January 2022 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

JAN UARY 2022

Five Tips To Avoid Claim Denials P.16

NEW! Leadership Series: Reimagining O&P P.30

NOW HIRING

RECRUITING AND RETAINING O&P TALENT IN A TIGHT LABOR MARKET P.20

Optimizing Prosthetic Designs for Female Patients P.36

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YOUR CONNECTION TO

EVERYTHING O&P

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

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

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

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

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

www.AOPAassembly.org

FABRICATED WITH ACCURACY & PRECISION

CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES

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JAN UARY 2022 | VOL. 71, NO. 1

contents

COVER STORY

FEATURES 20 | Now Hiring In today’s tight labor market, some O&P companies are struggling with hiring and retaining clinical and administrative staff. Hear from owners and managers who are finding ways to attract and promote key talent—by restructuring staff, providing more flexible work environments, and rethinking their recruitment strategies. By Christine Umbrell

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

AOPA reimagined

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

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

Transitions in the profession

P.10

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

Use Audit Results to Your Advantage

Five common reasons for claim denials

30 |

NEW! O&P Almanac Leadership Series: Reimagining O&P

New for 2022, this Q&A-style feature series interviews O&P leaders from different sectors of the industry for their takes on key topics facing the O&P profession—beginning this issue with questions regarding needed change, recognition as a medical profession, dealing with disrupters, and more. Interviews Conducted By Josephine Rossi

PRINCIPAL INVESTIGATOR Elizabeth Russell Esposito, PhD................ 36 Meet a research scientist with the DOD-VA Extremity Trauma and Amputation Center of Excellence and embedded within an experienced research team at the VA’s Center for Limb Loss and Mobility.

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

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

Mecuris Professional Orthotics & Prosthetics

AOPA News................................................ 43

AOPA advocacy, announcements, member benefits, and more

Welcome New Members................... 43 O&P PAC..................................................... 44 Marketplace.............................................. 45 Careers......................................................... 49

Professional opportunities

Ad Index...................................................... 50 Calendar....................................................... 51

Upcoming meetings and events

State By State........................................... 52

Illinois, Iowa, Kentucky, New York, and Virginia 2

JANUARY 2022 | O&P ALMANAC

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VIEWS FROM AOPA LEADERSHIP

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AOPA Reimagined

S WE MOVE INTO a new year, I am excited to share with you the results of AOPA’s strategic planning process. Designed with your direct input, the plan will help us advance the O&P profession by clarifying and refining why we exist, our longterm objectives, and the steps we can take to get there together. Let me start by talking first about our mission—this is why we exist. As we considered your feedback and discussed it as a board last year, we realized that we had an opportunity to better articulate AOPA’s mission in light of how this profession has changed over the past four years. I am therefore pleased to share with you AOPA’s new mission: A trusted partner, advocating for and serving the orthotic and prosthetic community by: • Fostering relationships with decision makers to ensure equitable access • Providing education that promotes professional excellence • Supporting research that informs innovative care • Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.

This statement continues to emphasize the three historical pillars of advocacy, research, and education that have always been part of AOPA’s mission. But, critically, it adds the concepts of partnership, service, and equality. We believe this strengthens AOPA’s “why” and more accurately represents where we want and need to take the O&P profession. Second, our vision is a description of the future. And, again, based on your input and feedback, we have arrived at a simple and powerful new vision for AOPA: A world where orthotic and prosthetic care transforms lives. This is what makes O&P such a rich and rewarding profession. Together, AOPA’s new mission and vision will serve as our North Star moving forward. Finally, I’d like to turn to our six strategic priorities that your feedback helped produce. These are the priorities we will focus on over the next three to five years: • Communicating the importance of orthotic and prosthetic care • Increasing patient access to clinically appropriate, evidence-based care • Helping members succeed in the changing healthcare environment • Identifying and influencing trends and learning that may impact orthotics and prosthetics • Enhancing AOPA’s value, engagement, and community • Driving collaboration by creating strategic relationships. I want to close by thanking the AOPA Board of Directors, staff, and all our members and partners who contributed to this strategic planning process. Your support and dedication were invaluable. And now, as we start this new journey, your collaboration will be equally invaluable. This is a talented, committed, and diverse community. Please reach out to AOPA if you would like to support our efforts to achieve any of the six strategic focus areas listed above. We want to partner with you. Together, I believe we are well-positioned to achieve our mission and the vision of a world where orthotic and prosthetic care transforms lives. Dave McGill is president of AOPA.

JANUARY 2022 | O&P ALMANAC

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

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

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AOPA CONTACTS

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

Editorial Management Content Communicators LLC

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

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

EXECUTIVE OFFICES

MEMBERSHIP & COMMUNICATIONS

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

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

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org HEALTH POLICY & STRATEGIC ALLIANCES Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, awhite@AOPAnet.org Susannah Engdahl, PhD, manager, health policy and research, 571/431-0843, sengdahl@AOPAnet.org Sam Miller, manager, state and federal advocacy, 571/431-0814, smiller@AOPAnet.org

AOPA Bookstore: 571/431-0876 REIMBURSEMENT SERVICES Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org O&P ALMANAC

Tina Carlson, CMP, senior director, education and meetings, 571/431-0808, tcarlson@AOPAnet.org

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

Kristen Bean, digital meetings specialist, 571/431-0876, kbean@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org

MEETINGS & EDUCATION

Kelly O’Neill, CEM, senior manager of meetings and exhibition, 571/431-0852, kelly.oneill@AOPAnet.org

JANUARY 2022 | O&P ALMANAC

Publisher Eve Lee, MBA, CAE

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/520-9632 , bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2022 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2022 for advertising options!

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NUMBERS

Rising Healthcare Costs Challenge Many Americans Affording healthcare is a top financial worry

OUT-OF-POCKET EXPENSES AND CO-PAYS AMONG INSURED

46% Said it’s very/somewhat difficult to pay for out-of-pocket costs not covered by insurance

IMPACT OF RISING HEALTHCARE COSTS

16%

12%

Put off vacations or major household purchases to pay medical bills

Used up all or most of their savings to pay medical bills

15%

11%

Cut spending on basic household items to pay medical bills

Took an extra job or worked more hours to pay medical bills

Said it’s very/somewhat difficult to pay their monthly insurance premium

PROBLEMS PAYING FOR PRESCRIPTIONS

22%

Took an over-the-counter drug instead of getting a prescription filled

16%

Not filled a prescription for medicine

13%

Cut pills in half or skipped doses

MANY AMERICANS DELAY MEDICAL CARE Significant percentages report having skipped or delayed care due to cost: 39%

A visit to the doctor’s office

Vision services

Mental healthcare

Hospital services

JANUARY 2022 | O&P ALMANAC

28% 17% 13%

26%

27%

Said it’s very/somewhat difficult to pay for prescription drugs

UNINSURED DELAY MORE CARE A Kaiser Family Foundation report from 2019 found that people without health insurance were disproportionately likely to put off or skip medical care or take over-the-counter medicines instead of prescription drugs due to costs. Three-fourths of adults 18-64 (76%) without health insurance reported this, compared to half (52%) of adults with health insurance. —“Americans’ Challenges With Healthcare Costs,” KFF, December 2021.

Canc appoin el tmen

SOURCE: “Americans’ Challenges With Healthcare Costs,” KFF, December 2021, www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/.

O&P facilities should understand that many of their patients have difficulty affording healthcare. “Americans’ Challenges With Healthcare Costs,” a new report from the Kaiser Family Foundation (KFF), finds that the cost of healthcare prevents some patients from pursuing needed care.

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Happenings RESEARCH ROUNDUP

Exoskeleton Facilitates Walking for Prosthesis Users University of Utah researchers have developed a prototype exoskeleton to reduce above-knee prosthesis users’ exertion when walking. Led by Tommaso Lenzi, PhD, assistant professor of mechanical engineering and director of the university’s Bionic Engineering Lab, the research team is testing the lightweight exoskeleton, funded by a grant from the Congressionally Directed Medical Research Program. “Most of the research effort in the last 10 years has focused on restoring ankle pushoff with powered prostheses. This approach is sound but has some intrinsic drawbacks,” explains Lenzi. “Available

JANUARY 2022 | O&P ALMANAC

A study subject with above-knee limb loss walks on a treadmill using his prosthesis and wearing a lightweight exoskeleton. further and with less effort, improving their mobility in the community.” Lenzi’s team also is extending the use of the exoskeleton to more activities, like climbing stairs and slopes. “From a development standpoint, we are working on a new generation of our technology that will incorporate the feedback we have received from the research participants that have used our current prototype,” he said. “The goal is to partner with leaders in prosthetics and orthotics to make this technology available to the people who need it.”

PHOTO: Tommaso Lenzi, PhD/University of Utah

The researchers found the lightweight exoskeleton reduces the metabolic cost of walking by 15%.

powered prostheses are two or three times heavier than their passive counterpart, and the added mass of a powered prosthesis is distally suspended through the socket, which makes it feel even heavier than what it is.” His team sought alternatives and discovered that powered hip exoskeletons, which can be made very lightweight, could be effective because most of the compensatory movements in amputee gait happen at the residual hip, above the amputation. The new exoskeleton wraps around the wearer’s waist and leg, connecting to the user’s thigh above the amputation. The exoskeleton’s AI understands how the person moves by interpreting the information from the integrated position and load sensors, according to Lenzi. Then, it sends a command to the battery-powered electric motors assisting the residual limb in flexion and extension while adapting to the user’s gait speed and cadence. “In our study with individuals with above-knee amputation,” he said, “we found that our lightweight exoskeleton reduces the metabolic cost of walking by 15%, which is equivalent to taking off a 26-pound backpack.” The assistive technology would serve as an extra tool for clinicians, offering prosthetists “the freedom to use whatever prosthesis they believe is the most appropriate for their patients.” While the exoskeleton was developed primarily for individuals with above-knee amputation, “in general, anyone who may benefit from some extra assistance during walking can use it,” Lenzi said. His team is currently testing the exoskeleton with people with hemiparesis due to stroke. “We are quickly realizing that our lightweight exoskeleton has the potential to help many different people to walk

HAPPENINGS

FAST FACT

RAISING AWARENESS

ABC Asks Clinicians To Promote the Profession The American Board for Certification in Orthotics, Prosthetics, & Pedorthics (ABC) is leading a multiyear effort to raise awareness of the orthotics, prosthetics, and pedorthics professions among high school and college students in an effort to build a strong pool of talent and build a diverse, robust talent pipeline. The board of directors of ABC hired a professional healthcare marketing and communications firm to help identify the tactics and methods for meeting the goal of raising awareness of the OP&P profession. The organization conducted quantitative research, with a large-scale national survey of over 1,000 respondents aged 14-28 years, as well as qualitative research through a series of virtual focus groups with participants ages 14-24. Through this research, ABC discovered the following: • More than two-thirds (68%) of respondents decided their career path in high school. • At least 82% of respondents are unaware of OP&P professions. • Of those who are aware of OP&P, familiarity is highest (52%) with prosthetics. • Online research (44%) and family/friends (38%) are far more influential than career counselors

(12%) or career fairs (6%). • Respondents want jobs where they know they can make a difference (84%) and work with different types of people (79%) more than jobs with competitive pay. Based on the research completed to date, ABC is creating a multifaceted plan for reaching the target audience through personal interactions, a robust career website, focused digital advertising, and social media engagement. ABC also is encouraging OP&P professionals from across the country who would enjoy helping young people understand the dynamic, flexible, and personally rewarding nature of the OP&P profession to join this effort. Interested clinicians can learn more about serving as ambassadors, who would share their personal experiences with young people through speaking opportunities, mentorship programs, high school career days, and more, by emailing ambassadors@abcop.org.

