March 2017 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

M AR C H 2017

Impending Changes Under the New RAC Contracts

This Just In: Submitting Proposals for Pilot Research Projects P.19

E! QU IZ M

P.16

EARN

BUSINESS CE

Orchestrating a Change of Location or New Office Opening P.30

The Future of Neural Prosthetics P.40

O&P Patient Care in Botswana

CREDITS P.18

TRENDS IN

PEDIATRIC BRACING EXPERTS SHARE TIPS AND TECHNIQUES FOR LONG-TERM SOLUTIONS P.22

WWW.AOPANET.ORG

P.42

YOUR CONNECTION TO

EVERYTHING O&P

#AOPA2017

Make plans to participate in a

HISTORICAL EVENT The second World Congress combined with AOPA’s 100th Anniversary Celebration will take place in Las Vegas, Nevada on September 6-9, 2017.

WHY YOU SHOULD ATTEND:

• Celebrate 100 years of the formalized O&P Profession in the United States. • Clinical Education so remarkable that it will be memorialized in an international scientific journal. • The best speakers from around the world. Hear from physicians, researchers and top-notch practitioners. • The largest exhibit hall in the Western Hemisphere will feature devices, products, services, tools and the latest technology from exhibitors around the world. • Earn 35+ continuing education credits. • Participate in hands-on learning and demonstrations during workshops

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

LAS VEGAS AOPAnet.org

• Preparation for the changes that U.S. Healthcare reform is sure to bring and its influence on global health policy. • Networking with an elite and influential group of professionals. • Ideal Las Vegas location, chosen for its popularity, travel ease excitement.

Visit AOPAnet.org to learn more.

contents

MARCH 2017 | VOL. 66, NO. 3

22 | Trends in Pediatric Bracing Orthotists who treat children may be most successful when they act as “problem-solvers” who empower patients to achieve optimal results by considering the long-term implications of their care. Some clinicians are leveraging new tools and strategies—such as lighter and lower-profile devices, gait-analysis apps, and tuning AFOs—to achieve their goals. By Christine Umbrell PHOTO: Reach Orthotic & Prosthetic Services

MARCH 2017 | O&P ALMANAC

PHOTO: Hanger Clinic

COVER STORY

FEATURES

19 | This Just In

Wanted: Proposals for O&P Pilot Grants AOPA has announced a new request for proposals for the 2017-2018 pilot grant program, with topics spanning 15 O&P-related themes. Since 2009, AOPA has invested more than $2 million in various research projects, and will continue its dedication to advancing O&P studies and evidence-based outcomes by funding several projects next year. The deadline for proposals is April 28, 2017.

30 | Making Your Move Business owners and office managers should take a strategic approach when contemplating opening a new facility location or planning a move. It’s important to establish a detailed plan and budget, identify trustworthy construction and real estate partners, and pay close attention to equipment needs and the physical office space. Considering how the move will affect staff members, patients, and referral sources also is imperative. By Lia K. Dangelico

contents

New

SPECIAL SECTION

AOPA’S 100TH ANNIVERSARY AND WORLD CONGRESS PREVIEW

AOPA’s Coding & Billing seminars through the years

40 | Bridge to the Future

P.11

Expanding applications of neural prosthetics

PHOTO: Courtesy of William Gadsby

36 | Then & Now

DEPARTMENTS

42 | The Global Professional

Views From AOPA Leadership......... 4 Insights from AOPA Board Member Teri Kuffel, JD

Q&A with a clinician in Botswana

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

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

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

COLUMNS

Research, updates, and industry news

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

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

Navigating the RAC Transition

Transitions in the profession

AOPA News.............................................. 48

How the process will change with Performant Recovery taking the lead

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

CREDITS

AOPA meetings, announcements, member benefits, and more

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

Coachella Valley Orthotics & Prosthetics Engineered Silicone Products

P.44

Welcome New Members ................. 50 PHOTO:Coachella Valley Orthotics & Prosthetics

P.16

Marketplace............................................... 51

Ad Index......................................................52 Careers......................................................... 53 Professional opportunities

Calendar......................................................54 Upcoming meetings and events

Ask AOPA...................................................56 Medically unlikely edits, and more

O&P ALMANAC | MARCH 2017

VIEWS FROM AOPA LEADERSHIP

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

Personalizing the Policy Forum

HE WORK YOU DO is exceptional. The people you help are extraordinary. The commitment you make to helping your patients restore mobility is more than admirable. Now consider taking that exceptional work to the next level. Consider helping your patients beyond the exam room by giving voice to their extraordinary lives. How can you do this? How can we all do this with our patients? We can do this together, by attending the AOPA Policy Forum in Washington, D.C., May 24-25. Now, more than ever, our patients need us to help them beyond the clinical sense. Insurance coverage is changing and being challenged at unprecedented levels. We need to help protect the patients we serve so that their access to care is not jeopardized. AOPA hears the call of its members and all those involved in the O&P profession. Increasing advocacy efforts was the number one ask of AOPA in its recent member survey. It remains quite the topic of concern in all O&P circles. So this year, please join us in D.C., and bring a patient. As O&P business owners, my husband and I have done so for the past seven years. We have listened as our patients shared their extraordinary lives with legislators and staff members. They were eager to learn about people who live with amputation and prosthetic devices, learn what brought them all the way to D.C., and learn why O&P policy issues are important to them. It’s the stuff that matters, and it’s the stuff that counts. I firmly believe that these advocacy efforts are a true test of practicing patience, persistence, and perseverance. But it works, and here’s how we know: For seven years we uttered the words “BIPA 427” (Medicare's proposed rule for qualified practitioners and suppliers of prosthetics and custom-fabricated orthotics) in our scheduled AOPA Policy Forum meetings with legislators and staff, as did all those who attended because we were given specific talking points to share. On Jan. 12, 2017, after 17 years on the back burner, Medicare released its intention to revive BIPA 427. That, my friends and colleagues, is because many of us took the test. We were patient and persistent, and we persevered. And now we know that our advocacy efforts did not go unnoticed. Our collective voices, many of which were extraordinary, have been heard. At this point we have the attention of our legislators, those in control of the rules that will be written that will affect our O&P community for years to come. We must continue to bring the message and our patients to them—the message of how the work you do as prosthetists and orthotists is unique, like our patients, who are simply extraordinary.

Teri Kuffel, JD, is a member of AOPA’s Board of Directors.

MARCH 2017 | O&P ALMANAC

Board of Directors OFFICERS President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL President-Elect James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Vice President Chris Nolan Ottobock North America, Austin, TX Immediate Past President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Edmonds, WA Traci Dralle Fillauer Companies Inc., Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Townsend Design, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

At Renewal, Remember

CAILOR FLEMING

Call first thing

&P O t n bes e pla d Fin uranc ins

r Call Cailo Fleming 8495 800-796-

ley

dfo

ail:

.co

ing

flem

lor cai

Contact Us Today • 800-796-8495 www.Cailorfleming.com/OandP.asp Orthotics and Prosthetics Program Application 4610 Market Street, PO Box 3989 Youngstown, Ohio 44513

1. Download the O&P Program Application at:

bit.ly/cailorflemingOandP

Policy Effective Date:

I. ACCOUNT INFORMATION 1. Business Name: 2. Mailing Address: 3. City: 5. Contact Name and Phone Number: 7. Coastal State: Yes

State:

Zip:

4. Phone: 6. Fax: 8. Number of locations:

(If yes, distance to body of water):

9. Do you have a website? Yes 10. Email address:

(If yes, URL):

II. DESCRIPTION OF OPERATIONS 1. FEDERAL TAX ID #: 2.Corporation:Yes 3. Provide a brief description of operations including years in business:

An ENDORSED MEMBER of AOPA

5. Practitioner for Patient Care Certified by ABC or BOC? Yes 6. Any business conducted other than Orthotics & Prosthetics? Yes 7. Current Insurance Carrier:

Individual: Yes

GENERAL LIABILITY

(If yes, please describe):

Years with carrier:

9. Check off if you are a member of any of the following: AAOP

Pedorthic Footwear Association

Is the facility accredited? Yes

AOPA

Other:

III. CLAIMS HISTORY 1. Have you had any losses in the past 3 years? Yes

(If yes, please describe below):

Description of Loss

Practitioners trust us most because we know your O&P business and we know insurance unlike any other program.

No No

Premium:

8. Prior Insurance Carriers and policy dates:

AOPA’S INSURANCE PROGRAM

PROFESSIONAL LIABILITY

4. If new venture, please explain your prior experience, how many years, and what position and field this experience is in:

Date of Loss

Amount Paid

IV. PLEASE INDICATE ESTIMATED SALES FOR EACH CATEGORY Last Term’s Sales

$ $ $

Retail Sales: Sales/ Revenue includes pre-fab items that you rent/sell to others. Off-the-shelf items that you do not repackage. Includes ‘prefab’ custom fit braces.

Medical Equipment Repair: Sales/ Revenue of Medical Equipment that is repaired, installed (no retail sales)

No direct sales to patients.

Est. updated sales for current term

$ Manufacturing: Items manufactured by you and sold to others to distribute. There is no patient care for this class $ $ Wholesale Distribution: Includes all items purchased from others that you resell to other facilities. Practitioner Patient Care: Includes all items fabricated for patients. Custom Products.

PROPERTY

2. Fill out the form. 3. Email the form to dfoley@cailorfleming.com Cailor Fleming Insurance will quickly provide your individual program quote.

AUTO

UMBRELLA

WORKERS COMP & MORE

AOPA CONTACTS

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

Editorial Management Content Communicators LLC

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

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

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

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

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

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

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

AOPA Bookstore: 571/431-0865

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

MARCH 2017 | O&P ALMANAC

Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email landerson@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options!

NUMBERS

AOPA’s Outreach Thousands leveraged AOPA’s tools to advance the O&P profession and patient care in 2016

POLICY ADVOCACY VIA POLICY FORUM

AOPA members who take advantage of AOPA’s products are reaping many benefits—for their facilities and for the O&P profession in general. Below is the latest annual data regarding AOPA’s programs, designed to help O&P professionals get the most up-to-date education, advocacy, and member services, based on 2016 numbers.

AOPA 2016

ONLINE ENGAGEMENT

CERTIFICATION & EDUCATION

9,551

Visits to LCodeSearch.com.

FORUM

>350

Face-to-face meetings with legislators and staff held during Policy Forum.

>5,000

7,655

750

Webinar participants.

3,612

Visitors to Mobility Saves website, mobilitysaves.org.

Twitter followers.

Canada

France

USA

Sweden United Kingdom

316

Coding & Billing seminar participants.

Russian Federation

Italy

COUNTRIES REPRESENTED IN MEMBERSHIP

MARCH 2017 | O&P ALMANAC

2,167

Certification hours earned in AOPAversity.

CE credits available via O&P Almanac quizzes.

Puerto Rico

2016 NATIONAL ASSEMBLY PARTICIPATION

Attendees.

Facebook followers.

4,341

~150

Policy Forum attendees.

Taiwan

Australia

109

Presentations.

HHHHHHHHH Award recipients.

“AOPA continued its funding of small pilot grants and expanded the number of grants in 2016 to seven, totaling $90,000, awarded through the Center for Orthotic and Prosthetic Learning and Evidence-Based Practice.” —2016 AOPA President James Campbell, PhD, CO, FAAOP

Don't sweat it,

we got this

Ready for the hand-off?

Happenings CODING CORNER

Jurisdiction D Releases Quarterly Audit Results

• L1832: 153 claims were reviewed, and 152 claims were denied. • L1843: 115 claims were reviewed, and 114 claims were denied. • L0648: 402 claims were reviewed, and 315 claims were denied. • L0650: 859 claims were reviewed, and 750 claims were denied. Based on these results, Noridian will continue its widespread prepayment reviews for L1832, L1843, L0648, and L0650.

MARCH 2017 | O&P ALMANAC

Researchers Design Prosthetic Arm Technology To Detect Spinal Nerve Signals Scientists at the Imperial College of London have developed sensor technology for a robotic prosthetic arm that detects signals from nerves in the spinal cord. The technology allows a subject to think about controlling a phantom arm and imagine simple movements to trigger sensor technology to interpret electrical signals sent from spinal motor neurons and use them as commands. The researchers, led by Dario Farino, PhD, say that detecting signals from spinal motor neurons—located in parts of the body that have not been damaged by amputation—may be an improvement over current robotic arm technologies that are controlled by users twitching remnant muscles in their shoulder or arm. “We’ve tried a new approach, moving the focus from muscles to the nervous system,” says Farino, who carried out some of the research while at University Medical Centre Göttingen. “This means that our technology can detect and decode signals more clearly, opening up the possibility of robotic prosthetics that could be far more intuitive and useful for patients.” The researchers conducted labbased experiments with six amputee volunteers. The volunteers underwent a surgical procedure that involved rerouting parts of the peripheral nervous system to healthy muscles in their body.

The rerouting allowed the researchers to detect the electrical signals sent from the spinal motor neurons. The researchers decoded and mapped some of the information in electrical signals sent from the rerouted nerve cells and interpreted them in computer models, then encoded specific motor neuron signals as commands into the design of the prosthesis. They also connected a sensor patch on the muscle that had been involved in the surgery, which was connected to the prosthesis. The subjects took part in physiotherapy training to learn to control their prostheses, after which they were able to make more extensive ranges of movements than would be possible using a muscle-controlled prosthesis. For example, they were able to move their elbow joints and complete radial movements moving the wrist from side to side, and were able to open and close the prosthetic hand. The study was published in February in the journal Nature Biomedical Engineering.

