July 2017 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

J U LY 2017

What's New in the Revised ABN? P.14

Electronic Medical Records for O&P P.26

Takeaways From the 2017 AOPA Policy Forum

OSSEOINTEGRATION EVOLUTION WHAT THE O&P COMMUNITY NEEDS TO KNOW ABOUT PROSTHETIC IMPLANTS P.18

P.32

Tips for Avoiding Claim Denials

WWW.AOPANET.ORG

P.37

E! QU IZ M EARN

BUSINESS CE

CREDITS P.15 & 39

This Just In : Planning for Health-Care Compliance and Ethics Week P.16

YOUR CONNECTION TO

EVERYTHING O&P

Looking towards the future while celebrating the past! Join us for the 2nd World Congress and AOPA’s 100th Anniversary Celebration in Las Vegas, September 6-9, 2017.

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

#AOPA2017

Why you should attend: • Celebrate 100 years of the formalized O&P Profession in the United States. • Clinical Education so remarkable that it will be memorialized in an international scientific journal. • The best speakers from around the world. Hear from physicians, researchers, and top-notch practitioners. • The largest exhibit hall in the Western Hemisphere will feature devices, products, services, tools, and the latest technology from exhibitors around the world. • Earn 40+ continuing education credits. • Participate in hands-on learning and demonstrations during workshops • Preparation for the changes that U.S. Healthcare reform is sure to bring and its influence on global health policy.

REGISTRATION IS OPEN

FOR THIS HISTORICAL EVENT Expand your knowledge, grow your market presence, and advance your career at this unique global gathering of high visibility and importance.

www.opworldcongressusa.org

• Networking with an elite and influential group of professionals. • Ideal Las Vegas location, chosen for its popularity, travel ease, and excitement. Register at www.opworldcongressusa.org. Earn more than

40 CE

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contents

J U LY 2017 | VOL. 66, NO. 7

JULY 2017 | O&P ALMANAC

More Americans are undergoing osseointegration procedures and attaching their prostheses to implants surgically connected to their residual limbs. Prosthetists should understand the different types of procedures being performed in the United States, and be prepared to work as part of rehabilitation teams in fitting patients with prostheses as more implants receive approval by the U.S. Food and Drug Administration. By Christine Umbrell

16 | This Just In Ethics in O&P O&P facilities are encouraged to implement formal written policies and procedures to ensure employees understand the laws and know what to do should a compliance issue arise. Learn the seven steps to implementing an effective compliance program, and find out how AOPA will assist members in promoting a compliant workplace during Health-Care Compliance and Ethics Week in November.

26 | EMR 101

32 | Unifying Voices

O&P facilities will be expected to adopt electronic medical record systems as the O&P profession shifts toward outcomesdriven and collaborative care. Hear from O&P professionals who have successfully incorporated EMR systems into their practices, and find out how to approach implementation of an EMR platform.

Fueled by a renewed sense of purpose to protect the profession and its patients amid an uncertain health insurance climate and a new administration, the 2017 AOPA Policy Forum united O&P professionals, patients, and advocates like never before. New and updated collaboration tools introduced at the event will ensure grassroots efforts continue year-round.

By Lia K. Dangelico

18 | Osseointegration Evolution

PHOTO: Hanger Clinic

COVER STORY

FEATURES

contents

SPECIAL SECTION

AOPA’S 100TH ANNIVERSARY PHOTO: Courtesy of Össur/CAF

AND WORLD CONGRESS PREVIEW

40 | Then & Now O&P Almanac through the years

P.11

42 | Bridge to the Future Microprocessor technology evolves beyond the knee

44 | The Global Professional Q&A with a prosthetist in New South Wales, Australia

DEPARTMENTS Views From AOPA Leadership......... 4 Insights from AOPA Board Member Brad Ruhl

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

Numbers......................................................... 8 At-a-glance statistics and data

Happenings............................................... 10 Research, updates, and industry news

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

COLUMNS

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

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P.14

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The New Advanced Beneficiary Notice

How and when to use the revised form CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

AOPA News.............................................. 50 AOPA meetings, announcements, member benefits, and more

Welcome New Members ................... 51 PAC Update ..............................................52

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R-131 (Exp. Form CMS-

Compliance Corner................................37

Back to Basics

Avoiding common documentation mistakes CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Member Spotlight.................................46 P.48

Transitions in the profession

ACOR

P&O Services Inc.

Marketplace..............................................54 Careers.........................................................56 Calendar......................................................58 Upcoming meetings and events

Ad Index......................................................59 Ask AOPA.................................................. 60 Surety bonds, office hours, and more

O&P ALMANAC | JULY 2017

VIEWS FROM AOPA LEADERSHIP

Why Engage in Strategic Planning?

S IT IMPORTANT TO have a strategic plan for your business?

I’m sure there are many of you who feel strongly about the positive value of having a strategic plan for your business, just as I’m sure there are many of you who feel that while a strategic plan may be a nice thing to have, it’s simply not necessary. At its foundation, strategic planning is really all about developing a vision, setting long-range goals for your business, aligning resources, creating objectives and initiatives to focus your efforts and activities on, and then frequently measuring your performance against those goals. Do you want to be a company that focuses on organic growth, or are you looking to accelerate growth through the expansion of your service offerings? Do you want to grow through a strategic alliance with a trusted partner, or perhaps by acquiring a similar company in your local area? These are the kinds of basic questions you need to answer in formulating a strategic plan for your business. The sooner you do this, the sooner you can focus on execution, which is the key to achieving positive results. Having a strategic plan for your business creates a vision about where you’re headed. It provides a compass for yourself and those you entrust in providing leadership for your business. It’s about setting a course to follow that helps provide guidance for you and your team as you focus on taking care of your customers, your employees, and your growth. In these times of uncertainty, compounded by all the talk and fear created by the media and the legislative activities involving health-care reform, never has it been more important to be actively engaged in lobbying for positive change and paying extremely close attention to how your business is running. Are your customers satisfied? Are you operating your business in the most efficient manner possible? Are you staying on top of your billing and collections activities? Are you investing in the training and development needs of your employees? Considering the relentless demands from payors in questioning what you’re doing, why you’re doing it, and what the outcomes are for your patients—and essentially demanding that you do everything possible to squeeze your margins to the extreme—you can ill afford to neglect a constant focus on how your business is operating and how all this will impact your plans for growth. So, is it important to have a strategic plan for your business? I’d say having a strategy for growth is imperative in times such as these. Not having a strategy, not executing against that strategy, and not staying on course is a sure recipe for delivering at best unpredictable, and at worst unforgivable, results.

Brad Ruhl is a member of AOPA’s Board of Directors.

JULY 2017 | O&P ALMANAC

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

Board of Directors OFFICERS President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL President-Elect Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Vice President Chris Nolan, LPO Ottobock North America, Austin, TX Immediate Past President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX 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, Edmonds, WA Traci Dralle, CFm Fillauer Companies Inc., Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Townsend Design, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

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AOPA CONTACTS

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

Editorial Management Content Communicators LLC

Our Mission Statement 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 Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@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

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org SPECIAL PROJECTS Ashlie White, MA, manager of projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org

Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com

Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org

Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com

AOPA Bookstore: 571/431-0865

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

JULY 2017 | O&P ALMANAC

Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan 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 landerson@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 © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted. COVER PHOTOS: Top and bottom: Salt Lake City VA, middle: Hanger Clinic

Advertise With Us! Reach out to AOPA’s membership and more than 12,500 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options!

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NUMBERS

Consumers increasingly seek electronic tools for well-being and health-care purposes

From wearables to apps to digital health records, consumers—particularly younger ones—are leveraging new technologies to monitor and improve their health. O&P facilities that recognize this trend and adapt their businesses accordingly may be best positioned to succeed in 2017 and beyond.

DIGITAL ACCESS TO HEALTH CARE

WEARABLES

ONLINE INFLUENCE IN HEALTH-CARE PROVIDER SELECTION

40 Percent Percentage of millennials who own a wearable.

95 Percent

10 Percent

Percentage of baby boomers who own a wearable.

Percentage of hospitals that allow downloading of digital health-care data.

Percentage of hospitals that allow viewing of digital health-care data.

HEALTH APPS BY CATEGORY

34 Percent

11%

OTHER

Percentage of millennials who have selected a provider based on online reviews.

12% DIET &

21 Percent

LIFESTYLE & STRESS

26 Percent Percentage of Gen Xers who own a wearable.

87 Percent

36%

NUTRITION

FITNESS

17%

Percentage of Gen Xers who have selected a provider based on online reviews.

24%

DISEASE & TREATMENT

8 Percent

Percentage of baby boomers who have selected a provider based on online reviews.

SOURCES: “Internet Trends 2017—Code Conference Report,” written by Mary Meeker and published by Kleiner Perkins; App Annie and IMS Health.

Electronic Health Adoption Among U.S. Office-Based Physicians 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

87% 21% 2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

SOURCES: “Internet Trends 2017—Code Conference Report,” written by Mary Meeker and published by Kleiner Perkins; Office of the National Coordinator for Health Information Technology.

JULY 2017 | O&P ALMANAC

SOURCES: “Internet Trends 2017—Code Conference Report,” written by Mary Meeker and published by Kleiner Perkins; ONC/AHA Annual Survey Information Technology Supplement; Rock Health Digital Health Consumer Adoption.

Digital Health Trends

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Happenings DIABETES DOWNLOAD

RESEARCH ROUNDUP

Researchers Test Amputation Procedure To Facilitate Prosthetic Use

Study Links Ulcers and Infections With ER Visits and Hospital Admissions

Individuals with diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs) are at greater risk for emergency department visits and inpatient admissions at hospitals, according to a research team led by Grant H. Skrepnek, PhD, from the University of Oklahoma Health Sciences Center. The researchers conducted a cross-sectional historical cohort analysis using 2007-2013 data from the U.S. Centers for Disease Control and Prevention National Ambulatory Medical Care Survey.

JULY 2017 | O&P ALMANAC

PHOTO: Jose-Luis Olivares/MIT

PHOTO: Getty Images/jorgeantonio

Skrepnek and his team studied the data of diabetic adults who had DFUs and DFIs. They found that 6.7 million (0.8 percent) of the estimated 5.6 billion ambulatory care visits were for these conditions. DFUs correlated with 3.4-fold increased odds of direct emergency department referral or inpatient admission, and DFIs were associated with 6.7-fold increased odds of direct emergency department referral or inpatient admission. These patients also were found to require longer times spent with physicians per visit. The research was published online in May in Diabetes Care.

Researchers at the Massachusetts Institute of Technology (MIT) are developing a surgical technique designed to increase feedback between muscles, tendons, and the nervous system, with a goal of improving proprioception. It is hoped that the prostheses of those patients undergoing the procedure might stimulate those areas in a more natural way. The research, MIT researchers are developing a new surgical approach that coauthored by Hugh Herr would allow amputees to receive sensory feedback from their and Shriya Srinivasan prosthetic limbs and improve their ability to control them. and published May 31 in Science Robotics, could aid in reducing The rats also were able to send electric the rejection rate of prostheses. signals that reflected the amplitude of the The new surgical technique, called the stimulation applied by the researchers. agonist-antagonist myoneural interface The researchers will test the proce(AMI), has been tested in rats and is dure with human subjects in the next designed to generate muscle-tendon phase of the study. They expect that the sensory feedback to the nervous system, brain will be able to rapidly learn how which could convey information about much control to exert to make prosthe placement of a prosthesis and the theses move in a certain way. “Using forces applied to it. The AMI procedure this framework, the patient will not seeks to emulate the agonist/antagonist have to think about how to control pairing of muscles at the amputation site their artificial limb,” said Herr. so the muscles and limbs surrounding “When a patient imagines moving a prosthesis may be able to sense and their phantom limb, signals will be transmit proprioceptive information sent through nerves to the surgically about the device and the force being constructed muscle pairs. Implanted applied to it. muscle electrodes will then sense these During trials, researchers cut through signals for the control of synthetic the muscles and nerves in rats’ hind legs, motors in the external prosthesis.” then grafted on paired muscles, wiring The strategy could potentially work them up to severed nerves. After four for almost any amputation scenario, months, the rats’ new muscles were as long as some healthy nerve remains, contracting and relaxing in tandem. according to Srinivasan.

HAPPENINGS

O&P ATHLETICS

CODING CORNER

Jurisdiction D Releases Data on Orthosis Claim Reviews Noridian Healthcare Solutions, which serves as the Jurisdiction D durable medical equipment Medicare administrative contractor (DME MAC), has released the results of its ongoing prepayment review of knee orthoses described by Health-Care Common Procedure Coding System (HCPCS) codes L1832 and L1843. The denial rate for both HCPCS codes was 100 percent for the claims reviewed from January 2017 through April 2017. There were 139 claims selected for review for L1832 and 117 claims selected for review for L1843. The four top denial reasons included the following: • Documentation does not support custom-fit criteria. • Documentation does not support coverage criteria. • Lack of response to request for additional documentation. • Proof of delivery is incomplete or missing elements.

Noridian also has released the quarterly results of its review of HCPCS codes L0631 and L0637. Between December 2016 and March 2017, Noridian reviewed 105 claims for L0631 and 135 claims for L0637. The results indicate a 98 percent improper payment rate (103 claim denials) for L0631, and a 96 percent improper payment rate (130 claim denials) for L0637. The top denial reasons included “missing proof of delivery” and “documentation submitted didn’t support the custom-fit criteria of policy.” Based on the results, Noridian will continue with its review of L0631 and L0637.

Amputees Participate in Dallas Mobility Clinic Dozens of people with lower-limb loss took part in the Össur Running and Mobility Clinic presented by Challenged Athletes Foundation® (CAF) in Dallas in June. The clinic was designed to help amputees achieve their mobility goals, regardless of ability. Four additional Össur Running and Mobility Clinics will be presented later this year at the following locations: Minneapolis, Minnesota; Louisville, Kentucky; Birmingham, Alabama; and San Diego, California.

CYBERSECURITY

HHS Publishes ‘Quick-Reponse Checklist’ • Report the crime to law enforcement agencies. • Report the threat indicators to federal agencies. • Assess the incident to determine if there is a breach of protected health information. The complete checklist and infographic are available at www.hhs.gov.

Participants try soccer at the Össur-CAF Dallas Mobility Clinic. O&P ALMANAC | JULY 2017

PHOTOS: Courtesy of Össur/CAF

PHOTOS:Getty Images/BrianAJackson/Alexsl

A new guide published by the U.S. Department of Health and Human Services’ Office for Civil Rights explains the steps to take in response to a cyber-related security incident. The guide advises entities covered by the Health Insurance Portability and Accountability Act, and their business associates, to take the following steps should an incident occur: • Respond by executing response and mitigation procedures and contingency plans.

Kids celebrate with Eric McIlvenny at the Össur-CAF Dallas Mobility Clinic.

PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Roger Rose has been awarded the 2017 Dale Yasukawa Scholarship by the Orthotic & Prosthetic Activities Foundation. Rose is expected to graduate from Northwestern University’s master’s program in prosthetics and orthotics in March 2018. He will receive $1,000 to further his education by attending a national, regional, or local chapter or society meeting.

Endolite has been named best overall winner of the 2017 Medical Design Excellence Awards for its Linx system, a fully integrated, microprocessor-controlled lower-limb system for aboveknee amputees. The company was honored with the Gold Medal Award in the Rehabilitation and Assistive Technology Products category, as well as the Best in Show Award, during a ceremony in New York on June 13. Endolite was selected from 45 finalists in nine medical technology product categories by a judging panel of clinicians, engineers, and designers. Awards were made based on five criteria: design and engineering innovations, functional (user-related) innovations, benefits to overall health care, benefits to patients, and market differentiation.

Claudia Zacharias, MBA, CAE, president and chief executive officer of Board of Certification/ Accreditation (BOC), has been named a top 50 women-led business leader by The Commonwealth Institute (TCI) of South Florida. Claudia Zacharias, Zacharias was recognized at the 12th annual Top MBA, CAE Women-Led Businesses Luncheon on May 18. TCI South Florida partnered with Kaufman Rossin to develop the list, surveying more than 10,000 women-led businesses. Zacharias has been with BOC for nearly eight years and has overseen the addition of two new credentialing programs.

