January 2024 O&P Almanac by AOPA

NEW FEES, CODES, AND COMPRESSION GARMENTS COVERAGE IN 2024 P.11 ETHICAL CONDUCT IN THE PROFESSION P.22

The FutureFocused Leader

FRESH FACES: MEET THE O&P PRO WHO CREATED ‘POPPED’ P.26

Six essential behaviors for lasting success P.14

JANUARY 2024

The Magazine for the Orthotics & Prosthetics Profession

AOPAnet.org

SEPTEMBER 12-15, 2024 CHARLOTTE, NC

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CONTENTS

January 2024 | Vol. 73, No. 1 COVER STORY

FEATURES

14 THE FUTURE-FOCUSED LEADER Successful healthcare companies are led by dynamic leaders who are willing to evolve as technology advances and the business climate shifts. Learn the six behaviors that define effective healthcare leaders—actions that will inspire productivity and innovation at O&P companies.

22 INTEGRITY MATTERS

By CHRISTINE UMBRELL

Defining “ethical” business practices can be a challenge in O&P, and new technologies and processes spur questions on what constitutes “doing the right thing.” Industry stakeholders discuss the importance of ethical behavior and new efforts to update training on this important topic. By MICHAEL COLEMAN

COLUMNS

DEPARTMENTS

11 Reimbursement Page NEW YEAR, NEW RULES

Updates on the fee schedule, HCPCS codes, and more Opportunity to earn CE credits by taking the online quiz.

How to reach staff

New for 2024, O&P Almanac debuts Fresh Faces. Here, you will meet interesting O&P professionals who are making an impact with their contributions to the profession. We begin this month with Adrienne Hill, MHA, CPO(L), FAAOP, program director of the O&P master’s program at Kennesaw State University and creator of the “POPPED” initiative.

29 Member Spotlight y LOUISVILLE PROSTHETICS y BIONIC POWER

O&P Almanac January 2024

Happenings Research, statistics, and industry news

26 Fresh Faces SPREADING THE JOY OF O&P

AOPA Contacts

People & Places Transitions in the profession

31 AOPA News

32 AOPA New Members 33 Marketplace 35 Calendar Upcoming meetings and events

35 Ad Index 36 State By State

AOPA announcements, member benefits, and more

MEET THE 2024 AOPA BOARD OF DIRECTORS, P.9

Updates from New York and North Carolina

AAOP 2024

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AOPA Contacts

A world where orthotic and prosthetic care transforms lives.

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Office: 571-431-0876 Fax: 571-431-0899 AOPAnet.org

Board of Directors

AOPA Staff

OFFICERS

EXECUTIVE OFFICES

President Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX

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

President-Elect Rick Riley O&P Boost, Bakersfield, CA Vice President Kimberly Hanson, CPRH Ottobock, Austin, TX Treasurer Chris Nolan Össur, Foothills Ranch, CA Immediate Past President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS Arlene Gillis, MEd, CP, LPO International Institute of Orthotics and Prosthetics, Tampa, FL Adrienne Hill, MHA, CPO(L), FAAOP Kennesaw State University, Kennesaw, GA John “Mo” Kenney, CPO, LPO, FAAOP Kenney Orthopedics, Lexington, KY James Kingsley Hanger Clinic, Oakbrook Terrace, IL Lesleigh Sisson, CFo, CFm Prosthetic Center of Excellence, Las Vegas, NV Matt Swiggum Proteor, Tempe, AZ Linda Wise Fillauer Companies, Chattanooga, TN Shane Wurdeman, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX

O&P Almanac January 2024

PUBLISHER EVE LEE, MBA, CAE EDITORIAL MANAGEMENT CONTENT COMMUNICATORS LLC ADVERTISING SALES RH MEDIA LLC DESIGN & PRODUCTION MARINOFF DESIGN LLC PRINTING SHERIDAN

Akilah Williams, MBA, SHRM-CP, director of finance and strategic operations, 571-431-0819, awilliams@AOPAnet.org

HEALTH POLICY AND ADVOCACY

Joe McTernan, director of health policy and advocacy, 571-431-0811, jmcternan@AOPAnet.org

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.

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571-431-0854, dbernard@AOPAnet.org Sam Miller, manager, state and federal advocacy, 571-431-0814, smiller@AOPAnet.org

MEETINGS & EDUCATION Tina Carlson, CMP, senior director, education and meetings, 571-431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, assistant director, meetings and exhibitions, 571-431-0852, kelly.oneill@AOPAnet.org

MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571-431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571-431-0810, bleppin@AOPAnet.org Nicole Ver Kuilen, manager of public engagement, 571-431-0836, nverkuilen@AOPAnet.org Madison McTernan, coordinator of membership and communications, 571-431-0852, mmcternan@AOPAnet.org AOPA Bookstore: 571-431-0876 Reimbursement/Coding: 571-431-0833, LCodeSearch.com

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

ADDRESS CHANGES Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2024 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 Share your message with AOPA membership— approximately 9,000 orthotic and prosthetic professionals, facility owners, and industry personnel. Contact Bob Heiman at 856-520-9632 or email bob.rhmedia@comcast.net. Learn more at bit.ly/24AlmanacMediaKit.

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Happenings RE SE A RCH ROUNDUP

Spinal Cord Stimulation Improves Balance for Prosthesis Users A new study of three individuals with transtibial amputation demonstrated that lateral lumbosacral spinal cord stimulation can evoke sensations from the missing foot. The proof-ofconcept study paves the way for additional clinical trials leveraging spinal cord stimulators to improve connections between the brain and prosthetic feet, according to researchers from the University of Pittsburgh School of Medicine. The Pitt researchers adapted a standard spinal cord stimulation system to deliver sensory signals as participants stood or walked. A pair of thin electrode strands implanted over the top of the spinal cord in the lower back was connected to a cell phone-sized stimulation device delivering electric pulses of varying amplitude and frequency. The system was programmed so that the level of stimulation automatically adjusted depending on the amount of pressure exerted on the leg, based on transmissions from sensors embedded into a shoe insole under the prosthetic foot. Study participant Lauren Gavron works with Bailey Petersen, DPT, at the Rehab The researchers found the system to be an accurate “mimic” Neural Engineering Labs at the University of Pittsburgh. of the sensations associated with walking and standing; participants demonstrated significant improvements in balance and to implant. … We are leveraging those technologies to produce stability using the system, according to the research team. Study meaningful improvement in function and reduction of pain,” said Lee subjects also reported reduced phantom limb pain, amounting to an Fisher, PhD, senior author of the study and an associate professor of average 70% reduction in this type of pain. physical medicine and rehabilitation at Pitt. “We are able to produce “We are using electrodes and stimulation devices that are sensations as long as the spinal cord is intact.” The study was already frequently used in the clinic and that physicians know how published in December in Nature Biomedical Engineering. PHOTO CREDIT: NATE LANGER, UPMC AND PITT HEALTH SCIENCES

MEDICA RE M AT T ERS

FEE SCHEDULE INCREASE FOR 2024 The 2024 Medicare fee schedule for orthotic and prosthetic services increased 2.6% over 2023 rates, effective Jan. 1, 2024. SOURCE: “DMEPOS FEE SCHEDULE: CY 2024 UPDATE,” CMS.GOV.

O&P Almanac January 2024

Study Explores Benefit of AFOs for Children With SCP Many children with spastic cerebral palsy (SCP) wear ankle-foot orthoses (AFOs) to correct gait deviations, but current studies on the outcomes of their use lack details regarding different gait patterns. Researchers from the Children’s Hospital of Eastern Switzerland conducted a study to investigate the effects of AFOs on specific gait patterns among children with SCP. The research team conducted a study of 27 children with SCP, observing participants walking either barefoot or with shoe/AFO combinations. They distinguished and classified several gait patterns: excess ankle plantarflexion in stance; excess knee extension in stance; and excess knee flexion in stance. The researchers identified spatial-temporal variables and

sagittal kinematics and kinetics of the hip, knee, and ankle when participants were barefoot and when they wore their shoes with AFOs. AFO use was found to improve spatial-temporal variables and reduce ankle power generation in pre-swing phase; decrease ankle plantarflexion in pre-swing and initial swing; and decrease ankle power in pre-swing. The researchers concluded that “although improvements in spatial-temporal variables were seen, gait deviations could only partially be corrected.” They recommended that AFO prescriptions and AFO design individually address specific gait deviations. The study was published in October in Prosthetics and Orthotics International.

Happenings

Stretchable E-Skin Could Enhance Sense of Touch

FA S T FAC T

Engineers at University of British Columbia (UBC) are partnering with Honda in developing stretchable e-skin for robotic prostheses. The material would enable prostheses to “sense” their environment in detail. According to Mirza Saquib Sarwar, PhD, a UBC researcher, the material is a smart, stretchable, and highly sensitive type of silicone rubber. The elastomer skin is made of fixed and sliding pillars that facilitate buckling and wrinkling, much like natural skin, as well as four deformable capacitators designed to distinguish between normal and shear forces. The goal is to allow users finer control during interactions with grasped objects, and to enable a wider range of daily activities using robotic prostheses. The research was published in November in The Science Times.

National healthcare expenditures (NHE) grew 4.1%, to $4.5 trillion—or $13,493 per person— in 2022, accounting for 17.3% of gross domestic product.

IN T ERN ATION A L O& P

UK Faces ‘Critical Shortage’ of O&P Clinicians A significant deficit in the number of prosthetists, orthotists, O&P technicians, and O&P support workers in the United Kingdom has been identified in a new study conducted by Staffordshire University. The Center for Biomechanics and Rehabilitation Technologies released “Profile of the UK P&O Workforce and Mapping the Workforce for the 21st Century” in November, commissioned by the British Association of Prosthetists and Orthotists. Researchers found that the current levels of 631 orthotists and 295 prosthetists employed in the UK is approximately 142 to 477 short of the number of clinicians needed to meet O&P standards of care set by the World Health Organization. Additionally, between 1,133 and 1,803 extra technicians and support workers will be required. Both “early year attrition” and a “proportionally high aging workforce approaching retirement” contribute to the current shortage. The report authors noted the “concerning theme” that “20% of prosthetists and orthotists … reported they ‘definitely do not’ or ‘probably do not’ plan to remain in the UK P&O workforce.”

