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MICHAEL COLEMAN
Across the country, O&P facilities are tracking and aggregating an increasing amount of data relating to their patient treatments and outcomes—and that information is being shared in a secure way to drive improved clinical decision making. Learn about the technologies, tools, and processes in place to facilitate O&P data collection.
By CHRISTINE UMBRELL
The 2023 AOPA National Assembly is fast approaching! Rev up for the premier O&P conference by previewing some of the hot-topic educational sessions lined up for Indianapolis.
or the active users with foot drop less support is needed during stance phase e flexibility – greater ROM
Greetings to all! I could not be more excited to invite you to join me, and what I hope will be more than 2,000 of our colleagues, in Indianapolis this fall, Sept. 6-9, for the 2023 AOPA National Assembly. At this time every year, I look forward to connecting with AOPA members in person. If you’ve attended the Assembly, you know what it’s all about—but if you haven’t, please join us to experience it firsthand!
As a member of the AOPA Assembly Planning Committee, I can personally attest to how hard the committee members and AOPA’s staff have been working not only to bring you educational sessions and events you’ve come to expect at the National Assembly, but also to provide you with enhanced content, engagement, and value.
Highlights include:
• Insightful clinical, business, technical, O&P digital care, and post-breast surgery education
• Guest speakers from Medicare, the VA, and DOD
• Learnings from top researchers, practitioners, and business experts
• Key takeaways from AOPA-funded research
• Exhibit hall highlighting the most transformative prosthetic and orthotic devices, solutions, and services
• Tailgate Welcome Reception
• Women in O&P brunch to support So Kids/Every BODY Can Move
• Reception for So Kids/Every BODY Can Move, held at the NCAA Hall of Fame
• Ability to earn more than 100 CE Credits!
In addition to all of these highlights, the National Assembly is a great opportunity for us to gather to celebrate the accomplishments of the past year, hold our annual business meeting, and plan for the coming year.
I think you will enjoy experiencing Indianapolis as it is a fun city with lots to do—and being in the Midwest, it is easily accessible to most in the country. If you can’t make it, we also will be offering most of the education virtually. The content will be available for 60 days starting Sept. 20. In-person attendance also gives you access to the virtual content, enabling you to see the sessions that you may have missed in person.
The goal of the 2023 AOPA National Assembly is to serve your professional needs and to help you facilitate connections with others in O&P. Serving our members and ensuring their needs are met are the most important priorities for AOPA. An engaging and informative program has been planned for you, so please join us and register at AOPAassembly.org (register by Aug. 1 to save $100).
It has been my absolute privilege and honor to be in the driver’s seat this past year serving as AOPA’s president. Please know I look forward to connecting with all of you at the 2023 National Assembly so that we can continue to learn from one another and work together to drive our profession in the best direction forward. See you in Indy!
Very truly yours,
Teri Kuffel, JD
OFFICERS
President
Teri Kuffel, JD
Arise Orthotics & Prosthetics, Spring Lake Park, MN
President-Elect
Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX
Vice President
Jeffrey M. Brandt, CPO Brandt Ventures, Exton, PA
Immediate Past President
Dave McGill Össur Americas, Foothill Ranch, CA
Treasurer Rick Riley Bakersfield, CA
Executive Director/Secretary
Eve Lee, MBA, CAE AOPA, Alexandria, VA
DIRECTORS
Arlene Gillis, MEd, CP, LPO International Institute of Orthotics and Prosthetics, Tampa, FL
Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX
Kimberly Hanson, CPRH Ottobock, Austin, TX
John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY
James Kingsley Hanger Clinic, Oakbrook Terrace, IL
Lesleigh Sisson, CFo, CFm Prosthetic Center of Excellence, Las Vegas, NV
Linda Wise Fillauer Companies, Chattanooga, TN
Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX
A world where orthotic and prosthetic care transforms lives.
AOPA staff and volunteers are committed to our mission of being a trusted partner, advocating for and serving the orthotic and prosthetic community by:
• Fostering relationships with decision makers to ensure equitable access.
• Providing education that promotes professional excellence.
• Supporting research that informs innovative care.
• Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.
A world where orthotic and prosthetic care transforms lives.
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MEMBERSHIP & COMMUNICATIONS
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AOPA Bookstore: 571-431-0876
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O&P ALMANAC
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O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/ December, 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 info@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.
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Copyright © 2023 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.
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Cailor Fleming is proud to offer new and existing customers a discount on premiums (5-15%) to
Providers who participate in the LLPR. Discounts to be applied at renewal or at the beginning of the policy year.
The LLPR is the first quality registry for hospital systems and prosthetic/orthotic practices for creating a collaborative database that focuses on acquired and congenital limb difference, as well as limb preservation, populations.
Researchers from the University of Saskatchewan in Canada studied the biomechanical and physiological challenges encountered by long-term users of locked knee-ankle-foot orthoses (KAFOs). Locked KAFOs are designed to maintain the knee in extension throughout the gait cycle. This design, whether implemented via drop-lock, bail-lock, or Swiss-lock, can impose an inefficient long-legged gait pattern on wearers, and offers additional challenges because it requires mechanical or manual release for sitting, according to the researchers.
Individuals who use locked KAFOs for extended periods may experience abnormal gait patterns due to insufficient knee flexion during swing phase, and increased energy expenditure. In addition, decreased capacity of lower-limb shock absorption can lead to low-back pain and osteoarthritis of the
lower limb and spinal joints, the researchers noted. Locked KAFO users also may experience excessive shear forces at the skin-orthosis interface as well as friction blisters, according to the research team, as well as physiological and myogenic issues associated with long-term immobilization, such as increased stiffness of the joint, cartilage softening, muscle atrophy, shortness of the muscle, and increased oxidative stress.
Given these findings, the researchers note that using a locked KAFO “must be justified for each patient uniquely based on their remaining muscular activity level and orthotic support required,” and that users consider specific exercise and muscle stretching activities to counter knee immobilization effects. The study was published May in Frontiers in Rehabilitation Science
Shirley Ryan AbilityLab has been awarded a fiveyear, $8.7 million grant from the National Institutes of Health to undertake a bionic arm osseointegration study to explore restoration of sensation for individuals with upper-limb loss. Investigators will combine osseointegration, targeted muscle reinnervation (TMR), and pattern-recognition control using implanted electromyographic sensors. The study is the first in-home trial of the e-OPRA system in people with upper-limb amputations who have had TMR surgery and use a Coapt Gen2 pattern recognition-controlled myoelectric prosthesis.
“With this combination of novel and advanced technologies, the device should feel much more like a person’s actual limb,” said Levi Hargrove, the study’s lead researcher and director of the Regenstein Foundation Center for Bionic Medicine at Shirley Ryan AbilityLab. “This study builds on many years of our leadership in bionic medicine and marks a significant step forward in making this intuitive technology broadly available for the first time.”
Shirley Ryan AbilityLab will partner with Northwestern Medicine and osseointegration company Integrum. Researchers will implant devices and perform TMR surgery on eight research subjects. The University of Chicago Medicine and Bionics Institute in Australia also will support the study.
Following participants’ surgeries, the research team will lead two clinical trials to evaluate the comfort and function with implanted electrodes through e-OPRA, compared to and combined with the clinical solution using the pattern recognition system, and will evaluate the effects of providing sensory feedback.
Sensors can be used to accurately measure certain gait parameters among individuals with lower-limb amputation, according to an international team of researchers. The researchers, from Ottobock and Denmark’s Aalborg University, recruited 10 individuals equipped with the Genium X3 prosthetic knee joint to take part in the embedded sensor study.
Participants were asked to perform level walking, stair/ramp descent, and stair/ramp ascent, with sensors embedded in their prostheses. The researchers recorded kinematics and kinetics using an optical motion capture system and force plates. They calculated root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance.
The outcome variables showed small but significant differences between the two measurement systems. “The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide variety of tasks,” according to the study authors. “This paves the way for assessing prosthesis performance in realistic environments outside the lab.” The study was published June in ScienceDirect.
Individuals with transtibial amputation who use running-specific prostheses may be challenged by incorrect sizing, according to researchers from University of Colorado Boulder and Gonzaga University. The research team, led by Janet H. Zhang-Lea, PhD, set out to determine a method for prescribing a standing prosthetic leg length that results in an equivalent running biological leg length for individuals with unilateral and bilateral transtibial amputation.
The team measured the standing leg length of 10 athletes with unilateral amputation, five athletes with bilateral amputation, and 10 nonamputee athletes. The researchers calculated standing and running biological leg length and prosthetic leg lengths and assessed the running-to-standing leg length ratio during ground contact at three touchpoints in the stance phase of running: touchdown, midstance, and takeoff.
Unilateral subjects had 2.4-cm longer standing prosthetic leg length than biological leg length, but
their prosthetic leg lengths were up to 3.3-cm shorter at touchdown and 4.1-cm shorter at midstance compared to biological leg length. During running, prosthetic leg lengths were consistently shorter than biological leg lengths, according to the researchers.
“To achieve equivalent running leg lengths at touchdown and takeoff, athletes with unilateral transtibial amputation should set their running-specific prosthesis height so that standing prosthetic leg length is 2.8-4.5% longer than biological leg length,” reported the researchers. Athletes with bilateral transtibial amputation “should set their running-specific prosthesis height so that standing prosthetic leg lengths are at least 2.1-3.9% longer than their presumed biologic leg length. … We encourage policymakers to consider task-specific biomechanics when setting athletics regulations.” The study was published May in Scientific Reports
More than 36,500 people ages 65 and older died of fall-related injuries in 2020, up from 10,100 in 1999.
O&P clinicians should understand consumers’ concerns with the current health environment and take their time when communicating with patients. Consumers say the system is “stretched thin” in a study conducted by The Harris Poll on behalf of the American Academy of Physician Associates (AAPA).
Among insurers participating in HealthCare.gov, the availability of managed-care plans has grown steadily since 2014. In 2023, 82% of plans available to consumers are health maintenance organizations (HMOs) or exclusive provider organizations (EPOs), plans that generally do not provide out-ofnetwork coverage.
SOURCE: “THE INDIVIDUAL HEALTH INSURANCE MARKET IN 2023,” MCKINSEY & CO.
Ticketing for the Paralympic Games Paris will launch Oct. 9. The Games, slated for Aug. 28-Sept. 8, 2024, will feature 4,400 athletes competing in 549 events in 22 sports.
Insurers that take part in HealthCare.gov denied almost 17% of in-network claims, according to a recent study of transparency data for the 2021 calendar year. A new study from Kaiser Family Foundation explored the data from the 230 major medical issuers associated with HealthCare.gov.
Among the 162 insurance companies that reported receiving at least 1,000 in-network claims, a total of 291.6 million in-network claims were received,
of which 48.3 million were denied, for an average in-network claims denial rate of 16.6%.
Some of the reasons for claim denials included denials due to an out-of-network provider; denials due to an exclusion of a service; denials based on medical necessity (reported separately for behavioral health and other services); and other reasons.
Consumers rarely appeal denied health insurance claims associated with HealthCare.gov; only 0.2% of denied claims were appealed. Of those, issuers upheld 59% of denials.
