June 2014 Almanac

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2014 AOPA Assembly Preview: Get Ready for Las Vegas Page 34 The American Orthotic & Prosthetic Association

JUNE 2014

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THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

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Credits Page 18

This Just In

Debating the Effective ness of Cranial H elmets

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2014 O&P Buyers’ Guide: Your Connection to Top Products and Services Page 40

Effecting Change at the 2014 Policy Forum Pros and Cons of Prior Authorization

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O&P JUNE 2014, VOLUME 63, No. 6

CONTENTS FeatureS

Cover Story

20 This Just In

22

By Adam Stone Industry leaders speak out against a recent study that questions the effectiveness of cranial helmets for infants.

SPECIAL FEATURE

30

40 This must-have resource

includes everything you need to know to meet your patients’ diverse needs, plus an index of manufacturers and list of AOPA supplier members.

COLUMNS

16

E! QUIZ M

2

Business CE

Credits

34 Vegas After Hours

By Bryan Ochalla As you plan your trip for the 2014 AOPA National Assembly, September 4-7, at Mandalay Bay Hotel & Casino in Las Vegas, check out these recommendations for food, fun, and entertainment.

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President’s Corner Insights from AOPA President Anita LibermanLampear, MA

6

AOPA Contact Page How to reach staff

8

At a Glance Statistics and O&P data

SEE PAGE 18

58 62

A Day for Change Makers

By Adam Stone More than 100 industry advocates participated in the 2014 AOPA Policy Forum in April to meet with legislators on important topics such as RAC audits, post-acute care bundling, reimbursement, and more. Discover how their efforts to educate elected officials are shaping legislation that will directly impact the O&P community.

Departments

Reimbursement Page New rules for fingerprinting, background checks take effect

Earn

Pushing for Profitability

By Christine Umbrell Successful O&P business owners and experts share “best practices” for reducing expenses and maximizing profits and offer strategies for decreasing non-revenue-producing activities and ensuring practitioners treat patients within an optimal scope of practice.

10 Ask the Expert Pros and cons of prior authorization Member Spotlight Össur

64

In the News Research, updates, and company announcements AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

72

AOPA Membership Applications and Member Milestones

76 Jobs

Opportunities for O&P professionals

78 Calendar

Upcoming meetings and events

79

Ad Index

80

AOPA Answers Expert answers to your FAQs

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

JUNE 2014 O&P Almanac

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President’s IN THE NEWS corner

Showing Up Pays Off

T

hey say time flies when you’re having fun, and that has never been more true for me. It seems it was only yesterday that Tom Kirk passed the gavel to me but it has already been six months, and what a half a year it has been! Not all fun, but successfully meeting challenges can, indeed, be fun.

Who would have thought that this would be the year—after four years of planting the seeds—that at last our vision of securing appropriated funds would blossom into $10 million in O&P research funding that made it to President Obama’s desk and was signed into law? But it was, it happened, and that is what proves so convincingly that persistence pays off. We just kept showing up.

Your involvement and showing up kept the drumbeat going, sending a strong message to Congress about O&P’s needs. Similarly, the April O&P Almanac article, “Ensuring Quality during Unprecedented Change” (page 26) discussed the needs of the profession and generated a thoughtful response from our good friend Steve Fletcher, CPO, LPO, director of clinical resources for the American Board for Certification in Orthotics, Prosthetics & Pedorthics. Fletcher took exception to the comments in the article authored by Brian Gustin, CP, president and founder of Forensic Prosthetic and Orthotic Consulting and an AOPA past president. Gustin expressed his personal opinion when he wrote that the master’s degree requirement was “self imposed” and “about image concern rather than need.” Fletcher offered his opposing view that, “The primary reason the profession as a whole coalesced around the change in educational requirement was due to the increasing body of knowledge needed to practice in the 21st century. It was not because of poor self image.”

These two instances of involvement, from advocating for our legislative needs to sharing differing viewpoints on professional development, are critical to our success. We need everyone to stay engaged. Resolving the Recovery Audit Contractor debacle and its negative consequences for patients; fixing the Administrative Law Judge appeals process; sorting out confusion around off-the-shelf orthotic split codes; seeking an exemption from any acute-care bundling process; continuing to press our lawsuit against CMS and making sure we have the resources to keep fighting—these are just some of the big challenges we face in the months ahead. I promise you we’ll keep showing up to express our needs and we hope you’ll be with us.

But don’t forget about another opportunity for involvement and socializing with colleagues.

Join us Friday, Sept. 5, 2014, at 6:30 p.m., for the Sixth Annual Wine Tasting and Auction Event during the Las Vegas National Assembly, Sept. 4-7. The auction proceeds go to support the AOPA PAC, so you can help by attending, donating, and bidding high. This event is one of the most rewarding and delightful ways to spend an evening with friends and colleagues—plus, you may find that perfect wine or other treasure (jewelry, trips, etc.) to take home with you. And please remember, it’s the PAC that has helped support legislators who believe in our “Mobility Saves” value proposition and all that we do and who have helped us with our research funding home run.

For more information, email Devon Bernard at dbernard@aopanet.org.

Sincerely,

Anita Liberman-Lampear, MA AOPA President

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O&P Almanac JUNE 2014

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AOPA IN THE Contact NEWS INFORMATION 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 EXECUTIVE OFFICES

MEMBERSHIP & Meetings

BOARD of DIRECTORS

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

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org

Officers

Directors

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

Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org

President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI

O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000 bob.rhmedia@comcast.net Lia K. Dangelico, managing editor and contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org Christine Umbrell, editorial/production associate and contributing writer, 703/914-9200 x33, cumbrell@strattonpublishing.com

Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, manager of membership services, 571/431-0843, landerson@AOPAnet.org Betty Leppin, project manager, 571/431-0876, bleppin@AOPAnet.org AOPA Bookstore: 571/431-0865 Government affairs Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org

President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD Vice President James Campbell, PhD, CO Becker Orthopedic Appliance Co., Troy, MI Immediate Past President Tom Kirk, PhD Member of Hanger Inc. Board, Austin, TX Treasurer James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA

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

Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Alfred E. Kritter Jr., CPO FAAOP, Hanger, Inc., Savannah, GA Eileen Levis Orthologix LLC, Trevose, PA Ronald Manganiello New England Orthotics & Prosthetics Systems LLC, Branford, CT Dave McGill Ă–ssur Americas, Foothill Ranch, CA Michael Oros, CPO Scheck and Siress O&P Inc., Oakbrook Terrace, IL Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company

Copyright 2014 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the 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.

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O&P Almanac JUNE 2014

AT IN THE A GLANCE NEWS

Impact of RAC Audits on DME CMS has released its latest report to Congress on the Recovery Audit Contractors: “Recovery Auditing in Medicare and Medicaid for Fiscal Year 2012.” The report highlights the overpayments, underpayments, and appeals numbers, with breakdowns for Part A, Part B, and Durable Medical Equipment (DME) claims. Below are highlights affecting the O&P industry.

Number of Medicare B and DME Claims in Which Providers Appealed:

Appeals Successfully Overturned: Part A Claims

Medicare Appeals Council........................ 102,136 Qualified Independent Contractor................ 6,955 Administrative Law Judge................................ 329 Departmental Appeals Board............................. 55

Total B/DME Appeals:.................. 109,475

Successfully appealed claims with decisions in provider’s favor

14%

Appealed claims with decisions not in provider’s favor

86%

Part B/DME Claims Successfully appealed claims with decisions not in provider’s favor

43% 57%

Appealed claims with decisions in provider’s favor

Source: “Recovery Auditing in Medicare and Medicaid for Fiscal Year 2012,” CMS.

99,492

Number of Part A and Part B/DME claims that were overturned with decisions in the providers’ favor.

27%

Percentage of all Part A and Part B/DME claims that were appealed and overturned with decisions in the provider’s favor.

$228.1 m i l l i on

Operating costs for Recovery Audit Program.

62,565

Number of only Part B and DME appeals that were overturned with decisions in the providers’ favor.

13% $1.9

Percentage of Medicare B and DME claims that were appealed.

Billion

Amount returned to the Medicare trust funds in FY 2012 after considering all costs, underpayment determinations, and appeal reversals.

AOPA believes Congress should mandate that CMS make its records on audits more granular. CMS refuses to record or provide data on O&P claims separate from the very different and larger pool of all DME claims. The former are licensed/certified health professionals while the latter are “suppliers.” AOPA has sought this O&P specific data from CMS for several years because diluting O&P claims by grouping them in one large batch with DME is misleading. Far fewer DME claims are appealed as contrasted to O&P claims. CMS has refused each such request—it seems to like the picture DME claims paint. This demand for granularity for O&P claims also is part of the O&P Alliance’s RAC Audit Reform Legislation.

Source: “Recovery Auditing in Medicare and Medicaid for Fiscal Year 2012,” CMS. 8

O&P Almanac JUNE 2014

IN THE NEWS

O&P Alliance Responds to DME MAC Joint Guidance The O&P Alliance, a coalition of AOPA and four other national O&P organizations, has written a letter to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) medical directors responding to the correct coding guidance issued March 27. The DME MACs’ joint guidance was titled “Definitions for Off-the-Shelf Versus Custom-Fitted Prefabricated Orthotics (Braces)-Revised.”

The letter from the O&P Alliance showed its support of the section of the joint guidance that links qualifications with the level of orthotic complexity. However, the letter expresses the Alliance’s concerns with other sections, including the following: “Substantial Modification”—The O&P Alliance believes CMS and its contractors are misreading the federal statutory definition of “off-the-shelf (OTS) orthotics” by dramatically expanding the scope of OTS orthotics. There is a wide range of ambiguity between orthoses that require “minimal self-adjustment” and those that require “substantial modification” by a qualified provider. The O&P Alliance asked that the DME MACs clarify matters by adopting “anything that goes beyond ‘minimal self-adjustment’” as the standard, and requested that they eliminate the new term “substantial

www.bocusa.org

modification” when defining OTS orthoses. The Alliance also asked the DME MACs to publish additional guidance as to when an adjustment rises to the level of requiring clinical expertise and is thereby considered custom-fit.

Clarification of Documentation to Prevent Unnecessary Audit Risk—The O&P Alliance also expressed concern with those aspects of the joint guidance that address documentation requirements. The Alliance explained that it often is not known until a provider directly assesses a patient whether an OTS or custom-fit device is required, which occurs after a physician prescribes orthotic intervention.

Therefore, requiring explicit documentation in the physician’s records as to whether orthotic treatment must be OTS or custom-fit is not practical or reasonable. Further, the Alliance recommended that what a physician can realistically be expected to record in a patient file to justify an orthotic prescription should be distinguished from what is expected for prosthetics documentation.

Implications for Competitive Bidding of OTS Orthoses—The Alliance expects “widespread confusion” if CMS proceeds to competitively bid OTS orthoses using the newly bifurcated orthotic codes, with a host of clinical, documentation, and administrative complications ensuing.

OTWorld Showcases International O&P OTWorld took place in Leipzig, Germany, May 13-16, bringing together representatives from multiple disciplines to see and discuss the latest research and product developments. Participants from the prosthetics, orthotics, orthopedic footwear, technical rehabilitation, and compression therapy sectors united at the conference in a unique interface between theory and practice. Technicians, doctors, and physiotherapists were among the participants at the event.

The meeting featured more than 300 speakers from across the globe, who disseminated information and discussed modern treatment approaches and trends. Among the seven keynote lectures was a presentation by Hugh Herr, of the Massachusetts Institute of Technology. Two packed exhibit halls featured nearly 600 exhibitors from 37 countries. Visitors also enjoyed the “Showcase Workshop,” where experienced and skilled technicians offered live

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O&P Almanac JUNE 2014

Left to right: AOPA Executive Director Tom Fise, JD; Stephen Blatchford; Chris Nolan; and AOPA President Anita Liberman-Lampear, MA.

demonstrations of the manufacturing process of devices aiding in standing, walking, and resting.

“OTWorld offers an opportunity to take a look at treatments in their totality and to involve all relevant expertise and specialisms,” says Klaus-Jurgen Lotz, president of the German Federation of Orthopaedic Technicians’ Guilds.

“This kind of interdisciplinary approach is unparalleled.”

IN THE NEWS

TRANSITIONS

Physical Activity Helps People with Disabilities Avoid Chronic Diseases The Centers for Disease Control and Prevention (CDC) has released the findings of a study indicating people who have disabilities are not getting enough physical activity, resulting in a greater number of chronic diseases among this population.

According to the data, adults with disabilities are three times more likely to have heart disease, stroke, diabetes, or cancer than adults without disabilities. And nearly half of all adults with disabilities get no physical activity, an important health behavior to help avoid these chronic diseases.

Individuals with mobility limitations are the least likely to get any aerobic physical activity.

Adults with disabilities are 82 percent more likely to be physically active if their health-care practitioner recommends such activity, according to the CDC. The organization is asking health professionals to ask patients who have disabilities how much physical activity they get each week, discuss the barriers to physical activity, and remind patients to exercise in a way that is compatible with their abilities.

Visit www.cdc.gov/disabilities/PA.

Percentage of Adults Who Get No Physical Activity, By Disability Type 57%

Mobility

40%

Cognitive VISION HEARING NO DISABILITY

36% 33%

people in the news

Michael Bissell, CPO, FAAOP, and Paul Morton, CPO, of Advanced Prosthetics & Orthotics in WinstonSalem, North Carolina, traveled to Haiti this spring and spent 10 days fitting prostheses at a clinic in northwest Haiti under the auspices of the nonprofit organization Phoenix Rising for Haiti. Working with two Australian prosthetists, Bissell and Morton treated patients using donated materials.

Jonathan Blum has resigned his position as Medicare director and principal deputy administrator of the Jonathan Blum CMS. Blum had a big role in reforming Medicare under the Affordable Care Act. He also oversaw the public release of Medicare physician payment data.

Declan Farmer

Team USA ice sledge hockey player Declan Farmer has been voted the International Paralympic Committee’s Best Male Athlete of the Sochi 2014 Paralympic Winter Games. Farmer, who is 16, was crucial to the team’s Gold-medal success in Sochi, where he scored three goals and recorded two assists.

Tyler Manee, CPO, has joined the Frederick, Maryland, patientcare facility of Ability Prosthetics & Orthotics.

The Amputee Coalition board of directors has elected Miles O’Brien, a veteran freelance broadcast and web journalist who focuses Miles O’Brien on science, technology, and aerospace, to its board. Based in Washington, D.C., O’Brien works on PBS NewsHour, NOVA, FRONTLINE, and other series. O’Brien became a transhumeral amputee in February after a heavy equipment case fell on his left forearm.

John Roberston has been named vice president, research and development, for Freedom Innovations, based in Irvine, California.

John Roberston

Kathy Schuerman has been promoted to the position of vice president of finance for North America at Ottobock. Schuerman Kathy Schuerman joined Ottobock in 2006 as controller and most recently served as executive director of finance. She will continue as a member of the regional management team, where she consults with the leadership team and offers financial expertise.

Ottobock’s Scott Weber has added the title of global product manager to his role at the company. He will serve a dual role, continuing to Scott Weber be Ottobock’s U.S. senior market manager for socket technology.

Tyler Manee, CPO

26%

Source: CDC National Center for Health Statistics

JUNE 2014 O&P Almanac

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IN THE NEWS

TAOP Meeting Gathers Practitioners, Vendors in Texas

Robert Gregg, PhD, of the University of Texas at Dallas was the keynote speaker at the TAOP Annual Meeting and Scientific Sessions in April.

Educational sessions also were offered during eight hours of programming on Thursday afternoon and 16 two-hour workshops on Friday. The program concluded on Saturday after a full day of general sessions.

Highlights of the meeting included a legislative discussion by Elizabeth Ginzel, CPO, LPO, of Baker O&P in Fort Worth, Texas, who offered an overview of AOPA’s Policy Forum, and a lunch discussion by Ray Smith, CPO, LPO, of Victoria, Texas, from the Texas Board of Orthotists & Prosthetists (TBOP). Smith discussed the recent changes in TBOP’s staff and plans for future board activities.

More than 40 vendors shared their wares at the Exhibit Hall, and participants enjoyed a live and silent auction fundraiser. Next year’s TAOP Meeting is scheduled for April 9-11, 2015, in San Antonio.

IPC Alpine Skiing Announces New Snowboard Discipline for 2014-2015 Following the well-received debut of snowboard cross at the Sochi 2014 Paralympic Winter Games, International Paralympic Committee (IPC) Alpine Skiing has announced it will introduce a new discipline for the 2014-2015 season and make changes to snowboard cross so that participants will race head-to-head.

After much campaigning, snowboard cross was added to the 2014 Games, featuring two medal events for athletes with lower-limb impairments. The IPC is looking to further grow the sport further in the years leading up to the PyeongChang 2018 Paralympic Winter Games.

“For the 2014-2015 season, we’re looking to introduce banked slalom that will involve athletes tackling a

12

O&P Almanac JUNE 2014

slalom course down a gulley run with a number of other features,” says IPC Alpine Skiing Sport Technical Committee Chairperson Sylvana Mestre.

“We also will look to change snowboard cross so that athletes will come down the course two-by-two. After a qualifying round, athletes will go head-to-head down the course, with the winner progressing to the next round of competition. These changes will help grow the sport further and are sure to be warmly welcomed by athletes, who will have more disciplines to compete in, as well as spectators and TV viewers,” says Mestre.

The IPC is in the process of finalizing the rules for these changes. IPC Alpine Skiing also confirmed that for the 2014-2015 season, all events will be for standing athletes only.

Photo: TAOP

The Texas Association of Orthotists & Prosthetists (TAOP) held its 2014 Annual Meeting and Scientific Sessions at the Hyatt Regency North Dallas in Richardson, Texas, April 10-12. Scott Kee, LPO, welcomed members and introduced the meeting’s keynote speaker, Robert Gregg, PhD, University of Texas at Dallas, who presented, “Initial Steps from Robot Locomotion to High-Performance Prostheses and Orthoses.” Gregg, assistant professor of mechanical engineering and bioengineering in the Erik Jonsson School of Engineering and Computer Science, is a recipient of a $2.3 million grant from the National Institutes of Health for research that will combine robot control theory and physical rehabilitation to revolutionize and improve prosthetic limbs and orthotic devices.

The meeting featured a full-day Compliance Boot Camp open to anyone in Jurisdiction C. Attendees from Texas, Louisiana, and Oklahoma were briefed on the latest in Medicare rules, regulations, and policies; audit and compliance issues; and facility accreditation during the session, which was led by Zita Upchurch of CGS Outreach; Jim Lawson of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics; and Linda Collins of Össur Americas.

IN THE NEWS

IAAPOC Holds Annual Meeting at Arizona State University

14

O&P Almanac JUNE 2014

Mike Lewis, CPO, an IAAPOC founding member, receives a plaque from Jack Steele, CO, FAAOP, president of IAAPOC.

Photos: IAAPOC

Alabama State University (ASU) was the venue for the 2014 Annual Meeting and Scientific Conference held by the International African American Prosthetic and Orthotic Coalition (IAAPOC), which took place April 10-12 at the Buskey Health Science Center and the school’s prosthetics and orthotics fabrication facility. ASU now offers a master’s of science degree in prosthetics and orthotics (MSPO). The MSPO program is directed by Chad Duncan, PhD, CRC, CPO, with the assistance of Lee Childers, PhD, CP, and Kimberly Hill-Covalli, CPO. The meeting featured two full days of lectures from both local and national speakers, hands-on demonstrations, the annual business meeting, and vendor exhibits. Several MSPO students from ASU were invited to the welcome reception to meet and network with IAAPOC members.

IAAPOC President Jack Steele, CO, LPO, FAAOP, opened the program on Friday with a summary of the missions of IAAPOC and ASU. Other speakers included Duncan, Pamela Hale of Allard, and Jim Williams of SPS. Childers led a tour of the university’s biomechanics laboratory, and attendees also toured the prosthetics and orthotics laboratory.

“The department of prosthetics and orthotics is honored to hold such an important meeting at ASU,” says Duncan. “I hope this is the first step to a successful and collaborative relationship between IAAPOC and ASU’s MSPO program. We are excited to show off our state-of-the-art facilities and growing campus. This event will hopefully not only create connections for our MSPO students but pique the interest of some of ASU’s undergraduate students who might be considering making P&O a career choice.”

Jim Williams of SPS sets up lamination.

TRANSITIONS

Chad Duncan, PhD, CRC, CPO, director of the MSPO program at ASU, presents “Psychological Aspects of O&P: Implications for Your Practice.”

BUSINESSES in the news

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) is conducting an extensive survey of ABC-certified orthotists and prosthetists to collect information necessary to develop a new Practice Analysis of Certified Practitioners in the Disciplines of Orthotics and Prosthetics. Last published in 2007, the ABC Practice Analysis is a validation study focusing on providing a contemporary description of the tasks and responsibilities of the O&P profession. The survey will be emailed to all ABC-certified practitioners in mid-June. For more information, visit www.abcop.org.

Ottobock announced it has made a strategic investment in Orthotic Holdings, Inc. (OHI), and Andreas Schultz, regional president and CFO of Ottobock North America, has joined the OHI Board of Directors.

Scheck & Siress has acquired American Limb and Orthotic Center Inc., a Chicago-based O&P facility previously owned by Teresa Thorpe, CO. Thorpe will continue to work at the facility.

IN THE NEWS Adrianne Haslet-Davis

2014 Keynote Speaker

Boston Bombing Amputee Debuts Dancing Prosthesis is programmed so the motor moves the limb in a way that is appropriate for dance.

Although the prosthesis was designed specifically for dancing, Herr said he envisions a time when bionic limbs can switch modes for different activities. “We’re beginning the age in which machines attached to our bodies will make us stronger and more efficient,” he said.

During the TED presentation, HasletDavis performed a short ballroom dancing routine for the first time since her amputation. “I’m thrilled to have danced again,” she said. “It was invigorating to dance publicly with my new leg, but also to realize that my return to dance may have the power to inspire other people to reach for their goals and be proactive in their lives.”

