June 2016 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

J U N E 2016

Understanding the VA RFP Process P.16

Participants' Take on Co-Creating Legislation P.32

Exclusive: Preview the 2016 Thranhardt Lecture Series P.40

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.19

Reaching for

Function

UPPER-LIMB SPECIALISTS DISCUSS EVOLVING TECHNOLOGIES AND ENSURING THE BEST FIT AND COMPONENTRY P.24

#AOPA2016

American Orthotic & Prosthetic Association

THE PREMIER MEETING for orthotic, prosthetic, and pedorthic professionals.

LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON

Preliminary Program and Registration Materials

Exhibits. Education. Networking. 32+ CE Credits.

There is a reason why more orthotic, prosthetic, and pedorthic professionals

This Just In: Driving Positive Change— An Update on Recent Advocacy Efforts P.20

choose the AOPA National Assembly. If you are going to attend a National

REGISTRATION IS

OPEN

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

AOPAnet.org

Convention, choose the one that has it all. Get access to the best in business education, advanced clinical programming from physicians, high-level researchers and top practitioners, the largest exhibit hall in the United States and of course, fun networking events.

SAVE $300

Membership Has its Benefits: Build a Better Business with AOPA Members save over $300 on their Assembly registration.

Learn more at www.AOPAnet.org/join.

Watch Your Mailbox for the AOPA 2016 National Assembly Preliminary Program

YOUR CONNECTION TO

EVERYTHING O&P

The premier meeting for orthotic, prosthetic, and pedorthic professionals.

#AOPA2016

AOPAnet.org

LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON

Earn more than

32 CE

SAVE THE DATE

CREDITS

Join us September 8-11, 2016, for the 2016 AOPA National Assembly at the Hynes Convention Center in Boston, MA.  PLOT A COURSE FOR FUTURE SUCCESS with 5 concurrent sessions for Orthotists, Prosthetists, Pedorthists, Technicians, Business Owners and Managers

The O&P community has experienced stormy seas for the past several years with legislative challenges, rising costs, and reimbursement pressures. If you are looking for a lighthouse in the storm—join us at the 2016 Assembly.

Our goal is to bring our profession together to build a strong future through clinical and business education, networking and the support of a strong supplier community.

 Cruise through the stormy seas of REGULATORY RULES with answers you can only get from AOPA  Navigate the country’s LARGEST O&P EXHIBIT HALL  Sail through spectacular general sessions with inspiring KEYNOTE PRESENTERS

 Partake in FUN NETWORKING EVENTS  Enjoy exciting and HISTORIC BOSTON BACK BAY  Catch up with the ALUMNI CONNECTION  Maneuver your way with CASE STUDIES AND SYMPOSIA  GET ONBOARD with MDs, PhDs, Wound Care Specialists, Research Scientists, Attorneys, Business Experts and Top-Notch Practitioners.

Questions?

Contact AOPA at 571/431-0876 or email at info@AOPAnet.org.

For information about the show, scan the QR code with a code reader on your smartphone

Visit www.AOPAnet.org to learn more, submit a paper, or to exhibit.

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contents

J U N E 2016 | VOL. 65, NO. 6

FEATURES

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

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

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

At-a-glance statistics and data

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

24 | Reaching for Function Advances in technologies and materials have led to more choices for arm amputees, who may be presented with passive, body-powered, and electronic options. Upper-limb specialists discuss how the technologies are evolving, and how they ensure patients are fit with the most appropriate componentry. Plus, learn how some orthotic patients are benefitting from myoelectric bracing.

By Christine Umbrell

20 | This Just In

P. 20

Driving Positive Change O&P stakeholders have been involved in several recent initiatives designed to improve patient care and reimbursement and promote the O&P profession. Learn more about the bills that have been introduced to legislators as well as interactions between O&P advocates, members of Congress, and CMS representatives on the future of the Local Coverage Determination on lower-limb prosthetics.

By Josephine Rossi

40 | Meet the Thranhardt Contenders Some of the best minds in O&P have been tapped to present their latest clinical studies as Thranhardt presenters at the AOPA National Assembly in Boston.

Get a sneak peek of the four presentations in advance of the September conference.

People & Places........................................ 14

Transitions in the profession

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

Mastering the VA Contract Process

How to bid on contracts for the U.S. Department of Veterans Affairs

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

CREDITS

Member Spotlight................................ 44 n n

Garrison’s Prosthetic Services Coapt

P. 32 AOPA News............................................... 48

32 | Action Through Ownership For the first time, participants at the AOPA Policy Forum had the chance to write a draft bill to advocate for the O&P profession and patient base. Five attendees who took part in the legislation writing congress share their perspectives on the experience of drafting the Prosthetic and Orthotic Care Modernization Act and sharing it with lawmakers on Capitol Hill.

Research, updates, and industry news PHOTO: Lake Prosthetics and Research

COVER STORY

Insights from AOPA Board Member David Boone, BSPO, MPH, PhD

AOPA meetings, announcements, member benefits, and more

PAC Update ............................................. 50

Welcome New Members ................. 50

Marketplace.............................................. 52

Careers......................................................... 56

P. 40

Professional opportunities

Ad Index........................................................57 Calendar...................................................... 58

Upcoming meetings and events

Ask AOPA.................................................. 60 Ultralight material codes, patient safety concerns, and more

O&P ALMANAC | JUNE 2016

3

VIEWS FROM AOPA LEADERSHIP

Validating O&P Decision Making

P

ROSTHETISTS AND ORTHOTISTS MAKE myriad treatment decisions

every day. We generally have a good idea about what we think will be best for our patients and we proceed ahead, without delay.

What should validate those decisions is research. Ideally, as a field we have prospectively considered alternatives and studied the ramifications of clinical choices. The continued progression of O&P demands that we seek out high-quality evidence to support our answers to some very basic questions—for example, what are the important prosthetic foot considerations for a K2 patient? And which orthosis maximizes physical restoration?

Answering such questions requires research, and AOPA is addressing this need by directly providing financial support for O&P research through a regular small grant process and by soliciting specific systematic reviews of the available literature. Most projects are small and may only provide pilot data to help move the research question to the next step. While the results of a pilot may not be an end in themselves, research is additive, with each study importantly building on the work before it. The funding also is additive: With pilot data and experience, researchers are far more competitive in securing time to do research, and are more competitive in seeking O&P research funding from large institutions like the National Institutes for Health.

Some research, like the systematic reviews sponsored by AOPA, are expected to be more definitive in their findings. Currently, three systematic reviews are nearing completion, and their important results will be presented at the September AOPA National Assembly in Boston and published in peer-reviewed medical journals. Look for these reviews; the findings will be the best support you will have available for specific questions. This is a terrific accomplishment for the year, and one of which all AOPA members should be proud.

Each research grant award made by AOPA is an investment, and for each we have an expectation of a return. As in many forms of investing, the keys to our strategy are selecting quality opportunities, maintaining a consistent approach, and having patience to realize the positive impact we seek on our profession and our businesses. We continue to have more and better quality applications than ever. This year, AOPA has received 24 requests for small grant funding, and that is a very good sign that we will be able to selectively pursue research investments that will be most impactful to the field.

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

Board of Directors OFFICERS

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

David A. Boone, BSPO, MPH, PhD, is a clinical director on the AOPA board, and is president of the Center for O&P Learning and Outcomes/Evidence-Based Practice.

4

JUNE 2016 | O&P ALMANAC

Bradley N. Ruhl Ottobock, Austin, TX

Handled with care.

Motion Control division of

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AOPA CONTACTS

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

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

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide.

These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

6

JUNE 2016 | O&P ALMANAC

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

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

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org.

Yearly subscription rates: $59 domestic, $99 foreign.

All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Copyright © 2016 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/aopamediakit for advertising options!

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NUMBERS

U.S. Health Insurance Coverage On the Rise More nonelderly adults have gained health insurance coverage since 2010

UNINSURED RATE FALLS FOR ADULTS AGES 18-64

A report from the U.S. Department of Health and Human Services (HHS) has found that provisions in the Affordable Care Act (ACA) have resulted in an estimated 20 million

43

people gaining health insurance coverage between the ACA’s 2010 enactment and early 2016. The report looked at increases ment) and from October 2013 through early 2016. Some of

Decline in uninsured rate for nonelderly adults between October 2013 and early 2016.

the data was conducted by analyzing the Gallup-Healthways Well-Being Index survey data through Feb. 22, 2016.

ADULTS AGES 19-25 GAIN COVERAGE MILLION

6.1

MILLION

8.3 Percent

Decline in the uninsured rate for men, resulting in 8.3 million adult males gaining coverage.

3.8 MILLION

9.4 Percent

Total number of young adults who gained coverage between 2010 and early 2016.

Decline in the uninsured rate for women, resulting in 9.5 million adult females gaining coverage.

41.2%

40%

34.5%

35%

Percent Uninsured

White, Non-Hispanic Black, Non-Hispanic Hispanic

38.4%

36.4%

33.6%

31.3%

30.3%

30.4%

31.6%

22.4%

18.5% 15.6%

15.7%

15% 10%

14.3%

14.3%

12.8%

5%

10.3%

9.5%

13.7%

Q4 2013

9.7%

8.6%

11.1%

8.1%

12.4%

12.3%

8.3%

8.1%

10.6%

7.0%

Q1 2014

Q2 2014

Q3 2014

Q4 2014

Q1 2015

Q2 2015

Q3 2015

Q4 2015

Q1 2016

The Office of the Assistant Secretary for Planning and Evaluation’s analysis of the Gallup-Healthways Well-Being Index survey data through Feb. 22, 2016

8

Health Insurance Marketplace benefited from better coverage

12.6%

0%

Q1 2012Q3 2013

for generations. Americans

or through their employers have

23.2%

20%

years that the country has sought with insurance through the

30.5%

30% 25%

Act, 20 million Americans have have seen progress in the last six

for Nonelderly Adults, Ages 18-64, By Race and Ethnicity 41.8%

“Thanks to the Affordable Care gained health-care coverage. We

QUARTERLY UNINSURED RATE ESTIMATES 45%

Uninsured rate for nonelderly adults in early 2016, down from 20.3 percent from October 2013.

FEWER MEN OBTAIN COVERAGE

Number of young adults who gained coverage from 2010 through October 2013.

Number of young adults who gained coverage from October 2013 through early 2016.

PERCENT

JUNE 2016 | O&P ALMANAC

and a reduction in the growth in health-care costs.”

—HHS Secretary Sylvia M. Burwell

SOURCE: U.S. Department of Health and Human Services, “Health Insurance Coverage and the Affordable Care Act, 2010-2016.”

2.3

11.5

PERCENT

between 2010 and October 2013 (the start of open enroll-

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I don’t think that’s too much to ask.”

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Happenings RESEARCH ROUNDUP

Statins Found To Reduce Amputation Rates in Patients With PAD Researchers have found that people with peripheral artery disease (PAD) who take cholesterol-lowering statins may have a lower risk of amputation and death than PAD patients who do not take statins. The researchers also found that higher doses of statins were associated with lower risks of amputation and death. The research was led by Shipra Arya, MD, SM, who is assistant professor in the division of vascular surgery at Emory University School of Medicine and also is affiliated with the U.S. Department of Veterans Affairs’ (VA) Atlanta VA Medical Center.

Arya and his team studied data and health information of more than

208,000 veterans with PAD, accessed from the VA database. The researchers studied the data from the time of PAD diagnosis through an average of 5.2 years later, and assessed patients’ risk of amputation or death. They classified the patients into three groups: those taking high doses of statins, those taking low to moderate statin doses, and those taking no statins.

For those PAD patients taking high doses of statins, researchers found a 33 percent lower risk of amputation and 29 percent lower risk of death, compared to those taking no statins. For those taking low to moderate doses of statins, researchers found a 22 percent

lower risk of amputation and death, compared to those taking no statins.

“Ours is one of the largest populationbased studies on PAD and suggests patients who have been diagnosed with PAD should be considered for placement on high-dose statins upon diagnosis if they can tolerate it, along with other medical management, including smoking cessation, antiplatelet therapy, and a walking program,” says Arya. Research findings were presented at the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology/ Peripheral Vascular Disease 2016 Scientific Sessions in May.

Researchers Develop Bionic Hand To Debut at Cybathlon

10

JUNE 2016 | O&P ALMANAC

pressure sensors embedded in the prosthetic socket, allows for the sensors to track movements in Letain’s remaining muscles as he performs actions such as grasping a bottle.

“The more data you give it, the more it will learn,” says Lukas-Karim Merhi, project lead. The system also pro(Left to right) Project Lead Lukas-Karim cesses incoming data to make Merhi, para-athlete Danny Letain, and SFU predictions in real time and Engineering Science Professor Carlo Menon generates computer models to improve future performance.

“With this new system, it feels like I’m Letain will use the system during the opening and closing my hand. The most Cybathlon, the inaugural international exciting moment for me was feeling my competition for people with disabilities left index finger and the little finger for who use robotic technology. During the first time since my accident,” says the event, which is expected to draw Letain. “With the hook you don’t use 80 teams from 30 countries, Letain those muscles at all. This system puts will perform everyday tasks such as my mind to work in a whole new way.” slicing bread, opening jars, and more.

