June 2018 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

J U N E 2018

How To Prepare for an ALJ Hearing

This Just In: Initial Results From the TPE Program P.20

P.16

Embracing Diversity in the O&P Workplace P.30

Travel Tips for the National Assembly in Vancouver P.38

Lower-Limb Studies From the University of Pittsburgh

HOW NEW CLINICIANS WILL ADVANCE THE O&P PROFESSION

P.44

WWW.AOPANET.ORG

Great EXPECTATIONS P.22

E! QU IZ M EARN

BUSINESS CE

CREDITS P.18

Check out the AOPA 2018 National Assembly Preliminary Program View at www.AOPAnet.org.

YOUR CONNECTION TO

EVERYTHING O&P

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

TION STRA I G E R

OPEN

tio forma ore in For m pp.12 & 38 see

PASSPORT

INNOVATION

Vancouver is easy to explore during your time at the downtown Vancouver Convention Centre as there are many nearby top attractions. • • • • • •

Capilano Suspension Bridge Vancouver Aquarium Forbidden Vancouver Stanley Park Horse-Drawn Tours Harbour Cruises & Events Flyover Canada

• Vancouver Lookout • Dr. Sun Yat-Sen Classical Chinese Garden • Vancouver Art Gallery • Science World • Grouse Mountain

Experience Beyond Vancouver’s unbeatable location makes it the perfect gateway to the rest of British Columbia and beyond, providing you with outstanding opportunities for pre- and post-conference travel. • Whistler • Okanagan Valley • Jasper • Victoria • Banff • Cruise to Alaska

AOPAnet.org

#AOPA2018

Experience all the AOPA National Assembly has to offer while visiting Vancouver.

contents

J U N E 2018 | VOL. 67, NO. 6

FEATURES

JUNE 2018 | O&P ALMANAC

COVER STORY

Recent O&P graduates are entering the O&P workforce armed with advanced educations and positive outlooks. These tech-savvy and research-driven young professionals are seeking guidance from more seasoned professionals during their residencies and early career years to enhance their patient-care and fabrication skills. By Christine Umbrell

20 | This Just In

TARGET

Encouraging Results From TPE Implementation

TPE

Program PROBE

EDUCATION

Reductions in improper claim payment rates have been reported for many of the categories of the initial audits under the new Target, Probe, and Educate program. Rates have improved for claims involving walking boot-style ankle-foot orthoses, spinal orthoses, and off-the-shelf diabetic shoes.

30 | Growing Diversity Many O&P companies are making headway into building more diverse O&P teams that reflect the populations of the patients they serve, but there’s still work that needs to be done to hire minorities in both staff and leadership positions. By Meghan Holohan

38 | Visiting Vancouver It’s time to make your travel plans for the 2018 AOPA National Assembly in Vancouver. Plan now to network with O&P colleagues, attend educational sessions, and walk the Exhibit Hall— and schedule some extra time at this unique venue to visit historical destinations, hike at area parks, explore the coast, and dine at world-class restaurants. By Meghan Holohan

PHOTO: Scott Annis, CO

22 | Great Expectations

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contents

PRINCIPAL INVESTIGATOR Goeran Fiedler, PhD .........................44 An O&P researcher who grew up in East Germany and now works as an assistant professor at the University of Pittsburgh discusses his career evolution and his current focus on lower-limb studies.

DEPARTMENTS Views From AOPA Leadership..........5 AOPA President-Elect Chris Nolan shares developments on the Orthotics 2020 initiative

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

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

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

COLUMNS

Research, updates, and industry news

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

Tips for ALJ Hearings

How to prepare for the third level of appeals CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Member Spotlight................................ 48 n

Stubbs Prosthetics & Orthotics

TRS Inc.

P.14 P.16

People & Places........................................14 Transitions in the profession

AOPA News...............................................52 AOPA meetings, announcements, member benefits, and more

Welcome New Members................... 53 Ad Index...................................................... 53 Careers.........................................................54 P.50

Professional opportunities

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

Ask AOPA.................................................. 60 Documentation for diabetic shoes, test sockets, and more P.48

JUNE 2018 | O&P ALMANAC

VIEWS FROM AOPA LEADERSHIP

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

Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Chris Nolan Ottobock, Austin, TX Vice President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Immediate Past President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, MPH, PhD, BSPO Orthocare Innovations LLC, Edmonds, WA Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Thuasne USA, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

Orthotics in the Crosshairs

N RECENT YEARS, WE have seen the shifting sands of reimbursement evolve our landscape. AOPA championed Prosthetics 2020 in an attempt to “create a moat” around existing reimbursement by demonstrating there is clinical reason for the treatment options we provide. With this ever-changing environment, there is a long-term risk to the viability of support for conservative treatment of orthopedic-related pathologies. The U.S. Office of the Inspector General (OIG) has targeted specific custom and custom-fit orthoses for years and believes that Medicare should be able to buy orthoses for its beneficiaries at Internet prices, while the Medicare Payment Advisory Commission (MEDPAC) has ignored costs for professional services that we provide. Recognizing these challenges, AOPA decided last year that it was time to act to protect the reimbursement we still have and fight to take back some of what we have lost. Rather than reinvent the wheel, we used the model created for Prosthetics 2020, and established Orthotics 2020 in July of 2017. The intent is to demonstrate that conservative treatment provided by O&P has value in treatment for the patients while providing an economic benefit for payors. Five areas were selected as the initial focus for the project: osteoarthritis, orthotic treatment for stroke, spinal bracing for trauma, scoliosis spine bracing, and plagiocephaly. Since those areas were identified, a lot of work has been done. Individual subchairs have been designated for each of the five treatment areas, and a full working committee has been established for each area, comprised of members from industry, clinical practice, and academia. Their efforts have resulted in clinical appraised topics (CATs) for the five areas, with a short summary of the best available research. Based upon these CATs, the Orthotics 2020 team has been able to draft request for proposals (RFPs) for future research. The RFPs have been published, and responses from researchers were due back by April 30. In addition, efforts have been progressing to establish a Medical Advisory Board to help review submissions and work with a Steering Committee to drive the effort. There are significant costs associated with Orthotics 2020, as we are investigating five areas of treatment and will need to support several opinion leaders in orthopedics, therapy, and research. Additionally, we are providing research grants to further strengthen the evidence used to justify reimbursement. Several manufacturers have already committed significant funds to help, as have many patient-care facilities, and we have asked for engagement by other associations aligned with the O&P profession. We need your involvement. After witnessing the collective effort of the O&P profession when we were initially threatened by the announcement of the Local Coverage of Determination for lower-limb prosthetics in 2015, I feel we can make a big impact by supporting Orthotics 2020. Visit bit.ly/orthotics2020 for details about Orthotics 2020 and to learn how you can get involved.

Chris Nolan is president-elect of AOPA.

O&P ALMANAC | JUNE 2018

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 Through advocacy, research and education, AOPA improves patient access to quality orthotic and prosthetic care.

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan

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

SPECIAL PROJECTS

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

Ashlie White, MA, manager of projects, 571/431-0812, awhite@AOPAnet.org

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org Don DeBolt, chief financial officer, 571/431-0814, ddebolt@AOPAnet.org

Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

MEMBERSHIP & MEETINGS

O&P ALMANAC

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

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

Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, communications specialist, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0876

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email landerson@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2018 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.

REIMBURSEMENT SERVICES Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org 6

JUNE 2018 | O&P ALMANAC

Advertise With Us! Reach out to AOPA’s membership and more than 11,800 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac18 for advertising options!

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NUMBERS

O&P Recruits

Hundreds of new entrants to the O&P field completed residencies and earned credentials in 2017

More than 370 individuals completed residencies via the National Commission on Orthotic and Prosthetic Education (NCOPE) Residency Program, and 350 individuals earned their orthotic and/or prosthetic certification from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) last year, according to data provided by the two organizations.

RESIDENCIES COMPLETED IN 2017

TYPES OF RESIDENCIES

INDIVIDUALS CREDENTIALED BY ABC IN 2017

Individuals completed prosthetic residencies

350

www.bocusa.org

Practitioners 5,917 Assistants 748 Technicians 598 Pedorthists 2,134 Orthotic fitters 1,269 Mastectomy fitters 1,174 Orthotic/mastectomy fitters 212 Therapeutic shoe fitters 578

SOURCE: ”ABC Annual Report to the Profession,” American Board for Certification in Orthotics, Prosthetics, and Pedorthics

JUNE 2018 | O&P ALMANAC

Mastectomy fitters

Therapeutic shoe fitters

INDIVIDUALS CREDENTIALED BY BOC IN 2017

TOTAL ABC-CERTIFIED INDIVIDUALS IN 2017

Pedorthists

Technicians

126

100

Assistants

Orthotic fitters

Individuals completed orthotic residencies

Individuals completed dual prosthetic/orthotic residencies

Practitioners

156

92:95

Ratio of males to females who completed orthotic or prosthetic residencies

Orthotic fitters

Mastectomy fitters

PROJECTED GROWTH IN EMPLOYMENT FOR SELECT HEALTH-CARE PROFESSIONS Percent change in employment, projected 2016-2026 Total, all occupations

Physical therapists

28%

Orthotists and prosthetists Physicians and surgeons

22% 13% SOURCE: U.S. Bureau of Labor Statistics

SOURCE: “ABC Annual Report to the Profession,” American Board for Certification in Orthotics, Prosthetics, and Pedorthics; National Commission on Orthotic and Prosthetic Education; Board of Certification/Accreditation; U.S. Bureau of Labor Statistics.

157

374

Individuals completed orthotic or prosthetic residencies

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Happenings RESEARCH ROUNDUP

Scientists Create Control Algorithm to Simulate Sensation in Prostheses

Aadeel Akhtar, MS, an MD/PhD student at the University of Illinois, developed a control algorithm to give prosthetic arm users reliable sensory feedback. adjusts the current level so users feel steady feedback, regardless of sweating or peeling, according to the researchers. The researchers tested the controller on two patient volunteers, examining the results over time as electrodes were progressively peeled back. Patients also performed tasks that caused them to perspire. “What we found is that when we didn’t use our controller, the users couldn’t feel the sensation anymore by the end of the activity. However, when we had the control algorithm on, after the activity they said they could still feel the sensation just fine,” Akhtar said. The team is planning additional trials with amputee participants and is developing a miniaturized version of the module that provides electrical feedback, so it will be able to fit inside a prosthetic arm instead of attaching to the outer portion of the artificial limb. “This is a step toward making a prosthetic hand that becomes an extension of the body rather than just being another tool,” said Akhtar.

Japanese Researchers Tout Advances in Exoskeletons In a recently published article in Science Robotics, Yoshiyuki Sankai, PhD, and Takeru Sakurai, who are both affiliated with the University of Tsukuba and Cyberdyne in Japan, discuss the scope of research related to exoskeleton cyborgtype robots, explaining that research has progressed “far beyond mechanisms” imagined by science fiction. The researchers also explore how “cybernics”—the fusion of humans, robots, and information systems—is “shaping the way toward novel methods of medical care.” Current hybrid voluntary and

JUNE 2018 | O&P ALMANAC

autonomous control assistive limbs— called “HALs” by the researchers—can be outfitted with sensors that pick up neurological signals, enabling exoskeletons to be controlled by the brain. New exoskeletons also are becoming more compact—lighter as well as less noticeable and intrusive, according to Sankai and Sakurai. In addition, HALs may offer assistance to users by incorporating physical therapy programming. The full article, “Exoskeletal Cyborg-Type Robot,” is available in the April issue of Science Robotics.

PHOTO: UI News Bureau

Researchers at the University of Illinois have developed a control algorithm to provide improved sensory feedback to prosthesis users. The algorithm has been designed to regulate currents to enable upper-limb prosthesis users to feel steady sensation. Led by Aadeel Akhtar, MS, who graduated from the University of Illinois’s Electrical and Computer Engineering Department in 2016, the research team is seeking to give sensation back to individuals who have lost a hand. “The idea is that we no longer want the prosthetic hand to feel like a tool; we want it to feel like an extension of the body,” said Akhtar, who also is an MD/PhD student in the neuroscience program and the medical scholars program at the University of Illinois. Akhtar’s team is trying to improve upon prosthetic arms that offer nerve stimulation via sensors in the fingertips, which may be unreliable; over time, electrodes connected to the skin can peel off, and sweat can impede the connections. Using a sensory control module developed at the University of Illinois, integrated into a prosthetic arm, the new controller monitors the feedback the patient is experiencing and automatically

HAPPENINGS

Systematic Review Advances Shared Decision-Making Principles In 2015, AOPA awarded a grant to Michael Dillon, PhD, of La Trobe University, for his project, “Evaluating Outcomes of Dysvascular Partial Foot and Transtibial Amputation: A Systematic Review for the Development of Shared Decision-Making Resources.” The project has now been completed, and the research team has accomplished the following: • Registered the systematic review protocol with PROSPERO; • Published six articles in peerreviewed journals, including a systematic review protocol (available as open access);

• Published two systematic reviews (both available as open access); • Provided an expert clinical viewpoint describing the development of the decision aid and discussion guide; • Completed two translational pieces challenging long-held views about the association between amputation level and mortality rates, as well as increasing amputation prevalence; and • Written the first decision aid and discussion guide to help support decisions about dysvascular amputation. See the open access publications and AOPA’s other funded research at www.AOPAnet.org/resources/research.

O&P ADVOCACY

AOPA Advances the O&P Agenda at Amputee Coalition’s Hill Days AOPA representatives took part in the Amputee Coalition’s Hill Days April 16-17. Ashlie White, AOPA’s manager of projects, led a presentation sharing the results of research studies demonstrating increased quality of life and cost effectiveness for patients who receive prosthetic intervention. White also discussed the provisions included in the Medicare O&P Improvement Act—S. 1191 and H.R. 2599. During 78 scheduled meetings with congressional members and staffers, Hill Day participants advocated for the provisions in the Medicare O&P Improvement Act. They also shared the message that individuals with limb loss and limb difference deserve O&P care provided by qualified clinicians. In addition, several participants sat in

on a hearing of the House Committee on Veterans Affairs, part of which was dedicated to discussing the Injured and Amputee Veterans Bill of Rights.

