January 2016 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

JAN UARY 2016

E! QU IZ M EARN

Understanding the Most Significant Reimbursement Issues

BUSINESS CE

CREDITS P.15 & 34

P.14

HIPAAâ&#x20AC;&#x2122;s Breach Notification Rules P.32

Is Consumerism Good for Patient Care? P.28

Muscular Care for IBM Patients

WWW.AOPANET.ORG

As the inclusion-body myositis patient population grows, experts examine bracing efficacy P.20 This Just In: President Signs Omnibus Budget Bill P.16

YOUR CONNECTION TO

EVERYTHING O&P

THE ONLY THING BETWEEN AMPUTEES AND A HIGHER QUALITY OF LIFE IS MEDICARE’S GLASS CEILING. MICROPROCESSOR KNEE

DARPA

BIONIC PROPULSION ANKLE

POWER KNEE

As seen in The Washington Post and The Hill

MYOELECTRIC

HIGH ENERGY FOOT

Medicare’s glass ceiling moves today’s prosthetic devices out of reach for most amputees. Decades of technological advancements mean that new levels of mobility, health and

Amputees Who Receive Better Prostheses Save Medicare Money*

Though new, higher quality custom prostheses are widely available, Medicare

independence are possible for amputees. The only problem? Medicare. The federal

K3 Prostheses (Higher Quality) $79,967

restrictions are a glass ceiling

government makes it highly unlikely that a

that keeps them out of reach

patient will qualify for these devices, and

of most amputees. Even

new regulations will make the situation

K2 Prostheses (Lesser Quality) $81,513

though it’s been shown these devices provide a better

worse, not better. FIRST 12 MONTHS, ALL HEALTH COSTS.

quality of life.

If Medicare is trying to save money, denying

10.3%

amputees prosthetic devices isn’t the

Who has fewer incidents that require

way to do it. A new study shows patients

expensive care? In most cases, it is the

who receive timely prosthetic and orthotic

amputees who have been given the

devices can actually save Medicare money

prosthetics that kept them active and

over patients who are not treated — more

healthy. And now Medicare and its

than $231 million was saved for Medicare in

contractors are planning to further restrict

2014 alone.

who can get these better prosthetic limbs.

fewer skilled nursing claims for people with high-quality prostheses

It’s an outrage that Medicare would deny amputees the life-changing mobility that comes with prosthetics. To learn more about the Medicare study

Who Had Fewer Medical Incidents?

Received Higher Quality Prosthetics

Received Lower Quality Prosthetics

and what you can do to stop these policies, visit mobilitysaves.org.

Fewer E.R. Admissions? Fewer Skilled Nursing Needs? Fewer Doctor Visits? Fewer Hospice Admissions?

* Dobson | DaVanzo analysis of custom cohort Standard Analytic Files (2007‐2010) for Medicare beneficiaries who received O&P services from January 1, 2008 through June 30, 2009 (and matched comparisons), according to custom cohort database definition.

2. 3.

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contents

JAN UARY 2016 | VOL. 65, NO. 1

FEATURES

DEPARTMENTS | COLUMNS

COVER STORY

Views From AOPA Leadership......... 4

AOPA President James H. Campbell, PhD, CO, FAAOP, introduces a new column

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 13

Transitions in the profession

20 | Muscular Care for IBM Patients The introduction of advanced, lightweight materials to lower-limb orthotics has allowed clinicians to find new ways to improve the quality of life for muscular-compromised patients. Some individuals who have inclusion-body myositis, a myopathy that affects males over the age of 50, may benefit from stance control orthoses that help prevent trips and falls and prolong safe ambulation. Researchers and orthotists share their initial findings with this patient population. By Christine Umbrell

Reimbursement Page.......................... 14

Taking Stock

In-depth look at the most significant issues affecting O&P reimbursement

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

CREDITS

Compliance Corner............................... 32

Breach Etiquette

Summary of HIPAAâ&#x20AC;&#x2122;s rules for breach notification and record keeping

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

CREDITS

16 | This Just In

P. 16

President Signs Omnibus Budget Bill

n n

O&P Almanac breaks down several recent legislative and regulatory issues affecting the O&P community, including two relevant provisions in the $1.1 trillion U.S. spending bill, the latest activity on the proposed Local Coverage Determination for lower-limb prosthetics, and the Office of the Inspector Generalâ&#x20AC;&#x2122;s 2016 Work Plan and its focus on orthotics.

28 | Consumerism and Change Throughout the health-care sector, patients are demanding more control over their treatment decisions. As savvier consumers visit O&P facilities, practitioners share their tips for ensuring patients are educated correctly and developing strategies to capitalize on the consumer-centric movement. By Christine Umbrell and Josephine Rossi

Member Spotlight................................. 36

South County Artificial Limb and Brace Vorum

AOPA News............................................... 40

AOPA meetings, announcements, member benefits, and more

AOPA PAC...................................................42 Marketplace............................................. 44

P. 28

Welcome New Members ..................46 Careers........................................................ 48

Professional opportunities

Ad Index....................................................... 49 Calendar..................................................... 50

Upcoming meetings and events

Ask AOPA................................................... 52 Miscellaneous codes, RAC auditor reviews, and more

O&P ALMANAC | JANUARY 2016

VIEWS FROM AOPA LEADERSHIP

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

A Question for CMS

HE QUESTION POSED IN last month’s column relating to CMS’s announcement of the creation of a workgroup as a follow-up to the draft Local Coverage Determination (LCD) was, “How will the voices of subject matter experts (the independent patient advocates, prosthetists, physicians, therapists, and researchers) be heard during the development of the consensus statement?” CMS operates under a web of regulations and statutory provisions, all of which may have been well intentioned in the hatching but can serve to undermine the objectives of the agency. A case in point are the ongoing concerns AOPA has expressed about the absence of visible oversight of the agency’s contractors— whether it be the recovery audit contractor auditors or the durable medical equipment Medicare administrative contractors. While AOPA will continue to engage with the policymakers in Washington, D.C., it’s incumbent upon all AOPA members to continue to become more fully and publicly engaged. Make no mistake, we’re locked into long, grinding battles at the regulatory and legislative levels, and there will be no escape from these matters. We may have been given a reprieve; however, the health-care system in which we provide care will not likely become less complex any time soon. The level of opposition shown over the recent draft LCD was unprecedented, and it is critically important that we maintain and build upon that momentum. As an AOPA member, you should consider reaching out to your elected officials at the state and local levels. Don’t wait until the next crisis—become engaged now and help regulators and administrators understand the importance of orthotic and prosthetic management and the positive impact it has on so many individuals across the nation. It is a privilege to serve as AOPA president. One of the great rewards of serving on the AOPA Board of Directors is the opportunity to share experiences, ideas, and solutions with the other members of the board whose due diligence and wisdom prepare and equip us to deal with the complex challenges we face. I believe it is important that my fellow board members have the opportunity of communicating directly with members to keep you updated on the status of key initiatives and our survival imperatives. Therefore, it’s my plan to invite my colleagues on the board to author one of these monthly columns; consequently, beginning in this issue of the O&P Almanac, this column has been renamed Views From AOPA Leadership.

Board of Directors OFFICERS

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

James H. Campbell, PhD, CO, FAAOP AOPA President

Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Bradley N. Ruhl Ottobock, Austin, TX

JANUARY 2016 | O&P ALMANAC

Why I Choose Plié 3...

“

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Both weatherproof and FULLY SUBMERSIBLE. The fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees. n The most responsive stumble and fall protection. n Users can instinctively move at their own pace in any direction...even if it’s taking small short steps or pivoting in confined spaces. n Streamlined, intuitive set up makes the Plié 3 MPC knee even easier for prosthetists. n n

To learn more, call your Freedom representative at 888-818-6777 or visit www.freedom-innovations.com/ Plie-3

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Connect with us

AOPA CONTACTS

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

JANUARY 2016 | O&P ALMANAC

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

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

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2016 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options!

NUMBERS

U.S. Diabetes Rate on the Decline CDC reports the number of new cases decreased significantly from 2009 to 2014

After years of alarming increases in the number of new cases of diabetes in the United States, the nation’s focus on prevention appears to be making an impact.

NEW U.S. CASES OF DIABETES

1.7 million 1.4 million Number of new cases in 2009, up from 573,000 in 1991.

ANNUAL NUMBER OF NEW CASES OF DIAGNOSED DIABETES Incidence for U.S. Adults Ages 18 to 79 YEAR

AGES 18-44

Incidence rate per 1,000 dropped from 4.3 to 3.2.

Number of Diabetes Cases, in Thousands

AGES 45-64

Incidence rate dropped from 13.9 to 10.5.

AGES 65-79

Incidence rate dropped from 12.8 to 12.1.

DIABETES-RELATED AMPUTATIONS

60 PERCENT Almost two thirds of nontraumatic lower-limb amputations in adults occur in people with diabetes.

73,000 Number of nontraumatic lower-limb amputations performed in people with diabetes in 2010.

“This is what’s supposed to happen when you put a lot of effort into prevention over the years.” —Edward Gregg, CDC researcher

500

JANUARY 2016 | O&P ALMANAC

1,000

1,500

2,000

Sources: Centers for Disease Control and Prevention, American Diabetes Association.

1991 573 1992 682 1993 752 1994 838 1995 796 1996 799 1997 813 1998 921 1999 979 2000 1,104 2001 1,213 2002 1,304 2003 1,349 2004 1,403 2005 1,468 2006 1,528 2007 1,605 2008 1,728 2009 1,732 2010 1,678 2011 1,536 2012 1,500 2013 1,448 2014 1,437

NUMBERS BY AGE FROM 2009 TO 2014

Number of new cases in 2014.

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PROPERTY

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UMBRELLA

WORKERS COMP & MORE

Happenings RESEARCH ROUNDUP

Amputees To Test Prosthetic Balance Recovery Technology “Powered prostheses can help compensate for missing leg muscles, but if amputees are afraid of falling down, they won’t use them,” Geyer said. “Today’s prosthetics try to mimic natural leg motion, yet they can’t respond like a healthy human leg would to trips, stumbles, and pushes. Our work is motivated by the idea that if we understand how humans control their limbs, we can use those principles to control robotic limbs.” The research team has used computer simulations and a cable-driven device to evaluate the neuromuscular model. Transfemoral amputees are expected to participate in further development and testing. Research results will aid not only in the development of powered prostheses but also in the design of legged robots, according to the researchers.

Early Weaning of Orthoses Offers Promising Results for Some Scoliosis Patients Researchers at the Oslo University Hospital in Norway have found that planned early weaning of scoliosis orthoses results in shortened bracing time in select patients. The researchers determined that for patients whose curve reduction is stable and the primary curve is 25 degrees or less, planned early weaning may be beneficial. A total of 381 patients with late-onset juvenile and adolescent idiopathic scoliosis and a mean primary major curve of 33.1 degrees were treated with a Boston brace and followed prospectively. The aim of the study was to evaluate progression of the scoliotic curve and the surgical rate in patients with unplanned early weaning (8 percent of the study group), planned early weaning (16 percent), and ordinary brace wear until maturity (76 percent). 10

JANUARY 2016 | O&P ALMANAC

The planned early weaning group was generally younger at brace start time, with smaller curves than the other groups. At the conclusion of the study period, 5 percent of the ordinary brace treatment group required surgery due to curve progression in spite of brace treatment. Of the planned early weaning group, 27 percent started a new period of brace treatment and 2 percent required surgery. For the unplanned early weaning group, bracing was resumed in 19 percent, and surgery was required for 38 percent. The researchers concluded that the benefits of planned early weaning in patients included overall shortened bracing time and positive clinical results. More information is available in the November issue of Scoliosis and Spinal Disorders.

PHOTO: www.cmu.edu

Researchers at Carnegie Mellon University are developing a robotic leg prosthesis to help amputees recover their balance using techniques based on the way human legs are controlled. Funded in part by a $900,000 grant from the National Science Foundation via the National Robotics Initiative, CMU researchers will develop and test new technologies with the assistance of above-knee amputees. The project is being led by Hartmut Geyer, assistant professor of robotics; Steve Collins, associate professor of mechanical engineering and robotics; and Santiago Munoz, CPO, instructor in the department of rehabilitation science and technology at the University of Pittsburgh. Geyer and his team are developing a control strategy to produce stable walking gaits over uneven terrain and improved recovery from trips. The strategy has been devised by studying human reflexes and other neuromuscular control systems.

HAPPENINGS

RESEARCH ROUNDUP

Protocol for AOPA-Funded Research on Dysvascular Amputations Accepted for Publication In 2015, AOPA partnered with the Center for Orthotic and Prosthetic Learning in issuing requests for proposals for systematic reviews, comparative effectiveness studies, and pilot research projects. Michael Dillon, PhD, of La Trobe University in Victoria, Australia, is the lead researcher for one of these reviews, titled “Describing the Outcomes of Dysvascular Partial Foot Amputation and How These Compare to Transtibial Amputation: A Systematic Review Protocol for the Development of Shared Decision-Making Resources.” The protocol for this systematic review has recently been published in the journal Systematic Reviews and will be completed later in 2016. The systematic review will be used to gather evidence on the outcomes of partial foot amputation. This evidence will be included in shared decision-making resources. These resources will help inform difficult conversations between doctors and patients about partial foot amputation. Read the protocol at bit.ly/dillonprotocol.