PHOTO: Dale Northey, SFU

A team of researchers at Canada’s Simon Fraser University (SFU) has developed a bionic hand embedded with pressure sensors in an armband that track muscle movements in the residual limb. The data is interpreted by an algorithm to move the hand.

The technology is being applied to a robotic arm on loan from Steeper Prosthetics, a company in Leeds, England, and will be used by Paralympic skier Danny Letain when he competes against other people wearing powered arm prostheses in an obstacle course of daily activities at the Cybathlon in Switzerland in October.

The more intuitive control system will replace Letain’s body-powered prosthesis with a pincer-like split hook.

The SFU system has been developed with several grip patterns to allow a variety of actions. The unique armband design, which offers an armband of

HAPPENINGS

MEDIA MADNESS

CERTIFICATION SPOTLIGHT

BOC’s Board Approves Program Changes for Orthotic, Prosthetic, and Pedorthic Certifications www.bocusa.org

Below-knee amputee Reggie Showers is one of 20 people who attempted to cross hundreds of miles through the Serengeti on the National Geographic Channel (NGC) series Mygrations, which premiered in May. Showers is the only amputee among the group, which was comprised of ex-special operations forces, survivalists, athletes, farmers, and others.

Mygrations follows Showers and 19 other individuals as they set out to follow in the steps of wildebeests to cross the savannah— where water, food, and shelter are limited—to reach the Mara River.

The travelers began the six-week journey with packs filled with rations of food and water. The “human herd” encountered mountains, deep ravines, bogs, rivers, and predators along the journey.

To watch Showers and the other competitors travel across the Serengeti, watch the NGC channel on Monday evenings. The finale will air on June 27.

O&P ALMANAC | JUNE 2016

PHOTOS:National Geographic Channel

The Board of Certification/Accreditation (BOC) Board of Directors recently approved a plan to sunset the acceptance of new applications for its orthotist (BOCO), prosthetist (BOCP), and pedorthist (BOCPD) certifications.

The decision will lead to greater growth opportunities for the organization and streamline the professions’ credentialing options. BOC will accept applications for the orthotist, prosthetist, and pedorthist credentials through July 31, 2016.

“BOC has been a recognized partner in these fields for more than 30 years and remains firmly committed to supporting our certificants and the millions of people who depend on BOC professionals to improve the quality of their lives,” says L. Bradley “Brad” Watson, BOCO, BOCP, LPO, chair of the BOC Board of Directors. “The board’s decision will have no impact on current BOC certificants like me. All BOC certificants will have the organization’s support throughout their entire career.”

BOC will continue to provide assistance to all BOC-certified professionals in meeting continuing education requirements, renewing their certifications, and ensuring BOC professionals deliver the highest level of quality patient care.

BOC also remains committed to

representing the interests of the orthotic, prosthetic, and pedorthic professions, including continuing membership and active participation in the O&P Alliance.

“As a leading provider of professional credentials for those providing prosthetic, orthotic, and pedorthic care, BOC has demonstrated for decades its commitment to the patients who depend on BOC certificants for highquality care,” says Susan Stout, president and CEO of Amputee Coalition. “We applaud BOC for standing by its current certificants, ensuring patients continue to have access to care from the providers they depend upon for these essential services. The BOC is making this transition with considerable integrity and commitment to the patients served by BOC certificants.”

The organization’s facility and pharmacy accreditation programs and certification programs for the orthotic fitter (COF), mastectomy fitter (CMF), and durable medical equipment specialists (CDME) are unaffected by the board’s decision. Offering these credentials remains a long-term commitment of the organization.

BOC has been acclaimed for its award-winning innovation and customer service, earning five internationally recognized Stevie Awards.

Both CMS and the Department of Veterans Affairs have accepted the BOC credentials as meeting their standards. Additionally, BOC practitioners are included as qualified providers in the Benefits Improvement and Protection Act of 2000.

Bilateral Amputee Attempts Serengeti Journey

11

HAPPENINGS

O&P ATHLETICS

Wounded Warriors Compete in Invictus Games

12

JUNE 2016 | O&P ALMANAC

president and chief financial officer of Ottobock North America.

“Active-duty military personnel and veterans are often the most challenging people to fit with medical devices. Highly active, aggressive, and goal-oriented individuals—with the determination to match—challenge us to provide the best products and services available,” adds Matt Swiggum, executive vice president of sales and marketing for Ottobock North America.

In addition to the athletic events, an international symposium on “Invisible Wounds” was conducted by the George W. Bush Institute. On May 8, warriors, experts, and community partners gathered to discuss solutions aimed at helping returning service members

improve outcomes for their transition back to civilian life. The discussions addressed the scale and scope of physical and psychological injuries such as post-traumatic stress and traumatic brain injuries.

Ken Fisher and Sarah Rudder

Dave Henson (center)

PHOTOS: Fisher House Foundation

First Lady Michelle Obama and England’s Prince Harry joined forces to open the 2016 Invictus Games in Orlando May 8-12.

The event featured competitions among more than 500 wounded, injured, and ill military personnel and veterans from dozens of countries.

Participants competed in 10 events, including archery, indoor rowing, powerlifting, road cycling, sitting volleyball, swimming, track and field, wheelchair basketball, wheelchair rugby, and wheelchair tennis.

Highlights of the event included double-amputee Dave Henson’s 25.04second run in the 200-meter event, as well Sarah Rudder’s seven-medal performance. Rudder, a U.S. Marine who lost her leg during cleanup of the 9/11 attacks in 2001, won medals in rowing, shotput, lightweight powerlifting, discus, and the 200-meter dash.

Ottobock provided prosthetic and orthotic technical service for the Invictus Games, and staffed a workshop where competitors could go for adjustments and repairs to O&P equipment during the games.

“Ottobock’s engagement in sport is enabling athletes with physical challenges to go to limits they have not reached before. Providing service for the Invictus Games competitors for the second year is an honor,” says Andreas Schultz,

Prince Harry and First Lad y Michelle Obama at th e Invictus G ames

HAPPENINGS

MONEY MATTERS

CODING CORNER

Jurisdiction D Announces LSO/TLSO Prepayment Probe Review Noridian, the Jurisdiction D durable medical equipment Medicare administrative contractor (DME MAC), recently announced the start of a prepayment probe review for all lumbosacral orthoses (LSOs) and thoracolumbosacral orthoses (TLSOs). The purpose of the review is to determine the possibility,

based on the DME MAC’s data analysis, of a potential problem area.

Practitioners who are contacted by Noridian with an additional documentation request (ADR) letter are encouraged to respond to the ADR with all of the documentation requested, including but not limited to the following: • Initial order and detailed written order • Medical records (from physician, hospital, skilled nursing facility, occupational therapist, physical therapist, etc.) that support the medical necessity • Documentation to support the custom-fitted or off-the-shelf orthosis code billed (if applicable) • Proof of delivery • Copy of the verification by the pricing, data analysis, and coding contractor, if required • Any other supporting documentation that may be relevant.

CMS Announces Interest Rate Increase CMS has announced that effective April 19, 2016, the interest rate that applies to Medicare overpayments and underpayments has risen to 10 percent, representing an increase of 0.25 percent since the last quarterly update. Federal regulations require the Medicare interest rate to be adjusted quarterly based on information published by the U.S. Department of the Treasury.

LICENSURE LOOKOUT

Minnesota Legislators Introduce State Licensure Bill

PHOTO: iStock.com/fotoguy22

The state of Minnesota has made progress in adopting a state licensure policy for orthotists, prosthetists, and pedorthists. H.F. 2344/S.F. 1368, An Act to License Orthotists, Prosthetists, and Pedorthists, was introduced May 15, 2015, with bipartisan sponsorship. As of April 11, 2016, the bill had passed review in all committees of the Senate. It is currently being reviewed by the Ways and Means Committee in the House of Representatives. If adopted, Minnesota would join the 15 states in the United States with state licensure requirements.

CORRECTION

In the “Sustainable Outreach” article in the May 2016 issue of O&P Almanac, Allen Ingersoll, CPO, was incorrectly identified as supporting the humanitarian organization Helping Hands for Haiti. The correct name of the organization is Healing Hands for Haiti. Information on the organization is available at www.healinghandsforhaiti.org.

Minnesota State Capitol O&P ALMANAC | JUNE 2016

13

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Michael Fillauer, CPO/L, has been named CEO of Fillauer Companies Inc. Ken Driver, former CEO, will continue to serve on the board of directors as the executive vice chairman of the board. Dennis Williams, CO, Michael Fillauer, BOCO, continues as president and chief CPO/L operating officer of Fillauer Companies Inc. Prior to being named CEO, Fillauer was president of Fillauer LLC, Fillauer’s Chattanooga-based manufacturing, central fabrication, and customer service division. Fillauer began his career as a certified prosthetist/orthotist and an upper-extremity prosthetic specialist in Knoxville, Tennessee. He joined the Fillauer board in 1993 and became president of Fillauer LLC in 2007. He will continue to provide support to Fillauer’s clinical and education teams.

Fillauer is the fourth generation to lead the company, following in the footsteps of his father, Karl Fillauer, CPO/L, FAAOP, current chairman of the board; grandfather, Carlton Fillauer, CPO, FAAOP; great-uncle, George Fillauer Jr.; and great-grandfather and founder, George Fillauer Sr. With this change, Sheri Hassler has been promoted to president of Fillauer LLC. Hassler began her career at Fillauer in 1995 and most recently served as the director of operations for the past nine years.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Össur held an online contest, #MyWinningMoment, encouraging adults with lower-limb loss to share their stories via photo or video on the www.mywinningmoment.com website during the month of May. “We launched this inspiring campaign to celebrate peoples’ everyday victories, whether that means running a marathon or catching up with a runaway toddler,” says Jon Sigurdsson, the company’s president and CEO. “#MyWinningMoment is intended to showcase individuals’ proudest achievements as they themselves define them.”

Entrants of the #MyWinningMoment contest had a chance to win a four-day, three-night trip for two people to Reykjavik, Iceland, home of Össur’s headquarters. Entries are being judged based on story, originality, proper use of prosthesis, composition, and subject. The winner will be announced in June.

David A. Smith has been appointed chairman and CEO of Freedom Innovations. Maynard Carkhuff will assume the role of vice chairman and chief innovation officer and will chair the board’s Technology and Product Portfolio Committee.

Smith most recently served as partner of Health Evolution Partners, and previously served as chairman and CEO officer of PSS World Medical Inc.

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JUNE 2016 | O&P ALMANAC

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REIMBURSEMENT PAGE

By DEVON BERNARD

Mastering the VA Contract Process Learn how to identify, bid, and win contracts with the U.S. Department of Veterans Affairs Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 19 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

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JUNE 2016 | O&P ALMANAC

T

HE RELEASE OF THE revised U.S. Department of Veterans Affairs (VA) prosthetic contracting template in 2014 will continue to have a direct effect on the competiveness of the marketplace when new prosthetic VA contracts are created and opened to the formal bidding process or the request for proposal (RFP) phase. With the new template, the award of VA contracts is now limited by the anticipated need for prosthetic services. The contracting officers—those people in charge of issuing contracts—are required to correctly identify the anticipated need for prosthetic services, to determine the correct number of contracts that need to be awarded outside of the VA system during any specific length of time or contract period.

To accurately predict the anticipated need for prosthetic services, the contracting officers perform a detailed prosthetic services analysis prior to the issuing of any RFPs. This detailed analysis involves reviewing the number of prostheses and repairs to prostheses that were provided to veterans during the previous fiscal year(s) listed in the RFP. The analysis is administered on an aggregate basis for all VA facilities listed in the RFP, as well as for each individual VA medical center identified in the RFP. Since the competition for VA contracts—especially prosthetics contracts—is increasing, this month’s Reimbursement Page reviews the steps involved in the VA contracting process.

Getting Ready To Bid

To be an official vendor to the federal government and compete for contracts covered by Federal Acquisition Regulations (FAR), which includes the VA, you must complete two mandatory steps to qualify as a federal contractor; in addition, there are some optional steps to consider as well.

First, you are required to apply for and obtain a Data Universal Numbering System (DUNS) number. A DUNS number is a unique, nine-digit number that verifies the existence of your company on a global basis. The federal government contracts with Dun & Bradstreet to issue and maintain DUNS numbers. You may apply for a DUNS number free of charge by calling 866/705-5711 or by applying online at http://fedgov.dnb.com/webform/pages/ CCRSearch.jsp. Once you have completed your application, you will typically receive your DUNS within two days.

REIMBURSEMENT PAGE

Second, you must register with the System for Award Management (SAM), formerly known as the Central Contractor Registration (CCR). SAM registration is mandatory for any business competing for contracts covered by FAR. If you previously registered with CCR, note that your CCR username will not work in SAM; you must register with and create a new username in the SAM system.

SAM registration is free and relatively quick, and must be completed online at www.sam.gov/portal/SAM/##11. On the SAM site, click on “Create User Account” and then “Create Individual Account.” Follow all of the prompts and provide the information requested.

