This could be a game changer for O&P, says Josh Utay, BCM assistant program director and instructor. Under this structure, providers who could not afford to hire on residents in the past might now be tempted to get involved in training, knowing there would be no out-of-pocket cost. Students take a financial hit, at least in the short term, paying for rather than being paid for their residency work. But they get out of school and into the job market considerably faster, so the equation roughly balances, according to the organizers. O&P ALMANAC | JANUARY 2015

Students work in the fabrication lab

JANUARY 2015 | O&P ALMANAC

MSOP faculty keep in close contact with each residency site, working with residency mentors, or “preceptors,” to track student training. Following each rotation, professors test the students and discuss clinical cases. In addition to classroom and clinical work, students must meet a research requirement. As a final project they may engage in data collection, conduct research through hands-on work with patients, or else work to define, design, and prototype a clinically relevant product or part related to O&P care.

What Students Say

So far, program managers are confident that the 30-month model is working. Students may not be getting a lot of sleep, but they are turning in quality work and are set to graduate on time. Fanny Schultea, MSEd, CSCS, 36, already had a master’s degree in exercise physiology when she decided to pursue a career in O&P. As an expeFanny Schultea rienced learner she was able to evaluate the various O&P schools around the country, looking for just the right fit. “I had been in school long enough to know my learning style. I knew my abilities, and I knew I prefer to be immersed in the material. I knew

I could learn more at a fast tempo: Throw it all in there and do it every day. I knew that a more intensive approach would be best for me, that I would ultimately learn more,” she says. BCM’s condensed time frame seemed to offer that kind of environment. Schultea also was attracted by the school’s willingness to stay engaged even as students moved into the residency portion of their education. “They don’t just stick you in this rotation and call it a day. Each residency is carefully thought out by the faculty and the clinical coordinator— and also by the students,” she adds. Ryan Butler, 25, came to BCM looking for a human experience. He had started down an engineering career track, but found it lacked the caring touch. By luck, he met up with a group building low-cost prosthetics for patients in the developing world. From there, he connected with a practitioner in Provo, Utah, and began his O&P journey. “I really enjoyed the human interaction, the opportunity to be working with real people and seeing the impact of the work,” he says. Still, the educational situation in O&P made him nervous. “I met a recent graduate, and he was frantically trying to find a residency. That surprised me. I hadn’t known it would be that tough after you graduate. So when I saw what BCM was doing, that was obviously

PHOTO: Baylor College of Medicine

BCM’s program managers also take a direct hand in lining up residencies for their students, in contrast to a system that has typically left students to fend for themselves in search of clinical experience. “In the past, the institutions have had little to do with getting someone a job. It is on the student’s shoulders to secure his or her own residency,” Utay says. “We see the residency as a really crucial part of the student’s education, and this allows us to manage that part, to create a completely new experience.” Students complete six three-month, full-time clinical rotations, organized by BCM educators. Participating facilities include Brooke Army Medical Center at Fort Sam Houston, Naval Medical Center San Diego, Michael E. DeBakey VA Medical Center in Houston, Shriners Hospitals for Children in Houston, as well as TIRR Memorial Hermann—The Institute for Rehabilitation and Research, and clinics throughout the community. That broad range of facilities makes it possible to expose students to diverse settings as they move through their rotations. “In the traditional residency model, they might see a lot of one thing, whatever their mentor was good at. Students might see many adults, but they never saw pediatrics, or they saw pediatrics but never saw spinal cases. Now, they have the opportunity to see a much broader spectrum of care,” says Howell.

interesting,” he says. As part of BCM’s first MSOP class, Butler is excited about the rigorous hands-on opportunities. “O&P is not a typical engineerRyan Butler ing problem. Every person is unique. You can read the textbook but then when you get out there in the clinic, everything has its own set of problems. There are a lot of skills you need to develop,” he says. For David Patterson, 30, the BCM program means having an opportunity to get working that much sooner. “I was really drawn by the possibility of getting into the clinical piece quicker, the chance to get busy and get experience handling patients,” he says. A member of the first MSOP class, he has already completed an orthotics rotation at Dynamic Orthotics and Prosthetics in Houston and is now in a prosthetics rotation there. Patterson is especially pleased with having the opportunity to practice in multiple disciplines. “I like possibility of having that wider exposure—exposure to different techniques, exposure to different methods of handling challenging patients, and just the variety of devices that we get to see,” he says. How did he and his classmates handle the accelerated course load? “Baylor became our home,” he says. “We were there every day from 8 a.m. to 5 p.m. doing coursework, and it made us rely on each other. We worked together. We were all as efficient as possible. And we all survived.”

The Bigger Picture

PHOTO: Baylor College of Medicine

Looking across the O&P landscape, some observers say the BCM model could drive interesting changes. For example, Gillis is intrigued at the possibility that an unpaid residency might make it possible for small providers to get involved in the education process. “There are practices who aren’t able to afford residents who could now have that option,” Gillis says. Those smaller providers in turn gain by having access

NCOPE Educational Summit Meeting Reconvenes in 2015 This spring, the National Commission on Orthotic and Prosthetic Education will hold its first major educational gathering in a decade. The 2015 NCOPE Educational Summit Meeting will convene April 10-11 at the Renaissance Hotel in Tampa, Florida, and is expected to draw roughly 50 participants drawn from the various O&P professional organizations as well as others in the O&P community. Paul Gaston, PhD, an expert in health-care accreditation, will facilitate, says NCOPE Vice Chair Charles Kuffel, MSM, CPO, FAAOP. “The profession is rapidly changing due to pressures from outside entities— DME, physician referrals, audits, etc.—as well as new educational standards necessary to practice within the profession,” Kuffel says. “These changes have necessitated the need for a global look at the educational requirements, professional capacities, and practice expectations for all levels of care in O&P.” While the meeting will span a broad range of topics, participants will review the major developments in the profession since the last Summit Meeting in 2005, and they will re-evaluate the relevancy of six recommendations set forth in that meeting to determine which may require further attention. Summit participants also will explore the issues currently facing the different levels of practice: clinical, assistant, fitter, technician. They will consider, in broad terms, recommendations that should guide the profession and its leadership through the next decade.

for the first time to students recently trained on the latest techniques and technologies. “Those students are going to come with all these new ideas, things those practices might not have been able to access before.” All that being said, it’s also likely that the BCM model will not work for every school. Some may shy away from the logistical burden that comes with maintaining deep involvement with the residency program. Others may

not have a suitable financial structure. With BCM’s effort still in its infancy, it remains to be seen how these factors will play out in the long term. In the meantime, leaders at BCM say they are optimistic that the combined emphasis on academic and clinical experience will help the school to give students the most thorough education possible. “We have the privilege of shepherding a student all the way through—from the very beginning, to the time when they are totally prepared to take their certifications exams,” Utay says. Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com. O&P ALMANAC | JANUARY 2015

By ADAM STONE

Minding the

Science

O&P researcher Jason Highsmith discusses what’s next for the profession and his career

“

&P RESEARCHER JASON HIGHSMITH,

field. Colleagues have nominated him for the AAOP Research PT, DPT, PhD, CP, FAAOP, Award and granted continues his steady climb him both AOPA’s in the profession. prestigious Thranhardt The new president-elect Lecture Award and of the American Academy the American Physical of Orthotists & Prosthetists Therapy Association’s (AAOP) recently earned Margaret L. Moore tenure at the University Award for Outstanding of South Florida, where New Academic Faculty. he teaches and is coPerhaps most impordirector of the Center Jason Highsmith, PT, for Neuromusculoskeletal DPT, PhD, CP, FAAOP tant: He cares. “We have Research. On December 29, always tried to keep attenhe left USF to become assistant direction on that population, to get a large percentage of our funding from the VA tor of research and surveillance at the so that we can find some answers for Extremity Trauma and Amputation those folks. It’s the least we can do to Center of Excellence (EACE), a joint help them, when they have given up research effort of the Department such a large part of themselves emoof Defense and the Department of Veterans Affairs (VA). tionally and physically. I can’t think of In recent years, Highsmith has a more deserving group.” conducted significant research on O&P Almanac recently spoke with the virtues of various knee therapies. Highsmith about his own evolving He also has led efforts to conduct career and the changing world of extensive literature reviews in the O&P research.

JANUARY 2015 | O&P ALMANAC

Tackling the Big Issues

To some extent, Highsmith’s career trajectory has been textbook: earning bachelor’s, master’s, and doctorial degrees from the University of South Florida. But his professional development had an unusual start that included several years of working with the Ironworkers Local Union #397. “My father was retired Marine Corps and a second-generation ironworker. There was nothing he couldn’t repair, nothing he couldn’t build, and it made an impression on me. I always thought I would like to be able to do that,” Highsmith says. He tested those waters after finishing his undergraduate work, while his wife worked on her degree in medical diagnostic imaging. Five years as an ironworker helped keep the family afloat, an experience that has served him well. The same skills he used to make ornamental handrails at Walt Disney World have helped him to make a more effective kayak hand. Creativity, mechanical skill, and an ability to envision materials and shape them to meet that vision—it turns out the leap from ironworker to O&P investigator is not as great as one might imagine. “For me, it was not really that big of a transition,” he says. At EACE, he’ll work to enhance collaboration between trauma and amputee care providers and conduct scientific research into traumatic injuries. The Research and Surveillance Division looks for gaps in research, and works with a range of partners to ensure research efforts are thorough across the community. “Someone has to do decide what is ‘meaningful activity’ and how to measure that. What technologies will you use to measure that, and how often will you measure?” Highsmith explains. By keeping watch across emerging research, he’ll be able to answer those questions. “Large systems like the VA have this data in various places. But someone has to go and do the detective work to find it and bring it together.” As the O&P world moves to embrace the International Classification of

“ “We think it is time now to chronicle in painful detail all of the training that goes behind an intervention. Otherwise, it is like trying to bake a cake and all you have is a box with a picture of a cake, but no directions on it.”