M AT ERI A L SCIENCE

Scientists Study Effects of Prosthesis Use in Space

NHE GREW 4.1%

SOURCE: “NHE FACT SHEET,” CMS.GOV, DEC. 2023.

DI A BE T E S DOW NL OA D

WEIGHT MANAGEMENT IMPROVES OUTCOMES

John McFall

British astronaut John McFall, a former Paralympic athlete with above-knee amputation, hopes to travel to the International Space Station (ISS) in 2025. Ahead of his travels, scientists at the European Space Agency (ESA) will conduct tests on his prosthesis to ensure it does not give off dangerous toxic gases. McFall’s prosthetic system relies on a socket made of carbon fiber and high-density foam, so scientists will determine whether it will emit too many gases in the sealed space station. Air in the ISS is continuously recycled so any significant amount of gases that are produced from a material may be amplified, rather than filtered out. The feasibility study will aid ESA in assessing the impact of having limb loss and wearing a prosthesis while living and working in space. The research team also will test solutions to any problems identified. PHOTO CREDIT: ESA ASTRONAUT ANNOUNCEMENT CLASS OF 2022

“Weight loss within the first two years of treating type 2 diabetes mellitus was associated with diabetes remission. Physicians should pay more attention to weight management in new-onset type 2 diabetes mellitus, particularly for young and obese individuals.” SOURCE: “WEIGHT LOSS WITHIN FIRST 2 YEARS OF TREATING TYPE 2 DIABETES ASSOCIATED WITH REMISSION,” MEDICAL DIALOGUES, NOV. 16, 2023.

January 2024 O&P Almanac

Happenings

HONORS & AWA RDS

Academy Podcast Wins Gold Award The American Academy of Orthotists and Prosthetists (the Academy) has won a Gold Award for its “O&P Rising” podcast in the 2023 MarCom international creative competition for marketing and communication professionals. The MarCom Awards recognize outstanding achievements by creative professionals involved in the concept, direction, design, and production of marketing and communication materials and programs. The “O&P Rising” podcast series, which premiered in January 2023, is a monthly podcast offering candid insights from seasoned O&P professionals on topics relevant to those interested in careers in O&P. A new “O&P Rising” podcast episode is released on the third Wednesday of each month.

BOC Honored With Business Award The Board of Certification/Accreditation (BOC) received a Gold TITAN Business Award for its continued commitment to providing outstanding customer service in the “Achievement in Customer Satisfaction” category. BOC was recognized for implementing the Net Promoter Score (NPS), a nationally recognized barometer ranging from -100 to +100 used for measuring customer loyalty and satisfaction. BOC began tracking its NPS in 2019, and the organization consistently achieves scores well above the industry benchmark provided by Survey Monkey of 45 for its category. BOC has recorded an average NPS of 76 since inception. “At BOC, we believe every aspect of a customer’s experience should be meaningful, efficient, and seamless,” said Judi Knott, MA, MBA, CAE, president and chief executive officer of BOC. “That’s why we hold ourselves accountable to rigorous standards of quality and service.”

O&P By the Numbers Number of Insured Reaches Historic High New census data reveals more people were insured in 2022 than in 2021, with the majority covered by employment-based insurance

Ty p es of C over a ge, 2022

He alth Insur anc e C over a ge, 2022

Individuals may be covered by more than one type of insurance

7.9% Uninsured

Employment-based

92.1% With Health Insurance

Ye ar- O ver-Ye ar Incr e ase

300.9

Million Insured

2021

2022

SOURCE: U.S. CENSUS BUREAU, SEPT. 2023

304.0

O&P Almanac January 2024

54.4%

Medicaid

18.8%

Medicare

18.7%

Direct purchase (private)

9.9%

Marketplace

3.6%

TRICARE

2.4%

Veterans Administration and Related

1.0%

*Due to rounding, numbers may not always add to 100%.

People & Places

AOPA’s 2024 Board Members Embrace Their Mission

OPA leadership has hit the ground running for 2024, leveraging their expertise and energy to advocate for AOPA members and advance AOPA’s vision: a world where orthotic and prosthetic care transforms lives. New and returning board members are excited to launch new programs and projects while advancing key ongoing initiatives. Mitchell Dobson, CPO, FAAOP, began his term as AOPA president Dec. 1 after being elected during the AOPA National Assembly in September. Dobson is supported by Rick Riley, president-elect; Kimberly Hanson, CPRH, vice president; Chris Nolan, treasurer; Teri Kuffel, JD, immediate past president; Eve Lee, MBA, CAE, secretary; and several additional board members. Nolan and Adrienne Hill, MHA, CPO(L), FAAOP, are the new to the board this year. Nolan, who has served on several past boards, has worked in the O&P profession for more than 25 years and currently is vice president of upper-limb prosthetics at Össur for the company’s combined Naked Prosthetics, Touch Solutions, and Livingskin business. Hill, a certified clinician who has a master’s degree in health administration, spent 15 years at Hanger and was area clinic manager in Atlanta before taking on her current role as program director and clinical assistant professor for the O&P master’s program at Kennesaw State University. She also developed a social media initiative called POPPED to promote O&P in layman’s terms to students and consumers nationwide. “The AOPA board members are extremely dedicated, using their expertise and energy to work tirelessly for their fellow AOPA members,” said Eve Lee, MBA, CAE, AOPA executive director. “Along with the staff, they are committed to ensuring that all AOPA members get the support they need to run their business and provide quality patient care. I look forward to working with the board and staff in the coming year to continue to advance the needs of our members.” To kick off the new year, board members are meeting and discussing important O&P topics during the AOPA 2024 O&P Leadership Conference this month. Elected by the membership, the AOPA Board of Directors is representative of the membership and serves as the governing body, responsible for the supervision and direction of its mission. Below is the full list of 2023-2024 AOPA Board of Directors members, who took office Dec. 1, 2023, and will serve through Nov. 30, 2024.

2024 AOPA Officers

Mitchell Dobson, CPO, FAAOP, President

Rick Riley, President-Elect

Kimberly Hanson, CPRH, Vice President

Chris Nolan, Treasurer

Teri Kuffel, JD, Immediate Past President

Eve Lee, MBA, CAE, Secretary (Nonvoting)

2024 AOPA Board Members

Arlene Gillis, MEd, CP, LPO

Adrienne Hill, MHA, CPO(L), FAAOP

John “Mo” Kenney, CPO, LPO, FAAOP

James Kingsley

Lesleigh Sisson, CFo, CFm

Matt Swiggum

Linda Wise

Shane Wurdeman, PhD, CP, FAAOP(D)

Jeffrey M. Brandt, CPO

Elizabeth Ginzel, MHA, CPO

Dave McGill

Special Thanks To Departing Members

January 2024 O&P Almanac

People & Places

PEOPL E IN T HE NE WS

BUSINE SSE S IN T HE NE WS

The Board of Certification/Accreditation (BOC) has announced its 2024 executive committee and the election of two new board members. The executive committee is comprised of officers of the board. Officers elected for 2024 include Chairman Cameron Stewart, BOCO, BOCP; Vice Chair Abel Guevara III, DHA, MHIM, FACHDM, Cameron Stewart, RHIA, mMBA, CPhT-Adv, CDME; SecreBOCO, BOCP tary Angela Presley, PhD, BOCPD, COF; Treasurer Daniel Griffis III, PharmD; Member-at-Large L. Bradley “Brad” Watson, BOCO, BOCP, LPO; and Immediate Past Chair Wayne Rosen, BOCP, BOCO, LPO, CDME, FAAOP. “I am honored to be elected as chairman for the BOC Board of Directors,” said Stewart. “As chairman, my goal will be to help the industry advance in this technological age of healthcare, and I look forward to collaborating with this esteemed group of professionals to further BOC’s mission.”

Hanger Inc. has entered into an agreement to acquire Fillauer. “We at Hanger have a long history of finding new ways to return personal independence to those with physical challenges by providing superior patient access, services, and clinical outcomes,” said Hanger CEO Pete Stoy. “The next step in expanding our industry-leading research is leveraging that work, along with our robust nationwide outcomes data, during the development of O&P products. Bringing a manufacturing partner into the Hanger family will give us a better perspective earlier in the research and development phase, positioning us to drive innovation and proactively enhance patient outcomes.” “As two long-standing O&P companies, we’ve really enjoyed our relationship with Hanger through the years,” Fillauer CEO Michael Fillauer said. “Hanger has been a great ally, a great partner, and a great friend to our organization. Our cultures and values are aligned, and together, we have the opportunity to enhance the impact we have on those we serve.” The transaction is expected to close in Q1 of 2024.

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O&P Almanac January 2024

Reimbursement Page

Take advantage of the opportunity to earn .75 CE credits. Quiz me! Scan the QR code or visit bit.ly/aopaversityquiz.

BY DEVON BERNARD

CE credits accepted by certifying boards:

New Year, New Rules Updates on the fee schedule, HCPCS codes, and more

Coding

Compens

ation

2024

Coverage

appy New Year! The first Reimbursement Page of 2024 examines some of the three Cs discussed in the November/ December 2023 O&P Almanac—coding, coverage, and compensation—and how they are changing this year.

Fee Schedule Increase

This year, you’ll see an increase in the fee schedule for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)—however, the increase will not be as high as it has been the past two years. The annual Medicare fee schedule increase for DMEPOS services and items is based on a combination of two factors. First is the change in the Consumer Pricing Index for Urban Areas (CPI-U) from June

to June of the previous year (June 2022 to June 2023), or a measure of inflation. Because inflation is lower than it has been the last two years, the 2024 fee increase is lower. The second factor is the annual productivity adjustment, or what is known as total factor productivity (TFP). This is a change in the economy-wide productivity equal to the 10-year moving average of changes in annual economy-wide private nonfarm business multifactor productivity, as calculated by the Bureau of Labor and Statistics. The TFP is then subtracted from the CPI-U, and this provides you with the final annual fee increase/decrease. The CPI-U from June 2022 to June 2023 was 3%. The official TFP was 0.44%. This means the 2024 DMEPOS fee schedule reflects an increase of 2.6%.