That takes care of the two mandatory steps required to bid on a VA contract or RFP, but there are two additional steps that may help ensure the VA bidding process is successful for your facility.

First, check with the Small Business Administration (SBA) and determine if you qualify for and are considered

a small business. The SBA typically uses certain criteria, such as average number of employees or average annual receipts, to determine if a business (sole proprietorship, partnership, corporation, etc.) is considered small. To review all of the criteria and determine if you are considered a small business, visit the SBA website at www.sba.gov/ contracting/getting-started-contractor/ qualifying-small-business.

Why is this important? FAR requires contracting officers to ensure that the interests of small businesses are considered when awarding contracts.

Depending on the ability of these businesses to provide adequate levels of service in the area where the proposed contract will operate, the contracting officer may issue an RFP with either a full set-aside or partial set-aside. If a contract is 100 percent set-aside for small businesses, then only those companies that qualify as a small business may submit a proposal. In areas where the need cannot be met by small businesses,

the contracting officer may issue the RFP with a partial set-aside, which means a percentage of the overall contracts will be awarded to small businesses.

The second optional step is ensuring that your practitioners’ credentials are current and valid, and that your facility’s accreditation information is up to date and accurate. Certain VA contracts may require that each location staff a full-time prosthetist in good standing, certified by either the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) or the Board of Certification/Accreditation (BOC), and that the certified individual be identified in your proposal. Some VA contracts also may require current facility accreditation through either ABC or BOC. In addition, you should verify that any other education requirements are up to date. For example, to provide prosthetic services under the VA prosthetic template, you may be required to demonstrate that your practitioners have received specific education or

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REIMBURSEMENT PAGE

training, perhaps through the manufacturer, if the device you are providing requires product-specific training. The VA reserves the right to determine which, if any, specific services or devices require additional training or education in order to be provided to veterans, so research whether your practitioners will need to obtain any special education.

Identifying Contract Opportunities

The best way to learn which contract opportunities are available in your area is to visit the Federal Business Opportunities website, FedBizOpps, at www.fbo.gov. FedBizOpps features information on all federal contracting opportunities so you should narrow your search to information regarding artificial limbs and braces and the VA—but don’t narrow your search so much that you accidentally omit an opportunity. Under the “Agencies” tab, select “Department of Veterans Affairs” and then do a keyword search for “artificial limb,” “prosthetics,” or “orthotics.” You also may search by your city or the nearest VA office.

While registration is not required on FedBizOpps, you will be able to better navigate the site by registering. To register, locate the box that says “Vendors/ Citizens” and click on “Register Now.” This will open a new window that will request your DUNS number. Enter your DUNS number in this field and click on “Proceed.” The information on file for your DUNS number should automatically transfer into the FedBizOpps system. During the registration process, you will create a username and password that will be used on future visits. Once you are logged into the site, you can search for contracting opportunities with the federal government. Registration also enables you to more quickly and easily add yourself as an interested vendor for RFPs. Another way to ensure you do not miss contracting opportunities is to contact the Veterans Integrated Service Network (VISN) near where you are interested in providing service.

All aspects of contracting with the VA (e.g., negotiations, issuing RFPs, 18

JUNE 2016 | O&P ALMANAC

collecting bids, awarding contracts, etc.) are handled at the VISN level. There are currently 23 VISNs throughout the United States, and each VISN has its own dedicated website with contact information for its headquarters as well as the VA medical centers that fall within its jurisdiction. A detailed map of the 23 VISNs, with links to each location, is available at www2.va.gov/directory/ guide/division_flsh.asp?dnum=1.

There are currently 23 VISNs throughout the United States, and each VISN has its own dedicated website with contact information for its headquarters as well as the VA medical centers that fall within its jurisdiction.

Once you locate the website of the nearest VISN, sign up for that VISN’s listserv to be notified of upcoming contract opportunities. You also may search for the VISN’s contracting officer and attempt to speak directly with that individual, since the actual RFP will be released by the contracting officer within the regional VISN. When you speak to the contracting officer, explain who you are, what you provide, and that you would like to be placed on any potential vendor lists for O&P services.

Demystifying the VA Contract Process

VA contracting rules are guided by FAR and must follow a very specific process, the details of which can be overwhelming. Before any RFP is submitted or contract is signed, be

sure you understand the set-asides for that particular contract, the length of the contract, the number of contracts being awarded, the type of discounts associated with the contract, and when the RFP must be submitted.

The proposal due date is a very important part of the contracting puzzle, so be clear on the deadline for each proposal you write. VISNs and the contracting officers may not be permitted to accept proposals that are returned after the due date listed in the RFP. The majority of VA contracts are awarded for a period of three to five years, usually with one or more “base” years and several “option” years. The base term of the contract, usually between one and three years, represents a timeframe when both parties must adhere to the contract. Option years allow either the VA or the contracting party to choose to renew or terminate the existing contract without penalty.

Typically if an option year is renewed, the terms of the existing contract remain in effect until the next option year, at which time the contract can again be terminated by either party.

The RFP usually provides an estimate of the number of contracts that will be awarded during the set period of time. This number is not set in stone—meaning the final number of contracts awarded may be more or less than the estimate. However, this information is helpful in determining if it is worthwhile pursuing the contract, and it may prove useful when determining what level of discount you are willing to offer, or are willing to accept.

While the VA has stated that price will not be the sole factor used in determining who is awarded a contract, most RFPs contain a section where you may indicate the discount you are willing to provide; the discount is taken as a percentage off of the Medicare fee schedule. The final discount is for all services, even those that may not have an established fee schedule amount.

For example, the new reimbursement policy for unlisted prosthetic codes (L5999, L7499, etc.) is set at 150 percent of your acquisition cost minus any contractually negotiated discount.

REIMBURSEMENT PAGE

The establishment of a consistent reimbursement methodology for unlisted procedure codes allows the contractor to make an informed decision regarding the economic viability of providing prosthetic services described by unlisted procedure codes.

Remember that offering a discount is a business decision that should be based on your understanding of the local marketplace and what is economically viable for your company, and should not be made on a whim—you will be held to it for at least three years.

Finally, each RFP and contract may have certain specifics or points not found in other types of contracts.

For example, with the new prosthetic template, you must be able to provide loaner units to patients who require them while their prosthesis is being repaired by a manufacturer.

In addition, some contracts may require a minimum attendance rate at VA clinics to guarantee your accessibility to veterans.

The Home Stretch: Contracts Awarded

Following the RFP process, the contracting officer at the VISN will review and evaluate all of the bids, make sure that all set-aside requirements have been met, and then award the contracts. If you have been awarded a contract, you will be notified and sent a final copy of the contract for review and final approval and signature by an authorized individual. By signing the contract, you agree to be bound by the terms of the contract for the full base period listed in the contract.

For those contracts you are not awarded, you have the right to file a formal protest—but this is only a viable option if there is evidence that the VISN and the contracting officer did not meet and follow all FAR regulations.

If you are not awarded a contract, you may continue to service the veterans with whom you have an existing clinical relationship. However, you must be willing to accept the payment

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terms of the VA, and sometimes these will be at the lowest negotiated rate of existing contract awards.

Once you understand the steps involved in submitting a proposal to win a VA contract, the process becomes much less overwhelming, and your chances of being awarded a contract greatly increase.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org.

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O&P ALMANAC | JUNE 2016

19

This Just In

Driving Positive Change O&P stakeholders have taken part in several initiatives to secure the future of the profession

G

OOD THINGS USUALLY DON’T

“just happen.” More often, it takes good people to make good things happen—and the follow-up to the April 26-27 AOPA Policy Forum demonstrates that truism. The kickoff legislation writing session, where participants authored the one-page Prosthetic and Orthotic Care Modernization Act, bit.ly/kerreybill, spawned several follow-on “good things.”

First, the stage was set by a pre-Policy Forum AOPA-sponsored press event on April 21, bit.ly/aopapress.

This telenews event underscored the damage caused by the continuing controversy triggered by the now-discredited draft Local Coverage Determination (LCD) and Policy Article for lower-extremity prosthetics. The LCD’s major flaw is that it reverts the standard of prosthetic patient care back to a 1970s level.

Four days later, Rep. Renee Ellmers (R-North Carolina), together with Rep. Jan Schakowsky (D-Illinois), introduced H.R. 5045, bit.ly/ellmersbill, a bill that would establish a moratorium on implementing a revised LCD until spring 2017 and require removal of the draft LCD from the websites of CMS and the durable medical equipment Medicare administrative contractors. The bill also would clarify that CMS is obligated to manage and instruct its contractors to avoid lingering fiascos like the LCD on lower-limb prosthetics.

Removal of the ill-fated proposal from

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the websites is necessary to avoid further private payor action as a basis for denying claims—such as what has happened with United Healthcare and CIGNA in their denials of vacuum-assisted suspension system claims based on the draft LCD provisions.

The morning of April 26 brought the Policy Forum legislation writing session, led by former Sen. Bob Kerrey (D-Nebraska), himself an amputee, who has been solidly engaged in the advocacy efforts by AOPA and its O&P Alliance partners against the draft LCD. Later that afternoon, Kerrey visited several key senators with the one-page O&P legislation in hand.

On April 28, the House Oversight and Government Reform Committee released a letter to U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell, criticizing the LCD efforts of CMS and its contractors, and launched an oversight inquiry requesting an extensive list of documents, including the comments received from the public related to

This Just In

promulgation of the draft LCD and transparency requirements of the process. The committee requested submission of a response from CMS no later than 5 p.m. on May 12, 2016. Visit bit.ly/ogrletter for a copy of the complete letter.

AOPA member Tom Watson, CPO, during his Policy Forum activity and then with an April 29 follow-up letter to Senate Majority Leader Mitch McConnell (R-Kentucky), outlined the details of the effort to stop the draft LCD in its original form from becoming final.

McConnell responded with a letter to CMS Acting Administrator Andy Slavitt on May 5 (bit.ly/mcconnellcms), enclosing Watson’s letter seeking clarification on four issues related to the process (bit.ly/watsonlettter): • What is the current status of the rule?

Why hasn’t CMS rescinded the draft rule? Is there a plan to retract the proposal in the future?

• Who are the stakeholders involved in the working group? How many

prosthetic users and makers are represented on the working group?

• Is the working group considering stakeholder comments submitted to the draft LCD? • Will the working group provide the industry with updates on the topics being discussed?

On May 20, Kerrey followed up with a letter (bit.ly/senatorletters) to eight senators, including Sen. Chuck Grassley (R-Iowa), chair of the Senate Judiciary Committee and member of the Senate Finance Committee.

The Source for Orthotic & Prosthetic Coding

Kerrey’s letter stated, “The favorable CBO score will clear the path for very quick action to enact S. 829’s provisions, whether via the conference report route that we discussed, or inclusion in the Audit & Appeal Fairness, Integrity, and Reforms bill, or other moving Medicare vehicle.” Kerrey’s letter also referenced the O&P Care Modernization act and urged that the senators “accept some of the clarifying language from the single-page version.”

All in all, a number of good things fell into place as the result of monumental efforts by a number of good people, including the 150 AOPA members who took time away from their patients to spend two days in Washington trying to get the profession a fair deal on some of our most difficult challenges.

Editor's Note: For more information and participant reaction from the 2016 AOPA Policy Forum and legislation writing session, please see page 32.

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COVER STORY

Reaching for

FUNCTION

SPECIALISTS DISCUSS THE STATE OF UPPER-LIMB O&P AND OFFER ADVICE ON FITTING PATIENTS

By CHRISTINE UMBRELL

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JUNE 2016 | O&P ALMANAC

COVER STORY

Need To Know Advances in upper-limb prosthetics have led to more options for patients in the form of lighter-weight componentry, improvements in socket designs, and more functional electric-powered devices.

While some patients still prefer passive or body-powered prostheses, recent technological advances mean that more patients have become candidates for upper-limb myoelectric devices that feature more intricate controls.

Health-care providers and payors are becoming more accepting of myoelectric devices as outcomes measures and increased research efforts validate improved function.

Fitting today’s upper-limb amputees often means getting to know the patients’ functional goals, then presenting a variety of options for patients to test. Some patients opt for more than one device, choosing secondary activity-specific terminal devices or cosmetic designs.

Many upper-limb specialists believe acceptance of myoelectric options will grow as pattern recognition systems advance, and as more patients undergo targeted muscle reinnervation and osseointegration surgical procedures to improve functionality with prostheses.

Orthotic patients also are benefitting from myoelectric technology: New myoelectric braces are helping control arm movement for some stroke patients and individuals diagnosed with amyotrophic lateral sclerosis, multiple sclerosis, and spinal cord injuries.

T

ODAY’S O&P PATIENTS ARE faced with many more choices

when compared to previous generations, including electronic options that have become more compact and intuitive. For upperlimb amputees, those options increase the chances that they will choose to use a prosthesis.

“I personally have seen more people with limb loss with the desire to utilize upper-limb prosthetics than ever before,” says Patrick McGahey, LPO, an upper-limb specialist for the Texas Region of Hanger Clinic. “With the advent of greater technological advancements and improved socket designs, patient acceptance has improved. Lighter-weight materials and componentry with improved function have made this a reality.”