Researchers at the Minneapolis Veterans Medical Center are developing a mobile at-home therapy app and launching a brain imaging study to explore the origins of phantom limb pain—a condition experienced by up to 80% of limb loss patients, according to Tonya Rich, PhD, OTR/L.
Rich, an occupational therapist and researcher at the Minneapolis Adaptive Design Engineering Program at the Minneapolis VA, previously conducted a phantom pain study of 50 veterans with limb loss and found that phantom limb pain is “highly variable,”
and that many veterans are unaware of therapeutic or simple strategies that may help reduce pain. Because researchers have had some success with mirror therapy, the Minneapolis team will create an app and online tools to aid veterans in conducting mirror therapy at home. The augmented reality app will allow patients to sit and hold video tablets over their legs; cameras on the tablets will create duplicate images to make it appear as if both legs are intact. Rich discussed the project during the Minneapolis VA Healthcare System VA Research Week 2023
Approximately 1,500 O&P stakeholders from 73 countries traveled to Guadalajara, Mexico, in April to participate in the 19th World Congress of the International Society for Prosthetics and Orthotics (ISPO). Nearly 300 speakers presented an extensive four-day scientific program revolving around the theme of “The Art and the Science,” and the exhibit hall featured products and services from 110 companies from 28 countries.
ISPO 2023
During the event, ISPO launched two special interest groups: one for bone-anchored limbs and one for upper-limb prosthetics. In addition, ISPO President Claude Tardif announced that David Constantine will
be his successor, effective immediately until 2025.
Joan Sanders, PhD, and her team from the University of Washington in Seattle were awarded this year’s Brian and Joyce Blatchford Team Prize for Innovation for their work on innovative technologies for socket interfaces.
World Congress participants and ISPO members can access recordings from the 2023 event at ispolearn.org. The next World Congress will be held June 16-19, 2025, in Stockholm, Sweden, and will feature the theme, “Science in Practice, Practice in Science: Collaboration and Innovation Toward Sustainable Rehabilitation.”
SOURCE: LEIPZIGER MESSE / SERGIO GARIBAY / RICARDO GUZMÁN
One size does not fit all. At Hersco, our team of professionals works to fabricate orthotics from your scans and casts to match your patients’ specific needs.
Customer service is at the heart of everything we do and we work endlessly to help you be as effective and efficient as possible. When you want the job done quickly and accurately, Hersco is here to help.
CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES
Carl Caspers, CPO, an O&P innovator and advocate, passed away June 10 at the age of 82. Caspers, who grew up in Minneapolis, lost his leg in an accident during his senior year of high school. That experience led him to attend Northwestern University and become a certified prosthetist/orthotist.
During his early career, Caspers practiced in St. Paul and Montana, then settled in St. Cloud, Minnesota. There, he founded Northwestern Artificial Limb & Brace and TEC Interface Systems. He helped develop innovative socket technology and co-authored the book In Pursuit of Socket Harmony. He received the 1992 Governor’s Award in Minnesota for outstanding achievement; he was honored with the Academy’s Titus-Ferguson Award in 2014 and AOPA’s Lifetime Achievement Award in 2022. He also had 41 patents and was recognized as a key advocate for osseo bone bridge.
Caspers enjoyed riding motorcycles, race car driving, boating, hunting, and his dogs. He is survived by his wife of 61 years, Barb; his children, Cori Schneider and Tony Caspers; and several grandchildren.
Max Lerman, CO, owner of Lerman & Son Orthotics and Prosthetics in Beverly Hills, California, passed away at the age of 95.
Lerman was the son of Jacob Lerman, who founded Lerman & Son in 1915. The company began as a shoe manufacturing company in Germany within a small department that focused on orthotics and prosthetics. During World War II, Lerman & Son fled Germany to Shanghai, China, where the company remained for 10 years. While in Shanghai, Lerman received an apprenticeship from the German Meisters, Leyser Brothers, where he garnered the experience he needed to partner with his father and eventually transition the facility to Lerman & Son Orthotics and Prosthetics.
In 1948, Lerman and his father moved the company to California. Lerman earned his ABC credentials and eventually taught orthotics in the Orthotics and Prosthetics Department at the University of California—Los Angeles.
Lerman & Son grew to one of the largest O&P facilities serving Los Angeles County and has remained a family-operated practice employing three generations. In 2006, Lerman was awarded the Clinical Creativity Award from the American Academy of Orthotists & Prosthetists. Lerman & Son celebrated 100 years in practice in 2015.
Lerman was a pioneer in O&P, an inventor with numerous patents, a devoted member of the O&P community helping the underserved, and a U.S. Army veteran. He maintained a strong presence in the industry and chose not to retire, remaining with his company until his death.
Jeffrey Yakovich, CO, former president at North Coast Orthotics and Prosthetics, passed away June 30 at age 69. Yakovich, who lived with limb loss, earned his bachelor’s degree in industrial technology from Bowling Green State University, then attended the O&P program at the Northwestern University School of Medicine in Chicago and became a staff orthotist at DT Watson Rehabilitation Hospital in Sewickley, Pennsylvania.
He later became the founding director of the O&P program at the Cleveland Clinic. He provided orthoses for the Cleveland Indians, Browns, and Cavaliers and maintained relationships with all three teams as a member of their medical staffs throughout his professional career.
Yakovich was active with AOPA and the Ohio Chapter of the American Academy of Orthotists & Prosthetists. He served as an orthotics examiner for the American Board of Certification in Orthotics, Prosthetics, and Pedorthics, and as the organization’s president in 2006. He enjoyed spending time with his family, fishing, golfing, skiing, and boating. He is survived by his wife, Kathy, his children, and grandchildren.
Art Dyck has announced his retirement from Fillauer Motion Control effective August 31. Dyck has been with the company for 35 years, serving as president for the past six years. “I want to thank Art for his many years of service at Fillauer Motion Control,” said Michael Fillauer. “His calm and rational approach to problem solving and leadership will leave a lasting impression.”
Jon Winegar has accepted the position of regional vice president and will be assuming Dyck’s previous responsibilities along with his current leadership role at Fillauer Composites. “I am grateful for this opportunity and am eager to listen, learn, and build relationships from such a great group of creative minds and leaders,” said Winegar. Dyck will work closely with Winegar to ensure a smooth transition.
The American Academy of Orthotists and Prosthetists has announced election results for the 2023-2024 governance year. Mark Holowka, MSPO, CPO, FAAOP(D), was elected president.
Other members of the Academy board include Susan Kapp, MEd, CPO, LPO, FAAOP(D), president-elect; Gerald Stark Jr., PhD, MSEM, CPO, LPO, FAAOP(D), vice president; Tiffany Graham, MSPO, CPO, LPO, FAAOP(D), treasurer; and JoAnne L. Kanas, DPT, CPO, immediate past president. Additional directors include Greg Armstrong, CPO, LPO, FAAOP; Duffy Felmlee, MSPO, CPO, FAAOP(D); Matthew Garibaldi, MS, CPO; Kevin Hines, CPO, LPO, FAAOP; Brian Kaluf, CP, FAAOP; and Seth O’Brien, CP, FAAOP(D).
Hanger has announced the promotions of Phil Stevens, MEd, CPO, FAAOP, to vice president of clinical affairs and Shane Wurdeman, PhD, CP, FAAOP(D), to vice president of scientific affairs.
Both Stevens and Wurdeman have made significant contributions to the development of Hanger’s Clinical and Scientific Affairs Department since its formation in 2015. In 2021, they helped establish the Hanger Institute for Clinical Research and Education, which helps explore and facilitate opportunities that advance science and care in orthotics and prosthetics.
Orthotics & Prosthetics Laboratories Inc. (O&P Labs) of Springfield, Northampton, and Pittsfield, Massachusetts, has been acquired by Ortho Dev America Corp. (ODA), an O&P company that has more than 70 patient-care facilities in the United States. The official acquisition took place March 31. James Haas, director of operations and former president, said, “We now have tremendous resources to draw from, creating opportunities to grow as a company and to better serve our patients.” O&P Labs will continue to operate with its same management team and patient-care model.
In past issues, Reimbursement Page has examined the results of recovery audit reviews, durable medical equipment Medicare administrative contractor (DME MAC) prepayment reviews, Target-ProbeEducate (TPE) reviews, and other types of reviews and audits, and has analyzed some of the most common denial reasons noted in the results. These denial reasons or errors typically focus on same/similar, medical necessity documentation, or missing and invalid documentation (proof of delivery or standard written order). One area we have not yet explored is ensuring the code on the claim is correct for the item or items billed. Unfortunately, incorrect coding appears to be on the rise for denials and error rates.
The DME MAC Prepay Review Quarterly Status reports from Jurisdictions B and C for the first quarter in 2023, Jan. 1 through March 31, revealed error rates ranging between 39% and 70%, with the top reason for denials being incorrect coding. In some cases, the incorrect coding denials were as high as 70%. The error
rates listed in these reports represent an overall average as a part of the TPE program and are not an overall error rate for the Healthcare Common Procedure Coding System (HCPCS) codes in general. However, the results are alarming, as they indicate that incorrect coding is becoming the number one error rate or reason for claim denials—by a large margin for some benefit categories.
CGS, the DME MAC for Jurisdictions B and C, did not provide information as to why the codes reported on the claims were considered incorrect. However, based on the codes being reviewed, we can make assumptions regarding the two main possible reasons: 1) not verifying or using a current Pricing, Data Analysis, and Coding (PDAC) contractor-approved code for the item billed, and 2) the code reported on the claim did not match the level of fitting provided at the time of delivery, or the inappropriate use of an off-the-shelf (OTS) code versus a custom-fitted code.
This month’s Reimbursement Page examines these two scenarios and demonstrates
their importance when it comes to proper code selection.
The PDAC contractor plays an important role in creating and publishing clarifying information regarding correct coding of O&P services delivered to Medicare patients. Palmetto GBA LLC has been the PDAC contractor since late 2018 and performs three main functions as the PDAC contractor: establishing and distributing pricing files for items and services designated as durable medical equipment, prosthetics, orthotics, and supplies; data analysis (to identify utilization patterns of HCPCS codes) and reporting; and HCPCS coding verification, used to establish coding guidance for specific products.
Coding verification may be a voluntary process where manufacturers can request a Medicare-approved coding decision for their product or service. However, a coding verification also may be mandated by a policy as a requirement for payment, and it is the duty of the PDAC to review these
products to provide the appropriate HCPCS code for Medicare billing.
Nine categories of O&P items currently require PDAC coding verification as a condition of payment: therapeutic shoes for persons with diabetes; spinal orthoses— cervical orthoses, thoracolumbosacral orthoses (TLSOs), and lumbosacral orthoses (LSOs); knee orthoses; anklefoot/knee-ankle-foot orthoses; upper-limb orthoses; lower-limb prostheses; upperlimb prostheses; surgical dressings; and functional electrical stimulators (see sidebar for exact codes)
If you provide an item described by one of the codes listed in the sidebar and the PDAC has not made and published a coding verification, your claim will be denied as incorrect coding. To check whether a product or item has received a published PDAC coding verification, visit the Durable Medical Equipment Coding System, maintained by Palmetto and available at www4.palmettogba.com/pdac_dmecs/, or visit the Product Classification List (PCL). The PCL is an official source for all O&P items with current and past PDAC coding verifications.