#ICYMI

CMS Implements Final Rule on Comprehensive Care for Joint Replacement In November, CMS issued a final rule titled, “Medicare Program; Comprehensive Care for Joint Replacement (CJR) Payment Model for Acute-Care Hospitals Furnishing Lower-Extremity Joint Replacement Services.” This final rule represents CMS action under its Innovation Center initiative in its first foray into implementing post-acute-care bundling. CMS skirted the objection by AOPA and others that Congress has never authorized CMS to invoke postacute-care bundling. The rule establishes a mandatory Medicare payment policy demonstration that will apply for hospital inpatient, outpatient, post-acute, and physician services rendered in connection with certain total hip arthroplasty, total knee arthroplasty, and select other lower-extremity surgeries for the duration of the inpatient stay and 90 days following hospital discharge. This policy would apply to hospitals in 67 metropolitan statistical areas (MSAs), beginning on April 1, 2016, and lasting through Dec. 31, 2020. The proposed rule had called for application in 75 MSAs and a start date of Jan. 1, 2016, representing two of the most significant changes CMS made in the final rule. Hospitals, physicians, and postacute-care providers would continue to bill and be reimbursed through Medicare fee for service, under their

respective payment systems, for the duration of the CJR demonstration. However, total Medicare Part A and Part B spending for services provided during the 90-day window would be reconciled against hospital-specific target expenditure amounts that are derived from a blend of hospital-specific and regional historical Medicare Part A and B payments for CJR episodes, transitioning from primarily provider-specific to completely regional pricing over the course of the five performance years. For Years 2 through 5, after reconciling actual spending with the target prices, hospitals (and any providers with which the hospital has entered into a joint risk-sharing contractual arrangement for the CJR model) would be required to repay the excess costs above the target price up to certain “stop-loss limits” that would vary by year, e.g., 5 percent stop-loss limit in Year 2. There would be no repayment obligation for excess costs in Year 1 of the program. Similarly, hospitals and their risksharing contractual partners that achieve actual episode spending below the target price (and meet quality performance thresholds on required quality measures) would be eligible to earn a reconciliation payment for the difference between the target price and actual episode spending, up to the stop-gain limit. O&P ALMANAC | JANUARY 2016

HAPPENINGS

RULES & REGULATIONS

O&P ATHLETICS

Paralympic Athletes Prevail in IPC Championships

Revisions to Stark Law Included in CMS Final Rule

JANUARY 2016 | O&P ALMANAC

2016 Paralympics Tickets Now Available U.S. Paralympics and CoSport have announced that individual tickets and packages for the Rio de Janeiro 2016 Paralympic Games are now available exclusively through cosport.com. CoSport has been appointed the International Paralympic Committee’s Global Authorized Ticket Reseller for the Rio 2016 Paralympic Games, serving the United States among 161 other territories vying for gold. The Paralympic Games will kick off in Rio with the Opening

Ceremonies on September 7, and will feature 11 days of competition. It is anticipated that Team USA will have its largest delegation to date at the Games, including hundreds of amputee athletes. U.S. residents are invited to create a cosport.com account. Individual tickets are being sold via live sales (first come, first served). Hotel and ticket packages, including access to some of the most sought-after events, are available.

PHOTO: Getty Images/Jamie McDonald

PHOTO: Össur

CMS issued a proposed rule in July that, in many ways, signaled the agency’s intent to ease the burden of complying with the Stark Law. On Oct. 30, 2015, CMS unveiled its final changes in this iteration of Stark Law rulemaking as part of the CY 2016 Medicare Physician Fee Schedule final rule. The final rule makes several significant changes, including new exceptions for the recruitment of nonphysician practitioners and timeshare arrangements. The regulatory changes take effect Jan. 1, 2016, with the exception of the changes related to determining the level of physician ownership in physician-owned hospitals, which will take effect Jan. 1, 2017. The final rule includes clarifications for physician-owned hospitals and revises procedural requirements, including recruitment and retention changes, and an update to the language for retention payment in underserved areas. While AOPA does not foresee that the changes to the new Stark Law changes will have a significant impact on O&P, there are new areas of exceptions, including nonphysician practitioner compensation assistance and timeshare arrangements. For more information, contact Joe McTernan or Devon Bernard at AOPA.

Hundreds of athletes took part in the 2015 International Paralympic Championships (IPC) held in Doha, Qatar, late last year, including several members of Team Össur. In all, Team Össur set six new world records, and won a total of seven Gold, six Silver, and four Bronze medals. U.S. sprinter Richard Browne Jr. won Gold medals while setting world records in the 100-meter (10.61 seconds) and 200-meter (21.27 seconds) events. He also took home a Silver medal as part of the U.S. 4- x 100-meter relay team. French athlete Marie-Amélie Le Fur was among the most decorated female participants, winning a total of four medals as a T44 competitor. These included Gold medals for her record-setting distance of 5.84 meters in the long jump and her record-setting time of 59.30 seconds in the 400-meter sprint. Le Fur took Silver medals in both the 100-meter and 200-meter events. Additional Team Össur winning performances came from Alan Oliveira of Brazil, Arnu Fourie of South Africa, Markus Rehm of U.S. sprinter Richard Browne Jr. Germany, Richard Whitehead of Great Britain, won Gold medals in the 100-meter and Daniel Wagner Jörgensen of Denmark. and 200-meter events.

HAPPENINGS

AUDIT ACTIVITY

RAC Contractors Resume Audits As a result of the original recovery audit contractor (RAC) contracts coming to an end and new RAC contract proposals being submitted and reviewed, the number of additional documentation requests (ADRs) has been reduced significantly. Several months ago, CMS advised its original RAC contractors to essentially hold off on issuing new ADRs until new contracts were finalized and implemented. CMS announced its plans to establish a single, national RAC contractor that would be responsible for RAC audits on all Medicare claims pertaining to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); home health; and hospice claims.

The new contract was initially awarded to Connolly Healthcare, which currently serves as the Jurisdiction C RAC contractor for all Medicare claims. While the contract award was issued in December 2014, a subsequent protest of the award initially delayed its implementation and eventually led to a CMS decision to issue new bids for all of the RAC contracts, including the national contract for DMEPOS, home health, and hospice claims. On Nov. 16, 2015, CMS announced that while new bids for RAC contracts are being accepted and reviewed, the existing four RACs may continue to perform RAC reviews and may begin to issue additional ADR requests. This

signals an effective end to the moratorium that was placed on new RAC activity. While it may take a few weeks for the current RACs to put in place the resources to restart full-scale activities, there is no reason to expect that they will not do so as soon as possible. RAC audits for O&P providers are still limited to a maximum of 10 audits per tax identification number every 45 days. AOPA encourages members to be aware of these limits and to challenge any requests that exceed the limits.

PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Dankmeyer Prosthetics and Orthotics has announced the addition of two new staff members: Kristen Beltran has joined the company as a resident prosthetist orthotist, and Kevin Hughes has been hired to help facilitate the company’s long-term patient-care initiatives.

The Amputee Coalition has released a webinar on “Preventing Secondary Limb Loss.” The webinar, which was produced in part by a grant from Organogenesis, is designed to promote diabetic foot care awareness and education among the U.S. veteran population. Visit www.amputee-coalition.org to view the webinar.

OPAF & The First Clinics have welcomed three new board members and new officers. Joining the OPAF Board of Directors are Lesleigh Sisson, CFom, Nikki Hooks, CO, and Mary Gangelhoff. Sisson is the owner of O&P Insight in Las Vegas and has experience working with the administrative side of orthotic and prosthetic practices. Hooks is part of the professional staff at Ability Prosthetics and Orthotics in the Greenville, South Carolina, location. Gangelhoff is an area manager of prosthetics with Össur Americas in Minneapolis. The OPAF officer slate will include Sue Borondy as president, Karen Henry as vice president, and Reggie Showers as treasurer.

ComfortFit Labs has released an iPadbased scanning system for use in imaging feet. The company has partnered with Tom-Cat Solutions to offer the iTOM-CAT, an iPad Air 2- based system that uses a structured sensor to capture a 3D image. The system is designed to increase turnaround times, allow for faster in-house casting, and offer compliance with the Health Insurance Portability and Accountability Act.

O&P ALMANAC | JANUARY 2016

REIMBURSEMENT PAGE

By JOE MCTERNAN

E! QU IZ M EARN

BUSINESS CE

CREDITS P.15

Taking Stock A look back and a look ahead at the most significant issues affecting O&P reimbursement

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 15 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

HE YEAR 2015 WAS an extremely

active year for orthotics and prosthetics. While the regulatory landscape was obviously dominated by the sudden release of the draft Local Coverage Determination (LCD) and Policy Article for lower-limb prostheses, other issues continued to develop through the course of the year—the impact of which is yet to be seen. These issues include the recently released final rule for prior authorization for certain prosthetic services, continued expansion of the definition of the term “minimal self adjustment” as it relates to off-the-shelf (OTS) orthoses, policy clarification regarding who is qualified to fit custom-fitted orthoses, changes to recovery audit contractor (RAC) audits and contractors, and revisions to the requirements for Medicare proof of delivery documentation. While it is important to comprehend what has happened in the past, it is equally important to understand what may happen in the future. Reimbursement challenges are likely to continue in 2016 as the issues that dominated 2015 are fully implemented and integrated into the O&P universe. The first edition of the Reimbursement Page for 2016 will review the issues that affected you most in 2015 and discuss how they may impact you in 2016 and beyond.

Looking Back

Last year started in a fairly positive manner. RAC audits were placed on hiatus as CMS finalized new contracts, including the following: 14

JANUARY 2016 | O&P ALMANAC

• A new, national RAC contract that would cover all durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); home health; and hospice claims. • A modest 1.5 percent increase in the Medicare O&P fee schedule. • A few changes to the HealthCare Common Procedure Coding System (HCPCS) codes that are used to bill for O&P services. The calm was quickly broken in February with the publication by the durable medical equipment Medicare administrative contractors (DME MACs) of a “clarification” regarding the requirements for Medicare proof of delivery documentation. In a published provider bulletin, the DME MACs “reminded” suppliers that the purpose of the Medicare proof of delivery was to not only ensure that the patient received the services that were billed, but also to verify that the items provided were coded correctly. To ensure this, the DME MACs stated that proof of delivery documentation must include a brand name, model number, or serial number for any prefabricated items or components and a complete narrative description of any customfabricated items or components. The bulletin went on to state that a simple list of HCPCS codes and descriptors did not meet the requirements for a valid proof of delivery. This was a long accepted practice for O&P services, and the sudden change of course had an immediate and negative impact on O&P audits. The number of claims denied

REIMBURSEMENT PAGE

for an invalid proof of delivery spiked shortly after the announcement and continues to trend higher than normal 10 months later. While adjustments have been made, it remains one of the biggest reasons for O&P claim denials. Following on the heels of the proof of delivery issue was the release of the draft LCD and Policy Article for lower-limb prostheses. This document, released on July 16, 2015, proposed fundamental and detrimental changes to Medicare coverage of lower-limb prostheses that, if finalized, would severely limit coverage of high-quality medically necessary prostheses.

rule was written by CMS and was sent to the Office of Management and Budget (OMB) for prepublication review. AOPA followed this proposed rule very closely and met with OMB representatives to express its concern regarding the potential impact of prior authorization on Medicare beneficiariesâ&#x20AC;&#x2122; access to timely and quality prosthetic services. The recent announcement that CMS has authorized the existing RAC contractors to restart audit activities while new RAC contracts are being prepared signals an effective end to the 18-month hiatus that has brought some much needed relief to Medicare providers. While the impact of this announcement will most likely not be felt until 2016, it remains a significant development. AOPA has questioned, and will continue to question, the structure of the RAC program, which highly incentivizes auditors through a commission-based method of payment and has generated a significant backlog in scheduling of higher levels of appeals.

Looking Ahead

The O&P community came together and spoke with a unified voice at both the CMS public meeting on August 26 and the rally at the Department of Health and Human Services headquarters that followed it. Fortunately, CMS made the decision to not finalize the LCD and Policy Article pending the formation of an interagency workgroup to review the proposal and provide guidance to the DME MACs. This decision represents only a temporary victory, as AOPA asked and continues to advocate for full rescission of the draft LCD and Policy Article. Prior authorization for certain prosthetic services was originally proposed in 2014 as part of a proposed rule published by CMS. While there was not a lot of public activity regarding this proposed rule in much of 2015, the final

While 2015 was truly a challenging year for O&P businesses, the challenges that lie ahead appear to be no less daunting. While the LCD and Policy Article for lower-limb prostheses has effectively been put on hold, CMS has announced the formation of an interagency workgroup in 2016 that will review the proposed policy and provide guidance to the DME MACs regarding revisions and changes to the policy. This process will begin in 2016 but may extend beyond the coming year as the workgroup is formed and gets to work. AOPA will continue to monitor this situation closely to ensure that Medicare beneficiaries continue to have proper access to high-quality, medically necessary prosthetic services. Prior authorization of certain prosthetic services resurfaced on Dec. 30, 2015, when the final rule for prior authorization was published by CMS, and becomes effective Feb. 29, 2016. AOPA is reviewing the final rule in depth and the February Reimbursement Page will be a review and analysis of the rule. RAC audits will continue to be a

concern for AOPA and its members during 2016. As new audits have been authorized and long-term contracts are being negotiated, the RAC program does not appear to be slowing down anytime soon. It is important to remember that claims you submit today are subject to RAC audits for three years. Taking the time to make sure that your documentation is in order before a claim is ever submitted will go a long way in defending your claim from future audits. The revised proof of delivery requirements have been in effect for almost a year but continue to cause unnecessary claim denials. While AOPA continues to challenge the regulatory authority of the DME MACs regarding proof of delivery, the rules are relatively clear, at least for prefabricated devices and components. Whenever possible, it is in your best interest to include available brand names, model numbers, or serial numbers on your proof of delivery documentation. This is one of the few pieces of documentation that O&P providers control throughout the claim submission process. While the clarification published in February 2015 may not be popular, it is relatively easy to comply with as long as folks are willing to change their process. The challenges of running a successful O&P business increased significantly in 2015 and will continue to grow as we move into 2016. That being said, it is not impossible to remain profitable. Through regular review of your processes and operations, including making changes when necessary, O&P remains a strong business with endless opportunities. Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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O&P ALMANAC | JANUARY 2016

This Just In

President Signs Omnibus Budget Bill The latest news on the government spending bill, the LCD, and the OIG Work Plan

N DECEMBER 18, President Barack Obama signed the omnibus budget measure funding the government through September 2016. The measure includes two important provisions of significance to O&P: 1) the limitation of Medicaid reimbursement rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitively bid items to current Medicare rates, and 2) a two-year suspension of the 2.3 percent medical device excise tax. The provisions that would limit Medicaid reimbursement for DMEPOS competitively bid items to current Medicare rates would not have an immediate impact on O&P services because they are not currently included in competitive bidding programs. If CMS eventually acts to incorporate off-the-shelf (OTS) orthoses into future competitive bidding programs, it would likely result in a significant impact, reducing Medicaid payments for this limited category of OTS (only) orthotic devices in the future. The second provision creates a two-year suspension of the 2.3 percent medical device excise tax, a tax that AOPA has opposed since its inception. While this would be good news for the medical device industry in general, it is important for AOPA members to recognize that AOPA secured a decision in 2012 that exempted orthotic and prosthetic

JANUARY 2016 | O&P ALMANAC

devices from the tax at the patient-care and manufacturer levels, and the longstanding, permanent O&P exemption will continue in the future regardless of what happens after the current two-year general exemption expires. Nonetheless, AOPA has consistently advocated for the complete elimination/ repeal of the medical device excise tax as it is an unnecessary burden on all medical device companies, and thereby upon all of American health care.