IN MEMORIAM

William McCulloch William “Bill” McCulloch, a former AOPA executive director, passed away May 26. Born in 1921, McCulloch graduated from the U.S. Naval Academy in 1944. Serving in the Marine Corps for 34 years, including during World War II, the Korean War, and Vietnam, McCulloch achieved the rank of brigadier general. He also served as an instructor at several military schools and earned a master’s degree in international relations from Georgetown University. McCulloch served as executive director of AOPA as well as three medical associations. He later founded Association Consulting and Management Services.

JULY 2017 | O&P ALMANAC

THE LIGHTER SIDE

REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

E! QU IZ M

The New Advanced Beneficiary Notice

EARN

BUSINESS CE

CREDITS P.15

What you need to know about the revised form

Editorâ&#x20AC;&#x2122;s Noteâ&#x20AC;&#x201D;Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 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.

CREDITS

N JUNE 21, 2017, the revised

advanced beneficiary notice (ABN) form went into effect for Medicare claims. While only minor changes were made to the form, all ABNs submitted for claims with a date of service on or after June 21, 2017, must be completed using the revised version, or the ABN will be considered invalid. The introduction of the revised form affords an excellent opportunity to discuss the purpose of the ABN, when it is appropriate for use, and how to make sure it is completed properly in order to avoid financial liability for Medicare claims you believe will be denied as not medically necessary.

Purpose of the ABN

JULY 2017 | O&P ALMANAC

Whatâ&#x20AC;&#x2122;s New?

The new version of the ABN is not substantially different from the previous version. The only significant change is the addition of a nondiscrimination notice at the bottom of the ABN form that indicates that CMS has the ABN available in alternate formats for patients who, for various reasons, may not be able to read the paper version of the ABN.

PHOTO: Getty Images/PeopleImages

The ABN has two distinct purposes within the Medicare program. First, it is used to notify Medicare beneficiaries that the provider of a service believes that Medicare will deny a claim as not medically necessary, and that if Medicare denies the claim for medical necessity reasons, the beneficiary will be financially responsible to pay for the services rendered. When used for this purpose, several conditions must be met in order for the ABN to be considered valid. The ABN must be provided to the patient within a reasonable timeframe for the patient to make an informed decision regarding whether to accept financial responsibility for the service should Medicare deem it not medically necessary. Also, the provider must state

the specific reason why he or she believes Medicare will deny the claim as not medically necessary. General ABNs that do not list a specific reason are not valid and will not relieve the provider from financial liability for the claim. The ABN must list the estimated cost of the item(s) in question. Finally, the ABN must be signed and dated by the patient, indicating that he or she understands the provisions of the ABN and accepts financial liability for the services if Medicare denies the claim as not medically necessary. Second, the ABN form may be used as a voluntary notice that a particular item or service is not a statutorily covered benefit under the Medicare program. While the use of the ABN form for this purpose does not have any impact on financial liability for the claim since statutorily noncovered items are always the financial responsibility of the beneficiary, it may be used for the purposes of informing the beneficiary of the noncovered status of an item as a courtesy to the beneficiary.

REIMBURSEMENT PAGE

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have to pay. below, you may er have D. health care provid are doesn’t pay for that you or your below. NOTE: If Medic even some care D. pay for everything, may not pay for the are Medic t Medicare does not F. Estimated you need. We expec care May Not Pay: Medi on good reason to think Cost Reas E. D.

The best way to ensure that you are using the

ion about your care. TO DO NOW: an informed decis WHAT YOU NEED reading. , so you can make have after you finish • Read this notice listed above. ions that you may receive the D. nce • Ask us any quest about whether to below use any other insura to option you we may help • Choose an us to do this. e Option 1 or 2, e choos requir t you If Note: but Medicare canno you. for that you might have, box a choose box. We cannot one now, but I only k may ask to be paid G. OPTIONS: Chec a Medicare listed above. You is sent to me on want the D. payment, which nsible for □ OPTION 1. I official decision on ’t pay, I am respo are billed for an Medicare if Medicare doesn If that also want Medic MSN. the stand ions on (MSN). I under . following the direct by tibles Summary Notice care deduc or Medi ys to appeal less co-pa are. You may payment, but I can ents I made to you, do not bill Medic refund any paym listed above, but does pay, you will care is notbilled. ot appeal if Medi want the D. eI for payment. I cann □ OPTION 2. I stand with this choic as I am responsible listed above. I under d pay. ask to be paid now woul care D. the Medi if want to see □ OPTION 3. I don’t payment, and I cannot appeal for am not responsible ation: H. Additional Inform ions on you have other quest . care decision. If 1-877-486-2048) an official Medi 0-633-4227/TTY: our opinion, not -MEDICARE (1-80 this notice. You also receive a copy. This notice gives are billing, call 1-800 stand this notice or Medic that you have received and under s J. Date: Signing below mean I. Signature: ation in an To request this public gov. ams and activities. equest@cms.hhs. minate in its progr ICARE or email: AltFormatR -MED CMS does not discri OMB control number. 1-800 it displays a valid t, please call: to average 7 minutes n of information unless alternative forma n. If ion collection is estimated to respond to a collectio

ion collectio required to complete this informat review the informat d, Attn: PRA 1995, no persons are 6. The time required and complete and rk Reduction Act of Boulevar ion collection is 0938-056 s, gather the data needed, write to: CMS, 7500 Security According to the Paperwo please number for this informat existing data resource improving this form, The valid OMB control the time to review instructions, search or suggestions for of the time estimate per response, including ts concerning the accuracy d 21244-1850. you have commen No. 0938-0566 Marylan Officer, Baltimore, Form Approved OMB Reports Clearance

Form CMS-R-131

most current version of the ABN is to make sure that the form contains the 03/2020 expiration date in the lower left corner.

(Exp. 03/2020)

While this change is not substantive as far as the content and purpose of the ABN, any revision to the official ABN form requires a new expiration date in the bottom left corner of the document. The new ABN form has an expiration date of 03/2020 and is the only version of the ABN that is considered valid for dates of service after June 21, 2017.

ABN to be considered valid. Equally important is a proper explanation of why you believe Medicare will deny the claim as not medically necessary. If the reason documented on the ABN is overly vague, or if Medicare denies the claim as not medically necessary for a different reason, the ABN is invalid and the patient is not responsible for payment.

When To Use the ABN

What Does the ABN Allow You to Do?

ABNs should only be used when one of the two situations discussed above exist: if you have a specific reason why you believe Medicare will deny a claim as not medically necessary, or if you are voluntarily notifying a patient that a specific service is simply not a benefit under the Medicare program. The purpose of the ABN in the first instance is to inform the patient, in advance of receiving the service, that you believe Medicare will deny the claim as not medically necessary for a specific reason. If a patient reviews the ABN and signs and dates it, indicating that he or she has made an informed decision to receive the service, he or she may be held financially responsible for payment for the service (up to your full usual and customary charge) should Medicare deny the claim as not medically necessary. It is extremely important that the patient sign and date the ABN prior to delivery of the service in order for the

A properly executed ABN allows you, as the provider, to collect your full usual and customary charge for a service at the time of delivery. While you remain obligated to submit a claim upon the request of the beneficiary, if Medicare denies that claim due to the reason stated on the ABN, you are not required to refund the patient any payment collected, and you are permitted to bill the patient directly for the service if no payment was collected at the time of delivery. This is valuable because general Medicare rules protect the patient from financial liability for services denied due to medical necessity unless it can be shown that the patient was aware that the service in question would most likely be considered not medically necessary by Medicare. The ABN serves as proof that the patient made an informed decision and can be held liable for payment to the provider.

Remember, however, that ABNs may only be used in specific circumstances. Medicare has openly stated that ABNs may not be used for general purposes that cover any medical necessity denial. These are called “blanket” ABNs and are not considered valid. In addition, ABNs may not be used on a routine basis. For example, an ABN should not be part of the general intake paperwork that a patient fills out during a visit. ABNs are circumstantial in nature and therefore should never be provided to every patient that enters your facility. In extreme cases, the routine use of ABNs as a means to shift financial liability to Medicare beneficiaries can be considered an abusive practice and may lead to negative consequences for the provider.

Where To Find the Form

The revised ABN form may be downloaded from the CMS website at www.cms.gov/medicare/medicaregeneral-information/bni/abn.html . The best way to ensure that you are using the most current version of the ABN is to make sure that the form contains the 03/2020 expiration date in the lower left corner. The ABN can be a very valuable tool that will protect you from unnecessary financial liability in certain circumstances. You must be careful that you use it properly, however. An invalid ABN may provide you with a false sense of security, so it is important to understand the rules surrounding its use. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

www.bocusa.org

O&P ALMANAC | JULY 2017

This Just In

Ethics in O&P AOPA to celebrate Health-Care Compliance and Ethics Week in November

OPA HAS OFFICIALLY ANNOUNCED

its collaboration with the HealthCare Compliance and Ethics Association to observe Health-Care Compliance and Ethics Week Nov. 5-11, 2017. This event is observed and promoted by hundreds of organizations around the country. The goal of Health-Care Compliance and Ethics Week is to elevate awareness of the benefits of formal written policies and procedures to make sure all employees understand the law and the consequences of violating it, know what to do when a compliance issue arises, and cultivate a culture of compliance and ethical conduct within the workplace. It’s not only the right thing to do—it’s just common sense to have an effective written compliance and

ethics program for your business. The Federal Sentencing Guidelines provide relief for any entity convicted of a crime that has an effective compliance program in place. While those guidelines don’t excuse the crime, they do require a court to determine a “culpability score” by reviewing any aggravating and mitigating factors. Having an effective compliance program in place would count as a mitigating factor that may help reduce penalties. On the other hand, not having an effective written compliance program in place could be an aggravating factor. Ethics and compliance go hand in hand, and celebrating HealthCare Compliance and Ethics Week provides an opportunity to reinforce your facility’s commitment to the

Your company can participate in the observance. A week-long focus on compliance and ethics will give you an 16

JULY 2017 | O&P ALMANAC

PHOTO: Getty Images/PeopleImages

rules of the road—especially in the compliance area where violations to the Health Insurance Portability and Accountability Act (HIPAA) are just one example of severe penalties imposed if there is a compliance lapse. In focusing attention on Compliance Week, AOPA will help encourage members to review or, if necessary, create a compliance program. The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) has developed resources to assist health-care providers in creating a compliance program and establishing internal controls that can help reduce fraud, abuse, and waste. OIG has identified seven steps to developing an effective compliance program: • Implement written policies, procedures, and standards of conduct; • Designate a compliance officer and compliance committee; • Conduct effective training and education; • Develop effective lines of communication; • Enforce standards through well-publicized disciplinary guidelines; • Conduct internal monitoring and auditing; and • Respond promptly to detected offenses.

This Just In

opportunity to introduce and reinforce the compliance and ethics standards your employees are expected to meet. Participation also may contribute to positive perceptions from the broader community about your facility’s commitment to ethical business practices. If you don’t have a compliance officer on staff, this is the opportunity to assign that responsibility. AOPA will make available tools to assist in your participation. For example, AOPA has developed a press release template that members may access to let the community know of your organization’s commitment. Posters and giveaways also are available to keep your staff engaged. There will be a daily “Compliance Message” you can forward to all employees during Health-Care Compliance and Ethics Week. You can sign up employees for one or all of the online seminars that will be offered during that week: • Gift Giving: Show Your Thanks & Remain Compliant, Wednesday, November 8 • Healthcare Compliance and Ethics Association’s hosted webinar, Thursday, November 9 (free for members) • Teaching Professionalism and Ethics During Residency, Friday, November 10 (free for members). In addition, each day during Health-Care Compliance and Ethics Week there will be a “compliance question of the day,” which your employees can answer to earn CE credits and to be included in daily prize drawings. For more information about this new event, go to bit.ly/aopaethics and download white papers, newsletters, videos, and other tools you can use within your company to promote compliance and ethics. Nearly all of the materials are made available on a complimentary basis so it is a cost-effective opportunity to instill a sense of commitment to a value system documented by your written compliance and ethics program—a win/win for your company and for your patients.

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O&P ALMANAC | JULY 2017

COVER STORY

Osseointegration EVOLUTION As awareness of osseointegration procedures grows, more Americans are receiving prosthetic implants both inside and outside the United States

By CHRISTINE UMBRELL

JULY 2017 | O&P ALMANAC

COVER STORY

NEED TO KNOW • Osseointegration procedures are becoming more common in the United States, as the U.S. Food and Drug Administration (FDA) has authorized the use of the Osseintegrated Prosthesis for the Rehabilitation of Amputees (OPRA) implant as part of an FDA-approved clinical trial for certain amputees, and also is allowing a limited clinical early feasibility study of the percutaneous osseintegrated prosthesis (POP) implant. • Additionally, some Americans have received custom implants that do not fall under FDA approval requirements because they are directed by surgeons, and others have travelled to foreign countries, such as Australia, to undergo ossseointegration procedures. • The goal of osseointegration is to provide amputees with greater mobility and increased comfort. Implants eliminate the need for a socket, and may allow prosthesis users to experience osseoperception—sensory awareness of the patient’s surroundings. • As interest in implants grows among amputees, U.S. prosthetists will be asked to play more prominent roles in the health-care teams that carry out the procedures. While osseointegration patients do not have sockets, they do require more exact alignment of the prosthesis. • Osseointegration technology is not expected to eliminate traditional socket use for all patients, but “it definitely has the potential to radically improve the lives of many candidates across the nation,” says Matthew Garibaldi, MS, CPO.

J PHOTOS: Top: Hanger Clinic, bottom two: Salt Lake City VA

bony integration between the UST A FEW YEARS AGO, internal implant and the osseointegration was surrounding bone tissue. A a procedure American percutaneous component prosthetists occaconnects to the implant sionally heard about at its proximal end and but never saw, since exits the limb where its clinicians in Australia Matthew Garibaldi, distal end is attached to and Europe were the MS, CPO a range of coupling devices. early adopters of the These devices permit the connectechnique. But osseointegration has now migrated stateside: Dozens tion of traditional external prosthetic of Americans have undergone the components. procedure, either overseas or in the Put more simply, “osseointegration United States, and have had titanium is the direct connection between bone rods implanted in the bones of their and implant that occurs as a result of residual limb to attach their prosthenew bone formation in and around the implant surface,” explains Matthew ses directly to their bodies. Garibaldi, MS, CPO, associate clinical The term “osseointegration” professor and director of orthotics actually describes a growing range and prosthetics at the University of of surgical techniques and implants. California–San Francisco (UCSF). Common to these approaches is a O&P ALMANAC | JULY 2017

COVER STORY

JULY 2017 | O&P ALMANAC

PHOTO: Salt Lake City VA

prosthetists will need to The OPRA system is the only be prepared to treat these osseointegration implant patients. The proceauthorized for use by the U.S. Food and Drug dure is “so novel and Administration (FDA) for cutting-edge” that not transfemoral amputees all prosthetists may be in the United States who aware of the different Rickard Brånemark, have rehabilitation problems types of implants, all of Patient with a POP implant MD, PhD with, or cannot use a convenwhich are associated with different patient protocols and The rise of osseointegration comes tional prosthesis, according to as more amputees become aware of the different patient experiences, says Phil Garibaldi. UCSF acts as the coorStevens, MEd, CPO, FAAOP, a director procedure and understand its benefits. dinating body for a multicenter in Hanger Clinic’s department of Some individuals seek out the proceFDA-approved clinical trial of the clinical and scientific affairs. “We have OPRA implant system. dure as an alternative to traditional an obligation as a profession to • Procedures performed with approaches. “Current socket bring ourselves up to speed on percutaneous osseointegrated systems are like a hard shell the various implant systems prosthesis (POP) implants. These worn on the outside of that are currently out there.” have been carried out as part of an the skin. And there are FDA-approved clinical early feasia number of complications associated with U.S. Osseointegration bility study of the POP implant with those,” says Sarina above-knee patients. Ten military Population Kay Sinclair, PhD, veterans became the first amputees Stevens suggests there are principal investigator in the United States to be surgically probably close to 100 individPhil Stevens, MEd, and research scientist implanted with a POP system at uals in the United States who CPO, FAAOP in the Osseointegration the George E. Wahlen Department have undergone osseointegration Clinical Research Program at of Veterans Affairs (VA) Medical procedures. Approximately 60-70 of the University of Utah Department of Center in Salt Lake City between those amputees have travelled to other Orthopaedics and the Department of December 2015 and April 2017. countries—often Australia—to have Veterans Affairs (VA), Salt Lake City • Custom implants. A limited number their procedures done. The rest have Health-Care System. Sinclair notes of implants that do not fall under had their surgeries performed in the that some amputees have trouble with FDA approval requirements are United States. the fit and comfort of a traditional described as “custom implants” Of those osseointegration procesocket, and are “constantly having to because they are directed by dures performed in the United States, adjust it.” Implants eliminate the need surgeons on an as-needed basis. there are three different types of for sockets. implants, says Stevens: As interest in osseointegraFor patients who have undergone • Procedures performed via the the first two types of procedures Osseointegrated Prosthesis for tion grows and the U.S. Food and (OPRA or POP), the FDA has ensured Drug Administration (FDA) begins the Rehabilitation of Amputees that certain minimum requirements to evaluate certain implants for (OPRA) implant system, which are in place, and clinicians must approval, more amputees are expected was developed by Sweden’s comply with these guidelines, says to undergo the procedure—and Rickard Brånemark, MD, PhD.