POLICY PROVISIONS

DME MACs Revise Lower-Limb Prosthesis Policy The durable medical equipment Medicare administrative contractors (DME MACs) have released revisions to the lower-limb prosthesis medical policy. The revisions do not represent any shifts in policy and coverage, but they now incorporate a previous DME MAC correct coding reminder on the proper usage of prosthetic skins and covers. The lower-limb prosthesis policy article now states: “Lower-limb prosthetic covers (L5704-L5707) are complete products and afford shape, protection, and waterproofing for normal daily usage of the prosthesis. They offer sufficient protection and weatherproofing for beneficiaries who require lower-limb prosthetics. “Protective outer surface covering systems (L5962, L5964, and L5966) are specialized covers intended to be worn over an existing prosthesis. They are used by a beneficiary who has special needs for protection against unusually harsh environmental situations where it is necessary to protect the lower-limb prosthesis beyond the level of protection that is afforded by L5704-L5707. They are not for cosmetic or convenience reasons, or for everyday usage in a typical environment. Protective outer surface coverings are different from the covering that is already reimbursed as part of L5704-L5707.”

O&P ALMANAC | JUNE 2018

HAPPENINGS

FAST FACT

Lower-Limb Amputations Much More Common Than Upper-Limb Amputations

35%

65%

Upper-limb

Lower-limb

SOURCE: “Limb Loss in the USA,” Amputee Coalition.

Shaquem Griffin Drafted to NFL Team Shaquem Griffin, a football player who had his left hand amputated at age 4 due to amniotic band syndrome, was selected in the fifth round of the National Football League (NFL) draft to join the Seattle Seahawks. Griffin, who played defensive back at the University of Central Florida (UCF) and was named the 2018 Peach Bowl Defensive MVP, drew the attention of scouts during the NFL Combine in March, when he completed 20 repetitions of 225 pounds on the bench press using a prosthetic device clamped to the weight bar. He also ran a 4.38-second 40-year dash during the Combine. Griffin will join his twin brother Shaquill, who was drafted to the Seahawks in 2017. Throughout his youth, he competed alongside his brother in track, baseball, and football activities. Seahawks Coach Pete Carroll indicated that Griffin may start out as a backup weakside linebacker, and will be placed in spots where he can utilize his speed.

NATIONAL ASSEMBLY NEWS

Visit Buntzen Lake During Your Vancouver Travels Enhance your trip to Vancouver for the 2018 AOPA National Assembly by visiting Buntzen Lake. Build an extra day into your itinerary for the scenic daytrip. Rent a car and head east for an hour to get to bucolic Buntzen Lake for a picnic and a hike around one of the many scenic trails. Entry is free, but locals recommend arriving early—before 9 a.m.— for the best parking, or visiting late in the afternoon. See "Visiting Vancouver" on page 38 for many more travel tips to aid in planning your trip to this year's AOPA National Assembly. Check out the AOPA 2018 National Assembly Preliminary Program View at www.AOPAnet.org.

JUNE 2018 | O&P ALMANAC

PHOTO: By elisfkc, Orlando, FL, CC BY-SA 2.0, via Wikimedia Commons

Types of Amputation

AMPUTEE ATHLETICS

HAPPENINGS

MEETING MASHUP

O&P Professionals Explore Emerging Technologies at OPTECH Conference

PHOTOS: UCSF/Matthew Garibaldi, MS, CPO

More than 100 attendees, presenters, and industry representatives travelled to the Fisherman’s Wharf in San Francisco last month to take part in the Third Annual Orthotic and Prosthetic Innovative Technologies Conference (OPTECH), hosted by the University of California—San Francisco (UCSF). O&P stakeholders from 26 states, as well as Canada, Great Britain, and Puerto Rico, participated in the conference, which was dedicated to fostering emerging technologies that may have a transformative impact on the field of O&P and advance patient care. “O&P clinicians are typically exposed to soundbites of emerging technologies occurring in isolated research groups, rather than being exposed to the full breadth of investigation across institutions and private development firms,” says Matthew Garibaldi, MS, CPO, associate clinical professor and director of the Orthotic and Prosthetic Centers at UCSF, who developed and organized the conference. “OPTECH was created to break down those silos, offers a unifying forum for private and public developers to share their emerging technologies, and to collaborate with their like-minded peers.” This year’s conference agenda was organized by Chrysta Irolla, MS, MSPO, CPO, clinical chief of pediatric orthotics at UCSF. Topics included the future of innovative O&P care models, 3-D printing, upper-extremity prosthetic advances, exoskeletal orthotics, neural feedback and instrumented devices, and osseointegration. “Our greatest challenge each year is determining which technologies we want to showcase,” says Irolla. “We ultimately focus on innovations that have the greatest potential for impacting patients and clinicians across the globe.” “OPTECH attendees are exposed to the future of our profession through

dynamic panel discussions and direct interaction with the most cutting-edge innovators and thought leaders in our profession,” says Garibaldi. Speakers included Saeed Zahedi, OBE, FREng, BSc, PhD, FIMechE, CEng, RDI, who stressed the importance of microprocessor ankles as a requirement for obtaining truly normalized gait, and Gil

Weinberg, an inventor of musical robots, who showcased individual prosthetic digit manipulation with the use of ultrasound sensors. Planning for the 2019 OPTECH event is already underway. Individuals interested in presenting or attending should contact Garibaldi at matthew.garibaldi@ ucsf.edu or visit http://optech.ucsf.edu.

THE LIGHTER SIDE

O&P ALMANAC | JUNE 2018

PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Craig Armstrong, CP, has joined Nabtesco-Proteor as clinical services manager. Armstrong has been a practicing clinician for more than 20 years, with the last 10 years focusing on clinical education for Motion Control/Fillauer, Freedom Innovations, and Martin Bionics. Armstrong, who is a congenital amputee, will serve as a resource to Nabtesco-Proteor’s distribution partners and direct customers, ensuring that they have the necessary knowledge and experience with the company’s products to meet the needs of their patients. He also will work closely with the development teams of Nabtesco Corp. and Proteor with development projects.

The Amputee Coalition is offering a Certified Peer Visitor (CPV) training program that teaches how to offer support, encouragement, and information from a place, and at a pace, that someone in a similar circumstance can absorb. The program is designed for people who are at least 12 months postamputation, or who serve as caregivers (spouse, partner, parent, or other family member) of someone living with limb loss or limb difference. Upcoming programs are scheduled for July 11 or 15 in Tucson, Arizona; August 25 in Little Rock, Arkansas; and October 13 in Elkins Park, Pennsylvania.

Mike Boggs has joined Reach Orthotic & Prosthetic Services, headquartered in Newport News, Virginia, as chief operating officer. Formerly a senior director for a large regional health system in Hampton Roads, Virginia, Boggs provided leadership for the center’s Mike Boggs home care and behavioral health operations. In his new role at Reach O&P, Boggs will oversee all financial and operational activities for the company’s five medical facilities, and guide strategic planning for future expansion. “Mike brings a wealth of experience in health-care administration to our practice, and has the expertise to manage our day-to-day operations and patient care,” said John Robb, CPO, Reach owner and president. “He’s joining our team at the perfect time to spearhead Reach’s regional expansion.” Nicole Ver Kuilen has been named the recipient of the inaugural National Association for the Advancement of Orthotics & Prosthetics (NAAOP) Fellowship. Ver Kuilen will learn about orthotic and prosthetic policy and Nicole Ver Kuilen advocacy, and learn how NAAOP and other O&P organizations function on behalf of O&P and within the broader rehabilitation/disability policy and advocacy community at both the federal and state levels. Ver Kuilen lost her leg to bone cancer at age 10 and recently completed a 1,500-mile triathlon to raise awareness about the amputees’ challenges in accessing appropriate prostheses. She filmed a documentary about her journey and has taken her message to Washington, D.C., educating policymakers about these issues.

JUNE 2018 | O&P ALMANAC

Hanger Inc. has launched a virtual reality experience called MIGOTM, a 360-degree immersive video experience that offers users a first-person pointof-view interaction with a fellow amputee. Users can take part in several “virtual” activities, such as walking down stairs, driving a car with two prosthetic legs, and cutting food with a prosthetic arm. The initial rollout of MIGO device took place in mid-April at Hanger Clinic's 2018 Bilateral Above-Knee Amputee (BAKA) Bootcamp. Nearly 60 attendees simultaneously used the technology, engaging in a virtual one-on-one peer mentorship experience and viewing what it’s like to be independent with prosthetic technology. Feedback from the initial rollout will be used during the development of a full-length MIGO virtual reality experience that will feature a variety of prosthetic users of various ages and amputation levels performing a number of different activities. Prosthetic Orthotic Associates (POA) recently hosted a First Stride Training and Clinic at Marist College in Poughkeepsie, New York, at the college’s School of Physical Therapy. More than 25 therapists and O&P professionals took part in a three-hour clinical classroom portion, followed by a two-hour hands-on “train-the-trainer” clinic with 15 local individuals with lower-limb amputations. “By working with OPAF on their First Stride Clinics, we are able to bring the therapists and patients in our own backyards training that is nationally recognized and top of the line,” said Mark Ford, POA’s president and managing partner. SPS has announced a new scholarship opportunity that will be awarded to two full-time O&P master’s students annually. Each August, SPS will award two $2,500 scholarships based on student academic achievement and essays. Students may apply directly to SPS no later than June 30, 2018, to be considered for this year’s scholarship; visit www.spsco.com/scholarship for details.

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REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

Tips for ALJ Hearings Proper documentation and knowledge of the process are key to preparation for the third level of appeals

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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JUNE 2018 | O&P ALMANAC

ECENT EFFORTS BY THE U.S. Department of Health and Human Services Office of Medicare Hearings and Appeals (OMHA) to reduce the backlog of requests for a hearing before an administrative law judge (ALJ) have included the low-volume appeals (LVA) settlement program. While the deadline to participate in the LVA settlement program was June 8, 2018, many providers have elected to continue to fight for fair reimbursement by remaining in the queue for an ALJ hearing. The LVA program has brought about renewed interest in the ALJ process and how it works. Though there is a continued delay in getting an appeal heard by an ALJ, it is important to be fully prepared to defend your claim when you finally get an opportunity to present your case at this level. This month’s Reimbursement Page focuses on how to best prepare for a successful outcome from the ALJ process. The ALJ hearing is the third level in the formal Medicare appeals process. It follows redetermination, which is performed by the contractor who made the initial determination, and reconsideration, which is performed by a single contractor known as the qualified independent contractor. While redetermination and reconsideration decisions must be based on published policy, ALJs have significantly more leeway in rendering decisions as they are not strictly bound by policy but rather by the framework of the law. Many claims that have been denied through redetermination and reconsideration are found to be valid and payable by the ALJ because they fall within the Medicare coverage guidelines as described in the Social Security Act.

Begin With Proper Documentation

The preparation for a successful ALJ hearing begins long before the request for, or scheduling of, the hearing. It begins during your first encounter with the patient. Anything and everything that occurs from this moment forward may ultimately play a role in determining your success or failure at the ALJ appeal.

The most important thing you can do to prepare for future scrutiny of your claim is to ensure that every effort is made to secure written documentation from the referring physician that supports the medical need for the orthotic or prosthetic device you are providing. While it is virtually impossible to understand the impact a decision may have on the outcome of a hearing several years down the road, taking small steps from the beginning to ensure that you have the proper support for your claim may make all the difference when a case is presented to the ALJ. The most important thing you can do to prepare for future scrutiny of your claim is to ensure that every effort is made to secure written documentation

REIMBURSEMENT PAGE

from the referring physician that supports the medical need for the orthotic or prosthetic device you are providing. The need for physician documentation is a critical component of the process, and the lack of it is the most common reason why claims are denied, especially at redetermination and reconsideration levels. Obtaining this documentation can be frustrating as it holds you accountable for the actions of others. While there is no sure way to force physicians to document the information that is expected to be included in their records, a small bit of education goes a long way. If you can provide your referral sources with specific education regarding the Medicare documentation requirements, you can encourage them to provide you with the proper documentation that will support you through the appeals process—and may help your claim get paid the first time. Being organized is another essential ingredient of proper preparation. The more organized your patient charts, the less likely an auditor will deny your claim because he or she simply could not locate a piece of required documentation. This organization requires coordination between the clinical and administrative staff in your office but can be achieved with proper communication and solid operating procedures. Ensuring that all facility staff members are following consistent protocols regarding clinical and administrative documentation may mean an initial investment in training and education but will usually pay dividends when faced with an audit or an appeal. Finally, it is critically important to complete the official CMS “Request for Medicare Hearing by an Administrative Law Judge” form completely and accurately to prevent a delay in the assignment and hearing of your case. A copy of the form may be downloaded at www.hhs.gov/ sites/default/files/OMHA-100.pdf. With wait times lasting three to five years for an ALJ hearing, the additional delay caused by improper completion of the form can create further strain on your cash flow and, ultimately, on your potential for success. While the form is

relatively self-explanatory, remember that in most cases, the provider is the appellant, not the beneficiary. Since you as the provider have accepted financial liability for the claim (unless you have a properly executed advance beneficiary notice on file), your company is the appellant and should be indicated as such on the form.

Be Ready for the Hearing

While it is your right to request an “in-person” hearing with an ALJ, travel expenses often make an in-person hearing unrealistic. As a result, the majority of ALJ hearings are performed via telephone or video conference. The ALJs are very accustomed to these types of hearings, and requesting an in-person hearing does not typically provide any additional advantage to the provider. It remains your decision, and you may request an in-person hearing if you are more comfortable being present in the same room as the ALJ—as long as you are willing to pay for the travel expenses associated with attending the hearing. Regardless of the format of the hearing, it remains a legal proceeding, and you will be sworn in and required to attest that your statements represent the truth to the best of your knowledge. Because OMHA has been completely overwhelmed by the increase in ALJ hearing requests as a result of increased recovery audit contractor and

other audits, you should expect your hearing to be relatively brief and focused primarily on the facts of the case. The ALJs are under tremendous pressure to reduce their docket size and are constantly looking for ways to quickly render fair and equitable rulings. This is where the preparedness discussed earlier in this article comes into play. The more concise and organized you are, the better your chance for success. If you can provide the judge with a reason to approve your claim, in most cases the judge is more than happy to do so. While it is important to tell your story, you do not want to waste the judge’s time with anecdotal information that is unrelated to the reason for denial. It is better to focus on the reason for denial and present a strong, factually based argument as to why the claim should not have been denied. Finally, a little respect goes a long way. Administrative law judges remain officers of the court and should be treated with respect and dignity. They should always be addressed as “Your Honor” unless they instruct you otherwise. Also remember that you are a participant in the judge’s courtroom even if you are not physically present. The judge controls his or her own courtroom, and a sure way to hurt your chance of a successful outcome is by failing to provide the proper respect to the courtroom and the judge.