Noridian, the durable medical equipment Medicare administrative contractor (DME MAC) for Jurisdiction D, has released the results of its ongoing audits of knee orthoses and spinal orthoses. Noridian reviewed 1,529 claims between July 2016 and October 2016, focusing on codes L1832, L1843, L0648, and L0650. The DME MAC found the following results:

RESEARCH ROUNDUP

HAPPENINGS

RESEARCH ROUNDUP

First Prosthetic Leg To Use BCI Debuts at McGuire VA Medical Center

PHOTO: Courtesy of William Gadsby

A revolutionary transfemoral leg prosthesis that takes commands directly from the brain has been developed by researchers at McGuire VA Medical Center in Richmond, Virginia, a facility run by the U.S. Department of Veterans Affairs (VA). The project, led by Douglas Murphy, MD, was funded by a $1 million grant from the National Science Foundation.

the brain’s motor cortex. “When the impulse goes from [the subject’s] brain and into the computer and comes back to here [the motor in the prosthesis], it activates the switches,” says Fox. Using the new componentry, Gadsby learned to activate the knee-unlocking switch on his prosthesis, which turned on the motor and unlocked the knee. He was able to walk up and down parallel bars while demonstrating his ability to unlock the knee to swing his leg and sit down. Throughout the study, Gadsby was able to successfully unlock the knee from 50 to 100 percent of the time. “The ultimate goal of this research is to provide the individual with a prosthesis that more easily and more successfully meets his or her needs for movement and walking,” says Murphy. “The system should be comfortable, easy to use, and serve useful purposes…. Our subject gave a very good example of how this system could help him.” The system is in the early stages of development, according to Murphy, and additional research is planned to improve and expand applications of the technology. PHOTO: Courtesy of Richmond VA Medical Center

William Gadsby, a veteran from California, has been participating in the testing of the brain-computer interface technology with Douglas Murphy, MD.

Researchers used noninvasive techniques, leveraging surface electrodes—not implanted electrodes—to create a brain-control interface (BCI) for subject William Gadsby, who lost his leg in Iraq in 2007. The technology has been designed so Gadsby—or other subjects—can activate a switch that unlocks a prosthetic knee. The technology offers improved mobility for activities that previously required manual adjustments, such as standing up, sitting down, and walking. Murphy says using surface electrodes is “a lot more difficult to do than the chip in the brain, but it is a lot more user-friendly. There is no surgery involved.” The electrodes are simply placed on the subject’s scalp. Murphy worked with John Fox, chief of the facility’s orthotic and prosthetic lab, to develop the prosthesis that works in conjunction with the BCI technology. The prosthesis features a small electric motor. The electrodes on the scalp pick up the electrical activity, or the brainwaves, from

COMPETITIVE BIDDING

CMS Announces Delay in Implementing Program CMS announced in February that it would temporarily delay the process of implementing the next phase of its durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program, commonly referred to as Competitive Bidding 2019.

The delay was implemented to “allow the new administration further opportunity to review the program,” according to CMS. The Competitive Bidding 2019 program was initially announced on Jan. 31, 2017, and did not include off-the-shelf orthoses as a product category subject to the 2019 version of competitive bidding.

O&P ALMANAC | MARCH 2017

HAPPENINGS

MEETING MASHUP

O&P Clinicians Gather in Vegas for Hanger Education Fair

Health-Care Companies To Increase Investments in Big Data Rising numbers of health-care organizations are expected to invest in Big Data— extremely large data sets that may be analyzed computationally to reveal patterns, trends, and associations. Nearly three quarters of health-care organizations—73 percent—are set to begin or increase investment in Big Data within the next five years, according to business intelligence provider GBI Research. There are a number of factors promoting the use of Big Data in health care, according to a report recently released by GBI Research. “Advances in technology have led to an explosion in health-care-related data generation,” says Arshad Ahad, analyst for GBI Research. “This data represents an invaluable resource, which can bring many commercial benefits to organizations if properly utilized and acted upon, although the fundamental properties of Big Data—its volume, velocity, and variability—make this a challenging prospect.” Big Data has been leveraged by some health-care companies to help advance technologies and provide commercial benefits. The GBI Research MEETING MASHUP

Ottobock Hosts Session at South by Southwest® Ottobock is hosting a session featuring U.S. veterans at the annual South by Southwest® festival in Austin, Texas, on March 10. The session, titled “How Wounded Warriors Are Transforming Biotech,” features three amputee who have achieved beyond expectations. The speakers include Captain Christy Wise, who

MARCH 2017 | O&P ALMANAC

report cites the example of mining data that, when used in conjunction with predictive modeling, could be used to identify new drug candidates with a greater likelihood of success. Big Data also could be used to overhaul clinical trial processes, to detect waste and inappropriate use of resources, to aid in the development of personalized therapies, to implement value-based health care, and to collect real-world evidence, according to the report. “Big Data is no longer an abstract concept that could provide benefits in the future,” says Ahad. “It exists now and is already providing competitive advantages for a variety of organizations. As such, companies which ignore its potential risk falling behind their peers in our increasingly data-intensive world.”

lost her right leg above the knee and continues to be on active military duty and recently participated in the Invictus Games; Heath Calhoun, a spokesperson for the Wounded Warrior Project; and Melissa Stockwell, the first female from the Iraq War to lose her limb in active combat and a competitor in two Paralympic Games.

PHOTO: Getty Images/weerapatkiatdumrong

More than 1,100 Hanger employees, including more than 850 O&P clinicians and therapists, travelled to Las Vegas from January 30 to February 3 to take part in Hanger Inc.’s 2017 Education Fair & National Meeting. The conference provided O&Prelated continuing education and served as a forum to recognize employees’ achievements, examine company strategy, and discuss how to empower patients. Highlights of the event, which was themed “Empower Together,” included guest speaker Sen. Bob Kerrey (D-Nebraska), who has been involved in O&P-friendly legislative initiatives. The fair also provided a forum for patients and their families to share their stories, with Hanger Clinic patient AJ Montgomery telling his personal story of overcoming limb loss to become a performer in a renowned Las Vegas show. In addition, more than 115 exhibits and over 370 exhibitor representatives were on display at the Education Fair. Several vendors and partners were recognized for their contributions at the Hanger Partner Awards.

DATA DOWNLOADS

HAPPENINGS

AWARD ANNOUNCEMENT

www.bocusa.org

BOC Unveils Jim Newberry Award

The Board of Certification/Accreditation (BOC) has established the Jim Newberry Award for Extraordinary Service, an honor named after James Newberry Jr., BOCP, BOCO, BOCPD. Newberry was a longtime practitioner, owner of Mahnke’s Orthotics and Prosthetics, and BOC board member who passed away in 2016. The new award will recognize outstanding individuals who perform extraordinary service to BOC and its community of stakeholders, and who live out the example modeled by Newberry during his more than four decades in the O&P profession. Winners might include—but are not limited to—current or former board members, test

James “Jim” Newberry Jr., BOCP, BOCO, BOCPD 1949-2016

development volunteers, vendors or other business partners, certificants, personnel from BOC-accredited facilities, consultants, and staff members. BOC is accepting nominations for the award effective immediately, and will consider nominees on an ongoing basis. Typically, there will be no more than one winner per year, and there is no requirement for

THE LIGHTER SIDE

BOC to name a winner every year. Newberry award winners will be invited to a BOC board meeting or other appropriate event to receive the award, with travel, lodging, and meal expenses covered by BOC. BOC also will recognize winners in a news release and other promotional materials, including signage at BOC headquarters. Nominations may be submitted at www.bocusa.org/NewberryAward. “All of us at BOC recognize the legacy Jim left behind, and we hope this award encourages others to make similar contributions to BOC and the professional communities we serve,” says Claudia Zacharias, MBA, CAE, BOC president and chief executive officer. FAST FACT

Hospital Admissions There were 104 hospital admissions per 1,000 people in the United States in 2015, according to research released by the Kaiser Family Foundation. When looking at the numbers by state, Alaska had the fewest admissions, with 70 per 1,000 people, and the District of Columbia had the highest admissions, with 192 per 1,000.

CORRECTION

In the February O&P Almanac article “Patient Empowerment,” the writer shared links to two Amputee Coalition program platforms that are not yet available to the public; the links should not have been published. Please follow the Amputee Coalition, amputee-coalition.org, for details on when these impactful programs will be available. O&P ALMANAC | MARCH 2017

PEOPLE & PLACES BUSINESSES

PROFESSIONALS

ANNOUNCEMENTS AND TRANSITIONS

PHOTO: Ottobock

Ottobock has acquired the BeBionic prosthetic products and related business from the British med-tech company Steeper. With the acquisition, Ottobock expands its product portfolio in upper-limb prosthetic solutions, adding BeBionic’s multiarticulated hand. Distribution of the BeBionic products will be controlled exclusively by Ottobock beginning May 1.

Michael M. Amrich Jr., CPO, FAAOP, has joined College Park Industries’ clinical education department. Amrich will be based in the Liberating Technologies Inc. office in Holliston, Massachusetts. College Park acquired Liberating Technologies in October of 2015. As an upper-limb product expert, Amrich will provide education, training, and customer support both domestically and internationally as well as assist in research projects and new product development.

PHOTO: ÖSsur

Össur is launching a new public education campaign on knee osteoarthritis featuring professional golfer William McGirt, who wears the company’s Unloader One® knee brace. McGirt, who is currently ranked 44th on the Official World Golf Ranking, was the 2016 champion of the Memorial Tournament presented by Nationwide, and finished in the Top 10 in a total of seven PGA tournaments last year. During his senior year in college, McGirt injured his knee and Top 50-ranked PGA golfer required a series of surgeries to Will McGirt is featured in remove portions of his damaged a new public education meniscus. Today, McGirt has mild osteoarthritis and estimates campaign on knee osteoarthritis from Össur. that he’s operating with “roughly 30 percent of my meniscus remaining.” He has been wearing the Össur brace since 2013 and is being featured in various Össur ads and promotional activities. Additional information is available at ossur.com/unloader-braces.

ANNOUNCEMENTS AND TRANSITIONS

VGM Group Inc. has promoted Dennis Clark, CPO, LPO, to serve as its new chief leadership officer. Clark will lead the advancement of values, mission, and brand for the employee-owned company. He also will serve as postacute Dennis Clark, health-care visionary and ambassador across CPO, LPO VGM’s health-care membership communities. To serve in his new capacity, Clark will transition out of his previous role as president of VGM’s Orthotic Prosthetic Group of America (OPGA). Todd Eagen, who previously served as OPGA vice president, has been named the new president of OPGA.

BUILD A

Better BUSINESS WITH AOPA

Visit www.AOPAnet.org/join today! Learn how AOPA can help you transform your business into a world class provider of O&P Services with: Coding, Billing, and Audit Resources Education, Networking, and CE Opportunities Advocacy Research and Publications Business Discounts

MARCH 2017 | O&P ALMANAC

Visit tables 389-391, 397-399 Academy AAOP 2017 Learn more about the Stride Family line and all our many other products.

Maximize your Stance Control outcomes with the Stride Family Line.

PreStride (For Evaulation)

FullStride

Scan the QR Code with your smart phone to view a video on the Stride Family Stance Control Line.

SafetyStride

Stride4

p 800-521-2192 | 248-588-7480 f 800-923-2537 | 248-588-2960 BeckerOrthopedic.com

REIMBURSEMENT PAGE

By DEVON BERNARD

Navigating the RAC Transition What to expect when Performant Recovery takes over review of all O&P claims Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

E! QU IZ M EARN

BUSINESS CE

CREDITS P.18

MARCH 2017 | O&P ALMANAC

begin once again and the hiatus would end. The Region 5 contract went to Performant Recovery. Unlike with the 2014 attempt at the awarding of new RAC contracts, no formal protest has been filed over the awarding of this contract and no postponement or rebid is expected. Performant Recovery has stated it will begin its auditing/ reviewing duties in late March. As we wait for Performant Recovery to begin auditing all DME, home health, hospice, and O&P claims, what should you expect under the new Region 5 RAC contract? This month’s Reimbursement Page takes a look at Performant Recovery and assesses what will change with the new RAC contracts—and what will remain the same.

PHOTO: Getty Images/adventtr

N JUNE 2016, AOPA reported that CMS had placed all of the activities of the four recovery audit contractors (RACs) for each of the durable medical equipment Medicare administrative contractor (DME MAC) jurisdictions on a brief hiatus, as a result of the upcoming award of new RAC contracts. This hiatus was to allow for a smooth transition to the new RAC contractors, including the single, national RAC (Region 5) contractor that will solely focus on claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), home health, and hospice services. On Oct. 31, 2016, CMS announced and awarded the new RAC contracts, indicating that RAC activities would

REIMBURSEMENT PAGE

History and Performance

PHOTO: Getty Images/courtneyk

Performant Recovery, formerly known as Diversified Collection Services, is based in California and has been involved with the RAC program since 2008. Most recently, Performant served as the RAC contractor for the Jurisdiction A DME MAC. To highlight the organization’s performance in this capacity, let’s examine the annual reports presented to Congress for the years 2013, 2014, and 2015. The information and data in these reports are not separated out into categories (i.e., DME, O&P, hospital, etc.) so we will have to look at these categories a whole. In 2013, Performant Recovery identified a total of 369,258 claims for review; this included overpayments and underpayments. This number was the third highest of the four RACs and accounted for $777 million in corrected claims; $762 million of that total were overpayments, also the third highest of the four RACs. Performant Recovery had an overall accuracy score/rate of 99 percent in 2013, as determined by the Recovery Audit Validation Contractor, or the RAC for the RACs. In 2014, Performant Recovery identified a total of 126,113 claims for review; this was the lowest total of the four RACs. These claims accounted for $418 million in corrected claims. That was the second highest total of the four RACs. This would indicate that Performant was focusing on complex reviews because those types of reviews tend to have a higher rate of return and are worth more money. The organization had an overall accuracy score/rate of 96 percent. Finally, in 2015, Performant Recovery identified a total of 247,064 claims for review. This was the highest total of the RACs, but these accounted for only $90 million in corrected claims, the third highest total. This would indicate that the RAC was selecting more items for review, but the claims under review were of lesser value. The RAC had an overall accuracy score/rate of 99 percent. Over the last three years, Performant has been at times extremely active, and at other times less active, but it has always had the highest accuracy

Medicare will continue to pay the RAC on a contingency basis.

rating. Its average accuracy score over the three-year period was 98 percent— higher than the average score of the four RACs combined, which was 96 percent.