MONEY MATTERS

Healthcare Spending Accelerated in 2020

PHOTOS: Getty Images

U.S. healthcare spending increased 9.7%, to reach $4.1 trillion in 2020—a much faster rate than the 4.3% increase in 2019. The acceleration is attributed to a 36% increase in federal expenditures in healthcare that occurred largely in response to the COVID-19 pandemic.

CMS Confirms 5.1% Fee Schedule Increase

The 2022 Medicare DMEPOS Fee Schedule will increase by a net total of 5.1% for claims with a date of service on or after Jan. 1, 2022, the largest annual increase in more than 30 years. The increase is the result of a CPI-U increase of 5.4% from June 2020 to June 2021 and a -0.3% productivity adjustment. SOURCE: CMS

INSURANCE INSIGHTS

One-Third of Children Are Underinsured A new study from researchers at the University of Pittsburgh found that 34% of U.S. children under age 18 were “underinsured”—insured, but with policies that fail to address their overall health needs or ensure access to preferred providers; that their insurance plan came with high out-of-pocket costs; or that it wasn’t in effect at all times. That number is up from 30.6% in 2016, which means 2.4 million more children are underinsured. The researchers pointed to “unreasonable” out-ofpocket expenses as the main problem. SOURCE: “Underinsurance Among Children in the United States,” Pediatrics, Dec. 6, 2021

SOURCE: “National Healthcare Spending in 2020,” CMS, Health Affairs, Dec. 15, 2021.

O&P ALMANAC | JANUARY 2022

HAPPENINGS

BRACE ADOPTION

Many Cerebral Palsy Patients Don’t Use Prescribed Orthoses Among individuals with cerebral palsy who were prescribed lower-limb orthoses, only 35% use their devices every day. This finding from researchers at Gaziantep University in Turkey was attributed primarily to difficulty in wearing orthoses. The authors recommend that patients work closely with a rehabilitation team and take part in follow-up appointments to increase adoption.

35%

AOPA Offers Certificate in O&P Business Management

O&P professionals can stay up to date on the latest business trends and information by earning a Certificate in O&P Business Management, offered via a new collaboration between AOPA and the University of Hartford. This joint certificate program provides a unique leadership experience, fresh insights, and education for O&P professionals to advance their careers while learning proven techniques for developing better business practices and improving their companies’ returns. Participants—O&P business owners, managers, clinicians, manufacturers, and distributors—will complete a series of business and management courses to explore business challenges related to finance, sales and marketing, business operations, and reimbursement policies and management. The program has been designed to be similar to nondegree continuing education programs that universities offer in conjunction with their MBA programs. Visit bit.ly/AOPACP for details. O&P CYBERSECURITY

Data Breaches Continue To Impact Healthcare Facilities More than 550 healthcare organizations reported data breaches affecting 500 or more individuals to the U.S. Department of Health and Human Services, Office for Civil Rights, in 2021. The protected health information of more than 40 million individuals was exposed as a result of the breaches. The 10 largest healthcare data breaches last year were hacking/IT incidents. SOURCE: “This Year’s Largest Healthcare Data Breaches,” Health IT Security, Nov. 30, 2021.

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

The Orthotic and Prosthetic Activities Foundation (OPAF) announced board members for 2022. Deborah Plescia, CPO, clinical specialist for Ottobock Orthopedic Services; Jacob Calvert, CPO, a clinician with Hanger Clinic and an adaptive fitness trainer; and Taushima Nixon, a graduate student at Alabama State University’s MSOP program who has experienced limb loss, have joined continuing members Matt Swiggum, Jena Baxter, Jackie Valdez, CO, and Elise Griset, CPO, on the OPAF Board of Directors. The executive board was re-elected to their positions, with 12

JANUARY 2022 | O&P ALMANAC

Travis Young, CPO, serving as president, Michelle Jamin, PT, DPT, as vice president, and Rebecca Snell as secretary and treasurer. Amputee Coalition CEO Mary Richards was elected as a member of the 2022 board of directors for the National Health Council (NHC). “NHC brings together the nation’s leading patient advocacy organizations, including the Amputee Mary Richards Coalition, to drive patient-centered health policies that improve lives,” said Richards. “I am excited to contribute to the leadership of the NHC and help expedite meaningful progress for Americans living with limb loss and limb difference and many other conditions.”

PHOTO: Getty Images

SOURCE: “Use of Lower-Extremity Orthoses in Patients With Cerebral Palsy and Related Factors,” Prosthetics & Orthotics International, Dec. 1, 2021.

CONTINUING EDUCATION

PEOPLE & PLACES

The Board of Certification/Accreditation (BOC) Board of Directors announced its 2022 Executive Committee, which is comprised of the officers of the board. The recently elected 2022 officers include the following: • Chair: Wayne R. Rosen, BOCP, BOCO, LPO, CDME, FAAOP • Vice chair: Abel Guevara III, MHIM, RHIA, CPHT, CDME • Secretary: William J. “Bill” Powers, MBA, LFACHE Wayne R. Rosen, • Treasurer: Cameron Stewart, BOCO, BOCP BOCP, BOCO, LPO, CDME, • Member-at-Large: Rick Todd, COF FAAOP • Immediate Past Chair: Bradley “Brad” Watson, BOCO, BOCP, LPO. “BOC’s Executive Committee showcases the leadership and commitment of our entire board,” said Rosen. “I am honored to lead this dedicated group in achieving continued success for BOC and for those we serve.” Jon Sigurdsson will retire from his position as president and CEO of Össur effective April 1, 2022. The company’s board of directors has appointed Sveinn Sölvason to Jon Sigurdsson Sveinn Sölvason succeed Sigurdsson as president and CEO. Sölvason has been with Össur since 2009 and chief financial officer since 2013. “On behalf of the board of directors, the executive management team, and Össur’s 4,000 employees, we want to sincerely thank Jon for his leadership over his more than twoand-a-half decades with the company,” said Niels Jacobsen, Össur chairman of the board. “A steadfast leader with a strong strategic vision, Jon has successfully guided Össur since 1996. Under his leadership, Össur has grown from being a niche company with $5 million in revenue and 40 employees, to a leading global medical device company with an annual revenue of approximately $700 million and 4,000 employees worldwide. In addition, Jon spearheaded more than 60 acquisitions over the years and has played an instrumental part in transforming the landscape of the O&P industry.” “I congratulate Sveinn on his appointment and look forward to working with him on the transition,” said Sigurdsson. “It has been an honor to lead Össur for the past 26 years. I have had the pleasure of working with a dedicated team of employees, customers, and end users alike, all of whom have made Össur the successful business it is today. I look forward to watching Össur continue to flourish in the years to come.” “I appreciate the trust given by the board of directors and am pleased to accept the opportunity of serving Össur in a new role as the president and CEO,” said Sölvason.

JANUARY 2022 | O&P ALMANAC

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The Hanger Foundation announced it will partner with five universities as part of the 2022 Hanger Foundation Diversity Scholarship program, which is entering its second year. The MSPO programs at these five institutions will award scholarships to students underrepresented in the field of O&P to help offset the cost of their degree: • Alabama State University • Eastern Michigan University • Northwestern University • The University of Hartford • The University of Texas Southwestern Medical Center. “Providing diversity scholarships provides us the opportunity to have a greater impact. The University of Hartford has been committed to equitable opportunities for eligible students for many years, and minimizing financial barriers further demonstrates this commitment,” said Matthew Parente, University of Hartford MSPO program director. Applicants can apply directly through the MSPO program at their respective university, and scholars will be selected by their school for displaying remarkable academic achievement, community service, and a passion for diversity within the O&P profession. In addition to receiving a scholarship, all recipients will be offered a two-year mentorship with the option of pursuing a residency at Hanger Clinic. WillowWood Global LLC has entered into a strategic partnership with Blue Sea Capital LLC, a growth-oriented private equity firm. “Since partnering with Ryan Arbogast in 2019, Daniel [Rubin, COO of WillowWood] and I have taken great pride in transforming a closely held, fourth-generation family-owned business into what is today the preeminent player in prosthetic products,” said Mahesh Mansukhani, CEO of WillowWood. “Having swiftly and successfully executed our operational playbook, our partnership with Blue Sea marks an important milestone in—and testament to—WillowWood’s long-term growth trajectory.” WillowWood selected Blue Sea as its preferred partner, “based on the team’s impressive track record supporting similarly growth-oriented healthcare businesses, with both organic and acquisition-driven initiatives,” said Rubin.

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REIMBURSEMENT PAGE

By JOE MCTERNAN

Use Audit Results to Your Advantage Five common reasons for claim denials— and how to avoid them Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80%, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.18

HE COVID-19 PUBLIC HEALTH

emergency (PHE) continues to impact the coordination and delivery of effective healthcare, and the changing role of audits may drive the development of successful business strategies. As the PHE evolved, we saw audits initially suspended, then witnessed a shift to a focus on postpayment review, and finally saw the return of the effective prepandemic prepayment review program known as Target, Probe, and Educate (TPE). The TPE program, which was covered in depth in the October 2021 Reimbursement Page, is a highly focused, less disruptive audit philosophy that focuses on education as a means to improve provider compliance so that common mistakes are not repeated. This month’s Reimbursement Page examines some of the more common denial reasons reported by CMS contractors through the various audit programs and discusses strategies that may help you better respond to audit requests, which could result in lower claim denial rates.

No documentation was received in REASON response to ADR. All audits essentially begin with a request for additional information or documentation, known as an additional documentation request (ADR). Providers

DENIAL

JANUARY 2022 | O&P ALMANAC

are required to respond to ADRs within a set amount of time; Medicare ADR requests must be responded to within 45 days of the date listed on the ADR letter. Failure to respond within the allotted timeframe will result in an automatic denial of the claim, regardless of the quality of the documentation in the patient’s medical record. Failure to respond to an ADR request is the most common reason why claims are denied— despite the fact that the process is entirely within the control of the provider. You can implement a few strategies to ensure that you receive and respond to ADR requests in the required timeframe. First, ensure that your correspondence address is accurate. If you have multiple locations, make sure those correspondence addresses are correct as well, especially if you consolidate administrative functions into a single, central location. Most payors will not consider the failure to receive an ADR request as a valid reason for an untimely response. Ensuring the timely receipt of ADR requests may result in a significant reduction of unnecessary claim denials. Next, develop standard processes to ensure that ADR requests are properly identified and communicated to appropriate staff members. There is nothing more frustrating than receiving a claim denial and then finding an unopened or ignored ADR letter.