COVER STORY

A History Rooted in Dentistry OSSEOINTEGRATION was initially introduced as a dental procedure in Europe: The first commercial use of the technology took place in the 1950s when Sweden’s Per-Ingvar Brånemark, MD—Rickard Brånemark’s father—discovered that osseointegration could be successfully used to secure dental implants, says Matthew Garibaldi, MS, CPO, associate clinical professor and director of orthotics and prosthetics at the University of California–San Francisco. The dental technology didn’t gain popularity in the United States until the early 1980s.

From left, Rickard Brånemark, MD, PhD; Richard O'Donnell, MD; Teresa Kocelj; and George Kocelj visit before George undergoes osseointegration surgery to receive an OPRA implant. The April 2016 surgery was the first of its kind in the United States.

PHOTO: Susan Merrell/USCF

Early Successes

Sinclair is principal investigator and Stevens is the research study prosthetist on the team leading the FDA-approved early feasibility study at the Wahlen VA Medical Center. Under the direction of surgeons Erik Kubiak, MD, and

Jayant Agarwal, MD, they are working with 10 human subjects trialing the POP system. The POP system was developed in collaboration with device manufacturer DJO Surgical and the lab of Roy Bloebaum, PhD, after a decade of osseointegration research. With the POP implant clinical trial process, participants have their posts attached four to six weeks after the first surgery, then the prosthesis is attached to the post 24 hours later, according to Sinclair. POP study patients typically retain the prosthesis they came into the trial with, but are approved to use any nonpowered knee. The first two patients in the study underwent the initial surgery in December 2015, and were up and walking in February of 2016. By the end of April 2017, eight additional veteran participants had undergone osseointegration. All 10 participants are above-knee patients who experienced limb loss due to trauma. At UCSF, where the OPRA implant has been adopted, the university has hired Brånemark as a visiting member of the orthopedic surgery department faculty. It is UCSF’s intention to offer “the most viable clinical options for amputee patients and to provide the most current osseointegration surgical training techniques,” says Garibaldi.

PHOTO: Getty Images/marvinh

Stevens. “When managing these patients prosthetically, you have very clearly defined safety boundaries,” he explains. Those patients with implants that do not fall under FDA requirements, and those patients who have undergone osseointegration outside of the United States, generally lack clear rehabilitation protocols or prosthetic fitting guidelines, he says. When patients go outside of the United States and come back, or otherwise have non-FDA approved osseointegrated prostheses attached, FDA regulations limit the follow-on prosthetic care that can be done in the United States, says Stevens. This means that these devices do not have safety boundaries that have been examined by the FDA to guide, for example, how much load can be attached, or how offset the alignment can be. When such boundaries do not exist, prosthetists have to examine their risk tolerance in working with these patients.

The procedure was first used for prosthetics in 1990, when Per-Ingvar Brånemark and Björn Rydevik, MD, performed the first osseointegration implant procedure for a transfemoral amputee in Sweden. “Since that time, bone-anchored external prostheses have been used successfully in several countries, improving the lives of many amputees across the globe,” says Garibaldi. “Rickard Brånemark later founded the Swedish company Integrum, responsible for creating the OPRA implant system.”

O&P ALMANAC | JULY 2017

COVER STORY

Early Adopters in

Australia T

Osseointegration Procedures Performed at the Institute of Musculoskeletal Reconstruction and Osseointegration at the Australia School of Medicine AMPUTATION LEVELS Transhumeral Transtibial

CASES PERFORMED WORLDWIDE

Canada 17

Cambodia 4

Fiji 1

Lebanon 2

New Zealand 8 United Kingdom 34

Worldwide Collaborators

130

United States 62

Transfemoral

218

Osseointegration Group of Australia (Sydney)

SOURCE: The Institute of Musculoskeletal Reconstruction and Osseointegration, Sydney, Australia.

JULY 2017 | O&P ALMANAC

301

Australia 173

PATIENT DISTRIBUTION BY COUNTRY

PHOTOS: Munjed Al Muderis

HE INSTITUTE OF MUSCULOSKELETAL RECONSTRUCTION AND OSSEOINTEGRATION at the Australia School of Medicine in Sydney is recognized as a leader in osseointegration technology. Surgeons at the Institute have completed more than 300 osseointegration procedures in Sydney and another 130-plus worldwide. Patients come to Australia from several other countries to undergo the procedure. The implant used at the Institute is made of highly porous titanium, designed to maximize bone ingrowth into the prosMunjed Al Muderis, MBChB, Osseointegration implant with the FRACS, FAOrthA thesis. This strong bone-prosthesis interface dual cone adaptor and connectors provides the user with proprioception and balance that is not achievable using the standard socket technology currently in place today, according New patients are screened according to the Institute’s to Munjed Al Muderis, MBChB, FRACS, FAOrthA, an guidelines and asked to meet with an “Osseointegration orthopedic surgeon and chairman of the Institute. Team” consisting of several orthopedic surgeons, “A dual adaptor is designed with a smooth surface an internal medicine specialist, prosthetists, a physto minimize friction and coated with titanium niobium ical therapist, a psychologist, and a pain specialist. for antibacterial purposes. The adaptor is then coupled Patients are required to undergo a 3-D computerized to a control device and is connected to the exterior of tomography (CT), a dual-energy X-ray absorptiometry the prosthetic limb,” he explains. “Putting on and taking (DEXA) scan to evaluate their bone density, and addioff the limb can be done in less than 10 seconds.” tional feasibility studies, according to Al Muderis.

COVER STORY

PHOTO: Susan Merrell/USCF

PHOTOS: Victor Wagoner/Munjed Al Muderis

The surgery takes about three hours, and each patient remains in the hospital for three to five days. Once an epidural catheter is removed, the patient begins loading. On the first day of loading, the patient begins by placing 5 kg of weight on the operative leg. Each day, another 5 kg of weight is added, until loading of 50 kg has been achieved. “The prosthetist then modifies their ‘old’ prosthesis to fit onto the end of the implant, and they then continue loading using their ‘new’ leg,” says Al Muderis. After patients are discharged, they are seen every day for physical therapy, and remain in Sydney for a total of 28 days so that a final evaluation can be done by the prosthetist prior to their return home. Victor Wagoner, a pilot who lives in San Diego and who lost his leg in a motorcycle accident in 2014, travelled to Sydney in January 2017 to undergo an osseointegration procedure at the Institute. Wagoner says he decided to have the surgery not because he was unhappy with his socket, but as a preventive measure to be sure he can maintain his active lifestyle for many years to come. “I walk eight to 10 miles a day and go backpacking,” Wagoner says. Because he occasionally experienced skin breakdown, sweating, and the need to adjust his socket, he decided to get an implant. As a pilot for Delta, Wagoner flies to Sydney on a regular basis, so he scheduled a personal visit and underwent the procedure on January 30. The recovery was quick, and he stayed on schedule with the rehabilitation. He returned to some of his piloting duties less than eight weeks after surgery. “It’s amazed me how much I’m able to do,” says Wagoner. “I just keep getting stronger. “I functioned quite well and had an excellent socket before the surgery, but it’s been a huge life-changer for me,” he says. “Sometimes I completely forget I don’t have a leg.”

Rickard Brånemark, MD, PhD, center, and Richard O'Donnell, MD, right, perform an osseointegration surgery with an OPRA implant on George Kocelj.

Victor Wagoner, after receiving his implant at the Institute of Musculoskeletal Reconstruction and Osseointegration in Sydney

X-ray of a patient who underwent osseointegration implant surgery at the Institute of Musculoskeletal Reconstruction and Osseointegration

UCSF coordinated the first recorded OPRA patient in the United States in April 2016 when Brånemark led a team in performing an osseointegration surgery on George Kocelj, who had lost most of his right leg due to a rare nerve tumor. UCSF also is collaborating closely with physicians at the Walter Reed National Military Medical Center (WRNMMC) on osseointegration opportunities. The Department of Defense Osseointegration Program, directed by Jonathan Forsberg, MD, PhD, is spearheading efforts at UCSF and nationwide to make the technology available to active duty military and veterans, as well as civilian patients. Forsberg and Benjamin Kyle Potter, MD, FACS chief of orthopaedics at WRNMMC, have spent the past five years learning the osseointegration technique from Brånemark. In addition to studying the OPRA implant, Forsberg and Potter have adapted the “lessons learned” from working with Brånemark and applied them to another implant based on the Compress® implant they helped design. The Compress implant—previously approved for endoprosthetic use for oncology patients—is being used on a limited, custom implant basis for osseointegration patients, and an FDA clinical trial of the device for transdermal use is expected soon. O&P ALMANAC | JULY 2017

COVER STORY

“We tested the implant in a large animal model” using funding from the Bureau of Medicine and Surgery from 2013-2016, and “implanted it in the first combat casualty in May of 2016 at Walter Reed,” says Forsberg. The Compress is uniquely suited for transdermal application because it is comparatively easy to revise in case of deep infection and preserves bone during the revision process—allowing re-implantation once the infection is cleared, according to Forsberg and Potter. “We’re taking this in a very conscientious and stepwise fashion in terms of the progression of who we think this is best indicated for,” says Potter. “What we’re really trying to do is provide the full spectrum of care to any service member with limb loss to optimize the functional capabilities of that individual.”

Benefits of the Technology

JULY 2017 | O&P ALMANAC

PHOTO: Salt Lake City VA

The goal of osseointegration is to provide amputees with greater mobility and increased comfort. Bone-anchored prostheses offer some fairly intuitive advantages, says Garibaldi, because the technology bypasses the need for traditional sockets. “Clinicians and patients alike know that the ‘socket’ is the weakest link to any prosthesis,” he says. “Although this technique has served patients well for some time, it’s fraught with potential complications associated with skin issues, limb volume changes, pain, donning challenges, unwanted rotation, temperature, sitting comfort, and limited wear time.” Eliminating the socket can alleviate many of these issues. In addition, “having an osseointegrated prosthesis seems to allow patients to engage more in the world, particularly when the prosthesis is waterproof,” says

Stevens. “It enhances their connection “Patients can now walk on the beach to their prosthesis, and allows them to and not have the socket pulled off by engage in more environments.” the soft, wet sand,” he explains. “They Stevens also cites “osseocan walk on the beach and not get sand inside the socket.” perception”—or sensory awareness Rosenblatt also cites improved of the patient’s surroundings—as an bone strength as another advantage additional benefit of implants, because for patients who have undergone the phenomenon can make the the procedure. “The longer prosthesis feel like “less of an amputee has been an a tool and more a part of amputee, especially above the body” for the wearer. the knee, the more osteoOsseoperception occurs as the prosthesis is anchored porotic they will become,” directly to the bone, which he says. “We have shown Solon L. Rosenblatt, transmits sensory signals, this with every one of MD resulting in patients recovour transfemoral amputees. However, within one year after the ering a certain level of feeling and osseointegration procedure, follow-up proprioception, explains Munjed Al on these patients has shown that the Muderis, MBChB, FRACS, FAOrthA, osteoporosis is reversed as the bone is an orthopedic surgeon and chairman now loading according to Wolf’s Law.” of the Institute of Musculoskeletal Reconstruction and Osseointegration at the Australia School of Medicine in Role of the Prosthetist Sydney, Australia. As interest in implants grows among Solon L. Rosenblatt, MD, a colleague amputees, U.S. prosthetists will be of Al Muderis and clinical director asked to play more prominent roles in at the Institute of Musculoskeletal the health-care teams that carry out Reconstruction and Osseointegration, the procedures. “Osseointegration isn’t has noted that patients who have just a surgical treatment—it’s a rehaundergone osseointegration at the bilitation option,” says Garibaldi. “This Institute “can feel things that they means that all parties involved, includnever felt before,” such as when they ing the physician, prosthetist, physical are walking on grass versus cement. therapist, nurse, patient, etc., must participate equally throughout the care process to ensure an optimal outcome. Strong team formation and accountability are critical to the success of this technology.” With both OPRA and POP implants, prosthetists are a key component of optimal treatment and rehabilitation, says Stevens—although prosthetists must alter their approaches when compared to patients using sockets. With implants, “we don’t have to worry about sockets anymore, but we spend more time refining alignment,” he says. “In the absence of the soft tissue cushion that exists in socket fittings, the alignment is more exacting with osseointegrated prostheses.” A patient with a POP implant tests his prosthesis.

COVER STORY

PHOTO: Hanger Clinic

Prosthetists who work with implant patients Don’t Miss the also must understand Osseointegration the concept of osseoperSession at the ception. “With direct World Congress! skeletal attachments, patients may be able to Make plans now to attend the session feel more around them, “Advancements in Osseointegration via osseoperception,” Technology for Amputees” at the AOPA says Stevens. “They can World Congress on Friday, September ‘feel the ground’ and give 8, from 1:30 to 3:00 p.m., in Las Vegas. feedback” during fittings Several of the individuals featured and alignments. in this article are scheduled to speak For both the POP and at the event, including Munjed Al OPRA protocols, there Muderis, MB, ChB, FRACS, FAOthA; are limitations regarding Rickard Brånemark, MD, PhD; Jonathan what types of components Forsberg, MD, PhD; Erik Kubiak, MD; can be used. Prosthetists Richard McGough, MD; and Richard Phil Stevens, MEd, CPO, FAAOP, works with a patient must comply with FDA O’Donnell, MD. with a POP implant. guidelines in choosing componentry, which are Forsberg and Potter predict that for the upper limb, and we’re interested ultimately tied to consumer safety. once surgeons can define the complica- in developing one for below the knee,” tion profiles of osseointegration, it may she says. She envisions a future when a POP platform could become even more be offered to a wider range of Looking Forward seamlessly a part of the human body, patients. But they emphasize Osseointegration procedures connected to something like the neurothe importance of proceeding have evolved since their with caution, as patient safety initial development for prosthetic technology being developed should be paramount. “We prosthetic patients, but at the Cleveland VA Medical Center and want to help people and we some challenges remain. Case Western Reserve University: an would like to see [osseointeFor example, researchers artificial leg that can be clicked directly are working on ways to onto the POP, and plugged directly into, gration] grow, but grow in a Jonathan Forsberg, MD, PhD reduce the possibility of or perhaps even wirelessly connected controlled fashion so that we’re infections, which arose with to, the wearer’s motor cortex. helping the maximum number of some of the earliest implant patients; The possibilities seem almost limitpatients and hurting as few as possible, newer implants have been found to if any,” they say. less. Osseointegration procedures are result in fewer infections. Stevens also encourages a “safety sure to become a much more common In the United States, the procedure first” mentality for those prosthetists procedure in the years ahead—but they is still in its infancy, so opportuniwho may work with osseointegration will not completely replace tradipatients. Prosthetists should become ties to receive implants are limited tional socket approaches. “The use “students” of the various types to participation in OPRA and POP of osseointegration will of implants—and understand the trials or custom implants. As the undoubtedly increase in its differences between them, he research grows and the FDA expands frequency,” says Garibaldi. says. “Patients will come to us its approvals, more amputees may “I don’t foresee this with their problems, and we become eligible to undergo the technology completely have a responsibility to field surgery. But exactly when the FDA eliminating traditional those questions and steer them might approve more devices is socket use for all patients, to answers,” he says. He encour- Benjamin Kyle Potter, but it definitely has complicated, due to the U.S. device MD classification system. While typical the potential to radically ages prosthetists to make sure external prostheses are classified as improve the lives of many there are safety boundaries for the low-risk, Class 1 devices, internal devices they intend to work with, and to candidates across the nation.” orthopedic implants are classified as adhere to those guidelines as outlined high-risk, Class 3 devices. Thus, there by the specific clinical care teams. is some uncertainty regarding how an Looking to the future, Sinclair and Christine Umbrell is a contributing osseointegration prosthesis should be her colleagues are working on POP writer and editorial/production associate classified, which the FDA will need to applications for other anatomical sites. for O&P Almanac. Reach her at address before moving forward. “We’re currently designing a platform cumbrell@contentcommunicators.com. O&P ALMANAC | JULY 2017

By LIA K. DANGELICO

EMR 101 Making digital medical records work for your patients and practice

NEED TO KNOW

While most hospitals and many physicians’ offices have already implemented electronic health record systems, some O&P facilities have not yet migrated their patient records to a digital system.