What Remains the Same

As Performant Recovery takes over, there are some things that will not change. First, the “look-back” period will continue to be three years. This means that Performant Recovery may not attempt to identify or collect on any overpayments or underpayments that are more than three years past the date the initial determination was made on the claim. The initial determination date will continue to be defined as the claim paid date. Second, Performant Recovery will still be bound by additional documentation request (ADR) limits, or a cap per a supplier’s tax identification (ID) number, on the number of medical records that may be requested by an individual RAC, per 45-day period. Typically, limits are set at 10 percent of all Medicare claims submitted for the previous calendar year, divided by 8 (the number of 45-day periods in a year). However, there will continue to be a hard limit

of no more than 10 ADR requests per 45 days per tax ID, regardless of the number of claims submitted in the previous calendar year, for orthotic and prosthetic suppliers categorized by one of the following taxonomy codes: 51—Medical Supply Company With Orthotist 52—Medical Supply Company With Prosthetist 53—Medical Supply Company With Orthotist/Prosthetist 55—Individual Certified Orthotist 56—Individual Certified Prosthetist 57—Individual Certified Prosthetist/Orthotist Third, Performant Recovery will still be required to regularly publish areas of vulnerability/approved issues on its website, www.performantrac. com, as well as provide detailed letters to providers explaining the specific reason why they believe the code(s) in question were paid improperly. There will be some improvements and minor tweaks made to these requirements in the new contract, and at this time there are no approved issues listed for O&P. Fourth, the RAC will continue to conduct two types of reviews or audits: automated reviews and complex reviews. Automated reviews are those that involve clearly defined Medicare rules and regulations, and a determination can be made without having to review the medical record (e.g., billing for more units than what is allowed by policy or billing for acrylic with temporary prostheses); these simply require the RAC to generate a recoupment letter. Complex reviews are those that require the expertise of trained professionals (nurses, coders, doctors, orthotists, etc.) to determine if the claim was paid improperly. These reviews usually begin with a request for additional information, such as copies of the medical record, and often involve the interpretation of medical necessity or other established guidelines and policy. Finally, Medicare will continue to pay the RAC on a contingency basis. This means that its payment is still based on a percentage of the dollars that it identifies as overpayments or underpayments. O&P ALMANAC | MARCH 2017

REIMBURSEMENT PAGE

What Will Change

MARCH 2017 | O&P ALMANAC

the review and notify the provider of its findings; this is a reduction of the previous 60-day window. The 30-day period begins when the RAC receives the medical record information from the provider—not when it initiates the review/audit. Also, if the review takes longer than 30 days, the RAC may not be able to collect its contingency fee. There also will be a 30-day window before the RAC sends a claim to the DME MAC for a final adjustment. This is an important change since, in the past, the RAC would send the claim to DME MAC for adjustment almost immediately, and not provide the supplier with a true chance to have a discussion period with the RAC directly. Now suppliers will not have to choose between initiating a discussion period and starting an immediate appeal. Because of this extra dedicated time, a supplier may now determine if there is any information that can be forwarded to the RAC, which may alter the RAC’s decision before the claim is sent for adjustment. Finally, Performant will not receive its contingency fee/payment until after the second level of appeal is completed, if a supplier decides to appeal an audit/review result. Previously, the RAC was paid almost immediately when it denied a claim and sent it to the DME MAC for recoupment.

Looking Ahead

Considering the adjustments that may take place once Performant Recovery takes over, it may be difficult to accurately determine how active or aggressive the organization will be in its role as the Region 5 RAC. [Performant will be focused on just a few select types of claims—DMEPOS, home health, and hospice—and must maintain a high accuracy rate and low overturn rate.] But it’s safe to say that the audits and reviews will likely be a little more direct, selective, and well-thought-out. As claims begin to be reviewed under the new RAC structure, time will tell how the transition will have an impact on O&P professionals. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

www.bocusa.org

PHOTO: Getty Images/Seraff

As the original RAC contracts were coming to an end, CMS listened to and evaluated concerns from providers and suppliers about the original RAC program and decided to implement changes with the focus of “reducing provider/supplier burden, enhancing program oversight, and increasing transparency in the program.” Some of these changes were implemented in 2014, and some are still to come. You will see some of these changes in the new contract for Performant Recovery. Here is a quick look at some of the alterations CMS made that may affect you or the RAC directly. First, Performant Recovery will be held more accountable because there is the possibility that there may be a decrease in its ADR limits. Performant will be required to keep an overturn rate of less than 10 percent at the first level of appeal and to maintain an accuracy rate of at least 95 percent. If it is unable to achieve either of these benchmarks, CMS will have the authority to reduce the ADR limits—the number of claims they may review. Looking at previous results of Performant’s accuracy rate over the last three years, it has remained steady and well above the 95 percent mark. Also, in regard to ADR limits, CMS will establish specific limits based on a provider’s or supplier’s compliance with Medicare rules and guidelines. This means that suppliers that have proven compliance via low denial rates could have lower ADR limits than providers with higher denial rates. It is important to note that the specific adjustments to the ADR limits will only be made by CMS and not by the RAC. At this time, there is little information on how and when CMS will make these adjustments, but it does show that CMS is willing to acknowledge and take into account a supplier’s compliance. Second, response times will be updated. For example, when conducting a complex medical review, the RAC will have 30 days to complete

This Just In

Wanted: Proposals for O&P Pilot Grants Research topics expanded and enhanced for 2017-2018

OPA HAS GREATLY EXPANDED

PHOTO: Getty Images/PeopleImages

the scope and type of topics in the 2017-2018 request for proposals (RFP) for funding of pilot grant projects. The grants are designed to support researchers seeking a starting point for conducting O&P-related studies that can lead to the funding of more comprehensive research projects by the National Institutes of Health and other government or private funders. Last year AOPA funded seven pilot research projects, three more than the typical four projects awarded in previous years. Last year’s awards ranged in size from $6,000 to $15,000. In prior years, four projects were typically funded at the $15,000 level. Based on recommendations from the Center for O&P Learning and Evidence-Based Practice (COPL), the AOPA Board of Directors authorized an additional $30,000 in funding last year, in addition to the budgeted $60,000, to broaden the mix of deserving projects. The 2017-2018 RFP invites proposals in 15 specific areas, plus an additional “open topic” offering researchers an opportunity to originate and submit a proposal for a project they might deem important that may have been overlooked. (See sidebar for the full topic list.) Nine of the topics included in this year’s RFP are new areas resulting from the wider net cast by AOPA and COPL

in developing this year’s research topics. AOPA also tapped into the O&P experience of the RAND Corp., resulting from its comprehensive review of all prosthetic-related research and literature in conjunction with its work on the economic value of prosthetic services, commissioned by AOPA last year to further guide providers and payors in appropriate treatment protocols. Adding to the mix this year are suggested topics related to community outcomes of patients that would include some emotional measures; distinguishing component selection on community activity levels rather than just the lab experience; origins and clinical goals of prosthesis

prescribing patterns; linking biomechanical performance measures to functional levels; how to record primary health outcomes such as falls and lower back pain in amputees; and demonstrating the validity and reliability of an outcome measure that can be used by practitioners to predict or document patient outcomes. A couple of more esoteric topics also have been included, such as creating a mechanism for crowd-sourcing incidence reporting and other issues of importance to patients, and the impact of changing type of prosthesis on physical activity and energy consumption. O&P ALMANAC | MARCH 2017

This Just In

Research Topics AOPA is accepting submissions until April 28, 2017, and has requested that proposals adhere to one of the following goals: ■■ Study community outcomes of patients, such as activity, social interactions, depression and anxiety.

■■ Demonstrate methods to record primary health outcomes, such as falls and lower back pain, in amputees.

■■ Microprocessor-controlled knee and ankle joints—safety benefits for non-variable-cadence (K-1, K-2) ambulators.

■■ Understand the effects of prosthetic component selection on community activity levels rather than in the lab.

■■ Demonstrate the validity and reliability of an outcome measure that can be used by practitioners to predict or document patient outcomes.

■■ How does restricted access for K-2 to hydraulic controls adversely impact patients?

■■ Study the origins/clinical goals and prevalence of prosthesis prescribing patterns. ■■ Link biomechanical performance measures to functional levels. ■■ Validate a novel technique for kinetic or kinematic assessment that can be reasonably accomplished in a regular prosthetics practice. ■■ Examine the impact of changing the type of prosthesis on physical activity and energy consumption.

Since 2009, AOPA, in collaboration with COPL, has funded 20 small grant projects, initially in amounts of $7,500 each. These smaller pilot grants have stimulated interest in O&P research far beyond the investment AOPA has made over the years and eventually led to the decision to increase the amount to $15,000 in 2012. This focus on research also paved the way for the groundbreaking Dobson-DaVanzo 2011 study that demonstrated that timely O&P intervention resulted in lower long-term costs for patients receiving O&P treatment compared to a matched cohort that did not receive O&P services, based on Medicare’s own data. This, in turn, led to expanded and more sophisticated literature review projects and comparative effectiveness 20

MARCH 2017 | O&P ALMANAC

■■ Create a mechanism for crowdsourcing incidence reporting and issues of importance to patients. ■■ Ankle-foot orthoses/knee-anklefoot orthoses (AFOs/KAFOs): Utilization and comparative effectiveness of custom versus off-the-shelf AFOs and KAFOs. Investigate and analyze patients who receive a custom orthosis subsequent to an off-the-shelf AFO fitting.

studies, as well as the decision to make a substantial investment in engaging the RAND Corp. to conduct research establishing the broader economic value of O&P services. The current study is expected to show in broader terms the economic impact of patients having better health, as well as indirect savings, such as returning to the workforce and taxes paid in addition to the basic medical-related expenses. All told, AOPA has invested more than $2 million in various research projects since 2009, most of which have furthered the objective of providing the basis for evidence-based practice guidelines in the future. Individuals who are interested in submitting a proposal should visit the RFP announcement at bit.ly/2017copl.

■■ Functional impacts of vacuumassisted socket suspension systems. ■■ Outcomes measures, evaluation of clinical benefit, and quality-of-life metrics related to orthotic management. (Note: Submissions should be pathology and/or condition appropriate, e.g., stroke, cerebral palsy, multiple sclerosis, polio, osteoarthritis.) ■■ Stance control KAFO, clinical application and measured outcome. ■■ Open topics—beyond the above priorities, top-quality clinical O&P research topics will be considered.

Awardees will be selected based on feasibility, scientific and clinical significance, originality, and anticipated contribution of the research to clinical practice. Applications also will be evaluated on the availability of adequate resources, including personnel and facilities. AOPA will submit applications to the COPL Board of Directors, which will review the grant proposals and provide input and recommendations to the AOPA Board of Directors, which will have the final decision on whether any research will be funded and in what amount. The deadline for proposals is April 28, 2017. Contact AOPA’s Yelena Mazur at ymazur@aopanet.org or 571/431-0876 with questions.

MAKE EVERYDAY AN ADVENTURE in ALPS High Density Liners

www.easyliner.com info@easyliner.com

COVER STORY

CHILD SUPPORT:

Trends in Pediatric Bracing Orthotists are embracing new materials and approaches to ensure long-term solutions for pediatric patients By CHRISTINE UMBRELL

MARCH 2017 | O&P ALMANAC

COVER STORY

Need to Know: • Setting long-term goals for pediatric orthotic patients is especially important to ensure patients’ success as they grow and develop.

• O&P professionals are using “sports apps” to demonstrate their patients’ gait improvements and to document the efficacy of O&P intervention.

• Because some orthotic components suitable for adult patients do not work well for children, creative O&P professionals are minimizing weight and form factor on their orthoses by using more composite materials and nontraditional designs.

• Some orthotists are tuning ankle-foot orthoses (AFOs) and using shoe modifications to improve gait in pediatric patients with neuromuscular impairments.

• Along with the trends toward advanced materials and customized cosmeses in pediatric orthotics is a movement toward greater use of central fabrication.

• Although tuned AFO-FCs can improve comfort, tolerance to wear, maintenance of range of motion at the ankle, and range of motion at the knee and hip, it is not suitable for pediatric patients with hip, knee, and or ankle contractures of greater than 20 degrees.

RTHOTISTS WHO TREAT

pediatric patients face a vast array of pathologies at their facilities. Children who require bracing fall across a wide spectrum—from those with sports injuries, to scoliosis and cranial remolding patients, to children with varying stages of cerebral palsy and muscular and neurological disorders. Because many of these children will require orthoses or other interventions for years to come, clinicians must approach patient care with both shortterm and long-term goals in mind. Pediatric orthotists are starting “to think ‘bigger picture’—more about functional outcomes than about joint positions, and are working to help patients achieve therapeutic goals,” says Bernie Veldman, CO, chief executive officer of Midwest Orthotic Services, and chief executive officer of SureStep. Orthotists who work with children need to be “problem-solvers,” says Curt Bertram, CPO, FAAOP, director of the national residency program at Hanger Clinic. “Pediatric patients are not ‘little adults.’ There has to be a very collaborative team approach. You need buy-in from the family, the therapist, the physician, and everyone else involved” when determining the most appropriate treatment plan.

Bernie Veldman, CO

Curt Bertram, CPO, FAAOP

Setting long-term goals for pediatric orthotic patients is especially important to ensure patients’ success as they grow and develop. “Keep in mind we’re helping mold them physically, but also their personality and goals, and whether they become successful adults,” says Jonathan Heifetz, CPO, owner of Presque Isle Medical Technologies. Even when working with cerebral palsy and muscular dystrophy patients who may stop using orthotic devices as they age, it’s important to remember the value of successful orthotic intervention. “We need to keep them as mobile as possible for as long as we can,” says Heifetz. “There are great developmental benefits that last their entire life.” To achieve optimal long-term outcomes for their youngest patients, today’s orthotists are leveraging several tools and strategies. Some of these tools include lower-profile devices designed with new materials, apps for viewing gait in slow motion, and tuning AFOs. Adopting some of these strategies may help improve mobility for pediatric patients while strengthening patient-practitioner relationships. O&P ALMANAC | MARCH 2017

COVER STORY

PHOTO: Hanger Clinic

Curt Bertram, CPO, FAAOP, (far right) and some of his pediatric patients gathered at Discovery World in Milwaukee, Wisconsin.