Further Update on Flawed LCD Proposal

The proposed but now delayed Local Coverage Determination (LCD) and Policy Article for lower-limb prostheses still warrants high-level attention, and that’s exactly what AOPA and partners in the O&P Alliance are doing to ensure this harmful proposal is never implemented in its original form. A quick recap: The White House and CMS released statements on November 2 basically saying the durable medical equipment Medicare administrative contractors (DME MACs) “will not finalize the draft LCD at this time.” That’s good news, but the bad news is a subsequent announcement, where the DME MACs simply said they were delaying any final action on the LCD. In addition, both CMS and the DME MACs have left the proposed LCD

This Just In

OIG 2016 Work Plan Targets Orthotics Medical Necessity and Cost

Key Excerpts From the 2016 OIG Work Plan ORTHOTIC BRACES—We will determine the reasonableness of Medicare payments for orthotic braces. We will compare Medicare payments made for orthotic braces to amounts paid by non-Medicare payors, such as private insurance companies, to identify potentially wasteful spending. We will estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for orthotic braces with those of non-Medicare payors. ORTHOTIC BRACES—We will determine supplier compliance with payment requirements. We will review Medicare Part B payments for orthotic braces to determine whether DMEPOS suppliers’ claims were medically necessary and were supported in accordance with Medicare requirements. Prior OIG work indicates that some DMEPOS suppliers were billing for services

on their respective websites, inviting repeats of the ill-fated decision by United Healthcare (quickly mirrored by CIGNA) to implement a policy on vacuum pump suction sockets based on the harmful provisions in the LCD, which held these sockets were “not a medical necessity.” AOPA has urged members to be on the alert to similar actions by other

that process DMEPOS claims include utilization guidelines and documentation requirements for orthotic braces.

that were medically unnecessary (e.g., beneficiaries receiving multiple braces and referring physician did not see the beneficiary) or were not documented in accordance with Medicare requirements. Medicare requires that such items be “reasonable and necessary.” (Social Security Act 1862(a)(a)9A). Further, LCDs issued by the four Medicare contractors

Editor’s Note: AOPA members can use this link to log in and access the Dobson DaVanzo Compendium documents: bit.ly/orthoticdata.

L0631: O&P Providers* Vs. All Other Providers $120 Million

MEDICARE ALLOWED CHARGES

The Office of the Inspector General (OIG) Work Plan includes two actions pointing toward orthotics. With respect to L0631 and L0637, it is valuable to bear in mind what the actual data has, and does, show: growth generated by those other than certified O&P personnel.

$100 Million

$80 Million

$60 Million

$40 Million

$20 Million

2006

2007

2008

2009

O&P Providers

2010

2011

2012

2013

All Other Providers

*Medicare Provider Codes: 51, 52, 53, 55, 56, and 57

private payors that may rely on provisions of the draft LCD to limit payment or treatment options for amputees. CMS is forming an interagency working group charged with developing a consensus statement on lower-extremity prosthetics that comprises “clinicians, researchers, and policy specialists from different federal agencies.”

The big question is: How will the real stakeholders—amputees and providers—have any input into a process that excludes them from a seat at the table? That’s why the vigilance and countermeasures must continue in high gear. Following is a description of steps being taken by AOPA and its O&P Alliance partners: O&P ALMANAC | JANUARY 2016

This Just In

• Legislative language has been developed by Rep. Renee Ellmers (R-North Carolina) that would impose an 18-month moratorium extending well into 2017 that would prohibit the Secretary of Health and Human Services or any Medicare administrative contractor from implementing and enforcing the policies in the draft LCD.

Rep. Tammy Duckworth (D-Illinois)

Rep. Renee Ellmers (R-North Carolina)

• AOPA and the O&P Alliance have pressed officials at the highest levels in CMS to remove the draft LCD from its website and from the DME MACs’ website as well as to intervene to demonstrate that the actions by United Healthcare and CIGNA are

contrary to both scientific evidence and the prevailing standard of patient care. Apparently, roadblocks in the form of government archiving requirements stand in the way of that logical solution for now. • Discussions also are underway with congressional offices to provide a solution to the flawed relationship CMS has with its contractors. Rep. Tammy Duckworth (D-Illinois) held a conversation with Acting Administrator Andy Slavitt and Deputy Director Patrick Conway regarding the LCD, during which they disclosed perceived limitations on their ability to manage their own contractors. Duckworth

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expressed dismay at their lack of authority to manage CMS contractors, such as directing the DME MACs to rescind the draft LCD or remove it from their website. Meanwhile, AOPA has met with major House and Senate committees on the committees’ interest in possible hearings and/or legislative action to clarify the respective management authorities of CMS and its DME MAC contractors.

Progress Afoot on the O&P Patient Registry Project

Capturing data on patient outcomes and treatments to help develop best practice standards and to measure outcomes through a patient registry program has been a conversation hot button for the AOPA leadership for at least five years. Progress is being made addressing possible funding as well as a possible working agreement between AOPA and the American Joint Replacement Registry (AJRR). Kenton Kaufman, PhD, PE, of the Mayo Clinic has submitted a grant request to the DoD for funding Kenton Kaufman, PhD, PE support, and has established an executive committee, a steering committee, and a technical committee for the registry effort. AOPA is working toward the possibility of a common enterprise with the AJRR that would help advance the effort swiftly, and potentially allow tracking of prosthetic patients back to their amputation among data being collected from the 600-plus hospitals that already participate in the AJRR. The dream of bringing similar patient registry outcomes to the field of O&P is closer to becoming a reality. More details on how this project will benefit all providers in O&P will be the subject of a special session during the 2016 O&P Leadership Conference sponsored by AOPA held at the Eau Palm Resort in Palm Beach Florida, January 8-10.

COVER STORY

Muscular Care for IBM Patients As the baby boomers age, the inclusion-body myositis patient population appears to be growing. Hereâ&#x20AC;&#x2122;s how orthotic intervention may be a game-changer. By CHRISTINE UMBRELL

JANUARY 2016 | O&P ALMANAC

COVER STORY

Need To Know: • The past 20 years have brought a number of advances to the field of lower-limb orthotics, and clinicians are finding new ways to improve the quality of life for patients who previously could not benefit from bracing. • One small but significant group of patients who could benefit are those who have inclusion-body myositis (IBM), a progressive disease with no cure that slowly weakens muscles and leads to decreased motor function and increased morbidity. Some clinicians are fitting them with lightweight orthoses—primarily stance control knee-ankle-foot orthoses (SCOs)—to help prevent trips and falls and prolong safe ambulation. • As physiatrists have gotten more involved in the management of myositis, the value of orthotic intervention for some patients is becoming clear. People are becoming aware that there may be a means to stabilize their lower extremities to increase ambulation. • Research on the efficacy of orthotic intervention for progressive myopathies is still in its infancy, however. One expert hypothesizes that the severity of the disease will determine which SCOs will be most beneficial for different patient populations. • Keen evaluation skills are important. Clinicians need to measure range of motion and muscle strength, assess center of mass, and use gait observation. For component selection, it is important to match the component performance to the physical limitations of the patient. • While bracing will not be effective or recommended for every patient with IBM, orthotists should strive to become more educated about the disease and be aware of how orthotic intervention may help patients in the early stages.

HE PAST 20 YEARS have brought

a number of advances to the field of lower-limb orthotics, including new materials, such as carbon fiber composites, and increased tensile strength and energy-storing capabilities. These advances have led to the development and manufacturing of advanced, but lightweight, components that have been used to improve stability and increase ambulation for several types of patients. As these orthoses become more commonplace, and more readily reimbursed, clinicians are finding new ways to improve the quality of life for patients who previously could not benefit from bracing. Patients who have inclusion-body myositis (IBM) are one small, but

significant, group that may benefit from these advances. IBM is “the most common myopathy in adults over the age of 50 years,” says Rahila Ansari, MD, MS, an assistant professor of neurology and neuromuscular subspecialist at Case Western University and the Department of Veterans Affairs. For patients with IBM, weakness is slowly progressive and leads to decreased motor function and increased morbidity. Weakness initially affects the quadriceps, and due to the role of the quadriceps in knee stabilization during foot strike, a weakened quadriceps results in falls. As the disease progresses, weakness also is noted in the finger flexors and ankle dorsiflexors; eventually, most skeletal muscles are affected. O&P ALMANAC | JANUARY 2016

COVER STORY

“IBM is a very different disease process, and orthotists cannot brace patients simply by looking at function. You need to realize IBM is a progressive disease, so if you don’t brace correctly, you may contribute to worsening the disease.” —Rahila Ansari, MD, MS

While all forms of myositis affect approximately 50,000 people in the United States, “a considerable number of additional IBM patients are probably misdiagnosed or remain undiagnosed,” according to The Myositis Association. “Sometimes it takes up to six years for IBM patients to be diagnosed correctly,” says Gary Bedard, CO, FAAOP, clinical application liaison at Becker Orthopedic, who has treated several patients with IBM over the past 15 years. An accurate diagnosis is established via electromyography, a muscle biopsy, and a clinical exam by a neuromuscular specialist. Presently, there is no known treatment for IBM. In patients with IBM, increased muscle usage, especially during activities requiring eccentric contractions, leads to increased muscle destruction, says Ansari. However, a 22

JANUARY 2016 | O&P ALMANAC

lack of activity also results in disuse atrophy and weakness. Therefore, patients are advised to stay active primarily through concentric muscle movement and stretching. While there is no cure for the disease, a few clinicians are seeking to assist these patients in preventing trips and falls, as well as prolonging safe ambulation, by fitting them with lightweight orthoses—primarily stance control knee-ankle-foot orthoses (SCOs). Anecdotally, there has been reported success in fitting orthoses for patients who are early in the disease progression. For this reason, IBM is gaining attention within the orthotic community, and some researchers, such as Ansari, are studying the efficacy of different types of SCOs.

braces can be used to restore function and augment strength in patients with IBM, while minimizing destruction due to the added weight and muscle strain from wearing orthoses. While research may be scarce, Bedard and a few other orthotists have found success in fitting some IBM patients with orthoses. Thomas Darm, CPO, CPed, based in San Antonio, is one such clinician. He has treated several patients who have IBM, the majority of whom were referred by neurologists when foot drop and knee instability were recognized. Darm has fit patients who are in the earliest stages of IBM with lightweight graphite ankle-foot orthoses (AFOs), and eventually SCOs.

Introducing IBM Patients to Orthoses

Many patients in the early stages of IBM do not understand their condition and are not aware of the possibility of orthotic intervention. Bedard, who spoke on this topic at AOPA’s 2015 National Assembly, believes that although there are not a lot of IBM patients, the patient population does appear to be growing. Ansari believes this is likely due to greater levels of recognition and diagnosis. Neurologists and rheumatologists typically manage patients with myositis; but recently, “physiatrists have gotten more involved, and the value of orthotic intervention for some patients is becoming clear. People are becoming aware that there may be a means to stabilize their lower extremities to increase ambulation,” says Bedard. Fitting SCOs for patients with progressive neuromuscular disease is a relatively new practice. “SCOs have been used successfully to restore function in patients with weakness due to spinal cord injury and trauma,” says Ansari. “However, SCOs have not been used clinically in patients with neuromuscular diseases, and only minimal research has evaluated SCO bracing in muscle diseases.” She is currently conducting research to analyze, quantify, and determine if SCO-style

IBM patients typically do not have “range-of-motion cessation, there’s usually skeletal alignment, and other health issues are typically pretty good. It’s devastating as this ideology progresses, but for the time that we are effective as orthotists, I find that they’re fairly easy patients to manage.” —Gary Bedard, CO, FAAOP

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COVER STORY

Research Demonstrates Efficacy of Orthotic Intervention for IBM Patients Several recent research efforts have studied the effects of bracing on patients with inclusion-body myositis (IBM): • In 2011, researchers in the Division of Orthopedic Surgery at the Mayo Clinic in Minnesota published a study titled, “Stance Control Orthosis Trial in Patients With Inclusion Body Myositis” in Prosthetics Orthotics International. Led by Kenton Kaufman, PhD, PE, the researchers conducted a clinical trial of nine IBM subjects provided with stance control orthoses for six months of home use. The results indicated a range of abilities and a range of gait outcomes, but all patients felt the orthosis was helpful in safeguarding against falls and providing stability. The researchers concluded that “stance control orthosis use will benefit patients with IBM, but care should be taken to choose the stance control orthosis option that best suits their individual clinical presentation.” • Rahila Ansari, MD, MS, an assistant professor of neurology and neuromuscular subspecialist at Case Western University and the Department of Veterans Affairs, spoke at the 2015 AOPA National Assembly about a study she recently conducted of IBM patients. Two patients were fitted with bilateral microprocessor SCOs with variable knee dampening, and one patient was fit with bilateral mechanical SCOs with fixed knee dampening. They were compared to a control patient with isolated, nonprogressive right quadriceps injury, who was braced unilaterally with an SCO with fixed knee dampening. The researchers quantified gait kinematics and muscle forces via modeling with joint moments and surface electromyography (EMG) measurements. Ansari concluded that patients achieved more physiologic gait patterns with all of the SCOs. Additionally, the EMG data revealed that the mechanical SCO was decreasing the muscle forces in the quadriceps, and therefore reducing muscle damage. Additional investigations are underway. • Andreas Kannenberg, MD, PhD, executive medical director for North America for Ottobock, also spoke at the 2015 AOPA National Assembly about a recent review of stance control orthoses. “What we found is there is reasonable evidence that patients who have the capabilities to use stance control orthoses benefit in comparison to a locked KAFO by the use of free swing and the reduction of compensatory movements, such as hip hiking, circumduction, and vaulting,” said Kannenberg. “We also found in the studies reduced metabolic energy consumption, reduced loading of the sound limb, and increased patient satisfaction.” Kannenberg also noted that identifying the most appropriate system for an individual patient remains a challenge. “Not all stance control orthoses available on the market are alike and a good solution for every patient.”