More O&P facilities will need to adopt electronic health record systems as the O&P profession shifts toward outcomes-driven and collaborative care, and to prepare for proposed legislation that would recognize the orthotist’s and prosthetist’s notes as part of the patient’s medical record.

Software that has been designed for general health-care needs may not translate well to the specifics of O&P facility workflows, but several companies offer platforms built around the needs of the O&P or durable medical equipment markets.

Before choosing the right solution, facility managers should work closely with all staff to determine the goals for the new system and incorporate employee feedback into the decisionmaking process.

HILE NEARLY 100 PERCENT of U.S

hospitals have implemented an electronic health record (EHR) system, according to a May 2016 data brief by the Office of the National Coordinator for Health IT, the O&P community still has a ways to go. The last few years have brought significant gains in technology and workflow solutions, but many O&P facility owners and managers are still trying to wrap their heads around what they should be doing in the digital medical record space. The gap between the adoption of EHRs— also known as electronic medical records (EMRs)—in U.S. hospitals and O&P may seem

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Migrating from paper to electronic medical records takes patience and management support—and an understanding that it will take time for staff to master all of the functionality in a new system.

Advantages of transitioning to digital health records may include improved communications with physicians and referral sources and more efficient overall process management. Patients also may benefit from more proficient and streamlined care.

striking, but the picture becomes clearer when you take a closer look at the incentives and regulations that exist. For example, in 2003, the Medicare Modernization Act required physicians to start using electronic prescription orders, which essentially forced doctors to begin using some sort of EMR system, says Darren Donnelly, CO, MBA, national accounts manager for OPIE Software, who will speak on the topic of EMR at the upcoming World Congress. Then, with the creation of Healthcare Information Technology Standards starting in 2006, as well as other incentives and reimbursement structures, more and more health systems made the transition to EMR.

created for doctors and hospitals are a single-treatment transaction use. For example, the patient comes in, is seen by a doctor, and they bill for that encounter.” But for O&P professionals, an EMR system needs to be able to track that WIP, where the patient may come in to get fitted for a prosthesis or orthosis he or she won’t get for several weeks. “We need [a system] to track that throughout the process,” he says. Chris Wallace, MS, CPO, FAAOP

In contrast, these incentives didn’t apply to the O&P profession. “I think many in O&P felt like, if it ain’t broke, why fix it?” says Donnelly. “A lot of people were able to get paid for what they were doing, the way they were doing it.” But as the industry continues its shift toward outcomesdriven and collaborative care, “we’re starting to see the value in having some systems in place that we can use to communicate to other physicians and referral sources and capture essential data quickly and easily,” he says. “It becomes important to have some sort of EMR system to be able to do that.” Electronic O&P records also take on greater significance with the introduction of the Medicare Orthotics and Prosthetics Improvement Act of 2017, which would recognize the orthotist’s and prosthetist’s notes as part of the patient’s medical record. “If the bill becomes law, O&P records will likely be much more heavily scrutinized by Medicare,” rendering well-managed and -organized EMR systems necessary, says Donnelly. Of course, EMR systems are not perfect. One of the biggest failures of the original push to EMR systems was “the lack of interoperability,”

says Donnelly. In promoting the benefits of EMR, it was always said, “if you live in New York but you go skiing in Colorado and break your leg, they should be able to bring up your records—know your allergies, your medications, know your entire history—and be able to treat you there without any problems.” The reality is that current technology isn’t there yet. Instead, “we’ve got a lot of these systems that are not really talking to each other.” But despite these limitations, says Donnelly, there are still many benefits to be had. Darren Donnelly, CO, MBA

Additionally, the majority of the EMR software on the market was built for broader health care as a whole and doesn’t necessarily translate well to O&P workflows. “One of the things that’s inherent in O&P is the ‘work in progress,’ or WIP,” says Donnelly. “Most EMR systems

Chris Wallace, MS, CPO, FAAOP, agrees. As the director of orthotics and prosthetics at Methodist Rehabilitation Center in Flowood, Mississippi, Wallace is currently implementing an EMR system across its six locations. When he and his team began their search for a software solution, it quickly became clear that a one-size-fits-all approach just wouldn’t work. The non-O&P based software that they considered “just couldn't check off enough of the boxes,” he says. “They just were leaving too many gaps for us. They were going to be expensive and then still not fulfill our needs.” Fortunately, there are a number of software platforms built around the specific needs of the O&P or durable medical equipment markets, including OPIE, Futura, MedFlex, Brightree, and others. These products are currently being used across many facilities, and each offers its own approach to implementation, workflow, and more.

Getting Organized

There are many different software products available that work for every shape and size of O&P practice—from solo owner outfits to large-scale corporations. Finding the right product and workflow solution takes time and effort, and should begin with defining what you’re looking to get out of it. O&P ALMANAC | JULY 2017

VA Announces Transition to New EHR System The U.S. Department of Veterans Affairs (VA) will move toward a commercial off-the-shelf product for its electronic health records, according to an announcement made in June by VA Secretary David J. Shulkin, MD. The VA will adopt MHS GENESIS, the same EHR system that is currently being used by the U.S. Department of Defense, in a move to integrate all patient data “residing in one common system and enable seamless care between the departments without the manual and electronic exchange and reconciliation of data between two separate systems,” said Shulkin. The VA previously used an EHR system created by the VA known as the VistA, which Shulkin said is in need of major modernization to keep pace with improvements in health information technology and cybersecurity. “At VA, we know where almost all of our veteran patients are going to come from—from the DoD,” he said. “Having a veteran’s complete and accurate health record in a single, common EHR system is critical to that care, and to improving patient safety.” In making the transition, Shulkin said the VA must maintain interoperability with DoD, “but also with our academic affiliates and community partners, many of whom are on different IT platforms.”

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PHOTO: Getty Images/sturti

While each O&P facility should search for a solution specific to its needs, Donnelly recommends looking for a system that can track the full episode of care—from the initial evaluation, to the production of the product, to the delivery of the item, and, finally, to the last follow-up appointment. Once they decided to implement an O&P-specific EMR system, Wallace and his team gathered the directors and key stakeholders from each department to form an implementation committee that researched and interviewed a number of software companies and products. They used a scoring chart to determine which offerings best matched their criteria. “There’s value in doing a systematic scoring process,” says Wallace, “first, establishing what your goals are for software, [and asking,] ‘Why are you even considering electronic medical records [in the first place?]’” Like any other business venture, going down the EMR path can’t be an emotional decision, he warns. “You don't want to jump into EMR just because everybody’s going to EMR or just because you think it's going to help one or two particular areas. It needs to be a systematic approach to what the value’s going to be for your organization.” Another factor is the people who will be using and interacting with the system on a daily basis—your staff. From his experience traveling to O&P facilities and teaching people how to use EMR software, Donnelly acknowledges that people generally don’t like change. The mentality of doing things “the way they’ve always been done” can be a barrier. With a staff of nearly 50 employees, Wallace is no stranger to how difficult big changes can be on staff. To generate buy-in, he made a point to include the whole team early on in the investigation process. At monthly managers’ meetings and biannual all-staff meetings, the leadership talked with staff about the need for an EMR system and how it would benefit the company as a whole. As the feedback

and conversation evolved, Wallace says they continued to educate their team on the value of this project. Once a final decision was made, staff didn’t feel decisions had been made in a vacuum, Wallace says. They understood that their needs and desires had been heard and factored into the selection process.

Putting It to Work

Just as strong communication and planning factor into the success of a facility’s EMR system, the steps taken to roll out the system also are critical, says Joanne Kanas, PT, CPO, corporate director of orthotics and prosthetics for Shriners Hospitals in Tampa, Florida. When Kanas implemented an O&P-specific EMR system in 2014, she made sure her team was onsite for each of her location’s “go live” weeks to provide support. “To be there and to be able to help them develop those processes and workflows that make their practice unique is important.”

EHRs or EMRs: What's the Difference? The Office of the National Coordinator for Health IT (ONC) defines an electronic health record (EHR) as “a digital replica of a patient’s medical chart that makes information available instantly and securely to authorized users… and can be inclusive of a broader view of a patient’s care.” EHRs create “a greater and more seamless flow of information within a digital health-care infrastructure, [which] encompasses and leverages digital progress and can transform the way care is delivered and compensated. With EHRs, information is available whenever and wherever it is needed.” The term “EHR” is often used interchangeably with electronic medical records (EMRs), which are defined by ONC as “digital versions of the paper charts… that contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment.”

Joanne Kanas, PT, CPO

PHOTO: Getty Images/pandpstock001

After the initial rollout, Kanas followed up with her team weekly to review their WIP and to coach staff on areas where improvement was needed. When she uncovered information that was out of place or that had been entered incorrectly, Kanas approached it as a teaching moment, not only to ensure the process is being followed but also to show employees that they are supported during the transition period. “Everybody needs to have that time to learn, apply, and improve. No one’s perfect, and no one’s going to get it all right the first time around.” Kanas’s team continues to conduct biweekly check-ins with staff in each location and complete regular compliance audits so they can address issues as they arise. Wallace also took a deliberate and hands-on approach to training and implementation. He and his team

doled out weekly assignments for staff members that were specific to their roles. This “forced interaction” helped get them used to the virtual environment and prepare for the full transition. He also encouraged a front-to-back approach to demonstrate the new workflow. “The front office would create a patient, set up an appointment, do the intake documentation, and then pass things off to the clinical staff member, who would see that appointment and do his or her side of it, send it back to the front office, and so forth,” he says. “They were beginning to work as a team even though there was some isolation in their processes.” Again, change is hard, so plan for extra time and effort to get things running smoothly. “It’s more than just teaching people how to click buttons on a computer,” says Donnelly. “It really does change everything that they do and how they do it.”

For example, the front-end intake process may become a bit more time consuming with some EMR systems. But, says Wallace, “it pays dividends on the back end later. When you need information, staff can just pull it out of the electronic chart… easily, without having to hunt for it.” Once that happens a few times, you can see it “click” with employees, he says. “They can answer a question [or request] quickly; they’re happy, the patient’s happy, the referral source is happy, and then it reinforces the use of that process, so that’s been really good for us.” O&P facilities that make the switch to EMR also must be prepared to respond to questions on the new system from referral sources. Now that Kanas and her team are working to maintain compliant EMRs, she often finds herself receiving pushback from outside physicians because they can’t do things the way they’ve always done them. EMRs don’t automatically mean O&P ALMANAC | JULY 2017

less work, she says. Often, it takes even more work to maintain a compliant patient record. For example, instead of just sending a prescription or canned letter, referring physicians must fully complete the patient record before sending it. In an effort to ease the transition, Kanas and her team have developed some dictation guides based on the physician requirement, and they also make an effort to share as much of their notes with the physicians as possible. “We know that we’re asking [physicians] to do more,” says Kanas. “But we ask, ‘What can we do to help you with that?’”

What’s To Gain

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Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com.

Don’t Miss the EMR Session at the World Congress! Make plans now to attend the session “Implementation of EMR— Catching Up With the Rest of Health Care To Communicate With Referral Sources” at the AOPA World Congress on Thursday, September 7, from 4:45 to 5:15 p.m., in Las Vegas. During this session, Darren Donnelly, MBA, CO, will expand on many of the topics covered in this article, including the steps to implement an EMR system, the logistics of changing systems, and managing expectations.

PHOTO: Getty Images/asiseeit

O&P facilities that take the time to research and carefully implement EMR systems will likely notice many benefits and efficiencies. “It gives you all the tools you need to be able to complete every step of the O&P process—from meeting all the requirements at the beginning of patient access and registration, through documentation, authorization, verifications, and letters of medical necessity, to physician notes to ensure compliance, as well as following up on accounts receivable and outstanding invoices,” Kanas says. For Wallace, implementing an EMR system brought about

several improvements to the way he managed his facility, its patients, and the employees who work there. For starters, it meant replacing an outdated paper scheduling system with an electronic schedule, which has helped improve process management and provides a better understanding of the daily schedule. It also has created efficiencies with addressing patient concerns and compliance efforts. Instead of driving to each location to pull reports and other data, “I can log into that patient file from anywhere, look at the information directly in a much more timely manner, and drive information from it that way,” he says. “Now, we can run a report to see, ‘Hey, which clinicians didn’t complete their note compliance this past week? Which patients no-call, no-show, or canceled and haven’t scheduled a future appointment?’ We need to make sure we follow up with those guys and figure out what happened,” he says. Being able to do “the things that we really didn’t have a way to manage manually [before], or if you did it was incredibly time-consuming, has been much more efficient.” Many of these benefits also extend to patients, who can enjoy more efficient, accurate, and timely care. “Using an EMR system is going to track all

the steps in that process so it’s easier for patients to get from the initial evaluation to delivery,” says Donnelly. “It’s also a lot more transparent.” For example, at any point, a patient can call and ask for the status of his or her device, and staff will be able to log in and provide an accurate update for the patient, whether it’s on hold for authorization or currently being fabricated. If the device has been received, patients can promptly schedule their next appointment. Of course, these improvements won’t come about by themselves. “It’s still a tool,” says Kanas. “There’s no magic button that you push—or magic wand. It’s still dependent upon good, quality documentation [and processes]. Good quality in, good quality going out.”

UNIFYING

VOICES In its 25th year, the AOPA Policy Forum continues the fight for O&P and introduces new collaborative tools

MAY 24-25 / WASHINGTON, DC

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2017

FFECTING CHANGE IS HARD WORK.

Just ask the more than 100 O&P professionals and patient advocates who attended the 2017 AOPA Policy Forum briefing and made more than 395 congressional office visits during their time in Washington, DC, on May 24 and 25. Armed with new communications tools and a mounting body of data to make their case, they traveled to the nation’s capital to gather support for smart policies from representatives of their home districts. For repeat attendees, their “asks” on Capitol Hill were familiar—support for the latest version of the Medicare O&P Improvement Act, funding for O&P research and education through the Wounded Warriors Workforce Enhancement Act, support for the Veterans Bill of Rights, and a rescindment of the draft Local Coverage Determination (LCD) and all related lower-limb audits. “These are not new concepts to you,” Peter Thomas, JD, counsel to the National Association for the Advancement of Orthotics and Prosthetics and the O&P Alliance, recognized as he briefed participants on these pressing issues. “They’ve been circulating, and we’ve been promoting them for some time. Sometimes in Washington, it just takes a lot of effort to roll the rock up the hill.”