Functioning, Disability and Health (ICF), data-driven care is going to change. New standards for effectiveness will drive new research methodologies, Highsmith predicts. Today’s laboratories are set up to look for certain evidence of effectiveness, “but what passes for evidence of effectiveness is itself changing, and so the labs are all going to have to find new ways of producing that evidence,” he says. Under ICF, researchers as well as practitioners, will be adhering to new outcome measures, proof that treatments simulate the entirety of how a person lives and functions, rather than simply charting walking speeds or flexibility. “The model exists, so for researchers now it is a question of tailoring your questions and outcome measures, while changing the conversation with your colleagues in the field,” says Highsmith.

Finding a New Model

Among his other titles, Highsmith is the newly elected president of AAOP. In its support of data-driven outcomes, this professional organization goes right to the core of Highsmith’s passions. “To me, it is all about evidence-based practice, with the patient as the center of the universe,

“

and the academy is a group that lives that,” he says. For more than a decade, the academy has produced conferences to review the latest data in O&P science. That process is now under revision, and Highsmith says he is eager to speed that change. “We are winding down the old model, which was a good model but which had its limitations.” Previously, a group of experts would get together around a topic, review the literature, and hold a mini-conference with experts in various aspects of the topic. This process generates a useful body of knowledge for clinicians, but it could take a year or two from start to finish. In the new paradigm, researchers will gather and disseminate knowledge more quickly, tapping into worldwide sources in an ongoing process of review. As a “state of the science” program, conferences will no longer be the sole focus. Rather, information will be shared based on the immediate scientific need and emerging evidence— this may be done through a conference, or through new publications. “If you can capture high-level evidence from all over the world, and you can do it at a faster rate than ever before, you are clearly going to be improving the quality of care,” says Highsmith. O&P ALMANAC | JANUARY 2015

Linking Training, Experience, and Data

For years, O&P researchers have shared a common shortfall. While their work could describe function with great accuracy, it sometimes lacked a crucial component—an explicit demonstration of the practitioner training that was needed to achieve a particular result. While the outcomes might be of interest, “it typically leaves a lot to the imagination as to what the possible training may have been that led to these outcomes,” Highsmith says. As O&P investigations continue to mature, it only makes sense to create as full a picture as possible of the interventions under scrutiny. “We think it is time now to chronicle in painful detail all the training that goes behind an intervention. Otherwise, it is like trying to bake a cake and all you have is a box with a picture of a cake, but no directions on it,” he says. Until recently, funders may have been willing to pay for explorations into functionality, few have been interested in funding a precise exploration of associated training methodologies. “When a company is trying to prove the effectiveness of their component, they will pay for the research to do that or the government will pay for that. But no one pays for the training. No one pays to chronicle that piece of the puzzle,” Highsmith says. In effect, the practitioner gets to buy a fancy car, but there’s no one there to teach him how to drive it. Going forward, Highsmith will be seeking—and will be pressing his colleagues to seek—ways in which training documentation can be built into an overall grant structure. It is, he says, a key component to the overall success of any intervention. Highsmith is at heart a data-driven guy. It’s real when you can prove it with numbers, repeatedly, in a controlled experiment. At the same time, he toils in a field dominated by longtime professionals who work by experience and intuition. O&P practitioners know what to do based on what feels right and what they know will work. Highsmith is sensitive to the balance 38

JANUARY 2015 | O&P ALMANAC

“ “We have decades of campfire lore and legend, but scientifically that doesn’t always work. You have to have some real, comparative basis if you are going to measure a treatment’s effectiveness.”

“

that must be struck between that approach and a data-driven program. He likens it to conventional medical situations, thinking about how he might deal with decisions in his own life: “If I were suddenly faced with a decision about how to choose a cholesterol medicine, do I want to make that decision based on the way a majority of people respond to that medicine? Or, do I want my doctor to take an educated guess?” he says. “There is probably value in both.” How to strike that balance? In Highsmith’s view, it makes sense to begin with the science and then layer on the intuition. “I am inclined to start with what the preponderance of evidence suggests. You go in more educated, even if you know that your situation is a little bit different from the average,” he says. “Then, if a provider has a wealth of experience and has seen many people with other, confounding conditions, they may understanding something in that situation that goes beyond just the preponderance of data.” There is tremendous value in the wisdom of the long-time practitioner, but that value has got to be weighed

against in intrinsic worth of solid science, he explains. “We have decades of campfire lore and legend, but scientifically that doesn’t always work. You have to have some real, comparative basis if you are going to measure a treatment’s effectiveness.”

Pushing the Research Envelope

Highsmith and the USF team in Tampa have seen some significant research success, and he will continue to work with them to expand upon those findings. His chief field of research has encompassed “Clinical Trials of Exoprosthetic Devices: Physical Performance of Persons with Limb Loss & Deficiency and Biomechanics.” In practical terms, this entails the comparative effectiveness of traditional prosthetic or physical therapy interventions, as compared to microprocessor-driven solutions. His published clinical trials showed microprocessors offering tremendous advantages in terms of function, safety, and economics. Moving forward, the team is looking at the possibility that microprocessors could enhance a patient’s ability to focus on diverse activities beyond basic motion. This “biometric efficiency” has been a point of continued research and review. While the evidence has been convincing as to the efficacy of microprocessors, some questions remain. “With all these reviews coming, there is consensus that all this is by and large true. Now the question is: Does this apply to every particular microprocessor, to every particular model?” Highsmith says. He offers an automotive analogy. We know sports cars are fast; now let’s figure out which one is fastest, and in what setting. Do vascular patients show different outcomes from pediatric patients? Are there demographic variations? “That is the edge of knowledge right now, that’s the cliff we are standing on, wondering where to go next,” he says. Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com.

Have you Heard the News That Mobility Saves?

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

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

The Results

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

Lower Limb Prosthetics

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

100000

Study Group Average Cumulative Medicare Payments

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

To learn more about the campaign, visit

80000

40000

20000

www.MobilitySaves.org.

Comparison Group

60000

9 10 11 12 13 14 15 16 17 18

Months from Index (Receipt of O&P)

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

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

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

Brainstorming the

Future

Industry leaders meet to discuss strategies for advancing the O&P industry during inaugural AOPA Leadership Conference

including representatives from clinics OW CAN WE POSITION the O&P such as Hanger, Dankmeyer Inc., De La industry for success in the uncerTorre Orthotics and Prosthetics, Snell tain future? That’s the million-dollar P&O, Level Four O&P, Scott Sabolich question for orthotic and prosthetic Prosthetics & Research, Geauga Rehab practitioners, business owners, and Engineering, Scheck & Siress, Tillges manufacturers. And that’s the central question to be discussed during AOPA’s Certified Orthotic Prosthetic Inc., and many more. Manufacturers and inaugural O&P Leadership Conference distributors such as WillowWood, this month. Ottobock, Becker Orthopedic, O&P business owners and execuEndolite, Cascade, Freedom tives will meet January 9-11 in Palm Innovations, Fillauer, Orthomerica, Beach, Florida, to discuss near- and PEL, and Boston Brace, among others, long-term shifts in the industry. By will offer their insight as well. gathering with the brightest minds in the O&P industry in one location for seven sessions of A Great Mix of high-level discussion and Participants and Topics idea-sharing, participants AOPA President Charles H. will come away with a Dankmeyer Jr., CPO, will kick better idea of how to best off the Leadership Conference provide O&P services and during a Welcome Session. He run successful facilities for will discuss comments received the ultimate benefit of the Charles H. Dankmeyer Jr., CPO from top-level executives from patients of the future. AOPA member companies, who More than 100 O&P business were asked to share their concerns as leaders will convene to anticipate well as opportunities related to the the future challenges in health care. future of the industry. Senior leaders from all of the bigMichael Lovdal, PhD, will discuss the current health environment. “The gest patient-care and manufacturing U.S. health-care landscape is in the companies will be in attendance,

JANUARY 2015 | O&P ALMANAC

midst of unprecedented change with critical implications for O&P,” says Lovdal, a partner with Oliver Wyman. “We will explore the major drivers of change to help this community strategically position for the future.” Thomas Kirk, PhD, will lead a session on proactive AOPA steps and “survival imperatives,” and also will discuss the results of the Dobson DaVanzo “Mobility Saves” study, which offers tangible proof of the cost savings of O&P intervention. Global perspectives will be addressed by Professor Hans Georg Näder of Ottobock, and Stephen Blatchford, MBA, of U.K.-based Chas Blatchford & Sons. U.S. perspectives will be provided by Vinit Asar, MBA, CEO of Hanger Inc., and Paul Prusakowski, CPO, founder of OPIE Software.

Thomas Kirk, PhD

Professor Hans Georg Näder

Attendees will have an opportunity to share their expertise and offer their own insights during breakout sessions moderated by James Campbell, PhD, CO, and Jeff Collins, CPA. During one session, participants will meet in small groups to focus on specific threats to the profession. They will cover challenges such as audits, competitive bidding, hospital and institution networks, poaching by other providers, and technology. A second breakout session

will tackle “opportunities” for the profession, with small groups examining disease trends, consolidation, research priorities, boutique and niche O&P services, and ancillary services. The small groups will meet back up with the full group to share their conclusions.

Colin Roskey

AOPA Past President Anita Liberman-Lampear, MA

During the second day of programming, attendees will hear from attorney Colin Roskey in a presentation called “The Crystal Ball—What Are Federal Reimbursement and Regulatory Impediments Going To Look Like for O&P Over the Next Five Years?” Says Roskey, “What’s going to happen to federal reimbursements is probably where the ballgame is going to be played for O&P over the next five years. We know Medicare payment policy and related delivery reforms will be a defining element. What we don’t know is how that will play out, but this Leadership Conference will be the first effort by the O&P community to try and get a better feel for what may happen and review strategies for success under various scenarios.” Campbell and William Gustavson will discuss lessons learned from the cranial helmet experience, and Thomas Fise, JD, will share his knowledge of the Food and Drug Administration as it relates to the O&P industry.