JANUARY 2016 | O&P ALMANAC

Darm has found that providing orthotic management for his IBM patients has led to demonstrable improvement in heel strike, in clearance during the swing phase of gait, and in knee stability. Patients earlier in the disease course who are fit with lightweight graphite AFOs may experience “much more confidence, so they can be active in the community and improve their quality of life,” he says. “Once these patients understand their medical condition, and you provide them with an orthosis in the early stages, they’re very pleased to learn they can have increased mobility and stability,” says Darm. Bedard says that in treating his patients who have IBM, he has been able to “highly impact these individuals in terms of changing their situation from a household ambulator to a community ambulator through the use of stance control technology.” Some patients with IBM “selfcensor their ambulatory ability,” says Bedard, often restricting themselves to household ambulation once they experience the initial trips and falls associated with the condition. While this is unfortunate, for some patients, “once you put them in orthoses, they may be able to go back out in the community and function quite well. From the standpoint of what we’re able to do with stance control orthoses, you may extend their ambulatory abilities for years.” Bedard says that many of his patients who have been fit with SCOs have remained more functionally stable for a prolonged period of time. He recalls the comments from the wife of one of his first IBM patients: “She told me, ‘Prior to getting the braces, we felt like prisoners in our home, but now we feel like we have gotten our lives back.’ So the orthotic intervention was a lifestyle change for this couple, to help them become participatory in their environment.” Ansari cautions that research on the efficacy of orthotic intervention for progressive myopathies is still in its infancy, and has hypothesized that the severity of the disease will determine

COVER STORY

SCOs are “vastly underutilized because they’re still considered investigational by many insurance companies, and I think that has to change. We have to make these technologies available to more patients than we have in the past.” —Andreas Kannenberg, MD, PhD

which SCOs will be most beneficial for different patient populations. She is continuing to collect data on this topic.

Evaluating New Patients

For those orthotists who do see patients who have IBM, keen evaluation skills are important. “IBM is a very different disease process, and orthotists cannot brace patients simply by looking at function,” Ansari explains. “You need to realize IBM is a progressive disease, so if you don’t brace correctly, you may contribute to worsening the disease.” “Clinicians need to use their assessment skills, measuring range of motion and muscle strength, and using gait observation—then determine what would be best for that patient,” advises Darm.

“When you fit orthoses on myopathic patients, it’s more about the clinical presentation,” explains Andreas Kannenberg, MD, PhD, executive medical director for North America for Ottobock. As a myopathy, IBM affects muscle without involving the nervous system. “Myopathies are muscle diseases, so the orthotist only has to consider flaccid paresis when bracing,” says Kannenberg. Patients with IBM “usually are not dealing with soft ligament issues or skeletal changes” like other typical stance control patients, such as stroke or spinal injury patients, says Bedard. With the IBM population, “you don’t typically find range-of-motion cessation, there’s usually skeletal alignment, and other health issues are typically pretty good,” he says. “It’s devastating as this ideology progresses, but for the time that we are effective as orthotists, I find that they’re fairly easy patients to manage.” Bedard lists several factors to consider when deciding how to brace IBM patients, including gender, age, height and weight, diagnosis and diagnosis comorbidities, orthotic history, current ambulatory capability, fall history, current rehab status, and occupation. It’s important to determine whether patients will need an orthosis primarily for household ambulation, or if they hope to return to work, requiring a higher level of function.

Physical examinations also are critical, including a center-of-mass assessment, “because it goes directly into how the componentry is activated,” says Bedard. He suggests noting whether patients arrive at a facility using a gait accessory, such as a cane, walker, or crutches. This will help determine whether patients will be able to maintain center of mass over their hip. “In general, you have to look at the capability of your patient, and the capability of your componentry,” as well as any documentation provided by a neuromuscular specialist, Bedard says. If it is determined that a stance control device will benefit a patient, orthotists must be aware of the different types of activation. Several mechanical component groups are available from different manufacturers that are suitable for application within the IBM population. “Some are weight activated, some are limb inclination, some are angle range of motion, and some are microprocessor control,” says Bedard. “As in any component selection, it is important to match the component performance to the physical limitations of the patient.” In some instances, says Bedard, total weight of the orthosis is the driving factor, while in other instances it is the ability of the component system to be utilized in stance control mode or static mode at the patient’s desire for safe operation. O&P ALMANAC | JANUARY 2016

COVER STORY

“I do think there are opportunities for orthotists to work with neurologists to explain how orthotic intervention can be beneficial to their patients.” —Thomas Darm, CPO, CPed

Kannenberg says the biggest challenge for the orthotist during component selection “is that different stance control orthoses use different mechanisms for locking and unlocking the knee,” and you have to match the best control mechanism with the individual patient. Some devices require some degree of residual ankle function to control the knee joint—which may be fine for most IBM patients, but patients with more widespread muscle weakness may need a different stance control orthosis. To determine the most appropriate device, “you need to have good knowledge of all of the patient’s needs and residual functions and all of the orthoses available,” says Kannenberg. Stance control orthoses with dampening systems may provide the most value for IBM patients, according to Ansari. SCOs with dampening systems “have some give in them when going from locked to unlocked and back,” which requires less effort from users

JANUARY 2016 | O&P ALMANAC

than systems that do not offer dampening. She hypothesizes that firmly locking SCOs may introduce more gait instability as a patient’s weakness progresses. Ansari is currently researching patient outcomes with both mechanical and microprocessor controlled KAFOs in IBM patients (see sidebar).

Reimbursement Challenges and Future Opportunities

While SCOs may be a good option in managing some IBM patients, Kannenberg notes they are “vastly underutilized because they’re still considered investigational by many insurance companies, and I think that has to change. We have to make these technologies available to more patients than we have in the past.” In general, there are many challenges in getting reimbursement for orthoses for patients with myopathies, especially for those devices featuring electronics or microprocessors. “Insurance companies may be reluctant to pay for a device that a patient will progress out of in a year or two,” says Kannenberg. However, because the progression of muscle weakness in IBM patients is fairly slow, and because the disease usually does not affect hip muscles until later during the disease course, there is more hope that reimbursement may be covered for advanced orthoses for IBM patients, says Kannenberg. While bracing will not be effective or recommended for every patient with IBM, orthotists should strive to become more educated about the disease and be aware of how orthotic intervention may help patients in the early stages. As the baby boomers age, the IBM patient population seems to be

growing, says Bedard. To be effective in returning these patients to productive lifestyles, it’s important to spread the message to both physicians and consumers that orthotic intervention may be a game-changer. Darm and Bedard believe that too few people are aware that orthotic intervention can improve their quality of life. “There are a lot of people who have weakness in their lower extremities who could benefit from orthotic management, but many do not receive an orthosis,” says Darm. He notes that when he is out in the community, he observes “many people who have high-steppage gait and foot drop, whether due to IBM or for some other reason, have no orthotic intervention.” He adds, “Any time we can help the public at large for any kind of physical limitations they have, it would be a great service to the patient.” Darm recommends reaching out to the IBM community and physicians: “I do think there are opportunities for orthotists to work with neurologists to explain how orthotic intervention can be beneficial to their patients.” Bedard suggests that O&P practitioners inform their referral communities about orthotic intervention for the IBM community. The Myositis Association, myositis.org, also serves as a resource for information about the disease and offers contact information for patient advocacy groups and local meetings. “Orthotists can check whether the association lists any physicians or rheumatologists associated with their local area, and reach out to them” to partner in treating IBM patients, says Bedard. Of course, it’s important to remember that scientists are in the early stages of learning which orthoses may be most beneficial to patients who have IBM. As more researchers study the efficacy of bracing on this patient base, orthotists will learn more about how their expertise may contribute to a solution. Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.

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By CHRISTINE UMBRELL and JOSEPHINE ROSSI

CONSUMERISM and

Is an educated patient really your best customer? NEED TO KNOW: • Recent studies of the U.S. health-care climate indicate health-care consumerism is on the rise, with more patients researching their medical options and demanding increased control over their treatment plans. • While many O&P professionals say the shift to a customer-service orientation has not yet taken hold in the orthotics and prosthetics profession, some see a definitive increase in the number of patients who arrive at a facility prepared with research and device questions. • Properly informed consumers can be assets to the profession because they understand the value provided by the O&P facility beyond the device they receive, but misinformed consumers may have unrealistic expectations regarding the purpose of O&P intervention.

JANUARY 2016 | O&P ALMANAC

• O&P providers can help educate interested consumers by providing accurate information and involving patients in the decision-making process during office visits. • Some practitioners believe increased consumerism may help elevate the profession, because well-informed consumers are the best advocates for change when communicating with insurance companies and legislators. They also will help push the profession toward increased outcomes measurement. • O&P facilities that embrace a consumerdriven health-care model can differentiate themselves by taking advantage of new technologies and adopting strategies to capitalize on a more educated patient base.

T SHOULD COME AS no surprise to O&P professionals that “health-care consumerism” has been named one of the top 10 health industry issues of 2016 by PwC’s Health Research Institute. The rise of consumerism in the medical arena has been making headlines, as more individuals seeking health care are presented with greater choices and outside influences. Access to health-care information via websites, social media, patient portals, and performance scorecards has grown considerably over the past several years, with consumers becoming more reliant on technology to answer their medical questions, according to research conducted by the Deloitte Center for Health Solutions. Many of today’s patients hope to partner with their providers rather than depend on them to make their health-care decisions. What’s more, today’s patients are bearing a more significant share of medical costs, such as rising premiums, deductibles, copays, and coinsurance. Understandably, they are taking a greater interest in where their money is going and how it is being spent. Many patients research their treatment plan before and after seeing a clinician, and they increasingly offer suggestions and seek meaningful involvement in decision making. As patients become more educated, health-care providers must adapt by working with them to answer their questions and explaining each step of the treatment process. Those healthcare businesses that understand and embrace the new climate will be best positioned to succeed in the long term, as patients continue to demand that their voices be heard, or choose to go elsewhere. While many O&P professionals say the shift to a customer-service orientation has not yet taken hold in the orthotics and prosthetics profession, some see a definitive increase in the number of patients who arrive at a facility prepared with research and device questions. As more patients demand greater control over their care, O&P facilities will need to adapt their practices to better meet their expectations.

Insurance Trends Spark Comparison Shopping and Paying O&P facilities must be prepared as employers move away from traditional insurance coverage for employees and adopt “defined contribution” (DC) plans instead, says Michael Lovdal, PhD, a health-care expert and emeritus partner at Oliver Wyman. Ultimately, “about half of all employers will move to some type of a defined contribution plan,” predicts Lovdal, who spoke at the 2016 AOPA Leadership Conference. With DC plans, employers give each employee a fixed dollar amount he or she may choose how to spend on health care. Typically, employees are allowed to use their DC plans to reimburse themselves for individual health insurance costs. Instead of pursuing treatment purely based on the coverage offered by an assigned insurance company at a facility under that insurer’s umbrella, patients with DC plans will have unlimited choices—but limited dollars. That should lead to much savvier consumers considering their health-care choices. To attract and retain patients once this shift takes hold, O&P businesses will need to “think like most other consumer service businesses,” Lovdal says. “We’ve got to think about how our consumers are different, and tailor offerings to the needs of each segment.” Facilities also will need to rethink their payment options for patients—and should recognize that many consumers will prefer using new technologies such as Apple Pay to pay their medical bills as they do their other bills. O&P facilities that want to meet these expectations should consider offering mobile payment options so patients can pay for their pay copays, deductibles, noncovered products and services, and outstanding balances. Practitioners should look at their payments systems and consider whether they are offering flexible choices. One health-care payments network, InstaMed, recently announced that Apple Pay is available to its customers, and customers can now pay via iPhones and iPads. “Consumers are increasingly using Apple Pay to make payments because it is simple to use and easy to understand,” says Chris Seib, CTO and co-founder of InstaMed. “Consumers can easily save their payment cards to their Apple mobile device and quickly make payments with their payment cards at their convenience.” O&P facilities of the future will need to be highly tuned into the needs of their patients in all arenas. “Recognize that consumers will have a fair amount of discretion in how they spend their money,” Lovdal says. “Start building consumer loyalty—especially with younger patients”—so they choose your facility as their options open up.

Current Consumers

At today’s O&P facilities, practitioners are noting that consumers are better informed than in years past. Patients are “coming in more proactive than they have ever been,” says Kevin Carroll, MS, CP, FAAOP, vice president

of prosthetics for Hanger Clinic. “Consumers are taking more ownership of their health care, and this is having a positive effect on outcomes.” Ron Manganiello, founder and CEO of New England Orthotic & Prosthetic Systems (NEOPS), says he has seen O&P ALMANAC | JANUARY 2016

the O&P profession as with similar orthopedic or neurologic “an increase, but not a they often have unrealistic presentation and are disappointed surge,” in patients who have expectations regarding when they are unable to function in a done their homework. “We similar manner,” he says. “Consumers see it for the most part in the purpose of O&P can have high demands and high those branches that are in intervention.” expectations; however, those demands more affluent communities.” It’s essential that have to be realistic in nature.” His observation reflects a patients understand the Still, the O&P profession is not more general health-care value provided by the O&P Kevin Carroll, MS, nearly as besieged by patient demands trend: Higher-income facility beyond the device CP, FAAOP as other health markets such as pharmagroups are more engaged they receive, including the than lower-income groups, service provided by certiceuticals, says Anita Liberman-Lampear, reflecting differences in access, awareMA, administrative director of orthotics fied practitioners in fitting patients and prosthetics for the University of with appropriate devices. “When the ness, and education, according to poorly informed patient arrives at home Michigan Health System and AOPA pastDeloitte’s 2015 Survey of U.S. Healthpresident. “People do not see a cool with their orthosis or prosthesis, they Care Consumers. knee prosthesis advertised on TV—as place a value on the [device] only, and Deloitte also discovered that they would a drug—and go to a practinot the services provided. In contrast, younger consumers tend to be more the well-informed consumer places highly engaged than older generations. tioner and say, ‘I want that.’” Staff at Eschen Prosthetic and Orthotic value on both the [device] as well as She agrees, however, that news the service,” says Kuffel. Labs have found this to be true, with articles and other media do have influyounger patients requesting more ence, especially when they highlight involvement in their care, says Alex cutting-edge innovations, Challenges and Meyers, MA, director of operations and she cites stories of the Opportunities and innovation. But Manganiello notes Boston Marathon bombing One advantage of working that many senior patients also arrive victims who were fitted with informed patients is armed with information, “because of a with new high-tech legs as that they become much lot of geriatric patients have caregivers one example. The challenge more involved in their own who are extremely educated.” care, says Manganiello. comes after patients see The shift to more patient-driven “An educated consumer is these stories, research health care may result in patients who not just aware of products, the manufacturer, and Anita Libermanhave a better understanding of what they’re knowledgeable about Lampear, MA decide they want the orthotic and prosthetic care is all how those products work same prosthesis—but their about. “Today’s patients are coming in and the science behind them,” he says. insurance won’t pay for it. That’s why as informed consumers; they are doing They also may be more aware of their it is incumbent upon practitioners to their homework before they ever enter condition and their prospects, as well be up on not only the latest devices, our clinic doors. They know they have as how treatment will likely proceed. but also insurance coverage, which is to get approval for orthotic and prosBut some patients who have done the primary market driver along with homework may have been exposed physician referrals. thetic devices, and this collaboration to misinformation, and this can be a Many patients are not a good fit is helping us in the delivery of quality challenge for O&P providers. “Our for an advertised device because they care to them,” says Carroll. primary responsibility to our patients have other issues, aside from insurance “Properly informed consumers are is to educate them on the recomcoverage. “If a patient loses a limb or an asset to our profession as these has other orthopedic or neurologiconsumers understand the goal of O&P mended orthosis or prosthesis, which intervention. These well-informed is frequently contradictory to the cal issues secondary to a disease, the consumers are well-versed in what information they have received from presentation is an outward manifestathey may need and have realistic advertisement sources,” says Kuffel. tion of the disease process. There is no expectations regarding functional He notes that some media outlets can ‘golden’ orthosis or prosthesis that will outcomes,” says Charles be misleading, showcasing cure all of a patient’s ailments,” Kuffel Kuffel, MSM, CPO, FAAOP, high-level athletes or other says. But through clinical education, a president and clinical individuals who are in othpatient can begin to have more realistic director for Arise Orthotics expectations of the benefits and limitaerwise good health. “Many & Prosthetics Inc. and chair of the patients serviced by tions of O&P intervention. of the National Commission O&P providers have numerMeyers notes that when a patient on Orthotic and Prosthetic arrives at his facility with a preconceived ous health problems and Education. Poorly informed comorbidities that result idea of what he or she wants or needs, consumers, on the other in limited function. These “we make a concerted effort to underCharles Kuffel, MSM, hand, “are a detriment to patients see a young athlete stand their goals and perspective.” CPO, FAAOP 30