This year, that effort was fueled by a renewed sense of purpose to protect the profession and its patients amid an uncertain health insurance climate and a new administration. During his general session address, freshman Congressman Rep. Brian Mast (R-Florida) provided encouragement to participants. He pledged to be an advocate for O&P as he asked participants to not only push for the legislative issues to benefit the O&P community but also to push their patients back home. As a bilateral amputee himself, Mast understands the personal relationships O&P providers have with their patients and credits his O&P team for challenging

Rep. Brian Mast (R-Florida)

Medicare O&P Improvement Act—What’s New?

OR THE PAST FOUR YEARS, AOPA and its team of lobbyists and advocates have been promoting legislation that would improve standards for O&P in Medicare. But because bills cannot be carried over from one Congress to the next, new bills must be brought forth. The 2017 version of the Medicare Orthotics and Prosthetics Improvement Act was introduced in both chambers of Congress prior to the Policy Forum. While the goal and main provisions of the Act remain the same as its predecessor bill, the chart below illustrates how it differs from the bill that was drafted (although not introduced) by attendees at the 2016 Policy Forum. The Medicare O&P Improvement Act of 2017 vs. The P&O Care Modernization Act of 2016

P&O Care Medicare O&P Improvement Modernization Act of 2016 Act of 2017

Payment based on provider/supplier qualifications Designate organizations for accreditation of O&P Payment based on complexity of care Orthotist’s and prosthetist’s notes considered part of the medical record Separate O&P from DME Clarification of “minimal-self adjustment” and OTS orthotics Rescind the draft LCD, and convene new committee to review the LCD

Peter Thomas, JD O&P ALMANAC | JULY 2017

The RAND Study: New Data for the LCD Fight

S PART OF THE AOPA PROSTHETICS 2020 INITIATIVE, and its ongoing effort to demonstrate the value of prosthetic devices and services to payors, AOPA commissioned a study of the impact of using advanced transfemoral and transtibial prostheses. It partnered with RAND Corporation specifically because of its reputation as an influential and unbiased research firm. “Much of their work has been the marker for where the future of health care goes, in defining a reimbursement system and structures and so forth,” AOPA Executive Director Thomas F. Fise, JD, explained at the 2017 AOPA Policy Forum, where he discussed some high-level results from the trans-femoral portion of the research that has been completed. As a baseline, RAND researchers looked at the 15 percent decline in payments for prosthetics from Medicare over a four-year period. “Basically, we should be looking at the value of prosthetics in determining the payments for advanced prosthetics systems,” Fise continued. “Some of the systems that we have are outdated, and O&P services are likely being under-reimbursed.” Thomas F. Fise, JD

Mark Rayder 34

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RAND also conducted a comprehensive literature review and consulted with experts to develop a 10-year simulation model of K levels and the distinctions between K2 and K3 among cohorts of transfemoral patients using microprocessor versus nonmicroprocessor knees. The model took into account pain, obesity, and several other factors; however, the most valuable insights came when comparing falls, deaths, and incidence of osteoarthritis between the user groups—microprocessors demonstrated a clear outcomes benefit for patients and significant cost savings for payors over the decade studied. AOPA will be submitting the full report to “major journals” and anticipates it will be published within the year. “[The study is] important because it is so contrary to where the LCD was pointing,” said Fise. “There, in fact, is an economic value as well as a health-care value to the availability of the advanced prosthetic devices to patients.”

him physically to a point where he can do almost any activity. “You have that relationship with [patients] that every person that receives medical care wishes they could have with their primary care provider,” he said when describing the high level of expert care he receives. “[It] is not a relationship where I get one or two or five minutes and then I’m passed off to somebody else. . . . I will be an advocate for the issues that matter to us both, so that you all can be the best possible providers for individuals that find themselves in the same situation that I find myself in.” With new administration and ongoing health-care reform, it can be easy to get caught up in the politics of health care—regardless of which

side of the aisle you are on. But the bevy of speakers was quick to remind participants the debate is a “process” that’s far from over. “You’re going to be trying to get beyond that, beyond the noise and down deep into issues that actually matter to you and what you work on every day for you and your patients,” said Mark Rayder, senior policy advisor for Alston & Bird, during his presentation on the effects of health-care reform on O&P practices. He and other speakers cited the most critical reform issues for the profession and patients: coverage for pre-existing conditions, the inclusion of essential health benefits and rehabilitative and habilitative benefits, and the continued funding for Medicaid to support amputee patients.

Sen. Bill Cassidy (R-Louisiana)

The latter—funding of Medicaid— was part of the briefing from Sen. Bill Cassidy (R-Louisiana), who delivered a congressional perspective of the Affordable Care Act repeal/revision. “If you speak to folks in Ohio, they’ll say the Medicaid expansion has played a major role in addressing the opioid epidemic, and. . .that’s probably something that [O&P providers] have to confront,” he said. “Some of the same folks who would be requiring prosthetics as a result of multiple trauma or something similar will have [opioid addiction] issues.” Cassidy also acknowledged the need for Medicare reform but said that will come at a later time because it is a topic the Republican party “politically is not prepared” to address. “We need decisions and actions far faster than what is currently happening,” he said. “[Concerning] the local coverage decisions…at some point we need standardization, particularly as—I’m sure you can tell me—high tech is entering into orthotics. Someone has greater mobility now with an orthotic than ever before, but I’m sure that comes with a certain expertise both in fitting and monitoring that should be available all over. But, CMS is not there yet. So, when we do Medicare reform, we have to figure out how to accomplish that.”

Proactive Measures

To further unite the profession and patients, AOPA leaders and industry partners introduced several communication tools at this year’s Policy Forum: the AOPA Co-Op, the Amputee Coalition’s Amplify project, and an update to the Mobility Saves initiative. These new tools can be used to “level the playing field with access to information,” according to

Rep. Wenstrup (R-Ohio) and AOPA President Michael Oros, CPO, LPO, FAAOP

AOPA President Michael Oros, CPO, LPO, FAAOP. “For too long, it’s been apparent that [because] insurance companies and larger payors have all of the data, they have the power. When you’re small, you have to figure out ways to leverage the capabilities and capacities that you do have. And one of the things that we can do better is to communicate with one another. That’s how our voice gets larger,” he said. More specifically, the AOPA Co-Op (www.aopanet.org/resources/co-op) is a new “Wikipedia” style, crowdsourcing platform, vetted by AOPA, for members to share information regarding reimbursement, coding, and policy. Along with other input sources, the Co-Op “will be taking information

as people provide it—whether it’s a trending topic on a code that’s getting denied in a certain state or by a certain payor, or if it’s a new policy change that is going to limit access to care for our patients,” Ashlie White, MA, AOPA’s manager of projects, explained. AOPA also has invested in a comprehensive data system that updates staff about any policy changes at the state level, and it will use the Co-Op to push out alerts to users via email, said White. The platform is accessible in desktop and app versions, and it goes hand-in-hand with the AOPA Google+ community. Once the Co-Op informs users about changes in policy, the private Google+ community will “mobilize and talk” about how to proactively address the issues. O&P ALMANAC | JULY 2017

Sen. Bill Cassidy (R-Louisiana) and Traci Dralle, CFm

Dan Ignaszewski and Jack Richmond of the Amputee Coalition

Ashlie White, MA

The Co-Op also includes information derived from AOPA’s collaboration with the Amputee Coalition and its Amplify tool, a two-part awareness and policy initiative. The public online component (www.amplifyyourself.org) is a hub for patients and their families to share their stories of living with limb loss and limb difference. Amputee Coalition’s communications team then pulls compelling stories from the platform to share with the media as needed.

The site also allows patients who are experiencing insurance denials or access to care challenges to contact their insurers directly using “a pre-crafted letter that will go directly to the medical director and the CEO of that person’s insurance company,” said Dan Ignaszewski, director of government relations for the Amputee Coalition. In addition, the site alerts patients to policy changes in a similar manner as the AOPA Co-Op, and it links to a template letter-writing tool

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focusing on the same concerns AOPA has for federal health-care reform and patient care: pre-existing condition protections, essential health benefits, and Medicaid expansion. AOPA’s Mobility Saves initiative (www.mobilitysaves.org) recently updated its mission, which will be reflected in a new website set to launch in July. The new site has been redesigned to reach three specific audiences: patients, practitioners, and payors, according to Traci Dralle, CFm, director of marketing for Fillauer Companies and AOPA board member. “We want payors to be able to go [to the Mobility Saves website] and see that we have proof that you’re going to provide the right and the best prosthetic care for patients, and it’s going to save you money in the long run,” she explained to attendees. “We want practitioners to. . . take their patients there, allow them to be advocates and voices for themselves, and to be able to get the products that they need.” Both Dralle and White also encouraged attendees to continue sharing their stories on Facebook, Twitter, and Instagram using the hashtag #MobilitySaves. Collectively, the stories and data disseminated from the Co-Op, the Mobility Saves and Amplify websites, and social media have the power to unite an unprecedented number of professionals and patients and ignite year-round grassroots advocacy efforts. Next year, Policy Forum participants will have an even stronger “resource kit” as they unite their voices for O&P.

COMPLIANCE CORNER

By JOSEPH MCTERNAN

Back to Basics Ensure that documentation is complete to help reduce claim denial rates

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 39 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

E! QU IZ M EARN

BUSINESS CE

CREDITS P.39

OMPLIANCE WITH MEDICARE RULES and regulations is no easy feat. As

audits by multiple Medicare contractors continue to increase, O&P claims are being placed under the microscope on a regular basis. Pressure to reduce overall health-care costs has led Medicare and other payors to look for new ways to justify denying payment on claims, regardless of whether the services are clinically appropriate for the patient. Unfortunately, a simple administrative oversight can mean the difference between getting your claim paid and having it denied. When discussing effective methods to ensure compliance with Medicare policies and regulations, it is important to start with the basics. This month’s Compliance Corner focuses on some of the essential considerations when developing a compliance plan that meets the specific needs of your organization.

Basic Requirements for Coverage

One of the most important issues regarding Medicare coverage of O&P devices—and one that is often overlooked—is basic coverage criteria. For all of the O&P services that are governed by a Local Coverage Determination (LCD) and Policy Article, the very first section of the policy addresses the general requirements for Medicare to consider coverage of the device. For example, in order for Medicare to consider coverage for any lower-limb prosthesis, there must be documentation that indicates the following: 1. The patient will reach or maintain a defined functional state within a reasonable period of time; and 2. The patient is motivated to ambulate.

PHOTO: MStudioImages

While it may seem that these two requirements are “understood,” failure to document them can immediately impact your ability to receive payment when you submit your claim. Leaving this information out of the patient’s medical record is a fairly common,

yet completely avoidable, mistake. Similarly, the LCD for ankle-foot orthoses and knee-ankle-foot orthoses states the following guideline: “The item must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the function of a malformed body member.” Without documentation that supports this basic but essential coverage requirement, the entire claim is placed at unnecessary risk.

Controlling What You Can

Two of the most common reasons for claim denials for O&P services are missing or incomplete proof of delivery documentation and missing or incomplete detailed written orders. These are both items that you, as the provider of the device, have complete control over—yet they are responsible for almost 50 percent of initial claim denials. Taking time to review your internal procedures regarding these essential documents will have an immediate impact on your company’s compliance with Medicare rules. O&P ALMANAC | JULY 2017

COMPLIANCE CORNER

Medicare requires that proof of delivery documentation contain the following information: • Beneficiary name • Delivery address (actual location where the patient took possession of the item) • Detailed description of the item delivered • Quantity delivered • Date delivered • Beneficiary signature. The detailed description of the item delivered can take many forms: It can be a detailed narrative of all separately billed components; a list of HealthCare Common Procedure Coding System (HCPCS) codes and complete descriptors; or a listing of brand name, model number, or serial number of the devices delivered. As a general rule, a member of the public should be able to read the proof of delivery document and understand what was specifically provided to the patient. However you choose to document this section of the proof of delivery, you must individually describe each component that will be billed with a separate HCPCS code. Since the proof of delivery documentation is almost always the responsibility of the provider of the device, failure to obtain a complete and valid proof of delivery is an avoidable, and often costly, error.

As with proof of delivery documentation, the provider of the O&P device is allowed to complete the detailed written order in preparation for the prescribing physician’s signature. The elements that must be included on a detailed written order include the following: • Beneficiary name • Physician’s name • Date of the order • Detailed description of the item(s) • Physician’s signature and date of signature.

Correct Modifiers

Using incorrect or missing modifiers is another common and avoidable reason for claim denials. Modifiers are important pieces of the puzzle when communicating with Medicare and other payors, so it’s important to use them properly. 38

JULY 2017 | O&P ALMANAC

PHOTO: Top-Getty Images/Tom Merton; Bottom right-Getty Images/PeopleImages

Remember that if you, as the provider of the device, are completing the detailed written order, it must contain both an order date (which you complete) and a physician signature date (which is applied next to the physician’s signature, in the physician’s handwriting). Taking the time to ensure that proof of delivery documentation and detailed written orders are compliant with Medicare guidelines will result in a significant reduction in claim denial rates.

Directional modifiers are required on all claims that involve either side of the body or, in some cases, bilateral services. The LT modifier indicates that an item is worn on the left side of the body while the RT modifier indicates that an item is worn on the right side of the body. In cases where the same device will be worn on both sides of the body (bilateral), the appropriate modifier is LTRT. Functional-level modifiers are used exclusively on lower-limb prosthesis claims, specifically on HCPCS codes that describe prosthetic feet, ankles, knees, and hips. These modifiers range from K0 to K4 and are used to indicate the functional level of the patient as assigned by the prescribing physician and the prosthetist. Claims for prosthetic feet, ankles, knees, and hips that are not submitted with a functional-level modifier will automatically be denied by Medicare. The KX modifier is used in certain circumstances to indicate that Medicare coverage criteria have been met and that required documentation is on file. By including the KX modifier on your claim submission, you are attesting that the information above is true. Including the KX modifier on claims where you have not secured appropriate medical necessity documentation may lead to ramifications beyond a simple claim denial.

COMPLIANCE CORNER

Collecting Required Documentation

Educating Others

While Medicare will allow you to deliver an O&P item based on a preliminary written or verbal order, you must have your documentation gathered and prepared prior to claim submission. There is no requirement that you provide documentation of medical necessity unless it is requested; however, once you submit a claim—especially if it is for a service where policy requires the use of the KX modifier—you are expected to be able to produce the documentation that supports the medical necessity of the service you provided. While the pressure to generate and book revenue may make it tempting to submit claims quickly, it may be more prudent to delay claim submission until all required documentation has been collected and reviewed for accuracy. Doing so will increase your overall compliance “score” and is good business practice, especially if regular referral sources do not always provide detailed documentation regarding the medical necessity of the items they prescribe.

Improving your processes for issues you directly control, such as proof of delivery documentation and most detailed written orders, will directly impact your ability to maintain effective Medicare compliance. In addition, there are ways to influence those things over which you have no direct control. For example, you can try to influence how other providers document the medical need for the services they are providing. It can be very frustrating to request clinical notes from a referral source and be told there are none or receive minimal information. While you cannot directly control this, you can influence the documentation of others through education. Taking a few minutes to sit down with your referral sources and explain not only what documentation you need from them but, more importantly, why you need it, may save you tremendous time and effort in the future. While it may be difficult to get access to your referral sources’ time, there is a good chance they will be willing to work with you if you present yourself efficiently and

The Source for Orthotic & Prosthetic Coding

professionally. Proper documentation is always in everyone’s best interest. Compliance is a subject that most people don’t like to talk about as it often leads to frustration and anxiety. While it is understandably a difficult topic, the value of an effective compliance program cannot be understated. Recognizing the basics of compliance is just the first step in creating an effective and valuable compliance plan that is appropriate for the size and scope of your organization. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

www.bocusa.org

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

HE O&P CODING EXPERTISE the

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

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

NEW

Manufacturers: for 2017! AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571/431-0876.

www.AOPAnet.org

O&P ALMANAC | JULY 2017

& NOW

THEN

O&P Almanac AOPA’s monthly magazine has served as AOPA’s seminal publication for decades

Then & Now is a monthly department for 2017. As part of AOPA’s centennial celebration, O&P Almanac will feature a different AOPA product or service and discuss how it has evolved over the years. This month, we focus on the association’s flagship magazine, O&P Almanac.