Service delivery models of the future will be the topic of discussion by Michael Oros, CPO, Dennis Williams, and Jonathan Day, CPO, during a session moderated by Dankmeyer. AOPA Past President Anita LibermanLampear, MA, will moderate the final session, focusing on the voice of the insurer and payer perspectives. “O&P may be a fairly small piece of the health-care pie, but it plays a huge role in helping people regain their mobility and ability to contribute more forcibly to society,” says Charles Birmingham, PhD, who will speak on “The Voice of the Insurer.” “As both quality and cost metrics increasingly come to dominate our definition of value in health care, the challenge will be to demonstrate to buyers—insurance companies and health systems that now act like insurance companies—to recognize the true value of the goods and services offered by AOPA members. We hope to bring more possibilities into play at the conference that can make this happen.” Additional industry experts will address related hot topics during the programming. “We hope that by having a group of owner/director leaders in one place, we can have meaningful dialogues and share our visions of the future for O&P as it impacts everyone—from the patient, to the provider, to the supplier and the manufacturer,” says LibermanLampear. “We want to ensure as much as possible that our future, while different than it looks today, will be positive and meaningful for those we ultimately serve—our patients.”

Laying the Groundwork

In advance of the conference, AOPA sent a four-question survey to the top executive of each AOPA member company, asking for responses to questions related to current industry concerns and thoughts on the future. The responses were used to guide the itinerary for the conference. The wide range of answers provides thoughtprovoking starting points for discussion when the O&P leaders gather. O&P ALMANAC | JANUARY 2015

The “most pressing challenges” noted by survey respondents ranged from the “inhibitory effect of state licensure programs” to “evolving changes in regulations and allowable reimbursements” to observations that “orthotics in general are being devalued as more and more are premade, and all that the clinically trained orthotist needs to do is ‘slap it on’ the patient.” Other responses singled out the future regulatory atmosphere, noting that “care is not coordinated with surgeons doing amputations, and it leads to poor care, inability to get documentation, and little communication between various providers.” A telling response bemoaned “audits and claw backs. The time required to fight the ridiculous denials will most likely cost me my business, my employees jobs, and Medicare beneficiaries their health. The future is bleak, and I’ve all but lost my will to fight.” When asked to identify the growth and profit opportunities for O&P, respondents suggested “focusing more on custom and pediatric product lines” and “leveraging new technology, use of unique materials, and outcomes based on product design that dramatically reduce the cost of custom product solutions.” Another cited “expansion of state Medicaid,” and still another advocated for “outcomes-based practice” as an opportunity for the future. One respondent saw the future as the “older population taking charge to change the laws and control how government takes care of its citizens.” Two other responses resonate among many in the field today: “I do not see any promising growth in the field of O&P,” and, “[There will be] consolidation to maximize efficiencies and improve margins.” Five years from now, survey respondents predicted that the world of O&P will feature greater consolidation and “less personal patient care.” 42

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A more specific response forecast that the “ultimate prescription writers will be [a] center for aggregation for clinical practices. Professional and technical resources will be added to larger aggregate practice groups and keep more services within the practice. Less and less services will be referred outside [the] practice group.” Several respondents predicted O&P businesses will staff more care extenders—for example, “fewer practitioners and technicians and more assistants and fitters.” One respondent even suggested that “continued Medicare behavior and a lack of timely appeals to incentivized denials may eliminate [O&P service options for] Medicare beneficiaries.”

But many of the high-level industry executives who responded offered a little more hope. One respondent commented that “all clinics are going to have to perform routine outcome measures that will likely become transparent to the public over the next 10 years, if it takes that long. We may want to begin to establish our own outcome measures for comparison before someone else determines how our profession will be measured.” Finally, survey respondents were asked to define the talents, skills, and expertise that will be indispensable in the future, and to explain how we can ensure that the individuals required to fill those needs will be attracted to the O&P profession. Responses varied greatly, from “notes-taking and documentation skills,” to “more business/ marketing expertise,” to “computer,

software, technology skills, and a willingness to become students of change.” Another respondent trumpeted the basics of “old-fashioned people who know how to have personal interactions, care for people, and deliver what they promise.” Similarly, one survey participant noted, “Empathy will always be high on the list.” “Any clinician that markets himself as a solution to a physician’s or therapist’s problems will continue to be of value,” concluded one insightful respondent. “As the role of care extenders grows, the value of a truly qualified clinician, orthotically or prosthetically, becomes much more valuable.”

Crafting a Strategy for the Next Decade and Beyond

As industry leaders congregate in Florida to discuss the questions and answers of survey respondents, hear thought-provoking presentations on the latest hot topics, and participate in small-group strategizing, it is hoped that the adage “There’s power in numbers” will prevail. The leaders of the O&P profession will be positioned to brainstorm solutions and pathways for the O&P profession of the future. The entire O&P profession stands to benefit from the AOPA Leadership Conference, as those who attend the event will return to their companies to share best practices and strategies for the future. Attendees will forge stronger connections with other industry executives, setting the stage for partnerships and a spirit of cooperation as we enter the year 2015 and prepare for changing services models and new regulatory challenges that will impact how O&P professionals provide care and run their businesses. Editor’s Note: Look for follow-up information on the AOPA Leadership Conference in a future issue of the O&P Almanac.

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Setting the standard for O&P certification for over 65 years.

Contemplating an O&P Patient Registry The O&P profession could follow the lead of the American Joint Replacement Registry to design a repository for patient information

VERYONE ACKNOWLEDGES HOW CRITICAL cost-effectiveness and

evidence-based outcomes data will be to the future of every medical discipline—that is, if they want to get paid for services. And in today’s data-driven world, how nice would it be to have a readily accessible comprehensive source of orthotic and prosthetic data to respond to the “show me” insurer folks who demand evidence before they will pay us?

AJRR’s experience instituting a patient registry teaches us that such a resource takes time to build, but there can be major growth in just a few years.

The idea of an O&P patient registry has been percolating for more than two years within the AOPA leadership. Part of AOPA’s research concerning a patient registry has involved learning about the American Joint Replacement 44

JANUARY 2015 | O&P ALMANAC

Registry (AJRR), a registry of orthopedic patient data developed in conjunction with the American Academy of Orthopaedic Surgeons (AAOS). The AJRR is a “national center for data collection and research on total hip and knee replacement with far-reaching benefits to society including reduced morbidity and mortality, improved patient safety, improved quality of care and medical decision making, reduced medical spending, and advances in orthopedic science and bioengineering,” according to the AJRR website. The registry is designed not just to demonstrate quality of care, but also as a tool for securing FDA approvals and conducting postmarket surveillance. On Nov. 13, 2014, AOPA President Charles Dankmeyer Jr., CPO, AOPA Executive Director Tom Fise, JD, and Jim Campbell, PhD, CO, FAAOP, traveled to AJRR’s offices in shared space with AAOS in Rosemont, Illinois. They met with the key players in the registry program as well as Kenton Kaufman, MD, of the Mayo Clinic, who has facilitated AOPA’s introduction to the AJRR effort. The AJRR team helped AOPA develop a fuller grasp of how a registry works, and how a similar registry could be created for O&P. They shared ideas on the types of information that could be included within a patient registry,

including patient intake data, provider information, cause of the diagnosis, patient compliance, function information, and much more. AJRR now has 224 participating hospitals. The AJRR registry has accepted data on more than 45,669 hip and knee procedures, reflecting information from 123 hospitals and approximately 1,800 surgeons during the 2013 calendar year. AJRR’s data reflects approximately 4.5 percent of the total joint replacements conducted in the United States, according to 2010 data from the Centers for Disease Control and Prevention. Only Oklahoma and Alabama are not represented in the registry by a participating hospital. Since the 2008 inception of the registry, data has been received on a total of 80,227 procedures from contributing sites. Big things have small starts: AJRR’s experience instituting a patient registry teaches us that such a resource takes time to build, but there can be major growth in just a few

years. Consider numbers from AJRR’s first five years of implementation: • In 2008, the first year of the AJRR registry, two hospitals submitted patient data, for a total of 1,089 procedures. • In 2009, there were still only two hospitals submitting information, for a higher total of 1,474 procedures. • In 2010, six hospitals reported on 2,270 procedures. • In 2011, 16 hospitals reported on 4,804 procedures. • In 2012, 63 hospitals reported on 24,971 procedures. • In 2013, the numbers almost doubled, with 123 hospitals submitting information about 43,823 procedures. The longer term financial success of AJRR is to become self-sustaining and to decrease the financial obligations of the original partners. A fee schedule was developed in 2013 for

participating hospitals and covers the AJRR Demand Reporting and Electronic Dashboard Services, with plans to collect fees in 2014. Thus far, support has come from AAOS, the American Association of Hip and Knee Surgeons, The Hip Society, The Knee Society, hospitals, health insurers, medical device manufacturers, and contributions from individual orthopedic surgeons. Implementing a similar system for O&P would be a good way to aggregate information to help answer payor questions and to track outcomes of patients who have received O&P care. Getting there will not be easy or cheap. If the O&P profession embarks on an effort that parallels the AJRR, it will require a major commitment of resources from within O&P as well as the time and energy of many practices. The O&P Almanac will continue to update the O&P community on progress for developing a patient registry for O&P.

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O&P ALMANAC | JANUARY 2015

COMPLIANCE CORNER

By JOE McTERNAN

E! QU IZ M EARN

BUSINESS CE

CREDITS

Documentation: The Key to Maintaining Compliance

P.47

Polish your company policies on proper documentation to reduce claim denials

Editor’s Note: Readers of Compliance Corner are CREDITS now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 47 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

Documentation. There is no other word that causes greater anxiety among O&P practitioners, administrators, and business owners. It is a source of tremendous frustration and uncertainty, with the rules seeming to change every time the wind blows.

The seemingly endless publications from the durable medical equipment Medicare administrative contractors (DME MACs) that report extremely high error rates on claims they select for prepayment review all tell the same story. The majority of the claim denials are due to insufficient or missing documentation—from the O&P provider, the referring physician, or both. Error rates that often exceed 90 percent or higher are partially indicative of a systemic problem and not all simply due to bad or lazy providers, but the fact remains that documentation requirements, fair or otherwise, are simply not being met. Providers who are looking to establish strong compliance programs must take a hard look at their documentation policies and find ways to improve the documentation that they are recording. In addition, providers must work with their referral sources to encourage them to document the information that Medicare and other payors are expecting to see when reviewing claims. This month’s Compliance Corner offers a summary of the kind of documentation that must be recorded for claims to be paid.