Once a request for coding verification— voluntary or mandated—has been received and the PDAC publishes its decision on the PCL, the coding verification becomes binding for Medicare purposes. Any claims submitted to Medicare must be coded according to the PDAC coding verification; claims for items that are coded in conflict with a PDAC coding verification will be denied as incorrect coding. Note that PDAC coding verifications are normally productand model-specific, so when checking the PCL, verify product and model information as well.
You should routinely check the PCL before delivering any item listed above, but this is particularly important for spinal orthoses, as the majority of spinal orthoses require PDAC coding verification. In fact, spinal orthoses had a denial rate of 70% for incorrect coding in the Q1 Prepay Review Quarterly Status reports.
Note that if custom-fabricated spinal orthoses (cervical, TLSOs, or LSOs) or custom-fabricated therapeutic shoe inserts that require PDAC coding verification are fabricated in your facility and delivered
Shoes for Persons With Diabetes
Spinal Orthoses—Cervical, Thoracolumbosacral Orthosis (TLSO), and Lumbosacral Orthosis (LSO), Prefabricated
A5512, A5513, and A5514
L0174, L0450, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0488, L0490, L0491, L0492, L0625, L0626, L0627, L0628, L0630, L0631, L0633, L0635, L0637, L0639, L0641, L0642, L0643, L0648, L0649, L0650, and L0651
Spinal Orthoses—Cervical, TLSO, and LSO, Custom-Fabricated
Knee Orthoses
Ankle-Foot/Knee-Ankle-Foot Orthoses
Upper-Limb Orthoses
Lower-Limb Prostheses
Upper-Limb Prostheses
Surgical Dressings
L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638, and L0640
L1832, L1833, L1845, L1851, and L1852
L1906 and L2006
L3960
L5856, L5857, L5858, L5969, L5973, L5980, and L5987
L6715 and L6880
A6545
Functional Electrical Stimulator E0770
directly to your patients, then PDAC verification would not be required. However, you must be able to provide a list of the materials used in fabrication and a description of your fabrication process, if requested.
In addition to coding verification for specific products, either voluntarily or mandated, the PDAC also will occasionally publish, in corroboration with your DME MAC, advisory articles that provide specific clarification regarding coding in certain scenarios or for specific product group of HCPCS codes. Just as with coding verifications, these articles and coding reminders, once published, become binding for the purpose of Medicare claim submission and must be followed;
they become de facto extensions of current Local Coverage Determination (LCD) and Policy Article (PA) policies; and, in some instances, they create a policy when one did not exist.
In some instances, the information published in the PDAC advisory articles will make its way into future revisions and updates of LCDs and PAs, but the advisory articles often stand on their own. PDAC advisory articles are located on the PDAC website: https://www.dmepdac.com/ palmetto/PDACv2.nsf/DID/B7CL2557
One example of an important DME MAC/ PDAC article was published March 12, 2021: “Custom-Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code— Correct Coding.” The article focused on HCPCS code descriptors for prefabricated
items that only include the term “includes fitting and adjustment,” and that don’t mention “off the shelf” or “customized to fit”—for example, the L1971 (AFO, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment). However, it also addressed other orthotic HCPCS codes that don’t have a corresponding OTS code, such as the L0460.
CMS in 2014 introduced a series of HCPCS code pairs, or split codes, that included both an OTS version and a version that requires custom fitting by an individual with appropriate expertise or training— customized-to-fit or custom fitted.
A total of 51 orthotic HCPCS codes did not have their descriptors changed and continued to simply state, “prefabricated, includes fitting and adjustment” or didn’t mention the type of fitting, or don’t have a corresponding OTS HCPCS code. The advisory article indicates that these 51 HCPCS codes are to be appropriately classified as custom-fitted orthoses, and therefore may only be used to describe orthoses that require customization and/or modification by a certified orthotist or other properly trained individual
at the time of fitting. So, an articulating AFO described by L1971 would be considered a custom-fitted orthosis for coding purposes.
If you deliver an orthosis described by one of these 51 codes, and it is delivered as OTS, without customization and/or modification, it must be billed using the appropriate not-otherwise-specified code (L1499, L2999, or L3999). If you deliver an L1971 and you did not do any custom fitting at the time of delivery, you would use the L2999.
When coding and billing for prefabricated orthoses, be sure to select the appropriate code to describe the type of fitting you are providing at the time of delivery: OTS or custom fitted. Also, document the type of fitting (i.e., what was molded, heated, bent, etc.) as well as who did the fitting. For a device to be considered custom fitted, the fitting and modifications done at the time of delivery must be made by a certified orthotist or someone with specialized training.
Denials and errors caused by missing or invalid medical necessity documentation have some subjectivity associated
with them, as they are “in the eye of the reviewer.” But incorrect coding errors and denials are a little more objective and easier to prove or disprove—and they are in your complete control. Take the time to review your coding by checking the PDAC PCL and ensuring you used the appropriate code to describe your level of fitting at the time of delivery. By using these two Medicare tips, you can ensure proper coding of the services you are providing.
Remember, according to the PDAC and the DME MACs, the “use of the appropriate HCPCS code assures that accurate processing can be accomplished, resulting in a proper claim determination and reimbursement.” In other words, correct coding ensures a clean claim, and a clean claim ensures prompt payment.
Successfully navigating the complex legislative terrain of the U.S. healthcare system takes a combination of savvy, persistence, and patience. AOPA and its allies are counting on that strategy to help push important legislation across the finish line this year on Capitol Hill and in state legislatures across the nation.
At the state level, AOPA’s primary legislative mission for 2023 is expanding the So Kids Can Move program that persuades state legislatures to provide American children and youth—and potentially Americans of all ages—greater access to medically necessary prostheses and orthoses. On the national level, AOPA is backing a major bill in Congress that would expand access to O&P devices,
protect against Medicare fraud, and level the playing field for competitive bidding exemptions by providing orthotists and prosthetists the same competitive bidding exemptions as those currently afforded physicians and therapists.
While the Medicare O&P Patient-Centered Care Act of 2023 mirrors previous bills that did not reach the legislative finish line in recent sessions of Congress, the latest version of the legislation is streamlined and carries a smaller price tag, while still promising significant benefits for the O&P profession and patients. Advocates are confident the changes improve its chance of passage.
f Advocacy efforts spearheaded by AOPA and O&P stakeholders have accelerated over the past year, with new legislation under consideration in national and state houses.
f In June, the O&P community scored a victory when the revamped Medicare O&P Patient-Centered Care Act was introduced in the House of Representatives as House Resolution 4315.
f HR 4315 has garnered bipartisan support and would expand access to O&P devices, protect against Medicare fraud, and allow competitive bidding exemptions for orthotists and prosthetists.
f At the state level, the So Every Body Can Move initiative has gained supporters across the nation, sparking a flurry of activity seeking passage of legislation expanding access to devices that enable physical activity.
f Victories in Arkansas, Colorado, New Mexico, and Maine have already resulted in laws mandating coverage associated with the So Every Body Can Move initiative. In Illinois, a similar bill awaits the governor’s signature as of press time.
f AOPA and its partners have set a goal to help pass similar legislation in 28 states by the year 2028, when the Paralympic Games will be held in Los Angeles.
“It has changed and evolved over time as the needs of our patients have changed because it is truly a patient-centered care act,” explains Joe McTernan, AOPA’s director of health policy and advocacy. “This bill is about increasing and improving access to O&P care for patients.”
The bipartisan bill— House Resolution (HR) 4315 —was introduced in late June by Republican Rep. Glenn “GT” Thompson of Pennsylvania, with Reps. Brett Guthrie, a New York Republican, and Democratic Reps. Mike Thompson of California and Angie Craig of Minnesota as initial co-sponsors. GT Thompson spent 30 years as a therapist, rehabilitation services manager, and licensed nursing home administrator prior to being elected to Congress, which he says gives him “a personal understanding of the challenges facing those who require orthotics or prosthetics.”
“This bill recognizes access to medically necessary and high-quality orthotics and prosthetics [is] critical for mobility and the overall quality of life of the patient,” GT Thompson said in a statement upon the bill’s introduction.
The proposed exemption from competitive bidding would ensure that patients have access to the full range of orthotic care from their primary O&P practitioner rather than forcing them to visit multiple providers when the orthotist or prosthetist treating the patient does not have a competitive bidding contract. This would help ensure efficient and convenient patient care while allowing O&P practitioners the same exemption as other healthcare professionals. Because O&P practitioners would be reimbursed according to the adjusted Medicare fee schedule established through the competitive bidding process for off-the-shelf orthoses, this provision would not cost the Medicare program additional money.
“We feel that this would elevate O&P practitioners to being treated similarly to therapists and physicians for this purpose, it would also not cost the government any money, and it would be patient-centric,” says Peter Thomas, JD, a Washingtonbased healthcare and disability policy attorney who serves as general counsel for the National Association for the Advancement of Orthotics and Prosthetics (NAAOP). Thomas, one of the O&P community’s leading advocates on Capitol Hill, has been working for years to convince Congress to enact provisions contained in the Medicare O&P Patient-Centered Care Act of 2023.
A proposed prohibition on the drop shipping of custom-fitted and custom-fabricated orthoses, and all prostheses, would help ensure only qualified providers deliver devices—and help prevent fraudulent billing practices, such as the $1.2 billion Medicare scam that saw unscrupulous doctors and vendors peddling orthopedic braces to hundreds of thousands of seniors and people living with disabilities, without proper fitting of the devices by qualified clinicians. In 2019, federal authorities charged 24 people, including doctors and
owners of medical equipment companies, in a scheme to defraud Medicare with bogus O&P device orders. In some cases, these bad actors billed Medicare and exhausted patients’ benefits to receive a custom-fitted device.
Under provisions contained in the 2023 Medicare O&P PatientCentered Care Act, only off-the-shelf orthoses would be allowed to be drop shipped to a patient’s home without any clinical intervention by a provider or supplier. The prohibition contained in HR 4315 would bar unscrupulous suppliers, who rely on “lead generators” that operate through a model based on late-night advertisements and telemedicine companies, from shipping custom-fitted and -fabricated orthoses and all prostheses to Medicare beneficiaries who have not been provided with appropriate clinical care.
“In our opinion, anything that’s custom fitted, or custom fabricated, should never be just shipped direct from a warehouse to a patient’s house without having instructions or the expertise of the clinician to fit the brace,” McTernan says, adding that this provision in HR 4315 could save Medicare millions of dollars.
“We think it will be a good provision to shore up the integrity of the program, but also make sure that patients who do need orthoses have them properly fitted, and that they meet their intended purpose,” Thomas explains.