JANUARY 2016 | O&P ALMANAC

will help break down the experience.” Clark encourages providIf a different solution is barriers imposed by the ers to create a “culture of care profesmore appropriate, staff at government and regulatory sionalism” within O&P facilities. “Every the facility try to present agencies regarding interaction should move the patient and the alternative “transpartheir family positively through their ently, by clearly articulating device coverage for rehabilitative journey, from the first the clinical rationale, and specific patients. request of information through billing Clark also believes conby providing resources they and follow-up.” can review on their own sumerism will play a part Alex Meyers, MA Meyers believes that O&P providers terms and time,” he says. in the accrual of outcomes The best way to handle misinformed data that will prove the efficacy of O&P who embrace a consumer-driven patients is to provide accurate inforcare to payors. “With consumers drivhealth-care model can effectively differentiate themselves by marketing ing the effort to ensure accountability, mation, according to Carroll. “We all a unique value proposition directly find things online that we think may be our profession will be compelled to to their patients, as well as capture the latest, and greatest, but if we can measure outcomes,” he says. “These find someone who can educate us on measurements will in turn help us ancillary revenue streams by diversifythat particular product or service as prove the value of the care we provide, ing their products lines. “At Eschen, it relates to us and our needs, we can as well as the value of new emerging for example, we actively market make better, more informed decisions,” techniques and technologies. several interdisciplinary specialty he says. “It’s our job as clinicians to “As a profession we will continue programs that we’ve built around educate the patient on what is going to expand the level of care we can sports medicine, prosthetics, and to be most beneficial to them and their provide, but it will be the consumer pediatric care,” he says. “We’ve also specific needs”—and to keep that infor- who refuses to accept substandard launched an e-commerce marketplace care that helps us prove that has opened the door mation as objective as possible. its value,” says Clark. to new customers and new “Consumerism will referral sources. Equally Positive Results compel us to measure the important, we survey every Some practitioners believe the rise impact we have on the single patient and intervene of consumerism may be just what is lives of those we serve, immediately if there are any needed to effect constructive changes and the consumer will issues or concerns.” for the O&P profession—if consumers carry our message.” Ultimately, most O&P are properly educated. Knowledgeable professionals agree that patients can speak to the benefits of Ron Manganiello consumerism in O&P will continue to proper O&P care without bias. “WellDemonstrating Value take hold, and adopting strategies to informed consumers are the best Going forward, experts expect that capitalize on a more educated patient advocates for insurance and legislative more educated O&P consumers who base may be the best approach. “The change, and their input and proactive are taking on increased financial O&P industry should rise right alongtendencies help to promote positive responsibility for their medical costs outcomes,” says Kuffel. “The consumer will continue to seek value for their side the consumerism movement,” can speak first-hand as to the necessity health-care dollars. O&P facilities hop- says Carroll. of properly trained and certified O&P And as has always been the case ing to gain new patients will be more professionals and the benefits that successful, says Manganiello, if they in O&P, it will continue to be importhese professionals provide regarding are attractive, efficient, and modern, tant to build solid provider/patient improved function, and a return to a with a knowledgeable front-office staff relationships: “If you build a strong ‘new normal’ following an orthopedic and skilled clinicians. relationship with your patient, they or neurological issue.” In addition to browsing O&P facility will stay with you forever,” Carroll As new techniques and technolowebsites and Facebook pages, consumsays. “I don’t think there is anywhere in the health-care world where there gies become available, consumerism ers are “using ratings and rankings to is as strong of a relationship with the can lead to increased choice, value, make their decisions now, and are makand quality of life for O&P patients, ing decisions based on other consumers’ patient/caregiver as there is in the orthotics and prosthetics industry.” says Dennis Clark, CPO, reviews,” says Clark. “With founder and partner at the immediate access to techLimb Lab, president of nology, consumers can not Christine Umbrell is a staff writer Clark and Associates only access online reviews and editorial/production associate Prosthetics and Orthotics, but can also post their own for O&P Almanac. Reach her at and president of Orthotic instantaneously. Your posted cumbrell@contentcommunicators.com. and Prosthetic Group of reviews are not solely based Josephine Rossi is editor for O&P America. He hopes the on the care provided by the Almanac. Reach her at jrossi@contentconsumerism climate prosthetist, but on the overall communicators.com. Dennis Clark, CPO O&P ALMANAC | JANUARY 2016

COMPLIANCE CORNER

By DEVON BERNARD

Breach Etiquette Follow HIPAA’s rules for making notifications once a breach has occurred

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 34 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

HE CHANGES TO THE Health Insurance Portability and Accountability

Act (HIPAA) that took place in 2010 and late 2013 have made an impact on O&P—especially with regard to the occurrence of breaches of patients’ protected health information (PHI) and individually identifiable health information and the requirements of notifying the appropriate entities of those breaches. Under HIPAA, practitioners have the burden of proving compliance with the Breach Notification Rule and proving that all of the required notifications have been made. This month’s Compliance Corner reviews who must be notified of breaches and when those notifications must be made. A “breach” means the acquisition, access, use, or disclosure of PHI in a manner not permitted under the HIPAA Privacy Rule, which compromises the security or privacy of the PHI. Impermissible use or disclosure of PHI will be presumed to be a breach unless it is demonstrated or documented through a risk analysis that there is a low probability that the PHI has been compromised. Identifying when a breach occurred and how many individuals have been affected is key to determining which type of notification a health-care professional is required to make. Below are explanations of the four types of notices and the timeframes during which the notifications must be made.

Notices to Individuals

E! QU IZ M EARN

BUSINESS CE

CREDITS P.34

JANUARY 2016 | O&P ALMANAC

You are required to notify each individual patient when a breach of his or her PHI has occurred and has been discovered, regardless of the number of individuals affected by the breach. A breach is considered “discovered” on the date you learn of the breach, and not on the date the breach actually occurred. The approved, and primary, method of notification is a written notice via first-class mail. However, it also is acceptable to use email if a patient has given you permission to contact him or her via email. Regardless of the method, the notification must be made within 60 days of the discovery of the breach. What type of information must you include in the written notice? First, include a brief description of

the breach, describing the types of information that may have been involved in the breach. For example, did the breach include the individual’s name and Social Security number, or did the breach only include his or her name and birthdate? Be sure to clarify when the breach may have occurred. Second, explain what you are doing in response. Describe what you are doing to investigate the breach, and what you are doing to limit the harm to the patient. You may want provide details regarding what you will do to prevent future breaches. Next, describe what the affected patient may do to limit the potential harm from the breach. This may include suggesting that the individual contact his or her banks and credit card companies,

COMPLIANCE CORNER

or monitor his or her credit score. Finally, include contact information for the individual within your company the patient may contact with questions. The contact person should be your compliance officer or a staff member with knowledge about breaches and HIPAA. If the breach was the result of or included one of your business associates, offer contact information for that business associate. What if your contact information for affected parties is out of date? In situations where you have inaccurate or out-of-date information, the method you must use to attempt to contact the affected individuals depends on the number of individuals for which you have incomplete, inaccurate, or out-of-date information.

If the breach included 10 or more people for whom you do not have sufficient contact information, you must post a notice on your website for at least 90 days indicating that a breach has occurred and asking patients to contact you to learn if their information was involved (the notice does not need to list the individuals affected). You also may provide a notice to the media—a local newspaper or TV station in the area in which you believe the individual resides—and should include a toll-free contact number. If you have out-of-date contact information for fewer than 10 individuals, then you may contact the affected individuals via telephone or any other means of contact at your disposal, such as email or text messages.

Notices to Media

While you are not required to notify the media for each individual breach that occurs at one of your facilities or offices, you must notify the local media if you experience a breach that includes or has the possibility to include more than 500 individuals. “Local media” includes TV, radio, and newspaper offices in the area where the affected individuals live. The most effective way to accomplish this notification is to create and distribute a press release to the appropriate media channels. The press release should include all of the information you would have provided in the individual written notices discussed above. As with the individual written notices, the notification to the media must be made without any delays and in no case later than 60 days following the discovery of a breach involving more than 500 individuals.

Notices to HHS

How and when you must notify the secretary of the Department of Health & Human Services (HHS) depends on the number of individuals affected or possibly affected by the breach; as with the requirement of notifying the media, the magic number is 500. If a breach affects less than 500 individuals, you must notify the secretary of the breach within 60 days of the end of the calendar year in which the breach was discovered. This means that any breaches involving

less than 500 individuals that occurred and were discovered in 2015 must be reported to the secretary by March 1, 2016. You are not required to wait until the end of the year to report the breach or breaches to the secretary; you may report them as they occur. The notification must be completed electronically via the breach portal on the HHS Office of Civil Rights website: https://ocrportal.hhs.gov/ocr/ breach/wizard_breach.jsf. Have the following information ready when accessing the portal: when the breach occurred, when it was discovered, what was breached, what you did to correct the breach, and what steps you took in notifying the patients. If the breach affects more than 500 individuals, you must notify the secretary immediately and without any unreasonable delay, but in no case later than 60 calendar days from the discovery of the breach. Use the same breach portal discussed above.

Notices to Business Associates

If you are acting as or considered a business associate (BA) to another covered entity, then you also may be required to notify individuals of a breach, if the covered entity has delegated this responsibility to you under your business associates agreement. If this is the case, you would follow all the breach notification protocols discussed above. If the individual notification duties were not delegated to you as a BA, you O&P ALMANAC | JANUARY 2016

COMPLIANCE CORNER

would, at a minimum, be required to notify the covered entity that a breach has occurred and that you discovered the breach. You must provide this notice to the covered entity without any delays and no later than 60 days from the day you discovered the breach. Your notification should include the identification of each individual affected by the breach, and any other information the covered entity may need as part of its notification to the individuals affected by the breach; this may include what type of information was breached, what is being done to correct the breach, etc.

Record Keeping

Documenting Disclosures

It’s important to know what to do if you need to document and demonstrate that a breach did not occur and that a proper notification was not required. First, your risk assessment should demonstrate a low probability that PHI has been compromised by impermissible use or disclosure. A valid and basic risk analysis should include the following steps: • Examine the unauthorized person who used the PHI or to whom the disclosure was made. Is the person/ entity required to follow HIPAA? • Determine if the PHI was actually acquired/viewed. Was the information encrypted? • Evaluate the type and amount of information that was accessed, used, or disclosed and the nature and the extent of the PHI. Is it sensitive information—for example, Social Security numbers? What type of information was disclosed and used—for example, clinical information? • Establish the extent to which the risk to the PHI has been mitigated. Were there corrective steps taken to stop future or further disclosures? Second, in addition to a low probability that PHI has been compromised, there are three exceptions to the definition of breach that would not require you to make a notification. The first exception applies to the acquisition, access, or use of PHI by any employee, if such acquisition, access, 34

JANUARY 2016 | O&P ALMANAC

or use was made in good faith and within the scope of authority granted to the employee, and does not result in further use or disclosure in a manner not permitted by the privacy rule. An example of this would occur if your biller pulls the wrong file of a patient by mistake. There is no breach because the access of the file was done during routine work under his or her authority and did not result in any further uses or disclosures. The second exception applies to the inadvertent disclosure of PHI by an individual otherwise authorized to access PHI at a facility operated by a covered entity or business associate to another person at the same covered entity or business associate, or at an organized health-care arrangement in which the covered entity participates, and the information received as a result of such disclosure is not further used or disclosed in a manner not permitted under the privacy rule. For example, this exception would apply if you send a detailed prescription to the wrong referring physician, you realize what occurred, and you correct the action—and the PHI is not disclosed or used any further. There is no breach because all parties were authorized to view the PHI, and are bound by HIPAA not to disclose or use the PHI. The final exception applies if you have a good faith belief that the unauthorized person to whom the impermissible disclosure was made would not have been able to retain the information.

Since you have the burden of proving you are compliant with the Breach Notification Rule and that all of the required notifications have been made, or that a breach did not occur and a notification was not required, consider creating and maintaining a record, or log, of all breaches or suspected breaches that may have occurred during any calendar year. Your log may include the results of your risk analyses, the dates that any breaches occurred or the date you discovered the breaches, a description of the breaches, the number of individuals affected, a description of who was notified of the breaches, and all actions taken to correct the breaches. This type of log will be helpful when you make your yearly report to the secretary of Medicare. Keep in mind that you must meet certain administrative requirements to be considered compliant with the Breach Notification Rules. For example, you must have in place written policies and procedures regarding breach notifications, you must train employees on these policies and procedures, and you must develop and apply appropriate sanctions against workforce members who do not comply with these policies and procedures. Adhering to the Breach Notification Rule can take a lot of time and documentation, but protecting your patients’ privacy is well worth the extra work. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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MEMBER SPOTLIGHT

South County Artificial Limb and Brace

All in the Family Northeast facility celebrates long tradition of treating community and VA patients

Josh James, BOCPO, CPO, fits a patient for a new Symes-type prosthesis.