McGahey says that higher-level patients have benefitted from designs like elbow lift assist components; lightweight frame designed sockets; and even smaller, lighter-weight external power sources (e.g., flexible battery cell technology). “Also, improvements in silicone sockets have increased wear time and success with the device.”

O&P ALMANAC | JUNE 2016

25

COVER STORY

A Continuing Evolution

PHOTO: Hanger

Advanced technologies options, says Lake. But “not have played a critical role in everyone finds they’ll benefit this evolution in upper-limb from myoelectric prosprosthetics. When electheses,” he says. “It’s easy to get distracted by how much tric-powered prostheses were better the options are today, first introduced, the possibilin terms of terminal devices, ities for improved function materials, and the electronic for upper-limb amputees Patrick McGahey, systems. This advanced increased dramatically. Now LPO technology indeed allows these advanced devices have us to fit much more difficult become more commonplace, patients than in previous years. But it with improvements in size, weight, is important to appreciate that we can materials, and design—but not all more efficiently fit patients now no patients are good matches for elecmatter what option they choose.” tronic options.

Patrick McGahey, LPO, fits an upper-extremity patient at the Klinik Hanger in Haiti.

PHOTO: Lake Prosthetics and Research

utilize pattern recognition software to While myoelectric devices are becomcontrol upper-limb prosthetic compoing more advanced and easier to fit and wear, there are still many patients nents has shown marked improvement whose externally-powered devices do in patient usage where they could not not use myoelectrodes. Some powered generate an isolated contraction on devices “simply use remnant muscles an electrode in the past. Now we can or the residual limb to engage take an array of electromyoswitches, linear transducers, graphic signals and use this or force sensors,” explains as a proportional control Lake. He continues to fit feature for a terminal device.” patients with various input Blair Lock, CEO of methods to maximize their Coapt and an engineer who prosthetic potential. “All of has worked in the field of these types of inputs can be upper-extremity Jonathan Naft, alternatives to, as well as powered prosthetics CPO supplements to, myoelectric since 2003, believes it’s control,” says Lake. an “exciting time” to be Christopher Lake, CPO, FAAOP, “The evolution of myoelectric involved in upper-extremity O&P. adjusts a patient’s externally upper-limb prosthetics has been driven Lock spent a decade working with powered partial hand prosthesis. by technological advances throughout Todd Kuiken, PhD, MD, at the the industry,” says McGahey. “We have Rehabilitation Institute of Chicago, At Lake Prosthetics in Euless, seen multifunctional fingers and grip as director of operations for the TMR Texas, half of the upper-limb patients patterns only imagined in the past. research group. “There have been lots use externally-powered devices, and We are closer than ever at producing of stories and hype in the past about half use passive, body-powered, or systems which will give back a more new technologies that are ‘almost task- or activity-specific devices, says enhanced functional envelope to our available,’ but now they are actually owner Christopher Lake, CPO, FAAOP. becoming available,” says Lock.

During the past few years, as electronic patients. The ability of patients to have true proportional grip or utilize Many upper-limb specialists options have advanced, “the patient surgical enhancements— believe myoelectric devices have been population who can benefit such as targeted muscle more accepted by payors due to the from myoelectric prostheses reinnervation (TMR) to increased research and outcomes has grown exponenfacilitate greater control measures related to the prostheses. tially,” says Lake, who has of upper-limb prosthetic “There’s clearly a swing to the more specialized in upper-limb devices—is simply remarkmodern technology because the prosthetics for 20 years. outcomes and data are showing a “More people are coming able.” McGahey notes that positive impact,” says Jonathan Naft, back now” to try upperyears of research have led Christopher Lake, CPO, general manager of Myomo limb devices, rather than to an explosion of newer CPO, FAAOP and president of Geauga Rehab go without a prosthesis, designs and more intricate Engineering in Chardon, Ohio. because there are more controls: “The ability to 26

JUNE 2016 | O&P ALMANAC

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COVER STORY

Advances in

Myoelectric Bracing T

HE PAST FOUR YEARS have seen significant progress in the development and use of myoelectric upper-extremity braces, says Jonathan Naft, CPO, general manager of Myomo and president of Geauga Rehab Engineering in Chardon, Ohio.

The growth in myoelectric bracing has been increasing, like that of myoelectric prosthetic development. “In the past, there were fewer options for restoring function with upper-extremity bracing. Orthotics focused on supporting and managing various anatomical abnormalities and deficiencies. Sometimes, it was considered a success if you just kept function from getting worse,” says Chris Long, fabrication and research and developChris Long ment supervisor for Geauga. “Now, we have more choices of methods to support a weak limb and restore function.

The use of myoelectric bracing in the O&P market is now a reality, and the ability to restore function is greater than ever.”

The main advantage of myoelectric braces is their ability to support the weakened arm and control movement, says Naft. “Static bracing offers support of the wrist and fingers in a fixed position. Myoelectric devices offer that support, plus they can control movement in the same manner as existing lower-extremity braces. For example, an ankle-foot orthosis (AFO) with dorsi-assist ankle joints supports a weak leg and promotes dorsiflexion at the foot. In a myoelectric brace, the orthosis supports the arm while the joints promote movement at the hand, wrist, and fingers—just like the AFO I described.”

Long, who has been involved in the design of myoelectric braces since their initial development at Myomo, says a typical myoelectric brace incorporates a motor, power supply, and electromyography (EMG) sensors with the intention of restoring function to an otherwise paretic limb. Such a device allows for full anatomical range of motion and also directs that motion.

Today’s myoelectric orthoses are being fit most frequently on stroke patients and brachial plexus patients, but Naft says they also are being used on some brain injury patients, as well as individuals diagnosed with amyotrophic lateral sclerosis, multiple sclerosis, and spinal cord injuries.

Seven years ago, upper-extremity stroke patients “tended to have static bracing on their weak side, but now we have increased the amount of bracing options available compared to 20 years ago,” says Naft. “It’s exciting to have more tools for patients who have an arm but can’t function—now, when appropriately matched with the best brace option, they can function more independently and safely in their home,” says Naft.

Long also notes a sense of satisfaction from seeing “the reaction on the face of a stroke survivor who moves his or her arm for the first time in years.” But he cautions that upper-limb function adds new challenges. “The rate of progress in this area requires a high degree of patience. The success of a device is not always immediately obvious, just like putting a prosthetic leg or lower leg brace on a patient and having him or her stand and walk,” he says. “It may take several therapy sessions and training to get advanced functions from an arm or myoelectric brace. It also requires an appropriate match with the patient and learning how to manage their expectations.”

Long sees a bright future for myoelectric bracing, as more people and payors come to understand the benefits. “As myoelectrics continue to gain acceptance and are encouraged in upper-extremity orthotics, the future of these devices will be just as bright” as upper-extremity prosthetics, says Long. “There will be a new paradigm regarding how to treat patients with upper-limb deficiencies or loss of function.

“What’s being accomplished today will motivate further interest into new products that will continue to improve function,” adds Long.

“We will likely see an increasingly blurred line between orthotics and prosthetics with regard to maximizing and improving function.”

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JUNE 2016 | O&P ALMANAC

PHOTOS: Geauga Rehabilitation Engineering

Patients wear myoelectric braces to complete activities of daily living.

COVER STORY

PHOTOS: Lake Prosthetics and Research

Christopher Lake, CPO, FAAOP, works with a patient to adjust an activity-specific prosthesis.

Naft says the use of standardized outcomes measures to evaluate patients before they are fit with a device, on initial fitting of the device, and again after they have used the device has led to increased recognition by both health-care providers and payors of the myoelectric devices.

Specifically, he notes that the Box and Block Test; the Disabilities of the Arm, Shoulder, and Hand (DASH) Score; and the Fugl-Meyer are being used to evaluate upper-limb patients. The data points provided by those tests “are nationally validated predictors of how patients will do at home and help guide you in training your patients,” says Naft. Low scores at the initial fitting help therapists conduct more extensive training for patients than is needed for patients with higher initial scores.

Outcomes measures help justify more advanced devices—which is critical for reimbursement. “A low score helps validate the need for a device, and an improved score over time helps justify that reimbursement dollars were spent appropriately,” says Naft.

Fitting Today’s Patients

Determining which type of prosthetic arm—whether electronic, body-powered, or passive—will work best for a particular patient is one of the greatest challenges in working with upperextremity O&P. That determination “is most often not fully fleshed out until the patient has had the opportunity to utilize a preliminary prosthesis,” says Matthew Garibaldi, MS, CPO, an upper-limb specialist and director of the Orthotic and Prosthetic Centers at the University of California— San Francisco (UCSF). “It’s the

prosthetist’s role to act as a guide to the patient in the device selection process; however, we want to create a patient-centered experience—so including them in the decision-making process is key to a successful outcome.”

Lake says he begins patient fittings by gathering information on each to identify the most viable prosthetic patient’s preamputation life as well solution.” as his or her vocational and avoca Many patients with upper-limb prostheses will settle on more than one tional goals. Then, he presents several solution—especially if they will benefit options. “The patient needs to play the from activity-specific devices. “It’s not dominating part of what will be the uncommon for users to have dedicated best path; then, I help temper expectaprostheses for recreational activities tions and paint the reality,” he says. such as cycling, fishing, golf, archery, When McGahey fits upper-exand more,” says Garibaldi. “Because tremity patients—using an increasingly these devices are only specific to one multidisciplinary team approach—the “functional needs and activities of daily activity, a second daily use prosthesis is quite common. Additionally, some living are assessed through common patients opt for a more cosmetic prosstandards such as the DASH test, hobbies, and work-related activities,” thesis in social settings, and utilize a he says. “By utilizing accepted practice more functional device as needed.” approaches developed in occupational McGahey also sees many patients therapy such as the DASH test, the who have more than one type of prosdesign is much more holistic, meeting thetic arm: “I have patients who utilize many needs of the patient.” externally powered devices where The final device decision grip strength is needed, may take time and several and when they desire trial runs. “The problem with this particular feature for patient input following the secure grasp. This may be early stages of amputation in the workplace or while is that they don’t yet fully performing activities of understand the limitations or daily living at their home. benefits of currently availThese same patients also Matthew Garibaldi, may incorporate activiable devices,” says Garibaldi.

MS, CPO “This is where a bit of ty-specific terminal devices, trial-and-error is required such as a body-powered O&P ALMANAC | JUNE 2016

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COVER STORY

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JUNE 2016 | O&P ALMANAC

and more advanced sensors will be available by way of implantable technology. “Those four things together are beginning to happen, and their convergence really makes for a significant change,” says Lock.

In particular, Lock notes that an increase in TMR surgeries for above-elbow amputees will be life-changing. “For above-elbow amputees, TMR really makes use of myoelectric devices much more accessible,” says Lock. “It is often very cumbersome to use myoelectric devices with above-elbow amputations—but with TMR, it can become more like a belowelbow fitting.”

McGahey believes the future will bring “simpler, user-friendly designs due to technological control improvements…. Microprocessors have truly been a game changer. The ability to enhance end-user function with complex microprocessors is impressive.” But he also believes the simple body-powered enhancements will be more widely utilized. In addition, McGahey says, “The newer prosthetic socket designs and interfaces, such as silicone, are greatly going to enhance the patient experience and provide added comfort for the end user in the future.”

As myoelectric options evolve, it is clear that, while some patients will continue to benefit from traditional options, upper-limb amputees will increasingly seek advanced myoelectric devices that evolve to meet patients’ increasing demands to return to an improved quality of life.

“I do not feel we should ever underestimate the need for human interaction and peer acceptance when it comes to upper-limb prosthetic use,” says McGahey. “Feeling whole again in the workplace or in society is now an attainable goal we should pursue for our patients as upper-limb clinicians.”

Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

PHOTO: Coapt

hook when working in the yard. Some of the best devices can sometimes be the simplest in design.” McGahey says the ability for a patient to get plugged into society is often achieved by supporting the patient with an avocational hobby or task. “We need to give the patients hope that they can return to a productive lifestyle, and often the best way is to provide tools for assisting the patients in activities of daily living and hobbies that they assumed they would never be able to pursue again.”