O&P ALMANAC | JUNE 2018

REIMBURSEMENT PAGE

Once you are sworn in, the judge will typically indicate that he or she has reviewed the case file and ask if there is any relevant information you would like to present. Technically, no new material may be introduced into the claim file after reconsideration; however, this is your best opportunity to discuss the merits of the case and explain to the judge why you believe the claim should be covered by Medicare. Make sure you speak clearly and concisely, and stick to the facts of the case. Since the judge has much more discretion than reviewers at the first two levels of the appeals process, this is a great opportunity to discuss why Medicare should pay for the claim as opposed to why the claim was not previously covered. If you present arguments regarding your opinion about earlier appeal decisions, you are simply wasting your time on past events. Remain positive and provide the judge with a reason to approve your claim rather than a reason to deny your claim. Do not be surprised if a representative of the contractor that denied either the initial claim or the appeal attends

the hearing to provide testimony as to why the claim was denied. This is becoming increasingly common as part of the ALJ hearing. While it is certainly acceptable to refute the testimony of the contractor representative, it is important to avoid becoming belligerent or unprofessional when doing so. Once you have presented your case, the judge will typically thank you for your testimony and may ask some additional questions, and then advise you on when to expect a final ruling. While it is rare that the judge will either rule for or against you in that moment, there may be an indication regarding the outcome of the case. If there is not, do not be discouraged, as every judge is unique. The hearing will then be adjourned and you will ultimately receive a written ruling on your case, usually within several weeks. If the judge rules in your favor, instructions will be sent to the durable medical equipment Medicare administrative contractor to pay the claim, including any interest that may have accrued on previous recoupment of payments made through the offset

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of future claims. If the judge does not rule in your favor, you will receive a written explanation as to why the claim remains denied. If you disagree with this ruling, you may continue the appeals process by requesting a review by the Departmental Appeals Board. While the lines to have a case heard before an ALJ continue to grow, this level remains a vital and valuable part of the Medicare appeals process. Failure to exercise your rights as a provider represents a truly missed opportunity. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org.

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

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This Just In

Encouraging Results From TPE Implementation Initial reports on Target, Probe, and Educate program provide generally positive outcomes

ORIDIAN HEALTHCARE SOLUTIONS, which serves as

TARGET

TPE

Program PROBE

EDUCATION

the Jurisdiction A and Jurisdiction D durable medical equipment Medicare administrative contractor (DME MAC), has released results for several of its initial audits under the Target, Probe, and Educate (TPE) program in Jurisdiction D. The TPE program, announced in August 2017 and implemented in all Jurisdictions as of October 2017, replaced previous processes for prepayment review in those areas. Results have been published for four “walking boot” ankle-foot orthosis (AFO) codes (L4360, L4361, L4386, and L4387), five knee orthosis codes (L1810, L1812, L1832, L1833, and L1843), eight spinal orthosis codes (L0627, L0630, L0631, L0637, L0642, L0643, L0648, and L0650), and off-the-shelf diabetic shoes (A5500).

The First Feedback

TPE audits performed during the last quarter of 2017 in Jurisdiction D offer generally positive results, with significant reductions in the improper claim payment rate for all of the categories except knee orthoses. 20

JUNE 2018 | O&P ALMANAC

The results of the TPE audits for the walking boot orthoses indicated an improper claim payment rate of 19 percent. This rate represents a vast improvement over error rates under the previous audit system, which consisted of a probe review followed by a widespread prepayment review. Improper payment rates under this program ranged from 66 percent to 100 percent for walking bootstyle orthoses. Results of the TPE audits for spinal orthoses showed a similar improvement in the improper claim payment rate, with a reported improper claim payment rate of 34 percent. Previous probe/widespread review audits for spinal orthoses resulted in improper payment rates in the upper 80 percent range. Regarding off-the-shelf therapeutic shoes, the TPE audits resulted in an improper payment rate of only 13 percent, a vast improvement over previous results from probes/widespread reviews—which at one point reported error rates as high as 97 percent. Unfortunately, the results from the TPE audits for the selected knee

This Just In

orthosis codes are not as encouraging as the outcomes from the other O&P services. Noridian reported that the incorrect payment rate for the five knee orthosis codes selected for TPE review was 77 percent. While this represents a slight reduction from results reported through probe/widespread review audits, the improper payment rate remains significantly high, considering that provider education efforts are part of the TPE program. Four common errors reported by Noridian include documentation that does not support coverage criteria, incomplete or missing detailed written order, documentation does not support custom-fitted criteria, and failure to respond to the request for documentation.

Understanding the TPE Program

The primary difference between the traditional probe review/widespread review model and the TPE program is that the TPE program is much more focused, not only in identifying a much

smaller pool of claims for review, but also in providing education for providers who do not pass the audit process in an effort to improve their compliance with Medicare policy requirements and regulations. The new program consists of three rounds of prepayment review. Each round involves 20-40 claims that have been identified for review through detailed statistical analysis that identifies specific areas of risk for the particular DME MAC contract area. Additional documentation requests are sent for each of these claims, and a standard prepayment review is performed. If the results of the first round of prepayment review are deemed acceptable or compliant, the provider receives a notice from the DME MAC that it will be removed from the audit pool for a period of one year. If, on the other hand, the results of the prepayment review are not acceptable, the provider is scheduled for a personalized education session with the MAC claims review department,

where common errors and strategies to improve compliance are discussed. After the personalized education process is complete, a second round of prepayment review takes place, again consisting of 20-40 claims. If, after a second round of targeted review and education is complete, the prepayment review results are still not acceptable, a third round may take place. During each round of prepayment review, providers have the opportunity to be removed from the audit pool if their results are considered acceptable. The goal of the TPE program, as stated by CMS, is not to identify claim errors and punish providers but rather to assist providers in achieving better compliance when submitting claims to Medicare. While there is clearly a need for improvement in documentation practices for knee orthoses, the results published by Noridian are generally encouraging. AOPA will continue to monitor the DME MAC websites for additional results from the TPE program.

O&P ALMANAC | JUNE 2018

COVER STORY

GREAT

EXPECTATIONS The newest generation of O&P clinicians enters the profession with abundant skills and a positive outlook By CHRISTINE UMBRELL

JUNE 2018 | O&P ALMANAC

COVER STORY

NEED TO KNOW:

· O&P residents and newly credentialed practitioners are entering the profession armed with master’s level education, a mastery of new technologies, and some experience with O&P research. · Young clinicians have typically grown up using computers and smartphones. While unburdened by the profession’s recent reimbursement challenges, most O&P graduates have been taught the importance of thorough documentation. · New practitioners arrive at their residencies having already learned to use outcomes measures and advanced technologies to gather data to demonstrate the efficacy of O&P intervention.

UNDREDS OF NEW CLINICIANS

enter the O&P profession each year. In 2017 alone, 350 orthotists and prosthetists earned their certification from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC). Though not all new certificants are young, a significant portion are in their 20s—qualifying most of these O&P professionals as either the tail end of the millennial generation or the start of Gen Z. These recent additions to O&P facilities are injecting fresh energy into the patient-care climate. They are entering the workforce unburdened by the profession’s recent reimbursement challenges and fully prepared to provide detailed documentation as “business as usual.” Armed with master’s level education, recent graduates have spent time at O&P schools analyzing outcomes and delving into research, and they

· As millennials and Gen Z-ers begin to populate O&P clinical staffs, more seasoned practitioners are called upon to share their expertise and experiences to ensure the next generation of O&P is primed for the rapidly changing health-care climate. · New clinicians may particularly benefit from advice and experience surrounding the finer points of patient-care interactions as well as advanced fabrication skills. · Today’s young practitioners are carrying on the tradition of “giving back” that has been a part of O&P for decades, and many seek to balance their work with opportunities to help improve communities and the world at large.

are technologically academic medical centers to prepared for the future of small, private institutions, evidence-based practice. says Robinson. Standards As a requirement for certifrom the Commission on Accreditation of Allied fication, they are taking Health Education Programs part in a diverse selection were adopted for the of residency opportunities residency program in 2017, at O&P facilities across reflecting an increased focus the nation. Residency Chris Robinson, on patient-centric care, the programs are typically MS, MBA, CPO, importance of interdiscidesigned to elevate resiATC, FAAOP(D) dents’ abilities to the “next plinary care, and the role of level” after completing clinically relevant outcome their university educations, with a measures “to drive clinical decisiongoal of learning to solve complex clinmaking and provide support for the value of orthotic and prosthetic care,” ical problems, says Chris Robinson, explains Robinson. MS, MBA, CPO, ATC, FAAOP(D), “NCOPE has always felt that the clinical resource director at the orthotic/prosthetic residency serves National Commission on Orthotic as the second half of a practitioner’s and Prosthetic Education (NCOPE). education by providing real-world In fact, the accredited O&P context to the foundation provided programs that offer residencies during the formal O&P education deliver unique learning environphase,” Robinson adds. ments in settings ranging from large O&P ALMANAC | JUNE 2018

COVER STORY

more time thinking about” patient actually have an edge in care, he says. The most recent O&P today’s health-care climate. graduates “are coming into standard “Members of this new practices, where the documentageneration coming in are not going to have an idea of tion is an integral part of the process all that has changed,” says already—so they are not having to Troy Kunst, CPO, orthotic adapt” as more experienced clinicians residency director at have had to do. Wright & Filippis’s headTwenty-five-year-old Cassandra Delgado, CO, explains that today’s quarters in Rochester Hills, clinicians have been trained to abide Michigan. A 35-year-old, by very strict docusecond-generation clinician, Kunst says mentation rules. his father’s colleagues “We’ve been taught had to work through to be thorough many challenges to and to look up L remain profitable. codes,” says Delgado, Several years ago, “our who completed profession was chalher O&P studies at Alabama State lenged to look at how Cassandra University and an we operate and adapt Delgado, CO orthotics residency to stay viable in a new at the University payor environment,” Troy Kunst, CPO (right), mentors and of Michigan. This month, she will says Kunst. In a 10-year oversees residents in his role as orthotic conclude her prosthetics residency at period, the profession has residency director at Wright & Filippis Prosthetic & Orthotic Associates Inc. transitioned from paper in Middletown, New York. “We’re to electronic records and documen Today’s highly educated residents a little less jaded, not having lived and young clinicians bring a lot to tation, and from devices “usually through the Dear Physician times.” the table, but their success will be being covered, to now having to think partially dependent on how thorabout whether each item will be reimbursed.” oughly they are trained and mentored Kunst himself—sandwiched by more seasoned professionals. between the “old” and “new” guards Experienced clinicians will need to of the profession—says his 10-year share their expertise and experiences with residents and newly credentialed career as a clinician has been marked by tumultuous times. “I was at the orthotists and prosthetists to ensure starting gate when health care took a the next generation of O&P is primed turn,” he explains. Initially, “we for the rapidly changing still had handwritten notes, health-care climate. billing was simpler, and there were promises of pay scales.” A Clean Slate All that changed when the Dear Today’s youngest cliniPhysician letter was published cians are approaching and reimbursement became O&P care with a fresh much more of a hurdle. perspective. Having Clinicians new to the field grown up with computTroy Kunst, CPO today are entering into a “new ers and smartphones, normal,” according to Kunst, they neither remember who mentors and oversees residents the days when handwritten notes were as they navigate the residency process standard procedure in O&P facilities and learn to master the on-the-job nor have had the experience of fitting skills necessary to become successful patients without concern that a claim might result in a denial. Although some clinicians. “We’ve turned a corner, and we’ve implemented technologies and might consider this lack of historical put processes in place. We’ve started to perspective a negative characteristic, Kunst with a patient chug along again and are able to spend others believe new clinicians may 24

JUNE 2018 | O&P ALMANAC

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COVER STORY

A Tech-Savvy Crew

takes time and experience. Annis believes that some basic In addition to a fresh perspective patient communications skills depend and master’s-level competency, O&P more on the individual. “In every graduates have another skill that will generation, there are some people who help them prosper in this field: their are better with patients than others,” mastery of new technologies. “My he says. Younger clinicians, notes generation is used to rapidly advancing Annis, have probably been introduced technology because we grew up with to a wider array of individuals from it,” says 25-year-old Morgan Oxenrider, different ethnic backgrounds. “Our CO, who completed an O&P master’s generation has the advantage of being degree at Georgia Tech and an orthotexposed to and being able to connect ics residency at Hanger Open to Mentoring with a wide range of cultures, types of Clinic in Jacksonville, Given their affinity for techpeople,” says Annis. “Being well-conFlorida. She is currently nology, it is important for working as a CO and young professionals to learn nected to the world has put some prosthetic resident at the to put down their devices perspective on things and broken the Hanger facility. and spend a few minutes bubble a bit.” Technologies such as “We are living in the during appointments social media and Skype are breaking age of efficiency,” with connecting face-to-face down barriers and offering expoadvanced tools that enable with patients. It’s become sure to different people and cultures, Morgan clinicians to become standard procedure at many including people in remote locations, quicker and more efficient, Oxenrider, CO facilities to have laptops says Annis. says James Skardoutos, 28, or iPads in patient rooms In addition, the younger generawho earned an undergraduate degree for documentation and note-taking tion may be more culturally aware of in business and worked as an O&P purposes. “You’re inputting data as you HR issues, according to Delgado, who technician for several years alonginteract because there’s so much more was required to take a class on the paperwork now,” explains Kunst. “Psychosocial Aspects of Disability” side his father, an O&P technician While young clinicians are expert during her master’s studies. “We have himself, before heading to California at the data-inputting aspect of clinical social acuity and recognize that certain State University–Dominguez Hills care, they “have to be taught how to terminology is not OK to use anymore.” (CSUDH) for his Master of Science talk to patients” during residencies, he She uses “person-first” language when in Orthotics and Prosthetics (MSOP). adds. Recent graduates should become speaking with patients and has been Skardoutos graduated last month and comfortable “conveying the known to point out to older is working on his prosthetics residency message to a new amputee clinicians when some of their at Advanced Prosthetics in Fresno. that ‘you’re going to be OK, language pushes the current Today’s O&P schools put a and we can handle this.’” boundaries of acceptability. maximum emphasis on technical Kunst notes that new While her generation prowess and evidence-based practice, clinicians must navigate has gotten a reputation for says Skardoutos. The curriculum at the same fundamental acting “entitled,” Delgado CSUDH was heavy on learning to use learning process as says young clinicians can outcome measures and advanced previous generations in use that mindset to their technologies to gather data to show James Skardoutos becoming experienced advantage to advocate on that O&P intervention leads to clinicians. “They need to behalf of their patients. For improvements for patients. “Almost be taught,” he says. “Every clinician example, if an insurance company all documentation can be done on really needs to understand that patient rejects a claim to cover a prosthetic the iPad, if you’re using it properly,” evaluation and gait mechanics [are part leg, “We’ll say, ‘No, that’s not an and in a HIPAA-compliant manner, of a] a career-long learning process.” acceptable answer—let me talk to says Skardoutos. Skardoutos notes that new cliniyour boss,’” says Delgado. “We want “We are able to speak the language fairness and equality.” of technology and are proficient in cians should look to mentors to learn On that same note, Oxenrider navigating software programs and how to make the “tough decisions” troubleshooting electronic compothat sometimes come up during patient suggests that a more innate undercare—for example, how to handle nents,” agrees 26-year-old Scott standing of technology “has changed patients without insurance or how to Annis, CO, who earned his MSPO the way we approach problem solving, treat senior patients who are becoming in that we are typically less likely to at Georgia Tech and completed his too weak to walk. Learning to navigate orthotics residency at the University think that something can’t be done” these difficult and emotional situations of California–San Francisco (UCSF), when treating patients. “While 26