New & Updated HCPCS Codes

We’re seeing several changes to the 2024 Healthcare Common Procedure Coding System (HCPCS) codes, with the potential for more on the way. In 2020, CMS made a change in how it processes applications and requests for new and revised HCPCS codes for orthotics and prosthetics. CMS implemented shorter and more frequent coding cycles. Previously, all code applications had to be submitted by the end of the calendar year, and then the applications would be reviewed the following mid-year, and any new codes or revisions would be implemented at the start of a new calendar year. This meant that if a code application was submitted in 2023, the review would take place in 2024 and a new code would be implemented in 2025. January 2024 O&P Almanac

Reimbursement Page

•

In addition, during the First Biannual 2023 review, the HCPCS Panel/Workgroup began the process of cross-walking existing temporary K-coded items to permanent L codes for supplies, products, and items that may have received a temporary K code between Jan. 1, 2020, and the end of 2022. As a result, three current K-coded orthotic and prosthetic items will receive new permanent L codes, with an effective date of service on or after Jan. 1, 2024. In July 2021, the HCPCS Panel/Workgroup created code K1022 (addition to lower-extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type), and it has now been cross-walked to the L5926. In June 2022, the workgroup created code K1014 (addition, endoskeletal knee-shin 12

O&P Almanac January 2024

L1681

L3161

L5615

991

•

system, 4-bar linkage or multiaxial, fluid swing and stance phase control), and it has now been cross-walked to the L5615. The HCPCS Panel/Workgroup also created code K1015 (foot, abductus positioning device, adjustable), and it has now been cross-walked to the L3161.

Under the updated process, code applications may now be submitted on a biannual basis for orthotics and prosthetics, and CMS publishes final coding decisions more frequently. Code applications either are submitted by the first business day in January with a review in May/June, and a new or revised code possibly becoming active in October; or applications are submitted by the first business day in July with a meeting and review in November/December and the approved codes becoming effective in April of the next year. For example, in 2023 we saw the introduction of two new codes in May and June, with an effective date of Oct. 1, 2023, instead of Jan. 1, 2024, and they were a result of the First Biannual 2023 HCPCS Panel/Workgroup review cycle that was held in May and June 2023. These two new codes have been effective since October: L5991—Addition to lower-extremity prostheses, osseointegrated external prosthetic connector L1681—Hip orthosis, bilateral hip joints and thigh cuffs, adjustable flexion, extension, abduction control of hip joint, postoperative hip abduction type, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.

L5926

The Second Biannual 2023 Review Cycle took place in late November 2023, and the preliminary results indicate the possibility of two new O&P codes being introduced with an implementation date of April 1, 2024. However, at the time this article was written, the final determinations were not released, so stay tuned. In some instances, new codes also may be created and introduced outside of the HCPCS Panel/Workgroup, and this occurred in 2023. Medicare, as the result of the new benefit category and coverage rules for lymphedema compression garments, had to create a whole new set of HCPCS codes and revise some current codes for 2024. The new codes, and some revisions, are discussed in the next section. However, to distinguish between compression garments used for lymphedema and those used for surgical dressings, Medicare made changes to three existing HCPCS codes—A6531, A6532, and A6545—for dates of service on or after Jan. 1, 2024. Prior to the new coverage rules for compression garments for lymphedema, these were the only codes Medicare would cover, as part of the surgical dressing benefit category, but only if they were used in conjunction with a surgical dressing and for the treatment of an open venous stasis ulcer.

To keep these codes available for the surgical dressing benefit, Medicare added the phrase “used as a surgical dressing” to the official HCPCS code descriptor. For example, A6531 now reads: Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each. As a policy reminder, when billing for A6531, A6532, and A6545, if all of the coverage criteria have been met, include the AW modifier on your claim.

Compression Garments for Lymphedema Coverage

In late Dec. 2022, Congress passed the Consolidated Appropriations Act (CAA), and a section of the CAA amended the Social Security Act to provide Medicare coverage for certain lymphedema compression treatment items (the creation of a new benefit category). As a result of this amendment and subsequent rulemaking (the final rule for the 2024 Home Health Prospective Payment System), CMS had to create new coverage rules and new codes—66 new HCPCS codes in the range of A6520 to A6610—to complement the existing compression garment codes. These new coverage rules for existing and new codes became effective Jan. 1, 2024. CMS and the durable medical equipment Medicare administrative contractors (DME MACs) did not create a new Local Coverage Determination or Policy Article because the regulations provided substantial guidance for what compression garments are covered for lymphedema treatment and when. Here are some highlights of the new coverage rules: Covers both prefabricated/standard and custom-fabricated daytime gradient compression garments and/or wraps with adjustable straps. Those with higher levels of compression, ranging from 18 mmgh to more than 40 mmgh. Patient may receive three daytime garments per affected body part every six months. Covers both prefabricated/standard and custom-fabricated nighttime gradient compression garments. Those that offer milder compression and are less snug against the skin. Patient may receive

•

Reimbursement Page

• •

two nighttime garments per affected body part every two years. Covers compression bandaging systems and supplies. Covers accessories, such as zippers, linings, paddings, or fillers, necessary for the effective use of a gradient compression garment/wrap.

So, if the patient has a diagnosis of lymphedema and a physician or other qualified practitioner orders them, you could bill for custom or standard lymphedema compression garments/wraps for more than one body part or area per patient, and you could bill for both a daytime and nighttime garment/wrap for the same body part or area per patient. Finally, here are how the new codes are grouped and classified: A6520–A6529: Compression garments for nighttime use A6552–A6564 and A6610: Compression stockings A6565 and A6582: Compression gauntlets A6566–A6569: Compression garments for head, neck, torso, and shoulder A6570 and A6571: Compression garments for the genital region A6572 and A6573: Compression garments, toe caps A6574–A6578: Compression arm sleeves A6579–A6581: Compression gloves A6583–A6589: Compression wraps with adjustable straps A6593: Accessory, not otherwise specified A6594–A6609: Compression bandages and bandaging supplies.

• • • • • • • • • • •

These are only the new codes and do not include any existing compression garment codes, which are still valid and may be covered as well. All of the new codes have been assigned fees for 2024, except for codes A6559–A6561 (custom gradient compression stockings, full length/chap styles). These codes will be temporarily paid on an individual consideration basis. If you plan to add lymphedema care and compression garments to your list of available Medicare services, first make

sure you are not required to have any new licenses under your state. In addition, make sure that you don’t require any new accreditation. Continue to follow the Medicare Supplier Standards and the DMEPOS Quality Standards. Be aware that the provision of compression items to treat lymphedema includes all aspects of providing the items and care, including the following: Taking all appropriate measurements of the patient’s affected body area(s) Providing all fitting services Training the patient on how to don and doff the garments/wraps Training the patient on proper care of the wraps/garments Providing any needed adjustments.

• • • • •

These services could not be billed separately.

A6574

A6572

A6565

A6570

A65

20 A6566

More To Remember for 2024

As of Dec. 31, 2023, Round 2021 of the Competitive Bidding Program officially ended. Any DMEPOS supplier may now furnish and deliver any of the 23 off-theshelf spinal and knee orthoses that were subject to Round 2021, and no contracts are required. The fees for these 23 items will reflect the fees established during the competitive bidding period. At this time, there have not been any announcements regarding a new round of competitive bidding including off-the-shelf orthoses, and any new rounds will most likely not occur until 2025 or later as it takes up to 18 months to implement a new round once it is announced. The DME MACs have informed AOPA that they continue to see O&P suppliers

misapplying the ST modifier. The ST modifier is only to be used with the orthotic HCPCS codes subject to prior authorization, L0648, L0650, L1832, L1833, and L1851, and only when there is an emergent need—in other words, only when there is an established and documented need for the brace and any delay would cause direct harm to the patient. This means that the patient could not wait between 2 and 5 days for the expediated or standard prior authorization process to be completed. So, if you use the ST modifier, document the harm that could befall the patient if the brace was not immediately delivered, and don’t simply use the ST modifier to bypass the prior authorization process. In 2021, the DME MACs and the pricing, data, analysis, and coding contractor released a joint correct coding reminder on how to classify or handle orthoses whose descriptor only states “includes fitting and adjustment” but doesn’t indicate if it is custom fitted or off the shelf. An example of this would be the ankle-foot orthosis L1951. The reminder indicates that these orthoses are to be considered custom-fitted orthoses, so you must document any adjustments made at the time of fitting/ delivery. If no adjustments are required, then you should look to use an off-the-shelf equivalent HCPCS code. If there is not an off-the-shelf equivalent HCPCS code available, then you must use the appropriate miscellaneous code. This coding reminder has been reinforced by recent updates on Dec. 7, 2023, to the Policy Article sections of the AFO/KAFO, KO, and LSO/TLSO Medicare medical policies. In addition, the policies state that these changes are retroactive to 2021 when the correct coding reminder was released. Happy New Year—and be sure to update your systems, policies, and procedures to capture the new fees, codes, new benefit category, and policy reminders. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org.

January 2024 O&P Almanac

Cover Story COVER STORY

O&P Almanac January 2024

BY CHRISTINE UMBRELL

Cover Story

THE FUTUREFOCUSED LEADER

Six behaviors that define long-term success

re the leaders successfully steering your business in the right direction? Ensuring the leadership skills of your high-level employees match the current and future needs of your company can be challenging, but understanding and embracing management skills that will inspire productivity and innovation will help drive employee buy-in and long-term success, according to experts. “Successful companies engage employees and focus on their empowerment, health, and welfare,” says Kelsey Troy, senior vice president and chief

human resources officer for Hanger. “The adage that employees don’t leave jobs, they leave bosses, can be true, so having leaders who inspire and support their employees is critical.” Just what defines great healthcare leaders? These six key actions, say experts: embracing change; educating teams; practicing humility and compassion; building a strong organizational culture; preventing employee burnout; and mentoring young professionals. A deeper dive into how—and why—these behaviors are effective offers insight for adopting them at O&P organizations.

NEED TO KNOW:

f Successful O&P executives and

managers embrace an adaptable and innovative mentality to anticipate industry trends and identify growth opportunities.

f Leaders can enhance their

teams and inspire loyalty by integrating employee education and development into their business plans.

f Effective managers do more

listening than talking, and consider input from those around them— including data from employee surveys—when making decisions and implementing changes.