Photos: TED/ Ryan Lash

Adrianne Haslet-Davis, a dance teacher who lost part of a leg in the Boston Marathon bombing last year, debuted a bionic limb designed for dance as part of a presentation by Hugh Herr at the TED Conference in March.

Herr, director of the biomechatronics group at the Massachusetts Institute of Technology (MIT) Media Lab and a double-amputee, designed the bionic limb with the assistance of MIT researchers. Herr’s presentation focused on the science of bionic limbs.

The researchers spent more than six months studying dancers’ movement and the forces they applied on the dance floor. The prosthesis they subsequently designed has 12 sensors, a synthetic motor system that can move the joint, and microprocessors that run the prosthesis’ controllers. The system

Hugh Herr at TED2014

Dancers Adrianne Haslet-Davis and Christian Lightner

This is the way the article segment on Snell’s Red-faces aren’t the preferred should read: look at the O&P Almanac, but when At Shreveport, Louisiana-based Snell’s a major goof occurs, indeed, red is Orthotics and Prosthetics, Clint Snell, CPO decided the color of the week. The magazine to expose his kids to the O&P field during their apologizes in every way for the teen years by offering them the chance to work at errors that occurred in the “Family the facility during summers and holidays. “The Ties” article in the March 2014 issue types of jobs they did for the company were not (pages 29-30), featuring long-time Left to right: Clint Snell, CPO; Gene “glamorous”, they were hard work. I wanted to AOPA members, Snell’s Orthotics Arant, CO (prior to his retirement after 50 years with the company); give them a chance to see if they had an interest in and Prosthetics of Shreveport, and Christopher Snell of Snell’s the business and a chance to earn a few dollars,” Louisiana. As many in the O&P said Snell. Founded in 1911 by Clint’s grandfather community know, the Snell families Orthotics and Prosthetics R. W. ”Pop” Snell, the facility has already been passed to occupy a special place in O&P, with several Snell family companies providing patient care for a century or more. The Clint’s father Jim Snell, who in turn passed it on to Clint.

After having had the benefit of hands on experience, out March article confused locations, company names, and a of the three Snell kids, the youngest and oldest Snells opted picture caption. to follow other paths. “In the end, they just didn’t have much To make sure the record and history are correct, we’re interest in the business,” he says. Son Christopher joined reprinting that section of the article with all corrections the 30-person practice in 2007, having already expressed an and with sincere apologies to Clint Snell, CPO, and interest while in college. His interest and hard work for the his wonderful family. And to the Arkansas-based Snell family business resulted in being awarded an ownership Prosthetic and Orthotic Laboratory owned by Frank Snell, a interest in 2013. separate company, we also send our apologies.

JUNE 2014 O&P Almanac

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Photo: Snell Prosthetic & Orthotic Laboratory

Correction from the May 2014 Issue

n

Reimbursement Page

By Devon Bernard, AOPA government affairs department

Risky Business With the rollout of new requirements, high-risk suppliers now face fingerprinting and background checks

e t a r e Mod isk R

Limited Risk O & P S upplier

C ategory

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O & P S upplier

I

High Risk

C ategory

n an effort to combat fraud and abuse in the Medicare program, CMS published a final rule in February of 2011 outlining new enrollment requirements for all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers. The basis for the new requirements was the creation of a system that would place suppliers into one of three risk categories, based upon CMS’s judgment about how likely each supplier is to commit fraud, waste, and abuse. From limited-risk to high-risk, each category has its own rules to follow for enrolling, which build on each other and increase the difficulty of remaining compliant.

The majority of the rules for each risk category have been in effect since March 25, 2011, and had a mandatory enforcement date of March 25, 2012, however, some rules for the high-risk group didn’t go into effect until recently, namely fingerprinting and background check requirements.

Before examining how the fingerprinting and background checks will be implemented and work, let’s quickly review the rules and requirements of each of the risk categories, as well as the category in which O&P supplies are placed.

O & P S upplier

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C ategory

The limited-risk category includes physicians, non-physician practitioners (i.e. nurse practitioners and occupational therapists), and medical groups or clinics. In addition, many Part A facilities that also do some Part B billing are included: ambulatory surgical centers, rural health clinics, skilled nursing facilities, and Department of Veterans Affairs hospitals. However, if a physician also has a DMEPOS supplier number, he/ she will be treated as moderate- or high-risk for that portion of this business, as appropriate, and will no longer be considered solely limited risk.

When it comes to enrolling limitedrisk category of suppliers/providers in Medicare, CMS follows three steps.

First, CMS will verify that the provider/ supplier meets specific requirements established by Medicare—for example meeting all the criteria of the 30 Medicare Supplier Standards. Second, CMS will conduct license verifications.

Third, CMS will conduct database checks. These checks will include verifying Social Security numbers, checking the NPI, looking for Office of Inspector General (OIG) exclusions, and verifying tax ID numbers.

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The moderate-risk category includes physical therapists, ambulance suppliers, hospice organizations, clinical laboratories, community mental health centers, portable X-ray suppliers, and currently enrolled DMEPOS suppliers and home-health agencies. If you have an active Medicare supplier number, you are considered part of the moderate-risk category.

Those suppliers/providers considered to be moderate risk will have to meet all of the enrollment requirements of the limited-risk category, plus one additional requirement. These suppliers/ providers also will be subject to additional site visits to ensure their compliance with all established Medicare regulations. These visits may be unannounced.

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The high-risk category includes all newly enrolling DMEPOS suppliers and home-health agencies. For the purpose of these rules, newly enrolling includes those providers/suppliers who are not currently enrolled with Medicare, as well as new offices of existing, enrolled suppliers. If you are already enrolled with Medicare but want to open a new branch, your new branch will be considered high risk, but your existing locations will be considered moderate risk.

Under certain circumstances, it also is possible for CMS to elevate or move an enrolling provider/supplier into the high-risk category even if the supplier/ provider would traditionally be categorized as low or moderate risk. Some of these special circumstances include if the enrolling supplier/provider had a CMS payment suspension within the last 10 years, if the provider/supplier has been excluded from Medicare, or if the provider/supplier had his or her billing privileges revoked within the last 10 years.

In addition to all of the enrollment requirements for the limited- and moderate-risk category providers/

suppliers, the high-risk category, as stated earlier, also will have to undergo background checks and fingerprinting.

Fingerprinting and Background Checks Fingerprinting and background requirements were introduced in 2011, but their implementation was placed on hold as Medicare examined how best to apply them. In early April 2014, CMS released the Medicare Learning Network Matters Article entitled, “Implementation of Fingerprint-Based Background Checks,” which provided guidance on how CMS will begin implementing the fingerprinting and background checks of those suppliers/ providers in the high risk category.

Beginning in 2014, CMS will send letters through its contractors to all those high-risk category suppliers/ providers who will need to comply with these requirements. Not all people in the company will be subject to the fingerprinting and background checks, only those who are listed as owning or having a 5 percent or more stake in the business. This means anyone listed in Section 9 of the CMS 855S form—the Medicare supplier application—may be subject to the fingerprinting and background checks.

Within the letter informing the individual(s) that they must be fingerprinted, there will be contact information for the Fingerprint-Based Background Check Contractor (FBBC).

The individual(s) must contact the FBBC, which will provide a list of at least three potential locations, including law enforcement facilities, where the individual(s) may go to have their fingerprints taken.

The individual(s) will have 30 days from the date of the notification letter to be fingerprinted and are responsible for all costs associated with this process. Once the fingerprints are taken, they will be forwarded to the FBI for processing and, within 24 hours, the FBI will compile the background information based on the fingerprints. The FBI will forward the

Reimbursement Page

results of the background check to the FBBC, and the FBBC will review the findings and make a recommendation to CMS. Based on those findings, CMS will make a final determination and notify the provider/supplier if the results of the fingerprinting and background checks result in the denial of the enrollment application and/or the revocation of existing Medicare billing privileges.

The individual(s) will have 30 days from the date of the notification letter to be fingerprinted and are responsible for all costs associated with this process.

Expanding CMS Powers Also as part of the 2011 final rule, CMS was granted additional rights or powers to help deter, detect, and eliminate fraud and abuse, including the ability to institute an application fee. Now when you send in your 855S form, or you enroll online using the Provider Enrollment, Chain and Owner System for a new enrollment or a revalidation of your existing supplier number, you will have to include a fee to cover processing of your application and, until the fee is received, your application will not proceed. In 2011, the application fee was $500, but this fee increases or decreases each year depending on the most recent consumer price index for urban areas. Currently, the application fee is $542. However, for simple changes to the 855S, such as a changing phone number, a new billing address, a change in the name of the supplier, or

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similar updates, an application fee will not be assessed because these changes do not constitute a new enrollment or revalidation.

The 2011 regulations also gave CMS the right to impose enrollment moratoria in six-month increments, either geographically or by provider type, if it identifies trends of fraud, waste, or abuse. These moratoria would only apply to newly enrolling providers or those enrolling new locations. Some examples of what might cause CMS to invoke a moratorium include a highly disproportionate number of suppliers in a category relative to the number of patients or a rapid increase in enrollment applications within a provider category. If an application has been submitted at the time a moratorium goes into effect, the application will be returned (unless it has already been processed and the only step left is to assign a supplier number, in which case it will be allowed to complete processing). Moratoria will not apply to mergers, changes of ownership/consolidations, changes in an existing practice location, or to managed-care organizations.

It is important to note that, at this time, CMS has not issued any type of enrollment moratoria on O&P suppliers. However, CMS has used this power for ambulance companies and home-health agencies in parts of Michigan, Florida, Texas, and Illinois.

One last power granted to CMS under the 2011 regulations is that it now has the right to invoke payment suspensions based upon a “credible allegation” of fraud. An allegation of fraud may come from any source, including but not limited to the following: • fraud hotline complaints • claims data mining • patterns identified through provider audits, civil false claims cases, and law enforcement investigations.

CMS has indicated that it will proceed with caution when implementing a payment suspension and

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One last power granted to CMS under the 2011 regulations is that it now has the right to invoke payment suspensions based upon a “credible allegation” of fraud.

that the suspensions will only occur when there is a credible allegation that has been investigated. Payment suspensions would be limited to 18 months, except when the case has been sent to the OIG or when the Department of Justice asks that it be kept in place due to an ongoing investigation.

At this time, CMS has not issued any payment suspensions on O&P suppliers. However, CMS has issued payment suspensions on other provider/supplier types.

Getting Revalidated

Medicare also is requiring all currently enrolled suppliers/providers that were enrolled with Medicare prior to March 25, 2011, to be reevaluated with the new screening/enrollment procedures (i.e. site inspections, database checks, fingerprinting, etc.) no later than March 23, 2015. So if you have not already revalidated your Medicare enrollment you can except to receive a letter from CMS and the National Supplier Clearinghouse between now and March 23, 2015, requiring you to revalidate your information and meet the new standards, including paying the application fee. Once you receive the letter, you will have 60 days to complete the

revalidation process. If you don’t revalidate your information within those 60 days, Medicare will deactivate your Medicare supplier number and your billing privileges.

If you have not revalidated your enrollment information with Medicare and you want to verify if you are slated to receive a revalidation request letter, visit the CMS website and the revalidation page at www.cms.gov/Medicare/ Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/Revalidations. html. On this site, you will be able to view a listing of suppliers who should have or will be receiving revalidation request letters. If you are listed and you have not received your letter, contact CMS and the NSC immediately, as you don’t want to risk having you billing privileges deactivated. a Devon Bernard is assistant director of coding, reimbursement, programming, and education for AOPA. Reach him at dbernard@ aopanet.org.

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By Adam Stone

This Just In

Speaking Out

on Cranial Helmets

Flawed study questions the effectiveness of treatment and could jeopardize practitioners’ compensation

A

recent study published in the journal BMJ, and reported in The New York Times, ought to be putting the O&P community on alert. While incomplete and flawed, the study could still jeopardize fair compensation for practitioners providing a valuable service to their patients.

In the study, Renske M. van Wijk and researchers at the University of Twente in the Netherlands looked at 42 infants, aged 5 to 6 months old, who had misshapen skulls. A key aspect that was lost in the article is that the study subjects had mild to moderate skull deformation. They were not patients who were near or beyond the boundary of those designated with an acute and serious need for treatment.

So the first potentially serious flaw would be if the study is misread as having any findings on the established success of the main body of patients who have a clear and acute need for treatment. As part of the study, the babies wore custom-designed helmets in order to allow flattened areas room to round out as the skull expands.

According to the findings, the helmets made no appreciable difference in correcting for skull flatness. Such a finding could give insurers a reason to decline coverage

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for these procedures. Yet any evenhanded analysis would identify significant shortcomings in the research and questions the overall validity of the findings.

Flawed Testing AOPA President Anita LibermanLampear, MA, responded to the study with a letter to The New York Times, noting first off that the pool of patients studied was artificially limited. “The study reported in BMJ related to one category in the use of cranial helmets, specifically how children who have mild to moderate indicators of positional skull deformation and are treated with cranial helmets progress, as contrasted with other similar patients who do not receive helmets,” she noted in her letter.

But this category of mild-tomoderate severity represents only one group of potential patients, omitting the potentially more significant pool of those with more severe symptoms.

“Cranial helmets have a long history of being used very effectively in treatment for children with more significant (beyond mild to moderate) symptoms, a usage which has passed muster as to effectiveness under FDA medical device regulations,” she says. “Nothing in the BMJ article either

questioned or studied the appropriateness of treatment with cranial helmets for these patients with more significant symptoms.”

Others in O&P say procedural omissions make the findings suspect.

“We have no definite information about about the helmet therapy clinical protocols. How often were the patients seen for follow-ups? We don’t know if the helmets were made from a cast, scan, or measurements. We have no idea if they follow the same manufacturing practices that we adhere to in the United States,” says Bill Gustavson, director of marketing for Orthomerica.

Procedurally, the researchers instructed parents to have infants wear the helmets 23 hours a day for approximately six months, while a separate pool with similar deformities received no treatment. After two years, a “blind” researcher, who did not know which babies had worn helmets, evaluated skull shape in the infants. According to the study, the improvements were not significantly different between the helmet-wearers and the infants not wearing helmets.

Among other flaws identified, the sample pool may have been too low to yield a meaningful result. “The participation rate in the [study] is low—21 percent,” says Liberman-Lampear. “It

is recognized across the medical and research communities that evidence from a randomized clinical trial must be supplemented by evidence from clinical effectiveness studies if any attempt is being made to inform best practice. This low level of participation prevents comparisons between sub groups and it is acknowledged by the authors as a limiting factor.”

Further, the equipment itself may have led to weak outcomes. Reportedly, 73 percent of participants said they experienced basic fitting problems, thus raising serious concern over the clinical application of the helmets used in this study. “One cannot expect a device which shows many signs of possibly having been fit improperly to yield optimal results,” says Liberman-Lampear.

And yet the study and The New York Times article are making ripples in the medical community. “The headline certainly achieved its purpose: The false and exaggerated news impression that ‘helmets are not effective,’ without regard to serious flattening problems and without any discrimination on the severity of the patient’s malformation, “spread like wildfire across the internet and to insurance companies and providers alike,” says Christina Hinton, CP, of Level 4 Star Cranial Center of Excellence.

A Trusted Practice This issue of cranial flattening can be traced to the good intentions of the medical community. For many years, parents have been urged to put newborns to sleep on their backs— known to help reduce the likelihood of sudden infant death syndrome. But the practice also has led to increasing incidence of flattened skulls. The New York Times reports: Roughly one baby in five under the age of 6 months develops a skull deformation caused by lying in a supine position.

To prevent the condition, concerned parents can alternate the side to which the infant’s head turns, once they are asleep on the back. It also may help to give infants more “tummy time” and to limit time spent in car seats,

the newspaper reports. There clearly are instances when overly concerned parents look at mild symptoms identified by their pediatrician and press for the certainty of “doing everything possible,” including use of a cranial helmet, which might not be indicated as necessary by standard treatment protocols.

When significant to severe acute symptoms of flattened skull conditions do arise, treatment by way of professionally fitted helmet has been shown to be highly successful, according to O&P leaders. Based on longstanding clinical experience, “this study is in direct conflict with what other studies that have been put out there over the years have shown,” says Joe McTernan, AOPA’s director of coding and reimbursements education and programming.

“Science demands replicability, and any new finding must be demonstrated as capable of validation through similar results reached by other investigators using parallel methods... no single article changes existing science.”

—Anita Liberman-Lampear, MA In fact, the legitimacy of helmet therapy has been made a part of the standard routine among O&P practice. “At least in the U.S., FDA regulations and increasing competition among providers have encouraged and developed ‘cranial remolding specialists’ among clinicians,” says Hinton. “These specialists now have the technology, resources, and experience behind them to monitor and guide the caregivers through an effective and successful treatment process and collect the data to provide to caregivers, referral sources, and insurance providers that document the correction obtained.”

In other words, the success of helmet therapy has made it an accepted part of both pediatric physician referrals and O&P practices.

And yet, many worry that the latest findings could create future reimbursement issues for such care.

Insurance Concerns “If this study is accepted as valid, and the poor fitting and shortcomings in differentiating patient severity problems are ignored, then I, as an insurer, may question the value of the expense of this therapy in treating patients,” says McTernan.

“If the study is misstated without validation by other studies as if it confirms no significant results from treatment, why, as an insurer, would I want to spend $3,000 to $5,000 for this therapy?”

Given the current fiscal environment, a study that questions the effectiveness of a particular therapy may well jeopardize any reimbursement for that treatment.

“I suspect [insurers] will be reviewing this study,” says Gustavson.

“Whether or not they accurately demonstrated any significant changes remains to be seen, but going by past experience, any study an insurance company can use to change or deny treatment, they will see it in their best interests to do so. Unfortunately, it is not in the best interest of the patient.”

O&P has good reason to be wary of these well-publicized findings, and concerned practitioners need to help gets the facts out to the public. “Those who provide this therapy need to chime in,” McTernan says. “They need to discuss and publicize the treatment that they have been providing.”

Finally, caution with these fragile patients is compulsory and hasty changes in treatment do not serve anyone well. Liberman-Lampear’s letter points out that validation via replication in more than one study is the required scientific standard before treatment standards can change: “Science demands replicability, and any new finding must be demonstrated as capable of validation through similar results reached by other investigators using parallel methods. In short, with rare exceptions, no single article changes existing science.” a Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com.

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Pushing for

Profitability Best practices for facility management and revenue optimization

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COVER STORY

By CHRISTINE UMBRELL

I

n the O&P landscape of today, survival depends on being able to do more with less. Facility owners and managers must re-evaluate their processes and procedures with an eye to cost-savings, finding ways to rein in expenses and maximize profitability.

Key Notes:

“There are a number of things outside of our ability to impact: low reimbursement, detailed prescription guidelines, documentation requirements—but we can identify opportunities that are in our control,” says Pam Lupo, CO, director of orthotics, and orthotic residency director at Wright & Filippis.

“We can control how we run our practice, including having practitioners and care extenders provide care within their scope of practice—optimizing revenue.”

Toward that end, Lupo launched a cooperative effort last year between four multi-office O&P facilities, conducting a time study to compare business practices. Each facility recorded how much time each type of practitioner spent doing different tasks (patient care,

Documentation must be accurate and efficient, so facility managers should closely examine practitioners’ time and ensure the most productive practices are in place.

documentation, lab time, marketing, etc.). Types of patient appointments also were recorded. The results, which were presented during an educational session at the 2013 AOPA World Congress, served to set benchmarks and spotlight areas of improvement for each of the participants. (See sidebar on page 26 for study details.)

After participating in the study , Lupo and her colleagues were able to learn from their facilities’ strengths and weaknesses, and implement some new strategies to improve their facilities’ bottom lines. Here, Lupo, along with Michael Oros, CPO, FAAOP, and C. Ralph Hooper Jr., CPO, share some best practices that should be considered by all O&P facilities.

O&P facilities can maximize profits by ensuring the most highly compensated staff avoid treating patients whose needs could be amply met by lowercredentialed staff.

Establishing a method to help practitioners make more cost-effective decisions not only helps deliver the most clinically appropriate devices but ultimately decreases the cost of goods.

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Photo: Wright & Fillipis

By scheduling appointments to coincide with practitioner arrival times, Wright & Filippis has decreased early morning non-revenue-producing time by more than 50 percent.

Getting an Early Start

“We need a new mindset: to share best practices to promote our industry and strengthen our ‘turf’—then use our individual facilities’ competitive advantages and operational excellence to promote our businesses.”

-Pam Lupo, CO

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Many facilities schedule the first morning appointments to begin after practitioners have had time to settle into the office, review notes, and catch up with the day. But this is a mistake, says Lupo.

At Wright & Filippis, Lupo found that by starting appointment times at 8:30 or 9 a.m., when practitioners were required to arrive at 8 a.m., resulted in 170 hours per week (across 35 total facilities) in lost patient-care events.

“That was 170 hours per week we paid practitioners to do non-revenueproducing tasks,” explains Lupo.

By scheduling appointments to coincide with practitioner arrival times, Wright & Filippis has decreased that early morning non-revenue-producing time by more than 50 percent, to less than 80 hours per week. And doing so has not been a hardship on office staff or practitioners.

“The misconception is that our schedulers would say, ‘What time would you like to come in tomorrow?’” explains Lupo. “Now we’ve changed the script to say, ‘Our first available appointment time is 8 a.m.’” And the company has found that many patients prefer early appointments, which make it easier to visit the facility before work or school.

The practitioners at Wright & Filippis have had to adjust their

documentation habits—but the new schedule keeps them in harmony with the company’s documentation policy. It turned out that most practitioners were using that early morning pre-appointment time to catch up on the previous day’s documentation, not complying with the company’s policy to complete documentation immediately after the patient is seen. “But we have reinforced our policy to finish each day’s documentation on that day at the latest, before leaving the office,” says Lupo—freeing practitioners to see patients as soon as they arrive in the morning.