REIMBURSEMENT PAGE

Finally, implement processes to respond to ADR requests within the required timeframe. Whether this involves a single employee or an entire team, there should be well-established timelines to allow staff to collect, organize, and submit the information that will give you the best chance for a successful outcome. Scrambling to respond to an ADR request at the last minute is never ideal—and often contributes to avoidable claim denials.

Insufficient documentation of REASON substantial modifications to a custom-fitted item. Current policy guidelines indicate that products that are part of a split code set are identical when removed from their packaging. To bill for the custom-fitted version of an orthosis, there must be clear documentation that describes the specific modifications that were made to the orthosis to permanently customize the orthosis to meet the medical needs of the individual patient.

DENIAL

For custom-fitted orthoses to be covered by Medicare, the modifications must be performed by a certified orthotist or someone with similar expertise.

PHOTO: Getty Images

In addition to documenting the specific modifications made to the orthosis, documentation that supports the medical need for these modifications also is required. This documentation may be recorded by either the prescribing physician or the orthotist, but it must be incorporated into the contemporaneous medical record. When documenting modifications, you must demonstrate that the

modifications go beyond basic cutting and bending, and that they permanently modified the orthosis so that it only fits the specific patient. Recent policy clarification has expanded this requirement beyond Healthcare Common Procedure Coding System (HCPCS) codes that are part of an off-the-shelf/custom-fitted split code set to include HCPCS codes that include the phrase “prefabricated, includes fitting and adjustment.” For custom-fitted orthoses to be covered by Medicare, the modifications must be performed by a certified orthotist or someone with similar expertise. Failure to document the modifications that were made to the orthosis and the reasons why the modifications were medically necessary to meet the specific needs of the patient may result in unnecessary and costly claim denials.

Documentation DENIAL doesn’t support REASON custom fabrication. Custom-fabricated orthoses are only considered medically necessary when there is specific documentation that clearly indicates that a prefabricated orthosis will not meet the specific medical needs of the individual patient. Typically, this documentation must be found not only in your documentation but also in the records of the treating/ordering physician. While not all policies are clear as to

what documentation is required to support the provision of a customfabricated orthosis, the Ankle-Foot Orthosis/Knee-Ankle-Foot Orthosis (AFO/KAFO) Policy provides specific guidance that can be referred to when providing custom-fabricated orthoses. The AFO/KAFO Policy includes five different conditions, any one of which may be documented to support the need for a custom-fabricated orthosis: • Patient could not be fit with a prefabricated item • Condition is expected to last longer than six months • There is need to control the ankle/ knee/foot in more than one plane • Prevention of soft tissue injury • Patient has an abnormal healing fracture. While ideal documentation would include information from the ordering physician documenting one of the reasons listed above, the orthotist’s records also may be used to support the need for a custom-fabricated orthosis if they are corroborated by information in the physician’s records. For, example if the prescribing physician orders an orthosis and states that the patient should come back in six months for a follow-up, or the notes show a long history of drop foot, these would be an indication that the condition would be long lasting and a custom brace may be required. O&P ALMANAC | JANUARY 2022

REIMBURSEMENT PAGE

Failure to properly document the medical need for a custom-fabricated rather than a prefabricated orthosis is a common reason for claim denial and can lead to significant lost revenue.

JANUARY 2022 | O&P ALMANAC

Authenticated by Approved by Completed by Signed by.

A handwritten signature is any mark or sign by an individual signifying knowledge, approval, acceptance, or obligation. Handwritten signatures are considered valid only if they are deemed to be legible. If a signature (a full name, a first initial, and last name; or initials) is legible, then it is automatically considered valid. When a document is missing a signature or the signature has been deemed illegible and invalid, two common and acceptable ways may be used to authenticate the signature and/or the medical record: a signature log or an attestation statement. Documentation that is not properly authenticated by the author can result in the automatic denial of a claim.

No need for replacement REASON documented. Replacement items, which are defined as identical or nearly identical items to the original, are normally covered by Medicare under certain circumstances, including the loss or theft of the original item, irreparable damage (damage not

DENIAL

Be Diligent

While the denial reasons included in this article are not the only reasons Medicare claims are denied, they consistently rank as some of the most common reasons for claim denials during Medicare audits. Attention to small details may significantly reduce you claim error rate and may help you reach an audit success level that reduces your likelihood of additional audits in the future. Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: www.bocusa.org

PHOTO: Getty Images

Documentation was DENIAL not authenticated. REASON It is well established that the ordering/referring physician must sign prescriptions and documents, such as the certifying statement for therapeutic shoes, but Medicare also requires that anyone documenting the medical necessity or need for items/services received by Medicare beneficiaries must be identifiable. All entries into the medical record must be authenticated by the author of the documentation. There are two main types of valid signatures: electronic signatures and the handwritten signatures. Stamped signatures, in most cases, are no longer acceptable; however, if the individual using a stamp has a disability that doesn’t allow them to handwrite their signature, then a stamped signature is acceptable. Electronic signatures are considered valid if the signature is accompanied by a statement similar to those below (this is not an all-inclusive list): • Electronically signed by

• • • •

caused by normal wear and tear), or a change in the patient’s condition that requires a new item (weight, functional needs, change of medications, etc.). When providing a replacement orthosis or prosthesis, you must document that at least one of the above replacement criteria has been met. This is especially true when you provide a replacement item when the original brace or prosthesis is still within its reasonable useful lifetime or when you are providing an item you believe will be denied as same or similar. If the item must be replaced because it was lost or stolen, consider obtaining a written affidavit that the item was lost or stolen from the patient, facility, insurance company, police department, etc. If the item is being replaced because of irreparable wear, describe the event that caused the damage and the extent of the damage. Replacement items require a new prescription/order, so the physician must document the specific reason for the replacement and the continuing need and use.

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COVER STORY

Now Hiring The working world has changed. Leaders share current strategies to attract and retain a highly qualified O&P staff. By CHRISTINE UMBRELL

JANUARY 2022 | O&P ALMANAC

COVER STORY

NEED TO KNOW • O&P facilities are among the many U.S. companies that are experiencing challenges in hiring and retaining key employees—a task made more difficult by the COVID-19 pandemic and the shrinking pool of candidates seeking jobs. • Hiring managers are looking to fill both clinical positions and administrative roles at many O&P practices, staffing up now that they are once again seeing patients at full capacity. • Some companies are reexamining their staffing structures and salary and benefits packages to increase their odds when competing with other employers. • Other facilities are offering more flexible hours and even remote work—for some positions—to allow for greater work-life balance. • Many O&P managers are focusing on recruiting recent O&P graduates or young professionals, which requires an understanding of their unique wants and needs.

OMPANIES ACROSS the United

States are struggling to find qualified employees to fill key positions—and O&P is no exception. As the country recovers from the COVID-19 pandemic and more workplaces return to full capacity, employees are reassessing their priorities. Some U.S. workers missed weeks, or even months, of work during the early days of the pandemic. As companies experimented with remote work, some employees came to appreciate greater flexibility and extra time spent with family—resulting in a whole new culture of work. The “ripple effects” of the new business practices during the early days of the pandemic “have continued to shake up our world of work,” according to a new report from Kforce, a professional staffing services firm. Many employees have been driven by factors like safety, increased desire for job security and stability, financial concerns, burnout, or a greater need for work-life balance, and are now searching for positions in “hyperflexible, people-first workplaces.”

With fewer workers available, it’s a candidate’s job market—so current employees are switching jobs more frequently, attracted by increased flexibility or significant pay bumps. Finding workers to fill positions after employees leave is harder than ever—the number of Americans filing initial unemployment claims fell to its lowest level since 1969 in November 2021. As an added blow to healthcare companies, resignations are highest in the healthcare and tech industries, according to data from the Bureau of Labor Statistics (BLS): 3.6% more healthcare employees quit their jobs in summer 2021 than in the previous year. Within O&P in particular, the profession was already facing predicted shortages of clinicians before the pandemic, given the growing senior patient population. Approximately 1,000 openings for orthotists and prosthetists are projected each year for the next decade, according to BLS data. BLS statistics also predict employment of O&P professionals will need to grow 18% from 2020 to 2030, much faster than the average of all occupations. O&P ALMANAC | JANUARY 2022

COVER STORY

Civilian Labor Force Participation Rate, Seasonally Adjusted Rates are still below prepandemic levels Civilian labor force participation rate, seasonally adjusted Total

Percent 68.0

66.0

64.0

62.0

60.0

58.0 Nov 2001

Nov 2003

Nov 2005

Nov 2007

Nov 2009

Nov 2011

Nov 2013

Nov 2015

Nov 2017

Nov 2019

Nov 2021

Note: Shaded area represents recession, as determined by the National Bureau of Economic Research.

SOURCE: U.S. Bureau of Labor Statistics, Graphics for Economic News Release

Add to that a greater number of baby boomer clinicians retiring amid the pandemic, and the available pool of O&P employees is shrinking. As we begin 2022, some O&P facilities are experimenting with talent management strategies to grow and retain their staffs. Here, O&P owners and managers offer suggestions for rethinking traditional structures, attracting new employees, and ensuring current staff members aren’t tempted to leave.

Shannon Latulippe

Consider Restructuring

O&P facilities are having a particularly difficult time hiring and retaining administrative staff. Front-office positions have become extremely difficult to fill, says Shannon Latulippe, director of administrative services at Wright & Filippis, with many candidates reporting they don’t want to interact with patients, 22

JANUARY 2022 | O&P ALMANAC

given the ongoing pandemic. Some companies furloughed administrative positions in spring 2020—when few patients were visiting healthcare facilities—and are now struggling to fill open positions. “When COVID hit, at one point we furloughed front-office staff,” recalls Eric Shoemaker, CPO, executive director of clinical operations at Ability Prosthetics & Orthotics. As patients began returning to Ability P&O’s 14 offices, the company started bringing staff back slowly. Now, however, “we’re ready to start filling positions, and we’ve opened new offices, but we can’t find people to fill the positions,” he says. Several administrative staff members have left for higher-paying jobs, sometimes with signing bonuses, according to Shoemaker. “We’ve lost some valuable people, but they’ve been presented with opportunities” that can’t be matched by O&P facilities. Ability P&O responded by restructuring front-office operations, according to Shoemaker. The company streamlined some work, so fewer employees are needed.