Creating a positive work environment requires prioritizing company culture, treating employees with respect, and implementing programs to prevent employee burnout.

f Mentorship is another important

aspect of productive management— particularly at healthcare companies where mentors help train the next generation.

f Leaders at new O&P companies

and startups face particularly difficult challenges in launching new products or services; these leaders benefit from tenacity, patience, a strategic mindset, and some level of caution in spending.

January 2024 O&P Almanac

Cover Story

Embrace Change

Improvement in any industry requires change. The best leaders are willing to think outside the box and challenge the status quo, rather than rely on what’s worked in the past. “Most successful executives and leaders in O&P companies possess a combination of particular skills, qualities, and attributes that contribute to their effectiveness in navigating the complex and dynamic healthcare industry,” explains Matt Swiggum, chief executive officer at Proteor USA and AOPA board member. In addition to demonstrating industry knowledge, business acumen, and communication skills, he asserts O&P leaders must have an adaptable and innovative mentality. “This includes anticipating industry trends, identifying growth opportunities, and developing strategies to position their company for long-term success. Matt Swiggum “The healthcare industry, including O&P, is subject to frequent changes,” Swiggum says. We have to be adaptable and responsive to changes in regulations, reimbursement, technology, and market dynamics.” A change mindset will be particularly important as the O&P landscape evolves with the maturation of innovations such as digital technologies, including 3D printing. Swiggum suggests leveraging new tools “to support a clinic’s ability to see more patients while managing a limited and transitioning talent pool. … It’s incumbent upon us to facilitate positive patient outcomes.”

Educate Your Team

The most successful leaders integrate employee education into their business plans—to pass on knowledge, to raise awareness of important issues, and to provide opportunities for employees to upskill. At Proteor, continuing education is crucial to employee development. The company recently launched an online learning platform to empower managers to further their skills at their own pace, says Swiggum. The platform features an extensive list of educational opportunities—from situational leadership, to time management, strategic thinking, communication skills training, and more—equipping managers with “the confidence and ability to inspire and motivate their teams and those around them,” Swiggum says. Hanger offers several options for employee training, “whether you are currently a manager or team leader, or aspire to be one,” says Troy. Some options include online training through a learnKelsey Troy ing management platform on topics such as strategic thinking, emotional intelligence, successful coaching, conflict resolution, and change management. In addition, the company recently developed two new programs. The “Leading Self” program was piloted in early 2023 and formally kicked off 16

O&P Almanac January 2024

in July, covering topics including leadership styles, time management, and active listening. “Our ‘Leading Others’ program will kick off in early 2024, after being piloted” in 2023, says Troy. Hanger also provides in-person training at its annual Hanger LIVE conference and at local and regional events. “Encouraging our staff to learn and grow also helps our whole profession expand and innovate, as they use their skills to help advance the field of O&P,” says Troy.

Stay Humble and Compassionate

Leaders who consider input from those around them and recognize others’ viewpoints gain the trust of their team and foster an environment in which staff feel comfortable suggesting new strategies and trying new approaches. “Effective managers do more listening than talking,” says Teri Kuffel, JD, vice president at Arise Orthotics & Prosthetics and immediate past president of AOPA. “They are quick to ask questions instead of pass judgement. They are intuitive and make great efforts to be supportive in challenging situations.” Open communication is a cornerstone of success, agrees Swiggum. “Communicate transparently, listen actively, and ensure that the team understands the company’s goals and values,” he says. By doing so, leaders contribute to the resilience, adaptability, and sustained success of an O&P company over the long term, Teri Kuffel, JD he says. “The combination of strategic foresight, effective team management, and a commitment to excellence sets the foundation for enduring success in the dynamic healthcare landscape.” “It is truly important that we focus on creating a healthy and supportive workplace culture across Hanger, where employees feel inspired to do their best work and are connected to our mission,” says Troy. The company focuses on ensuring “that we are communicating with employees regularly, soliciting honest feedback, and adapting and improving where we can, based on that feedback.” Troy says Hanger leaders often use the employee input and feedback from annual surveys and “pulse” checks to effect changes that improve culture. “We’re using data to drive decision making to best support team needs.”

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Cover Story

Leading in New Directions Leadership can make or break new companies—particularly those that are introducing new technologies and interrupting business-as-usual within an industry. Jimmy Capra, chief executive officer of Click Medical, learned that it takes tenacity, strategy, and fortitude to “lead the industry in a new direction” when Click launched its RevoFit kits enabling practitioners to build adjustable sockets, then applied for a CMS code to ensure reimbursement for this process. “We started Click Medical with the core goal of driving innovation and product development/consulJimmy Capra tancy into O&P to help businesses,” says Capra, noting that his company stays focused on the core goal of “helping people” while developing products to boost O&P providers’ profits. “What we’ve been trying to lead is innovative thinking within the space, which promotes improved outcomes.” Successfully launching a new O&P technology has required perseverance, according to Capra. “It’s scary being out in front and pushing a product or a new way of doing something,” he says. To successfully introduce new products that will ultimately improve function for O&P patients, Capra believes company leaders should demonstrate tenacity,

Build a Strong Organizational Culture

Effective leaders allow employees with leadership potential to build their skills within a comfortable and supported environment. Kuffel encourages O&P leaders to create a positive work environment by prioritizing culture, treating employees with respect, and fostering a sense of belonging and inclusion. “Offer an attractive hiring package within your means and include competitive pay and desirable benefits,” she suggests. “Provide opportunities for professional growth and development, in and out of the office/clinic. Encourage and model a healthy work-life balance by being flexible with work schedules and time off.” Troy takes the concept one step further: “To retain employees for the long term, it is also critical that we think about intangibles, including ensuring an inclusive and supportive work environment for all employees. We work to create a culture where employees feel inspired by the mission, know there are opportunities for them to grow and develop, and feel respected and listened to.” Advancement opportunities also may help. “Attracting and retaining employees is crucial for the success of any organization, including O&P companies,” says Swiggum. “Some things are 18

O&P Almanac January 2024

patience, a strategic mindset, and some level of caution in spending. He also suggests working with people who believe in the mission and can think outside the box. Several Click Medical staff members came from outside the O&P profession, “but they are innovative product developers and marketing strategists,” he says. Capra looks for three qualities when hiring staff: passion, strong organizational skills, and a strong sense of mission, in that “they know the work they do is really helping people,” he says. “It matters.” “We run Click like a family,” explains Capra. “I try to hire people who can do the job better than I can.” He recommends “hiring people who are great—and then giving them as much autonomy as you can, and the opportunity to contribute within an empowering framework. “O&P is full of problem-solving people with a passion for helping others and doing great work,” he says. “We can make great things happen. I have optimism that we’ll be able to solve problems together” in the future.

obvious, like compensation and benefits, but providing development opportunities, positive company branding, an inclusive and supportive culture, health and wellness, and flexible arrangements are important as well.” Proteor has lower-than-average turnover, in part, because management relies heavily on the human resources department “to create and provide a supporting cast of employee engagement opportunities,” says Swiggum. “By providing clear attraction and retention strategies, leaders in our O&P community can create an environment that not only draws top talent but also keeps them engaged and committed to the organization’s mission and success.” Hanger’s managers seek to personalize growth opportunities, says Troy, with leaders “connecting one-on-one with team members to understand development needs, professional goals, and motivations,” she says. “It is important to create the right environment for employees to be able to do their best work. …That means looking for opportunities to implement systems that promote efficiencies that allow our clinicians and patient-facing team members to do the work that they love—caring for people—and reduce some of the administrative burdens that can take up so much time.”

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Prevent Employee Burnout

Company leaders can play a key role in preventing employees from feeling burned out or compelled to leave their jobs. Last year, a survey conducted by Gerald Stark, PhD, MSEM, CPO, LPO, found that almost one-third (29%) of O&P professionals are at “severe risk or higher of burnout,” and 8% are at “levels of burnout that are affecting mental and physical health.” “Preventing and addressing employee burnout is critical, especially in high-stress environments like healthcare, including O&P settings,” says Swiggum. “I don’t recall in my career where burnout has risen to the stage it has recently.” Managers who are sensitive to employees showing any signs of distress or emotional exhaustion have an opportunity to address problems before they progress. “By combining prevention and support strategies, leaders can create a workplace culture that prioritizes employee well-being and actively addresses burnout,” adds Swiggum, noting that regular communication, flexibility, and a supportive environment are essential for preventing and mitigating burnout. “We continue to talk to employees as a check-in point while listening to the needs of each of them,” says Swiggum. “We take pride in a mission-driven, family atmosphere that strives to recognize and appreciate our team members. … We do our best to maintain a level of flexibility” in employee responsibilities, and take into account individual considerations. According to Troy, “one of the most important things leaders can do to prevent burnout is maintain that one-on-one connection between employees and their management and leadership teams, ensuring their individual needs are understood and that they continue to feel acknowledged and valued for what they contribute daily to the success of the whole team.” Volunteerism is another useful tactic. “Feeling the power of positive impact can help temper the challenges of the day-to-day administrative and clinical care, and ultimately burnout as well,” Kuffel says. At Arise O&P, “we have found that serving others, volunteering outside the exam room, and helping our O&P patients in nontraditional ways can bring feelings of peace, joy, and perspective,” she says. Opportunities that are popular at Arise include serving on committees for O&P organizations, volunteering at amputee mobility clinics, or contributing “time, talents, or treasures” at nonprofit charity events.

Be a Mentor

Mentorship is particularly important in healthcare because mentors help train the next generation of leaders. Providing guidance, feedback, and support to mentees, and serving as a role model, advisor, and ally are critical responsibilities. Mentoring can involve formal arrangements with structured meetings and feedback processes—or it can be more informal, given the size and needs of your company. At Hanger Clinic, “we pride ourselves on ensuring our employees have access to a large network of peers and leaders within the company who can provide on-the-job mentorship and help share their experience and expertise,” says Troy. 20

O&P Almanac January 2024

At Arise O&P, Kuffel, recommends mentorship through day-today interactions: “Keep open lines of communication a top priority, provide constructive feedback regularly, and be quick to commend when appropriate,” she says. Leaders should keep mentoring top-of-mind as they navigate their many responsibilities, adds Swiggum. “I strive to play an influential role in providing direction, fostering a positive and productive environment, and driving the collective efforts of the teams and organization toward achieving shared goals.”