The Right Match An O&P facility can maximize its profits by ensuring certified practitioners—usually the most highly compensated staff—avoid treating patients whose needs could be amply met by lower-credentialed staff. Oros, president and CEO of Scheck & Siress, notes that it’s important to track, in each device category, how many practitioners are truly spending their time “up to their level of certification.”

For example, are CPOs fitting only custom-fabricated devices, or are some also spending their time on repair work or off-the-shelf devices? During the time study, Oros found that between 20 and 25 percent of some practitioners’ time was spent doing “non-maxvalue” activities—tasks that could be completed by lower-credentialed staff, with lower compensation levels.

Solving that problem can be difficult, when the current staff level meets the needs of the current number of patients. Some of Scheck & Siress’ certified practitioners must complete lower-level work to ensure all of the tasks are completed. But Oros has found a solution: “The next practitioner we hire does not have to be a CPO.” When growth requires additional staffing, the addition may be a certified orthotic fitter or a technician who can “pull away at that 20 percent non-max-value time being spent by current CPOs,” he says.

Facility waiting area Management at Carolina Orthotics & Prosthetics defined tasks that can be performed by orthotic assistants or orthotic fitters and those C. Ralph Hooper Jr., CPO

that require certified practitioners.

technicians, and residents. “We identified new scheduling protocols per clinician scope of practice, which improved optimum performance by certified staff.”

Efficiency in Documentation

It’s extremely important to document correctly, especially in light of recent reimbursement challenges and increased audits affecting the O&P community. However, more isn’t always better. It may be beneficial to examine exactly how much time

each practitioner within a facility is spending on documentation, and whether all of that time is productive.

“We identified a wide range of documentation time for clinicians” during the time study, explains Lupo. Documentation accounted for anywhere between 5 percent and 28 percent of a clinician’s time. So management at Wright & Filippis conducted chart reviews, and identified anyone who spent an exceedingly high percentage of their time on documentation.

Cooperation Needed At AOPA’s World Congress last year, Pam Lupo, CO, director of orthotics and orthotic residency director at Wright & Filippis, shared the results of an independent study she spearheaded. She worked with representatives from three other facilities to gather data and compare notes to identify commonalities and areas of improvement in terms of O&P facility best practices.

In total, data from 56 facilities was included in the study: 35 Wright & Filippis facilities, 11 Scheck & Siress facilities, seven Carolina O&P facilities, and three Geauga Rehabilitation Engineering facilities. Each facility filled out a template that tracked practitioner activity throughout the day.

Practitioner time was divided into categories of patient care, documentation, lab time, and marketing. Each type of patient appointment also was recorded, and practitioners were clearly identified by their credentials.

What was most telling from the research was that “there were only two ‘like’ facilities out of all 56,” says Lupo, meaning only two facilities had similar services and practitioner mix. “It really opened our eyes to how unique this industry is—each

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facility is very different.” The size and geographical needs of each facility population make meeting the local needs at each facility a very individualized process.

Despite the disparities in size and services, the study participants were able to compare time studies (percentage of time spent on each category of care broken out by CPOs, COs, C.Peds, and certified fitters). By sharing their findings, Lupo and the other three participants—Carolina O&P’s C. Ralph Hooper Jr., CPO; Scheck & Siress’ Michael Oros, CPO, FAAOP; and Geauga’s Jon Naft, CPO—were able to identify areas of improvement, both in terms of improving patient-care events and increasing profits, for each of their practices, and shared their findings with participants during a World Congress session.

“We did this research to establish a philosophy of developing appropriate partnerships, and to change the mindset between competitors, to further our industry and advocate for the best patient care,” says Lupo. “It’s essential we all share best practices so as an industry we set guidelines and ideas that best represent our industry,” says Lupo.

Photo: C. Ralph Hooper Jr., CPO

At Carolina Orthotics & Prosthetics, management has taken a closer look at “practitioner time versus care extender time,” says Hooper, the company’s president. As a result of his facility’s participation in the time study, management clearly defined tasks that can be performed by orthotic assistants or orthotic fitters, as well as those tasks that require certified practitioners.

Similarly, managers at Wright & Filippis are striving to “optimize care extenders to provide care” for maximum profitability going forward.

The facility has implemented a system to ensure schedulers set appointments accordingly, by adhering to the Healthcare Common Procedure Coding System (HCPCS) codes.

Wright and Filippis has identified which HCPCS codes each type of practitioner should be providing care within, with different code set for CPs, COs, C.Peds, certified fitters,

“We are developing a system that allows a practitioner, while seeing a patient, to work through a series of checkboxes [electronically] that help fill out notes to meet medical policy requirements. ...This is an area where we can use technology to help us in patient encounters without losing touch with the patient.”

Managers at Wright & Filippis are striving to optimize care extenders to provide care for maximum profitability.

“There were some who were documenting extraneous information that was not contributing to a successful reimbursement outcome,” says Lupo. Management re-educated those individuals to ensure they were not recording useless or unnecessary information. “Documentation needs to be efficient and accurate,” she says.

At Scheck & Siress, management is preparing to implement a new methodology for documentation, with a goal of decreasing time spent in note-taking each day. “We used to freehand/type all of our notes and information,” Oros explains. “But we are developing a system that allows a practitioner, while seeing a patient, to work through a series of checkboxes [electronically] that help fill out the notes part to meet medical policy requirements,” he says. The hope is that the checkbox

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system will result in 90 percent of the documentation being generated electronically, according to the checked responses, with only 10 percent of documentation then necessitating manual entry.

“We’re working on the last piece— the hardware—before we implement the new system,” says Oros. He is testing iPads versus tablets for implementing the system, using smaller devices to ensure practitioners remain face-to-face with patients while filling in the checkboxes. “This is an area where we can use technology to help us in patient encounters without losing touch with the patient,” Oros says.

Examining Costs

As a result of their participation in the time study, managers at Carolina O&P “took a good look at some of the

Photo: Wright & Fillipis

–Michael Oros, CPO, FAAOP

devices we’re making, and considered the cost for an in-house technician versus sending out to central fab,” says Hooper. While there is still a great deal of in-house fabrication, “there were some products we were making in-house that we are now sending to central fab.”

For example, Hooper says an in-house technician may need five to six hours to fabricate a complicated

knee-ankle-foot orthosis (KAFO), but a central fabrication lab may be able to make that in two hours—simply because they have more experience and expertise in making that particular device. So even considering costs for shipping, it makes more financial sense to outsource fabrication of KAFOs. Each facility must consider the level of experience and the fabrication strengths of its in-house technical personnel versus central fabrication facilities to determine the monetary implications of outsourcing options.

Lupo also recommends that each facility find a tool to identify the devices with optimum reimbursement codes according to each payer. During the World Congress session, she presented a matrix demonstrating the HCPCS codes her facilities use versus reimbursement per payer source.

By researching reimbursement for various payers and cross-referencing the acquisition pricing, the matrix

is used to identify a hierarchy of preferred products.

Providing a methodology for practitioners to make cost-effective decisions, while delivering the most clinically appropriate devices, will ultimately decrease the cost of goods.

Knowing Where to Improve The suggestions outlined above can be helpful at any O&P facility—but consider designing your own time study to ascertain exactly how much time each specific staff member is spending on each task at your facility.

Doing so will help you identify areas of improvement, where expenses can be minimized.

“One of the most expensive line items at any facility is the people,” says Oros. Time studies require a significant buy-in from staff to complete, and some staff may be resistant to participating due to concerns about job stability. “But

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you need people to be honest about how they’re spending their time,” emphasizes Oros. The results can lead to a more effective and profitable O&P facility.

Better yet, consider collaborating with other facilities to conduct time studies and share results, as Lupo did. Though you may be reluctant to share data with competitors, working together may lead to advancing the O&P industry as a whole. Information sharing does not have to be detrimental to your practice.

“We need a new mindset: to share best practices to promote our industry and strengthen our ‘turf’—then use our individual facilities’ competitive advantages and operational excellence to promote our businesses,” says Lupo. a Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@strattonpublishing.com.

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Model P5

The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component.

The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

Model FA5

Model FF5

Model FP5

NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern.

Female portion of coupler accepts a pyramid.

Model T5

NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.

NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.

The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb.

The unit is waterproof and has a traction base pad.

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A Day for

Change Makers At the 2014 Policy Forum, practitioners, advocates, and industry leaders united to educate legislators and step up support for key issues

Key Notes:

AOPA unveiled its new initiative and lobbying tool Mobility Saves—backed by industry research demonstrating the costeffectiveness and other positive benefits of O&P treatment.

Competitive bidding, acutecare bundling, and Recovery Audit Contractor audits were just some of the critical topics discussed, with attendees and leaders sharing their frustrations and solutions.

The O&P industry must keep the pressure on Capitol Hill, encouraging legislators to adopt and support common sense legislation that promotes fairness and creates opportunities for O&P education and research.

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Participants of AOPA’s annual Policy Forum, April 2-4, at the Renaissance Hotel in Washington, D.C.

“It’s the boots on the ground that can change the day!”

W

ith these words, AOPA President Anita LibermanLampear, MA, kicked off AOPA’s annual Policy Forum, April 2-3, at the Renaissance Hotel in Washington, D.C. More than 100 O&P advocates gathered to educate themselves and to lobby Congress, pressing home to lawmakers the urgent nature of a range of industry issues.

Before their boots hit the ground on Capitol Hill, attendees heard from high-ranking officials and industry experts. They laid out a landscape of dire issues, including such wideranging subjects as Recovery Audit Contractor (RAC) audits, post-acute care bundling, O&P education, reimbursement issues, and more. All of these topics were on the table as O&P

advocates made the rounds—nearly 400 appointments scheduled with members of Congress and their aides.

Mobility Saves AOPA Executive Director Tom Fise, JD, set the tone for the event by introducing a new awareness campaign, Mobility Saves. In the coming months, AOPA advocates will be driving home this theme, using hard numbers to make their case among decision makers at the national level.

Pointing to new data showing the costeffectiveness of O&P, Fise declared a new and potentially more effective tool in O&P’s lobbying efforts. “We have known it in our hearts for years, but we haven’t been able to point to the data until now,” he told attendees.

Brad Ruhl and Charles Kuffel, CPO, FAAOP, discuss Recovery Audit Contractors and the Medicare O&P Improvements Act with Rep. Erik Paulsen (R-Minnesota).

For example, the latest findings show the cost of co-morbidity treatment among those patients who have a condition which would be a predisposing element for O&P care (e.g. amputation, stroke, MS, or CP) but are not treated by O&P practitioners far exceeds what the cost of care might have been had they received such care.

A study funded by AOPA, commissioned by the Amputee Coalition, and conducted by Dobson DaVanzo & Associates found that payers can realize a return on investment on O&P treatment within just 12 to 18 months, an indication that such treatments are highly cost effective. The cumulative cost of health care for those who received O&P care was lower than for those who did not, by up to 10 percent, depending upon the predisposing condition.

“Mobility saves time and money, mobility saves lives and money,” said Fise. “For the first time, we have solid, empirical evidence that O&P care is cost effective.”

Pressing for Education Education also was high on the agenda at the 2014 Policy Forum. Sen. Dick Durbin (D-Illinois) brought home the importance of a subject for which he has been a strong advocate, as he has pressed for legislation that would funnel significant funding into O&P education and O&P outcomes research.

The Senate majority whip said the need for O&P training is intimately tied to veterans’ issues.

When soldiers vow to fight for their country, that country, in turn, makes

AOPA President Anita Liberman-Lampear, MA, meets with Rep. Kevin Brady (R-Texas) after he delivered his Congressional Perspective, “What is the Future of Health Going to Look Like, 2014-2016.”

Challenging Competitive Bidding

Top: Jim Weber meets with Rep. Ann Wagner (R-Michigan) over the breaking point of Administrative Law Judge hearings.

Bottom: AOPA Executive Director Tom Fise, JD, introduces Mobility Saves, AOPA’s public relations campaign to promote the cost effectiveness of O&P care.

a promise to care for their needs over the long haul. In this era of seeming perpetual war, with so many soldiers coming home in need of medical attention, “it’s going to be an expensive promise to keep. But it is a promise we need to keep,” he said. “It’s a challenge to all of us.”

Following a great success in AOPA’s efforts—with special kudos to AOPA lobbyist Catriona Macdonald—that secured $10 million in funding via the Department of Defense budget for O&P outcomes, federal funding for O&P education has been stalled in Congress, tied up in the legislative process as part of a larger package related to veterans’ health and benefits. As the Senate looks for ways to trim the overall cost of the package, AOPA is lobbying vigorously to move that legislation forward while keeping the O&P component intact.

Of urgent interest to attendees was the ongoing matter of competitive bidding. Under this protocol, CMS insists that certain off-the-shelf (OTS) products are eligible to be competitively bid. By statutory definition, OTS refers to devices that require minimal self-adjustment. But CMS has continually tried to expand this definition.

With pressure to bring down the price of “commodities,” CMS has taken liberal leeway with its definitions of minimal self-adjustment, despite the fact that demonstration projects don’t show any substantial savings in this approach, according to Fise. Beyond the fiscal aspect, there is the matter of clinical repercussions. Classifying a wide array of devices as OTS puts patients at risk, depriving them of the clinical care needed to make proper use of these devices and to avoid worsening of their conditions and bad clinical outcomes.

The issue of determining which devices to bid out and how to maintain an appropriate clinical relationship in the face of economic pressures from CMS remains up in the air, and AOPA continues to advocate for the statutory definition that would help to ensure positive outcomes.

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Jim Weber (middle) continues his discussion with Rep. Ann Wagner (R-Michigan), encouraging the need for O&P to be exempted from any post-acute care bundling.

Fise urged practitioners to recruit patients willing to tell their personal stories as part of the ongoing advocacy effort. “The reason competitive bidding went so badly for the Durable Medical Equipment folks is because there were no patients who stood up and said: ‘This is a problem,’” he said.

At the same time, he urged practitioners to continue billing devices as customized, when provided that way with appropriate clinical care, rather than as OTS—despite the fact they are currently reimbursed at the same level—in order to show CMS a track record that indicates such devices are seldom commodities.

Tackling PAC Bundling A relatively new arrival on the regulatory horizon, post-acute care bundling (PACB) quickly has become one of the most serious threats to the O&P community.

Under the PACB regimen, CMS contracts with a single entity through a bidding process. Every patient in that entity—typically a local hospital or rehab facility—is discharged essentially carrying a 90-day warranty. During those three months, that provider is obliged to cover every service that patient needed, including his or her initial O&P care. To support the warranty, the entity establishes a bidding process for one party—the lowest bidder in all likelihood—to provide all those services for that patient. The impact to O&P could be disastrous, as the piece of pie is sliced into fewer pieces, with reduced dollar

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value per patient/device.

While AOPA’s vigorous advocacy has so far succeeded in preventing O&P from being included in a recent bundling proposal, the matter is far from settled. “We won one skirmish [but] the fight isn’t over. We will fight this battle again and again, because there is a huge amount of money on the table,” Fise said.

On a positive note, Policy Forum attendees heard a direct congressional indication that at least some on Capitol Hill have heard AOPA’s message regarding the urgency of O&P’s position. Rep. Kevin Brady (R-Texas), chair of the House Ways and Means Health Subcommittee, told the gathering that while it is too soon to tell how Congress will address PAC bundling, he and others are eager to hear input from the O&P community.

“We want to pay the right reimbursement for the right service at the right location. So we are taking a

AOPA 2014 President-Elect Charles Dankmeyer Jr., CPO, (right) welcomes Rep. Kevin Brady (R-Texas) to deliver the Congressional Perspective. exempted from any post-acute care bundling.

hard look at all the silos leading into the hospital and all those leading out of it,” he said.

RAC Audits Fury, Fear Alternately expressing fear and fury, attendees hunkered down to talk about RAC audits, the perennial terror of the O&P community, a looming menace that threatens the entire endeavor.

With RAC audits, CMS hires auditors to recoup alleged overpayments to practitioners. These individuals often get paid on a contingency basis for any money they collect, and while they can also identify under-payments as well, surprisingly they hardly ever do, said attorney Peter Thomas, general counsel for the O&P Alliance..

There is a growing backlash against the RAC audits. More than 100 members of Congress recently wrote to Health and Human Services Secretary Kathleen Sebelius expressing their concerns. House

AOPA Executive Director Thomas Fise, JD, (left) and AOPA Vice President James Campbell (middle) follow up with Rep. Kevin Brady (R-Texas) (far right) to support Part B-Recovery Audit Contractor audit legislation.

Special Thanks to the 2014 Policy Forum Corporate Sponsors:

AOPA members meet with Rep. Erik Paulsen (R-Minnesota) to enforce the Medicare O&P Act (HR 3112) as a means to reduce fraud and abuse.

Along these same lines, advocates pointed to the outrageous backlog of O&P appeals on RAC findings.

Instead of acting within the required 90 days, courts are taking at least 16 months and sometimes as long as 26 months to settle cases. And Chief Administrative Law Judge Nancy Griswold recently announced a suspension in the scheduling of appeals hearings for at least 24 months, only making the problem worse. For now, the best thing O&P practitioners can do is to continue filing their appeals. “Keep making the line longer and longer and longer,” Fise told attendees. “They have to do something about it eventually.”

Expedited judgments are in many ways a matter of fairness—a theme that rang throughout the Forum. For example, Dan Ignaszewski of the Amputee Coalition talked about the proposed Federal Insurance Fairness for Amputees Bill. This would require insurers who offer coverage for O&P devices to do so at the same level as other surgical and medical benefits, rather than imposing arbitrary caps.

Moving the Needle These subjects are not merely academic, attendees and speakers agreed. Every one of them has a direct impact on O&P providers’ ability to deliver care. Many issues, such as RAC audits, threaten providers’

ability to practice at all, as they tie up desperately needed operating funds in months’ and years’ worth of appeals, the vast majority of which are eventually settled in the provider’s favor.

Advocacy efforts, such as the one organized by AOPA each year, can have a powerful influence on lawmakers. Education combined with personal contact can play a crucial role in driving the message home and ultimately shaping legislation that will directly impact the O&P community.

“When you take time to travel here…the message really matters,” said Brady. “There is no substitute for that. Getting these issues off the paper and into real life in this industry is really critical.”

He reminded attendees that their efforts are more than merely theoretical. AOPA’s lobbying has been and will continue to be of vital importance in a political landscape in which lawmakers, sometimes driven solely by fiscal concerns, can lose track of the bigger picture. “As hard as you work, the thousands of decisions you make… we can wipe it out,” he said.

“So you’ve got to be here, both here in Washington and back home. You’ve got to be talking to your lawmakers.” a Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com.

JUNE 2014 O&P Almanac

Photos: AOPA

Ways and Means Committee ranking member Rep. Jim McDermott (D-Washington) has endorsed the idea of financial penalties for auditors who show a high rate of charges that are overturned on appeal.

Thomas described proposed RAC Fairness Legislation, an omnibus wish list submitted for congressional consideration. In a perfect world, Congress would adopt the following ideas: • O&P records should be part of the medical record for purposes of determining treatment. The weight of that clinical documentation should be given the same consideration as any other part of the medical record.

• O&P should be understood as distinct from durable medical equipment.

• If a claim is denied on one code, practitioners should still get paid on the balance of the claim while the contested code is being re-billed or appealed.

• If an appeal goes to second-level review, the provider should have the option to skip that phase and go right to the next higher level of review.

• Any judgment that takes more than 90 days to process should default in favor of the provider.

O&P likely won’t win on all of these points all at once. But the advocacy effort sets the bar high, challenging Congress to take a serious look at the perils the profession faces.

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MakE the most out of your trip to the 2014 AOPA National Assembly

Vegas

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By Bryan Ochalla

N

o matter what time of year you visit Las Vegas—the city often dubbed the “entertainment capital of the world”—there is always something for everyone.

Good news, as the Nevada metropolis, with its casinos, restaurants, resorts, and shops, will welcome members of the O&P industry for the 2014 AOPA National Assembly—held September 4-7, at the Mandalay Bay Resort and Casino. The four-day event is the premier destination for the world-wide orthotic, prosthetic, and pedorthic community, offering top-notch education, networking, and development opportunities. Register and find more information at www.aopanet. org/education/2014-assembly/attend/.

As you make plans to take in the sights after the conference winds down each day, consider these suggestions:

Photo: Las Vegas News Bureau

After Hours

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Whether you’re participating in the Assembly’s manufacturers’ workshops or waiting for the 5 p.m. Viva Las Vegas Welcome Reception in the Exhibit Hall, to begin, hopefully you’ll find yourself with enough free time to explore all of the restaurants, shops, shows, and other intriguing avenues that can be found at Mandalay Bay. For instance, the resort has a variety of dining choices, including Charlie Palmer’s American-cuisine-centric Aureole, Border Grill (which serves up modern Mexican fare by the Food

DINE Aureole 702/632-7401 www.charliepalmer.com/aureole-las-vegas/ Bayside Buffet 702/632-7402 www.mandalaybay.com/dining/bayside-buffet/

Network’s “Too Hot Tamales”), Hubert Keller’s Fleur, Wolfgang Puck’s Lupo, and more than a dozen other options.

Not to mention the on-site buffet, Bayside Buffet.

Those looking to imbibe should stop into one of the many lounges and bars. Check out Evening Call if frozen cocktails featuring exotic Russian vodkas are your thing, or the Mix Lounge if you’d like to bask in a stunning view of Las Vegas while winding down. The Rí Rá Irish Pub combines “a comfortable neighborhood vibe” with live music, while glacial ice is the name of the game at Minus 5 Ice Lounge, where everything from its seats to its glasses are made of the chilly, clear substance.