The third major provision of the Medicare O&P Patient-Centered Care Act would give beneficiaries access to custom-fitted and custom-fabricated orthoses when they need a replacement due to changes in their physical condition or clinical needs, or when the orthosis wears out or breaks and a repair would be exceedingly expensive. Existing Medicare restrictions disallow the replacement of orthoses during their “reasonable useful lifetime,” which is often five years. That means some particularly active O&P patients can be stuck with worn-out orthoses for years before they can obtain a new device under Medicare. The rule was created to address replacement of durable medical equipment such as wheelchairs, walkers, or hospital beds, but the five-year replacement threshold is too restrictive when applied to orthoses, which can be more fragile and are typically subjected to near constant strain on a daily basis.
A federal law created in 2000—the Benefit Improvement and Protection Act—does provide for exceptions to continuous use and useful lifetime restrictions for prosthetic devices if a doctor determines it is medically necessary in limited circumstances, but the bill now pending in the House would extend the exception to custom-fitted and custom-fabricated orthotic devices.
“In our opinion, anything that’s custom fitted, or custom fabricated, should never be just shipped direct from a warehouse to a patient’s house without having instructions or the expertise of the clinician to fit the brace.”
JOE MCTERNAN
The Medical and Health Stockpile Accountability Act (HR 3577) aims to alleviate equipment shortages by creating a critical new national system that will provide real-time updates of medical and health supply inventories nationwide. The COVID-19 pandemic and resulting public health emergency exposed a major vulnerability in real-time accounting of emergency medical equipment and supplies.
The Expanded Telehealth Access Act (HR 3875) would make physical therapists, occupational therapists, and speech-language pathologists permanent authorized providers of telehealth under the Medicare program.
The Strengthening Medicare for Patients and Providers Act (HR 2474) would provide an annual inflationary payment update to the Medicare Fee Schedule based on the Medicare Economic Index, which measures inflation for healthcare providers relative to their practice overhead expenses and wage levels. This bill would address CMS’s outdated Conversion Factor, established in 1992, that does not allow adjusting fees for inflation.
“This, to us, is an access issue,” McTernan says. “The new bill would take away that five-year default useful lifetime [restriction] and say that the need for a new brace or a different brace is only going to be tied to medical necessity. It doesn’t mean that the physician doesn’t need to document the medical need for that brace, and we’re not saying that patient should have carte blanche—just that it wouldn’t be arbitrarily tied to this random five-year useful lifetime requirement. Frankly, braces don’t last that long. If they’re worn 12 to 18 hours a day, they’re not going to last five years. They break down.”
“This new provision would allow a physician to say there has been a change in the patient’s condition or that the patient needs a more extensive or complex orthotic device and allow it to be covered by the Medicare program,” Thomas adds.
While the Medicare O&P Patient-Centered Care Act offers a fresh legislative take on pressing problems facing the industry and its beneficiaries, advocates and lawmakers backing the latest iteration of the bill on Capitol Hill decided to scrap some proposals they’d pressed for in previous legislation that failed to cross the finish line. One was a section that proposed treating orthotics and prosthetics differently from durable medical equipment in the statute.
“We want to move toward further differentiation between durable medical equipment and O&P, but it turned out that there were a lot of complicating factors so that it got very messy,” Thomas explains. “So, we decided just to work on that issue through CMS and through the regulatory process instead of through the legislative process.” Thomas, a veteran observer of Capitol Hill politics and policymaking, says AOPA and other advocates for similar bills in previous Congress are especially optimistic about the latest’s bill’s chance for success. “We’ve learned a lot, and we’ve taken a couple of the more controversial provisions out that were complex, and we’ve streamlined it; the bill is just three provisions now,” he says. “Hopefully, we’ll be able to move it in this Congress.”
On a separate legislative track, AOPA and other healthcare advocates are pressing Congress for an extension of telehealth patient visits under federal law. The allowance for telehealth visits
to determine patient needs in some cases has been extended through the end of 2024. AOPA and many other health advocacy organizations want it extended through 2024.“Everybody is pretty confident that telehealth is a good model and a successful model going forward,” McTernan says.
While AOPA’s focus on Congress is part of a longstanding national legislative strategy, a state-level campaign to expand access to activity-specific orthoses and prostheses for children and adolescents is picking up political steam, as well.
State, federal, and private health plans routinely deny access to O&P care for physical activity devices deemed not medically necessary. Without health plan coverage, children, adults, and families are forced to shell out big bucks—anywhere from $5,000 to $50,000—to obtain the devices and care they need. If they can’t do so, they may risk harm or injury from using lower cost, but improper, devices or resign themselves to sedentary lifestyles with potentially costly health complications, including obesity and diabetes. People with disabilities need specialized prostheses and orthoses to be able to participate in physical activity and exercise, just like their non-disabled peers.
The So Kids Can Move legislative outreach initiative, launched just one year ago by AOPA in conjunction with NAAOP, the Amputee Coalition, and AAOP, has achieved significant early success, with bills passed in five states—Arkansas, Colorado, Illinois, New Mexico, and Maine—that provide expanded O&P coverage for devices for physical activity not just for children and youth, but for people of all ages. To capitalize on the readily apparent willingness of state legislatures to tackle this problem, AOPA has changed the name of the initiative to So Every Body Can Move
“We’ve actually found that it’s more appealing to legislators [to expand coverage to adults as well as children], at least in the states that we’ve done this with,” Sam Miller, AOPA’s manager of state and federal advocacy, says. “They see it as more inclusive, and kind of more impactful. It’s been great to have that kind of support.”
AOPA is setting its ambitions high, with an eventual goal of passing similar legislation in 28 states by the year 2028 when the Paralympic Games will be held in Los Angeles. “We’re looking to expand to as many states as possible,” Miller adds. “We’ve already had over a dozen other states reach out with interest in the in the initiative.”
In the longer term, AOPA is hoping for congressional adoption of a federal law. “If you’re looking to address an issue at the federal level, it’s helpful if a majority of states have legislation,”
Miller explains. “If we have more than 25 states with a bill like this on the books, then we can go to Congress and say the majority of states support this, and we should be talking about this at the federal level.”
At a practical level, the So Every Body Can Move legislative initiative is about coverage, but it’s also about disability rights, Miller says.
“If somebody without limb loss injures themselves, and they need surgery to get back on their feet, or into exercise, they get that surgery covered because it restores their body to normal function,” Miller says. “But if somebody loses a limb, and they want to get back into exercising and moving, then it’s not covered. That difference between who’s allowed to exercise and who isn’t is fundamentally a human rights issue in the view of AOPA and our partner organizations. That really underscores a lot of the work that we’re doing.”
Michael Coleman is a contributing writer to O&P Almanac Reach him at mcoleman@contentcomomunicators.com.
SUPPORT
HR 4315
Editor’s Note: AOPA is asking members and O&P Almanac readers to help them ask Congress to support HR 4315. You can do so via the AOPAvotes platform, https://p2a.co/D9VT7kb, and the automated Twitter campaign tool on the platform.
Team Minnesota joins the ranks of the national movement #SoKidsCanMove by introducing legislation #SoMinnesotansCanMove with SF 3351 and HF 3339. This legislation will remove discriminatory practices and provide expanded coverage for those in need of O&P care and devices in Minnesota.
f O&P facilities are stepping up their efforts to collect demographic data, conduct patient satisfaction surveys, and perform outcome measures testing, propelling the O&P profession toward data-driven decision making.
f The National Limb Loss & Preservation Registry, a new repository that aggregates data from entities that treat patients with amputation, offers a new opportunity to share de-identified data—and approximately 180 patient-care locations have signed on to the registry so far.
f Whether data is used within individual patient appointments, for research efforts, or when working with referral sources, it’s important to recognize the ultimate goal is improved patient care.
f Several new technologies have been designed to assist with data collection, including one app that offers a library of outcome measures and a sensor-driven system that facilitates remote collection of patient data.
More facilities are making patient data collection standard operating procedure. Here’s how.
Imagine a patient with a traumatic transfemoral amputation arrives at your facility—and in addition to examining the patient and calling upon your education and experience, you can pull from a repository of treatment pathways throughout the country. You can search specifically for patients of a similar age and same gender with above-knee limb loss due to trauma, then look at actual devices prescribed, rehabilitation timelines, and long-term outcomes—and leverage that information to treat your new patient.
The world of data-driven care isn’t far away, according to some O&P stakeholders. In just a few years, that scenario could be possible in your facility.
Across the United States, O&P facilities are collecting various types of demographic information and outcomes measures data, and applying that data in-office. Some clinicians and owners are beginning to look at facility trends to inform clinical decision making, and they’re sharing that information with patients and referral sources.
The transition to more data-driven decision making started about 20 years ago when facilities began adopting electronic health record (EHR) systems. “Now that everyone uses EHR, it’s time to use the information we’re already collecting,” says Dennis Clark, CPO, owner of Clark & Associates and OPOS1. “With data collection and analysis, the chaos of clinical care becomes more organized.”
With an eye to the future, many facilities are using new tools and integrating sensors to aid in data collection. Some facilities also are adding their data to the new Limb Loss & Preservation Registry (LLPR), in an effort to populate a national database for more informed decision making.
“We need to be quantitative and find a way to apply the data actionably, and provide data that’s collated in a way for analysis,” explains Sarah Chang, PhD, chief scientific officer at Orthocare Innovations. “Each patient is unique, so we want to make sure we’re caring for them in the way they need.”
Toward that end, most facilities gather information about demographics, amputation details, and outcome measures and house that data in their EHR systems or elsewhere. Ottobock.care, formerly Ability Prosthetics and Orthotics, for example, was an early adopter of data-driven care; managers built custom dashboards using data collected in-facility, according to Jeffrey Brandt, CPO, founder of Ability, AOPA vice president, and current member of the Registry’s External Collaborative Panel (ECP), a multiple stakeholder team working to advance the LLPR effort.
At Hanger Clinic, collecting outcomes and aggregating data has become a key component of patient care. “The important thing to remember is using outcomes data for an individual patient appointment, in research efforts, or with a referral source, is all in an effort to improve patient care,” says Erin O’Brien, CPO, FAAOP, clinician and clinical education specialist at Hanger Clinic. “Whether we’re referencing an individual patient’s outcomes data to talk about the progress they’ve made since their last visit, using that same information to discuss therapy goals with their PT, or aggregating it with a large amount of other patients’ data to look at which type of foot, for example, improves mobility most in our K3 patients—it’s all in service of better patient care. We’re using outcomes data in all of those ways, but for the sole purpose of improving the lives of our patients—individually and as a population.”
Facilities have integrated aspects of data collection into their daily procedures—by collecting the required elements for their EHRs and by prioritizing outcome measurements during patient visits. “Collecting outcomes certainly takes time, but it doesn’t have to interrupt day-to-day work as much as one might think,” says O’Brien. Hanger Clinic primarily collects patient-reported outcome measures, so “the majority of time that is spent on the outcome measure is that of our patients.” Patients complete surveys in the waiting room, while their clinician works on their device, or during any other downtime at patient appointments, according to O’Brien. “Our lower-extremity prosthetics outcome measures are even set up so that the patient can complete them electronically prior to coming into the office.”
Jeffrey Brandt, CPO
“...Administrators typically start the process in the waiting room, and then allow the clinician, resident, or assistant to explain the results of the assessment as part of the normal patient-care interview process.”