JANUARY 2015 | O&P ALMANAC

Prescriptions

Documentation begins and ends with a single document, the prescription. While it is not the only piece of documentation required for claim payment, a noncompliant prescription will result in automatic denial of a claim without much recourse through an appeal. Fortunately, Medicare has published detailed information regarding exactly what must be included on a prescription for it to be compliant. Prescriptions for Medicare claims typically take two forms: a dispensing order and a detailed written order. While the only prescription that is absolutely required is a detailed written order, a dispensing order is valuable as it allows O&P providers to dispense needed O&P items quickly and efficiently without having to wait for the detailed order to be signed and dated by the referring physician. Dispensing orders may be verbal or written, but they all must contain the following information: • Beneficiary’s name • Description of the item(s) • Prescribing physician’s name • Date of the order and start date (if it is different from the order date) • Physician signature for written orders or supplier signature for verbal orders If you are going to rely on a verbal order as the dispensing order, it is important that all of the required information listed above is well documented in your files. Without proper documentation of a verbal order, the entire claim may be at risk if it is audited. Detailed written orders are required for all O&P claims and must be in your possession before a claim may be submitted to Medicare. While a verbal or written dispensing order allows you to deliver services to Medicare beneficiaries, you must have a compliant detailed written order in your files before claim submission. Detailed written orders must include the following information:

COMPLIANCE CORNER

• • • •

Beneficiary’s name Detailed description of the item(s) Prescribing physician’s name Date of the order and start date (if it is different from the order date) • Physician signature • Physician signature date The key to compliant detailed written orders is a complete description of every device or component of a device that will be separately billed. This description may be a narrative description or a list of Healthcare Common Procedure Coding System (HCPCS) codes and their descriptors. HCPCS codes alone are not detailed enough for Medicare purposes and will not be considered compliant. Many claim denials may be addressed by creating and implementing a process that ensures the prescriptions you receive are valid and compliant for Medicare purposes. This is one aspect of the documentation process over which you have significant control since you do not have to submit your claim until you obtain a fully compliant detailed written order. Putting procedures in place to ensure this piece of crucial documentation is consistently obtained may save you time and money down the road.

Physician Documentation

Physician documentation may be the largest source of frustration among O&P providers. This is the one aspect of the documentation process that the O&P provider cannot directly control. While physicians are used to documenting the medical need for the services they provide directly to patients, they often do not think about documenting the medical need for the services they refer to other providers. This creates an opportunity for O&P providers to educate their referral sources regarding the specific documentation that is needed to justify the medical need for the devices they prescribe. While some physicians may be reluctant to change the way they document, the majority of physicians will provide you with what you need as long as you are willing to help them get there. Regular meetings with your referral sources will allow you to educate

them on what documentation is needed and offer a forum to discuss the specific needs of your mutual patients. While influencing the documentation habits of your referral sources comes with a unique set of challenges, it is a crucial piece of the documentation puzzle and is intimately tied to your ability to obtain reasonable reimbursement for the services you provide.

O&P Provider Documentation

The clinical documentation that is in your records is a crucial part of the documentation process and should not be overlooked or downplayed. While it is true that Medicare looks to documentation in the physician’s record as the primary source for medical necessity documentation, what is documented in your records may ultimately be the difference between a paid claim and a denied claim. Unlike physician documentation, your documentation practices are fully under your control. It is essential that you create consistent and repeatable documentation policies within your practice that capture information essential to proving the medical need for the services you provide. While physicians are responsible for managing the overall health care of their patients, they refer patients to you for a reason. O&P providers have clinical expertise specific to the fabrication and fitting of orthotic and prosthetic devices—expertise the physician lacks. With that level of expertise comes a responsibility to record proper clinical documentation that supports the medical need for the O&P device from your perspective as an allied health professional. Ultimately, this documentation may be used to justify payment of your claim, whether upon initial submission or through the appeal process.

Proof of Delivery

A valid proof of delivery is a requirement for payment of all Medicare claims related to durable medical equipment, prosthetics, orthotics, and supplies. While the Medicare requirements for a valid proof of delivery are quite clear, approximately 20 percent

of all claim denials are a direct result of an incomplete or invalid proof of delivery document. A proof of delivery must contain the following elements to be considered compliant: • Beneficiary’s name • Delivery address • Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description) • Quantity delivered • Date delivered • Beneficiary (or designee) signature and date of signature If a device or supplies are mailed or shipped to a patient, Medicare will accept documented tracking and delivery information as a valid proof of delivery. In this scenario, all of the information above must be recorded within the provider’s files, along with documentation of receipt of the item(s) by the patient in the form of delivery confirmation from the post office or shipping service. Establishing policies and procedures regarding proof of delivery documentation is crucial to ensuring that you are compliant with Medicare requirements and is an easy way to immediately reduce instances of claim denials. Proper documentation remains an integral part of any successful compliance plan for O&P providers. Taking the time to make sure your existing company policies are fully compliant with Medicare regulations can help strengthen your business in a challenging health-care environment. Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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O&P ALMANAC | JANUARY 2015

TECH TUTOR

By BRAD MATTEAR, LO, CPA

The Polar Vortex of Fabrication Consider how extreme temperatures may affect O&P raw goods pre- and postfabrication

HAT A DIFFERENCE A week can

make! Last week, I was in shorts sorting out plastic in my garage; this week, I’m layered and have broken out the dreaded parka due to the “polar vortex.” In the world of fabrication, a week could mean the difference between success and failure. Technicians and practitioners alike need to be cognizant of the temperatures their custom-fabricated devices will be exposed to and modify fabrication techniques accordingly. Let’s travel back to school for a moment: “The chemistry behind selection of copolymer polypropylene versus homopolymer polypropylene is tied to the glass transition temperature of the plastic,” explains Gary Bedard CO, FAAOP, an industry expert who gives informative presentations on thermoplastic and thermoforming. Glass transition (Tg) is the temperature at which plastic exhibits glass-like tendencies—in other words, it becomes brittle. With temperatures for most of the country during the polar vortex dipping below—or well below—freezing, imagine the impact of the cold weather on our custom-fabricated devices. What can you do during these vortex times?

Every Degree Counts

We need to educate patients about the impact of these brutal temperatures on devices—but first we have to fabricate the devices with these temperatures in mind. Evidence proves that temperature does affect our materials. Technicians and fabricating clinicians around the country have said that modifying 48

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fabrication techniques are mostly “passed down” or “learned the hard way,” without much science behind the modification. But consider this: If temperatures impact the materials used in fabrication and consequently expose critical failures, what can we do to minimize these fractures/failures? In the orthotic world, we see a shift away from traditional polypropylene to copolymer due to the cold fracture that occurs. Says Bedard, “As a reference, the Tg of polypropylene is 0 degrees Celsius (exact Tg is dependent of resin formula), and the Tg of polyethlyene is generally -125 degrees Celsius; thus, adding a low percentage of polyethylene to polypropylene will increase the free volume of the molecular structure, allowing more flexibility through the lowering of the density and crystallinity.” In the Midwest and Northeast, we see a shift in material selection (polypropylene to copolymer) to accommodate the polar-like temperatures and decrease the chance for a fractured device. Scott Wimberley, CTPO, technical director of Fabtech Systems, says his biggest challenge in fabricating when faced with frigid temperatures is “the way forming materials react to cold molds.”

It has been suggested in the technical community molds should be warmed up prior to thermoforming. Wimberley backs this sentiment, saying, “Whether it be forming plastic or running resin, a cold model is a shock to the materials and delivers poor-quality results.”

Reconsidering Materials Storage

Where and how are you storing your plastics? Let me guess, it goes something like this: You need to order some plastic, and you place your order accordingly. The plastic shows up wrapped in either cardboard or clear plastic wrap. What we aren’t taking into consideration is what your plastic was exposed to during its travel to your facility. Did your plastic start in a warmer climate and end up in a sub 0-degree Michigan or Minnesota? Denise Yonney, sales manager from Airlite Plastics, says, “As far as packaging, we really don’t do anything different, and neither do the carriers. Plastic should be packaged for adequate product protection.” Concerning humidity during shipping, Yonney says, “Luckily, our olefins are not very hydroscopic so we aren’t dealing with plastic that absorbs moisture and

TECH TUTOR

can be more subject to freezing. Like any polymer, our plastics have cold temperature limits that could affect brittleness with impact. Typically, the lower the density, the better the cold temperature resistance.” I just visited an account in the Midwest that was storing raw goods in a “shed out back.” When I looked at the shed, I noticed it was a plastic shed that was purchased from a local box store with no climate control. Lisa Alston, sales manager for Allied Plastics, says, “Thermoplastics should be stored in a temperature-controlled, clean, dry area away from direct sunlight, which can cause yellowing in some plastics. They also should be stored flat in order to keep the sheets from bowing or distorting due to cold forming.”

Propylene molecular structure

Plastics that have been stored incorrectly with exposure to adverse temperatures are susceptible to cracks and breaks. “If you must store your plastic in an extremely cold environment, let it reach room temperature prior to any heating or fabrication,” says Alston. “This also will allow you to inspect the surfaces to ensure there are no issues that could affect the integrity of your plastic.” Fabricators also need to be aware of how adhesives are transported. “The majority of our materials are freeze-thaw compatible, meaning the short-term effects of colder temperatures will cause no ill effects,” says Wimberley. “Silicones and some resins, however, can react poorly if exposed to long periods of cold and must be handled accordingly.