For practitioners who are new to upper-limb patient care, there are plenty of resources An upper-limb amputee uses a myoelectric prosthesis. available. Lake cautions that prosthetists should do their most promise to address many of the homework before presenting electronic past challenges of myoelectric fittings options to patients and should read the that utilized one or two input elecliterature in manufacturers’ libraries, trodes.” He says, “Myoelectric control attend presentations at national meethas always represented an inherent level of control, which is more physiings, and stay current on the latest research. ologically correct. Pattern recognition Lock also encourages practitioners builds on the benefits of traditional who have not fit many myoelectric myoelectric control and adds signifdevices to conduct research and take icant processing that defines exactly part in educational opportunities. “The what the user intends. In contrast to burden involved in fitting a myoelectraditional myoelectric systems that require the patient to adapt to a preset tric device is not as overwhelming as it control method, pattern recognition once was,” he says. adapts to the patient’s unique neuroMore Advances on the Horizon muscular signature, thus allowing authentic volitional control of the Myoelectric devices have indeed come prosthesis.” a long way, but most practitioners Many upper-limb specialists believe the next few years will present believe that more functionality will even more innovation. be available to those upper-extremity Garibaldi predicts that more advanced control mechanisms will have amputees who are candidates for advanced surgeries (e.g., TMR and a great impact on upper-limb control. osseointegration). Lock predicts the “Not until we’re able to create a direct field of upper-limb prosthetics will neurological connection between the undergo a significant positive change patient and the device will we see as four phenomena mature and an uptick in functionality with more converge: TMR will enable a better complex devices,” he says. Toward that end, several brain-to-interface research way for devices to “get information” from patients; osseointegration will initiatives are underway at UCSF and offer a “better way to wear” devices; other institutions across the country. advanced control systems (computLake foresees a future in which myoelectric devices utilizing pattern er-algorithm enabling motions) will recognition systems will overtake all allow for improved communications other options because they “hold the between patients and their devices;

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AOPA 2016

POLICY

FORUM

ACTION THROUGH

OWNERSHIP ATTENDEES OF THE 2016 AOPA POLICY FORUM DISCUSS THE EXPERIENCE OF JOINTLY DEVELOPING A BILL AND PRESENTING IT TO LAWMAKERS

By JOSEPHINE ROSSI

JUNE 2016 | O&P ALMANAC

PHOTO: Top-Lawrence Jackson/whitehouse.gov

32

O

VER THE PAST 24 YEARS, the AOPA Policy Forum has become the seminal event for advocacy—not only for O&P professionals’ livelihoods but also for their patients whose mobility and quality of life hang in the balance. Each year, hundreds of providers and patients come together as a unified voice on Capitol Hill to meet with their respective lawmakers and educate them on the most pressing issues affecting the profession and how to resolve them.

This year, organizers took that participation level one step further by hosting a legislation writing session where attendees jointly authored a bill to address the various challenges the O&P community continues to face.

“It is critically important that we do not allow ourselves to be defined by the chaos that we find ourselves currently in,” James Campbell, PhD, CO, FAAOP, chief clinical officer at James Campbell, Hanger Clinic and AOPA president reminded participants.

PhD, CO, FAAOP “Rather, it is important that we are defined by the initiatives and the actions that we take within the chaotic environment.”

Led by former Sen. Bob Kerrey (D-Nebraska), the event featured group break-out sessions where smaller teams discussed the merits of a draft bill featuring seven key issues, including the separation of O&P from durable medical equipment, clear definitions for off-the-shelf orthoses and minimal self adjustment, the connection between the Former Sen. Bob qualifications of the provider and Medicare payments, and more.

Kerrey (D-Nebraska) “The good news is you don’t have to be a lawyer to write a law.

I’m not a lawyer, and I wrote laws up here for 12 years,” Kerrey told attendees. “But, you increase the likelihood that you’ll get what you want done done if you know what’s in that legislation, if you really own that legislation.”

The teams weighed not only the issues themselves, but also the semantics and syntax of how they were presented—and how lawmakers could perceive them. In the end, the teams elected to combine and eliminate two issues to form a one-page bill, the Prosthetic and Orthotic Care Modernization Act, consisting of five topics that Kerrey then personally presented on the Hill. (Visit bit.ly/kerreybill to read the full bill.)

“If it’s small and it’s narrow, I think you could actually get something done this year,” Kerrey said. “It’s hard for me to imagine the argument that any member of Congress could use against the language written.”

How did participants react to this new level of advocacy and ownership? Five attendees share their perspectives on jointly developing a bill and sharing it with lawmakers and their staffs on Capitol Hill.

S

USAN PAUL, PT, CEAS, came to

the Policy Forum to help raise visibility for practitioners as healthcare professionals. Paul, who spent 32 years as a physical therapist and rehabilitation director for a multisite company, was named director of compliance, regulatory affairs, and training for Comprehensive Prosthetics and Orthotics in Peoria, Illinois, in January.

We need to get “everybody to the table equally who is taking care of patients, and that should include O&P practitioners,” she says. “I think we’ve done a lot of things in the background for people, and now we need to be in the forefront.”

Susan Paul, PT, CEAS

Although Paul had participated in letter writing campaigns for the American Physical Therapy Association and policy development for other organizations, this was her first visit to Washington to “stump the Hill,” and crafting the bill with her colleagues was a new and beneficial experience.

“I think it helped to really direct our ask, inform us of what we were truly asking for. Normally, when I’ve gone to do anything, everything’s been laid out [for] us—‘This is what you’re asking,

O&P ALMANAC | JUNE 2016

33

AOPA 2016

POLICY

FORUM

this is what you’re going to do.’ I felt like we were much more a part of that ask … by writing that piece of legislation.”

On the second day of the Policy Forum, Paul and other participants from Illinois had appointments at nine congressional offices, including the office of Rep. Cheri Bustos (D), who unexpectedly met with the group.

“She was very well informed of what our issues were; we didn’t actually know that the new [bill] already had a number,” says Paul.

At the other offices, the group met with legislative aides. “Some of them, you could tell, were trying (Left to right) Scott Williamson, MBA; Dylan Baas (student); Rep. Martha Roby (R-Alabama); to be attentive and interested. and Glenn Crumpton, LPO, CPed It wasn’t their area,” she says.

“And then, in other places, the aides were pretty helpful. So we ended up funding to to academic institutions with some good direction [on how the for master’s- and doctorate-level O&P legislative process works], while we programs. “We’ve made a really nice were actually talking about our issues. commitment to taking residents and I hope [the meetings] raised the level of doing those trainings within our orgainterest in O&P … and I don’t think that nization, so that will continue, and I’m what we’re asking for is controversial. I hoping to build our residency program think it just makes sense.” to be even stronger,” she says.

Paul is already looking forward to next year’s event, when she will be LENN CRUMPTON, LPO, CPED, ready to “be a little more loud and and president and CEO of proud about what we need to have Alabama Artificial Limb & Orthopedic changed” in 2017. But in the meantime, Service Inc. in Montgomery, has been she and her organization are taking attending AOPA Policy Forums since to heart the tenets of the Wounded 2000. He says that while the issues disWarrior Workforce Enhancement cussed were similar to previous years, Act—another bill participants discussed “with the release of last year’s draft with lawmakers that seeks to provide LCD [Local Coverage Determination

G

(Left) Scott Williamson, MBA, and Glenn Crumpton, LPO, CPed

JUNE 2016 | O&P ALMANAC

A professional issues class last fall prompted second-year master’s degree student EMILY BELL to make the trip to Washington. “I was really excited to get involved; I noticed the climate in the O&P profession right now is coming to a head,” she explains.

“There are a couple of different paths that we could take, and there’s a big moment happening in the field, so I definitely wanted to go … and see what the details were about it, and then to do something about it.”

PHOTOS: Scott Williamson, MBA

34

and Policy Article for lower-limb prostheses], this year seemed like it had an added degree of importance. I felt that I needed to be sure that the message to CMS was at least on my legislators’ minds.”

Crumpton is no stranger to legislative activities. As an active participant at the state level, he has experience in drafting proposed legislation. Still, he appreciated the ability to participate at the national level during the policy writing session. “Sen. Kerrey was a valuable asset and helped promote a positive and productive experience.”

While none of his congressional representatives have a direct influence on the issues at the forefront of AOPA’s advocacy efforts, Crumpton visited a number of offices and spoke to three members from Alabama directly—Reps. Mike Rogers (R), Robert Aderholt (R), and Martha Roby (R). “[They] seemed to hear our message and offered to research the issues and support our position,” he says.

He’s also hopeful that attendees’ efforts will produce a result. “There was a lot of conversation about bills that were moving and had a possibility of passage that actually sounded positive,” he says. “I have grown accustomed to being hopeful to have very little happen. This year seems like a different tone. So, I am cautiously optimistic.”

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Shelly Hogan

Patients are scared of losing their benefits, says SHELLY HOGAN, compliance and prosthetic account manager at Yanke Bionics Inc., which serves three counties in northeastern Ohio. She participated in her third Policy Forum “to be their voice, to share their concerns to our Senate and congressional leaders about how important their orthotic and prosthetic services are to their everyday lives,” she says.

“The certification process ensures a standard of care that our patients deserve,” she says of issues affecting her business.

“Competing with the noncertified providers is a disservice to the orthotic and prosthetic industry as a whole, but what it does to the patients in our community is bordering on negligence.”

Although the experience can be a bit nerve-racking, Hogan says she is grateful to be able to participate in the Forum and have her message heard. During her time on the Hill, she visited the offices of Sens. Sherrod Brown (D) and Rob Portman (R) as well as Reps. David Joyce (R), Marcia Fudge (D), Steve Stivers (R), and Jim Renacci (R).

“I invited Reps. Fudge and Renacci to our offices so that they can meet our patients and hear from them the issues they are facing. Both of their offices were very positive and we will be scheduling visits in the near future,” says Hogan. “It will also be an opportunity for them to see our facilities and get a true understanding of the type of care we provide as licensed orthotic and prosthetic providers.”

PHOTOS: Shelly Hogan

professional and patient-focused organiBell, who is studying at the University of Pittsburgh, recently zations. It also solidified her decision to started her summer clinical rotations. go into research after graduation.

She’s never participated in a policy “Now I think I’m pretty sure that writing event and describes the I want to go into research and may experience as both educational and pursue a higher degree,” she explains. challenging. While she was pleased “That would be really rewarding for to see that a consensus existed me to be able to provide concrete among most participants regarding evidence,” and help satisfy the growing the tenets of the co-created bill, she demand for research in the O&P field. also was disappointed to have to pare “So there’s a lot to contribute to the down the bill so that it was palatable research body.” for lawmakers.

“It was kind of frustrating when you want to write a piece of legislation and you have so much that you want to say, but people keep telling you, ‘People aren’t going to pay attention if it’s too long,’” she says. “There are a number of items that people are concerned about, but it was frustrating that we had to just focus on a couple. That’s the nature of Washington, I guess.”

Because she is a student from out of state, Bell had the opportunity to visit lawmakers not only from Pennsylvania, but also from her home state of Virginia.

She met with Rep. Randy Forbes (R), who represents the county of her hometown of Richmond, and she also met with Sen. Mark Warner (D). “There really wasn’t much to say to Sen. Warner because he’s already on board, obviously, so that was kind of nice. It feels good to know that someone from my home state cares so much.”

The networking opportunity—with fellow students and veteran professionals— was just one of the benefits of going to the nation’s capital, says Bell. Being there heightened her interest in becoming (Left to right) Tony Sertick, Jim Lawson, Shelly Hogan, more active in various O&P Larry Allen, CPO, and Ryan Arbogast

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The staff at Yanke Bionics is diligent about educating its employees and patients about current health-care issues, and Hogan says many patients want to get involved. “Providing them with avenues to reach out to their Senate and congressional representatives is one way we can continue to make sure our message is being heard.”

T

ED DRYGAS, CPO, FAAOP, is no

stranger to advocacy work. The founder and owner of Care Crafters Prosthetics & Orthotics Inc. in Nanuet, New York, says the importance of community involvement was instilled in him by his parents and is a must for the O&P profession.

“The industry’s changing, and before the industry goes away, we need to be involved and make change. We have to,” he says.

doing this for “We’re health care—to move the patients forward, to be safe and secure, and as ambulatory as possible in

”

their daily routine.

–TED DRYGAS, CPO, FAAOP

In particular, Drygas questions the judgment of CMS, which has failed to follow Section 427 of the Benefit Improvement and Protection Act (BIPA) to only reimburse custom, licensed and/or certified O&P care providers. “Sixty percent of billing to Medicare is from noncredentialed suppliers. If they’re all about fraud and abuse, and then they’re not putting [into place something] that combats it”—that makes you wonder why, he says.

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JUNE 2016 | O&P ALMANAC

PHOTO: Ted Drygas, CPO, FAAOP

Participating in the policy writing event was “good to get us to understand the issues,” but he realizes the plethora of information can be a lot to handle. “It’s often overwhelming as a first timer,” says Drygas, who was attending his third Policy Forum.

While visiting lawmakers and their aides, Drygas and other O&P professionals from New York were accompanied by amputee Ed Steele, who presented a patient’s perspective on the critical role O&P clinicians play in ambulation. “Ed’s a great walker!

We should’ve made him come in an unfinished prosthesis and made him wear shorts,” says Drygas. “Because he looks good. Even if he wears shorts, it looks like he’s wearing a knee brace.

It doesn’t look like he’s an amputee.

And Medicare wants to take away his Harmony system.

“It’s not like we’re [running] a Ponzi scheme or anything. We’re doing this

for health care—to move the patients forward, to be safe and secure, and as ambulatory as possible in their daily routine,” Drygas continues. “You know, it’s weird that Medicare looks at why we’re not allowed to use our notes, and why the doc can’t follow up on our notes. They have to create notes. Well, I have to tell them what the notes have to say!”

Still, Drygas says his visit to the Hill was effective this third time around because he and his colleagues were able to build upon relationships started at previous meetings and Policy Forums.