Josh James, BOCPO, CPO, in front of the main office in Wakefield, Rhode Island

FACILITY: South County Artificial Limb and Brace LOCATIONS: Wakefield and Woonsocket, Rhode Island, and Plainfield, Connecticut OWNERS: Robert James, CPO, and Lois James

Josh James, BOCPO, CPO, modifies a cast for a solid ankle-foot orthosis. 36

JANUARY 2016 | O&P ALMANAC

HISTORY: 40 years

The composition of its work also has shifted during that time, with the proportion of prosthetics rising from about 15 percent to 40 percent of SCAL’s total workload. Typically, Josh James will consult with amputation patients before surgery and follow them regularly afterwards, using test sockets to monitor residual limb shrinkage. “We have really good results by staying on top of any issues that might occur,” he says. James notes that a local wound care center recommends SCAL because none of the facility’s amputees wind up there with problematic wounds. “We really want to be ahead of the curve, before a problem exists,” says James. James is a believer in hand fabrication. SCAL rarely uses computeraided design and manufacturing. “We use a scanner for some orthoses and above-knee prostheses, mostly just to get me started. I really do enjoy the hands-on.” Other than the Arizona gauntlet and knee braces, James and his technician conduct all fabrication in-house.

James teaches in addition to his clinical work. He lectures at the University of Rhode Island to graduate physical therapy students, where he discusses socket designs, levels of amputation, and various wrapping techniques. He also teaches in the physical therapy assistant program at the Community College of Rhode Island, often bringing students into his lab to observe fabrication techniques. “I try to give them as much information as I can so they understand what the O&P clinicians are doing, and answer questions if needed.” Like all O&P facilities, SCAL struggles to stay on top of documentation. “I have three staffers devoted to documentation issues,” says James. “We were having problems getting codes from doctors before, and now they’re dealing with ICD-10 [the new version of the International Statistical Classification of Diseases and Related Health Problems]. But we use a physiatrist to document all K levels for our prosthetic patients, and it seems to be working out well.” SCAL has dropped its marketing efforts for the time being. “We’re swamped,” says James. “We are on the verge of hiring another clinician, but for now, we have all the business we can handle.” James credits SCAL’s personal approach for the facility’s success. “We are a family-run business, and we make a point of treating all our patients like family. They trust us, and we take pride in what we do,” he says. “I am very thankful that my father taught me hand skills from a young age and gave me the abilities needed to continue to grow his business.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: South County Artificial Limb and Brace

OBERT JAMES, CPO, and his wife, Lois, founded South County Artificial Limb and Brace (SCAL) in 1976, with Robert as clinician and Lois as office administrator. They launched the new company when Robert concluded his involvement with the three-year Boston Interhospital Amputee Study, a Department of Veterans Affairs (VA) investigation that followed amputees from surgery to permanent prosthesis. He administered the study in partnership with surgeon Richard Warren, MD, of Massachusetts General Hospital. Forty years later, South County Artificial Limb is still thriving. The founders’ son, Josh, became clinical director in 2006. The facility is headquartered in Wakefield, Rhode Island, with satellite offices in Woonsocket, Rhode Island, and Plainfield, Connecticut. Most patients come from three local hospitals, including a VA hospital in Providence, Rhode Island, which accounts for “a good 30 to 40 percent of our work,” says Josh James, BOCPO, CPO. SCAL has grown in the past five years: Its three-person staff has expanded to include two office administrators, a billing expert, and a lab technician.

By DEBORAH CONN

National Partnership. Local Identities.

BCP Group is pleased to announce the newest partner in our expanding national network of high-quality O&P practices. Clinic Support Operations BEACON

Prosthetics & Orthotics

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New Member Clinic: BCP Group is an O&P management company based in Nashville, Tenn., dedicated to enhancing the viability of the independent, clinician-driven O&P practice model. We make ownership investments in high-quality clinical practices and then provide behind-the-scenes business support and resources that enable our partners to focus on patient care and practice growth.

Visit bcpgroup.net for more information about BCP Group and partnership opportunities.

MEMBER SPOTLIGHT

Vorum

By DEBORAH CONN

Technology for O&P Fitting Canadian company designs scanners and carvers for O&P

Vorum offers digital design solutions for prosthetics and orthotics.

ARL SAUNDERS HAD TWO

JANUARY 2016 | O&P ALMANAC

Carl Saunders and Ed Grochowski

COMPANY: Vorum LOCATION: Vancouver, Canada OWNER: Carl Saunders HISTORY: 26 years

the O&P industry, makes use of blue-light technology, enabling greater speed and accuracy, according to Vorum. The device is highly portable and needs only to be plugged into a laptop computer to start scanning. The two most popular carvers from Vorum are the three-axis carver and the robot carver, says Saunders. Introduced in 1995, the three-axis carver is able to produce a large spinal mold with a smooth-surface finish in under 20 minutes, reducing turnaround times for O&P facilities, according to the company. The seven-axis robot carvers are designed specifically for orthotics and prosthetics. They are able to carve a wide range of materials, from polyurethane foam to end devices in soft foam and ethylene vinyl acetate, and produce a wide array of devices. Vorum’s systems are installed in more than 35 countries, with the largest networked CAD/CAM installation at Shiners Hospitals for Children. The system will soon include five central fabrication centers to serve more than 22 hospital-based O&P departments. Saunders believes Vorum’s connection to customers gives it

PHOTOS: Vorum

interests when he was young: engineering and medicine. He found a way to combine these disciplines in developing computeraided design (CAD), and later computer-aided manufacturing (CAM), for the orthotics and prosthetics industry. In the late 1970s, Saunders worked at the University of British Columbia in Vancouver with Jim Foort, the first scientist to apply computer technology to prosthetic fitting, says Saunders. Initially, Saunders focused on design software, creating the Canfit prosthetic fitting system in 1986. In 1989, a Swedish company requested design technology for medical footwear. “That was the year of our big break,” says Saunders, who founded Vorum that year. “We developed foot scanners, carvers, and then full systems after that.” Today, Vorum occupies a 10,000-square-foot facility in Vancouver that houses both its headquarters and a state-of-the-art research and development center. The company produces a range of CAD/CAM tools for orthotists and prosthetists, including 3D scanners, computeraided shape modification software, and automated carvers. Its products include the scanGogh II and Spectra hand-held 3D optical scanners, and three-, four-, six-, and seven-axis carvers. In the past, the laser-based scanGogh line was hugely successful for Vorum, says Saunders, but demand for the next-generation Spectra is now taking over. The Spectra, which is the first optical scanner to be designed and built specifically for

a competitive edge. “One of the reasons we are still here is our training and customer support,” says Saunders. “We hold the customers’ hands, from the buying decision until they have successfully met their objectives with our products.” Such objectives can range from providing medical justification for replacing a socket, with evidence that the residual limb has lost volume, to improving productivity as a way to survive declining reimbursements. “We identify where the pain is for our customer, and we put together a training program based on their ‘why’ to invest. We make sure they achieve what they really want to,” he says. Vorum delivers this support in person through on-site training programs, on the telephone, or online. Saunders emphasizes that computer-aided design and manufacturing does not have to be prohibitively expensive. Scanners are smaller and more portable now, and clients can rent the software on a per-use basis rather than purchasing it outright. He is optimistic about the growing trend toward digital fitting and production. “When we first started, no one wanted to get rid of plaster. They trusted their hands, not the scanner. Today, practitioners are realizing that scanning offers the same, accurate shape every time, no matter which clinician is using it.” The system also allows users to input modifications created by expert prosthetists or orthotists that can be replayed when needed. “I did a calculation earlier this year,” says Saunders. “Every 90 seconds, someone, somewhere in the world, is being fitted with our technology. My goal is to make that one patient every second.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

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AOPA NEWS

Prepayment Reviews: What You Need To Know To Pass Register for the January 13 Webinar

Take Part in AOPA’s First Coding & Billing Seminar of 2016 January 25-26, Tampa, Florida

3 RACs have restarted. 3 The fee schedule has been reduced. 3 Prior authorization has been implemented

Prepayment reviews are not the same as recovery audit contractor audits, but they can be just as intimidating. Learn the ins and outs of prepayment reviews, and find out the best way to approach them, during the January 13 webinar: “Prepayment Reviews: What You Need To Know To Pass.” The following topics will be covered: • Learn about the prepayment review process and how it differs from other audits. • Examine the current results of ongoing prepayment audits. • Find out what type of information the durable medical equipment Medicare administrative contractors are seeking in the reviews, and make sure you are including the correct information. • Learn how to have yourself removed from the prepayment review list. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2016webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

for Medicare.

2016 will be a challenge...Give yourself a leg up by starting the year off with the AOPA experts. The Coding & Billing Seminar will teach you the most up-to-date information to advance your O&P practitioners’ and billing staff’s coding knowledge. Join AOPA in Tampa and benefit in several ways: • Receive up-to-date information on hot-topic issues. • Learn how to assess risk areas in your practice. • Learn successful appeal strategies and hints to avoid claim denials. • Practice coding complex devices, including repairs and adjustment. • Attend breakout sessions for practitioners and office staff.

Earn 14 CEs

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. In this audit-heavy climate, can you afford not to attend? Questions about registration? Contact rgleeson@AOPAnet.org. Questions about content? Contact dbernard@AOPAnet.org. Register now at www.AOPAnet.org/education/ coding-billing-seminar. 40

JANUARY 2016 | O&P ALMANAC

AOPA 365 Wherever You Go You used the AOPA app during the 2015 National Assembly—now you can use an AOPA app all year long! Download AOPA 365, AOPA’s new app that connects you with the important O&P-related information you need to help your business succeed. • Learn about AOPA. • Read the O&P Almanac. • See how membership with AOPA has its benefits. • Get current with “Hot Issues.” • Find out how Mobility Saves. • Visit the AOPA Bookstore. • Access the AOPA Membership Directory. • Connect with AOPA through social media. Download the app by scanning the QR code or by visiting www.tripbuildermedia.com/apps/aopa365.

AOPA NEWS

2016 Webinar Topics Released Mark your calendars for AOPA’s 2016 monthly webinars. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits—so you can still take advantage of the series discount and the valuable learning opportunities. Register for the complete 2016 series and get two free webinars! Members pay $990 and nonmembers pay $1,990, for the series. Register at bit.ly/2016webinars.

Have You Read the O&P Almanac’s Leadership Series? Find out what senior-level O&P professionals have to say about the most critical issues facing the O&P profession. Several 2015 issues of the O&P Almanac have featured a new Leadership Series, showcasing Q&As with O&P experts on targeted topics of importance to the profession. Visit www.aopanet.org/publications/op-almanac-magazine to access past issues of the magazine and read what executives have shared, in their own words, on these important topics: HOSPITALS—WHAT’S THE HYPE? Andrew Meyers, CPO; Jim Kingsley; and Rebecca Hast detail their success strategies. June 2015 O&P Almanac, page 34

2016 Webinars • January 13: Prepayment Reviews: What You Need To Know To Pass • February 10: SNF Billing: Beyond the Basics (The Ins and Outs) • March 9: Shift the Liability: The Proper Use of the Advanced Beneficiary Notice Form • April 13: Understanding Shoes, Mastectomy, & Other Policies

TECHNOLOGY SMARTS David Boone, PhD, MPH; Jan Saunders, CPO; and Stephen Blatchford share their insights. July 2015 O&P Almanac, page 36

LEADERSHIP SERIES

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

A Place in the

CONSOLIDATION Continuum?

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

• May 11: When Things Go Wrong: Making Lemonade Out of Lemons • June 8: Physician Documentation: How To Get It & How To Use It • July 13: Strategies and Levels: How To Play the Appeals Game • August 10: The Supplier Standards: Are You Compliant? • September 14: Fill in the Blanks: Know Your Forms • October 12: Knee Orthosis Policy: The ABCs of the LCD and Policy Article • November 9: Don’t Miss Out: Are You Billing for Everything You Can? • December 14: New Codes and What Lies Ahead for 2017

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

S O&P PROFESSIONALS GRAPPLE with reimbursement challenges and dwindling profit margins, it’s impossible to ignore the industry consolidation trends taking place within the greater health-care arena. The number of “independent” health-care providers across medical specialties is falling. In fact, the number of U.S. physicians in independent practice has dropped significantly, from 57 percent in 2000 down to 37 percent in 2013, with a predicted decline to 33 percent by the end of 2016, according to data published by Accenture. The same report finds that those independent physicians who have sold their practices or sought employment directly with health systems have done so largely due to disruptive market conditions, such as reimbursement pressures. Some of the independent physicians who have kept their practices are coping by experimenting with other models to remain competitive—for example, 17 percent of U.S. independent physicians are participating in accountable care organizations (ACOs). Today’s O&P practitioners are facing similar reimbursement challenges and increasing costs. Several independent O&P facilities have recently consolidated with larger O&P practices, or have aligned themselves with suppliers or distributors on the O&P production pathway. What do these consolidation and vertical integration trends mean for today’s typical O&P provider and the outlook for the O&P profession? O&P Almanac recently spoke with three O&P experts, who shared their insights on the current business climate and the pros and cons of industry consolidation.

Meet Our Contributors

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

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

Rick Riley is chief executive officer of Townsend Design in Bakersfield, California, a company with more than 150 employees. He worked in hospital administration before joining Townsend in 1995 as vice president of marketing, then took on duties as the company’s vice president of sales and marketing in 1997. He assumed the role of CEO in 2003.

PAM FILIPPIS LUPO, CO/LO:

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

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

O&P ALMANAC: What types of

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

LUPO: There are a number of differ-

ent ways O&P facilities are consolidating and being integrated into larger companies. For example, O&P companies are buying other O&P companies. Several O&P companies have made acquisitions, including Hanger, Wright & Filippis, Level Four O&P, and New England Orthotics and Prosthetics. Some O&P companies are combining with physical therapy. Some hospitals are buying O&P and durable medical equipment (DME) facilities. Some physician groups are acquiring prosthetists. On the manufacturing side, some manufacturers are working together,

or are working together with O&P as a provider, potentially under competitive bidding. There are numerous configurations. SOTAK: We’re seeing some consolidation on the patient-care side. Some larger regional players are looking to acquire other practices—facilities that are looking to get bigger for efficiencies of scale. For example, many organizations are feeling a need to hire compliance officers—but how can you afford to hire someone on staff as a compliance officer if you’re a two-person staff? So they’re looking to consolidate to justify hiring professionals necessary to consistently meet regulatory requirements. We’re also seeing consolidation at the manufacturer level, and I think we will see a lot more as manufacturers face new challenges in meeting expected financial performance. RICK RILEY: There is an emerging

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

38 SEPTEMBER 2015 | O&P ALMANAC

O&P—are vertically integrated to create increased synergy and efficiency. In some cases, a local O&P facility is purchased by a large medical provider, and in other cases the network is hiring in-house orthotists and prosthetists. Among suppliers and manufacturers, there is also increasing consolidation. The companies that have the financial capital to make acquisitions can amass a vast range of products. This creates a strategic advantage in terms of offering one-stop-shopping to group purchasing organizations and integrated provider networks. O&P ALMANAC: What types of opportunities do these mergers present for the O&P profession and its patients? LUPO: Mergers and acquisitions can

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

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

DISSECTING DISEASE TRENDS Thomas DiBello, CO, FAAOP; Phil Stevens, MEd, CPO, FAAOP; and Rudolf B. Becker offer their thoughts. October 2015 O&P Almanac, page 48

LEADERSHIP SERIES

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

Meet Our Contributors

LEADERSHIP SERIES

BROADENING

Our Scope

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

Meet Our Contributors

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

30 NOVEMBER 2015 | O&P ALMANAC

O EXPAND OR NOT TO EXPAND into the world of ancillary services? That was the question posed to four senior-level O&P executives for this month’s Leadership Series article. While some practitioners may believe it’s important to adhere to the core competency inherent in O&P—strictly defined orthotic and prosthetic services—others trust that tremendous opportunities are available to O&P business owners who broaden their scope of practice. Disciplines such as durable medical equipment, physical therapy, foot care, mastectomy services, and home remodeling are all possible areas of growth. Here, our experts share their personal thoughts and experiences related to offering additional services at traditional O&P practices, emphasizing that the only expansions that will succeed are those that are well researched, properly staffed, and reimbursable.