Try These Other Suggestions In addition to the six actions suggested, O&P leaders should display additional qualities, according to industry leaders. Of course, “wisdom and the know-how to get the job done and get paid” are paramount, says Kuffel. O&P professionals should demonstrate “perseverance” through the reimbursement process, “with all its incessant demands,” says Kuffel. “And, a good sense of humor,” Kuffel adds, “to keep employees balanced and the business on track through it all.” Creating a solid financial team to support profitable, sustainable growth toward the company’s mission is critical, says Swiggum: “No money, no mission, as they say.” “The combination of strategic foresight, effective team management, and a commitment to excellence,” says Swiggum, “sets the foundation for enduring success in the dynamic healthcare landscape.” Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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Feature

BY MICHAEL COLEMAN

INTEGRITY MATTERS

What constitutes ethical O&P business practices in 2024?

NEED TO KNOW:

f Many O&P practices lack written ethics policies that practitioners can turn to when in doubt, and ethical considerations are evolving as new technologies disrupt the profession.

f Industry stakeholders should continue to engage in

discussion of what is ethically appropriate when it comes to billing, patient care, privacy, technologies, and more.

f Baylor College of Medicine is currently developing

a curriculum in ethics for O&P students, which may eventually be shared with other O&P master’s programs.

f Examining compliance rules and ensuring that

employees understand company expectations can assist in facilitating more ethical O&P workplaces.

O&P Almanac January 2024

he basic definition of ethical behavior is doing the right thing instead of the wrong thing. Most O&P professionals certainly strive to adhere to this simple concept in their work, but it’s not always easy. Formal ethical training specific to O&P’s unique mission and business model has been sparse until very recently, and many O&P practices lack written ethics policies that practitioners can turn to when in doubt. Making matters more complicated, ethical expectations and considerations in O&P have continually changed over the history of the profession, and with the adoption of artificial intelligence and other new technology—not to mention shifting cultural norms—they will continue to do so. “What might have been considered appropriate or ethical behavior in the past may not be now,” says Mitchell Dobson, CPO, president of AOPA and Hanger’s senior vice president and chief compliance officer. “Ethics can, and do, Mitchell Dobson, CPO evolve over time.”

Feature

That’s why it’s important for the industry to engage in an ongoing conversation about what is ethically appropriate when it comes to billing, patient care, privacy, deployment of new technology, and other fundamental components of the profession

Identifying Ethical Dilemmas

“Dialogue about ethical behavior is important in several ways,” Dobson says. “It keeps ethics as a top-of-mind topic, and it allows reasonable peer conversations and the proverbial gut-check on specifics. When we don’t converse about ethics, we are prone to rationalize out-of-bounds behavior as acceptable.” It’s also important not to shy away from talking about thorny ethical questions with colleagues—and not to judge those who initiate such candid discussions. “Having peers we can trust to include in honest discussions about things that might be unethical helps us stay grounded in reality and lessens the chance of improper rationalization,” Dobson adds. “And it helps us to understand the underlying principles that guide our ethical behavior.” While ethical questions are a constant factor in the management of any business, O&P professionals face challenges that are unique even to the healthcare industry at-large. Here are just a few examples: Decisions about coding and billing for devices. Clinicians should resist the temptation to submit claims that inflate reimbursement or bypass medical necessity reviews and/or authorization processes required by payors. Incorrect coding can lead to poor patient care and trouble with reimbursements, and O&P practices and providers with a history of coding mistakes may face fines or federal penalties for fraud or abuse. Predelivery of an O&P product in advance of preauthorization from a payor. For example, a clinician might rationalize that a patient would benefit from a certain device before the insurance company or payor approves it, so they send the device home with the patient for a trial period. But instead of a one- or two-day trial to experiment with specific tasks/functions and test their navigation of environmental obstacles to determine if the device is working well for the patient, the practitioner simply sends the patient out on a device that is basically done. After the insurance approval is received, the clinic asks the patient to come back in to sign the proof of delivery. “While this might be ‘compliant’ because the date of service matches the date on the proof of delivery, it is arguably unethical, because of the misrepresentation of the date the patient took practical possession,” Dobson explains. “The rationalization is that the patient benefits while the big, bad insurance company is taking [a long time] to approve the device. But this creates an ethical quandary of misaligned delivery dates, the inconsistency of the clinical record, and the patient belief of when they got the device.” Contracting with a payor to pay—as an example—75% of a submitted charge for a NOS/NOC/99 code. Some clinicians might rationalize that because the payor makes recouping cost

•

so difficult, it is appropriate to inflate the price of the device so that when it is subsequently discounted, it is where the provider wanted it to be. The clinician may, in fact, be able to justify the increased cost of the device, but there is now a potential inconsistency from one case to another. If you have contracted at 75% of the submission, the ethical position would be to bill what you normally would and take the amount for which you agreed, Dobson says. The use of artificial intelligence (AI). AI can be immensely helpful in generating clinical summaries and other documents, but the technology is imperfect—mistakes can and will occur. AI platforms like ChatGPT and Google Bard are trained to predict strings of words that best match a query, but they sometimes “hallucinate” and might generate nonsense or data that is not contained in the relevant O&P documentation. A clinician could then unwittingly attest to something that is not factually accurate or that they did not know, examine, or discover. “For instance, if a comorbidity is commonly associated with a diagnosis, AI could errantly insert that the patient has that comorbidity when they actually don’t,” Dobson explains. “Or if AI pulls data from another healthcare provider record, but it is posited as known by the clinician, that could also create problems. The ethical position would compel the clinician to adequately disclose where the information came from or that two things are commonly associated, although not necessarily validated in that case.” Cultural and other biases. Practitioners should be aware of ethical concerns pertaining to racial, socioeconomic, cultural, or other biases, suggests Fanny Schultea, MS, MSEd, CPO, LP, FAAOP, an assistant professor at Baylor College of Medicine in Houston. Clinicians can subtly—or not so Fanny Schultea, MS, subtly—convey these biases in their clinical MSEd, CPO, LP, FAAOP notes, which can have adverse long-term effects on patient care.

Learning Curves

Part of the struggle for many O&P clinicians in navigating tricky ethical situations is that the profession lacks formal training in situational ethics. “Most clinical practices—even the larger ones—don’t really have ethics programs, and they certainly don’t have training and education to have the confidence to navigate those situations when you happen to come across them,” says Schultea, who is developing a comprehensive academic curriculum in ethics for O&P students at Baylor College of Medicine and taught the program’s first course in 2022. The program also hosts residencies across the country. Schultea and her colleagues plan to eventually share their still-developing curriculum with other O&P programs across the country. The goal is to establish a framework for standardized teaching about O&P ethics and compliance nationally. “It’s impossible to talk about one without the other,” Schultea says. January 2024 O&P Almanac

Feature While ethics codes may be hard to find at the clinical level in O&P, the American Board for Certification in Orthotics, Prosthetics, & Pedorthics does have a Code of Professional Responsibility & Rules and Procedures that outlines expected ethical behavior for the certified clinicians. ABC’s Professional Ethics Committee regularly reviews complaints, which can result in suspensions, revocations, or probations. The committee also delivers cease-and-desist orders to individuals or facilities that it learns are improperly representing ABC certification or accreditation titles. In 2023, ABC issued 57 cease-and-desist orders, received 15 complaints of improper conduct, and issued eight probations, suspensions, and revocations. The Board of Certification/Accreditation (BOC) also provides general ethical guidelines and features a complaint form on its website for individuals, groups, or organizations who want to submit an ethics complaint against a BOC certificant. Only 15 states currently require O&P practitioners to obtain a license that ensures they meet specific education, experience, and competency standards. “It’s very disjointed, and there is no [national] standard that says every O&P student must learn this—that doesn’t exist,” says Schultea. At the clinical level, Shultea suggests answers to hard questions of what is right or wrong in delivering a device, billing, or providing O&P care can be found in compliance rules. “With compliance, there’s really no gray area, whereas ethics is all gray,” she says. She explains that the O&P payment system, which is based on the delivery of appropriate prostheses and orthoses, is at odds with the clinician’s commitment to caring for patients and the amount of time that requires. “Clinicians feel they’re incentivized to spend less, to streamline their processes to make things faster and simpler, to see more patients, and to save their company money,” she says. “But perhaps approaches and choices that may be in the best interest of the patient are at odds with the business model. “We provide a service that takes time, just like any other healthcare provider, but we’re not reimbursed for the way that we provide care,” Schultea continues. “We get paid more from a compliance parameter, whereas the way we care for patients has more ethical parameters. It’s really hard for O&P providers to walk that tightrope.” She advises any O&P business that doesn’t have a compliance officer to strongly consider hiring one.