Materials and Methodologies

The introduction of carbon fiber to the O&P market has led to the proliferation of lighter and lower-profile orthotic devices. While some pediatric device manufacturers offer devices using this new material, carbon fiber has not been adopted as quickly for children’s devices as it has for adult componentry. Barriers to adoption include the cost and the fact that traditional thermoplastic devices can be more easily adjusted as children grow. Some of the orthotic components that work well in adult patients cannot work at the smaller sizes required for children, says Heifetz. “Parents

Jonathan Heifetz, CPO, works with a pediatric patient.

MARCH 2017 | O&P ALMANAC

Along with the trend toward advanced materials in pediatric orthotics is a movement toward greater use of central fabrication (c-fab), says Veldman. Such a change is usually a business decision, made to increase profit margins: “The second and third generations who are taking over family-owned O&P businesses are starting to realize it may be more profitable to use c-fab,” he says. In today’s challenging reimbursement climate, “we have to see more patients per day to make greater profits.”

PHOTOS: Jonathan Heifetz, CPO

always ask us to make devices as light as possible, and to make devices so that children can don and doff devices themselves.” When possible, the team at Presque Isle “uses the thinnest plastics we can while still achieving biomechanical goals,” he says. At EastPoint Prosthetics and Orthotics, clinicians are “trying to figure out how to minimize weight and form factor on our orthoses by using more composite materials and nontraditional designs,” says Brent Wright, CP, BOCO. For example, Wright has begun using Tamarack joints—traditionally used for ankle joints—on knee joints for pediatric patients, and also has used Oklahoma joints on knee-ankle-foot orthoses, which reduces the weight of the components.

Wright also has experimented with 3-D printing, and has used 3-D printers to make some orthotic parts. For example, “we will be 3-D printing brackets to hold rubber bands for a patient’s hip joint because the child is lacking hip extensors,” he says. While most O&P clinicians are proceeding with caution when it comes to 3-D printing, Wright notes that “you can create some things that have never been able to be created in a traditionally manufactured environment.” Regardless of what materials are used to make orthotic devices, componentry for children has a better chance of being used appropriately if patients appreciate the physical appearance, says Heifetz. “Colors and designs are as important as mechanical considerations in ensuring acceptance and use,” he says. Heifetz works with lamination and transfers to create unique designs, and he contracts with a local airbrush artist to customize cranial remolding helmets.

Play like a kid with the AllPro foot from Fillauerâ&#x20AC;&#x201D;whether you are young or young at . To learn more, follow us at @fillauerallproallstars.

www.fillauer.com ÂŠ 2017 Fillauer LLC

A Sampling of Pediatric-Specific Products Several manufacturers offer orthotic devices specifically geared toward young patients. Below is just a small sample of companies with pediatric offerings. Please visit AOPA’s online Product Finder, at opproductfinder.com and search “pediatrics”, to view a more comprehensive list of pediatric products. • Allard offers several child-specific products, including the KiddieGAIT ankle-foot orthosis, made of carbon composite.

• Össur carries a post-trauma pediatric line that includes the Miami Jr. cervical collar, plus a collar back and halo system.

• Anatomical Concepts Inc. offers multifunctional pediatric and infant lower-extremity orthoses to allow for sequential correction of existing or pre-existing deformities, and to accommodate children’s growth.

• Ottobock has several pediatric offerings, and will soon release its WalkOn Reaction Junior anklefoot orthosis, made of lightweight carbon fiber prepreg material. The device is geared toward children with dorsiflexor weakness requiring greater support than provided by traditional dorsiflexion assist orthoses.

• Cascade Dafo provides products and services in pediatric bracing, including prefabricated “Fast Fit” products for various purposes. • ComfortFit is involved in the pediatric market with both prefabricated products and two custom-made orthoses specifically designed for children.

• SureStep has several products, including supramalleolar orthoses that are made using measurements and patient demographic data, as well as spiro hinges and free-motion hinges designed for small bodies.

Apps for Outcomes Measures

MARCH 2017 | O&P ALMANAC

Tuning AFOs

Beyond embracing advances in materials and gait-review technologies, orthotists are adapting the way they fit orthotic pediatric patients. Some

PHOTO: Hanger Clinic

One of Bertram's pediatric patients

As the health-care profession moves to fee-for-value based care and O&P professionals seek to document the efficacy of O&P intervention, outcomes measurements are becoming a critical component of the O&P practice. A few forward-thinking O&P professionals have found that using “sports apps” to demonstrate how their patients’ gait compares pre- and post-treatment can be a quick and effective way to show improvements. In pediatric orthotics, “we’re having to do more outcomes measures to provide evidence that our treatment is providing a benefit to our patients,” says Bertram. Gait labs provide extremely accurate and detailed measurements of the kinematic and kinetic data, but they are expensive

and take time to set up and use. As a less costly alternative, Bertram uses two-dimensional video gait analysis via apps such as “Dartfish” and “Coach’s Eye.” These apps are designed to record and review sporting performances using a phone or tablet, and allow users to watch the performances played back in super slow motion and make annotations. “If you are using an encrypted phone and protecting personal health information (PHI), you can use these apps to take a video of the patient, then slow it down to see joint angles, abnormalities, and to see exactly where a patient has heel drop—something that’s hard to see in real time,” Bertram says. “But you can also look at the patient pre- and post-treatment. It’s easier than using a full gait lab and provides instant feedback.” The videos can be shared with physicians to demonstrate outcomes and prove that orthotic intervention is making a difference. But Bertram cautions that practitioners who choose to use these apps must store PHI properly and in accordance with regulations mandated by the Health Insurance Portability and Accountability Act. In addition, Bertram notes that taking videos as part of patient evaluations can “initially take longer, especially as you’re learning to do it,” so extra time must be built into appointments. While these video apps are not as advanced and do not capture as much information as more expensive gait lab equipment, they do demonstrate how orthoses are affecting and controlling the kinematics, says Bertram. “You can see the improvement in alignment and joint motion, and you can make inferences regarding the resulting improvement in kinetics. I can show these to a referral source, and they can see the outcomes and improvements.”

orthotists, including Bertram and Veldman, are turning to tuning anklefoot orthoses (AFOs) and shoe modifications to improve gait in patients with neuromuscular impairments.

Donald McGovern, CPO

“Tuning” is “optimizing the fit and function of the AFO,” says Donald McGovern, CPO, of the Prosthetics Orthotics Clinical Center at the Rehabilitation Institute of Chicago. McGovern has written and presented on this topic at several meetings, and follows the principles taught by Elaine Owen, MBE, MSc, SRP, MSCP, of Wales. “Tuning is shorthand for a process whereby an orthosis—in this case, an AFO—is optimized for comfort, performance, and function, preserving the structure of the foot/ ankle to achieve the highest level of gait for the individual,” McGovern says. This method includes careful attention to the footwear, “which will be the interface between the user and the ground. Footwear has an immense influence on the ground reaction forces that occur during walking.”

Elaine Owen, MBE, MSc, SRP, MSCP

During an evaluation for a child being fit with an AFO-footwear combination (AFO-FC), orthotists must consider the position of the anatomical foot and ankle. “The angle of the ankle in the AFO is discerned by evaluating the range of motion of the ankle, the stiffness of the ankle (how easily does it move in the available ROM), the integrity of the foot alignment (does the foot ‘escape’ out of the neutral

Casting Alternatives There are different ways to ensure the optimal fit for orthotic devices, but it can be a bit more challenging when working with pediatric patients. While scanning techniques have become popular for fitting pediatric patients requiring cranial remolding helmets and some scoliosis orthoses, some of the scanning technologies being used on adults don’t work as well with the pediatric population, due to children’s size and inability to keep still. In many cases, especially with lower-extremity patients, casting is still an important part of the orthotic treatment process. At Midwest O&P, practitioners have found another way to avoid casting in some patients: “We’re doing 50 to 60 percent of pediatric bracing from measurements instead of casts, which reduces appointment time,” says Bernie Veldman, CO, chief executive officer of Midwest Orthotic Services. “The CAD/CAM world is blowing up,” he adds, noting that in some instances, “we are able to fabricate start-to-finish without casting.” Clinicians at EastPoint P&O also are working on cutting down on the amount of casting needed for their pediatric patients by using 3-D scanning, via DigiScan 3D, to perform noncontact orthosis shape capture, says Brent Wright, CP, BOCO. “When we cast a child, it takes time on the UPS truck” to get the component to the central fabrication facility, he says. “This is much faster and super portable, plus we have an electronic copy for the chart,” making it easy to use when on the road.

position), and comfort (the position of the foot in the AFO must be tolerable),” says McGovern. The design of the AFO-FC must take into consideration the characteristics of the individual child and the goals he or she is motivated to achieve. “Owen has created algorithms to assist in making these decisions. They are extremely helpful guidelines for clinical practice,” says McGovern. The algorithms can be found in the Prosthetics and Orthotics International article, “The Importance of Being Earnest About Shank and Thigh Kinematics, Especially When Using AFOs” (POI, 34: 254-269). These algorithms are guidelines for determining the design of a fixed ankle AFO; Owen also has published an algorithm for guidance regarding articulated AFOs.

Using the tuning method, once the design of an AFO is ascertained, the AFO can be fabricated “to maintain optimal triplanar anatomical alignment decided upon from the assessment,” says McGovern. “One of the unique features of the AFO-FC process is that the angle of the ankle can be in plantarflexion.” O&P ALMANAC | MARCH 2017

COVER STORY

The AFO-FC concept looks beyond fit once the orthosis has been fabricated, and considers whether the pediatric patient can stand and walk well. Owen has published guidelines on measuring the front of the tibia, or “shank,” and recommends that patients have a shank-to-vertical angle of about 10 to 12 degrees to function at their highest potential. Footwear also needs to be carefully considered, and shoe modifications may be necessary to achieve optimal gait. “In many instances, the user will need to get experience and therapy using the new AFO-FC before a definitive alignment can be established—and that would be a tuned AFO-FC,” says McGovern. “A common error is thinking an AFO with a wedge is a tuned AFO—this is an oversimplification and often misleading.”

Forging long-lasting relationships can be one of the benefits of working with children.

MARCH 2017 | O&P ALMANAC

Exceeding Expectations

Orthotists who treat children can face a complicated mix of patient pathologies, and must use an array of technologies and bracing solutions to meet the individualized needs of these young patients. Staying up-todate on current trends and trying new approaches can yield optimal results for a diverse patient population. Pediatric orthotists are challenged with “a vast amount of diagnoses and treatment options,” says Bertram. “Having to manage it all is a challenge—but it’s also exciting, and there’s never a dull moment.” Forging long-lasting relationships can be one of the benefits of working with children. While clinicians who treat mainly adult orthotic patients may have a string of temporary patient relationships, those who work with children may have patients returning for years to come. “I’ve seen so many patients grow up—it’s great to see them transition into adulthood,” says Bertram. Orthotists who take the steps now to consider new technologies and treatment protocols can ensure the best outcomes for pediatric patients, who stand to benefit for months and years to come. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

Bertram says that orthotists who work with pediatric patients need to be "problemsolvers," and should involve a care team and family members in orthotic patient care.

PHOTO: Hanger Clinic

The concept of tuned AFO-FCs requires a gradual approach, and may be useful for several types of pediatric patients, including those with cerebral palsy, muscular dystrophy, spina bifida, rheumatoid arthritis, or others. McGovern has witnessed several benefits for patients he has fit with tuned AFO-FCs, including an increase in comfort, tolerance to wear, maintenance of range of motion at the ankle, and improved range of motion at the knee and hip. With his patients, he has seen “decreased energy expenditure, increased velocity, increased stability, maintenance or improvement of range of motion, and improved bony alignment in younger patients where ossification has not yet ended.” He also notes that some of his pediatric patients who were previously “limited community ambulators

with forearm crutches” using articulated AFOs were able to progress to become “limited community ambulators without crutches—a very big accomplishment for them,” once they switched to tuned AFO-FCs. But tuned AFO-FCs do not work for all patients, says McGovern. For example, “individuals with hip, knee, and or ankle contractures of greater than 20 degrees will reduce the efficacy of the AFO-FC tuning strategy,” he says. “Often another intervention can be considered to achieve an improved range prior to AFO-FC tuning.” Bertram and Veldman have adopted the concept of tuning AFOs for some of their patients and have seen first-hand the improvements in gait in some of these children. Tuning AFOs have improved the stance phase stability in many of Veldman’s pediatric patients, particularly in those patients with mild cases of cerebral palsy, he says. He has seen improved cadence and velocity, and more appropriate weight bearing. Some of his pediatric patients have been able to use their walkers less often. “Over time, there’s a lengthening of the muscles, and improvement in efficiency and stability of gait,” he says. Bertram says that he and other Hanger clinicians have embraced the tuning concept for some children, and have expanded it to “lower-extremity orthotics in general,” including KAFOs and reciprocating gait orthoses.

Discover the

AAOP 2017 - Booth 115

function with purpose. 424 9th Street, San Francisco, CA 94103 Press@LIMinnovations.com | 844.888.8LIM ÂŽ 2017 LIM Innovations All rights reserved. @ LIMInnovations.com facebook.com/LIMInnovations twitter.com/LIMInnovations instagram.com/LIM_Innovations

By LIA K. DANGELICO

Making Your

MOVE

Tips and tricks for opening a new location or moving your practice

NEED TO KNOW • When moving offices or opening a new facility, O&P business owners and office managers must consider a number of factors—such as interior design, geographical location, and how the move will affect employees, patients, and referral sources. • Before signing contracts with realtors or contractors, managers should evaluate the need for the move, plan the budget in detail, and engage staff in determining office layout and equipment needs for the new space. • It’s important to choose contractors, architects, and IT partners carefully, and to continuously oversee the construction process and equipment installation. • Both the interior and exterior of the new office space should be strategically planned, with ample room for orthotic and prosthetic patients to navigate inside, and a desirable and attractive geographic location that will be easy for patients to access.