If beach-side relaxation is more

DRINK

Border Grill 702/632-7403 www.bordergrill.com/bg_lv/bg_lvwel.htm

Evening Call 702/632-9374 www.mandalaybay.com/entertainment/ lounges/evening-call

Fleur 702/632-9400 www.hubertkeller.com/restaurants/fleur-byhubert-keller.html

Minus 5 Ice Lounge 702/632-7714 www.mandalaybay.com/entertainment/ lounges/minus5-ice-lounge

Lupo 702/740-5522 www.wolfgangpuck.com/restaurants/ fine-dining/3860

Mix Lounge www.mandalaybay.com/entertainment/ lounges/mix-lounge

Ronald’s Donuts 702/873-1032 Tiffany’s Cafe 702/444-4459 www.tiffanyscafelv.com/

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Rí Rá Irish Pub 702/632-7771 www.mandalaybay.com/entertainment/ lounges/ri-ra-irish-pub

your style, visit Mandalay Bay Beach— featuring 2,700 tons of real sand, a 1.6 million-gallon wave pool, and 100 rentable cabanas, day beds, bungalows, and personalized villas. Or explore Shark Reef, where you can see more than 2,000 varieties of aquatic life— sawfish, giant rays, endangered green sea turtles, piranha, jellyfish, and the rare golden crocodile, among them.

Of course, you also could try your luck in the resort’s 135,000-squarefoot casino.

Friday, September 5 Don’t miss Friday’s keynote address, given by Adrianne Haslet-Davis, a life-long dancer who lost her leg as a result of the Boston Marathon bombings. Haslet-Davis will kick-off the day with her story of hope and empowerment on her journey back to dance. Following the first full day’s sessions and concurrent education, covering such topics diabetic foot complications, microprocessor controlled knees, reimbursement and other business concerns, and capped off by a Happy Hour reception at 5:00 p.m. in the Exhibit Hall—you may want to indulge in a bit of culture.

And that’s exactly what you’ll get if you make your way to Las Vegas’ downtown area to take part in its “First Friday” festivities. Not only does this monthly “gallery walk” feature local artists who display and sell their wares, but it also showcases the talents of various musicians and local food truck chefs.

If you’d prefer to stay a little closer to the conference site, there’s still plenty of art for you to peruse, especially if you’re a fan of international rather than local art.

Photos: Las Vegas News Bureau

Thursday, September 4

Celebrating the Future of O&P

The next generation joins the profession, beginning their journey of changing lives through exceptional patient care.

And an ABC Practitioner was there

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

abcop.org 703. 836.7114

AOPA’s

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assembly ’14

Atomic Testing Museum 702/794-5151 www.nationalatomictestingmuseum.org

Mandalay Bay Beach www.mandalaybay.com/beach Mob Museum 702/229-2734 http://themobmuseum.org

Auto Collections at The Quad Resort & Casino 702/794-3174 www.thequadlv.com/things-to-do/the-autocollections.html “Da Vinci The Exhibition” at The Venetian 866/641-746 www.venetian.com/entertainment.html First Friday Las Vegas www.firstfridaylasvegas.com

Neon Museum 702/387-6366 www.neonmuseum.org “Painting Women: Works from the Museum of Fine Arts, Boston” at Bellagio 702/693-7111 www.bellagio.com/attractions/gallery-offine-art.aspx

Freemont Street Experience 702/678-5777 www.vegasexperience.com Golden Nugget Hotel & Casino 702/385-7111 www.goldennugget.com/lasvegas Las Vegas’ Insert Coin(s) 702/477-2525 www.insertcoinslv.com

Shark Reef 702/632-4555 www.sharkreef.com Wildlife Habitat at Flamingo 702/733-3349 www.flamingolasvegas.com/things-to-do/ wildlife-habitat.html

EXPERIENCE THE of the AOPA National Assembly

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For example, The Venetian’s “Da Vinci The Exhibition” promises “a hands-on exploration of the life and work of the original Renaissance man” and offers visitors the chance to operate a number of the 65 inventions and machines brought to life from Da Vinci’s Codices.

Another exhibit worth checking out is “Painting Women: Works from the Museum of Fine Arts, Boston,” which is on display at the Bellagio through the end of October and focuses on “paintings portraying female artists as confident practitioners of their craft.”

It also includes a survey of works by artists such as Mary Cassatt, Georgia O’Keeffe, and Berthe Morisot.

Saturday, September 6 After the award-winning Harmontree Business Lectures and powerful sessions on optimizing mobility for prosthetic patients, cranial remodeling treatment, and more, the second full day of the Assembly ends with a bang: the Exhibit Hall’s “Closing Extravaganza.” The 5:00 p.m. celebration offers attendees the chance to win a whopping $5,000 and other prizes, all while being entertained by Las Vegas performers. You aren’t going to want to miss it.

Afterwards, take the opportunity to seek out some of this vibrant city’s hidden and not-so-hidden treasures.

Here are just a few you may want to consider: • The Golden Nugget Hotel & Casino, a downtown Vegas landmark, has long been home to a 200,000-gallon shark aquarium.

Until recently, however, the public wasn’t able to tour “the tank” as it’s

Photos: Las Vegas News Bureau

HAVE FUN

•

•

•

www.savewithups.com/aopa

•

affectionately known. Fish friendly visitors also can take a ride through the tank on a 30-foot-high waterslide that provides thrill seekers an up-close-and-personal look at the deadly creatures.

Part of the Fremont Street Experience, “SlotZilla” zipline launches passengers from a 12-story slot-machine-themed tower and then sends them zooming over the thousands of tourists below. At the nearby Rio All-Suite Hotel & Casino, a contraption whisks customers from the pinnacle of the 50-story Masquerade Tower to the peak of the 20-story Ipanema Tower, 800 feet away.

Pay a visit to Las Vegas’ Insert Coin(s), which bills itself as “part bar and part arcade.” All sorts of drinks and games can be enjoyed at this establishment, with the latter skewering toward classics from the 1980s, such as Donkey Kong, Galaga, and Frogger.

For a more natural experience, check out the Wildlife Habitat at Flamingo, a free-of-charge outing that houses a flock of Chilean Flamingos and a collection of other birds and animals, too.

Last, but not least, Nevada’s most populous city lays claim to a whole

host of “only in Vegas” museums that are just begging to be visited. For starters, there’s the Atomic Testing Museum, which details the history of the aboveground nuclear testing that occurred just outside of Las Vegas.

The Mob Museum, on the other hand, calls on artifacts, interactive exhibits, and theatrical presentations to “present an exciting and authentic view of the mob’s impact on Las Vegas history,” while the Neon Museum collects, preserves, studies, and exhibits “iconic Las Vegas signs for educational, historic, and cultural enrichment.”

Sunday, September 7 Car buffs should plan to stick around following the Assembly wrap-up to check out the auto collection at The Quad Resort & Casino.

Promoted as “the world’s largest classic car showroom,” the collection includes 250 classic cars that span the century and beyond—and all of them are available for purchase (should you have somewhere between $20,000 and $3 million to spend).

If your tastes veer more toward coffee and sweets rather than cars, head downtown to Tiffany’s Cafe, a 60-plus-year-old greasy spoon frequented by the locals. Apparently it was Las Vegas’s first 24-hour restaurant, which is noteworthy in and of itself, but combine that with the fact that it sports an old-fashioned lunch counter, huge portions, and cheap prices and, well, you’ve got yourself an ideal end-of-conference destination.

Just be sure to leave enough room for a quick trip to Ronald’s Donuts, located near the city’s Chinatown.

Customers of all stripes seem to love these vegan treats (the shop has been reviewed by more than 400 Yelp users and sports a four-and-half-star rating), so why not give them a try?

Doughnuts are just the tip of the iceberg; Ronald’s also serves apple fritters, bear claws, and chocolate cinnamon twists. a Bryan Ochalla is a contributing writer to O&P Almanac. Reach him at bochalla@ yahoo.com

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2014 Buyers’

Guide

one-stop resource for O&P products and services

2014 Contents

The annual

41 Orthoses and Components 41 Orthotics—All

41

Ankle/Foot Orthoses-AFO

42

Foot Care: Custom Foot Orthotics

42

Knee Orthoses

42

Orthoses: Lower-Limb

43

Pediatric Orthoses

43

Spinal Orthoses

43

Upper-Extremity: O&P

44 Prostheses and Components 44 Prosthetics—All

44

Prosthetic Components

44

Soft Goods/Prosthetics

45 Feet 45 Knees

46

Lower-Limb Prosthetics

47

Upper-Extremity Prosthetics

47 Miscellaneous

47

Business Services

47

CAD/CAM Systems

48

Central Fabrication

49

Fabrication Materials

49

Specialty O&P Distributors

50

Reference Materials

52 Comprehensive Index

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O&P Almanac JUNE 2014

Orthoses and Components Orthotics—All Becker Orthopedic 635 Executive Drive Troy, MI 48083 800/521-2192 www.beckerorthopedic.com Becker Orthopedic was founded in 1933 by Otto K. Becker to provide high quality, innovative, orthotic components and central fabrication services. His vision continues today with new product offerings like the Stride Stance Control Family and SpineCor®. When it comes to orthotics, Becker has the options you are looking for.

• Largest orthotic component selection available • Custom central fabrication services • Dedicated technical support • Knowledgeable customer service staff • Educational in-services • Online support via WebEx For more information, or assistance with component selection, fabrication, or problem solving, please contact Becker Orthopedic at 800/521-2192 or visit BeckerOrthopedic.com.

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 www.professionals.ottobockus.com

College Park Industries Inc. 27955 College Park Drive Warren, MI 48088 800/728-7950 www.college-park.com New Tempo foot from College Park New for 2014! Our latest K2 foot provides a good range of motion and high weight limit in a light weight and affordable product.

This service-free design also has a full length toe lever for excellent stability and performance. For more information, call 800/728-7950 or visit www.college-park.com.

Fillauer 800/251-6398 423/624-0946 www.fillauer.com Dynamic Walk The Dynamic Walk is an AFO made of a lightweight moldable carbon fiber composite material. The open heel construction allows for optimal fit and comfort with various shoe types. The Dynamic Walk provides dorsiassist with subtalar inversion and eversion control. This high activity design enables freedom of motion and allows for walking, running, and climbing stairs.

Features: • High quality dorsiflexion assist technology • Lightweight • High strength • Fits easily into normal or narrow shoes • Flexible for multi-plane action • Dynamic medial/lateral control • Enables athletic activity such as moderate running.

2014 Buyers’ Guide

Differentiating yourself and your clinic. Staying on the cutting edge. Offering patients innovative solutions. All these goals are within your reach—and Ottobock is here to help you grow your orthotic business. As stance‑control products become more sophisticated, we’ve led the way, offering the FreeWalk, E-MAG Active, and Sensor Walk KAFOs to provide users with a secure, efficient gait. Now Ottobock opens a whole new world of mobility with the remarkable C-Brace orthotronic mobility system: fluid, natural, efficient movement with support on uneven terrain, on inclines, and going down stairs. Turn to Ottobock for all your orthotic needs.

Ankle/Foot Orthoses–AFO

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2014 Buyers’ Guide

PEL LLC 4666 Manufacturing Avenue Cleveland, OH 44135-2638 800/321-1264 www.pelsupply.com ToeOFF® Family from PEL The ToeOFF® family of products from Allard USA is the original and the leading carbon composite dynamic response floor reaction AFO. All available from PEL, the family includes: • Ypsilon™ – Mild to moderate footdrop only • ToeOFF® – Mild to moderate involvement accompanied with mild to moderate ankle instability • BlueROCKER™ – Footdrop, severe ankle instability, and/or proximal neuromuscular weakness/deficits • KiddieGAIT and KiddieROCKER to meet your pediatric needs.

Now available with Allard’s new SoftSHELL Covers that combine the SoftKIT soft interface system with fun yet functional textile covers that cater to a child’s sense of style!

For more information on any of these Allard ToeOFF products, contact PEL at 800/321-1264 or online at www.pelsupply.com.

FOOT CARE: CUSTOM FOOT ORTHOTICS Amfit Inc. 3611 NE 68th Street Vancouver, WA 98661 800/356-FOOT(3668) sales@amfit.com www.amfit.com

Knee Orthoses Fillauer LLC 800/251-6398 423/624-0946 www.fillauer.com SPL2 The Swing Phase Lock 2 (SPL2) uses a simple internal pendulum mechanism to lock and unlock the knee depending on the angle of the joint in the sagittal plane.

During gait, the device locks just prior to heel strike for support during stance and unlocks the knee at heel off in preparation for swing. This action is intended to mimic the normal physiologic action of the knee extensors. Because the mechanism is position dependent, it does not rely on heel loading or cabling as in other designs. This allows for a more normal gait pattern and prevents circumduction or hip hiking commonly seen in standard KAFOs.

ORTHOSES: Lower-limb Orthomerica 6333 N. Orange Blossom Trail Orlando, FL 32810 800/446-6770 www.orthomerica.com

Lower Extremity Fracture Bracing System from Orthomerica Orthomerica’s Orlando KAFO/HKAFOs are modular, lightweight and can be ordered and stocked as components, making them immediately availTrust your foot orthotic fabrication to able, or custom assembled to your Amfit Lab Services. Offering A5513 measurements. Orthotists choose Diabetic insoles starting at 3 for $60 from a wide selection of pelvic, femo(with shipping!) plus EVA, Carbon ral and tibial components, hip joints, Fiber, and Polypropylene devices. knee joints and shoe inserts to meet Send us your foam boxes or Amfit individual patient needs. digital records. Standard orthotics

Anatomically designed pelvic are fabricated and shipped within components offer a variety of shapes two business days. FootPrinter foam and sizes to accommodate even box processing and low and no cost the most difficult to fit patient. Unique, patented hip joints scanner options. Contact Amfit today to get started. With 30 control flexion/extension and abduction/adduction. Available in years of experience––outsource foot orthotic fabrication and optimize your time. Amfit. Where Technology Fits….Perfectly. individual prefabricated components, pre-assembled, customto-measurements or custom-to-cast.

For more information, call 800/446-6770 or visit www.orthomerica.com.

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O&P Almanac JUNE 2014

Pediatric Orthoses Cascade Dafo, Inc. Ferndale, WA 800/848-7332 bizdev@dafo.com www.cascadedafo.com Cascade Dafo FlexiSport Strut Flexibility Options The DAFO FlexiSport is a custom-fabricated, two-part orthosis that combines full wrap-around foot control with a posterior upright that provides graded, leaf spring–like resistance to plantarflexion and dorsiflexion. This brace style is designed for larger, active patients who need moderate-tostrong ankle control and sturdy support.

In response to customer requests, the DAFO FlexiSport can now be ordered with a choice of posterior strut flexibility—moderately flexible or semi-rigid – to meet your patient’s unique needs. Like all Cascade Dafo orthoses, the DAFO Flexisport is backed by a Full (90-Day) Warranty.

For more information, visit www.cascadedafo.com or call 800/848-7332.

M.J. Markell Shoe Co. Inc. Yonkers, NY 914/963-2258 markellshoe@optonline.net www.markellshoe.com

Spinal Orthoses Spinal Technology Inc. 191 Mid Tech Drive West Yarmouth, MA 02673 800/253-7868 info@spinaltech.com

6333 N. Orange Blossom Trail Orlando, FL 32810 800/446-6770 www.orthomerica.com NEW! Orthomerica® California® Catalina™ Custom Fit Spinal Orthosis Orthomerica introduces the new modular California Catalina Custom Fit Spinal Orthosis—the latest addition to the California Soft Spinal System family of spinal orthoses.

Key Benefits: • Mechanical advantage 2-pull string closure system with ergonomically designed pull-tabs • Modular components make it simple to reduce from LSO to LO • Easy circumferential adjustment for waists up to 50” (standard) or 66” (extended) • Custom individualized design allows personalized fit by the orthotist • Heat moldable removable posterior panel • PDAC Approved––HCPCS Codes L0637/L0650, L0631/L0648, L0627/L0642.

For more information, contact Orthomerica at 800/446-6770 or www.orthomerica.com.

UPPER EXTREMITY: O&P Motion Control—A Fillauer Company 888/696-2767 info@utaharm.com www.utaharm.com ETD • Rugged durability—enhanced further by optional titanium hook fingers • Powerful, responsive, and precise • Wide opening and fine tips allow high visibility • Lightweight at only 14 oz. (397 g)—lightest work TD available • Safety release • Water-resistant • High-speed motor—new option available with ProHand version.

JUNE 2014 O&P Almanac

2014 Buyers’ Guide

Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper and lower-limb orthotics, and prosthetics. Our ABC Certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products, fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry.

Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses.

For information, call 800/253-7868, fax 888/775-0588, or email info@spinaltech.com. Visit our website at www.spinaltech.com.

Orthomerica

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2014 Buyers’ Guide

Prostheses and Components Prosthetics—All Ottobock

ALPS 2895 42nd Ave. North St. Petersburg, FL 33714 800/574-5426 www.easyliner.com

Your goal is success for your patients and your business. You’ve always counted on Ottobock’s high-quality prosthetic products to provide increased mobility, confidence, and independence for your patients. Now turn to us for help to grow your business, too. Your patients get the benefits of Ottobock’s solutions, suitable for even for the most demanding situations, for every level of function and amputation. And you get the advantages of a dedicated support team of clinicians, reimbursement experts, and product specialists to put you and your patients on the road to success.

ALPS Guardian Suction Liner The Guardian suction liner from ALPS features raised GripGel bands that grip the socket wall to form a secure interface between the socket and the liner to prevent slippage or premature release. These low modulus GripGel bands stretch against the socket wall, while the inner wall conforms easily to the residual limb, to ensure there is NO RESTRICTION of blood flow or stiffening to inhibit donning. No seams and a single piece construction improve durability.

Available in both transfemoral and transtibial models, the Guardian suction liner can be fully inverted for ease of donning.

To accommodate for volume fluctuations please use the ALPS Skin Reliever (ENCP) for continued use of same socket.

PROSTHETIC COMPONENTS

Comfort Products Inc.

2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 www.professionals.ottobockus.com

ARTech Laboratory Inc. 309 West Avenue F Midlothian, TX 888/775-5501 www.artechlab-prosthetics.com The loss of a limb causes deep emotional trauma. Apart from the obvious difficulties with mobility and self-care, the disturbance in body image requires significant emotional readjustment. Our objective is to eliminate the stigma associated with the disfigurement.

As opposed to the robotic or mannequin look of a traditional prosthesis, our restorations have a natural appearance since they are sculpted and painted to match the opposite limb.

Without close examination, ARTech’s prostheses are virtually undetectable. It is our privilege to work in an industry that gives self-sufficiency, mobility, and self confidence back to those with amputations and birth defects.

For more information, call 800/775-5501 or visit www.artechlab-prosthetics.com.

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Soft Goods/Prosthetics

O&P Almanac JUNE 2014

931 River Road Croydon, PA 19021 800/822-7500 www.comfortoandp.com Complete Line of Prosthetic Socks The Comfort Products tradition lives on in the latest advancements in fiber technology with the finest knitting equipment available. Throughout the years we have become the Innovation Leader in Knitted Orthotic and Prosthetic Products. Our innovations include: • First to incorporate X-Static® silver yarn into products for Orthotics & Prosthetics • First to offer a Seamless Diabetic Sock • First to marry X-Static® silver yarn with CoolMax® fabric • Developed and introduced SpectraCarb™, a unique lamination stockinette that combines Spectra Fibers and Carbon.

We are committed to providing the best knitted products with the latest innovations and highest quality for wearers of orthotic and prosthetic devices. We believe that this commitment is unparalleled in the world of orthotic and prosthetic knitted goods today. With our full line of Prosthetic Socks we have something for everyone!

For more information, contact Comfort Products at 800/8227500 or www.comfortoandp.com.

PEL LLC

Ottobock

4666 Manufacturing Avenue Cleveland, OH 44135-2638 800/321-1264 www.pelsupply.com

2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 www.professionals.ottobockus.com

Guardian Suction Liner from PEL The new ALPS™ Guardian Suction Liner features a high performance knitted fabric cover created by integrating ALPS proprietary in-house knitting techniques with GripGel™ technology. The resulting material not only increases functional improvement and ensures durability, but also inhibits skin breakdown and surface discoloration.

Raised GripGel™ bands form a secure interface between the socket and the liner to prevent slippage or premature release.

Low modulus GripGel™ bands stretch against the socket wall while the inner wall conforms easily to the residual limb to ensure there is no restriction of blood flow or stiffening to inhibit donning.

Suitable for both transtibial and transfemoral amputees, the new liner is rated for K2, K3 and K4 activity levels.

Call PEL at 800/321-1264 or visit www.pelsupply.com.

The Triton Family of Feet from OttoBock The search is over! Now your high-mobility patients can choose from a variety of superb options to fit their active lifestyles. The Triton Low Profile (LP) and the Triton Heavy Duty (HD) are especially robust and waterproof, ready for the most challenging conditions. Or, choose the lightweight Triton carbon fiber foot; the Triton Vertical Shock (VS); or the Triton Harmony® with integrated vacuum technology for outstanding flexibility and support. Each foot features a split carbon toe, multi-axial terrain conformance, heel stiffness adjustment, and a weight limit up to 330 lbs.

Call 800/328-4058 or visit www.ottobockus.com.

Feet Ferrier Coupler Inc. North Branch, MI 800/437-8597 www.ferrier.coupler.com sales@coupler.com

PEL LLC 4666 Manufacturing Ave. Cleveland, OH 44135-2638 800/321-1264 www.pelsupply.com New Six-Bar Polycentric Knee from PEL PEL now offers Symphony, the latest knee from Nabtesco. Designed for patients who need both safety and dynamics, it orchestrates the various phases of the gait cycle to offer a harmonious solution with security, comfort and fluidity. The p-MRS system mechanically detects the different gait phases and adapts stability accordingly.

At heel strike, the system locks the knee geometrically and cushions with a stance flexion dampening feature. The knee’s selective lock function enables the patient to lock the knee manually whenever security is needed. At the preswing phase, the Symphony unlocks for an effortless switch to swing phase.