JUNE 2018 | O&P ALMANAC

which is part of the university’s Department of Orthopedic Surgery. He is currently working on his prosthetics residency at the same facility. “Working with a C-leg is kind of intuitive” for younger professionals, Annis explains. “We already have a basic understanding of software programming, 3-D printing, and other newer technologies.”

COVER STORY

beginning his prosthetics residency at fabrication time and the quality of the Advanced Prosthetics and Orthotics in devices we produce,” he says. Fresno this summer. A second-generation O&P professional—his father, Jim Research-Minded Practitioners Young, CP, FAAOP, is the owner and Many of today’s young clinicians are founder of Amputee Prosthetic Clinic benefitting from an increased emphasis in Georgia—Young spent time helping on research during their master’s level out at his father’s facility during his education as well as more researchteen years and was accepted into the oriented residency opportunities. MSOP program at CSUDH The requirement that CPOs obtain in 2015. “You need to have a master’s degree has helped produce some of those skill sets to more clinicians with O&P research help others. The fabrication experience, according to Oxenrider. side is crucial, and starting to “The subsequent increase in, and get lost,” says Young, who is promotion of, evidence-based praca big proponent of in-house tice and data/outcome measures has fabrication. benefitted our patients,” she says. “I Annis agrees that fabrigraduated with an appreciation and Continuing Focus understanding of the importance of cation skills remain critical on Fabrication Scott Annis, CO supporting my clinical decisions with at many O&P companies. Despite all the advantages research and outcome measures, “The older generation still a young mindset brings, which in turn has helped improve my has an advantage when it comes to there are still areas where younger patients’ mobility and quality of life. hand skills,” he says. “Additive manuprofessionals may benefit from the “The use of data/outcome guidance of seasoned professionfacturing is starting to take off, but we measures will allow us to quantify our are still using plaster casts and models, als—for example, fabrication. Many and we are still more efficient using the patients’ progress, as well as educate older clinicians started out as apprenand motivate them,” adds Oxenrider. older school techniques in regards to tices and were technically inclined. Students coming out of school today “have not had the time to fine-tune our hand skills,” which is important during fittings and fabrication, when “a millimeter can make a world of difference,” says Delgado. Previous generations also have more experience in metal bending and more traditional fabrication skills, which are less emphasized in the modern O&P schools. Of course, some schools of thought hold that future O&P clinicians will be spending more time in the clinic and less time fabricating. “But that’s not always realistic in today’s facilities,” says Delgado. “Today, you need to know how to pull plaster and plot data points.” “Millennials are very technology-oriented. My generation of clinicians is steering away from plaster and hands-on modifications, and the fabrication side is starting to get overlooked,” says Travis Young, 25, a certified prosthetic assistant who finished his orthotic residency last month at the Valley Scott Annis, CO, is working on his prosthetic residency at University Institute of Prosthetics and Orthotics of California—San Francisco. in Bakersfield, California, and is generations before us may have looked at a problem and said, ‘We can’t do that,’ my generation would be more inclined to say, ‘We can’t do that yet.’ Because technology is developing so quickly, we often approach problems with the mindset that a solution is just around the corner. This phenomenon has produced a generation that thinks outside the box and is not afraid to expect great advances in a short time. Then, when those advances come, we are able to quickly implement them to our patients’ benefit.”

O&P ALMANAC | JUNE 2018

COVER STORY

movements to further “Pretty much everyone who is study gait efficiency involved in O&P is interested in when using a prosthesis bettering lives, helping people, and and, in most cases, making an impact,” says Annis. While using the sound limb as he doesn’t think social awareness a control.” is unique to his generation, he does Delgado, who has believe 20-somethings are unique in had residencies in both the way they go about the process. a university setting “Our generation is hungry for knowland a more traditional edge as well as looking for new ways patient-care facility, has to help and give back on a larger scale,” experienced “the best of he says. “Elevating our field brings both worlds,” she says. about more resources and opportuniShe is already making a ties to give back.” Travis Young (second from left) with Pam Young, name for herself in the Rep. Austin Scott (R-Georgia), and Jim Young, research arena, having Benefits of Teamwork CP, FAAOP, during the 2015 AOPA Policy Forum been awarded a 2018 While their education and residency scholarship for scoliosis research. requirements have provided the “This data also can be used to support She also is active in activities led by basics in preparing new clinicians for recommendations for advancements ABC and has been awarded an ABC the O&P profession, the mentorship in the field. Considering the tremenResident Research Award. and experience passed along by more dous advancements that have been senior practitioners will make the made in our profession in just the last difference in ensuring decade, I believe the future of our Social Awareness truly successful careers. profession is limitless.” Many O&P professionals “Older clinicians have Annis also believes that new are drawn to the profession the empirical experience, professionals have “a much better because they enjoy helping and younger ones have grasp of the need for research—not people—and the newest extensive academic backjust for payors, but to prove to the generation is no exception. medical field the need for O&P “Millennials sometimes get grounds,” says Skardoutos. services through evidence-based a bad rap, but we also try to He hopes to see the two practices,” he says. “Anyone who goes pay it forward,” says Young. groups work together in through a master’s program at this “It’s going to make the world Travis Young developing top-notch point is getting exposure to some level a better place.” evidence-based practices. of research.” Annis has spent more Young has been involved in volun “It’s been a challenging eight to 10 time than typical O&P residents in years for O&P professionals, but, in teerism in O&P for many years. “As a research-related activities, having the past year, we have gotten back to kid, working in my dad’s facility, we worked on both his orthotic and what we do best,” says Kunst. “We’ve would go to the Extremity Games in prosthetic residencies at UCSF, which adjusted, incorporated new techOrlando and serve as the pit crew in has a partnership with UCSF’s Human the mobile lab” for amputee athletes. nology, and now we’re enjoying what Performance Center (HPC). The HPC Today, Young volunteers much of we do again.” is designed to help athletes of all levels his time, serving on the Board of “It’s a really exciting time to be in better understand how they perform, Directors of OPAF, attending the AOPA our field,” adds Annis. “There’s a huge how to prevent injuries, and how to Policy Forum and AOPA Leadership need for practitioners. And we’re at optimize efficiency in sports. “We go Conferences, and becoming active in a tipping point, with improvements [to the HPC] every Friday, and get the community in other ways. in resources, technology, materials patients in there for metabolic testing, Young’s eagerness for involvement sciences, and manufacturing sciences to track kinetic and kinematic data,” is mirrored by others in his age group. advancing at the same time as our says Annis. With his background in “Volunteering and giving back … is profession is becoming more objective exercise science, Annis is helping to something that many in our generaand scientific. It’s a great time to be develop a protocol to show patients, tion grew up with,” says Oxenrider. in O&P.” physicians, and payors objective “We often consider ‘work-life balance’ data to demonstrate improvements in addition to other factors when related to prosthetic componentry or making career choices because Christine Umbrell is a contributing improvements after a rehab regimen. we want to balance our work with writer and editorial/production associate “We’re also looking at gait asymmeopportunities to help improve our for O&P Almanac. Reach her at communities and our professions.” cumbrell@contentcommunicators.com. tries by capturing three dimensional 28

JUNE 2018 | O&P ALMANAC

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DIVERSITY O&P PROFESSIONALS EXPLORE THE BENEFITS OF A MORE DIVERSE PROFESSION, MORE REFLECTIVE OF CURRENT PATIENT POPULATIONS

NEED TO KNOW • Some O&P facilities are becoming more diverse and employing multilingual staff members, which can be especially helpful for facilities with multiracial patient populations, and allows patients to see themselves reflected in those contributing to their care. • Businesses that feature an inclusive environment for diverse patient populations may offer patients a broader range of skills, perspectives, and solutions to address patient needs. • Implementing a robust hiring system that includes several staff members in the decision-making process can help ensure diversity in the workforce. Some companies offer benefits—such as flexible scheduling, work-from-home opportunities, and assistance with student debt—to draw more candidates. • Many O&P professionals suggest reaching out to students in middle and high schools to introduce them to the profession at an earlier age, to encourage more young people to explore opportunities in orthotics and prosthetics. • While many companies are making headway into building more diverse O&P teams, there’s still work that needs to be done to hire minorities in both staff and leadership positions.

JUNE 2018 | O&P ALMANAC

Sean’s own experience helping to translate for patients reinforced her belief that having a diverse workforce that looks like the surrounding patient population is essential to the company’s success. And she sees the positive impact it has on patient care. Take gender: Several of the company’s clients are female and Muslim and cannot be treated by men. Fortunately, women comprise half the staff at Dynamics O&P, which means the company can treat everyone who visits in the way they need to be treated. “Having a diverse staff makes it easier when we have to accommodate,” she says. “We are very appreciative to have that staffing.”

Meeting Patients’ Varying Needs

HEN SUE SEAN WAS in high school, she began helping out and answering phones at her father’s business, Dynamics Orthotics and Prosthetics. As she advanced to college as a human services major and continued to pitch in at the facility, she was asked to help with a patient—and that’s when she began to reconsider her future. The patient spoke only Spanish and felt frustrated he couldn’t communicate what he needed. Sean, who is fluent in Spanish, listened and explained what the patient was saying to the staff. “That light that came across [the patient’s] face, that [he] could be understood, is great,” she says. With Sean’s help, the patient was able to communicate, and he “could be spoken to in his own language so [he] could understand and be compliant.” The experience—assisting in ensuring a patient’s needs were met— was instrumental in encouraging Sean to pursue the profession. She returned to school to take O&P courses and earned her certifications in prosthetics

and mastectomy fitting. “Being able to make someone feel better and be in less pain was something I felt I could do,” she explains. Dynamics O&P was founded in 1990 by Sean’s father, Peter Sean, CPO, who is Korean-American, after he had spent 11 years working as a prosthetist for the U.S. Army. Twenty-eight years ago, he was one of the few Asian-American clinicians in the profession. Today, Dynamics O&P has locations near Koreatown, Little Tokyo, and Filipinotown in Los Angeles, and these locales make it easier for the company to hire diverse staff. “We are in the melting pot of Los Angeles,” she says. A multiracial staff aids Dynamics in its work with increasingly diverse patient populations and needs; the company provides services to people of different ages, genders, cultures, abilities, sexual orientations, and backgrounds. “We do manage a big variety of people from different walks of life— younger, older, men, women, all of the above,” Sean says.

Dynamics O&P is just one of several companies—big and small—in the orthotics and prosthetics industry focused on building a more multicultural workforce to treat the almost 2 million people in the United States with limb loss. Diversity in America is on the rise, with the percentage of all racial and ethnic minorities growing faster than whites in recent years, according to the latest data from the U.S. Census Bureau. Hiring staff from different cultures and races—as well as varied genders, sexual orientation, ages, abilities, and experiences—helps companies tackle cultural differences, communicate with non-native English speakers, and foster an understanding.

Lisa Lodyga-Uhl

“A richly diverse workforce ensures that our patients have the opportunity to see themselves reflected in those contributing to their care. The ability to connect with one another is fundamentally important in establishing trust throughout the care continuum,” says Lisa Lodyga-Uhl, director of diversity and inclusion at Hanger. O&P ALMANAC | JUNE 2018

Knittel Ansa, CPO, is co-owner and lead clinician at Aspire Prosthetics & Orthotics in York, Pennsylvania. Connecting and building a relationship is an essential ingredient in generating successful outcomes for patients, and many experts note that having employees from varied backgrounds and experiences helps bolster practitioner-patient relationships.

Rory Cooper, PhD

“It is easier to establish rapport if there is some personal experience that creates a bridge between the provider and the patient,” says Rory Cooper, PhD, director of the Human Engineering Research Laboratories at the University of Pittsburgh, and a professor in the bioengineering, physical medicine and rehabilitation, and orthopedic surgery departments at the university. Cooper also holds the position of associate dean for inclusion in the School of Health and Rehabilitation Sciences. “Providers need to be culturally competent and be representative of the patient population in order to provide optimal care.” In addition, staff from different 32

JUNE 2018 | O&P ALMANAC

backgrounds and experiences provide unique insight into patient care. “When you create an inclusive environment for people with diverse backgrounds, thinking styles, communication styles, and experiences, innovation occurs,” Lodyga-Uhl explains. “Our patients benefit from a broader range of skills, experience, and perspective, which better address their unique and individual needs.” Angela Ansa, president of Aspire Prosthetics & Orthotics in York, Pennsylvania, agrees that having a diverse staff adds to her company’s ability to address patients’ needs in unique ways. Her husband Knittel Ansa, CPO, who is African-American, serves as the practice’s lead clinician and often is the first minority clinician their clients have ever visited. But his life experience and background in engineering help him offer creative solutions. “He is really able to take a different approach to the patient care and treatment,” she says. “They are blown away by his skill set and what he can bring to the table.”