—ERIN O’BRIEN, CPO, FAAOP
Several apps are available or in development to assist with data collection. The P&O COMET—or Clinical Outcome Measures Electronic Toolkit (COMET)—mobile app was developed by Orthocare Innovations to simplify and standardize the use of outcome measures in daily clinical practice to inform evidence-based care, according to Sarah Chang, PhD, chief scientific officer. P&O COMET provides a library of clinical outcome measures for O&P users and practitioners and allows clinicians to select an appropriate measure, administer a test, and immediately receive the result.
The app allows for both patient-reported measures via questionnaires appropriate for different patients’ etiology, and clinical outcome measures such as the Timed-Up-and-Go, Two-Minute Walk Test, and 10-Meter Walk Test, according to Chang. “The COMET provides anyone with the ability to collect outcome measures in a standardized and automated way,” says Chang.
Some facility owners worry that ramping up collection of outcome measures increases clinician burden and takes time away from patients. “One of the challenges that O&P facilities are experiencing is: How do we collect outcome measures, but do so with the least amount of burden?” asks Chang. But she notes that the goal is to take outcome measures as part of patient care, “and make sure they’re being collected in a standard way” to allow comparisons over time.
Positioning data collection as a priority for all facility staff helps ease the collection process, agrees O’Brien. “We have found that engaging the whole team in the effort really helps make the process successful,” she says. At Hanger Clinic, “administrators typically start the process in the waiting room, and then allow the clinician, resident, or assistant to explain the results of the assessment as part of the normal patient-care interview process. Not only does this make the outcomes process meaningful to the patient—especially since it ties it into their patient care for the day—it also allows our clinicians to make clinical decisions based on the results of the patient’s current assessment.”
Many tools are available to help, according to O’Brien, but it’s important to start by defining overall goals. “One of the biggest barriers to collecting data can be the infrastructure of the collection process,” she says. “Another barrier might be determining what type of data you want to collect—how and why are probably two of the biggest barriers to successful collection. Until you know what you want to
“Clinicians have the option to export the results into a PDF report to be compatible with the electronic health records and share the report with a patient,” adds Chang. These outcome measures also aid in justifying decisions to payors.
The app also facilitates sharing data with the Limb Loss & Preservation Registry, according to Chang, by providing outcome measures to the registry in a compatible format that complies with HIPAA regulations.
The Department of Defense is funding new research at Orthocare Innovations that builds on the foundational P&O COMET app, which will combine multiple domains of outcomes data with sensor data through HIPAA-compliant cloud capabilities to provide clinicians with actionable information about patient outcomes, says Chang.
find out about your patients, you may be asking the wrong questions and using an outcome measure that’s not ideal for your purpose or patient population. Similarly, if you’re using different outcome measures on the same patient over time, or the same outcome measure but on an inconsistent basis, then you’re collecting data that isn’t comparable in a helpful way. Outcomes data that means something in the long run requires collecting the same measure on the same schedule on the same type of patients, over and over again.”
She points to the availability of free outcome measures, including PLUS-M.org and OPRO-M.org from the University of Washington. In addition, some resources allow clinicians to access the right outcome measures for their patients, including Shirley Ryan’s database, www.sralab.org/rehabilitation-measures. “Because we now have access to those websites, even a single clinician could decide to start an outcomes program and be successfully administering outcome measures with their patient populations that would affect their daily care,” she says. “You can start small and still be very impactful!”
Facilities that aggregate data in-house are finding many ways to leverage that data to help their own patients—but some facilities are taking the next step and joining the new LLPR to be part of a more comprehensive O&P data movement. The registry was built to aggregate data from all of
the entities that treat patients with amputation, limb difference, and preservation, including facilities, hospitals, and patient self-reported instruments. With all of this information, “the aggregate will provide clues and trends for patient care, and evidence for payors,” says Brandt.
To date, 12 O&P practices, consisting of approximately 180 locations, have signed on to the registry, which is no cost to join through October 2023, according to Brandt. “We’ve proven that data transfer can happen from EHRs to the registry,” he says. “Now we’re ensuring the quality of the data is up to par.” He emphasizes that facilities push data to the registry, so contributing facilities can decide the frequency they want to provide data.
For most facilities, “the data you’re already collecting” via EHR systems like OPIE and Nymbl “is the beginning data the LLPR will be taking in,” says Clark. He encourages hesitant business leaders to overcome any preconceived notions regarding who will see the data and how it will be used. Clark’s patient-care facility was one of the first to join the LLPR and is ready to share de-identified data and patientreported outcomes for its eight locations.
Brandt emphasizes that all information in the registry is de-identified, so patient protected health information remains secure. And facilities can provide only the data that they are already collecting: “There is no requirement or minimum data contribution,” he says. “Whatever portion of the 109 P&O provider elements a provider has, is welcomed.” He notes that providers will receive “quality reports,” which will identify the data they are not providing. “Then the provider can, if they so choose, place more emphasis on collecting more of the elements, thereby increasing the quality of their submission to the registry.” Even if a facility can provide only 30 of the 109 data points, “those numbers will help the registry from a regional and national perspective,” Brandt says.
Within the next few years, the LLPR will become populated with much more information from a wide swath of O&P practices.
“You’ll be able to go into a dashboard and look for information on a specific cohort of patients,” explains Brandt, which will allow
Innovations are popping up across the O&P market to facilitate data collection. Dennis Clark, CPO, recently launched OPOS1, a company that offers a low-cost, low-profile system that leverages sensors to collect objective data. The goal is to help to measure clinical outcomes and improve quality of O&P patient care.
Clark began working on this project about six years ago when he began using a new glucose monitoring system to manage his own diabetes. “The system prevents me from having to stick my finger—I can just use an app, which monitors and stores [his glucose level] and sends the data to my endocrinologist,” says Clark. “It helps me stay much more regulated.” He realized similar technology could be helpful for the O&P community. “I thought, I need a monitor like this for my profession.”
After several iterations and a partnership with Simbex, Clark created the OPOS1 system. Small sensors that measure wear time and step count adhere to any type of prosthetic or orthotic device—“like a Band-Aid”—without interfering with its use. Using Bluetooth technology, data is sent to patients and prosthetists. The system passed Food and Drug Administration registration requirements at the end of 2022 and passed Federal Communications Commission requirements in early 2023. “We’re doing validity testing now at the Mayo Clinic,” says Clark, and several beta sites—O&P facilities as well as orthopedic and podiatry groups—are using the technology.
The system enables “remote therapeutic monitoring,” and informs patients whether they are meeting their individualized benchmarks for step count and activity, according to Clark. “This helps them stay within, or exceed, their ‘normal’ range,” he says. “The patient can see their own progress and say, ‘I was in the green five days in a row.’ It’s a constant motivator to do more and to do better,” which helps boost activity levels and prevent sedentary lifestyles—all promoting health and saving medical dollars.
This information can also be shared with referral sources, who may be reimbursed using existing CPT codes for remote therapeutic monitoring data in making care decisions and educating patients on their progress and care.
The technology allows for more object comparison across facilities. “I love the Timed-Up-and-Go and the Two-Minute Walk tests, but no two facilities implement these tests exactly the same way,” says Clark. “This is a sensor and data app that captures real-world data during the patient’s normal daily activities in their normal environments—not just data accrued in an O&P facility setting.”
users to build “a more informed patient view specifically about trauma patients, for example, and how quickly we think their rehabilitation journey ‘typically’ progresses,” he says. “You’ll be able to look more specifically within a patient cohort, which can lead to more predictive patient care.”
Users will be able to narrow the data scope to type of amputation, cause of amputation, specific comorbidities, and other defining characteristics, such as social determinants of health as well as healthcare disparities, “then get a more realistic patient-care journey” to share with patients, Brandt adds. While there is no cost to join and contribute data at the lowest subscription level, three pricing levels for more advanced dashboard reports will begin in January 2024.
For a small fee, registry participants can receive a personalized dashboard, through a recent partnership the registry has forged with BData, a healthcare data science company. “We have deep expertise in healthcare data, healthcare IT, advanced analytics, and research methods,” explains Bart Phillips, founder of BData. “We look to create value for multiple stakeholders from real-world healthcare data. In most engagements, this focuses on facilitating research and quality improvement initiative.” The company has partnered with other healthcare sectors, including burn care, in building web-based platforms to assist those sectors in understanding their patient populations and the variability in outcomes, with the goal of driving improvements in patient care and organizing data for research purposes.
forward, both payors and patients will demand evidence-based data following the continuum of care, says Danielle Melton, MD, director of amputation medicine and rehabilitation and associate professor, Department of Physical Medicine and Rehabilitation, University of Colorado. Melton also is a member of the Executive Advisory Panel to the LLPR.
“From a treating physician perspective, the number of peer-to-peer requests to justify medical necessity” has quadrupled over the past 20 years, she says. “Looking at it from a cost perspective, there are more requests to justify medical necessity; payors want more information, and payors are issuing more initial denials” that must be appealed to get reimbursement, says Melton. “I am constantly asked for proof—or evidence—such as whether interventions lead to a decrease in readmissions, or fewer falls. But we don’t have a lot of evidence.”
For the LLPR specifically, BData is in the initial phases of customizing dashboards for health systems and O&P practices. After facilities contribute data, participants will be able to log in and see relevant and actionable dashboards, and look at patterns in their data, according to Phillips. They may use the information for benchmarking that will eventually include machine-learning driven risk models. “We are helping to organize data to deliver it back to hospitals, providers, and eventually patients,” says Phillips.
Data from O&P patient-care facilities becomes more valuable when it is accompanied by data from the hospital systems that perform amputations and limb preservation procedures. Moving
In addition to payors, more consumer-minded patients will be demanding data-driven decision making from both their physicians and their prosthetists, Melton predicts. “As a patient advocate, I often get questions on how [patients are] doing compared to other patients,” and what benchmarks to expect, she says. Using registry data, “I will be able to say to patients: For someone your age and your level of amputation, this is what you can expect.”
Clinicians who work regularly with specific treating physicians should “help convince hospitals to add their information” to the registry, which will benefit those hospitals in the future, says Melton. For those O&P facilities that are reluctant to join the registry, Melton says the age of data is already here. “You have to participate or get left behind,” she says. “As soon as payors know certain providers are participating in a registry, they will expect participation” from the providers that submit claims.
“As soon as payors know certain providers are participating in a registry, they will expect participation” from providers that submit claims.
—DANIELLE MELTON, MD
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Rev up for the 2023 AOPA National Assembly by sampling the hot topics and high-profile speakers slated for the September conference
If you’re looking for a fast way to boost your knowledge of all things O&P, register now for the 2023 AOPA National Assembly, Sept. 6-9 in Indianapolis. Whether you’re an O&P clinician, business owner, manufacturer, student, researcher, or innovator, the Assembly educational lineup features can’t-miss content.
The National Assembly Planning Committee has been working in overdrive to bring you an enjoyable, engaging, and innovative experience that will fill your tank with that latest knowledge and hot-topic information. Attending the wide range of sessions offering more than 100 CE credits in several tracks—prosthetic, orthotic, digital O&P, business, post-breast surgery, and technical—offers you the opportunity to improve your techniques to better serve patients, participate in unique panel discussions, and receive timely updates from a wide spectrum of O&P experts.