MARCH 2017 | O&P ALMANAC

PHOTO: Getty Images/Zimmytws

• Communication is critical when prepping current staff for the transition or hiring additional employees for a new office. It’s also important to let patients and potential patients know about the new facility well ahead of the actual move-in date.

PRING IS A GREAT time to get

serious about planning for the future. With warmer weather and “spring cleaning” efforts top-of-mind, it’s the perfect opportunity to consider whether the moment is right to open an additional branch of your facility at a new location, or to think about changing locations if you are outgrowing your current space. Whatever the circumstances, if you’re contemplating opening a new office, you are not alone. Across the country, the demand for O&P providers is on the rise. Employment of orthotists and prosthetists is projected to grow 23 percent from 2014 to 2024, according to the U.S. Bureau of Labor Statistics’ (BLS’s) “Occupational Outlook Handbook.” That rate is “much faster than the average for all occupations. The large aging babyboom population will create a need for orthotists and prosthetists, because both diabetes and cardiovascular disease, which are the two leading causes of limb loss, are more common among older people,” according to BLS. If you find yourself in need of more space or considering expansion with a new facility, there’s no need to re-create the wheel. Many facilities have already gone through the experience and learned a thing or two about how to achieve success. Those efforts begin with a cohesive team effort, and continue with creating a detailed plan; tapping experts to navigate real estate, construction, and technology decisions; and never losing sight of the patients and employees who will benefit from the new space.

Alex Meyers, director of operations for Eschen Prosthetic and Orthotic Laboratories, which operates nine locations across the New York City region. “Budget the costs as well as the revenue opportunity. Are you increasing your service reach or improving the facilities for your patients? And then, plan thoroughly, addressing all of the details—from office aesthetics, to IT and networking. You cannot over-plan.” Engage staff members to find out what’s working and not working in your current locations to avoid repeating the same mistakes. Anne Sych Employees play a significant role in expansion efforts at Reach Orthotic & Prosthetic Services, based in Newport News, Virginia. The company has opened four facilities in total, including both purchasing and renting office space and planning the corresponding build-outs. “Make wish lists of what would be ideal in a new scenario, and let each team make suggestions to offer for improvements,” says Anne Sych, marketing coordinator at Reach. Respect that these are the individuals who work and live in the space every day; for example, staff members may suggest designing a larger gait room instead of a second exam room, or incorporating more

ample communal spaces for gatherings and events. Some of these items may not align with your current goals or budget, but employees’ ideas should at least be considered. Including staff in the planning process also helps get them excited and builds momentum. With the seemingly endless listmaking comes spending. “Most of our moves have been due to growth—adding offices—so we have needed to buy everything new,” says Sych. She urges facility managers to make a list of each and every item they will need to buy or replace. Even small purchases, such as paper towel holders and signage, need to be accounted for. “Do the math and plan for extra spending,” says Sych. Specifically, plan for an additional 10 percent in the budget as a buffer, says Jeff Brandt, CPO, founder and chief executive officer of Ability Jeff Brandt, Prosthetics & Orthotics. CPO After opening its doors in 2004, Ability introduced one new office every year for the first four years, and later, between 2011 and 2013, opened or moved seven of its now 11 offices, which are located across Maryland, Pennsylvania, North Carolina, and South Carolina.

Proper Planning

PHOTO: Getty Images/Ozgurdonmaz

It takes a good deal of work to transform the idea of a new office into a reality, and it all starts with research and planning. First, Alex Meyers “make sure you very clearly evaluate the need for a move or for opening a new location,” says O&P ALMANAC | MARCH 2017

PHOTOS: Reach Orthotic & Prosthetic Services

Designs for new facilities at Reach Orthotic & Prosthetic Services have included (clockwise from top left) wide entryways, organized lab spaces, easy-to-navigate gait labs, and light-filled lobbies.

As a result, Brandt and his team have facility design down to a science. They have created detailed spreadsheets and timelines for the moving process, including everything from getting the electric bill put in the company’s name to buying baskets for the restrooms.

Staffing Up

Of course, you need to have the right team in place to make and execute those lists and plans. Specifically, one in-house point person should be designated to manage the project and oversee all of the details. Ideally, he or she will be an organized multitasker who is able to hold all team members accountable. This point person serves as a leader—but he or she can’t do it alone and will require support from other staff members. “Delegating responsibilities is important,” says Sych. “People will have to pull out of their everyday roles for a bit, but having a good attitude helps.” Whether you are looking for a turnkey office space or planning a 32

MARCH 2017 | O&P ALMANAC

major build-out, you will likely need to tap trustworthy professionals outside of your office. For Meyers, that has meant working with a general contractor who has experience remodeling and building medical spaces to meet the requirements in the Americans With Disabilities Act. For Brandt, it has meant partnering with an architect who has designed all of Ability’s offices, and who has a good handle on the company’s standards and branding to ensure consistency from location to location. For others, a new office or move may be the perfect opportunity to consult an IT firm to review systems, equipment needs, and upgrades. Integra, a telecommunications provider based in Ashburn, Virginia, offers resources for navigating the technology aspect of a move on its website, integratelecom.com. The website features an interactive 12-month move timeline, an IT checklist, and a detailed best practices guide. The guide provides a few

key questions to ask as you assess IT needs ahead of a move: • Are you planning to migrate services to the Cloud? • Is there technology needed to support new IT initiatives? • Does your data backup solution support your business continuity plans? • Do you have enough bandwidth? • Do you need to upgrade your phone system to a new IP-Voice solution? • What services can you renew, eliminate, or consolidate? With an O&P facility, it also is important to consider whether all systems and processes at the new facility will align with the relevant requirements in the Health Insurance Portability and Accountability Act. There may be a bit of a learning curve when designing a new office, even when partnering with the most experienced professionals. Many

PHOTOS: Ability Prosthetics & Orthotics

New office designs at Ability Prosthetics & Orthotics have featured (clockwise from top left) wide doorways, appealing lobbies, roomy gait labs, and spacious exam rooms.

hear “medical space” and envision an average primary-care office—but there are many O&P-specific considerations as well. Brandt works with his team to ensure locations have adequate square footage so that both staff and patients can maneuver and “live in” the space with ease. Considering the O&P patient demographic, exam rooms and high-traffic areas should be able to accommodate wheelchairs, crutches, and family members and caregivers who may attend appointments with patients. “We concentrate on wider hallways, which we call ‘corridors,’” says Brandt. “We want our patients to be able to move easily down the passageway without rubbing up against or bumping into the walls.” Just as important as creating an O&P-friendly interior design is choosing an accessible and inviting location. The right venue can translate into more referrals and generally more business. Brandt says all of his facility’s locations are landmark-oriented. “If you select an office space that is near something everyone in town is familiar 34

MARCH 2017 | O&P ALMANAC

with, it’s going to be that much easier for them to find you.” Avoid the urge to take the less-than-desirable space—for example, behind the taco shop—just to save a few hundred bucks a month, says Brandt. Anna Heiserman, an associate with experience in selling and leasing medical facilities at Scheer Partners, a commercial real estate firm based in Washington, D.C., says that picking the right location is vital for success. The firm advises clients to ask the following questions when deciding on space: • Demographics—Who are you targeting? • Curb appeal—Is it a well-kept building that will make patients comfortable? • Traffic patterns—Is it a busy, well-traveled area? • Partner businesses, or referral sources—How will this make things easier for your patients? • Competition—Is the area already saturated with other companies with your same offerings?

Sometimes the excitement of finding “the perfect place” can cause you to gloss over crucial details, so try to remain focused and be ready to negotiate. After you find the right space and realize you can afford it, “from that point on, all these other points that are still fairly important can just sort of start to drop off your radar,” says Brandt. Pay close attention to leasing and other terms, and press the agent or landlord for details. For example, if the space has stood vacant for a while, you may be able to get the landlord to reduce the price or toss some money into your build-out, he says. It’s one thing to dream up an idea for your office and have an architect design it on paper, but you also have to have boots on the ground to closely manage the general contractor who is working on the space. Before drywall is hung at a new location, the Ability team does a walkthrough of the space. “We practice backing up, turning, and carrying boxes,” says Brandt, so if they need to make big changes they can do so without wasting too much

time and money. And someone on staff should visit the construction area every couple of days to check in and ensure plans are being followed, and to discuss the progress. “There are questions to be answered [about your space] that they’ll never ask if you don’t stop by,” he says. Finally, as the project progresses, remember that it’s OK to evolve from the model: If something isn’t working, don’t be afraid to address it, says Brandt.

The People Factor

As a facility owner or manager, you may find that employees and patients don’t always share your enthusiasm for new beginnings. Change is hard—for everyone—but there are some strategies you can employ to ease the transition. “Whether you’re moving or opening a new location, communication is critical,” says Meyers. “It is essential that your patients and referral partners are prepped for the impending change.” At Eschen, the staff hands out printed letters and fliers and also uses email and its website to communicate relevant details, such as key dates, directions to the facility, and new contact information. Then, says Sych, repeat, repeat, repeat. The team at Reach also uses strategically placed announcement signage and cards around the office. Another idea is to host an open house

event, where patients, referral sources, and members of the community have a chance to meet your team and explore the space before the grand opening. It’s inevitable, she says, that “some will like the move and some will not. But communicating that you are making improvements to service is a good message to give patients.” As you can imagine, it will be difficult to achieve any of this without having a dedicated staff on board, so don’t leave them in the dark. “Making employees aware of the move and why it is necessary is important,” says Meyers. “Give them an opportunity to sit with you and discuss their thoughts and concerns. Maybe the relocation

PHOTO: Getty Images/Matsou/Sturti

will extend their commute or prevent them from being home to walk their dog. Or maybe they have concerns about their job security. If you are opening a new location, explain how their role at the new location could be an opportunity for them to step up and take on new responsibilities.” You also can reassure employees by involving them in the planning process and showing them that the space was designed with them in mind. For example, Ability strives to incorporate as much natural light in its designs as possible, especially in staff offices and workspaces. Sych agrees: “Creating good working environments for our employees improves morale and increases productivity.” The most important goal is to set your team up for success. While you may not have much control over construction being completed on time, you can ensure that the location is ready to go when you open your doors so employees feel prepared. On the opening day of a new facility, Brandt says he “owes” the office manager and the staff a completed space, including such details having pictures, clocks, and emergency plans hung. “They’ll have all the supplies they need, and they’ll be ready to see patients and be fully operational on day one.” Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com. O&P ALMANAC | MARCH 2017

& NOW

THEN

AOPA’s Coding & Billing Seminars O&P clinicians and office staff rely on coding information provided at two-day presentations

Then & Now is a monthly department for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will feature a different AOPA member benefit and discuss how that benefit has evolved over the years. This month, we focus on the highly popular AOPA Coding & Billing seminars.

MARCH 2017 | O&P ALMANAC

seminar, presented in the mid-1990s, was designed to fill a great need among AOPA members. “Up until the early to mid ’90s, getting paid by Medicare, and to some extent other insurers, was pretty easy—send in a claim and get paid,” says Kathy Dodson, a former senior director of government affairs for AOPA. “But then Medicare started to institute more requirements for a ‘clean’ claim and thus more ways to run afoul of the rules, which meant much more attention needed to be paid to the accuracy of the information submitted, as well as more effort put into follow-up to ensure that payment was made. Unless you knew the rules, you were unlikely to be successful.” Although dealing with insurers, including Medicare, was less challenging in the 1990s than it is now, “members still needed to know the basics to receive all of the reimbursement they were entitled to while still following all required rules and regulations,” says Dodson. Recognizing that AOPA members would benefit from one national voice providing orthotic and prosthetic coding guidance, the AOPA Coding and Billing Committee joined forces with AOPA staff to develop a training course

that could be used across the country to provide much needed education and, at the same time, solicit members’ questions in person to determine the most pressing coding issues.

THEN

The reimbursement climate at the time of the inaugural Coding & Billing seminar was a bit disjointed, with practitioners in different parts of the country consulting local colleagues for advice on challenging coding questions. “AOPA was trying to figure out how to share coding and billing information on a national level,” says Michael S. O’Donnell, CPO, a member of the AOPA Coding and Billing Committee at the time, and one of the original presenters at the seminars. “There were a few individuals sharing that type of information in local areas, but there was no national forum.” Keith Cornell, CP, FAAOP, was one of the practitioners who was preparing coding information for a local gathering—one hosted by the Massachusetts Society of Orthotics & Prosthetics. He was asked to lend his expertise on the national level, and he joined the committee at AOPA spearheading the development of the first seminar.

TOP PHOTO: Getty Images/Kasto80

HE FIRST CODING & BILLING

THEN & NOW

Dodson and members of the Coding and Billing Committee—including O’Donnell and Cornell—took the lead in developing an agenda and content. “My staff and I concentrated on the regulatory and administrative side while the committee worked on the coding side,” says Dodson. The first seminar, held in Hartford, Connecticut, drew hundreds of participants. “We were expecting around 100 people, but it was standing-room-only,” says O’Donnell. The information was divided into several segments, and “six or eight members of the committee each presented a part of the seminar,” he says. Some of the topics covered included the history of the codes, the different categories of the codes, and how to apply them.

The success of the first seminar led to the decision to continue to offer seminars a few times a year, at different locations across the country, to allow practitioners from all corners easy access to the information. Las Vegas was a particularly popular destination: “We’d get 150 to 200 people at that location,” says O’Donnell. In the early days, preparation for each Coding & Billing seminar was time-intensive for both the volunteer committee members serving as presenters, who had to prepare their slides, and the AOPA support staff. “AOPA would spend one or two weeks prior to each seminar hand-assembling three-ring binders, filling them with Xeroxes and copies of information” to be discussed during the seminars, says Joseph McTernan, AOPA’s director of coding and reimbursement services, education, and programming. At the early seminars, presenters “would show a device and explain how it was coded and why,” says McTernan.

