The Magazine for the Orthotics & Prosthetics Profession
MAY 2017
E! QU IZ M EARN
The Latest on Prior Authorization and Competitive Bidding P.16
Bringing the Profession to Today's High Schools P.28
The Changing Role of Technicians
CREDITS P.17
Conditional COVERAGE HOW CHANGES TO HEALTH-CARE LEGISLATION AFFECT O&P P.20
P.36
Patient Care at Australia's Royal Melbourne Hospital P.38
The Just In: AOPA Discusses O&P Agenda With CMS Officials P.18
WWW.AOPANET.ORG
2
BUSINESS CE
YOUR CONNECTION TO
EVERYTHING O&P
#AOPA2017
Registration is OPEN for this
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. Register at www.opworldcongressusa.org.
contents
MAY 2017 | VOL. 66, NO. 5
20 | Conditional Coverage O&P businesses have spent the past several years adapting to the changes that came when the Affordable Care Act was enacted. Now, President Trump and key members of Congress are debating how best to repeal and replace the legislation, and O&P stakeholders are considering what might happen if there are significant changes to state exchanges, Essential Health Benefits, and more. By Christine Umbrell
18 | This Just In AOPA Meets With New CMS Team AOPA leaders communicated their top priorities to members of the new administration during a meeting with representatives from CMS and the U.S. Department of Health and Human Services. Key topics of discussion included recognizing the orthotist’s/prosthetist’s notes as part of the medical record, enacting the Medicare O&P Improvement Act, and proposed regulations regarding qualified providers.
28 | Early Access O&P clinicians and business owners are taking advantage of opportunities to meet with high school and middle school students to share their knowledge and expertise with young people. These experiences benefit not only the students, but also the O&P professionals, who are playing an important role in increasing awareness of what’s possible with O&P and teaching the next generation the trends and technologies that are shaping the profession. By Lia K. Dangelico
PHOTO: Curbell-Plastics
MAY 2017 | O&P ALMANAC
PHOTO: Getty Images/Mark Wilson
2
COVER STORY
FEATURES
contents
SPECIAL SECTION
AOPA’S 100TH ANNIVERSARY AND WORLD CONGRESS PREVIEW
34 | Then & Now
36 | Bridge to the Future
P.10
The evolution of the certified technician role
PHOTO: Susanne Lindholm
AOPA membership trends over the past century
DEPARTMENTS
38 | The Global Professional
Views From AOPA Leadership......... 4
Q&A with a prosthetist at Australia’s Royal Melbourne Hospital
Insights from AOPA Board Member Pam Lupo, CO
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
Prior Authorization and Competitive Bidding
Transitions in the profession
AOPA News.............................................. 44 AOPA meetings, announcements, member benefits, and more
CE Opportunity to earn up to two CE credits CREDITS by taking the online quiz.
PAC Update...............................................45
Member Spotlight................................ 40 n
Cypress Adaptive LLC
n
LimBionics
Marketplace............................................. 46 P.16
Careers........................................................ 48 Professional opportunities
Welcome New Members ................. 49
Ad Index..................................................... 49 Calendar..................................................... 50 Upcoming meetings and events
P.40
P.42
Ask AOPA...................................................52 Advanced beneficiary notices and more
O&P ALMANAC | MAY 2017
3
VIEWS FROM AOPA LEADERSHIP
A More Diverse and Inclusive Profession THE TOPIC OF “WOMEN IN O&P”—a subject that, quite frankly, has been whispered
about for years—is a conversation whose time has come. While attending AOPA’s O&P Leadership Conference in 2016, one of the speakers boasted of the number of women entering the O&P profession at a rapid rate. I must admit this left me a little perplexed. Having recruited hundreds of candidates over the years, my experience is that there has been an equal number of male and female applicants for some time. Many people would be surprised to learn that the women outnumbered the men in the orthotics program at Northwestern University when I attended 35 years ago. And today, enrollment in O&P master’s programs is roughly 50/50—but leaning more toward female students. My hypothesis is that the trend of women entering O&P began much earlier than is widely believed. While we are missing statistics from the early years, there is some recent data we can use to review the prevalence of women in O&P, and women in leadership roles. A 2006 survey by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) found that 22 percent of ABC-certified orthotists were female and 13 percent of the ABC-certified prosthetists were female. Nine years later, ABC’s 2015 “Practice Analysis of Certified Practitioners” reported that 28 percent of ABC-certified orthotists were female and 18 percent of ABC-certified prosthetists were female—indicating some progress. However, it’s important to note that at the 2016 O&P Leadership Conference, fewer than 15 percent of the approximately 150 attendees were women. As