Here’s a sneak peek at just a few of the educational sessions planned for the Assembly—be sure to consider these sessions when mapping your trip to Indianapolis.
The clinical education planned for the 2023 Assembly will help prepare your facility for the future of patient care.
Among the long list of prosthetic options, the “Female Amputee Care Topics” session, led by Jason Highsmith, PT, DPT, PhD, CP, FAAOP; Jason T. Kahle, MSMS, CPO, LPO, FAAOP; Sophia Mancini, MSPO; and Rebecca Miro, PhD, CP, will explain the unique needs of female patients and offer tips for optimal patient care. Scheduled for Thursday, Sept. 7, at 3:45 p.m., this session will summarize research related women’s care and help prosthetists understand strategies for fitting throughout pregnancy.
Technology-minded O&P professionals won’t want to miss “Smart Components: The Continuum of Data From Patient to Policy,” led by Todd Pharell, PhD; Andreas Kannenberg, MD (GER), PhD; Levi Hargrove, MScE, PhD; Blair Lock, MScE; and Bart Phillips, MS, and slated for Thursday, Sept. 7, at 2 p.m. Here, you’ll learn the latest on
wearable sensors and leveraging data to help justify medical necessity, allow for early intervention to improve clinical outcomes, and even guide clinical decision making.
As prosthetic implants become more commonplace, it’s important to understand how they work and for whom they’re best suited. These topics will be addressed via lecture, demonstrations, and patient interaction, during a post-show workshop titled “The 2023 Ultimate Guide to Bone-Anchored Limb Prostheses.” Christopher Hoyt, CP, will lead this in-depth four-hour presentation Saturday, Sept. 9, at 1 p.m. Clinicians of all experience levels are welcome. (Tickets required, $50.)
Among the orthotics curriculum, which also will feature pedorthic programming, the panel session “Exploring the Impact of AFO Intervention on Muscle Activity” will offer key information Thursday, Sept. 7, at 2 p.m. Jill Seale, PT, PhD, NCS, and Sally Kenworthy, MPO, CPO, will dig deep into a common fear surrounding AFO intervention: that users will become weaker or more dependent on orthoses over time. The speakers will explore the origin of this fear, discuss the impact of AFOs on muscle activity as measured by EMG, and share the knowledge necessary to engage in informed conversations with patients, families, and other providers.
For those with a pediatric population, you won’t want to miss a session from Anne Pare, CO, LO, on “Pediatric Gait Development: Developing Movement Strategies From Floor Mobility to Walking to Running and Jumping.” Scheduled for Friday, Sept. 8, at 3:45 p.m., this lecture will describe the development necessary to achieve a mature, energy-efficient gait pattern, and explain how orthotic intervention should lead to gait progression, not just the alleviation of a particular gait deviation.
Motivational speaker, comedian, and author Josh Sundquist will deliver the keynote address Thursday, Sept. 7, at the 2023 AOPA National Assembly in Indianapolis. See page 39 for details about Sundquist and his presentation, “One More Thing, One More Time.”
For the second year in a row, the Assembly will feature a digital O&P care track, with several cutting-edge sessions to choose from.
Highlights include “AFO Shape Capture Techniques and a Weight-Bearing Scanning Platform for High-Activity AFOs,” to be offered Friday, Sept. 8, at 10:30 a.m. Richard Miltenberger Jr., CPO, and Gary Wall, CPO, will cover methods and discoveries in the area of 3D scanning for AFOs, as well as their digital manipulation. Attend this session to learn a new technique of scanning the patient while weight bearing.
Another informative session, “3D Printing in Prosthetics: Common Concerns and Clinical Applications,” will take place Saturday, Sept. 9, at 10:30 a.m. Industry experts Jeff Erenstone, CPO; Sean McClure, ME; David Rotter, CPO; and Brent Wright, CPO, will discuss socket strength, digitally modifying and reprinting flexible inner sockets to address fit issues, and other important applications for 3D printing in O&P.
Back by popular demand, the hands-on “O&P Digital Care Showcase” at noon on Saturday, Sept. 9, provides an opportunity to view the latest technologies in action. Learn about computer-based 3D design software tools and observe as exhibitors present a fabricated mold, device, or 3D print utilizing a provided prosthetic or orthotic patient case (patient file, 3D scan, and positive model).
AOPA is known for its top-notch and timely business education—and this year’s Assembly is no exception.
Plan to attend “How To Survive an Audit” Friday, Sept. 8, at 3:30 p.m. Ken Cornell, CO, FAAOP, and Stacy Toner will break down Medicare’s AFO/KAFO Local Coverage Determination Policy, explain how to consistently write an audit-proof clinical note, and offer advice for managing the audit process.
Access tips for attracting and retaining O&P talent during a session from John Brinkmann, MS, CPO, LPO, FAAOP(D), and Nina Bondre, MPO, CPO, Saturday, Sept. 9, at 1 p.m. The speakers will discuss “Performance Incentives and Disincentives”—and
challenge the traditional concepts of what motivates employees and students. Brinkmann and Bondre will present research on alternative incentive structures and how to build a company culture that synergizes with these incentives.
Several sessions at the beginning of the conference will focus on O&P intervention related to breast health.
Learn how to integrate these niche services into your facility during the “Adding Post-Breast Surgery Care to Your Practice” session, delivered by Lesleigh Sisson, CFo, CFm, and Tammy Franklin, CFm, Wednesday, Sept. 6, at 4:30 p.m. Hear how and why adding this revenue stream could boost your bottom line.
Also consider attending “Lymphedema and the Role of Compression Therapy” Thursday, Sept. 7, at 10:30 a.m. Tanya Baer, CFo, CFm, will moderate this discussion, and experts will explain why proper compression garment selection is essential to patient compliance— and may prevent disease progression.
Finally, the technical sessions at this year’s Assembly offer practical advice for O&P fabrication.
Stop by the “3D Imaging Laminations” session, presented by Steve Werkheiser, CTPO, Thursday, Sept. 7, at 2 p.m., to review a technique to create a custom 3D carving of a screen print T-shirt image or fabric—and find out how to install LED lights or a sound module.
For those who are considering adding animals to their patient base, don’t miss “Veterinary O&P: Fabrication Considerations for Our Domestic, Farm, and Wildlife Friends.” James Alaimo, CPO, will discuss considerations for treating different types of animals and provide an overview of fabrication types, techniques, materials, and component selection.
The 2023 AOPA National Assembly will offer all of the topics outlined above—and so much more. Visit the Assembly website, aopaassembly.org, to access the Preliminary Program, view all of the sessions planned for Indianapolis, and to register for this premier event.
Stay up to date on the latest AOPA 2023 National Assembly information by visiting aopaassembly.org.
In each issue of O&P Almanac, the Transformations column features the success story of an O&P clinician who has worked with an inspiring or challenging patient. This month, we speak with Danica Nordstrom, MSPO, CPO, LPO, who assisted crane operator Eddie Garcia in returning to mobility after a traumatic bilateral transfemoral amputation.
“Never underestimate someone who never underestimates themselves.” That’s the message Danica Nordstrom, MSPO, CPO, LPO, shares after treating Eddie Garcia, a crane operator who came into her care after losing both legs abovethe-knee in a traumatic accident.
Nordstrom, who is area clinic manager at Hanger Clinic in the Dallas-Fort Worth metroplex, put her clinical and problemsolving skills to the test in working with Garcia. Learning to walk wearing prostheses with bilateral above-knee limb loss is one of the most difficult undertakings in the O&P rehabilitation journey.
“Bilateral patients can be very unique, but bilateral transfemoral patients have their own set of challenges,” Nordstrom explains, noting that individuals with
double above-knee amputations can expend up to three times more energy to walk independently compared to those without amputation. “Balance can be particularly evasive, and falls are a guarantee. Getting up from the ground as a bilateral transfemoral amputee can be maddeningly difficult without proper strength and coordination—not to mention the sheer weight of walking with two prostheses!” But under Nordstrom’s close care and wearing specially selected bilateral prostheses, Garcia returned to walking— and his livelihood—faster than anticipated.
Garcia was a hard-working crane operator who spent his free time weightlifting, playing instruments, and spending time with family when his life was interrupted by a
workplace accident two years ago at age 49: Garcia became trapped under a toppled crane. After tremendous efforts to move the crane failed—and several hours passed—a surgical extraction team, led by Lindsay Davault, MD, decided a field amputation was the only option to save Garcia’s life.
Davault’s team successfully performed the amputation and rescued Garcia from beneath the heavy equipment. The next few weeks were a haze for Garcia as he underwent follow-up surgeries and transferred institutions. Once he settled into a rehab in Dallas, Nordstrom was introduced to her patient.
“I first met Eddie … during his inpatient stay at Baylor Scott & White Institute for Rehabilitation, and he was still healing and had a long recovery ahead of him,” recalls Nordstrom. Hanger Clinic’s proximity to the rehab center “allowed me to develop a close relationship with the therapy staff, so I had regular communication and collaboration with them around Eddie’s milestones and needs as we prepared for his discharge to go home.”
As a clinician with expertise in all aspects of O&P—from cranial remolding helmets to high-tech prostheses—Nordstrom was uniquely positioned to care for Garcia. She had graduated from Marquette University in 2007, earned a certificate in orthotics from Northwestern University in 2009, then completed a master’s in O&P from University of Hartford in 2017.
Nordstrom recognized Garcia’s determination almost immediately: He “knew what he wanted and didn’t see barriers,” according to Nordstrom. “I had my work cut out for me—in the best way—with his long list of goals, but I was up for the challenge.”
Garcia was discharged from in-patient care, and “we began working on his prostheses as soon as he was healed enough to stand,” Nordstrom recalls. “We didn’t waste any time getting him up and moving.” The two set an initial goal to get Garcia upright and improve his strength. “He was already strong to start, but walking with bilateral transtibial prostheses is a whole other animal,” Nordstrom explains. “Once physical therapy got him into shape on his stubbies [short prostheses], our next goal was knees. We were very transparent that the stubbies training may take up to a year—but true to form, he exceeded every expectation within six months. He worked so hard and earned his knees in record time.”
Nordstrom meticulously selected componentry. “As a crane operator, his work environments varied significantly, not to
mention that just getting into the crane can be an athletic endeavor,” she says. “With that in mind, we elected to fit Eddie with X3 microprocessor knees so we could be confident that he and his prostheses would be safe, regardless of terrain and exposure possibilities.”
Microprocessor knees positioned Garcia to achieve his most important goal: getting back in his crane—but the process required much attention to detail. “Eddie is quick to tell you how much pride he takes in his work,” Nordstrom says. “To get him back to operating his cranes, I went out to the construction yard to program his X3s [microprocessor knees] while he was in the cab to make sure the angles were spot on,” she says. “Programming his microprocessor knees while he was sitting in his crane, preparing to return to the job he loves, was an honor. He was back in his element, and he was excited.”
Once that milestone had passed, Nordstrom helped him conquer his next goal: wearing cowboy boots. “There is a point in every amputee’s journey where they graduate from, ‘I just want to walk,’ to, ‘I now want to walk with my style,’ and that is really magical,” Nordstrom says. Kendra Krupp, a board-eligible clinician, worked closely with Nordstrom to make sure the alignment was perfect, so he could walk safely.