During the first few years, the seminars were given at a very basic level, with the goal of ensuring participants understood the basics of coding. The seminar also included a session called “Special Topics,” which focused on issues that had been brought to the attention of AOPA’s Coding and Billing Committee. “We would go through questions that had come into the committee, that committee members had batted around and come up with an answer to, and share those with attendees,” says O’Donnell. After the first year, the seminar staffing structure was formalized to include four speakers: Cornell, who presented the prosthetics information; O’Donnell, who presented the orthotics information; and two AOPA staff members. Cornell and O’Donnell spent the next six or seven years as the lead presenters, until taking a break to concentrate on their practices and other AOPA activities; Cornell went on to serve as AOPA president in 2003-2004. One byproduct of the seminars was the correction of some potentially bad billing situations that existed in various offices, says Dodson. “At almost every seminar, we would have office staff stop us at a break or after the meeting and say that they had been doing something wrong that could have been considered fraudulent, and that now they knew better and would correct it as soon as they returned home,” she says. “They had been in jeopardy not because they intended to bill incorrectly, but simply because they didn’t know any better. We also heard with great regularity that the office staff wanted their practitioners to come to a seminar to learn what they had just found out.”

Presenting the coding information in person also offered AOPA and the Coding Committee a better understanding of what the members were experiencing, and “allowed us to tailor the seminars to more accurately meet their needs,” says Dodson. The presenters could spot problems being caused by Medicare and work on fixing them with the Health Care Financing Administration, which filled the role CMS fills today. “It also allowed us to see variations between Medicare regions in how regulations were being interpreted and applied.” Holding those early seminars was an effective way for AOPA to take the temperature of its membership, says Cornell: “We learned a lot about what the typical office was like, and what practitioners’ concerns were—what was on the minds of the members.”

As the size of the audiences grew over the first few years, “we knew we were filling a real need,” Dodson says. AOPA regularly received positive feedback from the membership on how much they appreciated receiving accurate information that helped the office staff do a better job and the practitioners be fairly paid for their work. The introduction of the seminars was an important step in elevating the O&P profession, as the sessions offered O&P practitioners access to vital information to help them code correctly. “Before the seminars, everyone was trying to interpret the codes independently, or talking to people they knew to make challenging coding determinations,” says O’Donnell. “It was great when there was finally a voice, and a place to go to help everyone understand the coding.” O&P ALMANAC | MARCH 2017

THEN & NOW

Devon Bernard and Joseph McTernan, part of the current AOPA Coding & Billing seminar team

NOW

These days, the Coding & Billing seminars remain as popular as ever, but the format has evolved to better meet the needs of today’s attendees. In the early days, “we tended to

concentrate more on regulatory and administrative rules and not quite so much on the actual how-to of coding. All sessions included all of the audience,” says Dodson. But over time, organizers realized it would be

Upcoming 2017 Coding & Billing Seminars April 10-11

DENVER

The Westin Denver Downtown, 1672 Lawrence Street, Denver

July 17-18

PITTSBURGH

The DoubleTree by Hilton Hotel and Suites Pittsburgh Downtown, One Bigelow Square, Pittsburgh

November 6-7

PHOENIX

Sheraton Grand Phoenix, 340 N. 3rd Street, Phoenix

To register for the seminars, visit bit.ly/2017billing or contact AOPA’s Ryan Gleeson at rgleeson@aopanet.org.

MARCH 2017 | O&P ALMANAC

helpful to split the audience for part of the seminar, so that office staff could concentrate on billing rules while practitioners could take part in hands-on exercises. The advanced, two-day events are now held four times each year and continue to focus on how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts. They are designed for both orthotic and prosthetic practitioners and office staff. The current seminars are led by Mitchell Dobson, CPO, FAAOP; Jonathan Naft, CPO; McTernan; and Devon Bernard, AOPA’s assistant director of coding and reimbursement services, education, and programming. Because today’s seminars are offered at the “advanced” level, the basic information and materials contained in previous Coding & Billing seminars have been converted into nine one-hour webcasts and are available on AOPA’s website, aopanet. org. The advanced information at the current seminars builds on the basic information available on the webcasts and assists O&P professionals with detailed coding concerns. Participants receive 14 continuing education credits upon completion of the course, and also come home with a free manual containing comprehensive information on coding and billing. “We continue to get good feedback,” says McTernan. “We include a survey each time to find out participants’ thoughts.” He says that “no two seminars are alike,” and that suggestions in the surveys are often incorporated into future presentations. For example, “a few years ago, some people said we were spending too much time on therapeutic shoes and mastectomy services, so we replaced some of that information with more compliance program and documentation information,” he says. The seminars also have become highly regarded by outsiders to the profession, says McTernan. “The seminar as an entity is accepted by people outside of O&P as great education,” he says.

i-limb™ quantum precision. power. intelligent motion. The first multi-articulating prosthesis that can be controlled with simple gestures.

• Smarter: Use simple gestures to change grips

• Faster: Boost digit speed by up to 30%

• Stronger: Up to 30% more power when needed

‘‘

Now available in 4 sizes (extra small, small, medium, large)

‘‘

A prosthesis I can control with just one simple movement. It's a game changer - just like me! Rebekah Marine Bionic Model

Visit www.touchbionics.com or ask your

Touch Bionics rep about i-limb™ today.

USA (855) 694-5462 CANADA (416) 465-0266 WWW.TOUCHBIONICS.COM

BRIDGE TO THE FUTURE: THE INTERVIEWS

Thought Control Advances in neural prosthetics open doors for paralyzed and prosthetic patients By CHRISTINE UMBRELL

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

MARCH 2017 | O&P ALMANAC

PHOTOS: schwartzlab.neurobio.pitt.edu

the time, it was just the beginning of HE STUDY OF NEURAL prosthetics what will eventually be possible in the has come a long way since Andrew realm of neural prosthetics. Schwartz, PhD, first became involved in neurophysiology research 25 years ago. For more than two decades, Uncovering the Basics Schwartz, who serves as distinguished Over the years, Schwartz’s research has professor and chair in system neuroresulted in several important findings. First, his studies demonstrated science at the University of Pittsburgh, that arm and hand movements are has led researchers in studying the represented by large populations of relationship between cerebral cortical activity and arm movement, finding that neurons. “Each neuron has a noisy representation, but when contrithere is a good representation of the arm’s trajectory in the collective firing butions from multiple neurons are pattern of frontal cortical activity. combined, the representation is very Schwartz and his team have accurate,” he says. demonstrated their work in Second, his research has various studies throughout shown that movement is the years, progressing from controlled continuously on an working with monkeys in the instant-by-instant basis. 1990s to the first implemenSchwartz and his team also uncovered that the motor tation in a paralyzed human cortex—long thought to have subject in 2012. The global a primary role in muscle O&P community watched Andrew contraction—contains a lot of closely that year when Jan Schwartz, PhD information about the actual Scheuermann used neural movement of the hand and arm in a way signals tapped by electrode arrays that doesn't have to be linked directly implanted on the surface of her brain to muscle contraction. “That means to operate a high-performance robotic that higher-order aspects of movement, arm and hand, moving the prosthesis like the shape of a trajectory, can be to perform tasks of daily living and to extracted from a population of recorded high-five the researchers. neurons,” says Schwartz. Scheuermann’s 2012 accomplishThose three basic research findings ments represented “a spectacular leap “have allowed us to extract a hightoward greater function and indepenlevel ‘movement intention’ from the dence for people who are unable to cortical activity of human subjects move their own arms,” says Schwartz. who are paralyzed,” says Schwartz. As significant as the moment was at

BRIDGE TO THE FUTURE: THE INTERVIEWS

“We use this rich control signal to control a high-performance prosthetic arm. That means that our paralyzed subjects can move the arm, wrist, and fingers simultaneously with coordination and performance approaching that of ” unimpaired humans, he says. This research paved the way for Scheuermann’s famous thought-controlled movements, which were made possible after she heard about Schwartz’s research and volunteered for the study. Schwartz’s team placed two quarter-inch square electrode grids with 96 tiny contact points each in the regions of Scheuermann’s brain that would normally control right arm and hand movement. The electrode points picked up signals from individual neurons. Computer algorithms were used to identify the firing patterns associated with particular observed or imagined movements, such as raising or lowering the arm, or turning the wrist. Two days after the operation, the research team hooked up the two terminals that protruded from Scheuermann’s skull to the computer. Within a week, Scheuermann could reach in and out, left and right, and up and down with the arm, giving her three-dimensional control. Three months later, she could flex the wrist back and forth, move it side to side, and rotate it clockwise. She also was able to pick up and transfer small

objects using the robotic arm. The findings indicated that “by a variety of measures, [Scheuermann] was able to improve her consistency over many days,” says Schwartz. “The training methods and algorithms that we used in monkey models of this technology also worked for Jan, suggesting that it’s possible for people with long-term paralysis to recover natural, intuitive command signals to orient a prosthetic hand and arm to allow meaningful interaction with the environment.” The success of Scheuermann’s movements led to additional studies using a two-way electrode system to capture the intention to move and stimulate the brain to generate sensation, as well as research into whether the technology may become a fully implanted wireless system.

Building On

Today, Schwartz’s research focuses on dexterous manipulation with objects. “This necessitates an understanding of the way the brain controls force and motion simultaneously,” he says. “We also are working on making the whole prosthetic apparatus portable and useful in a way that it can be used robustly outside the laboratory.” The most important first step to achieve this goal is to develop telemetry “so the brain signal can be transmitted wirelessly, without the

PHOTO: schwartzlab.neurobio.pitt.edu

Action potentials from neurons are used to control manmade devices. In this cartoon, the axon of a pyramidal neuron (reconstructed from 20-micron histological sections) wraps around a cylinder to form a solenoid that activates a watch escapement.

need for skull-mounted transcutaneous connectors,” says Schwartz. This type of technology development will make neural prosthetics less exotic and more reliable so that they can be applied to a wider range of uses. Speaking specifically to prosthetic applications of his studies, Schwartz notes that his research “could have a big impact on amputees who want to use a high-performance prosthetic arm and hand to regain function.” The approach taken by Schwartz’s team “allows many more degrees-offreedom to be controlled with much less effort than even the most advanced approaches, such as the targeted muscle reinnervation approaches currently available,” he says. Schwartz believes his vision of the future will come to fruition, given the appropriate funding and by “achieving a scientific characterization of the way the brain controls elegant movements like dexterous manipulation.” In addition to aiding amputees, Schwartz says his research could be useful for individuals with spinal cord injuries—which may require collaboration with the field of optogenetics. “We are working on using light as a way to activate muscles in spinal-injured subjects,” he says. “The goal is to allow them to use their own limbs instead of a prosthesis.” Looking 10 or 20 years down the road, Schwartz hopes that advances in neural prosthetics “can be applied to a wider range of patients—the biggest target are those with cerebral strokes.” As orthotists and prosthetists contemplate the future of the O&P profession, they will have to consider how the stroke patients and amputees they treat today could be affected by the advancements in technology that could improve their situations in the future. Given a few years and the appropriate research and funding, a whole new world of possibilities may open up. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com. O&P ALMANAC | MARCH 2017

THE GLOBAL PROFESSIONAL

Mompati Puncho Segokgo South East District, Botswana O&P clinician details his work at the Bamalete Lutheran Hospital in Romotswa O&P ALMANAC: Describe a typical

work day for you.

As the O&P profession prepares for the Second O&P World Congress, to be held in conjunction with AOPAâ&#x20AC;&#x2122;s 100th Anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a questionand-answer section with international O&P experts. Each month, we spotlight an O&P professional from a different part of the world to find out how O&P is practiced across the globe, in anticipation of the upcoming World Congress.

MOMPATI PUNCHO SEGOKGO: As an orthotist/prosthetist at the Bamalete Lutheran Hospital, I start my day doing patient consultations. I evaluate patients to find out their needs and why they are being referred to the prosthetics and orthotics department. I take measurements, then manufacture devices only after looking into all of the possibilities and affordability of the materials available, and the payments by patients for our items. O&P ALMANAC: Describe the loca-

tion where you provide services.

SEGOKGO: Bamalete Lutheran Hospital (BLH) is a mission hospital. It collaborates with the government for public health services. There are two types of employees who work together at the facility â&#x20AC;&#x201D;government employees and BLH employees. I work as a government employee.

and through-knee amputees. On the orthotics side, we see a lot of patients with hyperkyphosis, scoliosis, coccygeal angulations, disk prolapse, back pains, and neck injuries. O&P ALMANAC: How are the devices

you provide paid for?

SEGOKGO: The government has some policies for providing health-care services, and our products are among services that the government subsidizes on behalf of patients in terms of buying materials, tools, etc., but not fully. Both the government and people who have employee health insurance have some responsibility. Patients as individuals usually pay 7 percent as a standard price across the board. Those who have health insurance pay 50 percent.

O&P ALMANAC: Explain the scope of Mompati Puncho Segokgo South East Disrict, Botswana

MARCH 2017 | O&P ALMANAC

SEGOKGO: I am trained to do the following: prescription examination, prosthetic and orthotic fabrication, initial check-up of the examination, and training patients in using prosthetics/ orthotics. I fabricate [the devices] I fit for my patients. We see a lot of above- and below-knee amputees, hip disarticulation patients, Syme amputees,

PHOTOS: Mompati Puncho Segokgo

the services you provide.

THE GLOBAL PROFESSIONAL

Those who do not have financial support—for example, due to poverty— will be offered services for free, and should be registered with social workers. But sometimes there are not sufficient materials for their provided services, so it’s a compromise. O&P ALMANAC: If the payor is other

than the patient, do nonpatient payors have an audit process? If there is an audit process, do you consider it to be fair? SEGOKGO: I have not seen any audits. We, as employees, take responsibility to account for the money given to each hospital department during the financial year.

around the country on a transfer basis by the government. I proved myself by starting one of the workshops; the department was later handed over to foreign local employees. I went for further studies at Tanzania Training Centre for Orthopedic Technologists and received my diploma there, a degree in orthopedic technology. After serving for more than three years, I left the government and opened a privatesector facility, partnering with one of the prosthetist/orthotists from South Africa based in Botswana. I have been certified to run a private workshop by the ministry of health. However, we had to close our private practice. I continue to study on my own, even though I sometimes lack sponsors through the government for further studies and refresher courses. O&P ALMANAC: What’s the biggest

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

SEGOKGO: The biggest problem is

government red tape, connected to international foreign policies. In most cases, there is not enough advocacy for our profession. Sometimes [the government relies on] nonprofessionals and professionals from foreign countries. Here there are two big mistakes: Nonprofessionals are foreign peers who sometimes make quick decisions,

which may not be the best solutions [for our patients]. Foreign employees are not aware of what urban clients really need, or our culture, and how our services should be distributed. They don’t always understand [the solutions that will work for] rural patients. Local employees are too often overlooked or [not given the credit they deserve]. The best way for me to help promote the profession in my country is to do my own research while on duty as part of the clinic. My research may not be written in fully standard written form, but I do the best I can.