For more information contact PEL at 800/321-1264 or customerservice@pelsupply.com. Customers can order online at www.pelsuppy.com

JUNE 2014 O&P Almanac

2014 Buyers’ Guide

The Ferrier Coupler provides options and is self-aligning. It enables the patient a complete quick disconnect or interchange in seconds without losing alignment and no need to remove garments. It also allows for a temporary replacement limb.

Models available for most mounts.

The Terra-Round accessory foot mounts directly inside a standard 30 mm pylon. The center stem flexes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when fitting the prototype limb. It is water-resistant and has a traction base pad.

KNEES

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2014 Buyers’ Guide

Lower-limb prosthetics DAW Industries Inc. San Diego, CA 800/252-2828 info@daw-usa.com www.daw-usa.com ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the Ground Reaction Force (GRF), vector is located in Sagittal and Coronal Planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF Vector leading to valuable weight positioning and posturing information.

New Sure Stance Knee by DAW This Ultra-Light, True Variable Cadence, Multi-Axis Knee, is the World’s 1st 4-Bar Stance Control Knee. The Positive Lock of the Stance Control activates up to 35º flexion. The smoothness of the Variable Cadence together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K-3 patients.

Fillauer 800/251-6398 423/624-0946 www.fillauer.com

• • • •

46

K2 Foot • Specifically engineered for K2 patients • Unique flexible keel/multi-axis design • Flexible, impact reducing design • Roll-Over Shape (ROS) designed for a natural gait Compliant dynamics for comfort and stability Positive lock foot shell interface for stability Simple, maintenance-free design Foot comes assembled in foot shell for an easy, “out-of-thebox” fit.

O&P Almanac JUNE 2014

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 800/328-4058 www.professionals.ottobockus.com Microprocessor Knees Fit with confidence! The first fully microprocessorcontrolled knee, today’s third-generation C-Leg®, is the most clinically evaluated prosthetic knee in history and PDAC-verified, too. The intuitive Genium® knee opens up a whole new realm of mobility—it’s the closest technology has come to a natural, physiological gait. Together with the Compact (for lower mobility patients), Ottobock’s family of microprocessor knees brings its proven advantages to all your patients. Your business gets the advantage of Ottobock’s unmatched reimbursement support.

Call 800/328-4058 or visit www.ottobockus.com to learn more about the benefits of Ottobock’s advanced microprocessor knees.

Spinal Technology Inc. 191 Mid Tech Dr West Yarmouth, MA 02673 800/253-7868 info@spinaltech.com Lower-limb Technology is a division of Spinal Technology, Inc. We are a leading central fabricator of upper and Lower-limb orthotics and prosthetics. Our ABC Certified staff Orthotists/Prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality custom products and prosthetic devices, fast delivery time, as well as unparalleled customer support to our customers.

For information, call 800/253-7868, fax 888/775-0588, or email info@spinaltech.com. Visit our website at www.spinaltech.com.

Upper-Extremity Prosthetics Hosmer—A Fillauer Company 800/827-0070 customerservice@hosmer.com www.fillauer.com

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 www.professionals.ottobockus.com

Miscellaneous

Reimbursement Services Get the support you need for success for your patients and your business. Find our Audit Survival Kit, coding help, and documentation guides at www.professionals.ottobockus.com/ reimbursement. If you have questions about Ottobock products, call 800/328-4058 and ask for reimbursement staff.

Cooperative Care Fitting and Clinical Support At Ottobock OR in your own facility—work with patients you may not see frequently, such as hip disarticulation or upper limb amputees. Learn how Cooperative Care can help you build your business. Call or email to get detailed estimates for components, fabrication and clinical services 763/489-5165 or cooperative.care@ottobock.com.

Business Services

CAD/CAM Systems

Cailor Fleming

Amfit Inc.

4610 Market Street Youngstown, OH 44513 www.cailorfleming.com

3611 NE 68th Street Vancouver, WA 98661 800-356-FOOT(3668) sales@amfit.com www.amfit.com

Hooks • Lightweight aluminum body • Canted “fingers” allow visual feedback • Available in 1/2-20 in. or M12x1.5 mm thread • Variety of anodized colors available: Black, Blue, Gold, or Red.

Foot Orthotic Technology— That is out of this World Amfit is the world leader of equipment and software for manufacturing custom foot orthotics quickly, accurately, and at a low cost. Choose either of our 3D scanners—the Contact Digitizer™ or the Impress Scanner—and combine with the Amfit CAD/CAM Mill to fabricate superior custom foot orthotics in your own facility.

Our Correct & Confirm™ software is highly accurate and easy to use. Amfit combines cutting edge technology and over 25 years of global experience, making us the best choice for any foot care professional.

JUNE 2014 O&P Almanac

2014 Buyers’ Guide

Since 1918 Cailor Fleming has carried a wide range of insurance products to meet all your needs, including: • Life & Health • Professional Liability • Property & Liability • Surety Bonds • Workers Gomp • Business Auto • Home & Personal Auto • Disability Insurance We have been insuring the O&P marketplace for over 20 years, and have the exclusive endorsements from three of the four main governing bodies in the O&P industry. We are a leader with paramount service and distinct competence. Experience the benefits of a rich history and a solid future by calling Cailor Fleming today!

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2014 Buyers’ Guide

Central Fabrication Amfit Inc. 3611 NE 68th Street Vancouver, WA 98661 800-356-FOOT(3668) sales@amfit.com www.amfit.com Minimize the mess and optimize your time. Casting and fabricating custom foot orthotics by hand is time intensive and messy. Trusting outside labs to understand your script is a leap of faith. Regain control with Amfit equipment in your office. Whether you add a Contact Digitizer or Impress Scanner and use our lab services or invest in a full fabrication system, you are empowered with the full suite of Amfit Correct and Confirm design software. By minimizing the time you spend on each pair this investment can quickly pay dividends in more patients or attention to other parts of your practice. Talk with us about how Amfit foot orthotic technology and services can help your practice move forward.

Becker Oregon 2280 Three Lakes Rd. Albany, OR 97322 800/866-7522 www.beckerorthopedic.com Becker Oregon is a full-service central fabrication facility that offers: • Stance control orthoses • Traditional thermoplastic and metal and leather orthoses • Prefabricated orthoses • Rotational control laminated orthotics.

You can trust Becker Oregon for unsurpassed quality, fit and timely delivery. We know how to establish clear lines of communication with our customers to ensure we meet, or exceed your expectations every time. Providing your patients with a Becker custom orthosis means less time fitting and more productive time for you.

For more information please call Becker Oregon at 800/8667522 or view our catalog online at beckeroregoncatalog.com

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O&P Almanac JUNE 2014

Bracemasters International LLC 5075 S. Emmer Drive New Berlin, WI 53151 Office: 262/797-9771 Fax: 262/797-9795 www.bracemasters.com Bracemasters International is transforming the O&P Industry as a central fabricator of custom and pre-fabricated lower extremity bracing systems. Bracemasters is leading dramatic change in clinical practice methods, engineering innovative product designs, leveraging technology to streamline manufacturing, and supporting practitioners to achieve breakthroughs in patient outcomes.

The DRAFO® Classic Series (HP, MP, DST, GTO, DRP) and the DRAFO® Gauntlet Series (DRG, DRG Flex, DynaStride) continue to revolutionize lower extremity outcomes. In addition, our traditional products remain at the core of Bracemaster’s commitment to quality service and support for custom lower extremity needs of all ages.

Cascade Dafo, Inc. 800/848-7332 Ferndale, WA bizdev@dafo.com www.cascadedafo.com Cascade Dafo FlexiSport Strut Flexibility Options The DAFO FlexiSport is a customfabricated, two-part orthosis that combines full wrap-around foot control with a posterior upright that provides graded, leaf spring–like resistance to plantarflexion and dorsiflexion. This brace style is designed for larger, active patients who need moderate-to-strong ankle control and sturdy support.

In response to customer requests, the DAFO FlexiSport can now be ordered with a choice of posterior strut flexibility— moderately flexible or semi-rigid—to meet your patient’s unique needs. Like all Cascade Dafo orthoses, the DAFO Flexisport is backed by a Full (90-Day) Warranty.

For more information, visit www.cascadedafo.com or call 800/848-7332.

Fillauer 800/251-6398 423/624-0946 www.fillauer.com Fillauer C-Fab 100 years of prosthetic and orthotic fabrication experience: • BK/AK/HD sockets and limb systems • BE/AE/SD fabrication • Spinal Orthoses • RGOs • Stance Control Orthoses • Custom AFOs • Custom KAFOs • Leather Gauntlets • CROW Boots • Scans or casts accepted

Hersco Ortho Labs 39-28 Crescent Street Long Island City, NY 11101 800/301-8275 www.hersco.com Hersco Ortho Labs is a custom orthotic and prosthetic central fabrication facility with over 75 years of experience. Hersco is committed to being first in customer satisfaction and orthopedic excellence. Our products include custom foot orthotics, AFOs, Richie Braces, ankle gauntlets and CROWs as well as lowerextremity prostheses. We have a passion for customer service and we will be happy to work with traditional plaster casts or digital files.

For further information, visit www.hersco.com or call 800/301-8275.

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 www.professionals.ottobockus.com

Soletech Inc. 425 Washington St., Suite 4 Claremont, NH 03743 877/625-9494 www.soletech.com Established in 1946, Soletech has a full line of fabrication materials for the O&P industry including the largest selection of EVA sheets, multi-durometer laminated sheets and blockers, Poron, Plastazote, Neoprene sheets, diabetic insoles, rubber and crepe outsoles and many other foam materials. Soletech introduced its registered brand of Cloud EVA to the O&P industry in the early 1980’s and is recognized as the industry leader for fabrication materials for custom foot orthotics and AFO’s as well as for build-ups and shoe modifications.

Specialty O&P Distributors Texas Assistive Devices LLC Brazoria, TX 800/532-6840 www.n-abler.org hps@n-abler.org TEXAS ASSISTIVE DEVICES (TAD) products are designed for UPPER EXTREMITY AMPUTEES and persons with HAND DYSFUNCTION or PARTIAL HAND AMPUTATION. The TAD system is meant to Texas Assistive Devices Components temporarily replace the hook or prosthetic hand on either body-powered or electronic UE prostheses to allow the user to efficiently and safely perform a wide range of activities. The system can also work with a W-H-O brace to which a quick disconnect coupler is attached in the palm area of the brace. TAD’s quick insert-release terminal device can hold a wide selection of interchangeable tools and implements including dining or cooking utensils, personal grooming devices, and tools for gardening, carpentry, mechanic work, sports, hobbies, etc.

TAD’s recommended L Code guide is available on request.

Also, TAD offers a Demo Kit Loaner program to allow the practitioners and end-users to evaluate the actual products in a clinical setting. Contact TAD for more info including catalogs and pricing. Call 800/532-6840 or email janet@n-abler.org .

JUNE 2014 O&P Almanac

2014 Buyers’ Guide

Whether your fabrication job is simple or complex, you want specialty facilities with the broadest range of services available, staffed by knowledgeable, caring people. That’s why Ottobock Fabrication Services is a perfect partner for your business: we offer decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Try our prepreg services for the most consistent fabrication outcomes. Our expert services include water transfer, lamination, and prepreg carbon fiber. You can count on timely turnaround delivering the results you want.

Visit www.professionals.ottobockus.com or call 800/795-8846.

Fabrication Materials

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2014 Buyers’ Guide

Reference Materials 2014 AOPA Coding Products Coding Suite New L codes? No problem! Order the 2014 AOPA Coding Suite today! Get your facility up to speed, fast, on all the O&P HCPCS code changes with an array of 2013 AOPA coding products. Get illustrations of each HCPCS code and the AOPA interpretations with the 2014 CodingPro software and 2014 Illustrated Guide. The CodingPro also contains Medicare fee schedules and medical policy information. Ensure each of your staff has a 2014 Quick Coder, a durable, easy-to-store desk reference of all the O&P HCPCS codes and descriptors. Now being offered at a lower price! (Coding Suite includes CodingPro single user, Illustrated Guide and Quick Coder): $350 AOPA members, $895 non-members.

AOPA Operating Performance Report Are you curious about how your business compares to others?

This updated survey will help you see the big picture. The Operating Performance Report provides a comprehensive financial profile of the O&P industry including balance sheet, income statement and payer information organized by total revenue size, community size and profitability. The data was submitted by more than 98 patient care companies representing 1,011 full time facilities and 62 parttime facilities. The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2012 operations.

Electronic Version • AOPA Member: $85.00 • Non-Members: $185.00 Note: The 2014 version will be available in September 2014 and will be automatically substituted for 2013 version. A new Benefits & Compensation Report also will be available.

2014 AOPA Coding Suite

• CodingPro CD-ROM (single-user version): $185 AOPA members, $425 non-members.

• CodingPro CD-ROM (network version): $435 AOPA members, $695 non-members.

• Illustrated Guide: $185 AOPA members, $425 non-members.

• Quick Coder: $30 AOPA members, $80 non-members.

Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

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O&P Almanac JUNE 2014

The O&P Almanac’s Buyers’ Guide is paid advertising.

Entries were submitted and paid for by product manufacturers and distributors.

AOPA and the O&P Almanac do not endorse, support, or recommend the use of any specific products included in the Buyers’ Guide. In addition, AOPA and the O&P Almanac neither sanction nor approve manufacturers’ claims about the function or reliability of their products.

These listings can also be found on AOPA’s website: www.AOPAnet.org. When you contact manufacturers about these products, be sure to tell them you saw them in the O&P Almanac Buyers’ Guide. a

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Comprehensive

INDEX Ability Dynamics LLC Tempe, AZ 480/361-1714 www.abilitydynamics.com rsainz@abilitydynamics.com

+Allard USA Inc. Rockaway, NJ 888/678-6548 www.allardusa.com info@allardusa.com

ACOR Orthopaedic Inc. ALPS Saint Petersburg, FL Cleveland, OH 800/574-5426 216/662-4500 www.easyliner.com www.acor.com cathie@easyliner.com requestinfo@acor.com

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Companies with

+ are Supplier Plus Partners.

Anatomical Concepts Inc. Poland, OH 800/837-3888 www.anatomicalconceptsinc.com info@anatomicalconceptsinc.com

Aspen Medical Products Irvine, CA 800/295-2776 www.aspenmp.com hdinkins@aspenmp.com

AOPM CORP Shelburne, VT 877/490-2676 www.aopmcenter.com info@aopmcenter.com

Atlantic Rim Brace Mfg. Corp.

Nashua, NH 800/233-0356 www.spinalbraces.com sales@spinalbraces.com

Advanced O&P Solutions LLC Hickory Hills, IL 708/237-4088 www.aopsolutions.com mangelico@aopsolutions.com

Alternative Prosthetic Services Inc. Bridgeport, CT 203/367-1212 www.alternativeprosthetics.com info@alternativeprosthetics.com

Aetrex Worldwide Inc. Teaneck, NJ 201/833-2700 www.aetrex.com info@aetrex.com

American Central Fabrication Shreveport, LA 318/636-3751 americancenfab@aol.com

Aqualeg Inc. Rock Hill, SC 803/324-8900 www.aqualeg.com aqualeg.usa@aqualeg.com

Algeos USA Santa Monica, CA 800/496-0987 www.algeos.com sales@algeos.com

American Prosthetic Components LLC Green Bay, WI 800/772-7508 www.apcomponents.com comments@apcomponents.com

Arizona AFO Inc. Mesa, AZ 480/222-1580 www.arizonaafo.com don.pierson@arizonaafo.com

AliMed Inc. Dedham, MA 800/225-2610 www.alimed.com wdegiacomo@alimed.com

+

ARTech Laboratory Inc. Midlothian, TX 972/775-2000 www.artechlab-prosthetics.com Mholt36107@aol.com

O&P Almanac JUNE 2014

AMFIT INC. Vancouver, WA 360/573-9100 www.amfit.com sales@amfit.com

Apis Footwear Co. El Monte, CA 626/448-8905 www.bignwideshoes.com apisfootwear@earthlink.net

Becker Oregon Inc. Albany, OR 541/967-1821 www.beckeroregeoncatalog.com cborn@beckerorthopedic.net Becker Orthopedic Appliance Co. Troy, MI 248/588-7480 www.beckerorthopedic.com mail@beckerorthopedic.net BioSculptor Corp.

Hialeah, FL 305/556-5815 www.biosculptor.com bio_info@biosculptor.com Bledsoe Brace Systems Grand Prairie, TX 972/647-0884 www.hopeortho.com aweiner@bledsoebrace.com

Bort-Swiss Orthopedic Supply Anderson, SC 864/760-0364 www.bort-swissortho.com beth.swiss@bort-swissortho.com Boston Brace International Inc./dba NOPCO Avon, MA 508/588-6060 www.bostonbrace.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Weymouth, MA 781/849-0247 www.nopcoclinics.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Boston, MA 617/975-3854 www.nopcoclinics.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Boston, MA 617/355-6887 www.nopcoclinics.com info@bostonbrace.com

Boston Brace International Inc./dba NOPCO Waltham, MA 781/216-1390 www.nopcoclinics.com info@bostonbrace.com

Boston Brace International Inc./dba NOPCO East Brunswick, NJ 732/651-1223 www.nopcoclinics.com dfornuff@yahoo.com Boston Brace International Inc./dba NOPCO Mountainside, NJ 908/233-3720 www.nopcoclinics.com dfornuff@yahoo.com Boston Brace International Inc./dba NOPCO Voorhees, NJ 856/258-6712 www.nopcoclinics.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Neptune, NJ 732/481-4500 www.nopcoclinics.com jshimkus@bostonbrace.com Boston Brace International Inc./dba NOPCO Philadelphia, PA 215/590-7702 www.nopcoclinics.com jwalker@bostonbrace.com Brightree LLC Lawrenceville, GA 888/598-7797 www.brightree.com M_blount@brightree.com

Bulldog Tools Inc. Lewisburg, OH 877/962-0205 www.bulldogtools.com rmeyer@bulldogtools.com

CyberKinetics LLC Silverdale, WA 360/692-2500 cyberkinetics.us.com dsaucier@cyberkinetics.us.com

Cailor Fleming Insurance Youngstown, OH 330/782-8068 www.cailorfleming.com dfoley@cailorfleming.com

Cybertech Medical La Verne, CA 909/447-7050 www.cybertechmedical.com cs@cybertechmedical.com

+Cascade Dafo Inc.

DavMar Waterloo, IA 800/214-6742 amanda.hewitt@vgm.com

Ferndale, WA 800/848-7332 www.cascadedafo.com dafo@dafo.com

Cascade Orthopedic Supply Inc. Chico, CA 530/879-1500 www.cascade-usa.com info@cascade-usa.com Centri— A Fillauer Co. Sollentuna, Sweden 46-8-505-332-00 www.centri.se Bengt@centri.se College Park Industries Inc. Warren, MI 800/728-7950 www.college-park.com info@college-park.com Comfort Products Inc. Croydon, PA 800/822-7500 www.comfortoandp.com info@comfortoandp.com Coyote Design & Mfg Inc. Boise, ID 800/819-5980 www.coyotedesign.com mailbox@coyotedesign.com

DAW Industries Inc. San Diego, CA 800/252-2828 www.daw-usa.com info@daw-usa.com

+Delcam

Salt Lake City, UT 877/335-2261 www.delcam-healthcare.com marketing@delcam.com

DJO Vista, CA 800/321-9549 www.djoglobal.com dale.hammer@djoglobal.com Dr. Comfort Mequon, WI 262/236-8469 www.DrComfort.com eric@drcomfort.com EMR Stat Waterloo, IA 800/214-6742 amanda.hewitt@vgm.com

2014 Buyers’ Guide

Boston Brace International Inc./dba NOPCO Burlington, MA 781/270-3650 www.nopcoclinics.com info@bostonbrace.com

Boston Brace International Inc./dba NOPCO Lawrence, MA 978/688-7900 www.nopcoclinics.com emerson@bostonbrace.com

+Endolite

Miamisburg, OH 800/548-3534 www.endolite.com info@endolite.com

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2014 Buyers’ Guide

Euro International Inc. Tampa, FL 813/246-5995 www.eurointl.com sales@eurointl.com Fabtech Systems LLC Everett, WA 425/349-9557 www.fabtechsystems.com greg@fabtechsystems.com Ferrier Coupler Inc. North Branch, MI 810/688-4292 ferrier.coupler.com sales@coupler.com

+Fillauer Companies Chattanooga, TN 423/624-0946 www.fillauercompanies.com customerservice@fillauer.com

Fillauer LLC—A Fillauer Co. Chattanooga, TN 423/624-0946 www.fillauer.com customerservice@fillauer.com Florida Brace Corp.