Strategic Hiring

Recruiting diverse staff in York, a small town in southern Pennsylvania where Aspire P&O is located, comes

with challenges that businesses like Dynamics or Hanger do not face. Even though the company has African-American, Asian-American, and female employees on staff, the facility has not yet been able to hire a Spanish-speaking employee. A staffing agency will connect them to people possibly willing to relocate to a small town, but finding an appropriately qualified candidate in the rural area remains challenging. “We make sure we hire to represent our patients,” Ansa says. “Having diversity is key, and we are very cognizant of that.” The facility tries to be flexible in scheduling to encourage diverse job applicants. Aspire P&O allows employees to work from home in some circumstances, and offers a flexible start-time so parents can arrive at work after sending their children to school, for example. But creating an inclusive workplace requires foresight and planning. “It is very important to be deliberative,” Ansa says. “We really embody that full diversity.”

Angela Ansa

Hanger and Dynamics O&P also offer flexible schedules to help accommodate their employees’ needs. And some companies have programs in place to help employees who are struggling with significant student debt. This can be a huge help to minority staff and employees with disabilities, who may face greater financial burden when it comes to higher education. Of course, hiring decisions must be based on whether candidates are both qualified and a good fit for a company’s culture. When Ansa hires, she doesn’t simply look at age, race, ethnic background, gender, ability, or sexual orientation. Rather, she first determines whether employees match Aspire’s six values: accountability, service, perseverance, integrity, respect, and excellence.

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“At the root of it all is ‘patient first,’” Ansa says. “We are able to hold our staff to the six core values. When you check all six boxes, then if all else is equal, [including] education and experience … you make some conscious efforts to consider diversity.” And connecting staff to a strong mission statement also makes it easier for the company to lure talented professionals to York, Ansa says. Implementing a robust hiring process helps ensure diversity in the workforce, explains Joyce Perrone, director of business development at De La Torre Orthotics & Prosthetics in Pittsburgh. To prevent biases in hiring decisions, Perrone involves several staff members in employee recruitment. Having several employees involved in the hiring decision means that many perspectives are considered when adding a new staff member.

Joyce Perrone

“I haven’t hired a person by myself for ages,” says Perrone. “You need to have the diversification. If you always have the same person doing the interview, that [may] be skewed to that person’s personal preference.” But it is impossible to hire diverse staff if the people graduating with the degrees aren’t diverse. While the 2017 class of O&P residency participants comprised slightly more women than men, according to the National Commission on Orthotic and Prosthetic Education (NCOPE), many agree that the O&P profession should work harder to attract people from

IAAPOC Advocates for African-American Practitioners The International African-American ProstheticsOrthotics Coalition (IAAPOC) is a collaboration of men and women promoting the benefits of the O&P profession to young African-Americans. Founded more than 25 years ago, membership is open to all members of the O&P field, says Treasurer Tony Thaxton Jr., CPO. There are three categories of membership: Active Member, Associate Member, and Honorary Member, according to Thaxton. An Active Member must be of African descent and certified as an orthotist or prosthetist by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) or the Board of Certification/Accreditation (BOC), says Thaxton. An Active Member has voting rights and can hold an office in the organization. An Associate Member must be of African descent but is not required to be certified by ABC or BOC. “For example, technicians can have associate membership,” he explains. An Honorary Member is any organization, company, or individual that is interested in the work of the IAAPOC and subscribes to its purpose. Each year, IAAPOC hosts an annual meeting to convene prosthetists, orthotists, educators, and vendors to share ideas and insights. This year’s meeting will take place October 18-20 in Oklahoma City, Oklahoma. The organization also offers an annual IAAPOC Scholarship, in honor of Sam D. Benson, CO, who was certified by the ABC in 1981. Benson is a founding member of the organization, and “he became the first president of IAAPOC in 1990,” says Thaxton. Funded by members of IAAPOC and other supporters, the scholarship is given annually to a deserving student in prosthetics and/or orthotics. Jack Steele, CO, currently serves as IAAPOC president.

JUNE 2018 | O&P ALMANAC

varying ethnic and racial backgrounds. “Access to higher education in order to become a provider is a significant barrier for individuals with disabilities, and for people from lower socioeconomic backgrounds,” Cooper says. “This tends to reduce diversity among health-care professionals.”

Looking to the Next Generation

Recruiting diverse staff in orthotics and prosthetics needs to start long before candidates are ready to take a position. Professionals should begin reaching out to students before they even enter college to encourage them to consider orthotics and prosthetics. “There needs to be more outreach to people in middle schools, to help them gain exposure early in their education choices,” Cooper says. Much of the current outreach is conducted piecemeal. But companies have been recognizing the need to engage more with local schools. Sean, for example, visits local vocational schools to speak to the students about the field. “It is very important that we, as an orthotics and prosthetics community, reach out to the younger folks at the high school,” Sean says. “The industry needs that recruitment from the young crowd. Someone needs to fill the shoes of the retirees.” Hanger leverages social media, networking, community outreach, and industry partnerships to understand both what diverse professionals want and how to best hire people from different backgrounds. And the company works with university partners to encourage diversity among students studying orthotics and prosthetics. The company is seeing a difference when it comes to its residents. “Their efforts to attract diverse student cohorts are abundantly evident in the residents we welcome into our national residency program each year,” says Rosie Alvarez, SPHR, director of talent acquisition at Hanger. “This diverse group of emerging talent brings with it energy and passion, but most importantly, valued perspective needed to strengthen care.”

Ansa hopes that the industry focuses more on how prestigious the O&P career can be as companies seek out more diverse students to consider the profession. From her own experience, she knows many minority parents push their children to be doctors, lawyers, or engineers, but these are well-known upper- to middle-class careers. Orthotics and prosthetics doesn’t sound as successful. “For people of minority culture, especially those of ethnic background, the career choice matters,” Ansa says. “Orthotics and prosthetics is not there yet, even though I think it is more than deserving.” Offering more financial help for women, minorities, and people with disabilities could be instrumental in attracting more young professionals and changing this perception. “There also need to be more scholarship opportunities and accommodations to make it possible for more people with disabilities to succeed,” Cooper says. He also advocates for “more financial aid to encourage greater diversity

among the student population.” Cooper also notes that examples and mentors from different ethnic backgrounds could help attract a more multiracial collection of young people to the profession. “There need to be more professional and professorial role models for students from diverse backgrounds,” he says. More and more women are

Rosie Alvarez, SPHR joining the industry—as evidenced by NCOPE’s recent residency numbers— and that is encouraging. But Ansa also hopes to see more women taking on leadership roles at O&P companies. “It shouldn’t be a male-run industry. I think women bring unique skill sets, such as multitasking and seeing things from multiple points of view,” she says.

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While many companies are making headway into building more diverse O&P teams that reflect the populations of the patients they serve, there’s still work that needs to be done to hire minorities in both staff and leadership positions. “On the most basic level, we all share in the responsibility of creating a work environment that is inclusive and celebrates the differences among our team members,” says Lodyga-Uhl. Meghan Holohan is a contributing writer to O&P Almanac.

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Vancouver O&P PROFESSIONALS WHO TRAVEL TO THE 2018 AOPA NATIONAL ASSEMBLY CAN TAKE ADVANTAGE OF THIS YEAR’S UNIQUE VENUE TO EXPLORE THE CITY AND SURROUNDING DESTINATIONS

NEED TO KNOW • In addition to experiencing the latest O&P technologies, educational experiences, and networking opportunities, participants in this year’s AOPA National Assembly have the unique opportunity to visit Vancouver and explore a different culture. • Vancouver is one of the fastest growing cities in Canada, and offers conference-goers the chance to explore a new city, experience the great Canadian outdoors, take in the culture, and try new foods and drinks. • Attendees can schedule their itineraries to include visits to parks, ski resorts, gardens, and the ever-popular Capilano Suspension Bridge Park. Visitors seeking indoor activities can explore museums, restaurants, and wineries and breweries. • AOPA has partnered with local companies to offer special rates on cruises, train rides, and day trips before, during, or after the National Assembly. Capilano Suspension Bridge Park 38

JUNE 2018 | O&P ALMANAC

LINICIANS, PHYSICIANS, TECHNICIANS, STUDENTS,

educational instructors, facility owners, researchers, and manufacturers of orthoses, prostheses, and pedorthics will convene in Vancouver, British Columbia, September 26-29, for AOPA’s National Assembly. Participants at this premier event will learn the about cutting-edge products, the latest in education, advances in legislation, and best practices in O&P business management. While the sessions, speakers, and workshops at the Vancouver Convention Center will provide participants with the most current information in the industry, the city of Vancouver offers an education in itself. Conference attendees should make plans now to explore the city and nearby attractions to make the most of the one-of-a-kind setting provided at this year’s Assembly.

Take Advantage of a Unique Venue

Vancouver is a relatively new city with an interesting back story. In 1867, Jack “Gassy” Deighton landed at a tiny fur trading outpost on the Pacific Northwest Coast of Canada with a barrel of whiskey and a dream. Deighton, who earned the nickname “Gassy” from his habit of telling longwinded tales of dubious origin, believed the area was the perfect place to start his own tavern. Within a day of arriving, Deighton opened a pub, which soon became the heart of a quickly growing settlement of lumber millworkers, furriers, and First Nation people. The locals began calling the area “Gastown” after the bar-owner. Three years later, the bustling town tried becoming more legitimate by renaming the area Granville—but the name never stuck, and “Gastown” lives on. Less than 20 years after Gassy settled in the area, the town was incorporated as Vancouver, named after British Naval Officer George Vancouver. In 1792, George Vancouver famously explored the Burrard Inlet, a shallow fjord that separates the

Burrard Inlet

city from the Burrard Peninsula. He also bestowed British names on numerous local landmarks. Soon after Vancouver’s incorporation in 1886, a fire ravaged the city, burning all but two of the city’s 400 buildings. Yet the city rebuilt and grew, with the original Gastown area remaining a vibrant and popular part of the city. Today Vancouver is one of the fastest growing cities in Canada. The Greater Vancouver region is the third largest metropolitan area in Canada, with almost 2.5 million diverse residents speaking multiple languages. Vancouver consistently ranks as one of the most livable cities in the world, according to the Economist Intelligence League, and remains a popular tourist destination; 10.3 million people visited the city in 2017, according to Tourism Vancouver.

Explore the Outdoors

It’s no wonder why the city is wildly popular. Vancouver offers abundant natural beauty, including miles of coastline and 230 parks, nestled among

neoclassical, gothic, Edwardian, and modernist architecture. With its strategic location on the Pacific Rim, the Port Metro Vancouver is Canada’s largest and most diverse port. The city is just an hour-and-a-half drive from Whistler, British Columbia—the location of Whistler Blackcomb, one of the largest ski resorts in North America. Several provincial parks, including Garibaldi, Shannon Falls, and Nairn Falls parks, are close to the resort, which attracts campers, skiers, hikers, and mountain bikers. The parks within the City of Vancouver offer plenty of opportunities for hiking, kayaking, walking, and bikeriding. Nature-loving O&P professionals should try to visit Stanley Park, one of North America’s largest city parks. It’s home to a 600-year-old Douglas fir, which bears the scars it sustained from the fire of 1886, and offers a view of Siwash Rock, a craggy monolith, rising from the Burrard Inlet, that is one of the only sea stacks in the area. The park also boasts more than 1,000 acres of forest, beaches, and wetlands. O&P ALMANAC | JUNE 2018

Visitors also may enjoy Kitsilano Beach Park, once known as Greer’s Beach, for its stunning views of English Bay and downtown Vancouver. This unique venue features a heated salt water tank for swimming as well as a fully inclusive playground built when the city hosted the 2010 Olympic and Paralympic Winter Games. While not all the venues used for the Games are located within the city, the Hillcrest Centre, used for Olympic skating events, features ice skating rinks and pools. Aboriginal artwork by contemporary First Nation, Inuit, and Metis artists decorates the center. Garden enthusiasts will want to visit two spectacular but vastly different spaces: Dr. Sun Yat-Sen Classical Chinese Garden and Queen Elizabeth Park. Dr. Sun Yat-Sen Classical Chinese Garden, designed according to Taoist principles, is the first “scholars” garden built outside of China. The Queen Elizabeth Park is home to Canada’s first geodesic conservatory and offers a traditional botanical experience. Dr. Sun Yat-Sen Classical Chinese Garden

JUNE 2018 | O&P ALMANAC

Another popular sight, the Capilano Suspension Bridge Park, offers brave Assembly participants the chance to cross a 450-foot-long suspension bridge, which hangs 230 feet above the Capilano River. A newly installed cliff walk makes it possible for people to skirt along the edge of the rock face that runs beside the river. The park has only been open since 1983 but has long been an unofficial stop for locals and tourists alike. Almost immediately after George Grant Mackay

purchased 6,000 acres of forest, he built a suspended footbridge spanning the river in 1888. His brave friends began visiting to face the challenge of crossing the perilous bridge. Over the years, it has become a well-known secret among locals who have tested their bravery along the bridge.

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Engage in Indoor Activities

While many Vancouver visitors enjoy the natural beauty of the land, the area also boasts a bustling cultural, food, wine, and beer scene. Assembly attendees will enjoy the city’s vibrant Chinatown and Gastown sections, which are popular tourist destinations. While many walk through Gastown to gain a sense of the area’s history, book lovers know the neighborhood because it’s home to the famous MacLeod’s Books store. Various museums set throughout the city invite visitors to explore natural history, local history, modern and traditional art, and First Nations’ history and artifacts. A visit to the Royal BC Museum is in order for any Assembly participant craving a deep dive into the natural history and First Nation people; the museum covers 10,000 years of history relating to Canada’s Indigenous populations. Royal BC Museum

Those seeking information regarding the labor of the region should check out the Britannia Mine Museum, once the largest copper mine in the British Empire, employing and housing 60,000 people. Visitors can take a 45-minute underground tour, which includes a ride in mine carts, and then can explore on their own. For a change of pace, the Vancouver Art Gallery introduces visitors to historical and contemporary British Columbian art with a focus on First Nation and Asian Pacific artists. The Museum of Vancouver offers exhibits focusing on the history of the city, including a look at Gastown as well as the city during the Depression and throughout World War II, as well as current city life. The Bill Reid Gallery of Northwest Coast Art is Canada’s only public gallery for Indigenous art from the Pacific Northwest. Reid, of Haida and Scottish-German heritage, is known for his Haida craftsmanship, which he used to produce jewelry and sculptures based on Indigenous traditions.