Garcia also returned to other activities he had enjoyed before the accident, including lifting weights at the gym, and playing the guitar and drums. Fortunately, Nordstrom and Krupp were able to fit Garcia with the right custom solution to help him advance on his rehabilitation journey. “We went through various socket suspensions to keep him mobile while his limbs evolved, and eventually got him into suction sockets, where he’s been successful for over the past year,” says Nordstrom. “Managing his evolving socket fit—and sky-high expectations of his own progress—was challenging but very rewarding. We learned a lot about how to keep him active without compromising his comfort.”
Today, Garcia sports bilateral acrylic laminated carbon sockets with flexible inner sockets, according to Nordstrom, and his prostheses are rugged enough to withstand water, dirt, and other elements; they feature multiple settings for day-to-day activities.
“Anterior and posterior cutouts reduce weight and improve comfort in sitting—not to mention, the exposed flexible inner socket on the anterior side of the socket is the perfect place for him to rest his guitar while playing,” she says.
“Now that his limb volume has stabilized, he reliably uses suction suspension. Beneath those sockets are the X3 knee and Triton feet. This system has been really successful in maintaining his mobility and independence.”
Garcia recently passed the tests to return to his job as a crane operator on a full-time basis. He put in “110%” to return to mobility and his well-loved job postamputation— and this intensity was matched by his prosthetist.
“The day I met Danica, she made it known that Hanger Clinic would support me all the way through my journey—even though I had no idea what prosthetics were about at the time,” recalls Garcia. “Danica and Kendra have been phenomenal and more than my prosthetists—they’ve become my friends, and I think of them as family. There have been times that Danica has stayed after hours to help fix something with my devices.”
“Going out to the crane yard to program his X3s was certainly a unique experience, but it was the best and most accurate way to get him up and running again in the field,” Nordstrom explains.
She also accompanied Garcia on a trip to Washington, DC, so he could attend Hanger Clinic’s Bilateral Above-Knee Amputee (BAKA) Bootcamp, an event designed to build confidence and community within the very small bilateral transfemoral amputee population. “There are so many things
that I cannot teach him as an able-bodied person that he can learn from his peers,” Nordstrom notes. “Plus, that networking extends far past the weekend event. Just a few months ago, we FaceTimed another participant to get tips on walking downhill and picking up items off the ground.”
In another field trip, Nordstrom traveled with Garcia to the Adaptive Sports Center in Crested Butte, Colorado, to participate in an adaptive ski trip. “That was incredibly rewarding because he was outside of his comfort zone, but still found ways to advance and thrive with our team’s support,” she says.
“I am truly proud of how committed Eddie has been to his rehabilitation. He’s given it everything he has, and it’s paid off.”
DO YOU HAVE A TRANSFORMATIVE PATIENT-CARE EXPERIENCE YOU’D LIKE TO SHARE WITH O&P ALMANAC READERS? Contact Editor Josephine Rossi, jrossi@contentcommunicators.com, with your story to be considered for an upcoming profile.
HISTORY: 115 years
When Thomas Allen purchased Fit-Well, an O&P facility in Midvale, Utah, in 1980, he took over a business founded in 1908. He had become interested in prosthetics after his father lost his arm in a sawmill accident years before, so he trained at the University of California—Los Angeles. Once he bought Fit-Well, the previous owners stayed on to bring him up to speed, according to his son, Scott Allen, CP, who took ownership of the facility in 1994.
“I helped as a technician as I was going to high school and college, and I was really interested in how the technology was evolving,” recalls Allen. At that time, advances were underway in terms of carbon fiber and Flex-Foot technology, and the University of Utah was working on a myoelectric arm. “It caught my eye, and I decided to become a prosthetist.”
Today, Fit-Well has three locations in Utah—in Midvale, Ogden, and St. George—and a staff of 21, including five practitioners and three technicians. Fit-Well offers a full range of services, including upper- and lower-extremity orthoses and prostheses, cranial remolding helmets, pedorthic offerings, spinal products, custom cervical orthoses, and sports bracing.
Allen is a self-described tinkerer who loves problem solving, saying, “I subscribe to the Thomas Edison theory: You don’t give up until you have your lightbulb. Even as a kid, I would tear apart old TV sets or speakers to see how they worked.”
As owner of Fit-Well, Allen enjoys devising solutions for patients who want to accomplish specific tasks. “People around here live an active life, and patients want to be able to scuba dive, or boat, or climb mountains,” he says. “Others want to compete in marathons or triathlons, so I listen and then come up with unique devices that allow them to do what they enjoy.” Fit-Well has developed a reputation as a facility that successfully treats patients with complex needs.
Allen enjoys the challenge of helping patients with complicated amputations, including shoulder disarticulations, rotationplasties, and hemipelvectomies.
Allen also solves problems for animals: He has fit dogs with a customized version of a Flex-Foot, and he
once developed knee braces for a camel at the local zoo. “These kinds of puzzles keep me alert and my brain active,” he says.
The facility does its own fabrication in house, with its primary fabrication lab located in Midvale. Allen is quick to adopt new technologies. The facility has multiple 3D printers for creating prototypes and test sockets. “3D printing has a place, but it’s not as strong as carbon fiber,” he says. “I think new technology may change that soon.” Allen is watching with interest the development of new technology that can print metal and inject carbon fiber into plastics.
The facility leverages outcome measures incorporated into its practice management software and measures how well it meets patients’ goals. “Patients want to walk with more comfort, or cover further distances, or compete in athletic events,” says Allen. “One of our patients wanted to participate in bobsled, and he’s now on the Paralympic bobsled team.”
Many of Allen’s success stories involve patients who attain goals beyond the reach of many ablebodied people, including skydiving or being part of search-and-rescue teams that require jumping out of helicopters or scuba diving. But other successes speak to the joy of more basic achievements—such as a woman in Haiti who was begging on the streets because she was unable to work. “We made her a prosthesis, and she immediately asked for a broom. She was able to sweep, and that allowed her to keep her job,” says Allen.
Allen spent 17 years doing short-term charitable work in Haiti through Healing Hands for Haiti before it became too dangerous to travel there. Today he receives referrals from a charitable group in Midvale and makes above- and below-knee prostheses from donated parts for those who cannot afford them.
Allen is hopeful that he may one day pass the family business on to one of his children. In the meantime, he plans to continue his focus on creating solutions for patients in Utah.
Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net
COMPANY: O&P Insight
OWNERS:
LOCATIONS: Based in Las Vegas
HISTORY: Eight years
After a career in O&P administration that began in 1992, Lesleigh Sisson, CFo, CFm, found herself looking for another opportunity in the field. Since the Medicare recovery audit contractor (RAC) program began in 2005, she had been fielding a lot of questions from colleagues and requests to help with RAC appeals. Sisson launched her consulting firm, O&P Insight, in 2015, and in 2018, Michelle Wullstein joined her as a consultant specializing in Medicare compliance.
The company helps facilities train new and existing employees on site, and sometimes sends a human resources consultant to help with training, ongoing support, and other human resources issues that may arise. Most facilities work with O&P Insight on a particular project, or they may prefer a monthly or long-term retainer contract.
Sisson recalls her first “real” client, someone she had never met. The facility owner was $100,000 in the red and close to shutting his doors. “He had a brandnew office manager who had been in another kind of healthcare practice but didn’t know anything about O&P,” Sisson says. “I spent a week with them, digging into the system and training [the office manager]. Between the two of us, we worked accounts receivable for two months, and in those two months, the practice collected more than it had in the first 10 months of the year.” After O&P Insight’s intervention, the client ended up $150,000 in the black, according to Sisson.
Today, O&P Insight has 12 employees on its team, including Curt Bertram, CPO, FAAOP, Sisson’s partner. The group has more than 150 years of collective O&P experience, and it offers services in four main categories: workflow, practice management, staff development, and compliance. “Our work in compliance encompasses a lot,” says Sisson. “We are uniquely positioned to help practitioners review documentation, educate them on policy, create documents that meet policy coverage, and ensure they get paid for what they do.”
Workflow consultants can help facilities improve their use of practice management software and manage the revenue cycle. “We have a team that can advise facilities on how to streamline and improve their billing practices, or we can actually contract to do their billing, accounts receivable, and appeals,” she notes. O&P Insight’s work in practice management runs the gamut from process development and policies and procedures to marketing, including social media. “We have a graphic designer on staff—my daughter-in-law—who can design logos, social media content, forms, brochures, and other marketing materials,” Sisson says.
Most of O&P Insight’s consultants work remotely, although Sisson and a few others offer on-site services. “Three days in a practice is very different from a one-hour Zoom meeting. I once visited a practice, opened a drawer, and found piles of paper that had never been processed, from checks to proof-of-delivery documents. That’s the kind of thing you need to be there to notice.”
O&P Insight runs an annual leadership conference in Las Vegas, building on the “LEAD” acronym of “love, engage, aspire, develop.”
Sisson is a strong proponent of giving back. She is a member of the AOPA Board of Directors and past president of the O&P Activities Foundation. As a member of the AOPA Coding and Reimbursement Committee, she teaches at AOPA’s seminars. Sisson also serves on the advisory board of Steps of Faith.
“I am just really grateful to have found a business where I can bring my skill set and passion and really affect lives,” she says. “The biggest compliment I can get as a consultant is that people don’t need me anymore.”
The O&P Insight team includes Melissa Spranger; Lesleigh Sisson, CFo, CFm; Curt Bertram, CPO, FAAOP; Tiffany Duggin; and Michelle Wullstein. Lesleigh Sisson, CFo, CFm, and Curt Bertram, CPO, FAAOPUpdated Medicare Codes 2023 Illustrated Guide
Purchase the Updated AOPA Illustrated Guide
Visit
you thinking about a career change? Is your company looking to hire? Visit AOPA’s online Career Center! With dedicated pages for job seekers and employers, the Career Center is the perfect place to make O&P career matches.
The
Sundquist was diagnosed at age 9 with a rare form of bone cancer and given a 50% chance to live. He spent a year on chemotherapy and underwent amputation of his left leg. Doctors declared him cured at age 13, and he took up ski racing three years later. Sundquist trained for the next five years and in 2006 was named to the U.S. Paralympic Ski Team. Today, Sundquist represents the United States as a member of the U.S. Amputee Soccer Team.
Sundquist is well known for his viral photos, especially his Halloween costumes, and was named to the 2017 Social Media Power List by People magazine. His videos have been viewed more than one billion times. As a social media influencer, he has worked with brands like Apple, Meta, Tommy Hilfiger, Chase, Chevrolet, and AT&T. Sundquist is an ambassador for Children’s Miracle Network Hospitals and makes regular appearances at events and in the media to raise money for children’s hospitals. He has written four books and is an executive producer and writer on the television series based on his childhood, “Best Foot Forward.”
Make plans now to see Sundquist in Indianapolis— visit aopaassembly.org for details and to register.
Stay up to speed on all of the rules and regulations for 2023— join AOPA’s regulatory staff and guest speakers for the 2023 monthly webinar series.