Then, it elevated several experienced patient-care coordinators to the role of “practice administrators,” making them responsible for the front offices at several locations. The company is still seeking patient-care coordinators who can be trained by practice administrators. “We like the restructuring,” says Shoemaker, but hiring clerical staff continues to be a challenge. “When it comes to patient-care coordinators or practice administrator positions, we’re competing with every industry.” Ability P&O also restructured its clinical side—where “it’s even more difficult to find” employees, given heightened competition from other O&P facilities, says Shoemaker. When changing employers, some clinicians must abide by two-year, 50-mile noncompete clauses. Consequently, facilities may have to ask job candidates to move from the area or commute an hour or more to remain in compliance with noncompetes—a big request in the current economy.

Eric Shoemaker, CPO

Promoting current employees has helped to alleviate some problems, too. “I elevated some of our more experienced clinicians to become clinical practice managers,” responsible for several offices, says Shoemaker. Instead of just two regional directors under the previous structure, Ability P&O now has five practice managers who share the managerial workload. “We’re starting to fill the holes back in through restructuring” and hiring young clinicians. Ability P&O’s restructuring also involved asking some managers to increase their patient load. Shoemaker himself had given up patient-care duties two years ago when he was promoted to his current position—but recently returned to seeing patients three times per week.

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COVER STORY

O&P Distribution Company Adds Remote Work, Temp Labor, and Automation Just as patient-care facilities are facing employee shortages, O&P suppliers also are experiencing workforce challenges. At Cascade Orthopedic Supply LP, the COVID-19 pandemic set off a series of events that led the company to explore new ways of staffing. “Like most businesses, we were forced to make some swift changes to staffing through Jeff Collins measures like furloughs and the reduction of working hours in the early days of the pandemic,” says Cascade President Jeff Collins. “These actions had a limited impact on long-term staffing as we were able to bring the vast majority of our staff back with assistance from the SBA PPP program and resumption of more normal business activity later in 2020.” However, Cascade’s operations “are still very limited for in-person work, with the exception of our warehouse operations, and so we have moved largely to a remote workforce,” Collins explains. Allowing staff to work remotely has provided “a level of accommodation and flexibility to our staff, which we believe has helped with staff retention,” he says. The expansion of remote work capabilities “opens up the talent pool,” adds Erik Lukasek, Cascade’s human resources business partner. “We have a wider variety of candidates to select from in more locales, although this also creates a challenge with candidates having more options to choose from as other businesses shift toward this same model,” Lukasek says. “Overall, the quantity has increased, but we still need to sift through applicants to find those who are ideal for the role.” Of course, certain functions don’t lend themselves to remote work. Cascade is having trouble staffing warehouse operations, and Collins has noted a significant uptick in overtime. “That signals that our tenured staff is working harder to support the operations with fewer people,” he says. “We have brought temporary labor into warehouse and bolstered accounting functions internally to provide relief.” The company also deployed an Invia Robotic Automation System in its distribution centers. The system is designed to increase warehouse productivity through the use of nimble robots, AI-driven optimization software, and monitoring capabilities. Explains Collins, “Warehouse staffing historically has the highest turnover, and so we hope that automating certain functions, like the storage and retrieval of goods, will provide a layer of operational stability while allowing our existing staff to elevate the type of work performed in the warehouse.” While the company is “on a path” to return to prepandemic staffing levels as the volume of business activity returns, enhanced warehouse automation is likely here to stay, says Collins.

JANUARY 2022 | O&P ALMANAC

Recruit Gen Z and Young Millennials The pandemic prompted baby boomers to leave the workforce at record rates. Almost 70% of the 5 million people who left the labor force between March 2020 and October 2021 were older than 55, according to researchers from Goldman Sachs, and many of them weren’t looking to return. This is problematic for O&P, with many current clinicians in the 55-and-older demographic. To fill the void, some O&P companies are recruiting young professionals.

Kurt Schlau, CP Leaders at Wright & Filippis are tapping its robust pipeline of residents to fill some positions. “We take our residency program very seriously,” says Kurt Schlau, CP, director of prosthetics. The company typically hosts seven residents each year—four orthotic and three prosthetic—and invests heavily in training and onboarding. When clinical staff leave, “it creates opportunities for residents,” he says. “We are teaching our residents to become independent, quality clinicians,” Schlau says. “We’re not just using them to alleviate clinicians’ workload—we’re teaching them through a yearlong process,” so they will be adequately prepared to embrace clinical roles as soon as they are certified. Ability P&O also has a vibrant residency program, “so we can build a workforce from within,” says Shoemaker. When selecting candidates, he seeks out individuals who want to stay with the company long-term. Then he pairs them with qualified, experienced clinical staff who become their mentors. Shoemaker also recruits recent graduates of the Baylor O&P master’s program, who have completed their residencies while simultaneously

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COVER STORY

Young O&P Professionals Face Unique Challenges

JANUARY 2022 | O&P ALMANAC

earning their degrees. “They’re already entry-level employees” when they onboard, says Shoemaker. “They can come in and be of value right off the bat,” overseen by more experienced clinicians.

Reevaluate Salaries

O&P companies cannot ignore the fact that salaries across the nation are on an upward trend. Across all industries, 40% of employers expect to have a higher budget for salary increases in 2022 than in 2021, according to Salary.com. Nationally, base pay may increase by an average of 3.9% in 2022, the largest projected hike since 2008, according to a recent wage survey from The Conference Board. In the survey, nearly half of employers cited the need to offer higher wages to attract workers. Within the O&P profession, salaries “have been stagnant for the past 20 years, for the most part,” says J. Chad Duncan, PhD, CRC, CPO, department chair of orthotics-prosthetics at Salus University. Clinicians at all levels may be seeking higher compensation given current inflation levels—with many of the youngest clinicians really feeling the pain. “Debt is a huge issue” for new clinicians, given the soaring prices of undergraduate degrees and O&P master’s programs, Duncan notes. (See sidebar, “Young O&P Professionals Face Unique Challenges.”)

PHOTO: Getty Images

New clinicians are among the most vulnerable to anxiety and stress, according to Gerald Stark, PhD, MSEM, CPO, LPO, senior clinical specialist at Ottobock and adjunct instructor at the University of Tennessee at Chattanooga, who recently surveyed O&P professionals on the topic of clinical burnout. Responses from more Gerald Stark, PhD, than 400 respondents (62% CPOs, 15% CPs, MSEM, CPO, LPO 12% COs, and the rest assistants and technicians) reveal an average burnout score of 43.19, which indicates the profession as a whole is “at risk for burnout,” Stark explains. Twenty-nine percent of respondents are at “severe risk or higher of burnout,” and 8% are at “very high risk of burnout,” according to Stark. Some of the factors contributing to risk for burnout include high patient volumes (which involve increasing amounts of documentation to support reimbursement activities); pressure from management regarding monthly income goals; and individual cost of entry to the profession, according to Stark. Stark, whose education doctorate is in organizational learning and leadership, is particularly concerned about clinicians with five or fewer years of experience, who reported surprisingly high rates of burnout and anxiety. “This should be the most happy and least anxious group,” he says. “But my survey found that this group was very anxious.” Contributing factors may include the revamped educational model that requires clinicians to earn master’s degrees and to become simultaneously proficient in both orthotics and prosthetics—which can add uncertainty about clinical performance. The high price of a clinical education can add to stress in the youngest demographic, as well. Many young clinicians may accrue up to $200,000, or more, in undergrad and graduate school debt. “And if clinicians are burned out at a young age, that could lead to more attrition in O&P in the next 10 to 15 years,” he says. How can O&P companies help their young employees? “We can recognize the warning signs, and manage in a different way,” says Stark. “We have to think about the context of our workers,” and recognize that millennial employees may have different expectations than Gen X and baby boomers. “We need to have greater empathy for their career expectations,” and recognize they may be carrying a large debt load, adds Stark. He also suggests finding ways to streamline patient care or leverage new technologies to alleviate the increasing number of tasks involved in seeing each patient—including paperwork and outcome measurement responsibilities. “We need to look at new ways to manage information.” Stark reminds older clinicians that millennials have a different mindset. “They’re always at work, and always at play,” he says, so it’s important to be tolerant of different work habits—including responding to young clinicians’ texts and emails at off hours. He encourages managers to teach young clinicians to avoid personalizing the experiences of their patients and to prioritize their own health.

COVER STORY

the O&P profession take lessons from the IT world in reassessing work. “IT has done a great job in creating flexibility in scheduling and focusing on wellness and well-being,” he says. “They’re looking at who their employees are and considering how they can retain them.”

J. Chad Duncan, PhD, CRC, CPO

Most facilities are limited in their ability to offer raises due to the O&P reimbursement structure. Because an O&P facility’s fees are set according to HCPCS code as determined by the payors, facilities cannot raise prices to offset salary increases like some other businesses, says Latulippe. Even so, some facilities have given modest pay bumps to employees over the past few months. Ability P&O, for example, has raised salaries and is offering some signing bonuses and relocation reimbursement. In addition, “we’re talking about offering some tuition reimbursement, which would be prorated over several years,” says Shoemaker, to help the youngest staff members.

Create Flexibility

The Kforce survey found that 70% of U.S. job seekers would be interested in flexible hours or the freedom to choose where they work when considering a job offer. Tailoring flexible options toward employees with young families may be of critical importance today, as the BLS data indicates the current resignation rates are highest among midcareer employees—those between 30 and 45 years old. Even for O&P employees, flexible and family-friendly workplaces can be higher priorities than salaries, according to Duncan. He suggests

Given the importance of one-on-one, in-person patient care, creating flexibility for clinicians is more difficult than for some other professionals. But it is possible, suggests Duncan. For example, “offer work schedules that aren’t traditional 9-to-5 hours,” he says. Allowing some employees to see patients in the evening or weekends, instead of limiting them to the traditional workday, could benefit clinicians who wish to spend part of their days at home with family—while also benefiting patients who prefer appointments

outside of their own working hours, says Duncan. The need for family-friendly workplaces has grown as society and the workplace have shifted demographics, according to Duncan. More women are choosing the profession— approximately 70% of the students at NUPOC, and many other O&P schools, are female. “Our profession has to realize that a shift has occurred, and our practices need to adopt more family-friendly policies,” to allow for longer maternity and paternity leave, flexible scheduling, work-life balance, and other family-friendly practices, Duncan says. “We can’t run our companies the way we have in the past. … You need to create parameters of what you need employees to achieve, then let those employees be flexible within those parameters.” Duncan also suggests that some employees could work remotely part of the time—for example, completing billing or documentation tasks from home. “As we move into the digital age, there are more options” for working remotely.