Winter Park, FL 407/644-2650 www.flabrace.com customerservice@flabrace.com FLO-TECH® Orthotic & Prosthetic Systems Inc. Trumansburg, NY 800/356-8324 www.1800flo-tech.com info@1800flo-tech.com Forbin Waterloo, IA 866/999-9469 www.forbin.com jeremyk@forbin.com

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O&P Almanac JUNE 2014

Freedom Innovations LLC Irvine, CA 888/818-6777 www.freedom-innovations.com info@freedom-innovations.com Friddle’s Orthopedic Appliances Inc. Honea Path, SC 864/369-2328 www.friddles.com info@friddles.com Futura International Inc. Ashburn, VA 727/791-3332 www.futuraintl.com accounting@futuraintl.com Grace Prosthetic Fabrication Inc. New Port Richey, FL 800/940-5347 www.gpfinc.com grace@gpfinc.com Hope Orthopedic Grand Prairie, TX 972/647-0884 www.hopeortho.com sales@bledsoebrace.com Hosmer Dorrance Corp.—A Fillauer Co. Campbell, CA 408/379-5151 www.hosmer.com customerservice@hosmer.com iWalk Inc. Bedford, MA 781/761-1560 www.biom.com contact@biom.com JMS Plastics Supply Neptune, NJ 732/918-8115 www.jmsplastics.com steves@jmsplastics.com

Kinetic Research Inc. Tampa, FL 800/919-3668 www.KineticResearch.com email@kineticr.com

Med Spec (ASO EVO) Charlotte, NC 704/573-4040 www.medspec.com request@medspec.com

Kingsley Mfg. Co. Costa Mesa, CA 949/645-4401 www.kingsleymfg.com info@kingsleymfg.com

Medex International Inc. Burtonsville, MD 301/657-2681 medexinternational.com info@medexinternational.com

KISS Technologies LLC Baltimore, MD 410/663-5477 www.kiss-suspension.com ann@kiss-suspension.com Knit-Rite Inc. Kansas City, KS 913/281-4600 www.knitrite.com sjensen@knitrite.com Lawson Medical LLC Virginia Beach, VA 866/631-6311 www.lawsonmedicalllc.com lawsonmedical@aol.com Levy & Rappel Saddle Brook, NJ 973/478-6511 www.LevyandRappel.com info@levyandrappel.com Liberating Technologies Inc. Holliston, MA 508/893-6363 www.liberatingtechnologies.com info@liberatingtech.com Maramed Orthopedic Systems Hialeah, FL 305/823-8300 www.maramed.com custsupport@maramed.com MD Orthopaedics Inc. Wayland, IA 877/766-7384 www.mdorthopaedics.com mdortho@farmtel.net

Medi USA Whitsett, NC 336/449-4440 www.mediusa.com events@mediusa.com MJ Markell Shoe Co. Inc. Yonkers, NY 914/963-2258 www.markellshoe.com markellshoe@optonline.net Motion Control Inc.—A Fillauer Co. Salt Lake City, UT 801/326-3434 www.UtahArm.com info@UtahArm.com Motion Medical Inc. Pelham, AL 205/982-1511 www.motionmedical.com sales@motionmedical.com Mueller Sports Medicine Inc. Prairie du Sac, WI 608/643-8530 www.muellerrx.com brett.mueller@muellersports med.com Nabtesco Proteor— USA Muskego, WI 504/319-1954 www.proteor.com lroberts@nabtescoproteor-usa.com

Naked Prosthetics Tumwater, WA 360/269-7115 www.nakedprosthetics.com dulcey@nakedprosthetics.com New Options Sports Dallas, TX 800/872-5488 www.newoptionssports.com iheather@newoptionssports.com nora systems, Inc. Salem, NH 496/201-8077 www.nora-shoe.com info-shoe@nora.com Northwood Inc. Center Line, MI 586/755-3830 www.northwoodinc.com debbiec@northwoodinc.com O&P 1 Central Fabrication Waterloo, IA 800/408-3598 www.oandp1.com sclark@oandp1.com O&P Business News/ SLACK Inc. Thorofare, NJ 856/848-1000 www.oandpbiznews.com oandp@slackinc.com O&P EDGE/Western Media LLC Northglenn, CO 303/255-0843 www.oandp.com/edge tonja@opedge.com

OPTEC USA, INC Lawrenceville, GA 888/982-8181 www.optecusa.com optecusa@aol.com

Parker Hannifin Corporation Cleveland, OH 216/896-2044 www.parker.com adorotheou@parker.com

Orthocare Innovations LLC Mountlake Terrace, WA 800/672-1710 www.orthocareinnovations.com cferrendelli@orthocareinnovations. com

PEL LLC Cleveland, OH 800/321-1264 www.pelsupply.com management@pelsupply.com

Orthofeet Northvale, NJ 201/767-6224 www.orthofeet.com andrea@orthofeet.com Orthomerica Products Inc. Orlando, FL 800/446-6770 www.orthomerica.com vthomas@orthomerica.com Orthotic & Prosthetic Group of America (OPGA) Waterloo, IA 800/214-6742 www.opga.com info@opga.com Össur Americas Inc. Foothill Ranch, CA 949/382-3883 www.ossur.com ogylfason@ossur.com OTS Corp.—A Fillauer Co. Weaverville, NC 828/658-8330 www.ots-corp.com info@ots-corp.com Ottobock Plymouth, MN 800/328-4058 www.ottobockus.com usa.customerservice@otto bockus.com

PFS Med Inc Springfield, OR 541/349-9646 www.pfsmed.com rirish@pfsmed.com POINT Health Centers of America Waterloo, IA 866/283-2872 www.pointhca.com info@pointhca.com Pro-Tech Orthopedics Raynham, MA 866/819-1157 www.protech-intl.com mandersson@protech-intl.com PROTEOR Dijon Cedex, France 011 33 380784285 www.proteor.com ht.orthopedie@proteor.com ProtoKinetics LLC Havertown, PA 610/449-4879 www.protokinetics.com info@protokinetics.com PSL Fabrication Fulton, MO 573/642-5554 www.pslab.com pslab1@sbcglobal.net

+Renia GmbH Cologne, Germany 011+49-221-630799-0 www.renia.com info@renia.com

+Restorative Care of America Inc. Saint Petersburg, FL 800/627-1595 www.rcai.com purch@rcai.com

Roden Leather Co. Inc. Royal Oak, MI 800/521-4833 www.rodenleathercompany.com rodenleather@gmail.com Royal Knit Inc. Lees Summit, MO 800/664-5648 www.royalknit.com royalknitinc@yahoo.com RX Textiles Inc. Monroe, NC 704/283-9787 www.rxtextiles.com joe.davant@rxtextiles.com Silipos Inc. Niagara Falls, NY 800/229-7105 www.silipos.com brij@silipos.com Simona America Inc. Hazleton, NJ 570/579-1300 www.simona-america.com jeff.hester@simona-america.com Soletech Inc. Claremont, NH 877/625-9494 www.soletech.com tom@soletech.com

2014 Buyers’ Guide

oandp.com Gainesville, FL 352/331-3741 www.oandp.com info@oandp.com

Orfit Industries America Jericho, NY 516/935-8500 www.orfit.com sales-us@orfit.com

Renewal Technologies Scottsdale, AZ 480/588-7887 mike.sperduti@emergesales.com

JUNE 2014 O&P Almanac

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2014 Buyers’ Guide

+Spinal Technology Inc. West Yarmouth, MA 800/253-7868 www.spinaltech.com info@spinaltech.com

SPS Port Orange, FL 800/653-0826 www.spsco.com dpresnell@spsco.com SPS Alpharetta, GA 800/767-7776 www.spsco.com kwilson@spsco.com SPS National Labs Alpharetta, GA 800/767-7776 spsnatllabs.com belliott@spsco.com Spyder Technologies Waterloo, IA 319/234-7942 sclark@oandp1.com ST&G USA Corp.

Placentia, CA 714/524-0663 www.stngco.com info@stngco.com SteeperUSA San Antonio, TX 210/481-4126 www.steeperusa.com john.gonzales@steeperusa.com SureFit Coral Springs, FL 800/298-6050 www.surefitlab.com jmeador@surefitlab.com SureStep South Bend, IN 877/462-0711 www.surestep.net bernie@surestep.net

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O&P Almanac JUNE 2014

Syncor Ltd. Abrams, WI 920/373-4300 syncorltd@gmail.com Tamarack Habilitation Technologies Inc. Blaine, MN 763/795-0057 www.tamarackhti.com info@tamarackhti.com TechMed 3D Inc. Levis, QC 418/836-8100 www.techmed3d.com mike@techmed3d.com

TRS Inc. (Therapeutic Recreation Systems Inc.) Boulder, CO 303/444-4720 www.oandp.com/trs bob@trsprosthetics.com Trufit Biomechanics Labs Orlando, FL 321/202-2800 www.trufitusa.com info@trufitusa.com

Trulife Poulsbo, WA 360/697-5656 The Bremer Group Co. www.trulife.com info@trulife.com Jacksonville, FL 904/645-0004 www.bremergroup.com VGM Education bremergroup@bremer.net Waterloo, IA 800/214-6742 ThyssenKrupp AIN www.vgmeducation.com amanda.hewitt@vgm.com Plastics Madison Heights, MI 877/246-7700 VGM Financial www.ainplastics.com Waterloo, IA lisa.anderson@thyssenkrupp.com 319/274-6661 www.vgmfs.com chamann@vgmfs.com Top Shelf Orthopedics Tracy, CA VGM Insurance 209/834-1158 Waterloo, IA 866/497-0836 www.pacmedical.com csindel@pacmedical.com www.vgminsurance.com service@oanpinsurance.com Touch Bionics Mansfield, MA Viscent LLC 855/694-5462 Plano, TX 214/501-0360 www.touchbionics.com info@touchbionics.com www.viscent.com bnorquist@viscent.com Townsend Design Bakersfield, CA Vorum 661/837-1795 Vancouver, BC 800/461-4353 www.townsenddesign.com townsend@townsenddesign.com www.vorum.com info@vorum.com

+

WBC Industries Inc. Westfield, NJ 908/789-1234 www.wbcindustries.com scott@wbcindustries.com WillowWood Mount Sterling, OH 740/869-3377 www.owwco.com info@owwco.com Yale Surgical Co./Yale Comfort Shoe Center Stratford, CT 203/372-7112 EJKaufman@yalesurgical.com Yale Surgical-Yale Comfort Shoe New Haven, CT 203/777-2396 www.yalesurgical.com kauf740@aol.com a

California Catalina ®

™

CUSTOM FIT

Orthomerica introduces the new modular California Catalina Custom Fit Spinal Orthosis—the latest addition to the California Soft Spinal System family of spinal orthoses.

Key Benefits • Mechanical advantage 2-pull string closure system with ergonomically designed pull tabs • Modular components make it simple to reduce from LSO to LO • Easy circumferential adjustment for waists up to 50” (Standard) or 66” (Extended) • Custom individualized design allows personalized fit by the Orthotist • Heat moldable removable posterior panel PDAC APPROVED—HCPCS Codes L0637/L0650, L0631/L0648, L0627/L0642

Adjustable, fits 28"–66" waists without cutting

No-cut adjustable length pull-tabs

CA Custom Fit 637

800-446-6770 | orthomerica.com

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Ask the Expert

By Joe McTernan, AOPA government affairs department

Is Prior Authorization Right for O&P? Exploring the potential benefits and challenges for reimbursement

Q.

Some folks in O&P have talked about prior authorization as if it might solve the Recovery Audit Contractor (RAC) and pre-payment audits. What are views on the potential benefits of prior authorization and what misconceptions are characterizing this position?

A. As the number of Medicare audits continues to rise and O&P companies face increased challenges to reimbursement for their services, one potential solution that is being discussed more frequently is the concept of prior authorization. While there has never been a Medicare prior authorization process for O&P services, several other benefit categories—for example, power wheelchairs—have been subject to demonstration projects to determine its feasibility in payment of Medicare claims.

On May 22, 2014, CMS issued a press release announcing a Notice of Proposed Rulemaking entitled, Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items. In the proposed rule, CMS included a “master list” of DMEPOS items that it believes are subject to prior authorization. This list contains 89 lower-limb prostheses codes. While the issue of Medicare prior authorization has been a frequent topic of discussion among O&P providers, the issuance of the proposed rule changes the playing field from a debate to reality.

This month’s Ask the Expert column will explore the various challenges that Medicare prior authorization presents as well as AOPA’s concerns about how they may impact O&P businesses and patients.

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O&P Almanac JUNE 2014

The potential benefits are fairly obvious. Prior authorization will provide you, the provider, with confirmation that the service you are proposing is covered based on the information submitted as part of the prior authorization request. This could provide relative peace of mind to providers who must purchase O&P components from manufacturers in order to fabricate the complete device. But Medicare prior authorization is different; most importantly, it does not constitute a guarantee of payment. Since claims may not be submitted to Medicare prior to final delivery of the completed device, a prior authorization decision might allow the provider to make a more informed decision regarding the purchase of the necessary components. Another potential benefit involves prior authorization requests that are denied. While certainly never a good thing, a denied prior authorization request would allow the provider to offer the patient an informed choice whether or not to receive the device and accept financial responsibility for payment by signing an Advanced Beneficiary Notice (ABN). Medicare only allows providers to request an ABN from a patient when there is reason to believe that the claim will be denied as not medically necessary. A denied prior authorization request would qualify as a valid reason for requesting the completion of an ABN by the patient.

Q. A.

Is Medicare prior authorization a bad idea?

Prior authorization is extremely limited in scope.

While it is a confirmation that coverage exists based on the information submitted, it is never a guarantee that a particular claim will be paid. (All of the same documentation requirements that exist in today’s Medicare environment would remain exactly the same under prior authorization.

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Every claim, even if a positive prior authorization decision is issued, would be subject to individual medical review, not to mention post payment scrutiny by Comprehensive Error Rate Testing (CERT) and RAC auditors).

AOPA’s testimony during a hearing held by the House Ways and Means Committee Subcommittee on Health

A flawed prior authorization program could result in a significant delay in claim payment and cash flow issues.

on May 20, 2014, identifies some key problems (see sidebar). This has been shown recently through the prior authorization demonstration project for power mobility devices, where significant delays in the processing of prior authorization requests have resulted in unacceptable delays in providing Medicare beneficiaries with needed services. Similar delays in the provision of prosthetic services may literally mean the difference between life and death for certain patients.

While the proposed rule states that Medicare will make a “reasonable effort” to complete prior authorization reviews within 10 days and will have a process for expedited review of critical cases, the Medicare system could easily be overwhelmed by the number of requests, resulting in significant delays in processing times. This could lead to significant cash flow problems for O&P providers, especially small businesses and, more importantly, could delay the delivery of needed prosthetic services to Medicare beneficiaries.

Ask the Expert

Prior Authorization: Not an Answer for Audit Challenges The topic of prior authorization in terms of Medicare is a complex one. The big hitch is that Medicare prior authorization is not a promise of payment, and therefore, AOPA and the vast majority of its patient-care facility members oppose it as any kind of “solution” to audits. CMS would be severely challenged to implement prior authorization.

CMS has unfortunately seen cookie-cutter solutions for Recovery Audit Contractor (RAC) audits. Therefore, two years ago, CMS leadership said, “If a demonstration project in prior authorization was acceptable for power wheelchairs (PME) in DME, let’s solve the O&P audit issues the same way.” A major problem is that, in reality, the PME demo project resulted in longer delays for patients. CMS insists the numbers are shorter, but reliable reports estimate that it takes between 70-100 days from the date the physician orders a power wheelchair until the prior authorization goes through and the power wheelchair reaches the beneficiary. That kind of delay simply doesn’t work for the care of amputees, who, even in the delays of the RAC environment, get their replacement limbs much faster. Prior authorization may have worked for a few limited cases in the private sector if, and only if, it is an absolute guarantee of payment (otherwise, it creates its own cash flow problems). That is not true in Medicare.

Q.

Several private payers that I am contracted with use prior authorization and it is very effective.

Wouldn’t Medicare have an effective process as well?

A.

That is a question that is difficult to answer. While many private payers have made great strides in streamlining their prior authorization process, Medicare is the single largest payer in the United States. With scale come challenges and what may work for regional or small national players may not necessarily work for Medicare. In addition, the need for Medicare to utilize contractors for most claim processing functions may present an entirely new series of challenges, especially if the contractor who handles the prior authorization request is not the same contractor who ultimately processes the claim. The potential

for miscommunication between contractors may lead to unnecessary claim denials, even if a claim was successfully pre-authorized.

Q.

Does prior authorization reduce the chance of a post-payment audit?

A.

Since prior authorization does not guarantee payment of the initial claim, you cannot assume that it lessens the likelihood of a post-payment audit of the claim. With multiple contractors (RAC, CERT, Zone Program Integrity Contractors, Durable Medical Equipment Medicare Administrative Contractors, etc.) performing regular post-payment audits for various reasons, the fact that a claim received a positive prior authorization decision has little bearing on whether or not that claim will be selected for post-payment review.

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Ask the Expert

Q.

What is AOPA doing to address the challenges of prior authorization?

A.

As part of the rulemaking process, a rule must first be released as a proposed rule, which must be accompanied by a minimum 60-day comment period where any member of the public can offer his or her opinion on the rule itself or how it can be made better. At this point, AOPA plans to aggressively oppose the prior authorization plan for O&P as set out in the CMS announcement with extensive comments and participation in the rulemaking process. The AOPA Board of Directors has created a taskforce of selected members who will carefully review the details of the proposed rule and provide written comments on behalf of AOPA. The taskforce will focus on the potential negative impact of the CMS proposal for prior authorization on the Medicare patient population as well as the negative impact of the proposed rule on small O&P businesses.

AOPA intends to work with members of Congress to make sure that if prior authorization is ultimately implemented certain legislative protections will be in place to ensure that O&P providers are treated fairly and that CMS does not overstep its bounds.

AOPA also will continue to demonstrate inherent flaws in the 2011 report on Medicare payments for lower-limb prostheses issued by the Office of Inspector General, which served as the basis for including lower-limb prostheses in the “master list” published in the proposed rule. a

A Look Ahead from AOPA Leadership on CMS’s Prior Authorization Proposal If, in June 2011, before the Health and Human Services Office of Inspector General issued a severely flawed report on lower-limb prosthetics a government official had asked, “How about we set up prior authorization for artificial limbs?” that individual would have been booed off the stage—by patients and providers alike. The fact that CMS has taken horrible, draconian steps in the interim doesn’t make a bad idea a good one.

I. AOPA believes that health professionals engaged in direct patient-care encounters—physicians, therapists, and O&P professionals—need to be considered as one category and there needs to be an exception from prior authorization for them. All three of these players share portions of the market for Medicare billings-—if O&P were subject to Medicare prior authorization but physicians and/or therapists were not, it would manipulate the Medicare market.

II. Key factors about prior authorization: These points address the reasons why O&P has consistently rejected the concept of prior authorization, and they would need to be addressed if AOPA were to consider not opposing: a. Prosthetists’ and orthotists’ notes must be recognized as a legitimate part of the medical record for both therapeutic and reimbursement purposes. b. O&P must be legislatively separated from Durable Medical Equipment. The former includes licensed/certified health professionals; the latter are “suppliers.” c. Delays as seen with power mobility equipment prior authorization must be avoided.

CMS would have five days to approve a prior authorization or to deny with an explanation, unique and specific to this patient why it is not approved. If no answer is granted within five days, it would be deemed approved and patient care would proceed. d. Prior authorization needs to constitute a guarantee of Medicare payment. e. There must be a threshold for prior authorization--more than 160 percent of the average total per patient prosthetic claim by Medicare data for last available year, inflation adjusted to become current year. f. Recovery Audit Contractors (RACs) and prepayment audits should be eliminated across all claims. g. RAC audits and bounty contractor programs should end immediately. There should be no linkage to CMS implementation date of prior authorization for any category of providers. h. There must be a remedy for appeals and a plan to hasten Administrative Law Judge (ALJ) hearings or funds should be returned until the ALJ hearing occurs. i. Other issues from the RAC legislation also must be addressed, for example, CMS should be required to make its records more granular and separate O&P appeals from DME appeals.

There is nothing about prior authorization that is better for patients than the current situation. Patients have been receiving devices, and if CMS refuses to pay the prosthetist, the patient still has that device. Under prior authorization, patients will not receive devices unless and until CMS approves. That may involve patients more directly in the fight, but it will make it harder for patients. Contrary to some popular misconception, it might not be a case where it is a choice between horrid RAC audits or prior authorization. O&P could have all the RAC problems and a series of entirely new prior authorization problems.

Following the Patient Protection and Affordable Care Act, CMS cares first and foremost about reducing the amount of money Medicare spends.

We will continue to keep AOPA members informed on this critically important regulatory topic.

Very truly yours,

Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@aopanet.org.

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O&P Almanac JUNE 2014

Anita Liberman-Lampear AOPA President

Thomas F. Fise AOPA Executive Director

ALPSTM new Guardian Suction Liner features raised Grip GelTM bands that grip against the socket wall to form a secure interface. The low modulus bands stretch against the socket wall, while the inner wall conforms easily to the residual limb. This ensures there is no restriction of blood flow or stiffening to inhibit donning.

Grip GelTM bands are strategically placed for both transtibial and transfemoral applications.

R

2895 42nd Ave. North St. Petersburg, FL. 33714 Tel: 1-727-528-8566 Fax: 1-727-528-8862 www.easyliner.com info@easyliner.com

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Member Spotlight

By Deborah Conn

New Beginnings

Photo: Össur

Össur Academy provides clinical education and research space, resources

More than two dozen O&P professionals attended the Össur Academy opening.

COMPANY: Össur Location: Headquartered in Iceland, 18 countries worldwide Owner: Publicly traded History: More than 40 years in business

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O&P Almanac JUNE 2014

Ö

ssur was founded in Reykjavik, Iceland, in the 1970s, when prosthetist and below-knee amputee Össur Kristinsson developed a silicone socket liner called the Iceross. Össur went public in 1999 and has since become an international business specializing in orthotics, lower-limb prosthetics, and compression therapy, with operational centers in Europe, Asia, and the United States. The company has subsidiaries in 18 countries worldwide and more than 2,200 employees. Össur Americas is headquartered in Orange County, California, with manufacturing facilities in Albion, Michigan, and Tijuana, Mexico.

Össur’s most well-known products include the high-performance Flex-Foot and Flex-Foot Cheetah blade used by amputee athletes, the Unloader One knee orthosis for patients with osteoarthritis and other knee pain, and the Rheo Knee 3, a prosthetic joint that uses artificial intelligence to adapt to the user. Another advanced device is the Symbionic Leg, which combines a microprocessor knee with a powered bionic ankle in an integrated unit that adjusts to changes in speed, stride, or surface. An extensive range of Iceross liners continues to be an important product line for the company, as are custom-made and off-the-shelf

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orthoses for patients recovering from injuries or living with osteoarthritis. Össur makes a point of developing strong relationships with both O&P practitioners and patients. Two of its programs, Team Össur and Össur Ambassadors, bring in elite amputee athletes, sports figures, and community role models to help raise awareness of what is possible for people with limb loss. Team Össur athletes are elite athletic competitors and receive cutting-edge prosthetic products at no charge, testing them for the company and providing valuable feedback. Össur Ambassadors are typically amputees who are active and engaged and are willing to share their stories on behalf of Össur. They often represent the company at trade shows, amputee clinics, and other community events, where they try to embody Össur’s motto of “Life Without Limitations” to inspire other amputees.