Ethical Employees

Increasingly, ethical lapses in O&P—and indeed all professions—are rooted in employee dissatisfaction. Gerald Stark, PhD, MSEM, CPO, LPO, FAAOP, is Ottobock’s director of clinical affairs for patient care, and he also researches behavioral traits and attitudes in the O&P profession using polling and data. Stark distributed a survey to O&P professionals in 2023 seeking their feedback on whether the industry has enough practitioners to meet demand. The short answer 24

O&P Almanac January 2024

was “no,” which is not exactly a secret in the industry, but Stark found more trouble in the comments on the survey findings. Many commenters sounded off about their job stress and burnout, so Stark sought more feedback by asking additional questions. His findings portend a potentially Gerald Stark, PhD, troubling trend for ethics in the profession. “We’re all, on average, at risk for burnout, MSEM, CPO, LPO, FAAOP and one in 10 of us is really burned out,” Stark says. “And one in three of us is beginning to notice that we’re changing our habits.” Today, changing habits might mean “quiet quitting”—a term that entered the American lexicon during the COVID-19 pandemic. Quiet quitting refers to employees who stopped working hard at their jobs because they are burned out and/ or resentful of management or responsibilities they consider unfair or unsatisfactory. These employees typically fulfill their job requirements but stop taking initiative or volunteering for extra projects or responsibilities. Stark’s recent research revealed that O&P professionals aren’t immune to this trend in the labor force. O&P employees with 16 to 20 years’ experience are quiet quitting with the most frequency, and those with 11 to 15 years’ experience are experiencing the most job burnout, according to Stark. These counterproductive mindsets can lead to ethical lapses, perhaps manifested in improper billing or coding or other behaviors that pump up revenue for the clinic or otherwise help the clinician meet their own needs—or what they view as unreasonable expectations of their employers. “Cheating happens when you start to split hairs and make these illogical choices that are not ideal,” Stark explains. “We feel so out of control that we can’t figure out another way to do it—and it’s a slippery slope. We call it ‘shadow diffusion’ because they’re willing to kind of skirt the edges to get what they need for themselves.” Given the growing numbers of O&P professionals experiencing burnout or engaging in quiet quitting behavior, managers and leaders should be on the lookout for these behaviors and ensure that employees understand ethical and compliant expectations in the O&P workplace. While ethical considerations should always be at the center of decisions about O&P patient care and business operations, Schultea urges O&P professionals to remember that they’re human. “We’re healthcare providers and clinicians, but at the same time, we’re considered suppliers, and that inherently is a conflict,” Schultea says. “But when people appreciate how hard the environment is that they’re working in, the more they can forgive themselves a little bit. And hopefully we can provide some tools to solve these problems.” Michael Coleman is a contributing writer to O&P Almanac.

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Fresh Faces

Spreading the Joy of O&P New AOPA Board Member Adrienne Hill, MHA, CPO(L), FAAOP, leverages community outreach and social media to share the O&P message

Adrienne Hill, MHA, CPO(L), FAAOP, at the O&P fabrication lab at Kennesaw State University

New this year, O&P Almanac features the Fresh Faces column, where we will introduce readers to innovative O&P professionals who are making a difference in the profession. This month, we speak with Adrienne Hill, MHA, CPO(L), FAAOP, program director at Kennesaw State University’s O&P master’s program and AOPA Board of Directors member.

Hill, who embraces community outreach efforts to raise awareness of the O&P profession, spent 15 years with Hanger Clinic before taking on a new role in academia at Kennesaw State University in 2022.

O&P Almanac January 2024

drienne Hill, MHA, CPO(L), FAAOP, has made quite an impact on the O&P profession during her 16-year career. An experienced clinician who worked for 15 years in Atlanta for Hanger Clinic—most recently as an area clinic manager—Hill started her current position as program director and clinical assistant professor for the Master’s of Science Program in Prosthetics and Orthotics at Kennesaw State University (KSU)—Wellstar College of Health and Human Services in 2022. During the pandemic, she began posting short informational videos about all aspects of an O&P clinician’s job. In those videos, Hill uses layman’s terms to explain different devices, fabrication processes, and equipment. They went viral.

Hill’s dedication to educating students and consumers about O&P stems from her deep love of the profession, which began during her childhood as she accompanied relatives to prosthetists’ visits. She graduated from Spelman College, earned a Prosthetics and Orthotics Specialty Certificate from the Newington Certificate Program, and became ABC certified in 2007. She later earned a master’s degree in health administration (MHA) from George Washington University. In addition to volunteering as a POP Ambassador for the American Board of Certification in Orthotics, Prosthetics, and Pedorthics (ABC), Hill recently joined the AOPA Board of Directors.

PHOTO CREDITS: ADRIENNE HILL, MHA, CPO(L), FAAOP

Fresh Faces

Hill works with O&P master’s students at Kennesaw State University, where she is program director and clinical assistant professor.

O&P Almanac: What brought

you to a career in O&P?

Adrienne Hill, MHA, CPO(L), FAAOP: I’ve known what I wanted to do from the time I was 10 or 11. My O&P journey started with my great-grandfather, who was a bilateral above-knee amputee, and my dad, who lost his right leg below the knee and has foot drop on his left leg, so he is both an orthotic and prosthetic wearer. The prosthetist who treated my great-grandfather and dad, who worked at NovaCare, was my first exposure to the field. He would let me go in the back [to the fabrication area] so I could “help fix my dad’s leg.” Visiting that prosthetist led to the solidification of, “Yes, I want to change people’s lives.” The energy it provides us as O&P professionals in giving joy to people, when they can do things they couldn’t do—there’s nothing like it. O&P Almanac: After becoming a certified clinician and working at Hanger Clinic, what led you to pursue an MHA and eventually go into academia? Hill: I was with Hanger Clinic for 15 years, starting as a resident. After my first six or seven years as a clinician, I started seeing PHOTO CREDITS: ADRIENNE HILL, MHA, CPO(L), FAAOP

the dynamics of healthcare changing, with more restrictions from insurance companies, more denials, and huge deductibles. At the time, my concern was urban and under-represented people—people without insurance or on Medicaid, or on managed care that only covered 50%. I was doing community outreach toward these populations and was concerned about growing costs. I also wanted to encourage people to live more healthfully. I went back to school to get my MHA, with a concentration in hospital contracting and community health, from The George Washington University—Milken Institute School of Public Health, and continued to work at Hanger. For my last several years at Hanger, I was area clinic manager in Atlanta, and I managed three clinics, five hospitals, nine nursing homes, and several outpatient clinics—I had exposure to everything! Even though I loved my position at Hanger, I decided to pursue a new opportunity [when I realized I was spending more time working than I wanted to as a mother of two sons]. Even though I was appreciated and making good money, it was time for change. At that time, the O&P master’s program transferred to KSU, to be housed in the Department of Health & Human Services [rather than engineering]. I spoke as a

guest lecturer, and I loved it! I saw the spark in the students’ faces. Seeing that joy, I found my passion again. So, I took on a full-time clinical professorship at KSU in August 2022. I was there for four months—then I transitioned into the program director role in February 2023 as a strategic opportunity for program growth in clinical experience and research. O&P Almanac: How is O&P education evolving, and what are your goals for the KSU program? Hill: I believe the profession is changing to be more patient-focused and value-based. The KSU master’s program was built on a great foundation, and it’s part of a public university, so we have access to students [and faculty] in other majors and interests—drawing and design, engineering, nursing, kinesiology, nutrition, exercise health, etc. The collaboration of healthcare is key, and we are starting with our master’s students; we are innovating and talking to future nurses, nutritionists, physical therapists; we are working with the engineering, biology, and physics majors and meshing it with health sciences. We’re bringing it all together. January 2024 O&P Almanac

Fresh Faces

O&P Almanac: What types of volunteer roles have you been involved in?

Hill launched the “POPPED” initiative—Promoting Orthotics and Prosthetics Positively Every Day—sharing samples of O&P componentry with students and guiding them in building their own prostheses.

O&P Almanac: How are O&P students and early-career professionals influencing the workplace and the provision of care? Hill: At KSU, students do [500 hours of] clinical rotations starting the first semester, so students know patient care is where our focus lies. We partner with Children’s Healthcare of Atlanta for pediatric rotations; the Veterans Administration in Atlanta for podiatry, vascular, and O&P rotations; and several local clinics. During our “Introduction to CAD/CAM” course, students learn new technologies, including 3D printing, electronic health record systems, and scanning technologies. We also have clinical competency exams, with real patient models. It’s a game changer in terms of preparedness for their career. 28

O&P Almanac January 2024

Hill: Before COVID, and while I was still at Hanger, I did a lot of community outreach, and I focused on helping urban and suburban under-represented communities. I went to schools and talked to students about the O&P profession, and brought prostheses and orthoses to expose them to the O&P field. Then COVID hit, and I couldn’t go into the schools anymore. But a guidance counselor at one of the schools asked me to continue the work [virtually]. I started dropping off boxes of O&P components, then giving presentations over Zoom, some of which were recorded. I could explain the different components—the socket, pylon, etc.—and let kids build their own prostheses. This was my “POPPED” initiative—Promoting Orthotics and Prosthetics Positively Every Day. Others heard about the “POPPED boxes” I was putting together, so I started sending boxes all over the country, followed by Zoom presentations. The boxes had old componentry like cranial remolding orthoses, above-knee prostheses, several below-knee prostheses, sockets, and a full range of feet. I also realized I could start making my own videos to educate people. Often, people don’t see all of the time and effort we put into our work—I wanted to expose more people to every aspect of the field. I started recording short videos and posting them to Facebook, LinkedIn, and Instagram. Some were about diabetic shoes, or AFOs, or how sewing machines contributed to the profession. I used layman’s terms— for example, explaining an “AFO” stands for “ankle-foot-orthosis” and is designed for people who “just can’t pick up their toe,” or “just can’t move their heel.” I filmed myself pulling a check socket, or making a foot orthosis in the lab, or using a Troutman. People would ask questions [via social media]. Through that exposure, I was introduced to Cathy Carter and Steve Fletcher from ABC. They started the “#WhatIsPOP?” program after seeing several clinicians and technicians like myself exposing the

During the pandemic, Hill continued student and community outreach efforts via Zoom.

world to what we do. ABC started recruiting volunteers to help introduce the profession to young people. I was happy to become a POP ambassador. This year, I’ve also become a member on AOPA’s Board of Directors. I love being on the board and working with all of the board members who have the same mission to support the profession. O&P Almanac: What are the biggest challenges and opportunities for the future? Hill: The biggest change is that we have a more educated patient population—they know about things like 3D printing and new technologies. Residents and clinicians need to listen when patients talk about innovations of their own, that they’re bringing in. In this way, some patients alter and direct where our field goes. The collaboration of our clinicians with our patients will pull the O&P field forward. We will need to partner with the patient population to drive the future.

Watch Hill in Action To view a video of Adrienne Hill, MHA, CPO(L), FAAOP, leading a community event in Los Angeles and introducing O&P technologies to students, visit https://youtu.be/ Qb2z5MKqqys?si=LswemzRjLMjEVr_5.

PHOTO CREDITS: ADRIENNE HILL, MHA, CPO(L), FAAOP

Member Spotlight

BY DEBORAH CONN

FACILITY:

OWNERS:

LOCATION:

HISTORY:

Louisville Prosthetics

Robert E. Luckett, CP(E); Bruce Luckett, LP; Wayne Luckett, CP, CPed; and Chris Luckett, CP, CFo

Louisville, Kentucky

71 years

Family Ties

Three brothers lead Kentucky facility with commitment to community

Bruce Luckett, LP, works in the fabrication area.