“At [Sen. Charles] Schumer’s (D) office... this year, we went into the conference room; the last two years we met out in the hall. So, I think creating a relationship helps us move forward.”

Josephine Rossi is editor of O&P Almanac.

Reach her at jrossi@contentcommunicators.com.

(Left) Ted Drygas, CPO, FAAOP, and patient advocate Ed Steele

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39

Meet the Thranhardt Contenders

Preview the clinical research to be shared during the Thranhardt Lecture Series in Boston

In 1995, J.E. Hanger estab-

TITLE

Increasing Functional Independence Through Prosthetic Rehabilitation: An Evidence-Based Project

AUTHORS

Gordon L. Stevens, CPO, LPO; Elizabeth Ginzel, CPO, LPO; Jennie Rhodes, MPO; Shannon O’Neal, DPT; and Omar Selod, DO

AFFILIATIONS

Baker O&P; Fort Worth PT; PMR Fort Worth

What prompted you to undertake this study?

As we all know, other sectors of health care are in the midst of a transition from fee-for-service to value-based care, and O&P will rapidly be faced with similar challenges. We routinely found that our patients who underwent a rehabilitative program with the physical therapist (PT) and physical rehabilitation medicine physician along with the prosthetist exhibited a greater increase in functional independence. Unfortunately, these observations were merely qualitative in nature, so we established a rehabilitation program and tracking system that could be easily accessed by the entire team to document outcome measures. The aim of the project was to provide quantitative data exhibiting an increase in functional independence by amputees who underwent the interdisciplinary team-based program.

Please describe your methods in lay terms.

The program used a health-care team of five prosthetists, two PTs, and four physical medicine rehabilitation physicians. Physicians provided medical necessity and directed care, physical therapists provided amputee-specific gait training, and prosthetists established continuity of care and prosthetic services. Transfemoral and transtibial amputees within the Dallas-Fort Worth metroplex, with the majority undergoing amputation secondary to dysvascular complications, were incorporated into the study. Patients underwent approximately six to eight weeks of prosthetic rehabilitation; both PTs and prosthetists administered tests from initial evaluation through six months postdelivery. Outcome measures included the Amputee Mobility Predictor, Timed Up and Go (TUG) Test, and the Six-Minute Walk Test.

How might the results affect the O&P field?

At the conclusion of the study, participants exhibited an average increase of 9 points on the Amputee Mobility Test and a 13.6-second decrease in the TUG Test, indicating a measurable increase of function with the use of the rehabilitation team. Our goal is that the preliminary findings provide data supporting the increased use of a multidisciplinary rehabilitation team in prosthetic rehabilitation, improve functional independence, and ultimately result in a reduction in health-care spending over the long term.

Do you envision future studies stemming from this one?

We have expanded upon the small test of change to include a larger sample size of amputees and are working to expand the program to other markets across the country. In addition, we are collaborating with the interdisciplinary team to form a similar program for neuro-based orthotics.

lished an award to honor Howard R. Thranhardt, CP, to recognize individuals committed to advancing O&P education and research. Contenders for the prestigious award present their research at the AOPA National Assembly each year, where the winner or winners are selected. The O&P Almanac asked this year’s four contenders a series of questions about their research and its potential impact on the field. *Author names in bold provided the information in this article.

Elizabeth Ginzel, CPO, LPO 40

JUNE 2016 | O&P ALMANAC

Beatrice Janka, MPO, CPO

Kenton R. Kaufman, PhD, PE

The Effects of AFO Stiffness and Alignment on Lower-Extremity Kinematics in Stroke and Multiple Sclerosis

Functional Assessment and Satisfaction in K2 Transfemoral Amputees Receiving MPK Knees—Initial Findings

Beatrice Janka, MPO, CPO; Nicholas LeCursi, CO; and Timothy Lindsay, PhD

Kenton R. Kaufman, PhD, PE; Kathie Bernhardt; and Kevin Symms, CPO

Becker Orthopedic; Eastern Michigan University

Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Hanger Clinic, Austin, TX

Compared to other disciplines, the evidence base in the field of orthotics is relatively small. Every day clinicians design lower-extremity orthoses to compensate for a variety of gait deficits. In many cases clinicians rely heavily on their experience rather than defined evidence to determine the best methods of treating each patient. This research is aimed at filling a small portion of the gap between knowledge and practice, to help develop more effective clinical methods and improve patient care.

There is evidence that high per capita health-care spending does not always lead to better health outcomes. This fact has increased the need for comparative effectiveness research and accountability for quality of care provided in clinical practice. There have been reports in the literature that K2 amputees who received a microprocessor-controlled prosthetic knee (MPK) improved functionally to a K3 level. The goal of this study was to develop high-quality, comparative-effectiveness clinical evidence for the use of microprocessor controlled vs. nonmicroprocessor controlled prosthetic knees in the aging transfemoral amputee population.

The focus of this study was to determine what effect sagittal orthosis characteristics have on gait and how patients’ patterns of biomechanical deficits impact the orthotic influence. Stroke and multiple sclerosis subjects walked on a treadmill while wearing custom-articulated anklefoot orthoses, and their gait kinematics were measured using a motion analysis system. The ankle joint facilitated control of plantarflexion resistance, dorsiflexion resistance, and ankle alignment to explore the effect of incremental adjustment of these features in relative isolation.

The study focused on K2 amputees who are not now deemed eligible for MPKs. Subjects, who were 55 to 93 years old, entered the study with a nonmicroprocessor knee. They switched to a MPK for 10 weeks and then converted back to their original knee. We evaluated how these patients functioned in their home environment.

We obtained objective measures of their functional outcomes as well as their safety, as measured by the number of stumbles and falls they experienced.

These results help improve our understanding of the relative contribution of each of these features to functional gait. Using this knowledge, clinicians may be able to improve the quality of care they provide to patients and more precisely tune orthoses to patients’ needs.

We hope, by the end of the study, to determine an objective metric describing which older individuals with limb loss will benefit from a MPK. This demarcation will make it clearer for both prosthetists and third-party payors to determine who should receive a MPK. We also hope that this information can then be used to change medical policy regarding medical necessity for receipt of a MPK in the aging population.

Most definitely. We have just uncovered the tip of an iceberg with these preliminary data. We plan to extend this pilot study to additional participants to increase the power of our results. By increasing the number of participants, we can further explore the influence of different patterns of biomechanical deficits. Beyond the effects that ankle component adjustments have on gait variables, it would be valuable to know how those adjustments affect temporal gait parameters and the efficacy of the orthosis. There also are other orthosis characteristics that need to be evaluated in addition to the three that were the focus of this study.

Today, many patients receive state-of-the-art prosthetic devices, which enable them to lead active, healthy lives, maintain employment, and pursue recreational and athletic interests. Unfortunately, prosthetic prescriptions vary considerably, and many patients with limb loss do not receive the same level of care. All research studies generate further questions if they are good studies. There may be a need to further refine the exact profile of an amputee who benefits from a MPK.

O&P ALMANAC | JUNE 2016

41

Meet the Thrandhardt Contenders Lauren White, PT, DPT, PCS

42

TITLE

Development and Implementation of a Clinical Decision-Making Algorithm for Aiding Orthotic Prescription for Patients With Neurological Impairments

AUTHORS

Lauren White, PT, DPT, PCS; Jennifer Boyle, PT, DPT; Mark Hopkins, PT, CPO, MBA; and Rebecca Martin, OTD, OTR/L

AFFILIATIONS

Kennedy Krieger, International Center for Spinal Cord Injury

What prompted you to undertake this study?

Several years ago, a team of therapists at Kennedy Krieger Institute’s International Center for Spinal Cord Injury sat down to discuss the idea of making clinicianfriendly guidelines to assist with orthotic prescriptions in patients with neurological injury who had a goal of walking. Initially, this project was geared specifically toward the spinal cord injury population. However, what began as small group meetings to develop clinician-friendly handouts developed into a multiyear project to create a comprehensive decision-making algorithm with supplemental resources. Our primary goal remained the same from day one: to improve accuracy and appropriateness—efficiency—of orthotic prescriptions for our patients.

Please describe your methods in lay terms.

Our team of physical therapists and orthotists has been meeting twice a week for several years to develop this project. We broke down the decision making based on the functional presentation of the patient. Through years of meeting as a team, we determined the overall design of the project to be a top-down function-based algorithm, with supplemental resources that would aid in orthotic prescription. Through many edits among our team, as well as feedback from small focus groups over the past year, the algorithm is now being translated from paper format to an electronic tool.

How might the results affect the O&P field?

We believe that our algorithm will help guide decision making such that patients with neurological impairments receive the right brace at the right time to optimize their mobility. Our goal is to improve patient quality of life and maximize their independence. Our hope is that this tool improves both efficiency and accuracy of orthotic prescriptions, therefore improving outcomes for patients.

Do you envision future studies stemming from this one?

Our vision is for this to be a living, breathing resource for medical professionals. Due to its electronic nature, we have the ability and plan to update this tool based on advancements and changes in the field, as well as feedback from clinical use. We envision future studies that focus on client outcomes, prescription accuracy, and user feedback.

JUNE 2016 | O&P ALMANAC

It’s not endo or exo, it’s

Proximal Attachment with Open Distal End

Multiple Attachment Options

This feature allows easy access for pull-in designs and provides the amputee with a transfer of force proximal to the cut bone end.

The NEXO system offers two socket ring options: set screws for easy adjustment and adhesive for a lowprofile, cosmetic finish.

Flexible PEEK Rods The NEXO’s PEEK rods are lightweight and strong.

Because of their flexibility, they reduce rotational and perpendicular vibration to the residual limb.

Quick Disconnect Wrist Included Simply change terminal devices with the USMCstyle quick disconnect wrist, previously only available for use in an exoskeletal system.

www.fillauer.com © 2016 Fillauer LLC

MEMBER SPOTLIGHT

Garrison’s Prosthetic Services

By DEBORAH CONN

Serving the Sunshine State Solo-practitioner facility celebrates 30 years providing O&P care in South Florida

A

N UNCOMFORTABLE PROSTHETIC LEG was the

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Kevin S. Garrison, CP, LP, sets a prosthetic knee rotation.

FACILITY: Garrison’s Prosthetic Services OWNER: Kevin S. Garrison, CP, LP LOCATION: North Miami Beach, Florida HISTORY: 30 years

Garrison adjusts the length of a prosthesis.

“I knew exactly what I wanted,” he says, which included special venting and full accessibility, with no ramps, steps, or other barriers, and no wasted space.

Garrison is the sole practitioner, with a technician and two office employees. Being in South Florida, he primarily treats geriatric patients, which account for 90 percent of his cases. Only 2 percent of his patients require upper-extremity prostheses. “About 20 percent of my patients in Chicago needed upper-extremity devices, so I got a lot of experience there,” he says. “When I get those few here, I enjoy working with them.”

South Florida also means the facility sees a large number of Spanish-speaking patients.

Garrison understands the language, and other employees speak it fluently.

In 2005, Garrison wrote a book, It’s Just a Matter of Balance: You Can’t Put a Straight Leg on a Crooked Man, that is informed by his experience as an amputee for more than 30

years. “I wrote it from the point of view of a skilled professional, discussing the psychological effects of losing a limb, degrees of adjustments, problems, and complaints. I am very honest about my feelings, including anger, which is a normal part of the process,” he says.

Garrison issued a second edition, updating a number of passages, in 2012. The book is listed in a military protocol manual for psychotherapists in the bibliotherapy section for amputee care.

Heavily involved in humanitarian efforts, Garrison travelled to Haiti two years ago with Medical Teams International, where he helped organize a prosthetic lab and provided care to residents. In Florida, his facility donates components to Bon Secours Hospital and offers pro bono care to some of its patients.

Another interest is research, and Garrison is involved in a study with Florida International University’s biomedical engineering department. “I can’t discuss the research yet, but it is something I hope will be part of my legacy,” he says.

Otherwise, Garrison plans to continue his prosthetic work as long as he is physically able.

“I know what I’m doing, and I really care about taking good care of my patients,” he says.

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

PHOTOS: Garrison’s Prosthetic Services

impetus that eventually led Kevin S. Garrison, CP, LP, to open his own facility: Garrison’s Prosthetic Services, in North Miami Beach, Florida. The facility celebrates its 30th anniversary this year.

Garrison lost his right foot to cancer in 1971, when he was a teenager. He went through three different prostheses, and none of them were comfortable. “One day I thought, I’m going to get a job in a prosthetic facility to see how I like it,” Garrison says.

“Then I can make my own leg.”

Garrison became the youngest student to ever apply to a belowknee prosthetics course at the University of California—Los Angeles. He subsequently attended the prosthetic program at Northwestern University, where he followed through on his plan and fabricated his own comfortable and pain-free prosthesis, which he laminated in purple.

After working as a prosthetist in Evansville, Indiana, and Chicago, Garrison moved to South Florida in 1981 to be near family. Five years later, he opened Garrison’s Prosthetic Services.

In 1991, Garrison bought and renovated a building to house his practice. The facility features a reception area, two cast rooms with sinks, two additional fitting rooms, and a 25-foot-long parallel bar room, with mirrors at either end. The fabrication lab accounts for about half of the facility’s 2,500 square feet and is accessible from every room.