Experiment With Local Flavors

After getting a dose of the area’s art and cultural scenes, Assembly participants may want to follow up with a visit to a local winery or brewery. While British Columbian wines are not well known outside the area, most people will recognize the region’s most famous export, ice wines—wines made from grapes left on the vine until the grapes harden from cold. 42

JUNE 2018 | O&P ALMANAC

After they’re picked, they’re pressed, giving the wine a concentrated flavor popular as a sweet, dessert-type wine. Just 30 minutes south of Vancouver is Lulu Island, home to the aptly named Lulu Island Wines, which offers 90-minute wine-tasting tours. The tour includes a visit to the vineyard and production facilities, along with a wine tasting of table wine, fruit wines, and ice wine, served with charcuterie. If a trip outside of town doesn’t fit into the itinerary, most local restaurants offer Canadian wines. British Columbia’s wine might be a well-kept secret, but Vancouver is well known as a haven for craft breweries. In 2017, Vogue magazine named Vancouver the new “craft beer capital of North America.” Vancouver Brewery Tours offers four different public tours, each covering several breweries in one trip. The Vancouver Brewery takes people to three different breweries in three hours, while the Vancouver Walking Brewery Tour offers the same, along with a hike throughout the city. Of course, Assembly participants will find it easy to visit breweries without a tour, as there are more than 60 in the city. Popular destinations include Brassneck Brewery, Main Street Brewery, Acres Brewing, Faculty Brewing, and Off the Rail Brewing. Those who love the farm-to-table movement should check out the Granville Island Public Market, a covered market house that offers local fish, cheese, fruit, baked goods, and vegetables, as well as a food court. It also is home to Canada’s first artisanal sake maker, two breweries, and a distillery. From June to September, the venue hosts an outdoor farmer’s market featuring local fruits, including cherries, peaches, and blueberries. Granville Island was once home to factories and plants, but today the peninsula houses theaters, galleries, and restaurants. Located across from downtown Vancouver under the Granville Bridge, visitors can take a mini-tugboat ferry across False Creek to reach the venue. O&P professionals also might enjoy Main Street, also known as Little India, which runs from Chinatown to Punjab

Market. The trendy, hipster-friendly neighborhood is where many of the city’s breweries are located, with lots of shopping and nightlife, including clubs, bars, and music venues. Vancouver’s Olympic Village is located in Main Street but has been converted to housing, shops, and restaurants. When it comes to food, Vancouver has been making a name for itself in the culinary world. With its large Asian population, the city has extensive Asian food and a vibrant Chinatown. Bao Bei remains a Chinatown favorite that offers small plates inspired by Taiwanese, Shanghai, and Sichuan food. Sai Woo offers Asian fusion food, focusing on Chinese and Korean cuisines with a heavy focus on vegetarian offerings. The city has several Izakaya restaurants, offering casual Japanese pub fare. Kingo is a favorite, and Guu has multiple locations throughout the city. Sushi also is plentiful, and Assembly attendees might enjoy Zest, Sushi Bar Maumi, and Masayoshi as much as the locals do. For local Pacific Northwest Cuisine, head to Royal Dinette, Farmer’s Apprentice, and Burdock and Co. It’s no surprise that Vancouver offers a number of seafood restaurants, including Blue Water Café, Ancora, and Boulevard Kitchen and Oyster Bar. For fast casual, Vancouver has a vibrant food truck scene, offering everything from tacos to Chinese West Coast fusion to Indian to waffles to fish and chips. Visitors should download streetfoodapp.com/Vancouver to locate the trucks and find out when they are open. This year’s AOPA National Assembly will offer O&P stakeholders a chance to take part in the latest O&P technologies, educational experiences, and networking opportunities. But the special Vancouver venue also will allow conference-goers to explore a new city, experience the great Canadian outdoors, take in the culture, and try new foods and drinks. Make your travel plans today, and allow time to enjoy the whole experience. Meghan Holohan is a contributing writer to O&P Almanac.

Add These Excursions To Your Itinerary

AOPA is partnering with several companies to offer special travel opportunities to National Assembly participants. Consider these unique add-ons before, during, or after your conference travels.

ATE TED R N U O LY DISC SEMB S A R FO DEES ATTEN

Cruise By Alaska AOPA has partnered with AlaskaBySea to offer Alaskan cruise options to meeting attendees who wish to explore the area and visit Alaska before the Assembly begins. Two Holland America cruise options are available, departing from and returning to Vancouver prior to the Assembly. Located along the coast of British Columbia, the Inside Passage is the longest sheltered inland waterway in the world. See orcas and humpback whales while traveling to the Alaskan ports of Juneau, Skagway, and Ketchikan. The two cruise options available are September 19-26 or September 15-22. Visit AOPA’s website at www.AOPAnet.org to view the schedule for the seven-day cruise and additional details.

Travel By Train Travel from Seattle to Vancouver via the Amtrak Cascades route for a gorgeous four-hour journey, to take in more sights—and potentially get a more convenient flight. Seattle offers direct flights to and from Miami, Tucson, Nashville, and other big cities. The Amtrak Cascades route also travels to Portland and terminates in Eugene, Oregon. As an added bonus, you won’t stand in any customs or passport control lines—they will come to you on the train! Visit bit.ly/vancouvertravel for more information and additional travel tips.

Schedule Day Trips and Tours AOPA has partnered with Landsea Tours & Adventures to offer AOPA Assembly attendees and their travelling companions special rates on sightseeing tours of Vancouver and the surrounding areas. Landsea is offering seven different tours, including a four-hour tour of Vancouver’s city highlights, and longer trips to Capilano Suspension Bridge Park; Whistler; Victoria; the Sea to Sky Gondola; and more. Special rates are available between September 22 and October 1. Private tours also are available. Browse the tour options at vancouvertours. com/aopa2018. O&P ALMANAC | JUNE 2018

PRINCIPAL INVESTIGATOR

Radical Transformations Goeran Fiedler, PhD, began his career in East Germany and traveled far and wide to reach his current role as assistant professor at the University of Pittsburgh

Goeran Fiedler, PhD

For 2018, O&P Almanac is introducing individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and health-care professionals who have carried out studies and gathered quantitative and/or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

JUNE 2018 | O&P ALMANAC

HILE GOERAN FIEDLER, PhD,

currently divides his time between instruction and research at the University of Pittsburgh, he has come a long way on his O&P journey—all the way from East Germany. “As a teenager in communist East Germany, I was faced with the task of picking a profession before the system of planned economy would assign me one,” he recalls. He began an apprenticeship in O&P in 1990, drawn to the versatility of the work. He assumed that the experience “would help me decide whether I preferred to be a cabinetmaker or a metal worker eventually. Fortuitously, the field turned out quite exciting on its own right, which was also owed to the tremendous technological advances it experienced after the opening of the economy in the wake of the German reunification.” In fact, Fiedler entered the profession at just the right time. “The standard of care in East Germany had been wooden exoskeletal prostheses and heavy leather-steel orthoses. Suddenly having access to modular components, lamination technology, and thermoforming equipment was magical,” he recalls. “Patients almost could not believe that their new device would be just half as heavy as their previous one. Realizing how much our work was able to improve their lives, I never regretted my career choice.”

An International Journey

In 1999, shortly after obtaining his German “Meister” certification—the equivalent to a master’s degree—Fiedler was hired by a large componentry manufacturer, where his main responsibility was to conduct fittings with the company’s new microprocessorcontrolled prosthesis knee (MPK). “This technology was very much new territory for the industry back then, and I would interact with the large research and development department frequently.” He quickly became involved in activities geared toward generating evidence on the effectiveness of MPKs. “Being exposed to the associated data collection and analysis methods gave me an appreciation of the challenges and rewards of scientific endeavor,” he says. In 2002, Fiedler decided to go back to school to grow his analytical and scientific skills. “One thing led to another, and, before I knew it, my student time spanned 11 years,” he recalls. “I had studied clinical engineering in Giessen, Germany; spent an exchange semester in Milwaukee, Wisconsin, where I ended up staying for a PhD in health sciences; and eventually had the opportunity for postdoctoral training in Seattle, Washington. By then, I had essentially become a researcher myself.” Fiedler joined the faculty at the University of Pittsburgh (Pitt) in early 2014, working within the university’s

PHOTO: Goeran Fiedler, PhD

PRINCIPAL INVESTIGATOR

Goeran Fiedler, PhD, (third from right) organized a 2014 excursion through Germany, where he and a group of MSPO students visited the University Hospital Heidelberg. School of Health and Rehabilitation Sciences in the Department of Rehabilitation Science and Technology. There, he has a wide range of duties. In addition to teaching several classes to MSPO students and performing the usual university service, advising, and committee work, he spends a great deal of time on research-related activities. “I am involved in a variety of studies, often in [partnership] with colleagues from different disciplines or even different universities,” Fiedler says. “The environment at Pitt is very conducive to that sort of work, as faculty are expected to be productive in research and are generally supported in their respective efforts.”

Optimizing Technology

PHOTO: Nicholas Sellas, MSPO, CPO

Fiedler’s research interests are driven by the belief that existing technology still holds a lot of untapped potential. He suggests “we can improve functional outcomes economically and swiftly by optimizing processes rather than focusing exclusively on expensive high-technology solutions.” Most of his research is focused on lower-limb studies, often with a goal of facilitating effective prescription and fitting of lower-extremity devices and achieving improved mobility outcomes. He is currently involved in some work at Carnegie Mellon University that aims to optimize control algorithms

of motorized knee-ankle systems. “It is great how this sort of approach can expand the boundaries of rehabilitation,” he says. “Yet at the same time, I am aware that the majority of prosthesis patients are unlikely to be candidates for such technology, as they are not healthy or active enough to be able to utilize it properly and justify the costs. Those patients are best helped by getting their socket fit, static alignment, or componentry selection right and by providing more effective prosthesis training. The individual gains may be small, but they are essentially free. So, I am researching methods of optimizing socket comfort, fitting, and alignment processes, and gathering high-quality outcome data.” Fiedler also is in the early phases of a study investigating the long-term effects of different liner materials— specifically to test the hypothesis that liners from phase-change material reduce sweating and skin health problems enough to allow users significantly higher levels of activity. “We will have 50 participants use both types of liner—regular and phasechange material—for six months each, covering equal amounts of warm and cold seasons. Order of interventions is randomized, and the study liners look identical to conceal the group allocation to participants and prosthetist,” he explains. Fiedler and his team will

collect step counter data and, at the conclusion of the study, will compare how many days participants were using their prostheses with either liner. “I am hopeful that this protocol proves to be useful, and that it may be adopted for similar studies in the future.” In his capacity as faculty advisor, Fiedler is overseeing a student’s dissertation project focusing on improving gait retraining after lower-limb loss. “We use real-time feedback and are testing which variable and mode are most effective,” he says. “The principle may be applied similarly to different patient populations in the future and would call for additional research to that end.” In addition, Fiedler is optimistic about a study, in its initial phases, that aims to answer the question of how much acclimatization time should be provided before assessing the effects of a prosthetic intervention. “We are changing the prosthetic foot in our participants’ prostheses and monitoring how many steps it takes until their gait normalizes at the new baseline,” he says. “Our results should help researchers decide on the accommodation periods provided in future research protocols, but they also may be relevant for clinicians when it comes to trying on different component options. This line of research also may be expanded in the future, investigating accommodation times to other interventions in prosthetics or orthotics.” O&P ALMANAC | JUNE 2018

PRINCIPAL INVESTIGATOR

Notable Works Goeran Fiedler, PhD, is inspired by the research ideas of students at the MSPO program at the University of Pittsburgh. Some of his recent collaborations with students have been published in O&P journals: • Muller A., Fiedler G. “The Control of Infectious Diseases in Orthotics and Prosthetics,” JPO—Journal of Prosthetics & Orthotics, in press 2018. • Beaudette R., Fiedler G. “Appropriateness of Sample Sizes in Published Research on Prosthetic Knee Componentry,” JPO— Journal of Prosthetics & Orthotics 2018, Vol. 30, No. 2, pp. 60-68. • Malchow C., Fiedler G. “Effect of Observation on Lower-Limb Prosthesis Gait Biomechanics—Preliminary Results,” Prosthetics and Orthotics International 2016, Vol. 40, No. 6, pp. 739-743.