Job Openings Rate, Seasonally Adjusted October 2018 to October 2021 Percent 7.4 7.0 6.6 6.2 5.8 5.4 5.0 4.6 4.2 3.8 3.4 3.0 Oct 2018

Apr 2019

Oct 2019

Apr 2020

Oct 2020

Apr 2021

Oct 2021

SOURCE: U.S. Bureau of Labor Statistics, “Job Openings and Labor Turnover, October 2021”

O&P ALMANAC | JANUARY 2022

COVER STORY

Kenney Orthopedics has adopted remote options for the 25-30 staff members on the company’s billing team, according to John “Mo” Kenney, CPO, FAAOP, the company’s owner. Prepandemic, Kenney was starting to consider remote work for some billing employees—then the pandemic “forced us to explore this issue,” and it became extremely popular. “We learned that if you let your billing staff work from home, you can draw from a bigger pool of candidates,” he says. The company invested some upfront costs in the form of computers, phones, and internet, but now less office space is required. Today, “all of our billing staff work from home.”

John “Mo” Kenney, CPO, FAAOP Wright & Filippis also has become more flexible in its approach to work. Certain job responsibilities allow staff to work remotely, full or part time, according to Schlau. Clinical work still requires hands-on, in-person patient care, for the most part. While many facilities turned to remote visits during the early months of COVID, most facilities rely primarily on in-person appointments, with exceptions for some follow-up visits.

Job Outlook for Orthotists and Prosthetists Percent change in employment, projected, 2020-2030, according to BLS

18%

Orthotists and Prosthetists Total, All Occupations

Note: “All Occupations” includes all occupations in the U.S. economy Source: U.S. Bureau of Labor Statistics, Employment Projections program

Foster a Positive Workplace Many workers have come to expect transparency from their employers, so companies should foster open lines of communication. Wright & Filippis, for example, communicates with employees often and plans “continuous, consistent meetings to keep employees up to date” on all information from payors and manufacturers and coding changes, says Schlau. And “we are forward-focused” when it comes to investing in the latest technologies, which keeps staff “excited, involved, and moving forward.” In addition to consistent meetings and communications, Wright & Filippis hosts monthly team lunches: Each site chooses a day to shut its doors for one hour at lunchtime to “get together and detach,” says Latulippe. The company also hosts an annual Employee Appreciation Day to recognize and thank employees. Company perks go far beyond flexible work hours to include “meaningful

conditions,” agrees Kenney. His company, which has 18 locations, has always sought to provide fun and motivational activities to improve morale at the workplace. Social activities such as chili cookoffs, chicken wing contests, and happy hours can offer “a big return on investment,” says Kenney. He also offers many opportunities for clinicians to earn CEUs, both in-house and at outside educational events. “All the money we’ve ever spent on employees [on both social and educational opportunities] has always come back tenfold,” he says. “When you take care of employees, that makes them happy, and that makes them productive.”

Focus on the Patients

Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com. 28

JANUARY 2022 | O&P ALMANAC

PHOTO: Getty Images

O&P facilities learned to work smarter during the pandemic, and to optimize patient care with leaner staffs. Now, companies are finding creative ways to build back their workforces. For those companies that survived the pandemic, “it’s made us stronger,” says Kenney. “We’ve always tried to take care of our employees. Our mission is to take care of patients—and we can’t do that without the right employees.” At O&P facilities nationwide, “the main focus hasn’t changed—that’s providing quality care,” agrees Schlau. “The changes are in how you go about providing that care.”

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L E A D E R S H I P S E RIE S

Reimagining O&P O&P leaders share their vision of the future and explain how the profession will come to be recognized as a medical profession Interviews conducted by JOSEPHINE ROSSI

EDITOR’S NOTE: For 2022, O&P Almanac has revived the popular Leadership Series, which originally appeared in the magazine in 2015, to once again feature revealing insights and opinions from senior-level leaders on topics of critical importance to the future of the profession. To complement AOPA’s launch of a new mission and vision and emphasis on “reimagining the profession,” subsequent installments of this feature will include interviews with O&P stakeholders on topics of key importance to O&P clinicians, manufacturers, researchers, and educators.

JANUARY 2022 | O&P ALMANAC

HAT ARE THE most important

Meet Our Contributors: Curt Bertram, CPO, FAAOP, has held a number of positions in O&P during the course of his more than 30-year career, from technician to chief operating officer. He currently is vice president of operations for the Prosthetic Center for Excellence and a partner with O and P Insight in Las Vegas. Bertram is a past president of ABC and is the current chair of AOPA’s Coding and Reimbursement Committee.

Kimberly Hanson, CPRH, is director of reimbursement, North America, for Otto Bock HealthCare. She has been with Otto Bock since 2006. Hanson earned a bachelor’s degree in biochemistry from Arizona State University. She has been a member of the AOPA Board of Directors since December 2018.

STR NGER TOGETHER

Eve Lee, MBA, CAE, has been executive director of AOPA since 2018. Previously, she served as executive director of the Society for Healthcare Epidemiology of America and senior director of membership at the American Academy of Otolaryngology—Head and Neck Surgery. Her experience and expertise include navigating the complexities of legislative and regulatory advocacy and working with volunteer leaders to create policy and position statements, practice guidelines, and continuing medical education content.

issues impacting the O&P profession, and how should the profession move forward in 2022 and beyond? O&P leaders from all sectors—clinicians, manufacturers, suppliers, educators, and more—are meeting this month to address these important questions and related topics during the 2022 AOPA Leadership Conference, held January 7-9 in Paradise Valley, Arizona. Building on AOPA’s new mission and vision (see Views From AOPA Leadership on page 4), O&P executives are convening to discuss reimagining the future of the profession. In this inaugural installment of the revamped Leadership Series, O&P Almanac speaks with three industry leaders who share their opinions on the big-picture concepts being discussed at the conference—getting recognized as a medical profession, bringing new technologies to market, and responding to disrupters—concepts that will guide AOPA and O&P professionals as they navigate the new year. O&P Almanac: What change is essential for us to truly reimagine the profession? Curt Bertram, CPO, FAAOP: The current landscape defines us as “suppliers” and not “providers.” Until that changes—literally from an act of Congress—we will need to reimagine our focus from the device to the patient. As we are in an era of evidence-based healthcare, this shift is critical to prove what we do works to transform the patients’ lives in a meaningful way. This goes beyond objective outcome measures and speaks to the patient and what benefit they derived from the device—for example, how did we change their life in a meaningful way? K-levels define potential and help determine componentry for reimbursement purposes; however, O&P ALMANAC | JANUARY 2022

training, education, and care that the talented professionals provide. Working with both orthotic and prosthetic patients takes knowledge, talent, and compassion—and these professionals serve their patients each day, spending hours helping them achieve their goals. This is not done by other “suppliers” in the DME space.

they are not related to the patient’s actual outcome. Our focus must be on long-term validated outcomes from the patient, relative to what they have been provided from us, to justify being a part of evidence-based healthcare. Kimberly Hanson, CPRH: I feel that the O&P profession needs to invest in clinical care guidelines mirrored from other medical professions in order to bring validation and consistencies to the care that talented O&P professionals provide.

JANUARY 2022 | O&P ALMANAC

O&P Almanac: What will be the most profound effect of O&P becoming recognized as a medical profession? Bertram: Being recognized as a medical profession would mean we focus on the long-term patient outcome. Our technology is wonderful and continues to amaze; however, it is only a means to the end. As medical professionals, we need to be concerned with the patient as a whole and recognize our role in the overall health of the patient and how our specialty in enabling mobility is a tool in their overall health. Hanson: Being recognized as a clinical care provider, instead of just a supplier, would bring out the extensive

O&P Almanac: How will “disrupters” affect the industry in years to come? Bertram: I believe there are two major disrupters. The first is technology and the ease of use and that anybody can make a “leg” or “brace.” We have seen encroachment from others into the O&P space in the form of off-the-shelf/prefabricated braces, digital scanning, prefabricated prosthetics sockets, 3D printing, and competitive bidding by CMS. It is easy for anyone to digitally scan a patient’s body part and have an orthosis or prosthesis fabricated. This has allowed non-O&P suppliers to provide O&P care and take a large portion of the available business, especially on the orthotics side of the industry. Competitive bidding will expand in the coming years, as CMS is saving money, and it will drive down reimbursement. We need to embrace technology because if we do not lead in this area, we have seen others will and have.

PHOTO: Getty Images

Eve Lee, MBA, CAE: I think those changes will come from how we see ourselves, the role we play in patients’ lives and in the profession. And, how we see the future. Sometimes we get mired down in putting out the day-to-day fires, that it almost seems like an endurance race that we will never finish. Taking the time to imagine that future, be a part of its design, and build it takes work and energy. Who has that extra time? Not many people I know. But what we have seen before is that it will be built for us, regardless of if we participate in that process or not. And chances are good that without our participation, it won’t serve patients or the profession. I know from my perspective at AOPA, we are continually inspired by

the transformational work done by our members on behalf of patients to eliminate barriers, solve problems, resolve issues, to create the path that will allow patients to live their fullest lives. This inspires the AOPA team to exactly that on behalf of our members and their patients: eliminate barriers, solve problems, and resolve issues. Being inspired by the work done to transform patients’ lives is our center. It’s our core. And we will draw from that to work together as a community to reimagine the profession.

Lee: This will put orthotists and prosthetists in the already wellestablished, recognized provider track within healthcare—where patients are at the center, and members of that care team work seamlessly together on behalf of that patient. It will recognize the clinical care already being provided and will “categorize”—for lack of a better word—it appropriately as it relates to healthcare regulation. And, it will raise the visibility of the profession within healthcare to those who are exploring options and looking to serve patients in a meaningful, unique, and dynamic way.

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The other disrupter is how CMS, DME MAC, and PDAC are looking at coding. I have seen CMS take a stronger role in how coding should be used, such as NCCI, ultimately narrowing coding options and creating more inclusivity with base codes. In addition, we are seeing the government contractors—DME MAC and PDAC— take a stronger role in determining coding for O&P products as it relates to competitive bidding and prior authorization. This, too, will continue as it is saving dollars; the downside is that it can limit technology and creativity on the custom side of O&P by limiting coding options for existing products. Hanson: The pandemic has been a significant disrupter for clinics, providers, and patients. Patients delaying care, clinics unable to open, and rising salaries have all contributed to disrupting the current environment. In addition, the change in coding definitions and intent of the codes when first granted is causing confusion and mandates submission to PDAC for code verification. The current environment seems to allow a few new product introductions and new codes, but very low payment allowables will eliminate new technologies from entering and assisting patients in their journey to ambulate and perform ADLs, and will reduce them to using other assistive items that do not promote maintaining or improving their health.

JANUARY 2022 | O&P ALMANAC

Hanson: Survive. [O&P professionals should] understand the impacts to their practices from the pandemic and be nimble to change models, become more efficient and cost-effective, and focus on seeing patients and helping them as they do so very well.

much more than telling patient stories, which are very compelling for sure, but don’t necessarily change the minds of policymakers. We need to be showing the impact of clinicians by telling their stories in conjunction with the patient stories. We need to be supporting clinical research to create the body of evidence that will inform and support the case for appropriate reimbursement from payors. We need to collect the data and evidence that supports appropriate coverage for O&P care by insurance companies and government payors and demonstrate how inappropriate coverage hurts patients. And once we have that well-researched, well-informed, and complete picture of the value of O&P care, we—and I mean all of us in the profession—get out there and tell that story! To regulators, insurance companies, legislators, media, and more. It will take all of us using the same voice to tell this story. It’s the complete picture, and not just one person or one stakeholder. We need to be all working together to share O&P’s story so the reimagined future can be realized.