women are entering the field at a palpable rate, there is a missing trajectory in leadership. What is lacking is an answer to the question of why there are not more women in O&P leadership roles. We may be able to look to other professions for some helpful information: One study found that 62 percent of women left the field of engineering due to factors including lack of mentors, work environments, family, and the glass ceiling. This also is a recognized trend with architects, veterinarians, lawyers, and accountants. What would you guess our numbers to be? I would be remiss if I didn’t also mention the lack of all diversity within our profession. One needs only to attend any committee, school, conference, or program within O&P to confirm this. The 2017 AOPA World Congress will be an exciting opportunity for sharing experiences and perspectives of our diverse partners from around the world. I would never claim to be an expert in the area of diversity and inclusion. But when asked, I willingly agreed to do my best to broach this very sensitive subject. You see, I am not making the news but merely reporting it. Our profession boasts some of the most compassionate individuals on this earth. We also are a collective group that takes action once we become aware that action is needed. My hope is that this column causes you to pause, take notice, and make a gesture toward a more diverse and inclusive O&P profession. I then will have done my job.
Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.
Board of Directors OFFICERS President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL President-Elect Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Vice President Chris Nolan, LPO 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, CFm 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
Pam Lupo, CO, is a member of AOPA’s Board of Directors.
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MAY 2017 | O&P ALMANAC
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 495 8
800-796-
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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
No
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:
No
(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
Individual: Yes
No
4. If new venture, please explain your prior experience, how many years, and what position and field this experience is in: 5. Practitioner for Patient Care Certified by ABC or BOC? Yes 6. Any business conducted other than Orthotics & Prosthetics? Yes 7. Current Insurance Carrier:
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:
No
III. CLAIMS HISTORY 1. Have you had any losses in the past 3 years? Yes
No
(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
No
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, 786/252-1667, 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
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MAY 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!
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NUMBERS
New data from the U.S. Census Bureau indicates the rate of uninsured dropped significantly after the launch of the ACA marketplaces As the country prepares for a potential shift in U.S. health care with the possible repeal or replacement of the Affordable Care Act (ACA), we can take a look back at how the climate has changed since 2010, when the ACA was first enacted. Information on county-level data aggregated by the Congressional Budget Office shows that for the first three years under the ACA, the population of people living without coverage dropped slowly. But at the end of 2013—once the online insurance exchanges opened and Medicaid expanded— the number of uninsured dropped more dramatically.
DECREASE IN UNINSURED RATE
18.2
PERCENT
6.3
10.5
8.9
POINTS Uninsured rate in 2010.
Age until which young people may remain on parents’ health insurance.
Overall decrease in U.S. uninsured rate.
POINTS
PERCENT
Uninsured rate in 2013 (the year the insurance exchanges opened, in October).
26
COVERAGE AMONG THOSE WITH LOW INCOMES SINCE 2013
16.6
PERCENT
ACA RULES AFFECTING COVERAGE
Uninsured rate in 2015.
12
POINTS
Decrease in uninsured rate among those below the federal poverty level. Decrease in uninsured rate among those with incomes between 100 and 200 percent of the federal poverty level.
STATE MEDICAID EXPANSION STATUS AS OF DEC. 31, 2015
DC
State Medicaid expansion status Expansion Nonexpansion
SOURCE: Centers for Medicare and Medicaid Services, 2015.
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MAY 2017 | O&P ALMANAC
31
Number of states (and the District of Columbia) that have expanded Medicaid under ACA.
DECREASES AT COUNTY LEVEL BETWEEN 2014 AND 2015
2,239 Number of U.S. counties in which the uninsured rate for those under 65 decreased (71 percent of all U.S. counties).
1,729 Number of U.S. counties in which the uninsured rate decreased among adults ages 18 to 64 living at or below 138 percent of the poverty level (55 percent of all U.S. counties).
1,785 Number of U.S. counties in which the uninsured rate among working-age adult males was higher than for females (57 percent of all U.S. counties).