HE MAGAZINE YOU’RE READING

right now has a rich history of sharing important O&P-related news for several decades. As the most respected source for industry insight and association news in the orthotic and prosthetic profession, O&P Almanac regularly publishes articles on important topics such as emerging technologies, coding and reimbursement education, premier meetings, people and businesses in the news, and industry modernization. But this fourcolor print-and-digital publication got its start with much more humble beginnings.

JULY 2017 | O&P ALMANAC

THEN O&P Almanac was first published when AOPA was known as the Association of Limb Manufacturers of America (ALMA)—so it made sense that it was originally called the The ALMAnac. During ALMA’s early years, the publication was issued by officers and volunteers of ALMA, and was a much smaller and more sporadic publication. A look back at the October 1937 issue of The ALMAnac—published almost 80 years ago—indicates a typical issue from that time period was about 16 pages, black-and-white, with some editorial and a few advertisements. The key feature was “Convention News”—a look back on the 18th Annual Artificial Limb Manufacturers Association and Convention. This article was offered in an attempt “to describe it to those of you who were not fortunate enough to attend so you may share in its glory.” Ads from Knit-Rite, Ohio Willow Wood, and the George S. Colton Elastic Web Company, among others, were featured in The ALMAnac.

In 1946, ALMA leaders invited orthopedic brace fabricators to join the association, resulting in a name change to the Orthopedic Appliance and Limb Manufacturers Association (OALMA). From 1946 to 1949, The ALMAnac was put on hiatus as funds were diverted to the new Journal of OALMA. But in 1949, the association resumed publishing, calling it the OALMA Almanac. The first issue of the OALMA Almanac, published in July of that year, was described as “nothing fancy…. It is our good will and public relations feature. The Almanac, carrying no ads, can be afforded only if it is accepted as a low-cost, quickly printed ‘house organ.’ …We hope it may be found of real value as a current bulletin on matters affecting the welfare of our membership family.” The debut issue included briefs on the Group Life and Health Insurance Program, the Ladies Auxiliary, new contracts with the U.S. Department of Veterans Affairs (VA), a new suction socket school, OALMA’s suction socket valve study, and OALMA convention details.

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APRIL 2017 | O&P ALMANAC

PHOTOS: Shirley Ryan AbilityLab

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M The facility is structured so that researchers and clinicians who focus on the same part of the body or the same pathology are working in the same spaces, and often they work together with the patient throughout the treatment process to produce immediate feedback and results. With this new model, research may be translated into patient care almost immediately. M The AbilityLab features innovative technology such as gait tracks and obstacle courses for patients working to improve mobility and navigate in the real world, as well as custom-made assisted staircases that help patients relearn walking and running up and down stairs. M O&P-related research goals at the AbilityLab include development of new upper- and lower-limb prosthetic and orthotic components, as well as new methods of control for O&P devices. Staff members also will be working to validate outcomes and the efficacy of existing O&P devices.

A new research hospital in Chicago places clinicians , researchers, and patients in shared spaces to innovate and drive outcomes

rtability

M The new Shirley Ryan AbilityLab, which opened last month in Chicago, is a state-of-the-art facility designed to help patients suffering from the most severe and complex injuries and conditions, including those with orthotic and prosthetic needs.

M What’s most exciting for the clinical operations manager of the facility’s Prosthetics & Orthotics Clinical Center is “the potential of what we can contribute to the rehabilitation field in general and to the O&P field specifically,” says Nicole Soltys, CP. “I think that we have the space and the mechanisms available to really develop some new technologies and techniques that we can share with the rest of the field.”

Pae White installation

on the 10th floor sky lobby

HEN YOU CLOSE YOUR

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and imagine the future of O&P and rehabilitative care, what do you see? What technologies enable your patients to walk with confidence? What devices improve their ability to drive a car or pick up their child? What do their faces look like as they experience their first breakthrough or success? This exercise is the vision behind the Shirley Ryan AbilityLab (sralab.org), which opened in Chicago in late March. Formerly the Rehabilitation Institute of Chicago (RIC), the AbilityLab has reinvented itself with a new $550 million, 1.2 millionsquare-foot research hospital. The state-of-the-art facility aimed at “advancing human ability” features the latest innovations and advancements to help patients suffering from the most severe and complex injuries and conditions—from smart

of the Shirley Ryan AbilityLab

thinking-speaking technology and equipment for stroke and head injury patients to experimental electromyography and movement analysis for patients with mobility issues. Most innovative of all is the facility’s goal to remove the barriers between research labs and clinical spaces to allow for “science-driven breakthroughs in human ability.” The organization is embracing the concept of translational medicine, which is defined by the European Society for Translational Medicine as “an interdisciplinar y branch of the biomedical field supported by three main pillars: bench-side, bedside, and community. The goal of translational medicine is to combine disciplines, resources, expertise, and techniques within these pillars to promote enhancements in prevention, diagnosis, and therapies.” O&P ALMANAC | APRIL 2017

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| O&P

ALMANAC

2017

O&P ALMANA

and the American Orthotic and Prosthetic Association in 1966.

Celebratory activities planned for the year include a commemorative membership directory, new columns in each month’s O&P Almanac, and special events at the AOPA World Congress and 100th National Assembly in September.

take part in this year-long celebration, featuring new columns such as “Then & Now,” which will highlight AOPA’s historical accomplishments, and “Bridge to the Future,” which will forecast the future of the profession. We begin the celebration this month, with a special to AOPA’s past 100 years. tribute In these pages, we share the story of how the association was founded and how the O&P profession has evolved, paying particular attention to historical events have shaped current achievements. that

20 JANUARY 2017 | O&P ALMANAC

| O&P ALMANA

O&P ALMANAC | JANUARY 2017

Once OALMA transitioned to AOPA, the publication became the AOPA Almanac. A look at the February and July 1967 issues—published 50 years ago—shows a 12-page, two-color publication. Headlines from that time period include “Food and Drug Administration Pushes Device Legislation,” “Basil Peters Resigns as AOPA President-Elect; Goes to NYU on Full-Time Basis,” and “VA Issues Immediate ‘Post-Op’ Handbook.” Companies such as Freeman Manufacturing, Southern Prosthetic Supply, Truform Anatomical Supports, and Florida Brace Corp. advertised in the magazine. Over the past 50 years, the publication has gradually become longer and more professional, and eventually transitioned to its current name, O&P Almanac. The magazine attracted readers outside of AOPA, and grew its advertiser base. The content in the magazine has evolved with the times, and has even earned awards. In 1992, the National Easter Seal Society presented the O&P Almanac with an EDI (Equality, Dignity, Independence) Award for an article that appeared in its May 1992 issue: “Disability in America: A Transition in Awareness.”

NOW

Today the magazine continues to be an important tool for thousands of AOPA members as well as industry stakeholders. With a tagline of

O&P Almanac—The Magazine for the Orthotics and Prothetics Profession, the magazine is published monthly in print and online. Each issue includes several feature articles focusing on timely and important business and clinical topics, a This Just In section with the latest industry reporting, a Reimbursement Page article with important coding and reimbursement news, a Happenings department featuring briefs of O&P-related news from around the country, a Numbers section with at-a-glance statistics and data, Member Spotlights featuring AOPA member companies, a Marketplace section with the latest O&P products, an Ask AOPA section that serves as a Q&A for reader questions, and much more. In addition to updating readers on the latest news, the magazine also helps educate them—and now offers CE credits. Readers of the monthly Reimbursement Page column and the quarterly Compliance Corner column can go online to take a short quiz; those who earn a score of at least 80 percent earn 2 CE credits. AOPA automatically transmits that information to the certifying boards on a quarterly basis. The quality content offered in the magazine is getting noticed, too. O&P Almanac received a Bronze award in the Association TRENDS’ 2015 All Media Contest for the monthly trade association publication category. The TRENDS All Media Contest is an annual competition held exclusively

for associations, recognizing the most creative and effective communication vehicles developed in the industry over the prior year. Last year, the magazine was awarded two Silver Awards of Distinction in the 2016 Communicator Awards Competition, an international program that honors innovation and achievement in communications/ PR and marketing. O&P Almanac was recognized for the “United We Stand” package in the October 2015 issue of the magazine, which covered the grassroots campaign built in response to the proposed Local Coverage Determination and Policy Article for lower-limb prosthetics. The magazine also was recognized for feature writing excellence for its December 2015 cover story, “Virtual O&P.” This year, the magazine has designed a special section in recognition of AOPA’s centennial celebration and in anticipation of the upcoming AOPA World Congress and 100th National Assembly. Each issue features a Then & Now column highlighting historical accomplishments, a Bridge to the Future column designed to anticipate the next 100 years of the profession, and a Global Professional section featuring a Q&A with a clinician in another part of the world. As AOPA members ponder the association’s accomplishments of the past 100 years and prepare for the new centennial, they can look to the O&P Almanac to publish the latest news and information to keep them informed and up to date on the profession and relevant happenings in the world around us.

Look Back at Past Issues

Interested in taking a walk back down memory lane and revisiting some of the past issues of O&P Almanac? Access all of the issues since 2009 by visiting https://issuu. com/americanoandp/stacks. Contact the AOPA office at 571/431-0876 or info@AOPAnet.org for archived issues from an earlier date.

O&P ALMANAC | JULY 2017

BRIDGE TO THE FUTURE: THE INTERVIEWS

Microprocessors Technology evolves beyond the knee By CHRISTINE UMBRELL

Bridge to the Future: The Interviews is a monthly column for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will look to the next 100 years—by interviewing noted experts in the O&P field to learn their vision for the future of O&P. This month, we speak with John Jump, CPO, on the topic of microprocessors and the future of the technology.

JULY 2017 | O&P ALMANAC

SK ANY PROSTHETIST ABOUT

seminal events in the history of technological advances in O&P, and it’s a good bet the topic of microprocessors will come up. While it’s been about 25 years since the technology first came to market, the number of amputees who are benefiting from this technology expands at a seemingly ever-increasing rate. In 1989, Blatchford began development of the first commercially available microprocessor-controlled prosthetic knee, the Intelligent Prosthesis. The device was programmed to each individual user to achieve an energy-saving gait pattern, and the first iteration was soon followed by the company’s hybrid pneumatic/hydraulic microprocessor-controlled knee, which was designed to respond to ramps, stairs, and speed. In 1999, Ottobock released the C-leg, the first fully microprocessor-controlled leg prosthesis system. Early users quickly adjusted to the technology, retraining themselves to walk in a different—but easier—manner. Since then, several more manufacturers have released microprocessor-controlled knees and devices, allowing a growing number of amputees to benefit from the technology. Most devices feature a microprocessor, software, sensors, a hydraulic or pneumatic resistance system, and a battery. As a patient

walks, the sensors may detect changes in walking surfaces and walking speed, and the microprocessor adjusts accordingly.

The New Normal

As the technology has evolved, microprocessors have moved beyond knees and now are used in feet, knee/foot combinations, hands, vacuum pumps, and more. And the devices are becoming less complicated than previous versions. “Manufacturers are making these devices easier and easier to program,” says John Jump, CPO, vice president of prosthetics for Level 4 O&P. “You don’t need as many ‘extra pieces’ to program them; you can just go to a website and download information. Now they almost program themselves.” With advances in microprocessor technology, prosthetists and patients alike have had to learn to use new prostheses to maximize benefits. “The learning curve for patients is so much shorter now,” says Jump. “Advancements in technology have made these products more user-friendly.” In the early years, clinicians and patients often travelled to off-site locations, sometimes overnight, to get trained on the technology. Today, “most manufacturers have representatives who are certified individuals who will come to your office and teach you how to use these devices,” he says.

BRIDGE TO THE FUTURE: THE INTERVIEWS

In addition, many manufacturers offer online training courses and webinars. Today’s prosthetists also are more prepared than ever to assist their patients in advanced componentry. “New young clinicians are coming out of schools ready to work with this type of technology,” says Jump. The technology surrounding the prostheses has evolved right along with the devices themselves. “When we first started fitting them, cell phone technology wasn’t what it is today,” and patients didn’t always understand they would need to charge their prostheses on a regular basis, says Jump. “Now everyone’s used to plugging in their phone every night, and they plug in their prostheses, too—that’s really helped with acceptance.” Jump also notes that battery life has lengthened since the devices first hit the market, and most microprocessor-controlled components can make it a full day before needing to be recharged—which John Jump, CPO, fits a patient with an integrated also increases acceptance levels.

Benefits and Challenges

microprocessor-controlled lower-limb system.

PHOTO: Courtesy of John Jump, CPO

Jump says his patients most frequently cite “stability” and the “ease with which they walk” as the most significant benefits of microprocessor-controlled lower-limb devices. “They feel more natural walking—it’s almost like it becomes second nature,” he says. For upper-extremity patients, they’re “able to do more task-specific things, and complete a broader range of tasks,” says Jump—although he notes that tasks with upper-extremity devices require “a little more thought” than their lower-limb counterparts. “But they become routine over time as well.” At Level 4, there has been a major trend in moving amputees with microprocessor-controlled knees to devices with microprocessor-controlled knees and feet, says Jump. “And they are very happy,” he says. But reimbursement continues to be a challenge in some cases. Despite the

fact that the technology has proven to be beneficial, “we’re putting on procedure codes [for microprocessors] that have been approved by Medicare that have been around for 10 or 15 years— and we still have kickbacks from payor sources saying they’re experimental or that the patient will be just fine with a different device,” says Jump. “Reimbursement can be a challenge when providing these levels of technology.” Extra time often is required to work with the payor source to ensure payment, and reimbursement frequently does not keep up with the research and development costs for these products, he says. Despite the challenges, O&P clinicians are advocating for those patients who are candidates for the technology, says Jump. “Most patients are very excited about [the technology]—and look forward to seeing and trying what

is available to them when they are in need of a new prosthesis.”

A Bright Future

As technology advances, microprocessor-controlled devices will likely be available to a broader range of patients and allow even greater functionality. Jump predicts the self-adjustment capabilities of the devices will improve: “As the volume of the residual limb changes or the temperature of the socket changes, devices that could self-adjust accordingly” may become more commonplace. Jump also notes that the Department of Defense is working with manufacturers to create even more advanced technology for amputees. “We as clinicians need to be ready to provide this level of care to our patient base,” he says. Developments in upperextremity technology also will impact the O&P market, says Jump. Researchers “are working on using the thought process in conjunction with microprocessor arms,” he says. And some microprocessor-controlled hands currently being developed are “just amazing,” he says. “We’ve learned [about these technologies] alongside patients and watched them do incredible things. Vacuum pumps are another area that is evolving, according to Jump. “A couple of manufacturers are putting microprocessors in vacuum pumps so we can read in real time what’s going on inside the socket,” he says. Some companies also offer pressure sensors that can slide into sockets. As more options come to market, it will be important for clinicians to educate themselves on new devices and determine which will work best for individual patients. As always, “we have to get to know our patients to make a good match,” says Jump. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com. O&P ALMANAC | JULY 2017

THE GLOBAL PROFESSIONAL

Stefan Laux, Bachelor P&O, CPD-AOPA New South Wales, Australia Prosthetist shares patient-care experiences in ‘Land Down Under’

O&P ALMANAC: Describe a typical

work day for you.