Wayne Luckett, CP, CPed, works with Dionte Foster, a tennis player and Special Olympics goldmedal winner from St. Kitts.

Why I’m an AOPA Member “AOPA is a great advocate for the O&P community. They provide research and educational opportunities, and they help bridge the gap between manufacturing, clinical care providers, and patients.” —Chris Luckett, CP, CFo

PHOTO CREDITS: LOUISVILLE PROSTHETICS

ames H. (JH) Luckett lost his leg in a train a full range upper- and lower-extremity prostheses, accident several decades ago. Dissatisfied with including knee and elbow disarticulation, swim, sports, the prosthetic care he received in Louisville, and partial hand and foot prostheses. Kentucky, in 1952, he founded Falls City Limb and Chris believes what separates Louisville ProsBrace Co. His company, now doing business as thetics from competitors is a strong commitment to Louisville Prosthetics, has remained in the family for patients, compassion for others, and attention to detail. three generations. JH’s son, Robert E. Luckett, joined “When someone comes in for the first time, or we see the facility in the 1960s and gained his ABC certificathem in the hospital before amputation even takes tion in 1971. Falls City became the primary local place, we make a commitment right then and there prosthetic company for the then-named Veterans that we’re going to do whatever it takes to provide Administration, and Robert became one of the most them with the best possible prosthetic solution to recognizable prosthetists in the state, says his son, achieve and even surpass any goals that they may Chris Luckett, CP, CFo. have,” Chris says. “And we always try to go above In the 1980s, JH’s grandsons, Bruce and Wayne and beyond to make sure that our patients are not Luckett, joined the family business. just satisfied, but thriving and doing “My brothers had helped around as well as they possibly can.” the facility while they were in high The three brothers keep current school,” explains Chris. “Not only with the latest advances in the was JH an amputee, but our other field. They often trial new compograndfather had polio as a child, nents, suspension systems, and so they were attuned to helping materials and have purchased a 3D others. They both attended Northprinter and digital scanner to create western University’s prosthetic test sockets. program and became certified.” One patient success story Chris, younger than his brothinvolves a tennis player from St. ers, later attended Northwestern Kitts, Dionte Foster, who has two and became certified in 2005. The gold medals from the Special Olym(Left to right) Chris Luckett, CP, CFo; three brothers and their father, pics. After he won his second medal Robert Luckett, CP(E); Bruce Luckett, who just retired from patient care, LP; and Wayne Luckett, CP, CPed in 2015, he was diagnosed with co-own the business. stage 4 osteosarcoma and had an In 2006, Falls City Limb and Brace moved to a above-knee amputation. “We got him to Louisville for much larger building and began doing business as his care, and with donated componentry, built him a Louisville Prosthetics. In addition to the Lucketts, prosthesis for free,” says Chris. “We fit him on Tuesemployees include a certified prosthetic assistant, a day, and by Thursday he was back on the courts!” prosthetic technician, and four administrative staffChris acknowledges that growth is the goal for ers. The facility added a satellite office about 9 miles many facilities, but it’s not a focus for Louisville east for the convenience of patients who live farther Prosthetics. “We may add another office for the from downtown Louisville. convenience of patients,” he says, “but otherwise, “Once we moved, we extended our services, and we plan to stay on top of the technology, perfect our we’re now able to see many more patients,” Chris processes, and deliver the best care possible.” says. The majority of patients, he notes, are vascular Deborah Conn is a contributing writer to O&P amputees, although the practice also sees traumatic Almanac. Reach her at deborahconn@verizon.net. amputee patients as well as children. The Lucketts fit January 2024 O&P Almanac

Member Spotlight

BY DEBORAH CONN

COMPANY:

OWNERS:

LOCATION:

HISTORY:

Bionic Power

Privately held

Vancouver, British Columbia, Canada

16 years

Bracing With Biofeedback Gualtiero Guadagni

A child uses the Agilik smart orthosis.

Why I’m an AOPA Member “AOPA provides great opportunities for us to meet orthotists, to expose them to our products, and to get great feedback from them. The recent conference in Indianapolis enabled us to show our devices to the O&P community, and for them to try out our Agilik and test drive it for themselves.” —Rob Nathan, marketing manager

O&P Almanac January 2024

Canadian company offers a smart orthosis with assistive and resistive properties

ionic Power, founded in 2007 to commercialize technology developed at Simon Fraser University in Vancouver, initially focused on military uses. The company had developed a powered orthotic device that improved endurance and reduced fatigue in soldiers by augmenting the natural walking movement. In addition, the exoskeleton used passive movement of the knee to create electrical current, providing a reliable source of electricity in remote locations. “Unfortunately, the original concept didn’t fly because of changes in battery technology,” explains Chief Executive Officer Gualtiero Guadagni, who joined Bionic Power in 2021. Guadagni, with 23 years of experience in medical devices, came on board after the company changed lanes in 2019 and began to use the same technology to develop an orthosis for children with cerebral palsy (CP). Bionic Power began working with Thomas Bulea, PhD, an investigator in the Functional & Applied Biomechanics Section of the Rehabilitation Medicine Department at the National Institutes of Health (NIH) Clinical Center in Bethesda, Maryland. Given that Bulea’s studies focus on the use of wearable smart orthoses for children with CP, spina bifida, and muscular dystrophy, the technology at Bionic Power piqued his interest. Bionic Power entered into a clinical research and development agreement with NIH, which created an algorithm and adapted the technology. “We developed a lightweight motor and generator, the strapping system, lightweight shells, and controlling electronics,” says Guadagni. “We combined these with the gait state machine, or GSM, developed by Dr. Bulea and his team.” The result is the Agilik smart orthosis, a mobility device that offers dynamic knee assistance and resistance when needed during the patient’s gait. The Agilik is appropriate for anyone 5 years or older. It is lightweight, easy to don and doff, and can be customized for each patient and adjusted as they grow or their condition changes, according to Guadagni. When using the Agilik, the user initiates any assistance from the device—a feature that differentiates the device from other powered exoskeletons, says

Guadagni. “The Agilik doesn’t control the gait; it only gives it a boost. This increased activity helps users develop better motor control. “According to research, about half of adolescents with CP who can walk will be unable to do so by early or middle adulthood,” says Guadagni. “We hope to stop or even reverse this deterioration by reducing crouch gait, increasing extension, and strengthening their legs.” For example, someone in crouch gait “is unable to fully extend the knee in stance phase,” he explains. “The device recognizes the different phases and in early stance can support weight loading of the patient by resisting flexion. Then the device’s sensors recognize the change from mid to late stance and can assist that, helping to speed propulsion of the gait, and then help the wearer extend in late swing. Microprocessors use biofeedback on each gait phase, adding assistive or resistive torque as needed.” Bionic Power has 12 employees in Vancouver, as well as several contractors. Guadagni is based in Toronto as the company plans to expand to the east coast. The company is working to obtain a Medicare code for its product while NIH continues clinical trials of the device. In the meantime, Bionic Power has a demonstration unit that physiotherapists and orthotists may use with patients who would like to try the device. The company sells directly to orthotists and central fabricators. Initial marketing efforts have involved attending trade shows and approaching orthotists and physical therapists. “In the future, we hope to establish a partnership with someone that has a sales force in place,” Guadagni says. As technology continues to evolve, Guadagni sees the Agilik as at the forefront of that trend. “There is nothing similar to our device right now—we have the only assistive and resistive orthosis. The possibilities for future development of the device are endless. Because it is so small and light, it can be extended to other joints, so we can think about making an elbow, wrist, or hip orthosis based on the same technology.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTO CREDITS: BIONIC POWER

AOPA News

SEPTEMBER 12-15, 2024 | CHARLOTTE, NC

Save the Date Mark your calendar for the AOPA National Assembly in September The 2024 AOPA National Assembly, with a theme of “Ignite 24,” takes place Sept. 12-15 in Charlotte, North Carolina. Plan now to attend this year’s Assembly.

Visit AOPA’s Co-OP: The Compendium of O&P

n online reimbursement, coding, and policy resource, the Co-OP features a collection of detailed information with links to supporting documentation for the topics most important to AOPA members. A Wikipedia of all things O&P, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of our membership. Visit AOPA’s website to sign in to your account.

Exhibitor registration is open now, and AOPA will release a call for papers soon. Visit the Assembly website at aopanet. org/2024-national-assembly/ for details.

Scan the QR code to download the app.

There’s also an app! Once you’ve signed up, download it to your mobile device. Enter aopanet.atlassian.net as the domain, and enter your email and password from the Co-OP. Questions? Contact Sam Miller, AOPA’s manager of state and federal advocacy, at smiller@aopanet.org.

FUN FAC T Charlotte, named after Queen Charlotte of Mecklenburg-Strelitz, is one of America’s largest banking centers and one of the nation’s fastest growing metropolitan areas.

SIGN UP FOR AN AOPA SMALL BUSINESS MASTERCARD The AOPA Small Business MasterCard launches this month. The card features low interest rates as well as cash back on certain purchases. Visit the AOPA website for details.

Purchase the Updated AOPA Illustrated Guide AOPA

COMPREHENSIVE GUIDE

The 2023 Illustrated Guide is now available! Purchase this easy-to-use digital guide, featuring the Healthcare Common Procedure Coding System codes for orthotics, prosthetics, and shoes. The 2023 Illustrated Guide is a digital product; you will receive a PDF file to view digitally or print on your own. Prices are for $135 for members and $425 for nonmembers. Contact info@aopanet.org or visit My AOPA Connection for details. PRODUCTS

The Most Popular Orthotic and Prosthetic Illustrated Reference

2023 Illustrated Guide Updated Medicare Codes for Orthotics and Prosthetics

January 2024 O&P Almanac

AOPA Members

Welcome New AOPA Members Alexander Prosthetics & Orthotics Inc. P.O. Box 351979 Los Angeles, CA 90035 310-621-9950 Majid Ashrafy, BOCP Patient-Care Facility Bold City Orthotics & Prosthetics LLC 9191 RG Skinner Pkwy., Unit 701 Jacksonville, FL 32256 Andrea Dean, CO Patient-Care Facility

Cranial Technologies 515 South Drive, Ste. 23 Mountain View, CA 94040 650-526-4568 Steve Watson Patient-Care Facility Dralle Advisers 824 Scenic Hwy., Suite 377 Lookout Mountain, TN 37350-1470 404-580-9299 Traci Dralle Supplier/Consultant

Miller Prosthetics & Orthotics 2354 Richmiller Lane Belpre, OH 45714 740-421-4211 millerprosthetics.com Mark Miller, CPO Patient-Care Facility

UNC Health Prosthetics & Orthotics 1807 Fordham Blvd. Chapel Hill, NC 27514 984-974-5783 med.unc.edu/prosthetics-orthotics Sean Zeller, MSPO, MBA, CPO Patient-Care Facility

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

SCAN TO FIND YOUR NEXT JOB!