Fiedler is hopeful that his work, along with the wide range of research studies underway at universities across the nation, will eventually play an important role in providing outcomes data for payors. Ongoing studies may lead to an improvement in assessment methods, by mitigating the factors that lead to unrepresentative data—such as the placebo effect, fatigue effects, and reactivity effect. “Likewise, expanding the collection of objective data, by way of wearable sensors and instrumented tools, has the potential to broaden the data base on which to make economic decisions,” he says. Fiedler’s current clinical trials also may result in outcomes that are of interest to payors. “For instance, in the event that our liner study shows a significant difference in the number of days that people do not wear their prosthesis depending on the liner material, this would be relevant,” he explains. “The associated lost days of work and taxable income have a more or less direct impact on revenue for the health-care system.” While Fiedler embraces the research aspects of his job, he also takes pride in contributing to the future of the O&P profession as an instructor. “I am in the privileged position to be part of their 46

JUNE 2018 | O&P ALMANAC

professional education and to pass on some of my excitement about research,” he says. “Some clinicians may have the opinion that research is not part of their job or is generally an intimidating or boring endeavor. I believe it is important to make it clear how evidence-based practice, and by extension engagement in research, is an instrumental aspect of providing optimal patient care. “We all want to achieve the best outcomes for our patients. So, in the end, everybody should be interested in how to best go about that,” Fiedler

PHOTO: Goeran Fiedler, PhD

Plenty of Work to Do

Goeran Fiedler, PhD

adds. He commends the way the National Commission on Orthotic and Prosthetic Education has set up the capstone research requirements of the master’s curriculum, requiring students to conduct individual independent projects. “It’s very effective in that it puts future clinicians through the process at least once,” he says. “I am sure that the lessons learned in these classes prepare graduates well for the challenges of being consumers of—and perhaps contributors to— research throughout their careers.” Fiedler encourages O&P clinicians to make themselves available as part of university-based research teams. “This is important to assure that the research is clinically relevant and is based on realistic assumptions,” he says. “I believe that most every journal article in our field should have at least one co-author with a clinical background.” He notes that O&P practitioners bring a unique set of skills and experiences to the table and “must not be intimidated by researchers’ academic credentials or by the mystifying atmosphere of some university labs.” While it can be challenging to find the time to dedicate to such activities, “the reward of having contributed to the generation of knowledge, and thus to the advancement of our field, is certainly worth the trouble.” Current O&P research will lead to a more accessible future, which is important to Fiedler as he looks to the world his children will inhabit. He and his wife are parents to a 1-year-old and 4-year-old, and enjoy spending their free time visiting playgrounds and museums and following the area sports teams. As his children grow, Fiedler hopes to travel more—and he has plenty of destinations on his list. “Visiting any of my three brothers, for instance, takes some doing, with one still in Germany, one living with his family in Norway, and one traveling around the world.” Fiedler has indeed come a long way from his humble beginnings in East Germany, and he continues to grow and share his thirst for knowledge by inspiring O&P students and studying topics that will lead to improved mobility for patients with limb loss and limb difference throughout the world.

O&P Care is Cost Effective

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MEMBER SPOTLIGHT

Stubbs Prosthetics & Orthotics

By DEBORAH CONN

The Magic of Mascots A pet bulldog and a stuffed bear help calm and amuse patients at a Chattanooga facility

TUBBS PROSTHETICS & ORTHOTICS Inc., based in

JUNE 2018 | O&P ALMANAC

Mark Stubbs, CPO, with amputee Barry Phillips

FACILITY: Stubbs Prosthetics & Orthotics LOCATION: Chattanooga, Tennessee OWNERS: Mark Stubbs, CPO, and Melanie Stubbs HISTORY: 37 years

Mark Stubbs, CPO

Stubby Bear

The building features four patient rooms, a fabrication lab, and an open gym area in the center with ramps, rails, and physical therapy tables; there, the staff has room to work out issues and help acclimate patients to new devices. The company also has a full-time satellite office in Dalton, Georgia, about 25 miles away. Stubbs P&O has a staff of 14, including three certified prosthetists/orthotists. Many of the company’s staff members have been with the Stubbs for more than 20 years, Melanie notes. “We work hard, but we have fun,” she says. “Over the years, we’ve developed a genuine team that works really well together.” The company keeps most of its fabrication in house, sending out work only when overloaded. Mark has used CAD/CAM, but he encourages his professional staff—clinicians as well as technicians—to learn hand casting. Says Melanie,

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

PHOTOS: Stubbs Prosthetics & Orthotics

Chattanooga, Tennessee, has two animal mascots—one real, and the other a Hollywood costume. The real one is a friendly English bulldog named Gus who hangs out in the front office and will occasionally greet clients. “Patients love him. And he can help remove some of the stress or anxiety they might feel coming into an unfamiliar place for an unknown service,” says Melanie Stubbs, the company’s business manager. Her husband, Mark Stubbs, CPO, is the company president and senior prosthetist. The animal costume, usually worn by a Stubbs technician, is that of a six-foot bear—also friendly, if a little pot-bellied. Stubby Bear makes appearances at trade shows, poses for photographs, and visits children in the hospital. The company also passes out miniature versions of Stubby as a calling card. Dogs and bears give Stubbs P&O greater visibility, but the key to its success, according to Mark Stubbs, is that business will come if you do an excellent job. Melanie explains, “That has proven true for us—and it’s been the foundation for our business. Excellent service may not always yield the most advantageous, immediate financial outcome for the company, but you have to look at the broad picture.” Mark and his father founded Stubbs P&O in 1981. Later, his father sold his shares to Mark and Melanie. Today, the main facility has approximately 7,000 square feet of building space.

“Mark has professed from day one that the clinician who sees the patients and assesses them and talks to them about their history and goals needs to be the one who makes the resulting modifications to the cast.” Each morning, clinicians meet to discuss the patients they saw the previous day, says Melanie. “They also review every patient on the schedule for the following day as well, to make sure they’re prepared and have everything in stock that might be needed to provide the scheduled services.” Mark stresses uncompromising patient care, and he is careful to hire staff who are willing to go the extra mile. “Our patient-care approach has helped us succeed in a very competitive market,” Melanie says, noting the high per-capita number of O&P facilities in the Chattanooga area. Stubbs P&O receives the bulk of its business from referrals and markets directly to physical and occupational therapists. But its primary marketing tool is word of mouth. “Business will come if you practice good business,” Melanie says. The company hopes to grow in the future, but plans to take its time and move thoughtfully. “There are so many changes in the industry right now, both in business and in technology,” Melanie says. “For now, we are watching some of them and deciding how to apply them to our future.”

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MEMBER SPOTLIGHT

TRS Inc.

By DEBORAH CONN

A Firm Grip on UpperLimb Componentry

Colorado company originated from a desire to create a better hand prosthesis

OB RADOCY HAS BEEN

JUNE 2018 | O&P ALMANAC

TRS patients

FACILITY: TRS Inc. LOCATION: Boulder, Colorado OWNER AND CHIEF EXECUTIVE OFFICER: Bob Radocy HISTORY: 39 years

Bob Radocy

The TRS facility covers about 4,000 square feet and has eight full-time employees, including Radocy. The company does all of its own polyurethane production, he says, but contracts out machine manufacturing because it is not a high-volume production operation. Instead, the company focuses on product innovation and works on international distribution with partners, such as Fillauer Europe and Myrdal Orthopedics in Canada, according to Radocy. “We sell directly to prosthetics facilities throughout the United States,” Radocy says, “and with prosthetists’ permission, we sell some of our simpler devices directly to the user.” One reason for TRS’s success, Radocy feels, is the emphasis on function, not appearance or anatomy. “We didn’t confine ourselves to devices that were anatomically correct, although many other companies forced themselves into that paradigm, which limits the ability to design highly functional, less expensive tools,” he explains.

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

PHOTOS: TRS Inc.

thinking deeply about hands— real and prosthetic—ever since he lost his own left hand in a 1971 automobile accident. He found the artificial hands available at that time to be unsatisfactory, and as a Colorado graduate student with several years of engineering experience, he began designing his own prehensile prototype hand that would allow him to participate in the same activities as his two-handed peers. In 1979, Radocy and his partner “hocked our homes,” secured a small business loan, and started a company to sell a single product: the GRIP prehensile hand, which they first manufactured in 1980. The early going was tough, says Radocy, but with the help of venture capital, they persisted, using their technology to design innovative voluntary closing devices for children. TRS began to grow steadily and, by the 1990s, focused more and more on activity-specific, upper-extremity devices. “My inclination was to use a single well-designed prosthesis for everything,” Radocy says, “but there was a market for specifically designed hands for different activities.” Today, TRS Inc., based in Boulder, Colorado, is one of the leading innovators of specialized, body-powered prosthetic devices. Its products are designed for a wide range of sports and recreational activities—from hockey and baseball to skiing, swimming, and weight lifting.

TRS offers devices for archery and recreational shooting, for example, and has developed a unique forearm prosthesis for golfers who have an above-elbow amputation. “It’s a one-piece, highly functional, flexible elastomer coupling that replicates the actions needed in swinging a golf club,” Radocy explains. The company also makes specialized prostheses for playing such musical instruments as the violin, cello, and drums. By the end of 2018, TRS plans to roll out a multipurpose gripping device called JAWS intended for use with ATVs, bicycles, personal watercraft, and other types of nontraditional vehicles that use handlebars instead of steering wheels. The challenge in developing the device, Radocy says, was that “people don’t want body-powered cables for this activity, and they can’t use advanced electronic devices in water.” JAWS, on the other hand, “is an adjustable-tension grabber that allows the user to grab the handlebars and use the right amount of force that meets the activity and safety levels they want,” he says. The company hopes to preview JAWS at the upcoming AOPA National Assembly in Vancouver. TRS has been growing rapidly, at eight to 10 percent annually, according to Radocy. His goal is to ensure the company’s product line remains current and innovative, even when he decides to retire. “We need to come up with a succession plan,” Radocy says. “Over the next five years, we’ll evaluate what is healthiest for the company, and ensure that our product line keeps going and our employees are protected.”

NEW SURVEY

How Does Your Business Measure Up? AOPA’s 2018 Operating Performance Survey

BENCHMARKING: the process of comparing one’s business processes and performance metrics to industry bests.

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Participate in O&P’s largest company performance benchmarking survey before the June 28th deadline!

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AOPA 2018 Annual Operating Performance Report • Identify where your O&P facility needs to improve. • Know how your company’s financial performance compares with industry leaders and others in similar markets.

COMPANY REPORT A VALUABLE RESOURCE FOR BUSINESSES IN THE O&P INDUSTRY

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AOPA NEWS

AOPAversity Webinars JULY 11

AUGUST 8

Outcomes & Patient Satisfaction Surveys Administrative Documentation: What Is Always Needed and What Is Sometimes Needed? Distinguishing “must-have” documentation from documentation that is needed in certain circumstances can be a challenge for O&P professionals. Plan to listen in to the July 11 webinar on “Administrative Documentation: What Is Always Needed and What Is Sometimes Needed?” You’ll learn important information on the following topics: • When to use an Advance Beneficiary Notice • What to include on a proof of delivery slip • When two orders/prescriptions may be required • When and how often HIPAA forms need to be signed • Who can complete the certifying statement for therapeutic shoes.

Your source for advanced learning EARN CE CREDITS 52

JUNE 2018 | O&P ALMANAC

These days, data of all types is essential to running a successful and profitable O&P company. Learn more about designing and administering surveys at your facility so you can aggregate information to help you serve your patients better. Take part in the August 8 webinar, when AOPA experts will address these topics: • What is the importance of conducting patient satisfaction surveys? • How should the results of patient satisfaction surveys be analyzed? • Why is it important to track outcomes? • How can tracking outcomes help you provide better care to your patients?

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/2018webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Sign up for the entire series and get two webinars free. All webinars that you missed will be sent as a recording. Register at bit.ly/2018webinars.

NEW MEMBERS

Date e h t Save

WE COR D I A L LY I N V I T E Y OU TO ATTE ND

Enjoy a night of ’70s soulful tunes, dinner, a silent auction, a disco dance off, and much more. Be there or be square. You are not required to wear your best ’70s threads, but we hope you will!

6:30-9:30 PM

September 27

2018

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Areli Medical Devices 101 S. Travis Street Sherman, TX 75090 800/372-2035 Patient-Care Facility Amanda Mitchell

That Seventies Bar a.k.a. Convention Center Level 3-Summit

BroadBay LLC 291 Collier Road Auburn, MI 48326 800/741-3806 Supplier Level 1 Tony Kayyod

This is a special event and will require a separate registration fee. Certain rules and restrictions may apply. For additional information about Party With A Purpose or to register please visit the AOPA Booth.

AD INDEX

Advertisers Index Company ALPS

Page

Phone

Website

7 800/574-5426 www.easyliner.com

American Board for Certification for Orthotics, Prosthetics, & Pedorthics Inc. 49 703/836-7114 Amfit Inc. 29 800/356-3668 ComfortFit Orthotic Labs Inc. 21 888/523-1600 Coyote Design & Mfg. Inc. 19 800/819-5980 Fabtech Systems LLC 25 1-800-FABTECH Ferrier Coupler Inc. 35 810/688-4292 Fillauer 9 800/251-6398 Hersco 1 800/301-8275 Naked Prosthetics 41 888/977-6693 Össur Americas Inc. 3 800/233-6263 Ottobock C4 800/328-4058 Spinal Technology Inc. 15 800/253-7868

www.abcop.org www.amfit.com www.comfortfitlabs.com www.coyotedesign.com www.fabtechsystems.com www.ferrier.coupler.com www.fillauer.com www.hersco.com www.npdevices.copm www.ossur.com www.professionals.ottobockus.com www.spinaltech.com O&P ALMANAC | JUNE 2018

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

- Northeast

Pleasant Hill, Sacramento, and Oakland, California

- 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.

Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

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

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

Nonmember $678 $830

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Member Nonmember $85 $150

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

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

JUNE 2018 | O&P ALMANAC

Collier O&P is a full-service orthotic and prosthetic patientcare facility with on-site fabrication. We are searching for a CO/CPO. The appropriate candidate will operate in a multioffice environment, so some travel is required. We offer a competitive salary/benefit structure commensurate with experience; it includes health, vacation, and continuing education.

Email your résumé to: Collier O&P Email: john@collieroandp.com Website: www.collieroandp.com

Mid-Atlantic

O&P Almanac Careers Rates

Certified Orthotist, Certified Prosthetist/Orthotist

Job location key:

Job Board

Pacific

Certified Orthotist

Fredericksburg, Virginia An orthotic and prosthetic company in Fredericksburg, Virginia, is seeking an ABC-certified orthotist. The ideal candidate needs to be motivated and dedicated to providing the best patient care possible. This person will be responsible for patient care, assessment/formulation of treatment plans, documentation, education, fabrication, and ordering proper components and supplies. We are a busy, growing prosthetic and orthotic company looking for the right person so that we may continue to expand our practice. This is a great opportunity for the right person to add to our orthotic department, which is very active with pediatrics to geriatrics. We offer a competitive benefits package and look forward to hearing from you. Interested candidates please email your résumé to Chris Taylor at chris@mobilitypo.com. Contact: Chris Taylor Email: chris@mobilitypo.com

CAREERS Inter-Mountain

Inter-Mountain

Certified Prosthetist/Orthotist

Clinical Specialist

Colorado The Denver VA Eastern Colorado Health-Care System is a Regional Amputation Center seeking an experienced ABC-certified prosthetist/orthotist to provide clinical O&P patient care. Prospective candidates should have extensive experience in both orthotics and prosthetics with solid clinical skills and successful patient outcomes. Experience working in an amputee clinical setting working with a multidisciplinary team of physicians, therapists, and other orthotists and prosthetists is preferred, but not required. Spinal bracing experience to complement our new Spinal Cord Injury Center also is preferred. We offer a large state-of-the-art O&P lab at our Jewel Clinic and an additional 1,000 square feet of lab space at our new VA Rocky Mountain Regional Medical Center scheduled to open in July 2018. See USAJobs.gov link below for full position details, requirements, and federal employee benefits. Applicants must apply only at: www.usajobs.gov/GetJob in order to be considered for this position.