MEMBER SPOTLIGHT

Coapt LLC

By DEBORAH CONN

Arms Control Company leverages pattern recognition to improve movements of myoelectric prostheses

T

HE FOUNDERS OF COAPT

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Blair Lock, Coapt CEO

COMPANY: Coapt LLC OWNERS: Blair Lock; Todd Kuiken, PhD, MD; Levi Hargrove, PhD; and Jonathan Sensinger, PhD LOCATION: Chicago HISTORY: Four years

Prosthetic arm and hand with Complete Control technology

standard myoelectric control and Complete Control: The former recognizes only volume, while Complete Control is like hearing what song is playing.

In addition, conventional myoelectric control often requires users to perform nonintuitive movements to control the prosthesis, such as flexing or extending muscles associated with the wrist to open or close the hand. With Complete Control, says Lock, contractions in muscles related to the hand control the prosthetic hand, and wrist-related contractions control the prosthetic wrist.

“Amputees can learn to use the device more quickly, because it is so intuitive. They also have the ability to recalibrate to account for changes in socket fit, skin condition, and other factors,” says Lock.

Complete Control is an add-on system that can be used with any myoelectric prosthesis. “We share good, collaborative relationships with the upper-extremity manufacturers in the market,” says Lock.

Because the system relies on an array of electrodes rather than one

PHOTOS: Coapt LLC

LLC—Blair Lock; Todd Kuiken, PhD, MD; Levi Hargrove, PhD; and Jonathan Sensinger, PhD— were all part of a research group at the Rehabilitation Institute of Chicago that spent 10 years developing a new system to control upper-extremity powered myoelectric prostheses.

The technology, called Complete Control, uses pattern recognition to predict an amputee’s intentions. It offers intuitive control of an upper-limb prosthesis, allowing the user to more easily and quickly perform controlled movements.

The standard of care in myoelectric prostheses is to apply single- or dual-side electrodes to the residual limb that pick up muscle signals. The user twitches a muscle in the limb to activate movement in the device.

“One electrode listens to one muscle system; the other to the antagonist, and the strongest signal controls the prosthesis,” explains Lock. “Movements are based on the strength of the signal and where it originates.”

By contrast, the Coapt system embeds an array of sensors into the socket that can pick up much smaller, quieter signals.

An algorithm recognizes patterns associated with various movements, such as rotating the wrist and opening and closing the hand, and tells the device which to perform. The result is more natural control of complex motions as well as the ability to modulate their intensity.

Lock uses a musical analogy to describe the difference between

or two, precise placement is less important and fittings take less time.

Coapt has eight employees, including Lock. (The other founders remain at the Rehabilitation Institute of Chicago.) Its Chicago facility houses engineering and research and development functions as well as product support. Customer service specialists develop educational materials and help with reimbursement issues.

Complete Control has been commercially available since 2013 and, says Lock, has been widely accepted by prosthetic practitioners. Coapt markets the system through contacts in the field and technical seminars at national industry meetings.

While little training is required, says Lock, the Coapt team offers in-clinic seminars and gives presentations and trainings at local O&P chapter meetings. “Most of the training has been on an as-requested basis,” he says.

Looking ahead, Lock says the company hopes to release the next generation of Complete Control by the end of this year.

Enhancements will include new features in the algorithm and improved software.

In the long term, Coapt recently signed a technology transfer agreement with Purdue University giving the company exclusive rights to a new, implantable electrode. The technology injects capsule-sized electrodes into muscles, offering better control than external sensors, and could one day be used for lower-extremity prostheses as well, according to Lock.

Whatever project Coapt takes on, Lock says, “It’s fun to be on the leading edge.”

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

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR

LAS VEGAS

EARN

NOVEMBER 14-15 | 2016

AOPA Coding Experts Are Coming to Las Vegas The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of O&P practitioners and billing staff.

The seminar features hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Take part in this seminar and to better your business, your staff, and your patients!

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2016billing.

In this audit-heavy climate, can you afford not to attend?

14 CEs

Top 10 reasons to attend: 1.

Get your claims paid.

2.

Increase your company’s bottom line.

3.

Stay up-to-date on billing Medicare.

4.

Code complex devices

5.

Earn 14 CE credits.

6.

Learn about audit updates.

7.

Overturn denials.

8.

Submit your specific questions ahead of time.

9.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience.

Find the best practices to help you manage your business.

Participate in the 2016 Coding & Billing Seminar!

Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

AOPA NEWS

JULY 13

AUGUST 10

The Supplier Standards: Are You Compliant?

Register for the August 10 Webinar

Strategies and Levels: How To Play the Appeals Game Register for the July 13 Webinar Join AOPA experts for the July 13 webinar, and find out how to navigate the appeals process: • Review the five levels of Medicare appeals.

• Access tips on how to navigate the appeals process.

• Learn suggestions on ensuring a successful appeal.

• Get an up-to-date status on the administrative law judge delays.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2016webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.

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JUNE 2016 | O&P ALMANAC

Join AOPA experts for the August 10 webinar, and learn important details about supplier standards: • Do you have a proper contract with your vendors on file?

• Are you required to have a surety bond?

• Can you use contracted employees?

• What happens if you’re non-complaint with the Medicare Supplier Standards?

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/ 2016webinars. Contact Ryan Gleeson at rgleeson@ AOPAnet.org or 571/431-0876 with questions.

Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.

THE LATEST

THE MPK THAT JUST WON’T BUCKLE !

Proven durability and dependability MPK with pinpoint programmable gait accuracy

Full range adjustable geometric stance control

Advanced Pneumatics with extremely high exion resistance

Trouble free low maintenance.

5-bar stability, fully adjustable stance exion

Fully programmable centrode Record-able gait data for seamless Bluetooth transfer to another Stealth MP Knee Patient weight: up to 275 lb

This latest New technology detects instantly any change in knee 3-D positioning. The programmable Stealth microprocessor translates the data and provides the optimum extension--exion resistance. Its advanced Pneumatics with unheard of high compression ratio never requires adding air. It can easily be set to provide the desirable resistance while walking down an incline or stairs.

AOPA O&P PAC

T

HE O&P PAC WOULD

like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*:

• • • • •

Jeff Brandt, CPO Maynard Carkhuff Thomas Watson, CP Rob Yates, CPO, FAAOP James Young Jr., CP, FAAOP

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.

*Due to publishing deadlines this list was created on May 9, 2016, and includes only donations/contributions made or received between Feb. 9, 2016, and May 9, 2016.

Any donations/contributions made or received on or after May 9, 2016, will be published in the next issue of the O&P Almanac.

WELCOME NEW MEMBERS

T

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

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Is Your Facility Celebrating a Special Milestone in 2016?

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

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JUNE 2016 | O&P ALMANAC

Original Bending Brace 3465 W. Montague Avenue, Ste. 101 N. Charleston, SC 29418 843/577-9577 Category: Patient-Care Affiliate Parent Company: Carolina Orthotics & Prosthetics LLC MaxMotion 5135 10 E. Avenue Montreal, QC H1Y 2G5 Parent Company: TechMed 3D Inc. 514/445-8733 Category: Supplier Affiliate John-Philippe Carmona

opSolutions 7271 Wurzbach, Ste. 128 San Antonio, TX 78240 210/614-5500 Category: Patient-Care Facility Jon Butler

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/aopamedia for advertising options.

ALPS High-Density Gel The High-Density (HD) Gel is ALPS’ new gel product line. It is ideal for those patients transitioning from silicone to gel liners. It has a dense and firm texture to accommodate most users. The firm nature of the gel provides active amputees with a great degree of control while still providing superior comfort. HD Gel is available in our Extreme and SP Liners.

For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Introducing Precise Insoles by Amfit Amfit is proud to announce a prefabricated, functional insole in 24 sizes. Confidently offer a noncustom orthosis with biomechanically engineered arch support built right in. Millions of unique foot shapes formed the basis for designing a ready-towear insole with true functional support and the widest size range on the market. Most high-quality premade insoles offer less than 10 shell sizes. Precise insoles were designed to bridge that gap so you can offer a high-quality, functional orthosis when full custom isn’t an option.

• Twenty-four sizes • Integrated length, width, and arch height • Anatomically correct design • Functional shell with no crack guarantee • Forefoot comfort insert • Stabilizing deep heel cup • Tablet-style digital sizing guide Opt for the Starter Kit (36 pairs, digital sizer, mount, and display materials) or order by the pair.

Ask about introductory specials at sales@amfit.com or 800/356-FOOT (3668), x264.

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JUNE 2016 | O&P ALMANAC

Amfit: It’s Your Patient, Shouldn’t It Be Your Orthotic Design, Too? Take complete control for the ultimate in patient satisfaction with Amfit Lab Services.

• Carbon fiber (flex and firm) • Polypropylene (flex, semiflex, rigid) • Five EVA styles and densities • One- to four-day turnaround • Diabetic-specific program: three pair for $60, includes shipping • Foam box processing • Contact Digitizer 3D digital casting system • Equipment rental and lease programs available.

Thirty years specializing in custom foot orthotics and orthotic technology, we will help move your practice forward while saving time and money. Contact Amfit Inc. today at 800/356-FOOT(3668), email sales@amfit.com, or visit www.amfit.com.

New Multiaxial Stubbie Feet: Sidekicks™ College Park’s Sidekicks are the first adjustable stubbie feet for bilateral, above-knee amputees.

With natural anatomical ankle motion, Sidekicks flex and plant in real-world environments for the ultimate balance and stability.

The feet encourage muscle activity to assist in the rehabilitation process, which can be especially helpful when the goal is a transition to microprocessor knees. Also sold as a single unit and certified safe for water use, the Sidekicks can be used by unilateral amputees for adaptive sports, like surfing or rock-climbing. The robust multiaxial ankle and small, treaded platform provide unlimited possibilities.

See the Sidekicks in action at www.youtube.com/CollegeParkInd.

MARKETPLACE New KS Sure Stance Knee by DAW This ultralight, multiaxis knee is the world’s first four-bar stance control and stance flexion knee.

The positive lock of the stance control activates up to 35 degrees of flexion. Unlike single-axis knees, there is no need to shorten the pylon, which produces undue strain on the lower spine.

All of the above, combined with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K2 patients.

For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

EZ-Access DawSkin The New MegaStretch DawSkin is the most durable tear-free skin in the world.

The New MegaStretch DawSkin provides the vertical ankle stretch required for multiaxis feet and energy restitution feet.

“Heat-shrink” skins limit the ankle movement and will tear; not so with the New MegaStretch DawSkin.

DawSkin New EZ-Access dons on and off just like a sock yet provides all the benefits of the New MegaStretch DawSkin.

For more information, call DAW Industries Inc. at 800/2522828, email info@daw-usa.com, or visit www.daw-usa.com.

DAW's DGEL Resin II Tubular Braid: • 38 million Modules Fiber means way stronger than the market best!

• Two layers lay-up is all you need for 75 percent of your patients.

• Double its strength when used in conjunction with DGEL Fiber Beam.

• Available in 4-, 5-, 6-, 7-, and 8-inch diameters to fill all your lay-up needs.

Epoxy Resin: • Half the resin—double the strength.

• So safe it can ship overnight.

• The “no smell” resin.

• Ultralight, ultrastrong, and ultrathin.

• Twice as strong as acrylic resin, “You can stand on it.”

For more information, call DAW Industries Inc. at 800/2522828, email info@daw-usa.com, or visit www.daw-usa.com.

Motion Control’s Next Generation ETD A U.S. Department of Defense grant, awarded to Motion Control of Salt Lake City, Utah, funded development of a new Electric Terminal Device (ETD) and wrist system.

For many in U.S. military hospitals, the ETD is the first-choice hand replacement for function and versatility.

The ETD is the only device that achieves true resistance against water, dirt, dust, and grease.

The next generation ETD is currently in field trials, and should be available for preorder in the summer of 2016.

For more information,contact Motion Control, a division of Fillauer, at 888/696-2767 or info@UtahArm.com.

NEXO™ by Fillauer® It’s not exo. It’s not endo.

It’s NEXO—a simple, new alternative in upper-extremity socket technology. Featuring an adjustable socket adapter ring, PEEK rods, and a USMC-style quick disconnect wrist, the NEXO is an easy-to-build upper-extremity socket system that is 50 percent lighter than existing sockets, allows quick access for pull-in socket designs, transfers the force proximal to the cut bone end, and reduces rotational and perpendicular vibration to the residual limb.

Contact Fillauer to learn more today at 800/251-6398 or 423/624-0946 or visit www.fillauer.com.

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

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

O&P ALMANAC | JUNE 2016

53

MARKETPLACE SwingBrim™

C-Leg 4

The end of rigid brims.

The new SwingBrim™ technology offers the same dynamic brim comfort as the full Socket-less Socket™, but can now be integrated into existing sockets as well. No more static brim shape. No more hard ischial seat. It’s the difference between sitting on a hard chair versus a soft hammock.

View the free SwingBrim™ and Socket-less Socket™ training at MartinBionics.com. Contact Martin Bionics at 844/MBIONIC.