STEFAN LAUX, BACHELOR P&O, CPDAOPA: I work for APC Prosthetics,

As the O&P profession prepares for the Second O&P World Congress, to be held in conjunction with AOPA’s 100th anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a question-and-answer section with international O&P experts. Each month, we spotlight an O&P professional from a different part of the world to find out how O&P is practiced across the globe.

which is a prosthetics service provider with branches in Sydney and Newcastle in New South Wales, Australia. My role is the clinical services manager for the Sydney branches with a team of 10 prosthetists and seven prosthetic technicians. The day is normally a mixture of managerial and clinical tasks. O&P ALMANAC: Describe the loca-

tion where you provide services.

LAUX: Sydney is a fantastic place to

O&P ALMANAC: What types of Austrailia

patients do you typically see, and what types of devices do you fit for these patients?

LAUX: APC Prosthetics provides the

full range of prosthetic services but no orthotics, so I waved good-bye to any

JULY 2017 | O&P ALMANAC

PHOTO: Stefan Laux, Bachelor P&O, CPD-AOPA

work and live; it has the world’s best harbor, beaches, many national parks nearby, and lovely friendly people. My work requires me to travel within Sydney to various rehabilitation hospitals, but the majority of my time is spent at our brand-new facility in Alexandria, Sydney, and also at our main branch in Northmead, Sydney.

orthotic device when I joined APC Prosthetics in 2003. I am personally also involved in the osseointegration program here in Sydney. There has been a significant shift in my patient load over the past five years with the ever-increasing popularity of osseointegration. The majority of patients that I see now are transfemoral osseointegration amputees. The difference that this surgical procedure can make to the lives of many amputees is simply incredible given the correct patient selection. I also have a very strong interest in and passion for hip-disarticulation and transfemoral prosthetics. I like working with amputees who present a complex challenge and am always happy to trial different approaches. We use a wide variety of prosthetic components for all ages and activity levels, and all our clinicians are certified in most of the latest technology, including high-definition silicone prostheses. Our osseointegration amputees mostly get fitted with microprocessor knees and a wide variety of energy-storage-and-return feet, but also some microprocessor foot-andankle systems. I really like fitting this cutting-edge technology because the difference it makes to an amputee’s life is instantly visible and puts a smile on people’s faces.

THE GLOBAL PROFESSIONAL

O&P ALMANAC: How are the devices

you provide paid for?

LAUX: There are a number of funding

schemes in Australia that provide funding for prosthetic legs; the type of technology provided varies greatly, though. The biggest change in several decades is the current nationwide roll-out of the National Disability Insurance Scheme, which takes over the funding for prosthetics from most state-based funding programs. There also is funding coming from workers’ compensation, motor vehicle insurance, and various others. We also work very closely with the Australian Defense Force. There are a number of individuals who fund their prosthetic services privately. O&P ALMANAC: If the payor is other

than the patient, do nonpatient payors have an audit process? If there is an audit process, do you consider it to be fair? LAUX: There is an audit system with

the state and federal funding schemes, and I believe it is a vital process to ensure that appropriate prosthetic services are provided to amputees.

O&P ALMANAC: Describe your

educational background and any certifications you have. How do you keep your skills sharp?

LAUX: My background is German,

PHOTO: Stefan Laux, Bachelor P&O, CPD-AOPA

and I undertook my initial education in prosthetics and orthotics in Heidelberg, Germany, in 1995. When I relocated to Australia in 2003, I aligned my qualifications and completed a bachelor of prosthetics and orthotics at La Trobe University in Melbourne in 2006. I have been involved in developing a certification program for osseointegration prosthetic fittings and am also certified for most microprocessor systems, hip joints, and various socket suspension systems.

Stefan Laux, Bachelor P&O, CPD-AOPA, works with a technician, explaining the specifications to which a prosthesis should be manufactured.

We have a strict continuing education program here in Australia that we need to adhere to for membership eligibility of our peak professional body, AOPA [Australian Orthotics Prosthetics Association]. I regularly present at domestic and international conferences and lecture at a couple of universities in Sydney once or twice per year. What I also really like is to get resin all over my shirt when I try to show my colleagues how a perfect lamination is done. O&P ALMANAC: What’s the biggest

challenge you face as a practitioner, and how do you deal with it?

LAUX: The biggest challenge for me

as a clinician is to manage the expectations of our amputees and have the often-tough conversation that some things people used to do are simply no longer possible. I actually don’t know

how I deal with it, other than being my blunt German self. O&P ALMANAC: Describe any chari-

table work you or your organization does. LAUX: We organize a number of social

events for the local amputees, often in conjunction with local amputee peer support groups and prosthetic manufacturing companies, such as Össur. My favorite event is the AmpCamp, during which amputee teenagers from all over Australia are brought to a local farm for a weekend of fun activities. We also help organize a surf day once a year and host an annual breakfast to raise money for children with amputations. Our team also participates in many other fundraising events throughout the year, such as Oxfam 100-kilometer walks and tough-mudder events. O&P ALMANAC | JULY 2017

MEMBER SPOTLIGHT

ACOR

By DEBORAH CONN

Manufacturing in the Buckeye State

Brothers pull from their experiences as clinicians to provide orthotic products

COR, A COMPANY THAT

JULY 2017 | O&P ALMANAC

Digital modification of orthotic shoe insert

COMPANY: ACOR LOCATION: Cleveland, Ohio OWNERS: Jeffrey Alaimo, CPO, and Greg Alaimo, CPed HISTORY: 45 years

Traditional hand sanding of trim lines

The company also developed its own triple laminate, known as TRILAM®. Other product developments include Quikformables®, Multicork®, and Wheeled Strips, among others. ACOR stopped making custom shoes, says Jeffrey Alaimo, when low reimbursements made them financially unfeasible to produce such a complex device and maintain quality standards. ACOR occupies two buildings in Cleveland totaling about 50,000 square feet. One is dedicated to warehousing; the other, manufacturing. Approximately 60 employees work at the company, which serves markets in the United States, Canada, Europe, Australia, and other parts of the world. Under the direction of Joe Merolla, ACOR’s vice president of sales and marketing, the company has a strong online presence. While the company still relies on print advertising, Google has become a heavily used resource.

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

PHOTOS: ACOR

manufactures orthotic materials, shoe inserts, and lower-extremity orthoses, was founded in 1972 by A.J. Alaimo, a Cleveland shoe repairman who began making arch supports for his customers. After realizing that physicians would be reluctant to refer patients to a shoe repair shop, he opened a small store to craft custom shoes, and his sons Greg and Jeffrey Alaimo joined him in the business. After a few years, Jeffrey Alaimo received his orthotics and prosthetics credentials from Northwestern University and started a patient-care facility in Cleveland. Greg Alaimo became a certified pedorthist. In his search for improved materials for making custom shoes, he began sourcing his own. Going to trade shows, he soon found that other manufacturers and practitioners would buy them, and ACOR added materials to the supply side of the business. For a time ACOR had five offices in Ohio, encompassing both patient care and manufacturing. Hanger acquired the patient-care division in 1999, and ACOR has focused on wholesaling since then. The company, currently co-owned by the Alaimo brothers, makes prefabricated and custom orthotic shoe inserts, ankle-foot gauntlets, Charcot restraint orthotic walkers, and Richie braces, as well as orthotic materials such as Microcell Puff®, Neosponge®, Poron® laminations, Plastazote®, and P-Cell®.

“Our marketing team puts a lot of effort into using it more efficiently,” says Merolla. “And every day, a new social media outlet becomes available, so we have a lot to take advantage of and have to decide where to dedicate our time and resources.” In addition to a Facebook page, ACOR is active on Twitter, LinkedIn, and Instagram. “It’s a lot to keep up with, but it does broaden our scope,” says Jeffrey Alaimo. The company takes full advantage of its website, where customers can find YouTube instructional videos, catalogs, safety data sheets, and copies of regulatory letters regarding coding and reimbursement. In March, ACOR introduced a new, simplified ordering system for custom orthotic shoe inserts, ankle-foot orthosis gauntlets, and Richie braces. This simplified system, called “Acor PRIME,” includes free shipping and the most common modifications for an all-inclusive price. Removing the guesswork from custom ordering has been well received by Acor’s customers, according to Jeffrey Alaimo. He believes that ACOR’s experience in patient care gives the company a competitive edge. “If a product was useful to us, it would be useful for our customers,” he says. “Anything we developed that would save time, we would roll those out into the field. Our background gives us a little more understanding of what practitioners want to use.” Looking ahead, Jeffrey Alaimo says the company plans to stick to the basics: designing products first and foremost for the patient, that are efficient and cost-effective for practitioners as well. “If you can hit those three bells, you have a product that’s worthwhile,” he says.

amp Seanâ&#x20AC;&#x2122;s an example of a successful fight for access to prosthetic care. To help create more stories like his, visit amplifyyourself.org for ways to write insurance executives and legislators, and to speak out on behalf of people living with limb loss and limb difference. The Amplify initiative is turning up the volume to make sure everyone has access to the care that they need.

Sean told his insurance company that no was not answer. Read his story at amplifyyourself.org and share yours today.

MEMBER SPOTLIGHT

P&O Services Inc.

By DEBORAH CONN

Humanitarian Origins Clinician from Pakistan brings his expertise to Michigan

IA UR RAHMAN, CPO, made

P&O

(Left to right) P&O Services Inc. staff: Zia ur Rahman, CPO; Cindy Winter; Tracy Bautista; Kathryn Blaharski, MSOP, CP; Paul Huhta, MSOP; and Syed Abdul Haq vices, I Ser n c.

his way to the United States from his native Pakistan through his work with Helping Hand USA, a global humanitarian and relief organization. Rahman graduated from the Pakistani Institute of Prosthetic and Orthotic Sciences in 2000. Following the devastating 2005 earthquake in Pakistan and Kashmir, which resulted in thousands of deaths and disabilities, Rahman worked for Helping Hand USA as rehab director, setting up multidiscipline rehabilitation centers to provide physical therapy, occupational therapy, and O&P services. In 2006, Rahman moved to Michigan to work with a large nursing home chain, where he established an O&P division, set up a successful O&P residency program, and worked as director of orthotics and prosthetics and residency director.

Prosthetics & Orthotics

FACILITY: P&O Services Inc. LOCATION: Southfield, Michigan OWNER: Zia ur Rahman, CPO HISTORY: Three years

Zia ur Rahman, CPO, scans a patient using an Omega 3D scanner.

JULY 2017 | O&P ALMANAC

Zia ur Rahman, CPO

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

PHOTOS: P&O Services Inc.

By 2014, when he decided to open his own facility, Rahman had established a solid reputation in the area. His prior experience, as well as a master’s degree in health-care management, served him well, and P&O Services Inc. quickly got off the ground. Beginning with Rahman and one office coordinator, the facility’s

staff has grown to include a certified prosthetist, Kathryn Blaharski, MSOP, CP; a certified orthotic and prosthetic fitter, Syed Abdul Haq; a resident clinician, Paul Huhta, MSOP; an office manager who handles billing and compliance; an office coordinator for billing and insurance verification; and a community liaison contractor, who assists with marketing and business development. P&O Services Inc. currently occupies a space of about 2,000 square feet but will soon double its size in a custom-built facility with larger patient rooms, clinical offices, and a comprehensive lab. Rahman prides himself on providing a technologically advanced patient-care experience. “We are one of the first private-sector facilities in this area to use the Omega 3D scanning system,” he says. “We do all of our own fabrication and, for most patients, CAD/CAM. The scanner has really helped us improve product quality and patient comfort. We are known in the area for our quality services and fast turnaround time.”

The facility offers a full range of lower-extremity and upperextremity orthoses and prostheses, spinal orthoses, and cranialmolding helmets. In volume, orthotic services account for about 60 percent of the business, although prosthetics makes up a larger portion in dollar value. Marketing efforts revolve around the facility’s professional educational in-services at hospitals and rehabilitation centers. “We talk to people about our products and services and do education in-services and presentations about the latest products and technology. That’s our key marketing strategy,” says Rahman. “In fact, much of our marketing efforts focus on educating fellow health-care specialists and rehab clinicians on the orthotics and prosthetics profession, and we consider ourselves part of the rehabilitation team.” Word of mouth also plays a large role in marketing, as does the company’s Facebook page, which has generated references and referrals. P&O Services Inc. is active in the community, sponsoring several activities, and expects to hold a golf outing for some of its patients next month. “What sets us apart from our competitors is our flexibility and commitment to patients,” says Rahman. “We are smaller and can accommodate our patients’ scheduling needs—even if someone needs to come in on a Sunday, we will be here. Our philosophy is that the patient comes first, and we don’t compromise on that.” As far as the future goes, Rahman says that while P&O Services Inc. anticipates growth, “we want to keep our focus on our goal to provide timely, consistently great patient care.”

NEW!

Co-OP

An AOPA Member Benefit As an online reimbursement, coding, and policy resource, this site includes a collection of detailed information with links to supporting documentation for the topics most important to AOPA Members. Like a Wikipedia of all things O&P, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of our membership body.

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

Learn more and sign up at

www.AOPAnet.org/co-op. www.AOPAnet.org

AOPA NEWS

JULY 12

AUGUST 9

What the Medicare Audit Data Tells Us & How To Avoid Common Errors

Know Your Resources: Where To Look To Find the Answers

You can learn a lot about how to submit a claim that will be paid without delay just by examining Medicare audit data. Learn from the mistakes of others and pick up tips to avoid common errors. Log on for the August 9 AOPA webinar and hear from the experts on the following topics: • What claims and services are being denied? • Why are they being denied? • What can I fix, so my claims will not be denied?

There is a vast array of O&P-related information available via manuals and on various websites, but it’s hard to know where exactly to go for answers to your questions. Find out how to narrow your search and locate the most relevant information by participating in the July 12 AOPA webinar. Experts will address the following topics: • Navigating the CMS website; • Understanding the website for Pricing, Data Analysis, and Coding; • Finding information on the websites of the durable medical equipment Medicare administrative contractors; • Understanding which Medicare manuals apply to O&P; and • Knowing where to go to find out about appeals.

Fulfill Your Education

The Easy Way

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/2017webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Sign up for the half-year series and get three sessions FREE! This includes two bonus webinars added for Health-Care Compliance & Ethics Week November 5-11. All webinars that you missed will be sent as a recording. Register at bit.ly/2017billing.

Online E

TOP REASONS

JULY 2017 | O&P ALMANAC

TO USE AOPAVERSITY

100+ COURSES

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 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.

Medcuro Orthotics & Prosthetics 9959 Lin Ferry Drive St. Louis, MO 63123 314/842-5569 Member Type: Patient-Care Facility Steve Finkeldei, CP Medcuro Orthotics & Prosthetics 11605 Studt Avenue St. Louis, MO 63141 314/567-8595 Member Type: Affiliate

Sky Orthotics & Prosthetics 1009 Maitland Center Commons Blvd., Ste. 213 Maitland, FL 32751 844/759-5462 Member Type: Patient-Care Facility Michael Newmyer Thermo-Ply Inc. 11811 31st Court N. St. Petersburg, FL 33716 727/573-1165 Member Type: Supplier Level 3 John Fay

Realize the facts. O&P care improves quality of life and is cost effective! Learn more at MobilitySaves.org. Reasons to visit MobilitySaves.org

O&P CARE IS A SAVER, NOT AN EXPENSE TO INSURERS!

Visit MobilitySaves.org. Follow us on social media!

Find supporting data to get your device paid for

Learn about the study proving orthotic and prosthetic care saves money

See how amputees rallied when their prosthetic care was threatened

“Search Mobility Saves” on Facebook, Twitter, and LinkedIn

O&P ALMANAC | JULY 2017

O&P PAC UPDATE

HE O&P PAC UPDATE provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: • Robert Arbogast • Jeffrey M. Brandt, CPO • Jeff Collins, CPA • Rick Fleetwood, MPA • Pam Lupo, CO • Joyce Perrone

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

2017

THURSDAY

September 7, 2017 6:30 – 9:30 PM Las Vegas

with a

PURPOSE

• Enjoy a fun evening with your O&P friends • Support the PAC and the future of O&P at this special 100th Anniversary event • Space is limited

JULY 2017 | O&P ALMANAC

To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo. com/forms/op-pac-authorization. *Due to publishing deadlines this list was created on June 1, 2017, and includes only donations/contributions made/received between April 18, 2017, and June 1, 2017. Any donations/ contributions made/received on or after June 1, 2017, will be published in the next issue of the O&P Almanac.