Prosthetics Materials

There is not much printed science uniquely addressing prosthetic materials and temperature. One study, led by Maria Gerschutz, PhD, addresses “Tensile Strength and Impact-Resistance Properties of Materials Used in Prosthetic Check Sockets, Copolymer Sockets, and Definitive Laminated Sockets.” One important consideration for colder environments is lithium ion batteries. Jeffrey A. Denune, CP/L, clinical director of prosthetics for WillowWood, says, “Batteries are obviously affected by temperature change. Internal material changes occur at higher and lower temperatures, so it’s understood that you could see less efficient operation with some electronic devices in extreme temperature conditions.” Beyond microprocessors, “The same goes for hydraulics, as the viscosity changes in these units with a change to temperature,” says Denune. “In hotter temperatures, I have seen patients overpower a hydraulic knee, and at lower temperatures, the knee can become stiffer when used.” With regard to resin saturation after being exposed to colder temperatures, resins typically “get thicker with cooler temperatures, and thicker resins are harder to saturate,” says Wimberley. “During your coldest days, this may mean floating your containers in a warm water bath for 20 to 30 minutes prior to using them. “Pay special attention to your gel times during the colder months as your time may increase,” Wimberley adds. “To combat this, you may, in addition to heating the products up, also have to increase the catalyst amount.” Andy Besser, CPO, manager of American Prosthetics & Orthotics in Davenport, Iowa, mentions a situation regarding a patient who used his prosthesis in extreme temperatures: “My experience with prosthetic malfunction in cold temperatures amounts to a patient that worked in a food cold storage warehouse. Due to the extreme cold, the viscosity of the hydraulic fluid changed enough to

render the knee useless. It became a locked knee. To remedy this, the patient would wrap additional layers around the knee as insulation. This worked only to a limited degree. The knee was still less reactive.” This is a prime example of the necessity of educating the patient on the limitations of his or her prosthesis and the impact of external temperatures on devices.  Whether it’s a polar vortex or an Indian summer, it’s clear that temperatures affect our raw goods in extreme ways. It also is clear that more information and studies are required to provide evidence of the effects of temperatures in O&P. Adhering to manufacturers’ recommendations on storage and fabrication and staying educated on process management will go a long way toward creating a structurally sound product. Brad Mattear, LO, CPA, is central U.S. and national strategic account manager for Cascade Orthopedic Supply Inc. Reach him at bmattear@cascade-usa.com. O&P ALMANAC | JANUARY 2015

MEMBER SPOTLIGHT

Optec USA

By DEBORAH CONN

Continually Improving By elevating manufacturing and customization capabilities, Optec adds value for its customers

PTEC USA, AN ORTHOTICS

JANUARY 2015 | O&P ALMANAC

Production team delivers a final brace to a customer service supervisor

FACILITY: Optec USA LOCATION: Lawrenceville, Georgia OWNER: Daniel Suarez Sr. HISTORY: 17 years

Customer Service Manager Melody Williams assists a customer by phone

online catalog, brochures, printed fitting instructions, and order forms. Recently, Optec decided to initiate several programs for customers that are unique to the company, says Valverde. The first, being reinstated after a hiatus, is called iMarket. “A lot of facilities don’t have a large staff for marketing, and they don’t have materials to promote their services,” he says. “Through iMarket, facilities can use templates of our marketing materials, such as our catalog or product fliers— and we will customize them for each practice.” Optec offers free design services, creating ready-to-print marketing literature featuring each facility’s logo and contact information. Facilities only need to cover the cost of printing. The company has also launched a new referral program that offers facilities gift certificates for referring new customers to Optec. And a brand-new customer loyalty program offers tiers of rewards for consistent business, with a year-end golfing trip to the Dominican Republic for the company’s top customers.

“It’s our way of saying thank you to customers for being with us,” says Valverde. Daniel Suarez has participated in various medical missions to the Bonao region of the Dominican Republic, along with Nirav Shah, MD, and Leo D’Orazio, practice administrator, both from Princeton Brain & Spine Care. The group has offered free spinal care to 5,000 children and their families, an effort sponsored by the Cigar Family Charitable Foundation school and medical facility. “Within the last five to 10 years, O&P facilities have shown the need for more customization in Optec’s bracing and attention to detail. Also, listening to feedback from our providing partners has assisted us in making improvements that keep us ahead, in terms of what we offer in products and service,” says Suarez. “We’ve elevated our manufacturing and fabrication capabilities to make sure we can address the needs of all those looking to provide the best to their patients.” As part of that effort, Optec recently added a new manufacturing facility in the Caribbean that will significantly increase production capacity. “We always have a plan in place,” says Valverde. “The industry is continually changing, and we have to reinvent ourselves to continue to satisfy our existing customers and attract new ones.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: OPTEC USA

manufacturing company founded by Daniel Suarez Sr., in 1997, got its start as a small producer of made-to-measure braces. The business quickly grew, and today it offers a full line of orthotic devices to customers throughout the United States and worldwide. Suarez is joined by his two sons in the business, Daniel, Jr., who is a business development manager, and Joseph, who is involved in product development. Optec provides both custom as well as prefabricated orthotic devices, ranging from cervical collars and spinal orthoses to lower-limb and pediatric products. The company also offers a variety of designer patterns that can be applied to custom spinal orthotics, custom ankle-foot orthoses, and ankle gauntlets. The company prides itself on its customer service, says Sales and Marketing Director Randall Valverde. It offers 24-hour service, every day of the year, with overnight or same-day delivery options. Sales representatives also are available to schedule in-service events for O&P facilities on specific products. In addition, says Valverde, nearly every product Optec sells already has an approved Medicare L code, improving the reimbursement process. Customers also can download approval letters for specific devices from the CMS Pricing, Data Analysis, and Coding contractor directly from the website. Optec’s website is a strong marketing and operational tool, providing complete information on every product, including an

Optec staff

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MEMBER SPOTLIGHT

Walkabout Orthotics & Prosthetics

By DEBORAH CONN

Providing Value Through Technology How Walkabout O&P uses innovations in management and care to better serve patients

ALKABOUT ORTHOTICS & PROSTHETICS was

JANUARY 2015 | O&P ALMANAC

FACILITY: Walkabout Orthotics & Prosthetics LOCATION: Wausau, Wisconsin OWNERS: Darrell Cook, CPO; Glenn Barclay, CO; and Joe Domini, CPO HISTORY: 15 years

ABC-certified practitioners, two technicians, and four support staff members. Practitioners see a full range of patients of all ages—about 2,000 each year. In addition, a local ski hill and other outdoor sports generate a fair amount of business, says Vice President Glenn Barclay, CO, one of the founders of the facility. “We see a lot of people who have been in accidents involving winter sports and outdoor activities,” he says. Walkabout has a direct contract with a local hospital to provide 24-hour on-call services, which also means their practitioners are available any time, day or night, to all their patients. “We are able to educate health-care professionals on the services and value we can provide to patients who are having an upcoming amputation,”

says Barclay. “We have seen an increase in fittings of a postoperative protective device on new amputees to help protect the residuum and develop a relationship with the patient.” Barclay and his colleagues pride themselves on keeping up with the latest technological advances, both in terms of devices and office management. Two years ago the practice launched an O&P office management software system that encompasses scheduling, electronic medical recordkeeping, and billing activities. The facility modified the software to meet its particular requirements, developing its own forms to ease navigation through the system. “It took quite a while to put all of our charts into the system,” says Barclay, “but it has definitely been worth it in production and timeliness of services provided.” In particular, he notes, the program has made it easier to successfully manage Recovery Audit Contractor prepayment audits. “Everything is in place. We conduct weekly chart reviews before sending out bills. We do it by the book and have had very little opposition to our notes and dictations,” says Barclay. “We use a detailed template, and on a recent visit, one of the ABC examiners said our patient charts were some of the most thorough and complete she had ever seen!”

PHOTO: Walkabout Orthotics & Prosthetics

founded in 2000 by three practitioners who wanted to provide O&P services to residents of north central Wisconsin. Initially, the company was located about five miles from Aspirus Wausau Hospital, a level II trauma center. Eventually, Walkabout relocated its main office across the street from the hospital to better serve its emergent needs. “Relocating our office was a pivotal moment in our company’s history,” says President Darrell Cook, CPO. “Not only did it drastically improve our response time to the hospital, but the area has grown into a medical plaza, which has afforded us the opportunity to grow our walk-in business and other referral services.” Walkabout O&P has a travel radius of 100 miles, with seven outreach clinics located at such sites as physical therapy centers, an outpatient orthopedic surgical center, and local hospitals and nursing homes. Among the company vehicles is a mobile van equipped with a Trautman router, air compressor, ventilator system, and working bench top, allowing practitioners to modify and adjust orthotic and prosthetic devices. Walkabout’s primary facility occupies 6,400 square feet and includes two prosthetic gait labs, a full-service O&P fabrication lab, and four patient-care rooms. Employees include four

Glenn Barclay, CO, fitting custom knee brace to patient

MEMBER SPOTLIGHT PHOTO: Walkabout Orthotics & Prosthetics

Walkabout’s mobile lab

The facility also contracts with a local rehabilitation and physical medicine doctor who performs prosthetic evaluations before practitioners provide a limb. “He interviews the patient, deals with any postsurgical complications, and refers them to us for prosthetic services,” says Barclay. While Walkabout O&P enthusiastically embraces new technology, it also strives to maintain a very personal, hands-on approach to patient care.

“We invest in the latest advances and update our knowledge with continuing education,” Barclay notes, “but we strive to make it personal. Real people answer the phone. We fabricate devices by hand. We use a computer-automated design program for helmets, check sockets, AFOs, and prosthetics, but we are directly involved in making each device.” Looking ahead, Barclay and his fellow owners hope to expand,

perhaps securing a few new locations and hiring additional practitioners. “North central Wisconsin is a vast outreach area,” says Barclay. “We’d like to increase our ability to reach the number of people we can serve.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

November | December 2014

An Agent of ChAnge: inMotion Will Be AvAilABle for free! From its humble beginnings as a four-page newsletter in 1991, inMotion magazine has expanded in size and readership over the years and has been through many transitions – both in content and design. Through it all, our goal has remained constant: to fulfill the Amputee Coalition’s mission to “reach out to and empower people with limb loss to achieve their full potential through education, support and advocacy, and to promote limb loss prevention.” To support our mission, we want to reach more people with limb loss, to engage them in our programs and to provide valuable information about living well with limb loss. We believe that eliminating inMotion’s subscription fee will help us to achieve that goal. Therefore, effective April 1, 2015, inMotion will be available free of charge in both print and electronic format. We encourage all prosthetists to make their patients aware of this opportunity to sign up to receive this valuable resource. As always, we welcome and look forward to your feedback and suggestions. Please feel free to contact us at editor@amputee-coalition.org.