Socket-less Socket Transfemoral— The End of Rigid Socket We’ve re-invented sockets from the ground up. No more static socket shape. No more hard ischial seat. No more loss of suction.

Using our NASA-based hammock-fit technology, the Socket-less Socket truly conforms to the user, providing a custom-fit socket every time you put it on.

Fitting a socket is now microadjustable in real time, eliminating the need for the antiquated casting, modification, and iterative test socket fitting methods from the past.

View the free Socket-less Socket training at MartinBionics.com.

Contact Martin Bionics at 844/MBIONIC.

C-Brace The C-Brace combines real-time gait analysis, the energy redistributing properties of carbon fiber, and the ability of software to customize joint response creating the ideal solution for your patient.

For more information, contact Ottobock at 289/288-4848 or visit www.ottobockus.com.

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JUNE 2016 | O&P ALMANAC

The C-Leg continually improves on the control strategies that enable real-time adaptation to the wearer’s gait, changes in surface, or speed, even when traversing unstable ground, stairs, or ramps.

For more information, contact Ottobock at 289/288-4848 or visit www.ottobockus.com.

Spinal Technology 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 and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry.

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

For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

MARKETPLACE Texas Assistive Devices (TAD) 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 temporarily replace the hook or prosthetic hand on either body-powered or electronic upper-extremity 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. Visit www.n-abler.org.

i-Limb Quantum: Precision. Power.

Intelligent Motion.

NOW AVAILABLE IN FOUR SIZES! Call us today to learn more about our new i-limb™ quantum.

For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

Visit us at Amputee Coalition in booth 509.

New OMEGA Scanning Technology & App The OMEGA® Structure Sensor is now available from WillowWood! We’re pleased to offer this compact scanning device to the O&P industry. The Structure Sensor works with the new OMEGA Scan App to turn your iPad into a 3D scanner. The OMEGA Scan app, available for free from the App Store, focuses the technology of this scanning device specifically on lower-extremity prosthetic applications.

For information, visit willowwoodco.com or call 800/848-4930.

2016 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2016 AOPA coding products. Ensure each member of your staff has a 2016 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

O&P ALMANAC | JUNE 2016

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AOPA NEWS

CAREERS

Opportunities for O&P Professionals

North Central

Job location key:

Orthotist, Orthotic and Prosthetic Technician, Pedorthist

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

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

Member $482 $634

Nonmember $678 $830

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

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

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

Job Board

Member Nonmember $85 $150

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

MARKETING OPPORTUNITIES

American Orthotic & Prosthetic Association (AOPA)

2016

AOPA

PRINT DIGITAL EVENTS

Discover new ways to connect with O&P professionals.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Ann Arbor, Michigan For over 100 years the University of Michigan (U of M) Orthotics and Prosthetics Center has provided exceptional service to a diverse patient population in an academic health-care system. Ann Arbor consistently ranks as one of the top cities to live in. U of M continues to be an employer of choice, offering a comprehensive benefit package highlighted by matching contributions to retirement, generous paid time-off program, competitive salary, and relocation assistance. Work with a professional team in a dynamic setting that provides limitless challenges and creative opportunities to help improve the lives of others.

We are looking for outstanding candidates for the following positions to join our team in servicing over 15,000 patients a year: • ABC-certified orthotist to lead our inpatient care team • ABC-certified orthotic and prosthetic technician • ABC-certified pedorthist View our online job descriptions to explore more about these unique opportunities at: http://pmr.med.umich.edu/divisions-programs/ orthotics-prosthetics/careers

Pacific ABC-Certified Practitioners Wanted!

Willamette Valley, Oregon Coast, Central Oregon Summit Orthotics & Prosthetics is a locally-owned, growing, independent O&P group with eight current locations spanning the Willamette Valley, Oregon Coast, and Central Oregon.

We are seeking CPOs and CPeds to be a part of our team, providing patient-centered care with expert knowledge and compassion. Bilingual applicants are encouraged to apply. We offer a competitive salary and benefits including paid vacation and holidays, medical, dental, and 401k. Send résumé to:

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

Contact Bob Heiman for advertising inquiries: E: bob.rhmedia@comcast.net P: 856-673-4000, F: 856-673-4001

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JUNE 2016 | O&P ALMANAC

Cammy Lucero, CEO Email: Cammy@Summitonp.com Website: www.summitonp.com

CAREERS

Northeast

Mid-Atlantic

ABC/BOC Orthotic Fitter

CPO/BOCPO

Queens, New York ABC/BOC orthotic fitter wanted for Queens area. Excellent pay and comprehensive benefits package. Must be professional, knowledgeable of orthopedic trauma, and caring.

Upbeat practitioners need only apply. Please apply by email: Email: mgpolab@gmail.com

SUBSCRIBE

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

Louisville, Kentucky 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, New York, and Pennsylvania. Due to an opening at one of our patient-care facilities in Louisville, Kentucky, we are seeking a CPO, or Kentucky-licensed BOCPO, with a minimum of five years’ clinical experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest-quality patient care. This position offers 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 résumé, in confidence, to:

Center for Orthotic & Prosthetic Care (COPC) Fax: 502/451-5354 Email: dkoch@centeropcare.com

ADVERTISERS INDEX Company

Page Phone

Website

ABCOP - American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc. ALPS South LLC Amfit Arizona AFO Charleston Bending Brace Foundation College Park Industries Custom Composite DAW Ferrier Coupler Inc. Fillauer Hersco Martin Bionics Motion Control, division of Fillauer Ottobock ROMP Spinal Technology Texas Assistive Devices Touch Bionics WillowWood

45 703-886-7114 www.abcop.org 7 800-574-5426 www.easyliner.com 27 800-356-3668 www.amfit.com 35 877-780-8382 www.arizonaafo.com 17 843-577-9577 www.cbb.org 37 800-728-7950 www.college-park.com 21 866-273-2230 www.cc-mfg.com 1, 49 800-252-2828 www.daw-usa.com 19 810-688-4292 www.ferrier.coupler.com 43 800-251-6398 www.fillauer.com 2 800-301-8275 www.hersco.com 31 844-BIONICS www.martinbionics.com 5 888-696-2767 www.fillauer.com C4 800-328-4058 www.professionals.otobockus.com C3 www.rompglobal.org 23 800-253-7868 www.spinaltech.com 51 800-532-6840 www.n-abler.com 9 855-694-5462 www.touchbionics.com 15 800-848-4930 www.willowwoodco.com O&P ALMANAC | JUNE 2016

57

CALENDAR

2016

June 24-25

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

June 8

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

Webinar Conference

June 9-10

MOPA: Michigan Continuing Education Meeting.

DoubleTree by Hilton Bay City—Riverfront, Bay City, MI. Now offering pedorthic continuing education credits.

Contact 517/784-1142 or visit www.mopa.info.

June 13-14

AOPA Mastering Medicare: Essential Coding & Billing Techniques Seminar.

Grand Hyatt, San Antonio. Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Seminar

June 23-24

Orthomerica Whole Limb Solutions Seminar. Newark, NJ. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Newark, NJ. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

July 1

ABC: Application Deadline for Certification Exams.

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

July 11-16

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

July 29-30

ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg College—Caruth Health Education Center, Pinellas Park, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

July 13

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

Webinar Conference

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

www.bocusa.org

Calendar Rates Let us

SHARE

your next event!

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JUNE 2016 | O&P ALMANAC

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.

CE For information on continuing education credits, contact the sponsor.

Questions? Email landerson@AOPAnet.org.

CREDITS

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

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

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR October 12

August 1

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

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

Webinar Conference

November 9

August 4-6

Alabama Prosthetic & Orthotic Association. Embassy Suites Birmingham-Hoover, Birmingham, AL. For more information, visit www.alabamapoa.org.

Don’t Miss Out: Are You Billing for Everything You Can? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

August 10

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

Webinar Conference

November 14-15

AOPA Mastering Medicare: Essential Coding & Billing Techniques Seminar.

The Tropicana, Las Vegas. Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Seminar

August 11-12

Orthomerica Whole Limb Solutions Seminar. Milwaukee. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Milwaukee. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

December 14

New Codes and What Lies Ahead for 2017. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

August 12-13

Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting.

Grand Hyatt on the Riverwalk, San Antonio. Contact Leslie Gray at 214/648-1006, email secretary-treasurer@txaaop.org, or visit www.txaaop.org.

August 18-20

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

September 8-11

99th AOPA National Assembly. Boston. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org.

For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

September 14

Fill in the Blanks: Know Your Forms.

Webinar Conference Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Ottobock 360˚ Education and Events

Select from a range of upper and lower limb prosthetic courses as well as orthotic training. Courses are offered around the country and at our North American Headquarters in Austin, TX. Go to our site, find the Education menu, and select Classroom Training to see the full list of options. www.professionals.ottobockus.com www.professionals.ottobock.ca

O&P ALMANAC | JUNE 2016

59

ASK AOPA CALENDAR

Facility FAQs Patient safety concerns, denials for ultralight material codes, and more

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@contentcommunicators.com.

Q

We have had a patient come in for an appointment whom we believed should not be driving. What guidelines, if any, can we use to determine the need to contact next of kin and voice our concerns? Would doing so violate the regulations of the Health Insurance Portability and Accountability Act (HIPAA)?

Q/

There is nothing regarding the obligation of a provider of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to report situations where driving may be considered dangerous due to a patient’s physical or mental status. However, there are several resources regarding a physician’s ethical and even legal obligations.

It is recommended that you report any concerns you may have to the patient’s referring physician. Such a communication is allowed under HIPAA as it constitutes communication between two health-care professionals and therefore does not violate HIPAA privacy laws. Once you have reported the information to the physician, that

A/

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JUNE 2016 | O&P ALMANAC

reflecting the proper use of the L5940-L5960 codes, but the directives have still not reached the LCD. However, you are reminded that once the DME MACs issue coding guidance, it is considered part of the policy.

physician has the responsibility to either take action or not based on his or her investigation of your concerns.

I am seeing a lot of Medicare denials for the ultralight material codes (L5940-L5960) when they are billed with preparatory base codes and certain other base codes.

I have reviewed the Local Coverage Determination (LCD) and Policy Article for lower-limb prosthetics, and these codes are not included in the list of codes that will be denied as not medically necessary when billed with an initial or preparatory prosthesis. Why is Medicare denying these codes?

Q/

About six years ago, CMS altered its opinion on the proper use of the ultralight material codes. For many years, policy stated that the ultralight material codes were only to be used to describe ultralight components of a prosthesis that did not include the socket. Effective with the Policy Article that took effect April 1, 2010, CMS reversed its opinion on the use of the ultralight codes and stated that they were only to be billed when material used in the fabrication of the socket was ultralight in nature.

CMS also issued instructions to the DME MACs advising them to create system edits that only allowed codes L5940-L5960 to be billed in conjunction with definitive base procedure codes and socket replacement codes.

These instructions, even though they are not listed in policy, are the cause for the denial of the ultralight codes when billing a preparatory device and other certain base codes.

The DME MACs have released coding directives or coding reminders

A/

Q/

How long is the initial prescription/order valid?

Medicare has not published or established a timeframe for how long an initial order is valid, and when or if you are required to obtain a new order if the initial order seems to be out of date. However, it is common practice and it is recommended that if your initial prescription is older than three months (90 days), then you should obtain a new initial prescription.

Obtaining a new initial prescription serves to verify that the item is still medically necessary (i.e., the patient still has a need for the item, and the patient still meets coverage criteria) and that the physician still wants the patient to have the item.

A/

What is the current interest rate for Medicare overpayment and underpayment requests?

Q/

As of April 19, 2016, the interest rate is set at 10 percent, which is an increase of 0.25 percent over the previous quarter.

The interest rates are adjusted quarterly by the U.S. Department of the Treasury, and in recent years the interest rate for overpayments and underpayments has fluctuated between 9 percent and 11 percent.

A/

ECUADOR EARTHQUAKE: CALL FOR DONATIONS ROMP IS ACTIVELY SEEKING DONATIONS OF NEW OR SLIGHTLY USED PROSTHETIC COMPONENTS TO AID THE VICTIMS OF THE DEVASTATING EARTHQUAKE IN ECUADOR.

How You Can Help With more than 500 deaths and 4500 injuries, Ecuador needs our help now more than ever.

Support relief efforts by donating the following: •

Feet (pediatric and sizes 21-26)

•

Modular components (tube clamps, pyramids, socket adaptors, pylons, foot adaptors)

•

Liners (all sizes and types, preferably new)

•

Knees (functional, all types)

•

Supplies (synthetic casting tape, stockinette 2”, 3”, 4”)

•

Prosthetic socks (all sizes, new socks only)

Any overflow components that are not needed for earthquake victims will be used to deliver care to meet the needs of the Ecuadorian public.

Please send all donations to: Eric Neufeld, Range of Motion Project 2425 S Colorado Blvd #100 Denver, CO 80222 United States For more information, visit www.rompglobal.org

For monetary donations, visit WWW.CROWDRISE.COM/ROMP-ECUADOR-EARTHQUAKE

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