PHOTO: Getty Images/Pgiam

If you plan on attending the 2017 AOPA World Congress, September 6-9 in Las Vegas, be sure to attend the “Party with a Purpose.” Space will be limited, so secure your spot early as the event is sure to be the cat’s pajamas! Stay tuned for more information on the event, including how to secure your spot, or contact Devon Bernard at dbernard@AOPAnet.org.

We also would like to thank those individuals who have recently donated directly to a candidate’s fundraiser or to an O&P PAC sponsored event: • Lisa Arbogast • Rudolf Becker III • Traci Dralle, CFm • Rick Fleetwood, MPA • Lisa Guichet • Scott Guichet • Maurice Johnson, CO • James Kaiser, CP • Teri Kuffel, Esq. • Sam Liang • Pam Lupo, CO • Jeff Lutz, CPO • Chris Nolan • Michael Oros, CPO, FAAOP • Rick Riley • Brad Ruhl • Stephen Schulte, CP, FAAOP • Scott Schneider • Chris Snell, CP • Clint Snell, BOCP • Peter Thomas, JD • Jim Weber, MBA • Shane Wurdeman, PhD, CP

AOPA Who’s Who 100th Anniversary Commemorative Membership Directory This special edition directory is a one-of-a-kind AOPA: Our Story Is Your Stor y keepsake with special A commemorative sections on O&P history celebrating a century of growth and advancement of the O&P profession. The directory includes contact information for all 2017 AOPA members and a supplier listing with a detailed product index.

s the American Orthotic and Prosthetic Association facilities through (AOPA) embarks challenging on its celebratin centenni al times and celebrati on, g successes clear that the along the way. it’s past 100 years AOPA and momentous the O&P professio have seen changes. Back matured and n have in 1917, when the associatio come into their own. While n was first it hasn’t always chartered, one could been an easy no facilities have imagined road, O&P and manufact the advances in medical urers have technology true to their stayed that would focus: restoring high-tech orthoses lead to O&P function for and prosthese patients. Today, O&P patients s, restoring Americans to a loss and limb with limb None of AOPA’s very high quality of life. difference are achieving better quality original members a have predicted of life at unpreced could levels, the evolution ented thanks practices that in business to the O&P would move professionals who are committe the industry a mom-andd to high-qual from care—and pop shop, hands-on AOPA, the associatio ity patient a spectrum of small-, medium-, industry, to the way n that leads in ensuring size companie and larges run the O&P business favorable treatment for certified orthotists by highly educated in laws, regulation , services; and prosthetis , and helping members of whom have ts—many earned master’s improve their management degrees. And no one could and have anticipated raising awarenes marketing skills; and the explosion of regulation s and understan s and laws the industry ding of that have led and the associatio heavily audited to a reimbursement n. The year 2017 which has climate, marks a signifi challenged stone for AOPA cant mileO&P practition to become and for O&P ers we celebrate documen in general. As this centennia working collabora tation experts while l and prepare a new century for to ensure optimal tively with physician s a look back of significance, we also outcomes for take at the history Throughout patients. of the associatio this evolution, and the O&P AOPA has worked n profession, side-by-side and pay tribute with members the events to of the past , guiding O&P that have led achievements to our today.

6 6

Who’s Who Who’s Who

th 100 100 th Anniversar Anniversary 2017 y 2017 Commemo Commemorative Membersh rative Membership ip Directory Directory

$75 AOPA members // $185 non-members

Order your copy today at www.AOPAnet.org.

Who’s Who

100th Anniversary Commemorative Membership Directory

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options.

ALPS SP High Density Liner The SP High Density Liner features black fabric that allows for stability for active patients. The SP Liner has similar characteristics as silicone but provides the superior comfort of gel. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Advanced Myoelectric Control The Complete Control system from Coapt is a powerful add-on enhancement to powered prosthetic arms. The controller provides more intuitive, natural control for prosthesis users and is specifically designed to work with commercially available prosthetic elbows, wrists, and terminal devices. Coapt’s advanced FDA-cleared pattern recognition technology works by using greater information from users' muscle signals and dramatically improves the function and adoption of the prosthesis. Other benefits include the elimination of mode switching, quick and easy recalibration, and better proportional control. For more information, call 844/262-7800 or visit www.coaptengineering.com.

Trans-Femoral Rotator (TFR) The Trans-Femoral Rotator (TFR) from Fillauer® is designed to be a welcome addition to any aboveknee prosthesis. The TFR allows patients to rotate the shin section of the prosthesis relative to the socket, making entry and exit out of tight spaces, such as cars and tables at restaurants, much easier. The TFR allows for cross-legged sitting and 360-degree rotation, and it is low profile and lightweight. It also offers a smooth, one-handed, push-button operation with an automatic relock feature. Contact Fillauer to learn more today! For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com.

JULY 2017 | O&P ALMANAC

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 800/301-8275 or visit www.hersco.com.

Ottobock Dynamic Vacuum System (DVS) The Dynamic Vacuum System (DVS) bridges the gap between valve and Harmony socket technology. Integrating innovative design with simplicity, the DVS reduces the movement between the limb and socket associated with limb volume fluctuations. The DVS generates vacuum during walking and maintains this elevated vacuum in both swing and stance phase. This sets it apart from passive systems, such as valve, where a vacuum is only generated in the swing phase. Increased suspension forces and intimate fit enhances the user’s perception of the ground beneath them. Dynamically, it adjusts to the user’s activity level. Call your local sales representative at 800/328-4058 or go to professionals.ottobockus.com.

design. dexterity. intelligent motion.

• Smarter: Uses simple gestures to change grips. • Faster: Boost digit speed by up to 30 percent. • Smaller: New form-fitting anatomical design reduces profile in every dimension. For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

MARKETPLACE Catalyst Propel OA Now Available in Custom VQ OrthoCare now offers the successful Catalyst Propel doubleupright osteoarthritis (OA) knee brace in a custom version with Q-hinges. The frame is custom-formed to the patient with the Q-hinges providing additional fine tuning of the desired OA correction. The double Q-hinges adjust the overall valgus/varus brace structure. This design allows the clinician to fine tune the corrective forces efficiently in the field during fitting for a compliant clinical effect. The Catalyst Propel OA brace is designed for maximum stability, relieving pain by reducing pressure in the affected compartment as well as addressing joint instabilities. For more information, call 800/652-1135 or visit www.vqorthocare.com.

AOPA Compliance Guide CD—Updated This Compliance Handbook helps patient-care facilities follow the fraud and abuse prevention guidelines recommended by the Office of the Inspector General. This product will assist you in developing a compliance plan for your facility, including guidelines for developing a standard of conduct, billing policies and procedures, and much more. With the help of the AOPA Compliance Handbook CD, you will be able to create an effective audit/quality assurance program to monitor compliance and conduct introductory training sessions for employees. • AOPA Compliance Guide CD—Updated: $159 AOPA members, $318 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

2017 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2017 AOPA coding products. Ensure each member of your staff has a 2017 Quick Coder, a durable, easy-to-store 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 Order at www.AOPAnet.org or call AOPA at 571/431-0876.

DOWNLOAD the

“AOPA 365” App on your iPhone, Android or iPad

Download the

Mobile App! Download the app by either scanning the QR code or by searching the keyword AOPA365 in the Apple or Google stores.

O&P ALMANAC | JULY 2017

AOPA NEWS

CAREERS

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

Northeast

Certified Orthotist/Certified Prothetist-Orthotist Long Island and Queens, New York Wanted: CO/CPO for busy Long Island and Queens practice. Excellent pay and comprehensive benefits package. Must be professional, knowledgeable, and caring. Upbeat practitioners need only apply. Please apply by email to careers@ mgpolabs.com.

- 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.

Email: careers@mgpolabs.com

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

Member $482 $634

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.

JULY 2017 | O&P ALMANAC

BUILD A

Nonmember $678 $830

Better BUSINESS WITH AOPA

Visit www.AOPAnet.org/join today!

Learn how AOPA can help you transform your business into a world class provider of O&P Services with: Coding, Billing, and Audit Resources Education, Networking, and CE Opportunities

MEMBER VALUE GUIDE

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Member Benefits

Dear O&P Professional: If you could do one thing to make the future of your O&P business more secure, would you do it? We realize getting reimbursed by insurance companies and Medicare is the most challenging obstacle you face on a daily basis. Your initial dream of delivering world-class patient care probably did not include struggling with denied claims, audits, and ALJ hearings. AOPA’s coding & billing experts—available by phone and email—guide members through these coding, billing and audit challenges. We know the ins and outs of compliance and we answer thousands of member questions each year with sound advice, so that you can focus on running your business and caring for patients. AOPA has many other products and services available to help you run a world class O&P company. From educational and CE opportunities, to the award-winning O&P Almanac, to unparalleled coding and billing products and resources, we have you covered. AOPA’s advocacy on your behalf seeks relief from regulatory challenges such as exemption for O&P devices AOPA secured from the 1.3% Medical Device Excise Tax. We hope you will take a few moments to peruse the many AOPA member benefits enclosed. We are confident that your investment in AOPA membership will help you grow a stronger business for tomorrow.

Sincerely, Thomas F. Fise, JD AOPA Executive Director

Advocacy Research and Publications Business Discounts

www.AOPAnet.org/join

CALENDAR

2017

August 1

July 10-15

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.

ABC: Application Deadline for ABC/OPERF Resident Travel Award. Four residents will be selected to present their directed study research project at the 2017 Academy Annual Meeting and receive $2,500 plus complimentary meeting registration. For more info or to apply, go to operf.org.

August 3-5

Amputee Coalition 2017 National Conference. Louisville, KY. Contact the Amputee Coalition at 401/766-4142 or amputeecoaliton@expotrac.com.

July 12

Know Your Resources: Where To Look To Find the Answers. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

July 17-18

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Pittsburgh. The DoubleTree by Hilton Hotel and Suites Pittsburgh Downtown, One Bigelow Square, Pittsburgh. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar

ABC: Practitioner Residency Completion Deadline for September Written and Written Simulation Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Apply Anytime!

Apply anytime for COF, CMF, CDME; test when ready; receive results instantly. Current BOCO, BOCP, and BOCPD candidates have three years from application date to pass their exam(s). To learn more about our nationally recognized, in-demand credentials, or to apply now, visit www.bocusa.org.

Calendar Rates Let us

your next event!

JULY 2017 | O&P ALMANAC

The Texas Chapter of the American Academy of Orthotists and Prosthetists 2017 Annual Meeting. Westin Galleria, Dallas. For information and registration, visit www.txaaop.org.

August 9

What the Medicare Audit Data Tells Us and How To Avoid Common Errors. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

August 11-12

August 1

www.bocusa.org

August 4-5

ABC: Orthotic Clinical Patient Management (CPM) Exam, International Institute of Orthotics & Prosthetics. Tampa, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Free Online Training

Cascade Dafo Institute. Now offering a series of seven free ABC-approved online courses, designed for pediatric practitioners. Earn up to 10.25 CEUs. Visit cascadedafo.com or call 800/848-7332.

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

CREDITS

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, 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.

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR

November 6-7

August 18-19

ABC: Prosthetic Clinical Patient Management (CPM) Exam, International Institute of Orthotics & Prosthetics. Tampa, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

September 6-9

100th AOPA National Assembly and Second World Congress. Las Vegas. Mandalay Bay. 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.

ABC Inspections and Accreditation. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

AFO/KAFO Policy. Register online at Webinar Conference bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

International African-American Prosthetic Orthotic Coalition Annual Meeting. Atlanta Marriott Suites Midtown, 35 14th Street NE, Atlanta, GA 30309. For more info, visit www.iaapoc.org or contact Tony Thaxton Jr. at thaxton.jr@comcast.net or 404/875-0066.

Gift Giving: Show Your Thanks and Webinar Conference Remain Compliant. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

December 13

Webinar Conference

October 26-27

November 8

New Codes and Other Updates for 2018. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

September 13

October 11

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Phoenix. Sheraton Grand Phoenix, 340 N. 3rd Street, Phoenix. Book by October 13 for the $179 rate by calling 800/325-3535 or by calling the hotel directly at 602/262-2500. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar

2018 September 26-29

AOPA National Assembly. Vancouver, Convention Center. For general inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

2019 September 25-28

November 5-11

Health-Care Compliance & Ethics Week 2017. AOPA will be celebrating Health-Care Compliance & Ethics Week and will be providing resources to help members celebrate.

AOPA National Assembly. San Diego, Convention Center. For general inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

ADVERTISERS INDEX Company ALPS South LLC Amputee Coalition COAPT LLC Custom Composite Fillauer Companies Inc. Hersco Ottobock Touch Bionics VQ Orthocare

Page Phone

Website

800/574-5426

www.easyliner.com

47 17 31 5 1 C4 9 13

888/267-5669 844/262-7800 866/273-2230 800/251-6398 800/301-8275 800/328-4058 855/694-5462 800/652-1135

www.amputee-coalition.org www.coaptengineering.com www.cc-mfg.com www.fillauer.com www.hersco.com www.professionals.ottobockus.com www.touchbionics.com www.vqorthocare.com/ecast

O&P ALMANAC | JULY 2017

ASK AOPA CALENDAR

Examining the Exemptions Answers to your questions regarding surety bonds, minimum hours open, and more

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, weâ&#x20AC;&#x2122;ll share several of these questions and answers from AOPAâ&#x20AC;&#x2122;s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Are orthotic and prosthetic providers/suppliers exempt from having to obtain a Medicare surety bond?

In some cases, O&P providers/ suppliers are exempt from having to obtain a Medicare surety bond, but there are certain criteria that must be met to qualify for the exemption. First, you must only be providing and billing for custom orthotic and prosthetic items or supplies. You may provide some prefabricated items, but you may not be providing any type of durable medical equipment (DME), or supplies not related to the custom orthotic and prosthetic items, such as mastectomy items or diabetic shoes. So if you are providing diabetic shoes to Medicare patients, you must obtain a surety bond. Second, if you are in a state that requires licensure, you must be licensed. Finally, you must be solely owned and operated by O&P professionals to qualify for an exemption. This means that any person listed as an owner must be an orthotist and/or prosthetist. Also, any orthotist and/or prosthetist treating

JULY 2017 | O&P ALMANAC

patients must be an owner. So, if you own the facility and you employ an orthotist and he/she is not an owner, then you must obtain a surety bond.

You also would be exempt if you are providing prefabricated orthoses and prostheses, including breast prostheses and accessories.

Supplier Standard 30 mandates that a supplier/provider must be open at least 30 hours a week. I thought O&P providers/suppliers are exempt from this requirement?

Yes, that is correct. Orthotic and prosthetic facilities are exempt from being open 30 hours a week, as long as they are only providing orthotic and prosthetic services/items. If they are providing any type of DME to Medicare beneficiaries, then the exemption does not apply.

If we are providing diabetic shoes to Medicare beneficiaries, are we required to be open 30 hours a week?

No. You would still be exempt under the custom orthotic and prosthetic exemption discussed above.

Am I allowed to send postcards to all my patients at any time, even if I have not seen them within the past 15 months?

According to the Supplier Standards, there is no prohibition in contacting your patients via mail. The only prohibition in contacting patients is in relation to direct telephone contact. Thus, you may mail postcards to former patientsâ&#x20AC;&#x201D;even if you have not seen them in the last 15 months.

AOPA Celebrates

Health-Care Compliance & Ethics Week November 5-11, 2017

Why Should you Participate? • Demonstrate your company’s commitment to ethical business practices. • Create awareness of the Code of Conduct, relevant laws, and regulations. • Provide your staff with recognition for training completion, compliance, and ethics successes. • Reinforcement—of the culture of compliance for which your organization strives.

AOPA has developed tools and resources to assist you. Learn more about our products, special webinars, compliance tip of the day, how to win prizes and more at bit.ly/aopaethics.

www.AOPAnet.org

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