The Living Well With Limb Loss Magazine

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free subscription effective April 2015 Research Studies Your Role and Rights Adjustable Prosthetic Fit With a Twist of the Wrist

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O&P ALMANAC | JANUARY 2015

AOPA NEWS

AOPA Recommends Provisions for Ways and Means Committee Draft Bill

OPA HAS BEEN ANTICIPATING that the House Ways and Means Committee will be putting forward a bill to address Medicare fraud, hospitals, recovery audit contractors (RACs), and the long delays for administrative law judge (ALJ) hearings. AOPA’s strategy has involved working closely with two representatives who have been developing their own bills to address RAC problems, Reps. Renee Ellmers (R-North Carolina), author of H.R. 5083: The Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014, and Mark Meadows (R-North Carolina), whose bill is under construction. With the support of its O&P Alliance partners, AOPA has recommended that several provisions be included in these two bills, and has recommended language grafted from the O&P Alliance RAC Audit draft legislative language. H.R. 5083 includes language to recognize the prosthetist/orthotist’s notes as a legitimate part of the medical record and language to require CMS to track specific data on O&P RAC appeals, distinct from the current data spanning indiscriminately “only all” claims related to durable medical equipment, prosthetics, orthotics, and supplies. It is hoped that having these provisions appear in bills already crafted by GOP legislators would make it far more likely that these provisions would find their way into the bigger Ways and Means Committee bill, which will be on a faster track for enactment. On Thursday, November 19, Rep. Kevin Brady (R-Texas), chair of the House Ways and Means Health Subcommittee, released a 146-page working draft Rep. Kevin Brady of his bill, which is in its second (R-Texas) draft. (AOPA also provided input on the initial draft prior to the AOPA Assembly in Las Vegas.) This draft includes the following provisions of interest/concern to O&P professionals: • Language to recognize the prosthetist/orthotists’ records and notes as being a legitimate part of the medical record; • A broad provision instructing CMS to publish its specific requirements for payment of lower-limb prosthetic claims; • Institution of a 30-day required “discussion period” between auditor and provider before an audited claim is transmitted to the durable 54

JANUARY 2015 | O&P ALMANAC

medical equipment Medicare administrative contractor (DME MAC) for adjustment or recoupment; • Language to require collection of audit data for O&P distinct from the rest of DME data; • Two provisions instructing CMS to develop data-driven claims resolution/settlement offers for Part B claims like O&P, generally paralleling the settlement offers of RACs that CMS already has extended to Part A hospital claims; • A lengthy provision to initiate a bundled payment system for several specific Medicare episodes of care (surgery and all services 90 days thereafter). While currently limited to hip/knee joint replacement, lumbar spine fusion, coronary artery bypass graft; heart valve replacement; percutaneous coronary stenting; and colon resection, AOPA is concerned that it would give the secretary discretion to add additional procedures or services. Like all legislation, there are things AOPA would like to see changed, and other things that give AOPA great pause. Clearly, the strategy AOPA has invoked to advance some of the provisions it has favored has been borne out, and clearly there is much more work to be done. AOPA will continue working with the Ways and Means staff and legislators sympathetic to O&P issues to try to refine and remedy some of the rough edges with this draft bill. AOPA will keep members apprised of any developments. The 146-page bill is available on the House Ways and Means Committee website, www.waysandmeans.house.gov. Of greatest interest are pages 38-41, 54, 62-63, and 105-133.

AOPA NEWS

Study Finds Many Medicare Patients With OTS Devices Subsequently Require Custom-Fitted or Custom-Fabricated Devices

EDICARE’S OWN DATA SHOWS that many patients who receive a Medicare-reimbursed off-the-shelf (OTS) device subsequently also receive a Medicarereimbursed custom-fitted or custom-fabricated orthotic device. Dobson DaVanzo recently analyzed Medicare data and found this to be the case in 19 percent of Medicare patients requiring several types of orthoses. Clearly, some modest portion of this data reflects instances in which OTS devices are fitted out of necessity in the acute or emergent setting and occasionally with the knowledge that a custom-fitted or custom-fabricated device will be required further down the road. There also are instances with progressive disorders where an OTS device may be sufficient for a period of time before a patient’s condition warrants a custom device. Clinical experience indicates that such instances could account for a relatively small portion of the 19 percent. But it also appears likely that a very significant percentage of cases exist where OTS devices do not fully or appropriately meet the patients’ needs.

Type

Total Patients

Received OTS as First Orthotic Device Patients % of Total Patients

TLSOs 20,408 1,519 7.4%

Subsequently Received Custom-Fitted/ Fabricated Device Patients

% of Total Patients

163 10.7%

LSOs 197,906 19,917 10.1% 3,372 16.9% AFOs 268,232 56,959 21.2% 11,359 19.9% Total 486,546 78,395 16.1% 14,894 19.0% Source: Dobson-DaVanzo Analysis of Custom Cohort Standard Analytic Files (2007-2010) for Medicare Beneficiaries Who Received O&P Services From Jan. 1, 2008, through Dec. 31, 2008.

It appears that delivering substantial numbers of OTS devices without any accompanying adjustment and clinical care may not result in patients getting better, but instead may result in wasted Medicare funds on the original OTS devices and a delay in the patients receiving

any improvement in their symptoms/ health—at least in a substantial number of instances. In this unfortunate reality, both the patient and the Medicare program will be negatively impacted as a result of increased patient co-payments and additional expenses to the Medicare program, and a disregard for patient health for Medicare beneficiaries as a result of CMS mandating that devices be provided to patients without professional adjustment and fitting, contrary to the premises for approved labeling by the Food and Drug Administration. Read the full study on www.MobilitySaves.org.

AOPA Comments on ALJ Backlog

OLLOWING THE OCTOBER 29 Medicare Appellant Forum hosted by the Office of Medicare Hearings and Appeals (OMHA), the Department of Health and Human Services (HHS) opened a comment period to solicit suggestions for addressing the growth in the number of requests for administrative law judge (ALJ) hearings, and to help to clear the backlog of pending cases. The OMHA office is currently receiving approximately 14,000 appeals per week, compared to the 1,250 per week in 2011 prior to the “Dear Physician” letter and subsequent increase in auditing activities. While OMHA has received a modest budget increase to expand operations and is implementing several pilot programs, the O&P community has yet to feel any relief. The current wait time for an ALJ hearing is 414 days from the time of the request until the decision. AOPA recently submitted its comments on this issue, emphasizing the following points: 1. Recovery audit contractor (RAC) activities must be refocused. 2. CMS should offer orthotic and prosthetic providers the opportunity to voluntarily settle claims that are awaiting an ALJ hearing using a statistically valid extrapolation process. 3. OMHA should overturn claim denials that cannot be scheduled for an ALJ hearing within 90 days of a hearing request. 4. Coordinated actions are needed by HHS, CMS, and OMHA. 5. OMHA must be funded at a level that supports its increased workload.

HHS had received 92 comments as of December 8. Read AOPA’s full comments on www.AOPAnet.org.

O&P ALMANAC | JANUARY 2015

AOPA NEWS

Reserve Exhibit Space for the 2015 National Assembly

Mastering Medicare Webinar

Fill in the Blanks: VA Contracting and the New Template Jan. 14, 2015

XPAND YOUR KNOWLEDGE, GROW your market

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

JANUARY 2015 | O&P ALMANAC

HE HEALTH INSURANCE PORTABILITY and Accountability Act requires payors to use codes from the Healthcare Common Procedure Coding System (HCPCS). The end of the year marks the beginning of new codes and modifier changes effective Jan. 1, 2015. Do you have a plan in place? Ensure your practice is sound and prevent unnecessary audits down the road. Join AOPA for a webinar that will focus on the new codes and medical policy changes for 2015 and will explain why awareness of these changes is critical. • Learn the new HCPCS codes effective Jan. 1, 2015. • Discuss verbiage changes to existing codes and how they may affect your business. • Find out which codes will no longer be used. • Discover other changes to the HCPCS system. • Find out AOPA’s interpretation of why the changes took place. • Learn other pertinent policy/legislative changes your facility should be aware of to succeed in 2015.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register online at bit.ly/aopawebinars. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with registration questions.

AOPA NEWS

AOPA’s 2015 Mastering Medicare Webinars Announced

ARK YOUR CALENDAR NOW for the 2015 AOPA Webi-

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

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

OPA IS SEEKING HIGH-QUALITY education presen-

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

tations for the 98th Annual AOPA National Assembly. Share your expertise and advance your career by being part of the country’s oldest and largest meeting for the orthotic, prosthetic, and pedorthic profession. Your submissions, based on sound research and strong empirical data, will set the stage for a broad curriculum of highly valued clinical and scientific offerings at the 2015 AOPA National Assembly. All free paper abstracts for the 2015 AOPA National Assembly must be submitted electronically. Abstracts submitted by email or fax will not be considered. All abstracts will be considered for both podium and poster presentations. The review committee will grade each submission via a blind review process, based on the criteria below, and reach a decision regarding acceptance of abstracts. • Relevance, level of interest in topic • Quality of scientific content • Quality of clinical content All papers should be submitted at bit.ly/presentin2015. AOPA is accepting submissions for the following topics: • Clinical Free Papers: The top-scoring papers will compete for the prestigious Thranhardt Award. • Technician Program • Business Education Program: The top papers will be considered for the prestigious Sam E. Hamontree, CP (E), Business Education Award. • Symposia • Student Poster Submissions • Technical Fabrication Contest Submissions Contact AOPA Headquarters at 571/431-0876 or TMoran@AOPAnet.org with questions about the submission process or the National Assembly.

O&P ALMANAC | JANUARY 2015

AOPA NEWS

Earn CE Credits by Reading the O&P Almanac!

E! QU IZ M EARN

BUSINESS CE

CREDITS P. 20 & 47

Coding Questions Answered 24/7

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

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

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

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JANUARY 2015 | O&P ALMANAC

WELCOME NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants www.AOPAnet.org for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the companyâ&#x20AC;&#x2122;s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPAâ&#x20AC;&#x2122;s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume:

Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million.