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

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

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

O&P ALMANAC: Why should O&P professionals consider including ancillary services as part of their practice? IVAN SABEL, CPO: As the landscape for O&P continues to evolve and change, it’s becoming more and more difficult to look at it as a pure orthotic or pure prosthetic business. Some people are navigating well around the headwinds that are affecting the profession; others are not faring as well. A pure O&P practice, which I define as a facility that solely offers custom orthotics and/or prosthetics, will continue to face reimbursement challenges as well as challenges with the orthotic and prosthetic codes. In this environment, ancillary services can be leveraged as bottom-line contributions to offset these challenges and the changes in the headwinds. ANTHONY FILIPPIS, CPO: There are a lot of synergies of products that patients need. O&P patients are coming into our facilities anyway, so we need to consider the items they may need as rehabilitative—when they can’t use an orthosis or prosthesis, or to use as additional support. For example, items such as canes, grab bars, bathroom aids, and raised toilet seats are examples of things that can make our patients’ lives better and easier. We need to be thinking: “What are the things that are going to help improve our patients’ lives?” MICHAEL TILLGES, CPO: Ancillary services provide the patients and referral sources a full-service facility—in essence, a “one-stop shop.” They also allow a facility to become better diversified, and to tap into different revenue streams and markets to increase profitability. JEFF LUTZ, CPO: Consider is the key word in this question. The possibility of adding services or product lines to an existing O&P practice is intriguing to many. However, owners will need to carefully consider the impacts the addition may have on their core business.

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

ability to identify and provide services to our patient population in a way that traditional business models outside of O&P don’t necessarily provide. Our referral sources come to us with one specific request—an orthotic or prosthetic device. But we need to look at patients in a much more holistic way; our patients need other services and products to continue to live their lives to the fullest. They come into our

facilities requesting just an orthosis or prosthesis, but they have a number of other needs in their treatment modality. By offering ancillary services, you’re contributing to a better quality of life for your patients, and you may make a profit to help offset some of the reimbursement and other recent challenges impacting O&P. FILIPPIS: I think it all ties to patient management. Sometimes we get tunnel vision and focus only on orthotics or only on prosthetics. But we have to look at the activities of the patient before and after they arrive at our facilities. We can meet some of their needs—either with ancillary services, or by serving as a resource. TILLGES: O&P’s core competency includes crafting and fitting of orthotic and prosthetic devices, as well as assessing the needs of the patient to provide appropriate products and services to better their life. O&P’s core asset includes the patients we take care of, our referral sources, third-party payors, and employees and staff members. By focusing holistically on the patients’ needs and providing them with the highest quality products and services, we enhance the quality of life for the patients we serve. O&P ALMANAC | NOVEMBER 2015

S THE O&P PROFESSION begins to collect patient data to demonstrate the effectiveness of orthotic and prosthetic intervention in restoring function— data that is increasingly important to payors—it’s a good time for O&P practitioners to take a look at those disease trends that are emerging from data generated by other health-care sectors. Many medical disciplines already have a vast array of patient information—data that could prove useful to orthotists and prosthetists as they consider patient demographics and set business plans. With reimbursement challenges on the rise and profit margins on the decline, it has become more important than ever for O&P businesses to understand which types of patients may be in greatest need of services in the near- and long-term future. Those O&P business managers and clinicians who follow disease trends will be best positioned to treat the patients most likely to visit their offices in the coming years. Here, O&P experts share their thoughts on the importance of following disease trends, such as diabetes and cerebral palsy, and offer suggestions for staying current on relevant medical advances.

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

48 OCTOBER 2015 | O&P ALMANAC

LEADERSHIP SERIES

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

DI SSECTING

DISEASE TRENDS

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

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

THOMAS DIBELLO, CO, FAAOP:

As we evolve as a profession, it’s important that we be very involved in understanding and appreciating the changes occurring in the diseases that we treat. For instance, if there were an effective way to completely cure diabetes, then there may be a diminished number of amputations for diabetes patients, and that would reduce the need for prosthetic devices for diabetic amputees. On the orthotics side, if physicians begin performing more prenatal intra-uterine surgeries to repair spinal insults that occur in unborn infants with spina bifida, and research shows that these patients are then more cognitively alert but still have neuromuscular limitations that require bracing, that may have an impact on orthotics treatments—and we would need to be aware that further advances could ultimately eliminate the need for those types of orthoses. One example of the importance of following disease trends can be seen in the case of a well-known rehabilitation hospital. During the course of a decade during the 1980s and ‘90s, the hospital transitioned from being primarily a spinal cord injury center to a hospital that primarily treats stroke patients. They were watching trends and recognized that the number of spinal cord patients was diminishing—mainly because the majority of spinal cord injuries occurred secondary to motor vehicle injuries. As cars became safer, there were fewer spinal cord injuries. A change in focus to stroke patients helped ensure the hospital’s longevity. We, as a profession, need to be equally aware of trends that may affect the work we do. PHIL STEVENS, MED, CPO, FAAOP:

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

services going to increase or decrease? For orthotics and prosthetics, disease trends constitute a big part of that forecasting. RUDOLF B. BECKER: It’s important to follow disease trends so the profession and the companies that supply practitioners can prepare for the future needs of patients and offer viable treatments to referral sources.

O&P ALMANAC: What do individual practitioners, or the O&P profession as a whole, need to do to ensure we follow disease trends? DIBELLO: I know there is a lot of uncertainty in the profession these days related to possible Local Coverage Determination (LCD) changes and downward pressures on reimbursement, but we need to devote human and financial resources within the O&P profession to look at these trends, as so many other professions do. In the past, we have not studied the changes occurring in general medicine related to our patients whose diagnoses

we encounter the most. At times, we have been caught by surprise. We have to face this as a profession. We know very little about these areas of medicine we are most affected by, and we are at risk of being caught in a situation for which we are unprepared. STEVENS: I think individual practitioners will continue to be dependent on larger entities within the profession to follow disease trends. Individual practitioners don’t have the time or means to access the kinds of data that tell those stories. However, organizations like AOPA and the Academy do. Journalists within the profession can also do so. Once these entities create secondary knowledge sources that summarize these trends, then it’s up to individual practitioners to consume them and include those findings in their decision making. BECKER: AOPA does a fine job of publishing data and the appropriate links in its biweekly AOPA in Advance Smart Brief and monthly O&P Almanac. They couldn’t be easier to access, and if you want more data, just use one of the search engines available online. O&P ALMANAC | OCTOBER 2015

BROADENING OUR SCOPE Ivan Sabel, CPO; Anthony Filippis, CPO; Michael Tillges, CPO; and Jeff Lutz, CPO, share their experiences. November 2015, O&P Almanac, page 30.

O&P ALMANAC | JANUARY 2016

AOPA O&P PAC

Special Thanks to the

2015* PAC Contributors

AOPA would like to thank the following individuals for their contributions in 2015 to the O&P PAC:

PRESIDENT’S CIRCLE ($1,000-$5,000)

SENATOR’S TABLE ($500-$999)

CHAIRMAN’S TABLE ($100-$499)

Michael Allen, CPO, FAAOP Vinit Asar Kel Bergmann, CPO Maynard Carkhuff J. Martin Carlson, CPO Charles H. Dankmeyer Jr., CPO Thomas DiBello, CO, LO, FAAOP Rick Fleetwood, MPA Sam Liang Anita Liberman-Lampear, MA Pam Lupo, CO Ted Muilenburg, CP, LP Walter Racette, CPO John Roberts, CPO Bradley Ruhl Scott Schneider Ronald Snell, CP Rick Stapleton, CPO Gordon Stevens, CPO, LPO Thomas Watson, CP Pam Young

Frank Bostock, CO James H. Campbell, PhD, CO, FAAOP Ralph Hooper, CPO Jeff Lutz, CPO Michael Oros, CPO, LPO Lisa Schoonmaker, CPO, FAAOP Jack Steele Frank Vero, CPO James Weber, MBA Eddie White, CP

Mehdi Arani Thierry Arduin Rudy Becker Jr. George Breece Daniel Busch, CO Erin Cammaratta Kenneth Cornell, CO Don DeBolt Joseph DeLorenzo, CP James Fenton, CPO Wesley Haygood, CP Robert Hellner, CPO Alfred Kritter, CPO, FAAOP Teri Kuffel, Esq. Eileen Levis David Mahler, CPO Brad Mattear, LO, CPA Wendy Miller, BOCO, CDME Catherine Mize, CPO Mark Porth, CPO Ricardo Ramos, CP, CPed, LP Jack Richmond Rick Riley David Ritchie, CPO, LPO Donald Shurr, CPO, PT Sean Snell Shane Wurdeman, CP, FAAOP, PhD, MSPO James Young Jr., CP, LP, FAAOP Claudia Zacharias, MBA, CAE

1917 Club (Up to $99)

JANUARY 2016 | O&P ALMANAC

Haley Branch, CPO Matt Carroll David Hughes Chris Nolan

AOPA O&P PAC

2015 PAC Supporters These individuals have generously contributed directly to a political candidate’s fundraiser and/or have donated to an O&P PAC sponsored event. Gordon Baker Kent Baker Tom Becker Rudy Becker Jr. Kel Bergmann, CPO Frank Bostock, CO Katie Brinkley Tim Bulgarelli, CPO James H. Campbell, PhD, CO, FAAOP Maynard Carkhuff Michael Carpenter Matt Carroll Rodney Cheney, CPO, FAAOP Ron Cheney Jeff Collins, CPA Thomas Costin John Cronin Michael Curtin Charles H. Dankmeyer Jr., CPO Don DeBolt Jehan de La Brosse Joseph Delorenzo, CP Thomas DiBello, CO, FAAOP David Dillon, CP Michael Dodd, BOCP, CO George Easton

Meredith Eaton David Edwards, CPO, FAAOP Kathy Edwards Diane Farabi Anthony Filippis, CPO Thomas Fise, JD Rick Fleetwood, MPA Zack Flores Professor Hans Georg Näder Elizabeth Ginzel, CPO Paul Gudonis, MBA Lisa Guichet Hanger PAC Robert Hellner, CPO James Kaiser, CP Jim Kingsley, COO Thomas Kirk, PhD Al Kritter, CPO, FAAOP Dixon LeGrande Eileen Levis Sam Liang Anita LibermanLampear, MA Pam Lupo, CO Jeffrey Lutz, CPO Sara Lutz Joe Martin Clyde Massey, CPO

Special Thanks

Sara McDonald David McGill Bill Moore, CPed Martin Moore Tina Moran-Carlson Schuyler Nelson Chris Nolan Tim O’Neill Michael Oros, CPO, FAAOP Michael Park Andrew Pedtke Walter Racette, CPO Rick Riley, CEO David Ritchie, CPed, CPO John Roberts, CPO Amelia Rosetta-Warren Brad Ruhl Scott Schneider Donald Shurr, CP, PT Christopher Snell Clint Snell, CPO Sean Snell Mike Sotak Karla Spero Jack Steele, CO, FAAOP Gordon Stevens, CPO Peter Thomas/PPSV PAC Frank Vero, CPO VGM PAC Amelia Warren

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

Monty Warren Tom Watson, CP, LP Jim Weber, MBA Ashlie White Eddie White, CPO Steve Whiteside, CO Shane Wurdeman, PhD, MSPO, CP, FAAOP Travis Young, CPA Pam Young James Young Jr., CP

* Due to publishing deadlines this list was created on Nov. 18, 2015, and includes only donations received between Jan. 1, 2015, and Nov. 18, 2015. Any donations received on or made after Nov. 18, 2015, will be published in the next issue of the O&P Almanac.

O&P ALMANAC | JANUARY 2016

MARKETPLACE

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The Unstoppable RUSH™ Foot Collection Virtually indestructible even in the most extreme conditions. Maintain a natural gait even in the most rugged or uneven terrain. One foot for all adventures. Water? Mud? Sand? No problem. Carbon feet can’t say the same. To learn what RUSH™ Foot is right for your patient, visit www.rushfoot.com. Online ordering is now available.

New AFO Gauntlets From Acor! A custom AFO gauntlet is prescribed to assist in stability and allow functional mobility without demanding excessive energy. For 2015-1016, Acor is offering a selection of our refined-design AFO gauntlets hand-made in our Cleveland, Ohio, facility. Also known as a “leather lacer,” and our most popular AFO gauntlet, the G9110 offers a choice of color, polypro reinforcement, and a leather or optional X-Static®-covered NeoSponge™ lining. See our ad this issue for information regarding our new Custom Products catalog, or just call Acor to get a copy.