Lee: We need to be communicating the value of O&P care more broadly and more articulately. This involves

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

O&P Almanac: What is the one goal the O&P profession should focus on accomplishing in 2022? Bertram: While most goals in our industry take longer than a year, we should stay focused on the patient and create long-term outcomes related to the effectiveness of the O&P intervention. When we change lives through mobility, we can create long-term outcomes for our patients— allowing them to live their lives more fully. We need to continue to prove this to be recognized as healthcare professionals.

PHOTO: Getty Images

Lee: It’s hard to always know what is coming down the pike. Technology moves so much faster than our day-to-day lives. Given that we can’t always predict the future, I think we need to create space for disrupters, rather than fight them. If we don’t include them in our fray in some way, where we can—influence and maybe even collaborate—we run the risk of disrupters going around us, and ultimately right past us, making changes that impact the profession and its patients without our involvement. Working with disrupters, creating a

path for them to enter the profession/ industry, allows us to keep the focus on what is best for patients, which is safe and effective, evidence-based care.

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Personal Connections Improving outcomes for service members and veterans

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

LIZABETH RUSSELL ESPOSITO, PhD, whose doctorate is in bio-

mechanics and motor control, says that her passion for O&P research has deeply personal roots. She had limited exposure to this field until she met her now-husband, who is a combat-injured service member. “He introduced me to both Walter Reed and the Center for the Intrepid (CFI), the two places where he received his surgical and rehabilitation care after his Humvee hit an IED in Afghanistan in 2009, shattering both his lower legs,” she recalls. “I was moved by the work being done to care for these

individuals and took a research position at CFI to contribute toward improving outcomes for service members with extremity trauma and amputation, as well as the greater community of veterans and civilians.” Today, Russell Esposito—a research scientist with the Department of Defense-Department of Veterans’ Affairs Extremity Trauma and Amputation Center of Excellence and embedded within an experienced research team at the VA’s Center for Limb Loss and Mobility—is well known for her contributions to studies that help improve outcomes for individuals with a range of musculoskeletal injuries.

Focusing on Women

JANUARY 2022 | O&P ALMANAC

PHOTO: Gregory Voss, Minneapolis VA

Andrew Hansen, PhD; Elizabeth Russell Esposito, PhD; and Matthew Major, PhD, evaluate the mechanical properties of adjustable heel height prosthetic feet with different footwear.

Russell Esposito has focused some of her research on specifically studying women with lower-limb amputation, paying particular attention to the use of women’s shoes. Her footwear studies were inspired by a female patient at CFI who reported walking better using a creatively modified prosthetic foot in four-inch stiletto heels than using her flat gym shoes. Russell Esposito recalls that her colleague, Christopher Rábago, PT, PhD, “had the good sense to do a biomechanical gait analysis to determine what features of her gait actually improved with high heel use.” This case study became their first contribution to the sparse literature focused on women with lower-limb amputation and spurred a line of research in this area.

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PRINCIPAL INVESTIGATOR

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A rocky treadmill design is used as part of proprioceptive rehabilitation for patients with destabilizing ankle injuries.

Studying Proprioception

Proprioceptive training is another important area of focus for Russell Esposito. In a series of studies, she is evaluating the use a treadmill covered in rocks to facilitate the sensorimotor rehabilitation of individuals with lower-limb injuries. “Physical therapy currently uses 38

JANUARY 2022 | O&P ALMANAC

PHOTO: Wyatt Ihmels, VA Puget Sound

Currently, Russell Esposito is leading a study to investigate the unique needs and challenges faced by women with amputations in collaboration with Matthew Major, PhD, at Northwestern University; Andrew Hansen, PhD, Christopher Erbes, PhD, and Billie Savvas Slater, MAEd, CCRC, at the Minneapolis VA; and Andrea Ikeda, MS, CP, at the Shirley Ryan AbilityLab. “Our team’s work certainly includes footwear limitations, but also targets specific differences between men and women, the development of new prosthetic feet that can accommodate a variety of different footwear, and mechanical and biomechanical effects of various women’s shoes on energy return and gait,” she explains. One important finding from their work is that footwear and clothing limitations experienced by women with lower-limb amputation extend beyond preference and relate to poorer body image, reduced functional capabilities, and lower reported participation in daily activities. “Our results show that it’s about so much more than fashion,” she says, “yet adjustable heel height prosthetic feet are still treated as a luxury item.”

Benjamin Shuman, PhD, and Russell Esposito test the mechanical properties of ankle-foot orthoses in the EMPIRE (Evaluation of Mechanical Properties in Rotating Exoskeletons). destabilizing surfaces such as Bosu balls and foam mats. The rocky treadmill takes it a step further, quite literally, and brings the instability of moving in the outdoor environment into the controlled setting of the physical therapy clinic.” Her team is starting their research by concentrating on ankle sprains— and the ensuing chronic ankle instability—“because it is the single most common acute injury that plagues the military,” says Russell Esposito. Her current clinical trial will determine if a progressive rocky treadmill training intervention can improve outcomes and reduce reinjury rates. “If effective, we hope this intervention extends far beyond ankle sprains to the broader population of individuals who use sensorimotor training as part of rehabilitation, such as those with lower-limb amputation or traumatic brain injury,” she says. “Someday soon you may see our rock-covered treadmills in physical therapy clinics as routine parts of care.”

Investigating AFO Properties

Russell Esposito also has worked to optimize the design and prescription of ankle-foot orthoses (AFOs). “We have

explored the impact of a broad range of factors, from stiffness to bending axis to alignment across a variety of different tasks,” she explains, “as well as the training people receive on how to use their AFO.” Her team is currently trying to determine how best to evaluate the mechanical properties of AFOs. By knowing the properties of the devices, they can be used in a variety of different applications, like an ongoing AFO emulator study or in modeling and simulation work. “This is important because having information on the mechanical properties allows us to progress past comparative effectiveness studies looking at a very narrow range of currently available devices and allows us to test—either in vivo in human subjects or in silico in modeling and simulation—a far broader range of both existing devices and new or hypothetical designs.” At the moment, Russell Esposito is leading a study that allows patients to “test drive” different AFOs using an exoskeleton developed by Humotech that can be programmed to mimic the AFO’s mechanical properties. David Morgenroth, MD, also collaborates on this study, “which is particularly

PRINCIPAL INVESTIGATOR

Modeling and Simulating

Looking back at her career, Russell Esposito notes a particular study that made a significant impact on the O&P field. Her 2014 paper, “Does Transtibial Amputation Lead to a Greater Metabolic Demand of Walking?” shows that below-knee amputation and use of a passive prosthetic foot does not inevitably increase the energy demands of walking. “This work contradicts decades of research that assumed an increase in metabolic demands to be an unavoidable consequence of amputation,” she says. “Assumed differences in rehabilitation care between the recent studies on service members and all the prior studies on civilians may be an important part of the outcomes observed. Now, we want to do everything we can to better understand what specific, modifiable factors contributed to these outcomes so we can achieve them again and again.” She has already made strides toward getting those answers. “Of course, we cannot conduct longitudinal studies on individuals pre- and post-traumatic lower-limb amputation,” she says. However, it can be simulated through modeling and simulation, and “we can use predictive optimization to evaluate the independent effects of the amputation. It lets us ask a new range of ‘What if?’ questions, such as ‘What if we have muscle atrophy?’ or ‘What if we increase prosthetic push-off power?’” She is working closely with Ross Miller, PhD, at University of Maryland to perform longitudinal studies in silico using the same “person” pre- and postlimb loss to see what factors contribute to outcomes such as walking energetics

PHOTO: Humotech

helpful as he recently completed a similar test drive strategy with prosthetic feet,” she says (see “The Tech Effect” in the October 2021 O&P Almanac). “Together, we will be able to determine if having the ability to try out different design properties of both prosthetic and orthotic devices is useful for determining which one a user will prefer long term. Our goal is to give clinicians additional tools to augment their valuable clinical expertise.” Russell Esposito with Humotech’s exoskeleton design for test-driving commercially available ankle-foot orthoses

and gait quality. “Our work shows that maintaining muscle strength, particularly in the residual limb, may prevent an increase in energy expenditure postamputation,” Russell Esposito says. She and Miller have expanded this work, with DOD funding, to create a robust and validated 3D model of limb loss and are currently developing an above-knee amputation model, as well. “We will continue to make this work publicly available so the research and clinical communities can freely use it and expand on it.”

Prioritizing Care and Education In addition to her research duties, Russell Esposito is affiliate faculty in the department of mechanical engineering

at the University of Washington in Seattle and in the Department of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She relies heavily on her clinical colleagues as well as the study participants themselves to help her understand what lingering unmet needs are affecting their outcome and quality of life. “The best way to determine today’s most pressing clinical questions is to ask the clinicians and patients directly,” she explains. “Burying yourself in journal articles will only get you part of the way. Researchers welcome your input and feedback to help put more evidence behind the practice.” Given her own experiences in learning from patients, Russell Esposito conveys the importance of “caring for the person beyond the prosthesis,” she says. “Investing in additional training and rehabilitation may improve outcomes for individuals with limb loss.” She is now looking forward to the next step in her research journey, which will involve taking on the Neuromusculoskeletal Injuries Research Portfolio for the Military Operational Medicine Research Program. “I am grateful to be able to make an impact to this field in a new way through this role.”

Notable Works

Elizabeth Russell Esposito, PhD, has been involved in dozens of impactful published studies, including the following: • Russell Esposito, E., Rodriguez, K.M., Rábago, C.A., Wilken, J.M., “Does Transtibial Amputation Lead to Greater Metabolic Demand During Walking?” Journal of Rehabilitation Research and Development, 2014; 51(8): 1287-1296.

• Russell Esposito, E., Blanck, R.V., Guckert, N.L., Hsu, J.R., Wilken, J.M. “How Does Ankle-Foot Orthosis Stiffness Affect Gait in Patients With Lower-Limb Salvage?” Clinical Orthopaedics and Related Research, 2014; 274(10): 3026-2035.

• Russell Esposito, E., Miller, R.H. “Maintenance of Muscle Strength Retains a Normal Metabolic Cost in Simulated Walking With Below-Knee Limb Loss.” PLoS One, 2018; 13(1):e0191310.

• Shuman, B.R., Russell Esposito, E. “Multiplanar Stiffness of Commercial Carbon Composite Ankle-Foot Orthoses.” Journal of Biomechanical Engineering, 2022; 144(1):011004. O&P ALMANAC | JANUARY 2022

MEMBER SPOTLIGHT

Mecuris

By DEBORAH CONN

Digital Designs German company offers web-based software for designing O&P solutions

ECURIS, A PROVIDER OF

JANUARY 2022 | O&P ALMANAC

Mecuris offers a digital platform for designing orthoses and prosthetic sockets.