• Explore new career opportunities for FREE! • Click on any websites, emails, and videos to learn more. • Download the guide to look back on organizations and opportunities that appeal to you.

Ad.indd 32AOPAO&PProgram Almanac Book January 2024 1

8/7/23 9:49 PM

Marketplace

HAVE A PRODUCT OR SERVICE FOR MARKETPLACE? Contact Bob Heiman at bob.rhmedia@comcast.net.

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

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%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% 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 biobased renewable material that has been tested and proven in research and industry. Call today, 800-301-8275, for a free sample.

Naked Prosthetics oﬀers four finger prostheses: PIPDriver, MCPDriver, ThumbDriver, and GripLock Finger. ™

™

IT’S ALL ABOUT FUNCTION.

It’s about comfort and natural gait. Can you kneel?

Can you walk backwards?

Can you stand up with both feet on the ground?

Can you walk on uneven ground?

www.coyote.us/dynamicstruta

Coyote’s Dynamic Strut Coyote’s Dynamic Strut was designed with varying thicknesses to flex and move, helping the patient navigate real world conditions. The strut excels at creating a comfortable natural gait for daily use, walking, working, hiking, biking, and golf. It works great with a thermoformed orthosis and provides the needed energy response. Comfortable natural gait Works great with thermoformed braces Provides energy response New smaller size available Contact Coyote at 208-429-0026 or coyote.us.

• • • •

January 2024 O&P Almanac

Marketplace

The Xtern Line: A Step Up for Foot Drop By Turbomed Orthotics Turbomed has extended its line of AFOs to include three models: Xtern Classic, Summit, and Frontier. The Xterns will allow running, walking, and even hiking as long and far as you want without discomfort. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees, and provides the user with unparalleled levels of function. The Xtern Summit is lighter than the Classic, has more dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the shoe!

Kinterra® Introducing the completely redesigned Kinterra® that is redefining the ankle experience. With an industry leading user weight rating of 330 lbs without an increase in product weight, and clinically optimal 17 degrees of hydraulic ankle range of motion for energy return, slope adaptation, and increased socket comfort without sacrificing stability, more persons with amputation can benefit from ankle technology. PDAC verified for L5981 and L5968, the Kinterra also features a dorsiflexion assist spring, redesigned EnduraCore® footplate with split keel and heel for added mediolateral terrain adaptation, improved valve design for larger range of PF/DF resistance adjustments, and water submersion rating. Trial the Kinterra today experience the highest level of satisfaction with a hydraulic ankle. Visit proteorusa.com.

Be Part of the

CHANGE Join AOPA

GET PAID, SAVE, STAY INFORMED, GROW YOUR BUSINESS…

Join the AOPA Community Access to reimbursement experts and resources to help you get paid

Savings on all education, exhibit space, insurance, shipping, and products

Regular updates on happenings in O&P

Help growing your business

Visit AOPAnet.org/join for more information.

TOP QUALITY ORTHOTIC, PROSTHETIC, AND PEDORTHIC EDUCATION AND CE CREDITS FROM THE ORGANIZATION THAT KNOWS O&P.

Start earning your credits today! 34

O&P Almanac January 2024

Calendar

SHARE YOUR UPCOMING EVENT WITH O&P PROFESSIONALS Contact Bob Heiman at bob.rhmedia@comcast.net.

2024 January 1–31

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

January 11, January 25

The Goralign Advantage: A Webinar for Certified Prosthetists. Improve your understanding of the Goralign Self-Adaptive Prosthetic Ankle and earn 1.25 CEU credits by attending our upcoming ABC-approved webinar. “Understanding the Goralign Self-Adaptive Prosthetic Ankle” will be offered virtually on Jan. 11 and 25, 2024, from 1-2 PM ET. Register now at impulse-technology.com/education.

Live and Online/On Demand CEs

The Pedorthic Footcare Association: Diabetic Wound Prevention, Management, and Healing Program. 10-session online education program series. Approved CEs by ABC and BOC, monthly classes are 1.5 hours each. For more information and to register, visit pedorthics.org/page/Diabetic_Series_LMS_List.

April 15–16

AOPA Policy Forum. Washington Marriott Capitol Hill, Washington, DC. Visit aopanet.org.

June 28–29

PrimeFare East. Sheraton Grand Hotel Downtown Nashville. In-person meeting. For information, contact Cathie Pruitt at 901-359-3936, primecarepruitt@ gmail.com, or visit primecareop.com.

September 12–15

AOPA National Assembly. Charlotte, NC. For more information, visit aopanet.org.

Share Your Calendar Event

Advertise O&P events for maximum exposure with O&P Almanac. Contact Bob Heiman at bob.rhmedia@comcast.net or learn more at bit.ly/24AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or emailed to 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.

Advertisers Index 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. Scan the QR to start advertising in the O&P Almanac or visit bit.ly/24AlmanacMediaKit.

COMPANY

PAGE

PHONE

WEBSITE

Allard USA

866-678-6548

allardusa.com

ALPS South LLC

800-574-5426

easyliner.com

Coyote Prosthetics & Orthotics

800-819-5980

coyote.us

Hersco

800-301-8275

hersco.com

Naked Prosthetics

888-977-6693

npdevices.com

Ottobock

800-328-4058

professionals.ottobockus.com

ProComp

PROTEOR USA

855-450-7300

proteorusa.com

TurboMed Orthotics

888-778-8726

turbomedorthotics.com

fabwithprocomp.com

January 2024 O&P Almanac

State By State

BECOME AN AOPA STATE REPRESENTATIVE If you are interested in participating in the AOPA State Reps network, email smiller@AOPAnet.org.

Votes and Vetoes Legislative updates from New York and North Carolina

New York Senate Bill (S) 3131, which directs the Commissioner of Health to conduct a study related to New York Medicaid’s rate adequacy and patient access, was vetoed by Gov. Kathy Hochul in late November after passing both chambers of the state legislature. Hochul said she is supportive of the bill’s goal but has budgetary concerns related to S 3131 and several similar “study” bills. Advocates in the state are assessing the situation to determine alternative pathways to obtaining state Medicaid-related information.

North Carolina

The Cranial Remolding Orthosis (CRO) Policy at North Carolina Medicaid, which was updated via a collaboration between North Carolina Medicaid and AOPA’s CRO Workgroup to reflect best practices and the current body of scientific literature, was officially approved with a unanimous vote by North Carolina Medicaid’s Physician Advisory Group. The policy will be adopted after a brief public comment period. Interested in getting involved? Email advocacy@aopanet.org to learn more.

O&P Almanac January 2024

The Latest From So Every BODY Can Move Here are the most recent developments in the So Every BODY Can Move initiative, developed by AOPA in conjunction with the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), the American Academy of Orthotists and Prosthetists, and the Amputee Coalition. The movement advocates for a policy solution rooted (Left to right) Steve Woolfenden, Maggie Baumer, JD, state Rep. Mathew in dignity and justice by empowering Muratore of Massachusetts, and Arthur Graham state-by-state legislative action, expanding access to medically necessary New Hampshire Senate Bill (SB) 177, introduced orthotic and prosthetic care for physical activity. in Jan. 2023, has officially passed out of the Senate Health and Human Services Committee In Massachusetts, House Bill 4096, which with a 5-0 vote in favor after being re-referred requires that state commercial plans, public to the committee in February. As part of the employee plans, and Massachusetts Medicaid compromise that allowed the bill to move provide coverage for activity-specific devices, forward, SB 177 now focuses solely on was heard Nov. 14 in the Joint Financial Services coverage of activity-specific prostheses for Committee. Witnesses providing testimony state commercial plan enrollees under 18 included Arthur Graham, past president years of age. of Massachusetts Society of Orthotics and Prosthetics; David Crandell, MD, medical Senate Bill (S) 3919 in New Jersey, which director of Spaulding Rehabilitation Hospital; ensures coverage of activity-specific orthoses Steve Woolfenden, a survivor of the Boston and prostheses for enrollees of all ages in state Marathon bombing attack; Maggie Baumer, JD, commercial and public employee plans, now president of NAAOP; Ryan Geddie, government has a companion bill. Assembly Bill 5875, relations specialist at the Amputee Coalition; sponsored by Assemblyman Herb Conaway Jr., and Sam Miller, state and federal advocacy is identical to S 3919; the bills can now move in manager at AOPA. tandem through the legislative process.

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

ACCESS YOUR PERSONAL ACCOUNT, VIEW VIDEOS, PRINT CERTIFICATES, OR REVIEW CE CREDIT HISTORY 24/7.

If you do not currently have an AOPAversity account, visit www.AOPAnet.org/education to create a profile. You will need your AOPA member ID and the Zip code affiliated with your membership when you create your profile to access the free offering. Already have a profile? Log in at www.AOPAnet.org/education. Your username is the email used to create your profile.

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It’s as easy as 1-2-3 1. Set up your free personal online account 2. Choose your education and study 3. Take the quiz and print your certificate

Visit www.AOPAnet.org/education.

With over 100,000 fittings to date, the C-Leg is trusted by more users than any other microprocessor knee in the world. And it’s no wonder: Studies show the C-Leg provides the exceptional reliability and performance users need to focus on what really matters — enjoying a healthy, active lifestyle.

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C-Leg 4. Choose proven performance.