Webinars provide relevant content and the opportunity to earn 1.5 continuing education credits each month. They are a great way to promote team building, providing an opportunity for your staff to come together and refresh their skills. One registration provides access for five staff members at your office location. (Contact Kristen Bean at kbean@AOPAnet.org to register more than one person from your facility— maximum of five per facility.)
New this year, and in response to feedback on preferred ways to access the webinars, all 2023 webinars will be available on demand (asynchronous) instead of live. Topics will be announced at the beginning of the month, and the webinars will be automatically delivered to AOPAversity accounts by the end of the month—then remain available. The
popular Clinician’s Corner session will be featured in several webinars.
The full-year series is $790 for AOPA members—a great value at 12 for the price of 10! Nonmembers may purchase the series for $1,999. Individual webinars may be purchased at $79 for AOPA members and $199 for nonmembers.
Register for the series at My AOPA Connection. You also may register for single topics.
Bionic Power
2661 Lillooet Street
Vancouver, BC V5M 4P7, Canada
778-729-0680
bionic-power.com
Rob Nathan
Supplier Startup
BionicM Inc.
113-0033 Bunkyo Tokyo
The University of Tokyo
Entrepreneur Plaza 203
7-3-1 Hongo, Japan
0803-141-3827
bionicm.com
Xiaojun Sun, PhD
International
CADTECH
8035 Wenatchee Place NW
Silverdale, WA 98383
Jennifer Dowell, CPO 360-471-5522
Supplier Consultant
Limber Prosthetics & Orthotics
10620 Noakes Road
La Mesa, CA 91941
619-838-1595
limberprosthetics.com
Herbert Joseph Barrack, CPO
Supplier Startup
Mosaic Manufacturing
111 Peter Street
Toronto, ON M4V 2G9, Canada
647-703-3764
mosaicmfg.com
Ainishah Hemraj
Supplier Startup
O and P Mexico
Guanajuato 1235
44260 Guadalajara, Mexico
oandp.com.mx
Fernando Saul Ortiz Salazar
Supplier Startup
The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.
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FLOW AFOs are Allard’s newest generation of AFOs fabricated with a new proprietary formula. This proprietary formula offers increased ROM in the sagittal plane and smoother transition (flow) throughout the gait cycle. The footplate is shaped to allow more clearance for the forefoot in the shoe toe box. Plus, both Ypsilon® FLOW ½ and ToeOFF® FLOW 2 ½ are designed to accommodate lower shoe heel heights, fitting more shoe styles. For more information call 888-678-6548 or email info@allardusa.com. Request your free magnetic level!
ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement.
For more information, call ESP LLC at 888-932-7377 or visit wearesp.com
Hersco is delighted to offer HP’s advanced 3D-printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a biobased renewable material that has been tested and proven in research and industry. Call today, 800-301-8275, for a free sample.
In the quest for diabetic shoes, it’s important to find a shoe that has features like seamless lining, extra depth, and multiple widths. Mt. Emey® and FITec® branded diabetic footwear have these key attributes, which make them ideal options for those who need accommodation, protection, and support!
Mt. Emey and FITec collection of diabetic shoes are billable under Medicare A code A5500 for Medicare Therapeutic Shoe Bill. All display samples are free of charge delivered to your practice!
For more information, visit apisfootwear.com
Mecuris provides CPOs with a flexible software that enables them to design individual orthoses and prostheses online. The software is provided on the web-based Mecuris Solution Platform. It will help streamline a clinic’s business for the best patient care possible. The lean structured tools and functionalities can be used free of charge. In the Free Plan, five downloads/month are included as well.
See how to best combine traditional with digital workflows in a free webinar while earning CEUs in the process. For more information, go to www.mecuris.com/en
It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All are available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit npdevices.com
We are excited to announce the latest addition to our WalkOn Family Portfolio—the WalkOn Lateral Jr! The trusted WalkOn Family helps patients walk with greater safety and ease, no matter their age or lifestyle. By introducing the WalkOn Jr, Ottobock is proud to offer the most complete range of carbon ankle foot orthoses on the market.
For more information, visit shop.ottobock.us
The Kinnex 2.0 microprocessor ankle was designed for real life, without compromise. Featuring 30 degrees of ankle ROM (20 deg PF, 10 deg DF), a full length EduraCore© footplate with a split keel and heel, accommodations to shoe heel heights from 0-2 inch, dynamic and manual locks, sandal toe availability, and full water submersiblility, Kinnex allows users to live their lives without worry. With the GaitLab app for CPs and the Freedom Innovations app for users on iOS and Android, use your favorite phone to see what Kinnex can do for you! For more information, visit proteorusa.com
Turbomed has extended its line of AFOs to include three models: Xtern Classic, Summit, and Frontier. The Xterns will allow running, walking, and even hiking as long and far as you want without discomfort. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees, and provides the user with unparalleled levels of function.
The Xtern Summit is lighter than the Classic, has more dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the shoe!
As part of our commitment to sustainability, Ottobock is now offering a new line of GreenLine materials: OrthoEpox resin, hardener, and parting agent as well as a phthalate-free hardening powder. This is a milestone for Ottobock and the Materials portfolio as we are combining sustainability, health and safety, and functionality!
For more information, visit shop.ottobock.us
Contact
Bob Heiman at bob.rhmedia@comcast.netJuly 1–31
ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at abcop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org or visit abcop.org/contact-us
July 24–25
AOPA Virtual Coding and Billing Seminar. 12-4 pm ET both days. Learn how to get claims paid, survive audits, collect interest from Medicare, and file successful appeals. To register, visit aopanet.org
July 27–29
Alabama Prosthetic & Orthotic Association Meeting. Birmingham, AL. Visit alabamapoa.org
August 24–26
Texas Society of Orthotic & Prosthetic Professionals Meeting. San Antonio. Visit txsop.org.
September 6–9
AOPA National Assembly. Indianapolis. For more information, visit aopanet.org
October 13-14 (Note Corrected Dates)
PrimeFare Central. Tulsa Renaissance Hotel and Convention Center. In-Person Meeting. Contact Cathie Pruitt at 901-359-3936, pruittprimecare@gmail.com; or Jane Edwards at 901-487-6770, jledwards88@att.net For more information, visit primecareop.com
November 8–10
New Jersey AAOP Annual Meeting. Harran’s Resort, Atlantic City, NJ. Visit njaaop.org
The Pedorthic Footcare Association: Diabetic Wound Prevention, Management, and Healing Program. 10-session online education program series. Approved CEs by ABC and BOC, monthly classes are 1.5 hours each. For more information and to register, visit pedorthics.org/page/Diabetic_Series_LMS_List
Advertise O&P events for maximum exposure with O&P Almanac Contact Bob Heiman at bob@rhmedia.comcast.net or learn more at bit.ly/23AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 223340711 or emailed to jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, 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.
A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.
Each month, State By State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at AOPAnet.org/resources/co-op
The Kansas Department of Health and Environment’s Division of Healthcare Finance will increase the reimbursement rate of the Medicaid fee schedule for durable medical equipment, prosthetics, orthotics, and supplies, to 80% of Medicare, with a proposed effective date of July 1, 2023.
Senate Bill (SB) 3131, which directs the New York commissioner of health to conduct a study related to New York Medicaid’s reimbursement rate adequacy and patient access, has passed both the House and Senate and now awaits the signature of Gov. Kathy Hochul. The bill has overtaken the progress of its previous version, SB 7023, which passed the Senate during the last legislative session but failed to pass the House.
SB 797, legislation reinstating insurance fairness in the state after being sunset in 2017, has been signed into law by Gov. Tina Kotek after successfully passing through both the Senate and the House. The bill will take effect Jan. 1, 2024.
Texas House Bill 134, legislation mandating coverage of cranial remolding orthoses (CROs) for patients
covered by Medicaid and the Children’s Health Insurance Program, was approved by the House Insurance Committee before passing the House floor vote. A coalition of Texas healthcare providers and AOPA’s CRO Intervention Workgroup assisted in moving the bill by providing testimony, writing letters of support, and organizing grassroots support.
For more information on these and other state developments, visit the AOPA Co-OP or contact Sam Miller at smiller@AOPAnet.org
In Arkansas, House Bill (HB) 1252, which mandates that state commercial plans cover one additional prosthesis for athletics or recreation and one additional prosthesis for showering or bathing, has been signed into law by Gov. Sarah Huckabee Sanders. The bill takes effect July 1, 2023.
In Colorado, HB 1136, legislation requiring that state commercial plans cover activity-specific prostheses for enrollees of all ages, has been signed into law by the Colorado executive branch after passing both chambers of the state legislature. The bill will take effect Jan. 1, 2025.
In Illinois, Senate Bill 2195, which requires commercial plans in the state to cover orthoses and prostheses intended for physical activity for enrollees of all ages, has passed both
chambers of the Illinois legislature. Next, it will be sent to Gov. JB Pritzker’s desk for his signature and enactment into statute.
In Minnesota, the Minnesota Society of Orthotists, Prosthetists, & Pedorthists has introduced companion bills HF 3339 and SF 3351 related to commercial insurance plans in the state. The bills would implement insurance fairness, cover both activityspecific devices and devices intended for showering/bathing for enrollees of all ages, and require that insurance companies follow nondiscrimination standards related to the coverage of O&P care.
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⚫ The knee joint and the AXON tube adapter are waterproof and corrosion resistant in salt, fresh and chlorinated water
⚫ The X3 has the highest IP Rating of any MPK on the market
What is an IP rating?
⚫ Weatherproof but not corrosion resistant
⚫ Protected from dust, sand, dirt and temporary submersion in fresh water (up to 1m for 30min)
⚫ Accidental water damage does not void the warranty
their goals to the next level.
⚫ An IP “Ingress Protection” Code or Rating classifies the degree to which a device is protected against various elements such as dust, solids, water and corrosion.
IP ratings are important for prosthetic devices because they’re exposed to things like dirt, sand and water in everyday activities. Where and how your prosthesis can safely be used, without damage, is crucial in deciding what’s the best device for individual needs and goals.
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⚫ Weatherproof but not corrosion resistant
⚫ Protected from dust, sand, dirt and temporary submersion in fresh water (up to 1m for 30min)
⚫ Accidental water damage does not void the warranty
⚫ Designed specifically for lower mobility users
⚫ Not waterproof or corrosion-resistant, but protected from dripping water
What do the numbers in an IP rating mean?
⚫ The numbers that follow IP each have a specific meaning. The first digit indicates the level of protection that the enclosure provides against access to hazardous parts (e.g., electrical conductors, moving parts) and the ingress of solid foreign objects. The second digit rates the enclosure’s protection against liquids and uses a scale of 0 (no protection) to 9 (high pressure water from different angles). The following page has the IP rating guideline for your quick reference.
Protection from solids: From 0 (no protection) to 6 (dust tight)
Protection from liquids: From 0 (no protection) to 8 (continuous immersion)
*Disclaimer: for reference only. Please refer to the Instructions for Use for product-specific details, care, and handling.
Source: https://www.iec.ch/ip-ratings, IEC (International Electrotechnical Commission)