Össur Academy One of the most recent developments for the company is the new Össur Academy in Orlando, Florida. The grand opening of the 6,000-square-foot structure, held March 6-7, 2014, featured speakers discussing new technological developments in the field, clinical education, and improvements in

patient outcomes. Attendees had the opportunity to take specialized training courses in such areas as reimbursement, bracing technology, functional assessments, and the treatment of osteoarthritis.

According to Tom Daniels, director of Össur Academy prosthetics, the primary purpose of the facility is the clinical education of O&P practitioners, but it will be used for research and product and clinical testing as well.

The building was originally owned

by Evolution Industries, which Össur acquired in 2011, and it still houses Evolution Industries’ central fabrication facility. Today, Össur Academy can accommodate as many as 150 people at a time for lectures or 15 to 20 for hands-on training. It offers a large multi-functional seminar room with 3-D sports simulators, Wii stations, a treadmill, ramps, and stairs. The building also features motion-tracking software, the Solo Step ceilingmounted walking system to help prevent falls during rehabilitation, and a 110-foot running track.

Courses for the rest of this year include one- and two-day programs on Össur’s knee systems and prosthetic feet, Iceross liners, locking mechanisms, and adapters.

“Most courses starting now are focused on transtibial solutions,” says

O&P professionals attend a clinical lecture at Össur Academy Orlando.

Daniels. “But we will offer training on transfemoral solutions later this year, and we continue to provide a monthly, two-day course developed

by Evolution Industries on elevated vacuum systems.”

Developing course content is a high priority for the academy, and Daniels says they are willing to customize workshops to meet the needs of their customers and partners. Depending on the course, practitioners may bring their own patients and build customized prostheses for them during training, or Össur may bring in local O&P users to demonstrate particular products. All courses provide continuing education credits. Most courses are fee-based, which covers training, materials, and some food.

For Össur, the academy is a natural progression in its commitment to serving the O&P community. “We clearly understand the value of educating our customers,” says Daniels. “This is not only about selling products, but making sure that when our partners use our products, they understand how to get the most out of them.” a

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

JUNE 2014 O&P Almanac

Photos: Össur

Kelly Ramirez demonstrates treadmill equipment at Össur Academy Orlando.

Member Spotlight

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AOPA HEADLINES

AOPA WORKING FOR YOU

Readers Shared, AOPA Listened Keep an eye out for the magazine’s new look and other exciting changes in the coming months

75% say that as a result of seeing an ad in the O&P Almanac they have adopted a new product or service in their practice.

89% are highly satisfied with the publication

88%

consider the O&P Almanac a

significant member benefit

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M

akeovers are pretty common in the magazine publishing business. It comes with the territory if you want to capture new readers and maintain the loyalty of the current readers. AOPA’s Board of Directors concluded that the timing was perfect for an O&P Almanac makeover and pulled together some diverse talents from the Board to create a Publications Workgroup, chaired by AOPA Treasurer Jim Weber, MBA. While the entire run of AOPA publications was reviewed, naturally the primary focus was the O&P Almanac, the flagship magazine for O&P since the 1950s.

Venerable it is, with a history of loyal readers who look to the monthly offering to keep their clinical and management skills apace with the needs of their patients and colleagues. But venerable may not be enough in this fast-moving world of Twitter, Facebook, and the many other venues that bring news and people together. There also is a danger for publications to rest on their laurels. The Board workgroup certainly saw that as a possibility and concluded it was time to shake things up a bit, add some graphic excitement, and sharpen the content to more clearly reflect reader needs and wants.

You, the readers, will start seeing this “freshening effect” beginning with the July 2014 issue of the O&P Almanac, and we hope you like it.

Typically, these makeover efforts often start with a readership survey. Not only can these surveys be enlightening but they also can reveal some terrific opportunities to better serve readers that may have been previously overlooked.

The surveys also provide somewhat of a report card on how the magazine is perceived today.

For the O&P Almanac, it’s a pretty good news story. The survey of 1,543 randomly selected readers elicited 215 responses, which is about 13 percent and pretty typical for readership surveys.

Results were favorable, as readers find the content useful for their work and a big member benefit. They also engage with advertising, as nearly 75 percent say that as a result of seeing an ad in the magazine they have adopted a new product or service in their practice.

While the vast majority wants to read the O&P Almanac in print, more than 40 percent also are interested in accessing content on the AOPA website. Nine out of 10 readers find something of value in each issue. According to the findings, readers are not very interested in accessing social media for O&P Almanac content—13 percent are “interested/ extremely interested” and 71 percent are “not interested.”

Advertisers look to the pass-along rate to help gauge the exposure for their ads.

Respondents to the survey say they pass their copies along to an average of two other readers, which equates to an actual readership of more than 42,000, based on average circulation in the 12,000- to 14,000-range each issue.

So be sure to look for the July and future issues and let us know how we’re doing. Thank you for being a loyal reader—and a special thanks if you took the time to participate in the survey. You provided so much good info to help us be an even better resource for you and your colleagues in the months and years ahead. Lastly, many thanks to Jeff Collins, CPA, and Scott Schneider, the other two members of the Publications Workgroup. a

AOPA HEADLINES

AOPA Achievement PAST PRESIDENTS 1917-1919 George E. Marks* 1920-1921 Thomas C. Moore* 1921-1923 Charles W. Frees* 1923-1924 James F. Rowley* 1924-1925 McCarthy Hanger Sr.* 1925-1927 Chester B. Winn* 1927-1928 George R. Fuller* 1928-1929 H.T. Odgers* 1930-1932 McCarthy Hanger Sr.* 1932-1934 Lowell Jepson* 1934-1936 Joseph Spievak, CP* 1936-1939 Clyde Aunger, CP* 1940-1946 Chester C. Hadden, CPO* 1946-1948 Walter R. Sievers, CPO* 1948-1949 Adelbert P. Gruman* 1949-1950 Daniel A. McKeever, CP* 1951-1952 Lucius Trautman, CPO* 1952-1954 Lee Fawver, CPO(E)* 1954-1955 McCarthy Hanger Jr.* 1955-1956 W. Frank Harmon, CO* 1956-1957 Charles A. Hennessy, CPO* 1957-1958 John A. McCann* 1958-1959 Karl Buschenfeldt, CO* 1959-1960 Paul E. Leimkuehler, CP* 1960-1961 Ralph Storrs, CO(E)* 1961-1962 Fred Quisenberry, CPO* 1962-1963 Carlton E. Fillauer, CPO* 1963-1964 Robert C. Gruman, CP(E)* 1964-1965 Herbert J. Hart, CPO* 1965-1966 Fred J. Eschen, CPO 1966-1967 George H. Lambert Sr., CPO* 1967-1968 Alvin L. Muilenburg, CPO* 1968-1969 Michael P. Cestaro* 1969-1970 William L. Bartels, CO(E)* 1970-1971 Roy Snelson, CPO(E)* 1971-1972 Mary S. Dorsch, CPO* 1972-1973 Claude J. Lambert, CPO* 1973-1974 Robert V. Bush, CPO* 1974-1975 Ralph (Ronney) R. Snell, CPO, FAAOP*

1975-1976 Howard R. Thranhardt, CP(E)* 1976-1977 Ben B. Moss 1977-1978 Daniel G. Rowe, CPO 1978-1979 William M. Brady, CP(E) 1979-1980 William D. Hamilton, CP 1980-1981 John E. Eschen, CPO 1981-1982 Thomas R. Bart, CO(E) 1982-1983 Garvin D. Marty 1983-1984 Gene C. Jones* 1984-1985 Joseph M. Cestaro, CPO 1985-1986 William B. Smith, CO* 1986-1987 Franklin M. Floyd, CPO 1987-1988 Bradley C. Rosenberger, CPO, FAAOP 1988-1989 Larry R. Bradshaw 1989-1990 Gregory F. Scott, CP 1990-1991 David C. Schultz, CPO* 1991-1992 Donald E. Hardin 1992-1993 John M. Yarbrough 1993-1994 H.E. (Ted) Thranhardt, CPO(E) 1994-1995 Rudolf B. Becker III 1995-1996 S. Dwayne Mullins, CPO 1996-1997 Anthony J. Filippis, CPO 1997-1998 William W. DeToro, CO 1998-1999 Ralph (Ronney) R. Snell, CPO, FAAOP* 1999-2000 C. Michael Schuch, CPO, FISPO, FAAOP 2000-2001 Thomas H. Watson, CP 2001-2002 David C. Schultz, CPO* 2002-2003 Jon P. Leimkuehler, CPO, FAAOP 2003-2004 Keith D. Cornell, CP, BOCO, FAAOP 2004-2005 Michael E. Hamontree 2005-2006 Walter L. Racette, CPO 2006-2007 Ronald “Ted” Snell, CP 2007-2008 Bradley N. Ruhl 2008-2009 Brian Gustin, CP 2009-2010 James A. Kaiser, CP, LP 2010-2011 Thomas V. DiBello, CO, FAAOP 2011-2012 Thomas V. DiBello, CO, FAAOP 2012-2013 Thomas F. Kirk, PhD 2013-2014 Anita Liberman-Lampear, MA

LIFETIME ACHIEVEMENT AWARD RECIPIENTS 1994 Louis Pulizzi, CPO 1995 Ben Moss & Anthony J. Filippis, CPO* 1996 Charles W. Rosenquist, CO 1997 Carlton Fillauer, CPO* 1998 Alvin L. Muilenburg, CPO* 1999 Roy Snelson, CPO(E)* 2000 Sam E. Hamontree, CP 2001 Ralph R. (Ronney) Snell, CPO, FAAOP* 2002 H.E. (Ted) Thranhardt, CPO(E) 2003 Donald E. Hardin

2004 David C. Schultz, CPO* 2005 Joseph M. Cestaro, CPO 2006 Garvin D. Marty 2007 Charles H. Dankmeyer Jr., CPO 2008/9 Anthony J. Filippis, CP 2010 Ivan Sabel, CPO 2011 Robert E. Arbogast and

Rudolf B. Becker, III 2012 Wade Barghausen, CP 2013 Professor Hans Georg Näder

*Deceased JUNE 2014 O&P Almanac

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AOPA HEADLINES

AOPA Makes Statement on Combating Medicare Fraud, Waste, and Abuse AOPA recently delivered the following statement to the House Ways & Means Subcommittee concerning Medicare fraud and the delivery of care to Medicare beneficiaries who have suffered a loss of a limb or impaired use of a limb or the spine: “Annual Medicare spending for custom orthotics and all prosthetics is less than one percent of all Medicare spending.

However, Medicare fraud has an outsized impact on the beneficiaries whose limb loss or impairment results in the need for orthotics or prosthetics. Patients treated by AOPA’s members already are confronted with the trauma of limb loss or impairment, loss of mobility, diminished independence, and sometimes financial hardship. When seen by a fraudulent supplier, the patient also oftentimes experiences a financial loss after paying for a device that is inappropriate or never delivered. Additionally, a patient in this situation has to find another supplier and make another copayment, and he or she may lose important time in the rehabilitation process. Dobson-DaVanzo’s research concluded that nearly one third of the $3.62 billion CMS paid between 2007 and

2011 for orthotic and prosthetic services for Medicare beneficiaries went to unlicensed providers, as well as those who fail to meet the accreditation requirement legislated by Congress in 2000. Additional research by Dobson-DaVanzo tracking Medicare data has demonstrated the overall costeffectiveness of O&P care. For example, the analytic work indicated that over the first 18 months patients who receive spinal orthoses had total Medicare episode payments that were 0.3 percent lower than those who did not receive orthotic bracing for the comparable back ailment. These are important trends for saving Medicare dollars.

“AOPA and its members believe the best way to fight fraud in the orthotics and prosthetics sector is to prevent fraud in the first place. We also believe that it is possible—and preferable—to combat fraud without punishing an entire health-care sector because of the actions of a handful of bad actors. Regrettably, it seems that CMS has opted for the latter approach, despite Congress having given the agency adequate authority to drive fraudulent suppliers from the Medicare program.”

Donate to AOPA’s Annual Wine Tasting & Auction AOPA’s 2014 National Assembly in Las Vegas will feature the 7th Annual Wine Tasting & Auction. This exciting event provides attendees with a unique opportunity to mingle, network, learn about and taste a variety of wines, and raise awareness of and funds for AOPA’s government relations outreach.

Your special donations are what make this event unique and successful. Possible donations include jewelry, artwork, wine glasses, a bottle of your favorite spirit, cigars, etc.

We also have a team of personal shoppers who can locate that perfect item for you if you would prefer to make a monetary donation.

Please consider donating today. Visit https://aopa.wufoo. com/forms/2014-wine-tasting-and-auction-donation/ for a donation form. Contact Devon Bernard at dbernard@AOPAnet. org or 571/431-0811 with questions.

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AOPA HEADLINES

Join the June and July Audio Conferences June 11: Self-Audit: A Useful Tool

July 9: The OIG: Who Are They and Why Are They Important?

Why perform a self-audit? Government agencies are scrutinizing vast numbers of claims to reduce overpayments for health-care services. To ensure your documentation can withstand the scrutiny of these audits, perform a self-audit and find out what the auditors are looking for. Join AOPA June 11 for an AOPAversity Mastering Medicare Audio Conference that will focus on catching mistakes before they become problems.

• How do you create an in-house or self-audit?

• Where do you start?

• How often you should perform self-audits?

• What type of audits audit works best?

You have heard the name “Office of Inspector General” (OIG). You may have seen the reports. But do you know what the OIG really is and what exactly it does? Do you know how this government agency affects your business?

Join AOPA on July 9 for an AOPAversity Mastering Medicare Audio Conference that will help you find the answers to these questions. You will learn: • How to submit for an advisory opinion • How OIG reports impact your business • The importance of the OIG exclusion list • How the OIG operates

AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring

at least 80 percent. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions.

Register online at http://bit.ly/aopa2014audio. Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876 with registration questions.

Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques June 12-13: Sheraton Boston Hotel

Join your colleagues June 12-13 at the Sheraton Boston Hotel for AOPA’s Mastering Medicare: Advanced Coding & Billing Techniques seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more.

Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group.

Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage.

AOPA has reserved a block of hotel rooms at the Sheraton Boston Hotel. Call the hotel directly at 617/236-2000 and indicate you are with the AOPA group for best available rate.

Register online for the Boston seminar at http://bit.ly/ aopa2014boston.

Questions? Contact Devon Bernard at dbernard@aopanet. org or 571/431-0854.

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AOPA HEADLINES

Calling O&P Students and Residents:

Gain National Recognition and Advance Your Career Enter to win one of two prestigious awards: The StudentResident Poster Awards honor two meritorious scientific papers submitted for presentation as a poster at the AOPA National Assembly.

The Otto and Lucille Becker Award will be presented for the best orthotic abstract submitted by a qualifying student or resident. The Edwin and Kathryn Arbogast Award will be presented for the best prosthetic abstract submitted by a qualifying student or resident.

•

• Abstracts will not be considered for either award if they have been previously presented or published, or are currently submitted with pending decision on acceptance elsewhere.

• These awards have been made possible by a special endowment by Becker Orthopedic and WillowWood.

Submit your abstract at https://aopa.wufoo.com/ forms/2014-aopa-studentresident-poster-submissions/.

The poster must be exhibited and presented at the AOPA National Assembly for the award recipient to receive the prize. The winners of the two scientific poster awards will be published in a future issue of the O&P Almanac.

The winners will receive a $500 cash award, registration to AOPA’s National Assembly, coach-class airfare to the meeting, and three nights’ hotel stay. To qualify to present a poster in this category and be eligible for consideration for this award, the main author must be a student (baccalaureate or master level) or a resident at a qualified patient-care facility.

•

From left, Edwin and Kathryn Arbogast 2013 Award Winner Darren Bolger, AOPA Immediate Past President Tom Kirk, and Otto and Lucille Becker 2013 Award Winner Kier Book.

en · er · gy 3rd

ANNUAL

Compete in the Third Annual Technical Fabrication Contest

en · er · gy noun, plural en·er·gies. The capacity for vigorous activity; available power; an adequate or abundant amount of such power; often, energies. A feeling of tension caused or seeming to be caused by an excess of such power; an exertion of such power; the habit of vigorous activity; vigor as a characteristic.

Take part in AOPA’s Third Annual Technical Fabrication Contest, which has a theme of “Energy.” Fabricate a lowerextremity orthosis or prosthesis that best reflects your interpretation of “energy” as it applies to prosthetics and orthotics. Your project will be judged on ingenuity, design, finish, and function.

One winner and one runner-up will be selected in each of the three categories: practitioner, technician, and student. All three categories will also be entered into the People’s Choice

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Award—where AOPA National Assembly attendees will vote and select their favorite device.

First-place winners receive a $500 cash prize. Runners-up receive a $200 cash prize.

The People’s Choice Award recipient will receive $300, special recognition in the form of a trophy, and a press release.

All entries require a statement that provides the contestant’s insights as to why they fabricated the specific design submitted. Enter the contest at https://aopa.wufoo.com/ forms/2014-aopa-opta-technical-fabrication-contest/.

en · er · gy

AOPA HEADLINES

EW N

E! QUIZ M Earn

Read the O&P Almanac and Earn CE Credits!

2

Business CE

Credits Easy & free!

Find the digital edition of O&P Almanac at: Because of the highly www.aopanet.org/publications/digital-edition/. educational content Find the archive at http://issuu.com/americanoandp. of the O&P Almanac’s Access the January, February, March, and April 2014 Reimbursement Page and quizzes at: Compliance Corner columns, O&P Almanac readers can now • http://www.aopanet.org/publications/op-almanac-magazine/ quiz-archive/ earn two business continuing The May 2014 quiz is located at: education (CE) credits each • https://aopa.wufoo.com/forms/ time you read the content and pass the accompanying op-almanac-may-2014-reimbursement-page/ quizzes. It’s easy, and it’s free.

Simply read the Reimbursement Page column (appearing in each issue) and Compliance Corner column And be sure to read the Reimbursement (appearing quarterly), take the quizzes, and score a Page article in this issue and take the grade of at least 80 percent. AOPA will automatically June 2014 quiz, available soon. transmit the information to the certifying boards on a quarterly basis.

New Business Education Programs for 21st Century Entrepreneurs:

BUY 3

GET 1

FREE Survive and Thrive— Bottom-Line, Profit-Oriented Business Programs for O&P If you missed the 2013 O&P World Congress, don’t let this opportunity to participate in these important programs pass you by: • Everything You Need to Know to Survive RAC and Prepayment Audits in a Desperate Environment • Competitive Bidding: Devastation to Orthotic Patient Care, Or Just a Passing Storm?

• Food and Drug Administration Compliance for Patient-Care Facilities, Manufacturers, and Distributors • Your Mock Audit: Are You Ready for the Auditor to Examine Your Claims Record?

You and your staff can now have a private viewing of business saving strategies and earn continuing education credits at the same time. Learn more about each session by visiting http://bit. ly/CreditCEpromo.

AOPA members just $59 per session ($99 per session for nonmembers), and the price covers your entire staff. Take advantage of a special offer to buy three, get one free. Review the videos as many times as you like.

Register at http://bit.ly/aopabusiness.

Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with any questions.

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AOPA HEADLINES

O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA member for their recent contributions to and support of the O&P PAC*: Wendy Miller AOPA would like to thank those individuals who in 2014 have donated directly to a candidate’s fundraiser or to an O&P PAC sponsored event, as they, too, are valuable supporters in achieving the legislative goals of AOPA and the O&P PAC*: James Campbell, PhD, CO Maynard Carkhuff Jeff Collins, CPA Charles Dankmeyer, CPO Mitchell Dobson, CPO, FAAOP Rick Fleetwood, MPA Elizabeth Ginzel, CPO John Horne, CPO Paul Johnston, CP, C.Ped, Cfo Thomas Kirk, PhD Alfred Kritter Jr., CPO, FAAOP Eileen Levis Anita Liberman-Lampear, MA Ron Manganiello David McGill Michael Oros, CPO, FAAOP Jeff Parson, CO Matt Perkins Rick Riley Brad Ruhl, CEO Scott Schneider Christopher Snell Clint Snell, CPO Ted Trower, CPO, FAAOP Frank Vero, CPO Jim Weber, MAB James Young, CP, FAAOP Pam Young

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The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@ AOPAnet.org.

In addition to direct contributions each year, the O&P PAC organizes fundraising events for members of Congress who have been supportive of O&P. For each event, AOPA members make a personal contribution to the member’s campaign and spend time with the member talking about a variety of issues including health care and the provision of O&P. These events are a unique way to share O&P concerns and get to know a member of Congress, and they have been very successful in getting Congress to understand O&P concerns. a *Due to publishing deadlines this list was created on April 21, 2014, and includes only donations received between April 1, 2014, and April 21, 2014. Any donations received on or made after April 21, 2014, will be published in the next issue of the O&P Almanac.

Mark your calendar to participate in this upcoming O&P PAC event—the Seventh Annual O&P Wine Tasting & Auction Fundraiser. The event will be held September 5, 2014 from 6:30 PM to 8:00 PM during the AOPA 2014 National Assembly.

Everyone knows that the Wine Tasting and Auction is an important component to support the O&P PAC and the legislative activities of the profession. What everyone does not know is: The Wine Tasting and Auction is a fun event for everyone!

AOPA HEADLINES

AOPA’s 2014 Coding Products are Available in the Bookstore 2014 Illustrated Guide This easy-to-use reference manual provides an illustrated guide to the coding system in use for orthotics, prosthetics, and shoes, including HCPCS codes, official Medicare descriptors, and illustrations.