Inter-Mountain

Clinical Specialist Position With Ottobock Orthopedic Services The key and essential duties and responsibilities of the clinical specialist, Ottobock Orthopedic Services, position will be directly involved with the assessment of patients before, during, and at the time of delivery. This will include coordination of care with the patient’s physician and other CPs or CPOs within their facility. This also will include working diligently to ensure all applicable documentation is accurately completed as part of the patient’s records. The clinical specialist will be asked to assist practitioners in a clinical environment to comply with appropriate regulatory guidelines. Position Requirements • Knowledge and experience in prosthetic clinical practice and technology. • ABC-certified practitioner in prosthetics and orthotics as a CPO or CP. • BS, Certificate MPO/MS in prosthetics and orthotics • A minimum of three to five years of practical clinical experience in prosthetics and orthotics. • State licensure in the state of residence, if applicable. • Must be professional, team oriented, and be committed to providing the best possible quality customer service to patients and to internal and external business partners. • Extensive travel required.

Certified Prosthetist/Orthotist, Certified Prosthetist, Certified Orthotist

Phoenix, Arizona Well established, privately-owned O&P practice in gorgeous Phoenix, AZ, is looking for a dynamic and motivated CPO, CP, or CO. ABC-accredited contemporary facility with fabrication lab and comfortable patient-care areas. We offer competitive salaries, health insurance, profit sharing, and an excellent opportunity for professional growth. Arizona Prosthetic Orthotic Services Contact: Rosemary Goldstein Email: azprosthet@aol.com Phone: 602/448-3039

Website: www.ottobockus.com

O&P Services

Prudential Billing and Consulting An Orthotics and Prosthetics Billing Company

A full-service billing company providing initial insurance verification through final payment posting including any denial management or appeals necessary. Consultants committed to providing the service you need to be successful!

Contact: www.prudentialbilling.org Phone: 888/862-9377 Email: info@prudentialbilling.org O&P ALMANAC | JUNE 2018

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac18 for advertising options.

ALPS Flex Sleeve (SVX) ALPS Flex Sleeve (SFX) has a seamless knitted construction with a 30-degree pre-flexion that allows for ease of bending and reduces bunching behind the knee. It features our HD Gel, which has a relatively firm nature and provides maximum comfort. Call us at 800/574-5426 or visit www.easyliner.com for details.

Coyote Design Quik Glue New name, same great adhesive. 50 cc or 220 cc. Available in 30- and 60-second set times. • Great for attaching componentry • Multiple repair uses • Very quick set with no sag. They ship nonhazardous and are safe with no odor. For more information, contact Coyote Design at 208/429-0026 or visit www.coyotedesign.com.

Fabtech Systems 3-D-Printing Capabilities Fabtech Systems and Extremiti-3D provide the highest quality 3-D-printed prosthetic devices to the O&P industry. Products provided: Protective covers, above-knee and below-knee sockets. Features: • Precise form, fit, and functionality your patients deserve • Twenty industry standard skin tones and 16 custom protective cover designs • Reformable definitive for individual customization • Carbon additives provide long lasting durability • Eliminates pulling deformities encountered with manual fabrication • 3-D printed to your exact measurements. For more information, call 800/322-8324 or visit www.fabtechsystems.com.

JUNE 2018 | O&P ALMANAC

Standard and Custom Pediatric Formula Feet The Formula foot is the ideal balance of flexibility and power. A first of its kind, the Pediatric Formula is a high-performance, customizable, pediatric foot that grows with the child. The long, lightweight carbon pylon provides critical energy return through the posterior attachment, while the compact shape of the ankle simplifies cosmetic finishing without hindering performance. The Standard and Custom Pediatric Formula feet are transforming pediatric prosthetics for kids who require exceptional performance and flexibility. Let them be little. Let them play big! For more information, visit Fillauer Companies Inc. at 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 800/301-8275 or visit www.hersco.com.

Iceross Seal-In X Options Introducing the new Iceross Seal-In X-Classic, Seal-In X-Volume, and Seal-In X-Grip movable seals. For use with the Seal-In X and Seal-In X TF liners, these seals feature an improved textile donning aid and Easy Glide low-friction coating, making donning the socket easier without the use of alcohol or lubricant spray. Improve your patients’ skin and limb health, control volume, and reduce pistoning and rotation. Seal-In X provides personalized, optimal fit and secure suspension. Recommended for use with Unity sleeveless elevated vacuum for excellent volume control and suspension, with minimal added weight and no added build height. Ask your Össur rep about a demo today! For more information, contact Össur at 800/233-6263 or visit www.ossur.com.

MARKETPLACE Keeping Up With Kids Ottobock’s 3R67™ children’s knee joint is a prosthesis with hydraulic stance and swing phase control specifically adapted for young users. The knee meets the everyday demands of children during a myriad of activities, including different walking and running speeds and a flexion angle of up to 150 degrees for maximum freedom of movement. For everyday use, it can be worn with the robust 1K10 foot. For more information visit: professionals.ottobockus.com.

Ottobock Omo Neurexaplus Shoulder Orthosis Redefine recovery with Ottobock’s Omo Neurexaplus. The shoulder orthosis facilitates active rehabilitation by correctly positioning the arm and promoting movement for patients with shoulder subluxation. The Omo Neurexaplus inhibits pathological movement patterns, improves body posture and gait, and can be applied by patients themselves with one hand. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lowerlimb 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 more information, visit us on the web at www.spinaltech.com or call us at 800/253-7868.

TRS “KIDDO” Criterium Pivot Available NOW! Introducing the “KIDDO” for children tricycling and bicycling. The WEDGE design with integral radial, ulnar pivoting action, provides greater versatility, control, and safety for the rider. The two models (soft and firm) have different flexibilities and a “clasping action” on the handlebars. The KIDDO is less than three inches long, lightweight (6 oz.), and fits both left and right prostheses. Priced inexpensively, the KIDDO is available for kids three years old and up. For more information, contact TRS Inc. at 800/279-1865 or visit trsprosthetics.com.

2018 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 2018 AOPA coding products. Ensure each member of your staff has a 2018 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • 2018 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • 2018 CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • 2018 CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • 2018 Illustrated Guide: $185 AOPA members, $425 nonmembers • 2018 Quick Coder: $30 AOPA members, $80 nonmembers. Order at www.AOPAnet.org or call AOPA at 571/431-0876.

O&P ALMANAC | JUNE 2018

CALENDAR

2018

July 11

Administrative Documentation: What Is Always Needed and What Is Sometimes Needed? Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

June 13

Audits: Know the Types, Know the Players, and Know the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

July 1

ABC: Application Deadline for Certification Exams. Applications must be received by July 1 for individuals seeking to take the September Written and Written Simulation certification exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

July 13

PrimeFair East—The Providence Nocturnal Scoliosis System. Downtown Hilton, Nashville, TN. 8:00 a.m.- 12:15 p.m. This course instructs orthotists on the use of a nocturnal orthotic system for the nonsurgical treatment of adolescent idiopathic, juvenile, and neuromuscular scoliosis. The program will educate on how to satisfactorily address the needs of patients via thorough review of scoliosis principles and the use of innovative technology to optimize fit, comfort, and compliance while stopping curve progression in a nocturnal-only setting. Presented by Barry McCoy, CPO, Spinal Technology Inc.

July 1

ABC: Practitioner Residency Completion Deadline for Fall Clinical Patient Management (CPM) Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

July 13–14

PrimeFare East Regional Scientific Symposium. Hilton Downtown Nashville. Contact 888/388-5243, email primecarepruitt@gmail.com, or visit www.primecareop.com. 20th Anniversary of PrimeFare East!

July 23–24

July 9–14

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 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars. St. Louis. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar

Apply Anytime!

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

Calendar Rates Let us

your next event!

JUNE 2018 | O&P ALMANAC

Free Online Training

Cascade Dafo Institute. Cascade Dafo Institute offers eight free ABC-approved online continuing education courses for pediatric practitioners. Earn up to 12.25 CE credits. Visit cascadedafo.com or call 800/848-7332.

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

CREDITS

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

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR

August 1

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

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 2018 Academy Annual Meeting and receive $2,500 plus complimentary meeting registration. For more info or to apply, go to operf.org.

August 8

Outcomes & Patient Satisfaction Surveys. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

August 10–11

The Texas Chapter of the American Academy of Orthotists and Prosthetists 2018 Annual Meeting. Westin Galleria, Dallas. For information and registration, visit www.txaaop.org

October 20

Advancements in Conservative Treatments of Scoliosis. San Mateo, CA. Schroth instructors, orthotists, and MDs from around the country will be joining us to discuss topics relating to conservative and surgical scoliosis treatment. Grant Wood, Align Clinic, & Beth Janssen, Scoliosis Rehab. For more information, visit www.align-clinic.com or email evaldez@align-clinic.com.

November 4–10

Health-Care Compliance & Ethics Week. AOPA is celebrating Health-Care Compliance & Ethics Week and is providing resources to help members celebrate. Learn more at bit.ly/aopaethics.

November 7–9

NJAAOP. Harrah’s, Atlantic City, NJ. For more information, visit www.njaaop.com. Contact Brooke Artesi, CPO, LPO, with questions at Brooke@sunshinepando.com.

November 12–13

2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Las Vegas. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Coding & Billing Seminar

September 12

Medicare As a Secondary Payor: Knowing the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

September 26–29

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

November 14

Evaluating Your Compliance Plan & Procedures: How To Audit Your Practice. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

November 28–30

New England Chapter AAOP. Please join us at Mohegan Sun in Connecticut for an outstanding ABC/BOC continuing education program. Registration and more information at www.neaaop.org

October 10

Year-End Review: What Should You Do To Wrap Up the Year & Get Ready for the New Year? Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

December 12

New Codes, Medicare Changes, & Updates. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

October 18–20

International African-American Prosthetic Orthotic Coalition Annual Meeting. Embassy Suites Downtown Medical Center, Oklahoma City. For more information, contact Tony Thaxton Jr. at 404/875-0066, email thaxton.jr@comcast.net, or visit www.iaapoc.org.

2019 September 25–28

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

O&P ALMANAC | JUNE 2018

ASK AOPA CALENDAR

Rules and Responsibilities

Answers to documentation and billing questions regarding diabetic shoes, test sockets, and more

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

May an individual other than the certifying physician—such as a physician’s assistant, nurse practitioner, or a different medical doctor—document all of the requirements for diabetic shoes, with the certifying physician signing off on their findings or notes?

The answer is yes and no. A nurse practitioner, a physician’s assistant, or another medical doctor may document the secondary foot condition (criteria 2 on the certifying statement), and then the certifying physician may sign off on those notes; that is acceptable under policy. However, all other documentation requirements must be completed by the certifying physician and only the certifying physician. This requirement is reinforced by the recent revision to the diabetic shoe policy, which now states: The certifying physician must be a doctor of medicine (MD) or doctor of osteopathic medicine (DO) and may not be a podiatrist, physician assistant, nurse practitioner, or clinical nurse specialist. It is not sufficient for the supervising physician to sign off on the nonphysician practitioner’s evaluation.

Are we allowed to provide more than two test sockets when we provide a prostheses?

Yes. The policy states that no more than two test sockets will be considered medically necessary; however, if there is a medical necessity to provide more than two test sockets, you may do so. The additional test socket(s) may be denied, and you would have to appeal the claim and demonstrate the medical necessity of the additional test socket(s).

JUNE 2018 | O&P ALMANAC

May we bill a claim to both Medicare and the U.S. Department of Veterans Affairs (VA) if the patient is eligible to receive benefits from both?

It is possible for a patient to be eligible to have coverage from both the VA and Medicare, and use both insurances for different aspects of their care. However, they must choose one of the agencies to handle their orthotic and prosthetic services, and they may not use both insurances at the same time. A claim may not be submitted to both agencies for the same date of service and for the same items; this includes any potential balance billing.

If I have a patient sign an advance beneficiary notice (ABN) and I use the GA modifier, will this automatically result in a claim denial?

It may sometimes appear that whenever you use the GA modifier your claim is automatically denied, but that is not always the case. It is possible that your claim will automatically be paid when you use the GA modifier. The GZ modifier will automatically cause your claim to be denied as not medically necessary, and you would have to appeal the denial or write off the claim because you will be held financially liable.

AOPA Coding Experts Are Coming to

St. Louis July 23-24

ATLANTA

FEB. 26-27 | 2018

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA July 23-24 in St. Louis to advance your 14 CEs O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics.

EARN

AOPA experts provide the most up-todate information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group.

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/2018billing.

Top 10 reasons to attend: 1.

Get your claims paid.

Increase your company’s bottom line.

Stay up-to-date on billing Medicare.

Code complex devices

Earn 14 CE credits.

Learn about audit updates.

Overturn denials.

Submit your specific questions ahead of time.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience. The Westin St. Louis 811 Spruce Street St. Louis, MO 63102 Book your hotel by July 6 for the $149/night rate.

Find the best practices to help you manage your business.

Participate in the 2018 Coding & Billing Seminar!

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

3R67 Knee joint

1K10 Foot

3S80=1 Sport knee

1E93 Runner junior™

Keeping Up With Kids Lower limb solutions for active children

The technology of the 3R67 polycentric hydraulic prosthetic knee joint meets the everyday demands of children during a myriad of playtime activities. These activities include different walking and running speeds and kneeling with a flexion angle of up to 150 degrees. For everyday use, patients should wear it with the robust 1K10 foot. For more active sports, your young patients will be more agile with the 3S80=1 rotary hydraulic sports knee joint and 1E93 Runner junior™ foot, which has a durable and lightweight carbon spring that delivers a powerful drive and stable turning characteristics.

• professionals.ottobockus.com