O&P ALMANAC: Describe your

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

SEGOKGO: I grew up in a village called PHOTOS: Mompati Puncho Segokgo

Moshupa, with my grandmother fostering us. I began working as an assistant orthopedic technician after learning about O&P when my father was injured in a car accident, when I was 17. The following year, I had to work and study at the same time. When I was unable to find a sponsorship for my studies, I worked with international organizations, taking part in four workshops

Romotswa

O&P ALMANAC | MARCH 2017

MEMBER SPOTLIGHT

Coachella Valley Orthotics & Prosthetics

By DEBORAH CONN

Family Tradition Henry Molina, who introduced his sons to the O&P industry

A second-generation practitioner caters to a diverse community

HE MOLINA FAMILY HAS

MARCH 2017 | O&P ALMANAC

Russell Molina, CPO, works with his son, Russ Molina, who is completing his residency at Coachella Valley O&P.

FACILITY: Coachella Valley Orthotics & Prosthetics LOCATION: Palm Desert, California OWNER: Russell Molina, CPO HISTORY: 25 years

Technician Ricardo Ayala works on a prosthesis.

In addition to the Palm Desert location, Coachella Valley opened a satellite office in Irvine, California, which sees patients daily except for two days every other week. Russell Molina’s son, Russ, takes care of things a fitter would do, and the elder Molina travels to the facility when more involved cases arise. Palm Desert is a predominantly Hispanic community, so four front-office staff members and three of the clinicians are fluent in Spanish. Orthotic patients range from infants to seniors, and prosthetic patients range from middle age to seniors. “We do a good mix of orthotic and prosthetic work,” says Russell Molina, “from spinals to AFOs in orthotics and below- and above-knee and upper-extremity devices in prosthetics.” Over the last year or two, the practice has become heavily involved in the use of office management software and electronic medical record keeping, which has reduced waiting times and allowed patients to spend more time with clinicians, Russell

Molina says. Patients are asked to complete a brief survey when they leave, and the facility has a 95 percent satisfaction rate. The facility’s compliance officer, Camela Wilson, oversees monthly chart audits and attends seminars on regulatory issues. All staff members take part in quarterly webinars on any changes that have occurred in health-care rules. In addition, the facility has a dedicated staff member who obtains necessary information and documentation from doctors, including letters of medical necessity. “We’ve made a huge effort in educating physicians and teaming with physical medicine and rehabilitation doctors to make sure they know what to do,” says Russell Molina. As a result, the facility has an excellent track record in passing audits. “That wasn’t true about three years ago. It took a learning curve to get where we are today, and I’m very proud of this change,” he says. At this point, Coachella Valley O&P doesn’t have to market itself beyond word of mouth and seeking and maintaining contracts. The community recognizes the facility’s culture, a three-generation family business. “We bring that family approach to our patients and staff, and we act as a cohesive team,” says Russell Molina. “It benefits all parties: Patients are satisfied and physicians are happy with us. We do the work, and people appreciate that.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Coachella Valley Orthotics & Prosthetics

been involved in orthotics and prosthetics in California for more than half a century, ever since Henry Molina lost his leg at Iwo Jima in World War II and became a prosthetist. Both his sons joined the business—Roger Molina, CPO, now in Modesto, and Russell Molina, CPO, at Coachella Valley Orthotics & Prosthetics (O&P) in Palm Desert. Generation three is well on its way, with Russell’s son Russ completing his residency at Coachella Valley, and Roger’s son Ryan Molina, CO, owning Crown City Orthopedics in Arcadia. Russell Molina launched Coachella Valley O&P in Palm Desert 25 years ago, “leaving the nest,” he says, in Pasadena, where he and his brother had taken over their dad’s facility. He started his business as a solo practitioner in a 750-square-foot office, and today his practice has grown to encompass a 10-employee staff in a 4,200-square-foot facility. In addition to father-and-son clinicians, Jose Ledezma, CPOA, CFO, works closely with patients. The facility features a reception and waiting area, two smaller fitting rooms, and a full walking room with parallel bars, stairs, ramps, and mirrors. Longtime technician Ricardo Ayala works in a 2,000-square-foot fabrication lab and a dedicated casting room. “We outsource some devices, like Arizonas and scoliosis braces, but we do most fabrication in-house, including prostheses, custom diabetic insoles, anklefoot orthoses (AFOs), and Crow walker boots,” says Russell Molina.

Why should you attend? Educate lawmakers on the issues that are important to YOU:

The Policy Forum is your

BEST OPPORTUNITY

to learn the latest legislative and regulatory details and how they will affect you, your business and your patients.

• Make sure O&P has a place in any new health-care legislation • Ensure O&P has fair representation in any O&P LCDs • Make sure Prior Authorization is administered fairly • Prevent the expansion of off-the-shelf orthoses and competitive bidding

Once you are armed with the facts, we as a profession will educate our members of Congress to offer common sense solutions and share how the O&P profession restores lives and puts people back to work.

Questions regarding registration, travel or the agenda should be directed to Ryan Gleeson at rgleeson@AOPAnet.org or (571) 431-0876. Questions regarding programming, congressional visits or key issues should be directed to Devon Bernard at dbernard@AOPAnet.org or (571) 431-0854.

2017

HOST HOTEL: Ritz Carlton, 1250 South Hayes Street, Arlington, VA 22202 Reserve online at http://www.ritzcarlton.com/en/hotels/washington-dc/ pentagon-city with the code AOIAOIA, or by phone at 1-800241-3333, with the Group Name: AOPA 2017 Policy Forum Reservations must be received by May 2 for AOPA’s rate of $279. Meet your member of Congress and tell them how, through orthotics and prosthetics:

Visit www.AOPAnet.org to learn more.

MEMBER SPOTLIGHT

Engineered Silicone Products

First Responders Liner and valve manufacturer designs products in answer to customers’ requests

ACK IN THE 1990s, Louis

MARCH 2017 | O&P ALMANAC

ESP staff members (from left) Bailey Frey, Patricia Lukasik, Robert Ashworth, Michael Haberman, CPOA, Elizabeth Raderstorf, and Nicholas Toso

A recent addition to ESP’s catalog is a new elevated vacuum valve. Another advance spearheaded by Michael Haberman was developing a common interface for ESP’s main line of valves. “I’ve COMPANY: made it my priority to listen to our Engineered customers,” he says. “Clinicians inquired if they were able to retSilicone Products rofit our various sized valves into an already cast socket. Originally, OWNER: that was impossible. After much Louis Haberman, research and development, we CPO, LPO were able to retrofit our large line of valves into one universal LOCATION: housing. This allows a practitioner Newton, New Jersey to purchase our kit and determine which valve best fits the HISTORY: patient’s needs without having to 20 years make an entirely new socket.” In addition to valves and preflexed and conventional liners, ESP makes knee sleeves (both gel and neoprene), silicone accessories, and alignment devices. The company occupies a 4,500-square-foot facility in Newton, New Jersey. ESP is smaller than some of its competitors, “but we operate like the big dogs. Being smaller, we have the advantage of Nicholas Toso uses the adapting to our customers’ injection molder to inject a liner. needs quickly and implementing

changes when necessary,” says Michael Haberman. Innovation and technology are important to ESP’s future, he notes. “We will constantly add to our growing catalog with at least three new products a year,” he says. “I want ESP to grow into a virtual think tank, with creative ideas and constant evolution.” ESP markets its products through print advertising in trade publications and industry trade shows around the world. The company is revamping its website, using Michael Haberman’s experience in search engine optimization to attract more traffic. The website already features a few instructional videos, and the company plans to make the site increasingly interactive by posting training and awareness videos on YouTube. Michael Haberman also has plans to hire a new public relations director to give the company a strong presence on social media. “This will enable us to assist, comment, and educate patients as well as clinicians immediately,” he says. ESP prides itself on its responsiveness to customers. “We manage our business by listening to our customers as well as our employees. All ideas are considered, no matter how far-reaching they may appear.” Before assuming the role as ESP’s operations manager, Michael Haberman wrote technical manuals for the Department of Defense on weapons systems. After leaving, he became a certified prosthetic orthotic assistant at Garden State Orthopedics Center in Oakland, New Jersey. “I went from working with weapon systems to making people walk again,” he says. “I have an absolute passion for this industry, and I’m in it to improve people’s lives.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Engineered Silicone Products

Haberman, CPO, LPO, noticed how many of his patients required custom liners—and how few were available. He decided to produce his own, founding Engineered Silicone Products (ESP) in 1996 to manufacture prosthetic liners. One of ESP’s first products was the Aegis bent knee liner, a product that revolutionized the industry, says Louis’s son, Michael, a certified prosthetic orthotic assistant who serves as operations manager. “The natural flexion of a person’s knee is approximately 43 degrees,” Michael Haberman explains, “and a bent knee liner prevents creasing or discomfort while sitting or standing.” From there, Louis Haberman worked in collaboration with various colleagues to develop additional product lines, including valves used in suction sockets. “Before the advent of the Lyn Valve®, the valves used in suction suspension systems would leak, causing massive failures,” explains Michael Haberman. It took approximately 12 years to perfect the valve, which provides continuous suction with no leakage and allows both manual and auto expulsion. “The demand for our valves has grown dramatically from when we first started,” says Michael Haberman. “Today, we sell all over the world. We entered several new countries in 2016, including Columbia, Egypt, and Israel, and we plan to expand further in 2017.” ESP produces a variety of valves for different needs, including upper-extremity as well as aboveand below-knee prostheses.

By DEBORAH CONN

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR

DENVER

EARN

APRIL 10-11 | 2017

AOPA Coding Experts Are Coming to Denver, CO

14 CEs

Top 10 reasons to attend: 1.

Get your claims paid.

Increase your company’s bottom line.

Stay up-to-date on billing Medicare.

Code complex devices

Earn 14 CE credits.

Learn about audit updates.

Overturn denials.

Submit your specific questions ahead of time.

Advance your career.

Westin Denver Downtown, Denver, CO Join AOPA April 10-11 in Denver to advance your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up¬-to¬-date on all the hot topics. AOPA experts provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group. Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2017billing.

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

Mark your calendar for the next seminar:

JULY 17-18 Pittsburgh, PA

The DoubleTree by Hilton Hotel and Suites Pittsburgh Downtown, One Bigelow Square, Pittsburgh, PA Find the best practices to help you manage your business.

Participate in the 2017 Coding & Billing Seminar! Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

AOPA NEWS

APRIL 12

Grassroots Advocacy

Sign Up for the 2017 Webinars Mark your calendars for AOPA’s 2017 monthly webinars. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits—so you can still take advantage of the series discount and the valuable learning opportunities. Register for the complete 2017 series and get two free webinars! Members pay $990 and nonmembers pay $1,990, for the series. Register at bit.ly/2017webinars.

Your voice is needed to help elevate the profession and inform legislators about the value of O&P intervention. Be part of the solution by getting involved in grassroots advocacy efforts. Find out more during the April 12 webinar on “Grassroots Advocacy,” where you will learn: • How to effectively lobby for fair treatment of O&P on the local and national level • How to work with patients to help them become advocates for their own cause • How to effectively communicate with representatives in Washington, D.C., and in your office • How to act locally to change things nationally

Upcoming Webinars • March 8: Marketing Your Business • April 12: Grassroots Advocacy • May 10: Modifiers: What Do They Mean and When Should They Be Used? • June 14: Internal Audits: The Why and the How of Conducting Self-Audits • July 12: Know Your Resources: Where To Look To Find the Answers • August 9: What the Medicare Audit Data Tells Us and How To Avoid Common Errors • September 13: ABC Inspections and Accreditation • October 11: AFO/KAFO Policy • November 8: Gift Giving: Show Your Thanks and Remain Compliant • December 13: New Codes and Other Updates for 2018

MARCH 2017 | O&P ALMANAC

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2017webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2017billing.

AOPA NEWS

2017 AOPA Coding Products

Get your facility up to speed, fast, on all of the O&P HCPCS code changes with an array of 2017 AOPA coding products. Ensure each member of your staff has a 2017 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers

Share Your Memories

Join AOPA's centennial celebration this year

AOPA would like to include personal member stories in its year-long 100-year anniversary celebration. Please visit bit.ly/ celebrateaopa to share your photographs, memorabilia, and memories, which may be featured on AOPA’s commemorative website, on social media, and at the AOPA World Congress. Visit AOPA100.org to see AOPA’s history, photo gallery, timeline, and stories.

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

The Source for Orthotic & Prosthetic Coding

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

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

Log on to LCodeSearch.com and start today. Need to renew your membership?

Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org. www.AOPAnet.org

O&P ALMANAC | MARCH 2017

AOPA NEWS WELCOME NEW MEMBERS

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

Horizon Prosthetics LLC 8232 Park Meadows Drive Lone Tree, CO 80124 Member Type: Patient-Care Facility 303/660-1238 Tammy McKenna

Medical Arts Prosthetics Clinic 7818 Big Sky Drive, Ste. 111 Madison, WI 53719 Member Type: Patient-Care Facility 608/833-7002 Gregory Gion

Pediatric Orthotic & Prosthetic Services—Chicago 2211 N. Oak Park Avenue Chicago, IL 60707 Member Type: Affiliate Parent Company: Shriners Hospitals for Children Headquarters 773/466-6922 William Craggs, CPO

Reliant Prosthetics Southwest LLC 1300 Country Club Road, Ste. B Santa Theresa, NM 88008-9449 Member Type: Patient-Care Facility 575/589-3200 George Fernandez

Precision Orthotics & Prosthetics Inc. 8915 S. Pecos Road Henderson, NV 89074 Member Type: Affiliate Parent Company: Precision Orthotics & Prosthetics, Las Vegas, NV 702/293-5502 Lezlie Neetz

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

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

Visit MobilitySaves.org MobilitySaves.org. Follow us on social media! “Search Mobility Saves” on Facebook, Twitter, and LinkedIn

MARCH 2017 | O&P ALMANAC

Learn about the study proving orthotic and prosthetic care saves money

See how amputees rallied when their prosthetic care was threatened

Find supporting data to get your device paid for

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

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

Custom Stealth Foot Orthotics Custom carbon fiber foot orthotics—and boy, are they pretty. And strong. And lightweight. Trusted to protect the feet of our service members, this beauty goes more than skin deep. Fabrication available from foam boxes or Amfit digital files in two rigidities (firm or flex). Corrections and adjustments are molded into the carbon fiber to eliminate movement of pads and edges during wear. EVA heel counter maintains stability in the shoe or boot. Contact our customer service team to learn more today, orders@amfit.com or 800/356-FOOT(3668), x250.

Foam Box Lab Services for Diabetic, EVA, and Rigid Orthotics FootPrinter allows you to send your own boxes or use ours. Standard EVA orders manufactured in three to four business days; diabetic A5513, carbon fiber, and polypro in three to five days. PDAC approved A5513 diabetic pricing includes shipping costs for bi-lam and tri-lam styles. EVA available in soft, medium, dual, firm, and cork blend. Carbon fiber fabrication offered in flex or firm to best suit your patient. Milled polypropylene available in three widths and thicknesses for excellent fit and wear. Get started right away by emailing orders@amfit.com for an account form, or call 800/356-FOOT.

MARKETPLACE

Pediatric V-VAS™ custom KAFO The Pediatric V-VAS™ custom knee-ankle-foot orthosis (KAFO) is fabricated for your young patients who present or require treatment for all lower-limb bowing deformities. The dynamic V-Vas™ joint system allows for sequential correction of the deformity and allows for accommodation of growth with outstanding patient compliance. It is the only system that creates a bending moment that maintains the four-point correction throughout the full range of knee motion. The KAFO design is adaptable to incorporate a medial or lateral step lock or drop lock joint opposite of the V-VAS™ joint to simplify straightening adjustment and increase knee stability if needed. For more information, visit AnatomicalConceptsInc.com or call 800/837-3888.

Introducing the Coneiak Mini Polishing Arbors From Fillauer Perfect for your pediatric fabrication needs. Use these with your Dremel or Trautman Carver to reach tight spaces and small edges. To order your five-piece kit or individual arbor, contact Fillauer or your preferred O&P distributor today. For more information about Fillauer, visit www.fillauer.com or call 800/251-6398 or 423/623-0946.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call at 800/301-8275 or visit www.hersco.com. O&P ALMANAC | MARCH 2017

MARKETPLACE New Prosthesis for Chopart and Lis Franc Patients!

Pediatric AFO Solutions From Ottobock

Custom Composite Manufacturing’s new Partial Foot Prosthesis is designed specifically for Chopart and Lis Franc patients. The prosthesis restores normal foot biomechanics and properly transfers energy from a rigid lever arm to a progressive resistance carbon footplate. The Partial Foot Prosthesis is lightweight, durable, and custom made from a cast. It comes with a foam liner, Velcro® strap, and toe filler. It is the lightest, most functional design available today. Suggested L-Codes: L5020, L5634, L5654, L5785, L5976 For more information, contact Custom Composite Manufacturing at 866/273-2230 or visit www.cc-mfg.com.

You can now fit your pediatric patients with a full range of Ottobock pediatric (shown with ankle-foot orthosis (AFO) solutions, from optional flesh tone paint) the new WalkOn Reaction Junior to the new Aqualine Junior waterproof ankle joints. The WalkOn Reaction Junior offers the same dynamic properties as the WalkOn Reaction, but in a pediatric size. It is easy to trim/fit, is durable, and provides all-day comfort. This durable, lightweight, dynamic lower-leg orthosis features a slim design that is inconspicuous and comfortable—the perfect solution for your pediatric patients. For more information or to schedule a free trial, contact your Ottobock sales representative. Visit professionals.ottobockus.com or call 800/328-4058.

design. dexterity. intelligent motion. • Smarter: Uses simple gestures to change grips • Faster: Boost digit speed by up to 30 percent • Smaller: New form-fitting anatomical design reduces profile in every dimension. For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com. Visit us at AAOP in booths 74 and 75.

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

ADVERTISERS INDEX Company

Page Phone

ALPS South LLC

800-574-5426

Website www.easyliner.com

Amfit

9 800-356-3668

www.amfit.com

Anatomical Concepts

www.anatomicalconceptsinc.com

Becker Orthopedic

800-521-2192

www.beckerorthopedic.com

Cailor Fleming Insurance

800-796-8495

www.cailorfleming.com

800-837-3888 / 330-757-3569

Cascade Dafo Inc.

800-848-7332

www.cascadedafo.com

Fillauer Companies Inc.

800-251-6398

www.fillauer.com

Hersco

1 800-301-8275 29

Ottobock

C4 800-328-4058

www.professionals.ottobockus.com

Touch Bionics

www.touchbionics.com

MARCH 2017 | O&P ALMANAC

844-888-8LIM

www.hersco.com

LIM Innovations

855-694-5462

www.liminnovations.com

CAREERS

Opportunities for O&P Professionals Job location key:

O&P Almanac Careers Rates

- Northeast - Mid-Atlantic - Southeast - North Central

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

Member $482 $634

Nonmember $678 $830

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

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

- Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

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

Member Nonmember $85 $150

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

Career Opportunities... Oregon

Medford, CPO

California

Fresno, CP/CPO Salinas, CO

Washington

Richland, CP/CPO

To apply, submit resume to: careers@pacmedical.com

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services. The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others. A competitive salary, benefits and profit sharing are offered based on position/experience.

Our Culture & Commitment

â&#x20AC;&#x153;We will serve and help others grow personally, professionally, and strive to put others needs first and foremast as demonstrated by our positive attitude, teamwork and professionalism.â&#x20AC;?

O&P ALMANAC | MARCH 2017

CALENDAR

2017

April 1

March 1-4

43rd Academy Annual Meeting & Scientific Symposium. Chicago, Hyatt Regency Chicago. Visit academyannualmeeting.org or contact Diane Ragusa at 202/380-3663, or dragusa@oandp.org.

March 8

Marketing Your Business. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

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

April 10-11

2017 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars. Denver. The Westin Denver Downtown, 1672 Lawrence Street, Denver, CO 80202. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

April 12

March 10-11

ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg Collegeâ&#x20AC;&#x201D;Caruth Health Education Center, Pinellas Park, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

March 13-18

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

March 17-18

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

April 25-26

Amputee Coalition Hill Day. Washington, DC. To register or for more info, email federal@amputee-coalition.org or call 888/267-5669, ext. 7102.

May 10

Modifiers: What Do They Mean and When Should They Be Used? Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg Collegeâ&#x20AC;&#x201D;Caruth Health Education Center, Pinellas Park, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

www.bocusa.org

Apply Anytime!

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

your next event!

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

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

Calendar Rates Let us

Free Online Training

CREDITS

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

MARCH 2017 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR May 24-25

AOPA Policy Forum. Washington, DC. Come make a difference! Educate Congress on issues affecting your patients. For more information, contact Devon Bernard at dbernard@AOPAnet.org or call 571/431-0876.

June 8-9

Michigan Orthotics & Prosthetics Association Continuing Education Seminar. DoubleTree by Hilton Hotel Bay City—Riverfront. Exhibitor and Sponsorship Opportunities Available! Attendees earn CE credits! For more information and registration, please contact Amy Shea at MichiganOPA@gmail.com or 810/733-3375.

June 14

Internal Audits: The Why and the How of Conducting Self-Audits. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

July 12

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

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

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

November 6-7

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

November 8

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

Motion Control

SUPERCOURSE SPRING 2017 APRIL 5 - 8, 2017

August 4-5

Motion Control Headquarters, Salt Lake City, UT

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

• In-depth training of Utah

• Latest MC components,

• Hands-on training with

• Convenient Wednesday -

• Casting/ﬁtting/socket design

Plus training in the F.L.A.G. (Force Limiting Auto Grasp) feature for ETD & Hand

Arm 3+ / Hybrid Arm / ProPlus TDs and Wrist

UI software - bring your Windows laptop & iOS device (iPhone®, iPad®, iPod touch®)

August 9

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

for SD/FQ, T-H, T-R levels; patient subjects provided

100th AOPA National Assembly and Second World Congress. Las Vegas. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org. ABC Inspections and Accreditation. Webinar Conference Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

November 5-11

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

Coding & Billing Seminar

September 13

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

December 13

July 17-18

September 6-9

October 11

integrating with i-limb, bebionic, and others

Saturday schedule

The 4-day SuperCourse fee is $1,350.00 CEUs: 28 (estimated) ABC/BOC For more information or to register for the SuperCourse, email: info@UtahArm.com

115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801.326.3434 • Fax: 801.978.0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com O&P ALMANAC | MARCH 2017

O&P Almanac Calendar Ad SuperCourse Spring 2017.indd 1

2/1/17 11:30 AM

ASK AOPA CALENDAR

Exceeding Unit-of-Service Limits Answers to your questions about ‘medically unlikely edits’

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

I received a denial based on “established MUEs.” What are MUEs, and how can I be sure I adhere to them?

“MUEs” stands for “medically unlikely edits,” and is a Medicare unit-of-service claim edit applied to medical claims against a procedure code. MUEs are part of Medicare’s National Correct Coding Initiative, and are designed to lower the paid claims error rate for Part B Medicare fee-for-service claims.

MARCH 2017 | O&P ALMANAC

If I know I am going to exceed the number of units established by an MUE, may I have the patient sign an advanced beneficiary notice (ABN) and make him or her responsible for the potential MUE denial?

No. Medicare considers an MUE denial to be a coding issue denial and not a medical necessity denial. The ABN is only used when you believe an item will be denied due to medical necessity issues.

Do Medicare Advantage plans have to follow Medicare policies and guidelines?

In a nutshell, the answer is no. The Advantage plan “must provide enrollees in that plan with all Part A and Part B original Medicare services, if the enrollee is entitled to benefits under both parts,” according to the guidelines. This means the plan must provide patients with the same benefits they would normally receive under traditional Medicare. So, if Medicare covers an item and provides it as a benefit, then the Advantage plan must cover and provide the same service. However, how the plan chooses to provide that service or benefit is at the discretion of the plan.

PHOTO: GettyImages/simonkr/misomaru

An MUE establishes the maximum numbers of units of service that you could possibly provide to a single patient, taking into account bilateral situations, on a single date of service, and under most normal situations. For example, the MUE for an anklefoot orthosis (AFO), code L1960, is two units. This means that on any given date of service, a patient would not typically receive more than two L1960 AFOs, one for each foot. On the prosthetics side, the MUE for socks, L8420, is set at 24. This means that a typical patient could receive 12 socks per side on any given date of service. The MUEs are updated on a regular basis, and the current amounts may be found on the CMS website at www.cms.gov/Medicare/Coding/ NationalCorrectCodInitEd/MUE.html. Note, however, that Medicare does not list all of the MUEs, so just because you don’t see an MUE listed does not mean that an item you are providing is not subject to MUEs. You may exceed the MUE limits, but if you do, be prepared for part of your claim to be denied. You will have to appeal the denial and demonstrate the need for the number of units provided.

www.bocusa.org

Need CEs? Learn and earn with the AOPAversity

70+ TOP-QUALITY ORTHOTIC, PROSTHETIC, AND PEDORTHIC EDUCATION COURSES.

Online Learning Center

EARN SCIENTIFIC, BUSINESS, AND PEDORTHIC CE CREDITS BY STUDYING THE COURSE MATERIAL AND PASSING THE QUIZ.

ACCESS YOUR PERSONAL ACCOUNT, VIEW VIDEOS, PRINT CERTIFICATES, OR REVIEW CE CREDIT HISTORY 24/7.

Learn & Earn From March 1 to April 30, 2017, try our online learning center for FREE! Access the “Boston Strong Grand Rounds” free and earn 2.5 scientific credits—a $55 value. Create your account today!

It’s as easy as 1-2-3 1. Set up your free personal online account 2. Choose your education and study 3. Take the quiz and print your certificate

Membership has its benefits:

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

Visit www.AOPAnetonline.org/aopaversity for more information.

www.AOPAnetonline.org/AOPAversity

American Orthotic & Prosthetic Association 330 John Carlyle Street, Suite 200 Alexandria, VA 22314

WalkOn Reaction Junior

Aqualine Junior Ankle Joint

Keep Kids Moving with AFO solutions from Ottobock

The WalkOn Reaction Junior offers the same dynamic properties as the WalkOn Reaction, but in a pediatric size. It is easy to trim/fit, durable and provides all day comfort. This durable, lightweight, dynamic lower leg orthosis features a slim design that is inconspicuous and comfortable – the perfect solution for your pediatric patients. The Aqualine Junior is not only waterproof but durable, versatile and also lightweight, perfect as an everyday brace while suitable for swimming and water-related activities. Whether it is the dynamic WalkOn Reaction Junior, waterproof Aqualine Junior, self-aligning flexible X-ible joints, plantar flexion SNAPstop™, or the lightweight customizable Carbon Ankle Seven, there are many AFO options available to best suit your patients’ specific needs. For more information on these new pediatric orthotic solutions or to schedule a free trial of the WalkOn Reaction Junior, contact your Ottobock Sales Representative. Ottobock US . P 800 328 4058 . professionals.ottobockus.com

You can now fit your pediatric patients with a full range of Ottobock Pediatric AFO solutions from the NEW! WalkOn® Reaction Junior to the NEW! Aqualine Junior Waterproof Ankle Joints.