ALPS Guardian Suction Liner The Guardian suction liner from ALPS features raised GripGel bands that grip the socket wall to form a secure interface between the socket and the liner to prevent slippage or premature release. These low-modulus GripGel bands stretch against the socket wall, while the inner wall conforms easily to the residual limb, to ensure there is no restriction of blood flow or stiffening to inhibit donning. No seams and a single-piece construction improve durability. Available in both transfemoral and transtibial models, the Guardian suction liner can be fully inverted for ease of donning. To accommodate for volume fluctuations, please use the ALPS Skin Reliever (ENCP) for continued use of same socket. For more information, contact ALPS, 2895 42nd Avenue N., St. Petersburg, FL 33714. Call 800/574-5426 or visit www.easyliner.com. 44

JANUARY 2016 | O&P ALMANAC

New Sure Stance Knee by DAW This ultralight, true-variable cadence, multiaxis knee is the world’s first four-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients. For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

DawSkin New Mega Stretch

DawSkin New MegaStretch is the most durable tear-free skin in the world. It is the ideal skin for your patient to shower on both legs (definitely the safer way). DawSkin MegaStretch provides the vertical ankle stretch required for multiaxis feet and energy restitution feet. “Heat-shrink” skins limit the ankle movement and will tear. DawSkin New EZ-Access dons on and off just like a sock yet provides all of the benefits of the DawSkin New MegaStretch. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the ground-reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

MARKETPLACE Introducing the Stronger, Smarter, Submersible Plié® 3 MPC Knee Stronger construction makes the new Plié 3 MicroprocessorControlled (MPC) Knee both submersible and more rugged than ever. Yet it’s still the fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees. With the most responsive stumble and fall protection, users can instinctively move at their own pace in any direction...even if it’s taking small, short steps or pivoting in confined spaces. And with a more streamlined, intuitive set-up, the Plié 3 MPC knee makes it even easier for prosthetists to help patients expand their freedom. To learn more about the Plié 3 MPC knee, contact Freedom Innovations at 888/818-6777 or visit www.freedom-innovations.com.

Freedom Foot Products Just Got Better

Now, with the broadest range of sandal-toe options available anywhere, you can focus first on performance and rest assured that your patient’s desire to wear sandals can be easily satisfied. Achieve improved clinical outcomes by delivering a product designed to meet your functional objectives. Whether it’s shock absorption, hydraulic ankle motion, heel height adjustability, or multiaxial ground compliance, the new sandal-toe product line delivers form and function—unrestricted. Choose from 13 high-performance designs: • Highlander® • Kinterra® • Pacifica® & Pacifica® LP • Renegade® & • Runway® & Runway® HX Renegade® LP • Thrive® • Agilix™ • WalkTek® • DynAdapt™ • Sandal-Toe Foot Shell • Sierra® Our second-generation Sandal-Toe Foot Shell is available in sizes 22-28 cm and in three different skin tones (light, medium, and dark). For additional information, contact customer service at 888/818-6777 or email us at info@freedom-innovations.com.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call at 800/301-8275 or visit www.hersco.com.

New Aluminum Components Our new line of aluminum pylons, adapters, and tube clamps is designed and tested to support up to a 300-lb weight limit while providing you with a cost-effective, high-quality solution. The line includes double adapters at various lengths, a 30-mm pylon, a 30-mm tube clamp, and a pyramid adapter. For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.

Polycentric Pneumatic Knee The key element of the new 3R106 Pro is the servo-pneumatic control unit. Its powerful dual-chamber pneumatic unit with progressive damping has a flexion valve set for the patient’s normal walking speed. At faster walking speeds, the flexion resistance increases, which prevents too much knee flexion. This helps provide more consistent swing phase even during fast walking. With three options for the proximal connection (pyramid, threaded connector, and lamination anchor) and a 275-lb weight limit, the 3R106 Pro offers you great fitting options. For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.

O&P ALMANAC | JANUARY 2016

MARKETPLACE Go Sleeveless with the Unity® Sleeveless Vacuum System by Össur® Elevated vacuum systems typically require a sleeve to maintain vacuum. The problem is, sleeves are bulky. They bunch behind the knee, restricting range of motion. They can also puncture, leading to a loss of vacuum. Building on established Seal-In® technology, the Unity Sleeveless Vacuum System by Össur is the first elevated vacuum solution to generate 15-22 inHg of vacuum without a sleeve. Unity Sleeveless Vacuum is compatible with a variety of Flex-Foot® feet, including low-activity, low-profile, and microprocessor solutions. Visit www.ossur.com/unity2 to learn how to get certified and check out the entire line of Unity-compatible Flex-Foot feet.

Preorder Your 2016 Coding Products Today Get your facility up to speed, fast, on all of the O&P HCPCS code changes with an array of 2016 AOPA coding products. Ensure each member of your staff has a 2016 Quick Coder, a durable, easy-tostore desk reference of all of the O&P HCPCS codes and descriptors. • Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Available now! Preorder now at bit.ly/aopastore.

WELCOME NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an www.AOPAnet.org 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. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Is Your Facility Celebrating a Special Milestone in 2016? O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@contentcommunicators.com.

JANUARY 2016 | O&P ALMANAC

AOPI Orthotics and Prosthetics Inc. 1000 Hawthorne, Ste. I Athens, GA 30606 706/850-5604 Category: Affiliate Parent Company: Augusta Orthotics & Prosthetics, Augusta, GA Roy Rice, CP Great Lakes Orthopaedic Center 4045 W. Royal Drive Traverse City, MI 49684 231/935-0900 Category: Patient-Care Facility Richard Costa, CFO

Janco Inc. P.O. Box 857 Dover, NH 03821 603/742-1581 Category: Supplier Level 1 Tim McGonagle Momentum Prosthetic Clinic LLC 120 South Avenue West Missoula, MT 59801 406/926-1321 Category: Patient-Care Facility Randy Rosenquist, CPO

The Source for Orthotic & Prosthetic Coding

The O&P expertise you’ve come to rely on is now available 24 hours a day. Match products to L codes and manufacturers—anywhere you connect to the Internet. This exclusive service is only available for AOPA members.

Here is what AOPA members are saying:

“LCode Search.com is my go to resource for quick and accurate coding advice.” “It’s one convenient location for codes and fees, so it saves me time and money.” “Coding for common devices is at my fingertips.”

Get Connected! Need to renew your membership? Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org. www.AOPAnet.org

Supplier Members: For information on listing your products, contact Devon Bernard at 571/431-0876, x254, or by email at dbernard@AOPAnet.org.

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Southeast

Job location key:

Prosthetic Technician, Orthotic Technician, and/or Orthotic and Prosthetic Technician

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

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

Member Nonmember $85 $150

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

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

JANUARY 2016 | O&P ALMANAC

Tampa, Florida Pediatric Orthotics and Prosthetics Services LLC, located in Shriners Hospitals for Children in Tampa, has full-time openings for experienced O&P technicians. The position requires a high school diploma or equivalency, technical certificate or degree a plus. The candidate ideally should have a minimum three years of experience fabricating a variety of upper- and lower-limb orthoses and/or prostheses, as well as experience in completing orthotic cast modifications. Additionally, the ideal candidate has pediatric experience, good to excellent orthotic cast modification skills, and central fabrication experience. With minimal supervision, he/she should be able to efficiently fabricate structurally sound and cosmetic orthoses and or prostheses in a busy laboratory setting. The candidate also must be able to build and maintain supportive relationships with staff co-workers and practitioners. Shriners Hospital, an Equal Opportunity Employer, is located on the campus of the University of South Florida campus and housed in a state-of-the-art 10,000-square-foot facility. The O&P facility was thoughtfully and carefully built with employee safety and a professional setting as a high priority. We offer excellent benefits, salary commensurate with experience. If you are a technician with good to excellent skills, give us a call at 813/975-7116. Send résumé to:

Attention: Human Resources Department Shriners Hospitals for Children 12502 USF Pine Drive, Suite 100 Tampa FL 33612 Email: rgingras@shrinenet.org Phone: 813/975-7116 Fax: 813/631-7169

CAREERS

Mid-Atlantic

Northeast

Certified and/or Licensed Pedorthist & Orthotic/Prosthetic Technician

Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Pittsburgh, Pennsylvania Certified, well-established, reputable, multi-office, orthotic and prosthetic facility located in the Pittsburgh area seeking energetic and motivated pedorthist that is licensed or eligible for licensing within the state of Pennsylvania. Candidate should be skillful, hard working, organized, and able to provide services to/for pediatric, adult, and geriatric patients. We offer competitive salary with benefits. Send résumé to:

Watertown, New York A well-established, multioffice practice has immediate openings for residents and ABC-certified CPOs/ CPs/ COs. Candidates must be motivated individuals who possess a strong clinical presence, technical experience, the ability to document all aspects of patient contact, and the desire to improve the quality of life for those who require our services. Northern Orthopedic Laboratory is based in Watertown, New York, located on the outskirts of scenic Lake Ontario and St. Lawrence River. We offer a competitive salary (commensurate with experience), medical, dental, vision, 401K, and profit sharing. Send résumé to:

Michael Serenari, LO, CO Email: michaelserenari@gmail.com

Northern Orthopedic Laboratory Inc. 1012 Washington Street Watertown, NY 13601 Office: 315/782-9098 Email: nolcpo@aol.com www.northernorthopediclaboratory.com

ADVERTISERS INDEX

Company

Page Phone

Website

Ability Dynamics

855/450-7300

www.abilitydynamics.com

ACOR Orthopedics Inc.

800/237-2276

www.acor.com

ALPS South LLC

800/574-5426

www.easyliner.com

ARTech Laboratory Inc.

888/775-5501

www.artechlab-prosthetics.com

BCP Group

615/550-8774

www.bcpgroup.com

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

ComfortFit Orthotic Labs Inc.

888/523-1600

www.comfortfitlabs.com

DAW

800/252-2828 www.daw-usa.com

Freedom Innovations LLC

888/818-6777

www.freedom-innovations.com

Flo-Tech O&P Systems Inc.

800/356-8324

www.1800flo-tech.com

Hersco

800/301-8275 www.hersco.com

Össur Americas Inc.

800/233-6263

Ottobock

800/328-4058 www.professionals.otobockus.com

www.ossur.com

O&P ALMANAC | JANUARY 2016

CALENDAR

2016

January 23

The Changing Role of Pedorthic Materials. Atlanta. 8 CE credits. 8 a.m. to 5 p.m. Advanced hands-on practical laboratory begins with changing your materials expectations, then focuses on creating a foot orthotic and modification of a shoe. Gait and foot analysis is detailed. Contact 866/338-2597, email info@academyofpedorthicscience, or visit http://academyofpedorthicscience.com/ceu.

January 11

ABC: Application Deadline for all March Exams. Applications must be received by January 1 for individuals seeking to take the March ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

January 25-26

Mastering Medicare: Essential Coding & Billing Techniques Seminar. Marriott Westshore, Tampa, FL. For more information visit bit.ly/2016billing or contact Ryan Gleeson at rgleeson@aopanet.org. Mastering Medicare

January 8-10

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

February 1

January 11-16

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

February 10

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

January 13

Webinar Conference

Prepayment Reviews: What You Need Webinar Conference To Know To Pass. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

No Application Deadlines

Online Training

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

www.bocusa.org

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

JANUARY 2016 | O&P ALMANAC

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

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

CREDITS

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

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less 26-50 51+

$40

$50

1/4 page Ad

$482

$678

$50

$60

1/2 page Ad

$634

$830

$2.25/word $5.00/word

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

CALENDAR February 21

Taping It to the Next Level. Raleigh, NC. Focus on balance and gait, orthotics, shoes, and taping while supporting a good cause. 8 credits. Register at Footcentriconline.com.

June 8

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

February 27-28

Children and Their Feet. Sanford, NC. Focus on balance and gait, orthotics, shoes, and taping while supporting a good cause. 16 credits. Register at Footcentriconline.com.

March 1

March 5-6, March 19-20

The Foot and the Ankle: To Mobilize or To Stabilize. Greenville and Greensboro, NC. Focus on balance and gait, orthotics, shoes, and taping while supporting a good cause. 16 credits. Register at Footcentriconline.com.

March 9

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

March 18-19

PrimeFare West Regional Scientific Symposium 2016. Denver Marriott City Center, Denver. Contact Jane Edwards at 888/388-5243, jledwards88@att.net or visit www.primecareop.com.

April 7-9

Texas Association of Orthotists & Prosthetists. Dallas/Addison Marriott Quorum by the Galleria, Dallas. For more information, visit www.TAOP.org.

April 13

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

June 13-14

Mastering Medicare: Essential Coding & Billing Techniques Seminar. Grand Hyatt, San Antonio, TX. For more information visit bit.ly/2016billing or contact Ryan Gleeson at rgleeson@aopanet.org. Mastering Medicare

June 24-25

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

July 13

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

August 10

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

August 18-20

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

September 8-11

99th AOPA National Assembly and New England Chapter Meeting. Boston. For exhibitors and sponsorship opportunities, contact Kelly Oâ&#x20AC;&#x2122;Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

September 14

Fill in the Blanks: Know Your Forms. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

April 22-23

PrimeFare Central Regional Scientific Symposium 2016. Southern Hills Marriott, Tulsa, OK. Contact Jane Edwards at 888/388-5243, jledwards88@att.net, or visit www.primecareop.com.

May 11

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

October 12

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

November 9

Donâ&#x20AC;&#x2122;t Miss Out: Are You Billing for Everything You Can? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

O&P ALMANAC | JANUARY 2016

ASK AOPA

Miscellaneous Code Must-Haves Answers to your questions regarding miscellaneous codes, sequestration reduction, and more

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

What type of information should I include with my claim when I am billing for a miscellaneous code?

The Medicare medical policies are very clear on what type of information you should be including with your claims when billing for a 99 code. The policies state that each claim should include the following information:

• Manufacturer’s name • Product name, model name, and model number • Narrative description of the item (for custom-fabricated items) • Justification of patient’s medical necessity for the item. Policy also states that if the item is custom fabricated, you should include information on what makes the item custom or unique; in addition, include a breakdown of your charges, such as information on the materials used and the labor/ time involved in the fabrication. What is the total number of O&P claims a recovery audit contractor (RAC) auditor may review?

The answer depends on the amount of claims submitted in the previous year. The maximum number a RAC auditor may review in a 45-day period is 10 per tax identification number.

JANUARY 2016 | O&P ALMANAC

In 2016, will my Medicare payments still be subject to sequestration reduction?

In 2016 all Medicare claims will still be subject to the 2 percent payment reduction as a result of sequestration.

How do you bill for repairs to diabetic shoes?

You may bill for repairs using the code A5507. Remember that each unit of A5507 billed counts toward the total number of inserts/ modifications a patient is eligible to receive a year. If a patient has already received his or her allotted amount of inserts/modifications, the repairs will be noncovered and you must bill the patient.

BOSTON 2016 AOPANET.ORG

Mark your calendars September 8-11, 2016, for an ideal combination of top-notch education and entertainment at the combined 99th AOPA National Assembly and New England Chapter Meeting in Boston, MA. We look forward to seeing you in 2016!

EXCELLENCE in EDUCATION Prosthetic

Orthotic

Pedorthic

Technical

Business

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

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