COMPANY: Mecuris OWNERS: Public and private investors LOCATION: Munich, Germany HISTORY: Five years

Gate Bridge—huge constructions. But most of the technology in these comprehensive software solutions will never be used for medical devices,” he notes. By contrast, “our software is designed by orthotic and prosthetic technicians, so it is specifically crafted to meet the industry’s needs.” Mecuris’ platform allows medical professionals—even those without prior knowledge in 3D technologies—to upload 3D scans and produce digital files that can be used with a milling machine or a 3D printer to produce functional forms, orthotic shells, or prosthetic sockets. The vast majority of facilities will outsource the actual manufacturing, says Fröhlingsdorf, although about 10% have the equipment to fabricate the devices or functional forms themselves. Clinicians can customize the process to fit their needs, without having to use every step provided— giving them flexibility in combining traditional and digital processes. Fröhlingsdorf sees Mecuris’ digital platform as the natural evolution of technology in O&P,

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

PHOTOS: Mecuris

digital services for the medical aids industry, was founded in Germany as the result of two separate research projects back in 2014. Jannis Breuninger was investigating additively manufactured prostheses at the Fraunhofer Institute for Manufacturing Engineering and Automation in Stuttgart, while trauma surgeon Simon Weidert, MD, at the Ludwig Maximilian University (LMU) Hospital in Munich, was looking for ways to provide his patients with customized orthoses from 3D printing. The two joined forces with a team of doctors, engineers, IT specialists, business economists, and designers to launch Mecuris as a spinoff of the LMU Hospital. Today, the company has 25 employees and serves customers across the globe. The company’s goal is to improve people’s lives by becoming the gold standard for individual orthopedic care. The Mecuris team achieves that goal via a digital platform for designing orthoses and prosthetic sockets. The platform is designed to put control in the hands of individual practitioners, rather than fabrication companies. “We have the only web-based software for this purpose that allows the technician 100% freedom in combining the digital advantages and his traditional knowledge,” says Mecuris CEO Peter Fröhlingsdorf. “Facilities don’t need to buy a DVD or install the software on their computers. You just follow the link and get started.” The company’s CAD software is unlike most others on the market, he says. “Generally, such software is designed to build something to fly to the moon or rebuild the Golden

and he expects the tools will grow rapidly in their application, thanks to new materials offering more flexible, comfortable, and functional devices. The shift to digital goes beyond the tech, however. “There’s also the question of reimbursement,” he says. “The drive to innovation is faster and more powerful than payors can keep up with.” He participates in several taskforces to help educate insurance companies on reimbursing for digital services. His dream is that Mecuris continues to develop better digital tools that will favorably impact the environment, as well as society. “In large parts of the world, people in need of individual aids don´t have access to them,” he notes. The company markets its software through a sales force located both in Germany and around the world. It uses social media, email, and a physical presence at trade shows and O&P industry meetings. Like at many companies, the necessity of virtual marketing during the COVID-19 pandemic has developed into continuing online training, demonstrations, and facility visits. As part of its global citizenship, Mecuris supports Handicap International (HI), a foundation that supports vulnerable populations around the world, particularly those with disabilities. “If a facility downloads our platform, a portion of the proceeds is directed to HI.” Fröhlingsdorf has been with Mecuris for two years and relishes his role there. “The enthusiasm and passion of the whole team is wonderful,” he says. “It’s a young team that embraces our company culture of honesty and humanity. We also have many students in Munich from all over the world, and many of them want to continue working with Mecuris.”

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MEMBER SPOTLIGHT

Professional Orthotics & Prosthetics

By DEBORAH CONN

From Pediatrics to Geriatrics Sole clinician serves a full spectrum of patients in Kansas

FTER BRANDON SMITH, MSOP, CP, BOCO, sustained

JANUARY 2022 | O&P ALMANAC

Brandon Smith, MSOP, CP, BOCO, works with a lower-limb prosthetic patient at Professional Orthotics & Prosthetics. uses 3D scanning technology and houses a 3D Create 5400 printer to produce prosthetic sockets. POPs focuses heavily on prosthetics, says Smith, and mainly serves a population at either end of the age range: OWNER: pediatric and geriatric patients. Brandon Smith, “Much of our work is prosthetics, MSOP, CP, BOCO, therapeutic shoes for diabetes and Cindy Smith patients, and mastectomy supplies,” says Smith. One of the LOCATION: company’s administrative staff Manhattan, Kansas, members is a mastectomy fitter. and Clay Center, The facility is committed to an evidence-based approach, Kansas using both performance outcome measures and self-reported meaHISTORY: sures to create a comprehensive Two years plan of care for patients. POPs leverages principles developed by Elaine Owen, MSc, SRP, MCSP, a physical therapist from the United Kingdom who specializes in gait analysis and orthotic and physical therapy management of children and adults. These principles “include listening, informing, and Smith at his Kansas facility involving each patient in their

FACILITY: Professional Orthotics & Prosthetics

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

PHOTOS: Professional Orthotics & Prosthetics

an injury while serving in the U.S. Army in Iraq in 2004, he was assigned to the brace shop of a military hospital as part of a medical transition team. “I loved it,” he says, “so I pursued it with everything I had.” Smith soon became certified in orthotics by the Board for Certification and Accreditation. He eventually earned his undergraduate degree from the University of Massachusetts, Lowell, and attended Baylor College of Medicine to earn his master’s in orthotics and prosthetics in 2017. After working for another provider, he and his wife, Cindy, opened their own patientcare facility in 2019. “I had always wanted to be a business owner,” explains Smith. “I first came to Manhattan, Kansas, because of the military. We liked the area, so this is where we decided to stay.” Professional Orthotics & Prosthetics, or POPs, has a satellite office in Clay Center, Kansas, and Smith divides his time between the two locations. He is the sole clinician, with three other employees, including Cindy, who serves as office manager. The Manhattan office features three patient rooms, a gait lab, a casting room, and a fitting room that also displays his new high-tech prosthetic socket products. The Clay Center office has two patient rooms, a gait and casting room, and a fitting room. Employees at POPs fabricate most of their prosthetic devices in house and outsource nearly all of their orthotic work. The practice

choice of care,” says Smith. Smith markets his facility through a variety of channels. “I try to have four touches with all my referral sources each year,” he says. “They get something tangible, whether it’s a flyer, an in-service, or even a cookie delivery. It helps us maintain our relationships and educate our referral sources.” POPs recently updated its Facebook page and posts frequently. In addition, “we have a marketing company that takes care of our Google account and manages the reviews,” says Smith. “We are making a collective effort here to get our patients to leave reviews, mentioning it at both delivery appointments and follow-ups.” The facility also contributes to charitable groups in the community, such as Flint Hills Foster Teen Camps, a nonprofit that offers several programs to help teens in the Kansas foster care system. At some point, Smith would like to expand the practice, but plans to first bring another practitioner on board. He and his wife have four children. “I would love to work side by side with at least one of them one day,” he says. “I hope they share the commitment, passion, and drive that their parents do.” Until then, Smith will continue to follow his mission: “We don’t just deliver O&P devices; we offer a better life, function, and progress for those who use orthoses and prostheses.”

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

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Strategies for Effective Revenue Collection

February 9

Lower-Limb Prostheses Policy: A Review

March 9

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April 13

Clinicians’ Corner: Techs and Fitters

AOPA MEMBERS

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

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O&P PAC

Special Thanks to the 2021 PAC Contributors AOPA would like to thank the following individuals for their contributions* in 2021 to the O&P PAC: Ryan Arbogast Curt Bertram, CPO Gerald Bernar, CP Jeffrey M. Brandt, CPO George Breece Joy Burwell Victor Bustamante, CPO, LPO Erin Cammarata Russell Cannon Maynard Carkhuff Tina Carlson, CMP Jeff Collins Thomas Costin John Chad Duncan, PhD, CPO Michael Fenner, CP, LPO, CP Marty Frana Arlene Gillis

Paul Gudonis Kimberly Hanson Scott Hebert, CPO Denise Hoffmann Shelly Hogan Steven Hoover Aaron James, CO, BOCPO John “Mo” Kenney, CPO, LPO, FAAOP Charles Kuffel, CPO, FAAOP Teri Kuffel, JD Eve Lee, MBA, CAE William Leimkuehler, CPO William Lester, CPO James Lewallen, CO James Liston, CP Melanie Liston Mahesh Mansukhani

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

JANUARY 2022 | O&P ALMANAC

Brad Mattear, CPA, LO, CFo Dave McGill Martin McNab, CPO Matthew Nelson, CPO Joe McTernan Wendy Miller, LO, BOCO, CDME Jon Naft, CPO Michael Oros, CPO, LPO, FAAOP Sara Peterson, PhD, CPO, FAAOP Jeff Quelet, CPO Rick Riley John Roberts, CPO Peter Rogerson, COA Scott Schneider Lesleigh Sisson, CFm

Mike Sotak Frank Snell, CPO, FAAOP Jack Steele, CO, FAAOP Jason Tanner, CP Bernie Veldman, CO Greg Wahl James Weber, MBA Ashlie White, MA Dennis Williams, CO, BOCO Scott Williamson, MBA Linda Wise Paul Werner, CPO, LPO Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) James Young Jr., CP, LP, FAAOP

* Due to publishing deadlines this list was created on Dec. 20, 2021, and includes only donations or contributions made or received between Jan. 1 and Dec. 20, 2021. Any donations or contributions made or received after Dec. 20, 2021, will be published in the next O&P Almanac.

MARKETPLACE

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

Smart Orthotic Treatment (SOT) Resting Hand Orthosis

Coyote’s Dynamic Foot

EnergyOne by

pdAc Verified

Many complications can cause reduced mobility in the hand, which can result in contractures if left untreated. Starting hand therapy at an early stage, before spasticity is established, may help to maintain or increase mobility of the hand. Smooth and lightweight, the SOT Resting Orthosis has an aluminum core that allows adjustment to the desired resting position. A good biomechanical position may reduce the risk of flexor shortening in the wrist and fingers. • The soft, elastic cover eliminates pressure points from bulky straps • Available in sizes XXS–XL. For more information, contact Customer Service at 888/678-6548 or email info@allardusa.com.

pdAc Verified

www.coyote.us/feet

The EnergyOne by Coyote combines movement, strength, and durability in a comfortable dynamic foot. • Three bumper options provide an adjustable heel shock • Pyramid has 10 mm of AP slide • Rugged and water-resistant • Made in USA. For information, contact Coyote at 208/429-0026 or visit www.coyote.us.