Audubon Orthotic & Prosthetic Services 4110 Briargate Parkway, Ste. 200 Colorado Springs, CO 80920 719/867-7335 Category: Affiliate Member Parent Company: Audubon Orthotic & Prosthetic Services, Colorado Springs, CO Coastal Orthotics & Prosthetics 1100 CM Fagin Drive, Ste. 100 Hammond, LA 70403 985/345-9940 Category: Affiliate Member Parent Company: Coastal Orthotics & Prosthetics, Mandeville, LA Lori Walsh

Cranial Technologies Inc. 2163 Oak Tree Road, Ste. 102 Edison, NJ 08820 908/754-0572 Category: Affiliate Member Parent Company: Cranial Technologies Inc., Tempe, AZ Denise Smith Cranial Technologies Inc. 1065 Gessner Road, Ste. 300 Houston, TX 77055 713/465-1496 Category: Affiliate Member Parent Company: Cranial Technologies Inc., Tempe, AZ Amy Culpert, OTR

Cranial Technologies Inc. 800 8th Avenue, Ste. 124 Fort Worth, TX 76104 817/810-9223 Category: Affiliate Member Parent Company: Cranial Technologies Inc., Tempe, AZ Amy Culpert, OTR Cranial Technologies Inc. 2762 N. Lincoln Avenue, Unit C1 Chicago, IL 60614 773/883-2466 Category: Affiliate Member Parent Company: Cranial Technologies Inc., Tempe, AZ Mary Kay McGuire Cranial Technologies Inc. 128 Vision Park Boulevard, Ste. 100 Shenandoah, TX 77384 936/271-1900 Category: Affiliate Member Parent Company: Cranial Technologies Inc., Tempe, AZ Amy Culpert, OTR Mercy Clinic East 3524 E. Milwaukee Street Janesville, WI 53546 608/755-8686 Category: Affiliate Member Parent Company: Mercy Health System, Janesville, WI

Mountain Orthotic & Prosthetic Services 106 West Bay Plaza Plattsburgh, NY 12901 518/324-6569 Category: Affiliate Member Parent Company: Mountain Orthotic & Prosthetic Services, Lake Placid, NY Myomo One Broadway, 14th Floor Cambridge, MA 02142 617/401-2623 Category: Supplier Level 1 Paul Gudonis, MBA, CEO Scheck & Siress O&P Inc. 1525 E. 55th Street, Ste. 204 Chicago, IL 60615 312/757-5270 Category: Affiliate Member Parent Company: Scheck & Siress O&P Inc., Oakbrook Terrace, IL University of Maryland Medical Solutions 8322 Bellona Avenue, Ste. 204 Towson, MD 21204 410/724-8667 Category: Patient-Care Facility Matthew Irby

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

AOPA O&P PAC

Special Thanks to the 2014* PAC Contributors AOPA would like to thank the following individuals for their contributions in 2014 to the O&P PAC:

PRESIDENT’S CIRCLE ($1,000-$5,000)

CHAIRMAN’S TABLE ($100-$499)

1917 Club (Up to $99)

Michael Allen, CPO, FAAOP Ryan Arbogast Maynard Carkhuff Charles H. Dankmeyer Jr., CPO Thomas DiBello, CO, LO, FAAOP Thomas F. Fise, JD Rick Fleetwood, MPA Thomas Kirk, PhD Alfred Kritter, CPO, FAAOP Ronald Manganiello Ann Mantelmacher John Roberts, CPO Frank Snell, CPO, LPO, FAAOP Bernie Veldman, CO

John Allen, CPO Rudolf Becker III James Bernardino, CPO Michael Burton Robin Burton Erin Cammaratta Don DeBolt Ted Drygas, CPO Jim Fitzpatrick Steven Foy, CPO Michael Fulkerson, MSHA Susan Guerra, RN, CFO David Johnson, CO Steven Kelly Steven King William Kitchens, CO Teri Kuffel, Esq. Alan Lett, CPO Sam Liang Anita Liberman-Lampear, MA James Liston, CP, FAAOP Pam Lupo, CO Jeff Lutz, CPO Joe Martin, COO Brad Mattear, CPA, Cfo Wendy Miller, BOCO, CDME Jonathan Naft, CPO Chris Nolan Michael Oros, CPO, LPO J. Curt Patton III, BOCPO, CP Ricardo Ramos, CP, CPed, LP Tonja Randolph Rick Riley Andreas Schultz Donald Shurr, CPO, PT C. William Teague, CP James Weber, MBA Pam Young Claudia Zacharias, MBA, CAE

Dale Anderson, CPO Michael Angelico Vincent Benenati Luke Brewer, CPO Scott Buser Kieth Capps Vinny DeCataldo Mark Degroff Susi Ebersbach Kristin Faircloth, CPO Arlene Gillis, MEd, CP, LPO, FAAOP Melody Giralo, CPO Paul Gudonis Warren Hagen, CO, BOCO, CPed, PTA Denise Hoffman Neal James Rosie Jovane Brian Kasprowicz, CO Jim Kingsley Eileen Levis Carlo Luetto Mark McDonald, CPO Larry Powers, CP Chrissy Thomas Terry Thompson, CO Robert Tillges, CPO, FAAOP Steve Tillges Mike Vanek Jeff Wensman, CPO

SENATOR’S TABLE ($500-$999) Kel Bergmann, CPO Frank Bostock, CO Jim Campbell, CO, FAAOP, PhD J. Martin Carlson, CP Marbee Gingras Richard Gingras, CPO Elizabeth Ginzel, CPO, LPO William Gustavson Jon Leimkuehler, CPO, FAAOP Paul Prusakowski, CPO Walter Racette, CPO Bradley Ruhl Ronald Snell, CP Gordon Stevens, CPO, LPO Frank Vero, CPO John Wall, PT, CPO, FAAOP Ashlie White Eddie White, CP

JANUARY 2015 | O&P ALMANAC

AOPA O&P PAC

2014 PAC Supporters These individuals have generously contributed directly to a political candidateâ&#x20AC;&#x2122;s fundraiser and/or have donated to an O&P PAC sponsored event. Daniel Bastian, CP Rudolf Becker III Kel Bergmann, CPO Jim Cahill Jim Campbell, CO, FAAOP, PhD Maynard Carkhuff J. Martin Carlson, CP Rikki Cheney Jeff Collins, CPA Glenn Crumpton, CPO Charles H. Dankmeyer Jr., CPO Don DeBolt Mitchell Dobson, CPO, FAAOP Susi Ebersbach Jeff Erenstone Mike Fenner, CP, BOCPO, LPO Thomas Fise, JD Rick Fleetwood, MPA Elizabeth Ginzel, CPO, LPO John Horne Frank Ikerd Lori Jack Paul Johnston James Kaiser, CP, LP Jim Kingsley Thomas Kirk, PhD Alfred Kritter, CPO, FAAOP Eileen Levis Anita Liberman-Lampear, MA Tom Loposer

Special Thanks

Ronald Manganiello Dave McGill Kenneth Meier, CPO, FAAOP Michael Oros, CPO, LPO Jeffrey Parsons, CO Matt Perkins Ricardo Ramos, CP, CPed, LP Rick Riley Paula Rogerson-Doherty Bradley Ruhl Kurt Schlau Scott Schneider Donald Shurr, CPO, PT Chris Snell William Snell, CPO Gordon Stevens, CPO, LPO Peter Thomas, Esq. Ted Trower, CPO, FAAOP John Tyo Frank Vero, CPO James Weber, MBA Elliot Weintrob, CPO Lisa Williams-Guichet Pam Young James Young Jr., CP, LP, FAAOP Claudia Zacharias, MBA, CAE

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate to educate them about O&P issues and to help elect those individuals who support the O&P community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@aopanet.org.

* Due to publishing deadlines this list was created on Dec. 11, 2014, and includes only donations received between Jan. 1, 2014, and Dec. 11, 2014. Any donations received on or made after Dec. 11, 2014, will be published in the next issue of the O&P Almanac.

O&P ALMANAC | JANUARY 2015

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopa14media for advertising options.

New ALPS Thin Seamless Suspension Sleeve Features include: • Thinner profile, 2mm • New black knitted fabric • Seamless, single-piece construction • Formulated with ALPS gel, the SFB suspension sleeve seals with the skin without restricting circulation. For more information, contact ALPS at 800/574.5426 or visit www.easyliner.com.

Coyote Design’s Zero-Clearance Lock

The Proximal Lock is a zero-clearance lock mechanism that also controls rotation. Mounted on the side of the liner and socket proximally instead of distally allows for the use of any distal adaptor. Use on its own, or with a distal pin system for extra suspension and controlled rotation. The Proximal Lock was designed to work with and can be primary suspension for long limbs that may not have room distally for other lock options. Can be used with short limbs but should be used with a distal pin and will act only as rotational control. For more information, contact Coyote Design at www.coyotedesign.com.

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

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

Orthomerica Introduces the Wise Choice for Diabetic Wound Care

• • • •

NEW! Orthomerica® Wound & Limb Salvage (OWLS) Program The OWLS™ Program is a culmination of 10-plus years of clinical orthotic development—treating diabetic ulcers classified Wagner 1-4 with custom orthoses. These orthoses will complement the ongoing wound therapies and postoperative care being offered at Wound Centers worldwide. OWL Products include: Wound Healing Orthosis: Heel Relief Wound Healing Orthosis: Forefoot Relief Wound Healing Orthosis: Midfoot/Walking AFO Advanced Diabetic Orthosis.

For more information, contact Orthomerica at 877-737-8444 or www.orthomerica.com.

JANUARY 2015 | O&P ALMANAC

MARKETPLACE Ottobock ProCarve

Silicone, Urethane, and Copolymer Liners

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

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

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Ottobock • 800.328.4058 www.professionals.ottobockus.com Circle # 3

Coyote Design’s Proximal Lock From PEL

SHOWCASE

PEL now offers the new Proximal Lock by Coyote Design. The Proximal Lock is a zero-clearance, proximally mounted lock that works for suspension and rotational control. Using the distal adaptor of your choice, the new lock design allows for easy donning while the silicone liner attachment is more flexible and larger for increased pull. Benefits and features include: • Zero-clearance lock • Suspension and rotation control • Ideal for long limbs with minimal clearance • Silicone adhesive remains flexible after it sets • Flexible attachment rolls on easier • Water-resistant

medi USA Introduces the 4Seal TFS Liner The new medi 4Seal TFS Liner combines a revolutionary sealing technology with a unique self-gliding surface, providing extraordinary suspension, comfort, and ease of use for those with transfemoral amputations. Features and benefits include: KK Integrated seals for easy inversion and a highly secure fit. KK Easy Glide PLUS outer surface—no donning aids or sprays required. KK Excellent tissue control due to a highly effective, full-length matrix. KK Optimal radial stretch for greater comfort. KK Simple to use gel-grip spacer socks for easy application (available separately).