2014 Coding Pro The Coding Pro is O&P’s comprehensive guide to Medicare codes, reimbursement, and medical policies. This is the singlesource reference for all of your coding needs! The Coding Pro CD-ROM provides updated Medicare fee schedules for all 50 states and allows you to customize and import other fee schedules used by your office. Illustrations of the codes allow you to quickly sort codes. And writing prescriptions just got easier with the

prescription writing tool. Network Version for use on multiple office terminals.

2014 Quick Coder Stop searching through numerous pages to find a code! AOPA’s redesigned Quick Coder provides a speedy reference to the HCPCS orthotic, shoe, and prosthetic codes and modifiers. These laminated cards are durable, longlasting, and convenient to store.

2014 Coding Suite Save $50 when you purchase the newly updated Coding Suite, which includes all of the coding products discussed above: 2014 Illustrated Guide, 2014 Coding Pro (Single-User CD Software), and the 2014 Quick Coder.

Go to the AOPA Bookstore and order your Coding Products today; visit http://bit.ly/BookStoreAOPA.

O&P ALMANAC—Y o ur co NNectIoN to everY thINg o&P

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Don’t miss the New and Improved O&P Almanac—July 2014 The O&P Almanac has been a core part of the profession’s long history and the nearly 100 year existence of the association. O&P professionals from large and small facilities have come to rely on the O&P Almanac to run their business and care for their patients. You may find similar information in other publications, but you know that you can count on the accuracy of the Almanac and the expertise of the writers and AOPA staff.

With the upcoming July 2014 issue, we’re releasing a new and improved O&P Almanac.

Don’t worry we’ve kept your favorites columns like the reimbursement page and compliance corner. But we are also unveiling new relevant information for clinicians, technicians and of course our core business readers.

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MEMBER MILESTONES

Congratulations to AOPA members The O&P Almanac celebrates the important milestones being celebrated by established AOPA Members in 2014.

100-Year Anniversary: Fillauer

100-Year Anniversary: United Prosthetics Headquarters: Boston, Massachusetts Locations: 2 Employees: 18 Owners: Paul Martino, CP, president; Greig Martino, CP, vice president; Mary Martino, treasurer; Gary Martino, production coordinator; and Christopher Martino, business manager

Headquarters: Chattanooga, Tennessee Locations: 6 Employees: Approximately 300 Owner: Karl Fillauer, CPO, FAAOP

Company History: Facility History: United Prosthetics was founded in 1914 by Philip Martino, an Italian shoemaker. Martino became interested in prosthetics after working with returning World War I veterans. His son Joseph joined him in business after serving in World War II as a B-24 ball turret gunner. The company is currently run by the third generation of Martinos, and has entered its fourth generation of ownership with the addition of Paul’s son, Christopher.

What Makes This Facility Successful: One of the most important factors to a successful facility is being able to separate business initiatives from personal emotions. You must realize that though a decision or idea was not one of your formulation, all involved are looking for the same outcome. At an early age, we were taught there is no place for an ego in a successfully run facility. Having not only multiple siblings (third generation) but also a nephew (fourth generation) involved, ideas and abilities range across a broad spectrum. It is this amalgamation of individual experiences that not only allows for a smooth-running business but also lends credence to a successful continuation of the business.

What Makes This Company Successful:

How the Facility Will Thrive in the Future:

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O&P Almanac JUNE 2014

We attribute Fillauer’s success to our commitment to the patient, our understanding of the practitioner, and our investment in innovation.

By focusing on what makes us successful, Fillauer will create and invest in innovative O&P solutions for patients and practitioners around the world.

Photos: Fillauer

How the Company Will Thrive in the Future: Photo: United Prosthetics

Continued education is first and foremost. Also important are the addition of new ideas in the form of younger staff and the ability to understand that though their ideas may differ from yours, that does not necessarily mean that they are wrong. The ability to integrate these ideas along with advanced technology allows for the continuation of growth and success. Taking the time to not only impart knowledge but also listen and learn is key. In short, investment in equipment, technology, and new minds is essential.

In September of 1914, George Fillauer Sr. started White Cross Pharmacy in Chattanooga, Tennessee, which grew into Fillauer Surgical Supplies. George’s sons, George Jr. and Carlton, joined the family business with George Jr., a pharmacist, managing the pharmacy side and Carlton, a certified prosthetist orthotist, managing the O&P division. In the mid 1990s, soon after a hostile takeover of Durr-Fillauer, Carlton’s son, Karl Fillauer, CPO, FAAOP, purchased the O&P manufacturing and patient-care divisions and expanded the company’s product offerings through the acquisitions of Hosmer-Dorrance, Motion Control, Centri, and OTS. Today, Karl’s son, Michael Fillauer, CPO, is president of Fillauer LLC, and David Fillauer, CPO, is president of Fillauer’s patient-care clinic.

MEMBER MILESTONES

35-Year Anniversary: Achilles Prosthetics and Orthotics Inc.

25-Year Anniversary: Jonesboro Prosthetic & Orthotic Laboratory, JP&O Labs

Headquarters: Bakersfield, California Locations: Santa Maria, San Luis Obispo, and Templeton, California Employees: 17 Owner: Daniel J. Newton, CP, FAAOP

Headquarters: Jonesboro, Arkansas Locations: 6 Employees: 47 Owners: Rob A. Yates, CPO, LPO, FAAOP, and Robin M. Yates

Facility History: Jonesboro Prosthetic & Orthotic Laboratory was founded in 1989 by David and Robin Yates of Jonesboro, Arkansas. David and Robin Yates identified a need for a high-quality, state-of-the-art O&P facility in Jonesboro.

Over the years, JP&O has added five additional locations throughout Arkansas and Southern Missouri.

Photo: Achilles Prosthetics and Orthotics Inc.

What Makes This Facility Successful:

Facility History:

The strength of our practice has been and always will be the quality of care that our practitioners are able to provide. Quality care, warm friendly service, and an excellent team have always been the keys to our success.

How the Facility Will Thrive in the Future: JP&O will continue to invest heavily in our people, our technology, and our patients. As the landscape for providing health care continues to change over the next several years, we are committed to being a place that provides outstanding patient care and a warm, family friendly environment.

Achilles Prosthetics and Orthotics Inc. was founded in 1978 by Daniel J. Newton, CP, and David A. Wegner, CPO. Over the years, we have experienced steady, continual growth and have become a faith-based family business spanning two (and soon to be three) generations of the Newton family.

What Makes This Facility Successful: We attribute our success to warm, compassionate customer service and producing comfortable, functional prostheses and orthoses of the highest quality. Our employees are knowledgeable and highly skilled at their respective positions, creating a safe and interactive environment for the patient experience.

How the Facility Will Thrive in the Future: Photo: JP&O Labs

Achilles will remain on the cutting edge of O&P technology while adjusting our business model to accommodate changing times. And we will always put patient care and customer service first and foremost. We believe this is the recipe for future success and longevity.

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MEMBER MILESTONES

Headquarters: Exton, Pennsylvania (founded in Gettysburg, Pennsylvania) Locations: 10 Employees: 34 Owners: Jeffrey Brandt, CPO; Jeffrey Quelet, CPO; and Clay Barrow, CO

Facility History: Ability was founded on three guiding principles: patient-centric initiatives; providing education and awareness to advance patient care and the profession; and expertise on material/ product knowledge.

What Makes This Facility Successful: Ability puts the people first, then the systems/protocols, and then the facilities. We have always set a high expectation for our employees and patients. We say what we do and do what we say.

How the Facility Will Thrive in the Future: Ability is nimble simply due to its construct and culture. It is a company of collaboration. We all move in sync. That is important when it comes to steering the organization toward or away from opportunities and perils. That is the high-level answer.

On an operational level, we’ll prosper in the offices and with successful outcomes for patients because of outcome measures, freshness of brand, and adoption of new products and protocols. You have to be reinventing yourselves along the way, while simultaneously providing stability and consistency in delivery of products and services to our patients. a

Is Your Facility Celebrating a Special Milestone This Year?

O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email umbrell1@verizon.net.

AOPA Applications Welcome new members!

The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership.

Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

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

Orthotic & Prosthetic Center of Boston LLC

Orthotic & Prosthetic Center of Boston LLC

197 Quince Avenue Braintree, MA 02184 781/794-9991 Fax: 781/794-1769 Category: Affiliate Member Parent Company: Orthotic & Prosthetic Center of Cape Cod & The Islands LLC , West Yarmouth, MA George Boutross, CPO

380 Merrimack Street Methuen, MA 01844 781/794-9991 Fax: 781/794-1769 Category: Affiliate Member Parent Company: Orthotic & Prosthetic Center of Cape Cod & The Islands LLC , West Yarmouth, MA

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O&P Almanac JUNE 2014

Orthotic & Prosthetic Center of Boston LLC 63 Eddie Dowling Hwy. North Smithfield, RI 02896 781/794-9991 Fax: 781/794-1769 Category: Affiliate Member Parent Company: Orthotic & Prosthetic Center of Cape Cod & The Islands LLC , West Yarmouth, MA

Simona America Inc. 64 N. Conahan Drive Hazleton, NJ 18201 570/579-1300 Category: Supplier Level 1 Member Jeff Hester

The Sen Technology Inc. 5F, No. 10, Wuchuan 7th Road Wuku Dist.

New Taipei Industrial Park New Taipei City, Taiwan 24890 886-2-22982180 Category: International Member Jeff Chen a

Photos: Ability Prosthetics & Orthotics

10-Year Anniversary: Ability Prosthetics & Orthotics

USING ALPHA LINER?*

COOL LINER

JOBS CALENDAR

Find your region on the map to locate jobs in your area.

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

Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate.

Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color

1/2 page, color

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org.

No orders or cancellations are taken by phone.

Ads may be faxed to 571/431-0899 or emailed to scuster@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711.

Note: AOPA reserves the right to edit Job listings for space and style considerations.

Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

Southeast Technician, Clinician Nashville, Tennessee Restorative Health Services has immediate openings for experienced O&P technician and clinicians. We are a rapidly growing business in Nashville, Tennessee, and surrounding counties. Candidates must be a team player, and possess strong clinical and technical skills. Technician candidates will fabricate devices in our local laboratory. Competitive salary and benefits package are offered.

Send resume to:

Restorative Health Services Inc. Email: Ivaughn@rhs-tn.com Fax: 615/890-2361

Job Opportunity CPO/BOCPO At Center for Orthotic & Prosthetic Care (COPC) our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, and New York. Due to an opening at a new patient-care facility in Paducah, Kentucky, we are seeking a CPO, or Kentuckylicensed BOCPO, with a minimum of five years’ clinical experience. Because we have experienced rapid growth at our patient-care facilities in the Binghamton, New York, area, we are seeking a CPO/BOCPO with a minimum of two years’ experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest quality patient care. These positions offer a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses.

If you meet these requirements and have an interest, please submit your resume, in confidence, to:

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140

For the Paducah, Kentucky, position, via fax at 502/451-5354 or via email to copchr@centeropcare.com. aOPa marketing

Be served a bigger

media kit

slice of the pie!

dollar of of the 3.5 billion AOPA Find your slice begin with an O&P business— opportunity today! advertising

rates effective

American Orthotic Promoting O&P

& Prosthetic

Since 1917

Association

Jan. 1, 2014

(AOPA)

Anet.org www.AOP

net.Org

www.AOPA

76

DISCOVER more AOPA advertising opportunities.

Call Bob Heiman, Advertising Sales Representative, at 856/673-4000 or email bob.rhmedia@comcast.net

20 14

OPPOrtunities

AOPA 2014

MediA Kit

1

O&P Almanac JUNE 2014

For the Binghamton, New York, position, via email to dsickles@centeropcare.com.

CALENDAR JOBS

“The most gratifying piece of what I do

every day is to get up early in the morning, get to the office and know that we are going to make a difference.”

- Kevin Carroll, MS, CP, FAAOP

Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic.

Join Hanger Clinic and make a difference today.

AVAILABLE POSITIONS CLINIC MANAGER

Ardmore, OK Bartlesville, OK Charleston, WV

Lynchburg, VA Zanesville, OH

Albuquerque, NM Brunswick, GA Columbus, OH Dayton, OH Denver, CO Englewood, CO Enid, OK Folsom, CA Gurnee, IL Kissimmee, FL Las Vegas, NV Macon, GA

Oklahoma City, OK San Antonio, TX San Francisco, CA San Jose, CA Santa Rosa, CA St. Louis, MO Tallmadge, OH Thomasville, GA Tulsa, OK Springfield, IL Columbia, MO

Wichita, KS Bronx, NY Evansville, IN Havertown, PA Johnston, IA Kansas City, KS La Mesa, CA

Olivette, MO Salisbury, MD Valdosta, GA Wethersfield, CT Burr Ridge, IL Cincinnati, OH Hammond, IN

Overland Park, KS Riverside, CA

Pittsburgh, PA

PROSTHETIST/ORTHOTIST

ORTHOTIST

To view available positions and apply online visit: www.hanger.com/careers or scan the QR code.

Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law.

Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.

PROSTHETIST

www.AOPAnet.org

AOPA’s

national

Sept. 4–7, 2014

assembly ’14

Mandalay Bay Resort and Casino

The premier meeting for orthotic, prosthetic, and pedorthic professionals

Las Vegas, Nevada

Experience the energy—attend the country’s oldest and largest meeting for the orthotics, prosthetics, and pedorthic profession.

Energize your staff—ask about group discounts and space for your company to hold their own corporate meeting in conjunction with the Assembly.

The 2014 National Assembly education program will feature a learning program tailored specifically to meet your needs with programs to teach you the latest technology, best business practices, premier patient care through case studies, symposia, manufacturers workshops, panel discussions, live demonstrations, and fun networking events.

There is a reason why more O&P professionals attend the National Assembly than any other national meeting.

Visit www.AOPAnet.org for information and updates.

CLINICAL | BUSINESS | TECHNOLOGY

EDUCATION

Exhibits. Services. Networking.

Earn Choice CE Credits!

REGISTRATION IS

NOW OPEN

JUNE 2014 O&P Almanac

77

CALENDAR

■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

www.bocusa.org

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

■

■■

2014 ■ June 20 Summer 2014: Learning and Leisure—“Dynamic Response Orthotic System” Certification Course. Join us at Harrah’s Hotel in New Orleans. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.”

7.75 CEUs. For registration information, visit www. phatbraces.com. For more information, call 515/554-6132.

BIO-MECHANICAL COMPOSITES, INC.

PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Words

Member Rate

Nonmember Rate

25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word

■ July 1 ABC: Application Deadline for Certification Exams.

Applications must be received

by July 1, 2014, for individuals seeking to take the September 2014 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. Contact 703/8367114, email certification@abcop. org, or visit www.abcop.org/ certification.

July 7-12 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 orthotic and prosthetic technicians in 250 locations nationwide. Contact 703/8367114, email certification@abcop. org, or visit www.abcop.org/ certification.

■

■ July 9 AOPAversity Audio Conference–The OIG: Who Are They and Why Are They Important? Register online at http://bit.ly/aopa2014audio.

For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org.

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email scuster@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.

For information on continuing education credits, contact the sponsor.

Questions? Email scuster@AOPAnet.org.

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O&P Almanac JUNE 2014

■ August 13 AOPAversity Audio Conference–AFO/KAFO Policy: Understanding the Rules. Register online at http:// bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

■ AUGUST 14-15 Spinal Technology Scoliosis Orthotic Symposium— Scoliosis Management, Spinal Trauma Management, and Lower-Limb Orthotics Management. Spinal Technology Inc. hosts our annual Scoliosis Symposium in Boston. Course will cover full-time scoliosis bracing protocol for adolescent idiopathic scoliosis; the Providence Nocturnal Scoliosis System; measurement techniques and brace options for lower-limb orthotics; with hands-on demonstrations in each segment. Presenters include Tufts Medical Center orthopedic surgeons, a Tufts neurosurgeon, and ABCcertified practitioners. Eligible practitioners can earn 16.25 ABC credits for attending the full presentation. Contact Nancy Francis at nancy_f@ spinaltech.com or call 508/7750990 x8374.

■ SEPTEMBER 4-7 97th AOPA National Assembly. Las Vegas.

Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org.

■ September 10 AOPAversity Audio Conference–Urban Legends in O&P: What To Believe.

Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

IN THE NEWS

■ October 8 AOPAversity Audio Conference–Medicare Enrollment, Revalidation, and Participation. Register online at http://bit.ly/aopa2014audio.

For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

visit www.regonline.com/ builder/site/?eventid=1567170.

For more information, call 515/554-6132.

BIO-MECHANICAL COMPOSITES, INC.

October 10 Fall 2014: Learning and Leisure—“Dynamic Response Orthotic System” Certification Course. Join us at the LaGuardia Airport Marriott in New York the day prior to the POMAC meeting.

Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.75 CEUs. For registration information, visit www.phatbraces.com.

■

■ October 16-18 Virginia Orthotic & Prosthetic Association. Glen Allen, VA. Wyndham Virginia Crossings Resort & Conference Center.

For more information, visit www.vopaweb.com or email vopainfo@gmail.com.

■ NOVEMBER 6-7 COPA 2014 Northern California Educational Event.

Hilton Garden Inn. Emeryville, CA. For more information,

■ November 12 AOPAversity Audio Conference–Gifts: Showing Appreciation Without Violating the Law. Register online at http://bit.ly/ aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

■ November 15 Midwest Chapter AAOP— One-Day Fall Symposium.

Hickory Hills, IL. For more information, visit www.mwcaaop.org/meetingsevents.html or email mwcaaop@ gmail.com.

■ December 10 AOPAversity Audio Conference–New Codes and Changes for 2015.

Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

2015 ■ OCTOBER 7-10 98th AOPA National Assembly. San Antonio.

Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org. a

AD INDEX

Company

Page

Phone

Website

Ability Dynamics

25

855/450-7300

www.abilitydynamics.com

ALPS South LLC

5, 71

800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, prosthetics & Pedorthics Inc.

37

703/836-7114

www.abcop.org

Amfit Inc.

13

800/356-3668

www.amfit.com

Cascade Dafo

27

800/848-7332

www.cascadedafo.com

College Park Industries

51

800/728-7950

www.college-park.com

DAW Industries

1, 75

800/252-2828

www.daw-usa.com

Dr Comfort

7

877/713-5175

www.drcomfort.com

Ferrier Coupler Inc

29

810/688-4292

www.ferrier.coupler.com

Fillauer

19

800/251-6398

www.fillauer.com

FLO-TECH O&P Systems Inc.

59

800/356-8324

www.1800flo-tech.com

Hersco

2

800/301-8275

www.hersco.com

Orthomerica

57

800/446-6770

www.orthomerica.com

Ottobock

C4

800/328-4058

www.professionals.ottobockus.com

PEL

C3

800/321-1264

www.pelsupply.com

Spinal Technology

C2

800/253-7868

www.spinaltech.com

Texas Assistive Devices

9

800/532-6840

www.n-abler.org

Willowwood

Insert

800/848-4930

www.willowwoodco.com

JUNE 2014 O&P Almanac

79

n

Reimbursement Page AOPA Answers

Strength in Numbers Answers to your questions regarding NPI, PTAN, and supplier numbers

AOPA

receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.

Q.

We have multiple offices but our billing is done from a central location, does each office need a separate Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI) number?

A.

Yes. The PTAN and NPI numbers are not attached to a specific billing location, but rather attached to each physical location where Medicare services are rendered. You are not required to bill from each location, but your claim should indicate where the service was rendered. That is why the CMS-1500 form has the separate boxes for billing location and services rendered location.

80

O&P Almanac JUNE 2014

Q.

I’m buying an existing O&P company.

Do I need to get a new supplier number, or can I use the business’s original number?

A.

Whether you request a new supplier number depends on the kind of purchase that transpires when you purchase the facility. If you are making an assets-only purchase, you will need a new supplier number.

This is because you will be obtaining a new tax identification number (TIN) for that new business and will need a new supplier number to go with it. (Supplier numbers are tied to TINs.) However, if you are making a stock purchase of the assets and liabilities, where you will be operating the business under the original TIN, you do not need a new supplier number.

Q.

I just bought a company and am waiting for my new PTAN number.

Will the new PTAN number be retroactive?

A.

Yes, it is possible for your PTAN number to be retroactive to the date of the sale of the company, as long as all of your operating information (i.e., licenses, bonds, etc.) are up to date and you are in compliance with the supplier standards. a

ALPS Guardian Suction Liner • Raised GripGel bands grip socket wall wall creating secure interface between socket and liner to prevent slippage • Low modulus GripGel bands help ensure no restriction of blood flow • Single piece construction improves durability; no seams • Transtibial rings begin 3 ½” from center of distal end • Transfemoral rings begin 5 ½” from center of distal end • For volume fluctuations use ALPS ENCP skin reliever for continued use of same socket

Aspen Medical Products Horizon™ Lower Spine Bracing • Fully adjustable; comfortably fits 24” to 70” waists • Unique independent upper/lower tightening system for customized pain relief • Effective treatment for low back pain, improves compliance and satisfaction • Tri-Band technology system and integrated vertical stays provide stability and comfort PDAC approved – Codes L0456, L0637, L0631 and L0627 • PDAC approved Codes L0456, L0637, L0631 and L0627

Let’s complete someone’s life today.

The products you need. The service you deserve.

There are bigger O&P supply companies out there, sure. But you won’t find one that cares more about its customers than PEL. Just ask the people who know us. Or better yet, get to know us yourself. Learn more at pelsupply.com ©2013 PEL, LLC

Harmony® E2 vacuum socket system Maximize your K2 patient outcomes

Now there’s a great vacuum socket solution for your K2 patients. The Harmony E2 is the quietest electornic pump on the market and keeps more surface area under vacuum for better linkage and control, while automatically maintaining vacuum levels.

Volume management For a consistent socket fit all day long.

Waterproof No problems in the rain or even underwater up to 10 ft.

Connection Over 21 inHg max vacuum.

Removable Pump can be removed while vacuum is maintained in system.

Options Add an Anatomic 3D liner and ProFlex sleeve for even greater success!

To find out more about how the Harmony E2 can give your patients all-day security, visit us at www.professionals.ottobockus.com