Coyote’s New Dynamic Strut AFO

Support for Better Life ALPS BioStep™ ALPS BioStep™ range is a breakthrough innovation among dynamic response feet. Active users can experience a high dynamic response combined with a fluid step and stability on all terrains. ALPS Biostep™, powered with patented NRG™ technology, is based on a biomimetic design that enables dynamic patients to perform a wide range of activities with just one single foot. ALPS BioStep™ will be released in early 2022. Stay updated on product features and release through social media or call your sales representative at 800/574-5426.

Designed to flex and move with the patient, creating a more natural gait. It’s strong enough to climb stairs and offloads the foot and ankle. • Natural gait • Works great with thermoformed braces • Provides energy response. Our unique varying thickness creates a comfortable natural gait. For information, contact Coyote at 208/429-0026 or visit www.coyote.us.

O&P ALMANAC | JANUARY 2022

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

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

JANUARY 2022 | O&P ALMANAC

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

Naked Prosthetics

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

MARKETPLACE Ottobock C-Leg® 4 You commit to their quality of life every time you trust the C-Leg® 4. As the original MPK, C-Leg redefined the standard of care for aboveknee amputees. Featuring technology to keep your patients safe with real-time adaptation across terrains and speed, this knee has an unmatched, industry-leading track record. After decades of innovation, the microprocessor technology of the C-Leg continues to raise the bar for an industry that demands innovation to achieve one primary goal: give amputees the mobility they deserve. To learn why C-Leg is the most studied, proven, and preferred microprocessor knee in the industry, visit professionals.ottobockus.com.

Ottobock Taleo Side Flex

More than a foot, a foundation. Have you met the Taleo Side Flex? The Taleo family was designed for active individuals who navigate varied indoor and outdoor environments and place a high value on effortless walking and socket comfort on uneven services. The Terrain Adaptation Unit in the latest addition, Taleo Side Flex, provides mediolateral adaptability of 20 degrees (10 degrees medial and 10 degrees lateral) for immediate and full-surface ground contact while walking and standing, including on uneven surfaces and slopes. The Taleo family allows your patients to be ready for everyday life. For more information, visit www.professionals.ottobockus.com or talk to your sales rep.

PDI 3D Central Fabrication

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

800/459-0177 | WWW.PROSTHETICDESIGN.COM

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

O&P ALMANAC | JANUARY 2022

MARKETPLACE Spinal Technology Inc.

Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis. For information, contact 508/957-8281 or visit Spinal.Tech/Almanac.

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

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

www.bocusa.org

Start earning your credits today!

MONTHLY WEBINARS TOP QUALITY

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

JANUARY 2022 | O&P ALMANAC

CAREERS

WANTED!

Opportunities for O&P Professionals

A few good businesses for sale.

Job Location Key: - Northeast

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

- Mid-Atlantic - Southeast - North Central

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

- Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge. Refer to www.AOPAnet.org for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

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

Northeast CPO, CO, CPed

Maine Do you want to be more than a number? We are a terrific, patient-orientated company looking for some awesome practitioners. Is this you? Advance Orthotic & Prosthetic Services Inc. is a well established, ABC-accredited O&P facility seeking selfmotivated, energetic CPO/CO/CPed practitioners. We are a hard working, quality minded staff, with patient care being our top priority. Our Southern Maine locations are in close proximity to the coast and mountain region. Our comprehensive compensation package includes bonuses commensurate with productivity. Learn more about joining our team of dedicated specialists by contacting: Email: djaops@midmaine.com

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board 50 or less

Member $85

Nonmember $280

For more opportunities, visit: http://jobs.AOPAnet.org. SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.

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

Runnin h

ADVOCACY

RESEARCH

We ARE AOPA

EDUCATION

ADVOCACY | RESEARCH | EDUCATION

O&P ALMANAC | JANUARY 2022

AOPA NEWS

CAREERS

, SHARE FAITH, HAVE HEART

CAREER OPPORTUNITIES… CALIFORNIA Salinas & Modesto Washington Tacoma, Richland, & Yakima Oregon Portland, Bend, & Corvallis Submit resume to: www.pacmedical.com/ Careers

FOLLOWING THESE PRINCIPLES HAVE MADE US AN INDUSTRY LEADER IN THE ORTHOTICS AND PROSTHETIC FIELD. WITH A HEART TO HELP AND SERVE OTHERS PAC MED IS DEDICATED TO THE ADVANCEMENT IN TECHNOLOGY, EVIDENCE BASED MEDICINE, AND THE PROFESSIONAL SUCCESS OF OUR GROWING TEAM. BASED ON EXPERIENCE OUR CPO POSITIONS OFFER THE FOLLOWING ADVANTAGES:

 COMPETITIVE SALARY AND BENEFITS- MEDICAL, DENTAL, VISION, ER PAID LIFE FOR

EMPLOYEE, VOLUNTARY BENEFITS, FSA DEPENDENT FSA, HSA, 401K, AND GOAL PATH FINANCIAL WELLNESS.  CONTINUE EDUCATION ALLOWANCE- PRE-APPROVED CEU’S WILL BE REIMBURSED AT 100% UP TO $1500 PER YEAR WITH RECEIPTS.  RELOCATION ALLOWANCE- PRE APPROVED RELOCATION EXPENSES WILL BE REIMBURSED UP TO $4000 WITH RECEIPTS.  PROFIT SHARING- FOLLOWING 1 YEAR OF EMPLOYMENT EMPLOYEES HAVE NON-VESTED TOP SHELF SHARES.  ORTHOLIFE COMMISSION INCLUSION- BASED ON EXPERIENCE, PAC MED MAY OFFER CM INCLUSION BASED ON THE O&P TERRITORY.  ANNIVERSARY PROGRAM- ALL LOYAL EMPLOYEES THAT REACH MILESTONE ANNIVERSARIES WITH THE COMPANY (5, 10, 15, 20 YEARS) ARE ELIGIBLE TO CHOOSE THEIR OWN LUXURIOUS ANNIVERSARY GIFT.

ADVERTISERS INDEX

Advertisers Index Company

Website

Allard USA Inc.

866/678-6548

www.allardusa.com

ALPS South LLC

800/574-5426

www.easyliner.com

Amfit

19 800/356-3668

www.amfit.com

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

23, 25

800/819-5980

www.coyote.us

888/WEAR-ESP

www.wearesp.com

Coyote Prosthetics & Orthotics

Page Phone

ESP LLC

Hersco

1 800/301-8275

www.hersco.com

Naked Prosthetics

www.npdevices.com

888/977-6693

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

855/450-7300

www.proteorusa.com

Spinal Technology Inc.

508/957-8281

www.spinal.tech/almanac

The Bremer Group Company

800/428-2304

www.bremergroup.com

Tillges Technologies

855/484-5832

www.tillgestechnologies.com

TurboMed Orthotics Inc.

888/778-8726

www.turbomedorthotics.com

JANUARY 2022 | O&P ALMANAC

CALENDAR

March 18–19

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

April 13

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

WEBINAR

May 11

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

WEBINAR

May 10–13

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

2022

May 18–20

January 12

Strategies for Effective Revenue Collection. 1 PM ET. For more information, visit www.AOPAnet.org. WEBINAR

June 8

January 1–31

WEBINAR

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

at www.AOPAnet.org.

visit www.AOPAnet.org.

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

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

July 13

March 2–5

WEBINAR

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

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

Calendar Rates

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

September 28–October 1

March 9 WEBINAR

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

June 24–25

February 9 WEBINAR

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

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

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@ AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Words/Rate 25 or less 26-50 51+

Member Nonmember $40 $50 $50 $60 $2.25/word $5.00/word

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

$482 $634

$678 $830

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

O&P ALMANAC | JANUARY 2022

STATE BY STATE

Become an AOPA State Rep.

Rules and Regulations

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

Updates From Illinois, Iowa, Kentucky, New York, and Virginia

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

Iowa

Last year, the Iowa Prosthetic, Orthotic, and Pedorthic Association worked with the state legislature to introduce SF 140, a bill that entitles workers’ compensation patients to more than one replacement prosthetic device over the course of their lifetime. Currently, 18 states have similar entitlements to prosthetic replacement on their books. AOPA is tracking this important state legislation. For the complete bill text, visit the Iowa page of the AOPA Co-OP.

Kentucky

Illinois

The Illinois Department of Financial and Professional Regulation (IDFPR) extended the deadline for license renewal requirements, including continuing education (CE) credits and sexual harassment prevention training, to Dec. 31, 2021. The Sept. 30, 2023, license renewal date remains the same. In addition, IDFPR proposed an emergency amendment on Nov. 29, 2021, that would remove the 15-hour limit for online CE credits, allowing practitioners to complete credits in any combination of in-person and online formats. For the full text of the amendment and rulemaking comment guidelines, visit the Illinois page of the AOPA Co-OP. 52

JANUARY 2022 | O&P ALMANAC

In October 2021, Kentucky Medicaid’s prior authorization contractor began asking O&P practitioners for estimates of fitting and fabrication time, as well as descriptions and cost estimates of materials and labor. The Kentucky Department of Medicaid Services reports that, per state regulations, such a requirement is within the scope of the agency. AOPA is looking into this memberreported issue and is seeking feedback from members in the state. Visit the Kentucky page of the AOPA Co-OP for the full text of the Kentucky regulation.

New York

New York Medicaid has made a change to its prosthetics coverage to not allow for addition/ substitution codes to be added to temporary or preparatory below-knee

prostheses. Instead, temporary and preparatory base codes are all inclusive and considered complete items, with add-ons, upgrades, adjustments, modifications, substitutions, etc., not separately reimbursable. AOPA is working to ensure members in New York are aware of this rule, and the association is seeking feedback.

Virginia

Virginia House Bill 2669 received unanimous recommendation from the Virginia Health Insurance Reform Commission. If passed, it would change the existing code of Virginia to require private and employee-sponsored insurance plans to provide coverage for prosthetic care. AOPA has been tracking this legislation and testified in favor of it in January 2020. For the latest information, visit the Virginia page of the AOPA Co-OP.

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

Submit Your State News

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

Are you ready to take your career and your business expertise to new heights? The all new Certificate in O&P Business Management can help you do just that!

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

Participating is easy… 1. Enroll in the program. 2. Select and complete four required Core Courses and four Elective Courses within four years and pass a Course specific quiz for each program. 3. Be awarded a frameable certificate from both the University of Hartford and AOPA.

Sound good? Enroll today at bit.ly/AOPACP. Need more information? Visit www.AOPAnet.org.

bebionic® with Myo Plus pattern recognition

bebionic is now PDAC verified

Unlock hidden potential.

The enhanced bebionic by Ottobock allows your patients to express themselves with confidence and style. Together with Myo Plus pattern recognition, users achieve direct and natural control of the hand. See and experience the difference with the Myo Plus app, featuring the patented EMG SpiderPlot display. professionals.ottobockus.com

January 2022 O&P Almanac

Articles inside

Calendar

Happenings

State By State

O&P PAC

People & Places

Views From AOPA Leadership

Marketplace