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medi USA • 800.633.6334 www.mediusa.com Circle # 196

For more information, contact PEL at www.pelsupply.com.

Absolute Suspension Sleeve from Fillauer The Absolute Suspension Sleeve optimizes comfort, durability, and range of motion. The sleeve is made of thermoplastic A large number of O&P Almanac elastomer and covered with a reinforced readers view the digital issue— Lycra®-type material. The preflexed design If you’re missing out, apply for allows maximum range of motion and an eSubscription by subscribing alleviates posterior bunching when the at bit.ly/AlmanacEsubscribe, or The Absolute Suspension knee is flexed. visit issuu.com/americanoandp Sleeve is available in multiple sizes and your choiceofof beige or black. to view your trusted source

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O&P ALMANAC | Fillauer LLC • 800.251.6398 www.fillauer.com

JANUARY 2015

AOPA NEWS

CAREERS

Southeast

Inter-Mountain

CPO or CO

Orthotics and Prosthetics Technician

Chattanooga, Tennessee Fillauer Companies Inc. is seeking a CPO or CO to join its team as the director of orthotics at its headquarters in Chattanooga, Tennessee. In this role, the qualified candidate will manage the product development and clinical education for Fillauer’s orthotic product lines. Requirements: • Education minimum: Bachelor’s degree in O&P. Engineering degree and/or a master’s degree in O&P a plus. • ABC certification, preferred. • Minimum of five years of recent patient-care experience with emphasis on orthotics. • Licensed or ability to be licensed in the state of Tennessee. • If not currently living in Chattanooga or the surrounding area, candidate must be willing to relocate. • Engineering experience preferred. Proficient in CAD and SolidWorks a plus. • Must work well in a team environment. • Excellent communications skills, including oral and written, are necessary. • Must have the ability to travel up to 30 percent or as needed.

Dallas, Texas Texas Scottish Rite Hospital for Children is currently seeking an orthotics and prosthetics technician. Under the direction of the lab supervisor, this position supports the orthotic and prosthetic team. An ideal candidate must be a graduate of an accredited O&P program or hold a technician certification from ABC, and have at least one year experience, preferably in pediatrics, and a desire to learn from an experienced technical staff. Excellent benefits and pay commensurate with experience. Please apply online at www.tsrhc.org or submit resumes to tsrhhr@tsrh.org.

Texas Scottish Rite Hospital for Children 2222 Welborn Street Dallas, Texas 75219 Phone: 214/559-7590 Email: tshhr@tsrh.org Website: www.tsrhc.org

Fillauer Companies Inc. offers a competitive benefits package, including 401K and medical, dental, and vision insurance. Please apply at:

Website: Fillauer.com/careers

ADVERTISERS INDEX Company

Page Phone

Website

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

703-836-7114

ALPS South LLC Cailor Fleming Insurance Coyote Design DAW Industries Hersco Orthomerica Ottobock PEL Touch Bionics Inc.

51 5 9 1 2 11 C4 7 15

800-574-5426 www.easyliner.com 800-796-8495 www.cailorfleming.com 800-819-5980 www.coyotedesign.com 800-252-2828 www.daw-usa.com 800-301-8275 www.hersco.com 800-446-6770 www.orthomerica.com 800-328-4058 www.professionals.ottobockus.com 800-321-1264 www.pelsupply.com 855-694-5462 www.touchbionics.com

JANUARY 2015 | O&P ALMANAC

www.abcop.org

CAREERS

Opportunities for O&P Professionals Job location key: - Northeast - Mid-Atlantic

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

Member $482 $634

Nonmember $678 $830

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

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

- Southeast - North Central - Inter-Mountain - Pacific

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

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

The Source for Orthotic & Prosthetic Coding

Member Nonmember $80 $140

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

Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopa14media for advertising options.

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

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

Log on to LCodeSearch.com and start today. Need to renew your membership? Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

NEW

Manufacturers: for 2015! AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571-431-0876.

www.AOPAnet.org

O&P ALMANAC | JANUARY 2015

CALENDAR

2015

February 1

January 9-11

O&P, Its Leadership, and Its Future. Palm Beach, FL. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and technicians in 250 locations nationwide. For more information, visit www.abcop.org/certification, contact 703/836-7114, or email certification@abcop.org.

February 9-10

January 12-17

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

February 11

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

January 14

Fill In the Blanks: VA Contracting and the New Template. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

January 15-16

POMAC (Prosthetic and Orthotic Management Associates Corporation) Continuing Education Seminar. Shorebreak Hotel at Huntington Beach, CA. Contact John Shreter at 800/946-9170 x108 or email jshreter@pomac.com.

February 21-22

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

March 11

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

Year-Round Testing

Online Training

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

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

www.bocusa.org

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

JANUARY 2015 | O&P ALMANAC

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

CREDITS

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

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

$40

$50

1/4 page Ad

$482

$678

26-50

$50

$60

1/2 page Ad

$634

$830

51+ $2.25/word $5.00/word Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations.

CALENDAR March 14-15

The Foot and Ankle: From Athletic to Decrepit. Chapel Hill, NC. Study pathology-based treatments, orthotics, shoes, and taping while supporting a good cause. 16 credits. Register at FootCentriconline.com.

June 19-20

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

July 8

March 20-21

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

April 8

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

April 13-14

Whoâ&#x20AC;&#x2122;s on First? Medicare as a Secondary Payer. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

July 13-14

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

August 12

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

Off-the-Shelf vs. Custom Fit: The True Story. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

April 24-25

Prior Authorization, How Does It Work? Register online at bit. ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

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

April 30-May 2

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

May 13

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

May 14-16

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

June 10

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

Webinar Conference

September 9

Webinar Conference

October 7-10 98th AOPA National Assembly. The Henry B. Gonzalez Convention Center, San Antonio, TX. More information at bit.ly/2015assembly. For exhibitors and sponsorship opportunities, contact Kelly Oâ&#x20AC;&#x2122;Neill, 571/4310852, or koneill@AOPAnet.org. General inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

October 14

Understanding the LSO/TLSO Policy. Register online at bit.ly/ aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

November 9-10

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

November 11

How To Make a Good Impression: Marketing Yourself to Your Referrals. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

O&P ALMANAC | JANUARY 2015

ASK AOPA

Exceptions and Exclusions Answers to your questions regarding surety bonds, office hours, and more

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

Are all durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers and providers required to have a surety bond?

No. Not all DMEPOS suppliers and providers are required to have a surety bond, as there are some exceptions. If your facility meets the following requirements, then you are exempt from having to obtain a surety bond.

First, if you are in a state that requires licensure, you must be licensed. If you are in a state that does not require licensure, you are not automatically required to obtain a surety bond—but you must meet the next two requirements to be exempt. Second, your business must be solely owned by O&P professionals. This means that anyone who has an ownership stake in the company must be an orthotist and/or prosthetist. Third, you must be providing custom-made orthotics and prosthetics and supplies, and this does not include diabetic shoes. So, if you are providing diabetic shoes, you must obtain a surety bond even if you meet all of the other criteria. If my facility provides items such as the WalkAide or Bioness to Medicare patients, are we required to be open at least 30 hours a week?

Yes. The exemption to being open less than 30 hours a week, under Supplier Standard 30, applies only to facilities providing custom orthotics and prosthetics. The Walk Aide and Bioness are categorized as DME by Medicare; if you provide any type of DME to Medicare patients then you must be open at least 30 hours a week. If you are providing the WalkAide or Bioness, but provide it to Medicare patients, then you may still be eligible to open less than 30 hours a week.

What is the current Medicare enrollment application fee?

The current Medicare enrollment application fee is $553. This is a 2.1 percent increase (or roughly $11) over the 2014 amount. This fee must

JANUARY 2015 | O&P ALMANAC

be paid before your Medicare enrollment or revalidation request can be processed. The fee does not apply to anytime you wish to update your current Medicare enrollment application, i.e., change your address or add/delete a product line. I am opening a new facility. With the current enrollment procedures, are all of my employees subject to the new fingerprinting requirement?

No. The only people who are subject to the fingerprinting and background checks are those individuals who have a vested ownership interest in the company—typically, anyone who owns at least 5 percent of the company.

How can I determine if any of my employees have been or currently are excluded from the Medicare program?

You may use the Department of Health and Human Services Office of Inspector General’s (OIG’s) exclusion database, www.exclusions.oig. hhs.gov. It is a good idea to check all new hires against this database because any services provided by someone on the OIG exclusion list are subject to automatic recoupment. You also should routinely check to make sure your vendors and any other people who have contracts with your facility are not on the OIG exclusion list, as this is a requirement of Supplier Standard 4.

Products & Services

For Orthotic, Prosthetic & Pedorthic Professionals

2014 OPERATING PERFORMANCE REPORT AOPA Helps Run

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

AOPA Operating Performance Report

2014

(Reporting on 2013 Results)

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

HOW TO ORDER BY FAX: 571/431-0899

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

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

Embrace The Everyday with Michelangelo速 Help your patients do more

Give your patients the intuitive, responsive functionality they need. The new FDA-approved Michelangelo hand mimics the appearance and function of the natural hand like no other myoelectric with soft fingertips, a flexible wrist that locks in various positions, and a wide open palm to make it easier to hold or grasp items. Michelangelo is the answer to how your patients can get greater function with seven different hand positions and a powerful grip function. Talk to your Ottobock Sales Representative or call 800 328 4058 to find out how your patients can embrace the everyday with Michelangelo. www.ottobockus.com www.ottobock.ca