SOURCES: “Small Area Health Insurance Estimates: 2015,” U.S. Department of Commerce, Economics, and Statistics Administration, U.S. Census Bureau; “Maps Show a Dramatic Rise in Health Insurance Coverage Under ACA,” NPR.
Millions More Insured Since ACA’s Inception
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Happenings RESEARCH ROUNDUP
Study Reports Benefits for Injured Soldiers Who Have Early Amputations likelihood for wound complications, osteomyelitis, and musculoskeletal disorders. Although the study did not examine why the outcomes were different among the groups, Melcer said he believes that favorable outcomes for those troops with early amputation can be partially attributed to the fact that they went through rehab with many of their comrades. “Early aggressive rehab promotes their psychological wellbeing as opposed to the other group, which go through limb salvage or wait for amputation,” said Melcer. “They have to go through many surgeries. Their outcome is uncertain. And there is a lot of trauma going through multiple surgeries.” The researchers also found that while those with early amputation reported a lower rate of psychological issues, both groups had a high level of PTSD—which did not manifest itself until one year post-trauma. The data aggregated in this study, which was published in the January 2017 edition of PLOS ONE, will be included in the Wounded Warrior Recovery Project.
PHOTO: Getty Images/Geber86
The Naval Health Research Center and the Veterans Administration Hospital in La Jolla, California, have collaborated on a long-term study of wartime amputees to investigate the differences in health outcomes between combat-injured patients treated with early amputation (within 90 days after injury) and those who have later amputations and limb-salvage procedures. The researchers found that early amputation in service members with severe lower-extremity injuries is generally associated with lower or similar prevalence for physical and psychological disorders than those treated with late amputation or limb salvage. Research psychologist Ted Melcer, PhD, led a review of the medical records of 625 troops with severe lower-limb injuries that occurred between 2001 and 2008 during the conflicts in Iraq and Afghanistan. He found that service members who had early amputations sustained lower rates of post-traumatic stress disorder (PTSD) and lower rates of infection than the other group. Early amputation also was associated with reduced
Osseointegration Patients May Hear Through Vibrations in Implants
Driving is an example of when the patients benefit from osseoperception. Hearing via the limb implant and touch sensations are important parts of osseoperception.
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MAY 2017 | O&P ALMANAC
osseoperception for patients with artificial limbs fixated into their skeletons,” said lead researcher Max Ortiz Catalan, PhD, head of the Biomechatronics and Neurorehabilitation Laboratory at Chalmers. “In practice, the stimuli received by the patients are perceived more strongly and carry more information because they are composed of two modalities: touch and hearing.” The researchers believe this discovery is an important step in understanding the osseoperception phenomenon and, more generally, the tactile and auditory perception of humans. “This discovery may offer a new starting point for implementing novel prostheses that provide enriched sensory feedback to the user,” said Ortiz Catalan.
PHOTO: Susanne Lindholm
An international group of researchers has found that people with a prosthesis attached directly to their skeleton can hear by means of vibrations in their implants. This “sound transmission through bones” is a key part of osseoperception, which is sensory awareness of the patient’s surroundings provided by the prosthesis. The researchers, who were from Scuola Superiore Sant’Anna in Italy and
Chalmers University of Technology, Sahlgrenska University Hospital, and the University of Gothenburg in Sweden, explained their discovery in a paper in April in Nature Scientific Reports. The researchers tested 12 patients with various degrees of amputation on their upper or lower extremities, and found the patients could perceive mechanical vibrations applied to their titanium implants, through hearing as well as touch. Patients also reported audible sound. According to the researchers, the subjects could perceive very small stimuli and react more quickly to them due to additional perception by hearing. “Until now, the consensus was that the sense of touch played the primary role in
HAPPENINGS
DIABETES DOWNLOAD
Diabetes Diagnoses Among Youths On the Rise
PHOTO: Getty Images/FatCamera
A new study published in the New England Journal of Medicine has found that the prevalence of Type 1 and Type 2 diabetes diagnoses among youths has increased in recent years. Led by Elizabeth J. Mayer-Davis, PhD, of the University of North Carolina—Chapel Hill, researchers studied cases and analyzed diabetes trends at five U.S. study centers. The research, titled “SEARCH for Diabetes in Youth,” surveyed data from 11,244 youth with Type 1 (ages 0-19) and 2,846 with Type 2 (ages 10-19) diabetes who were diagnosed with the disease between 2002 and 2012. The researchers concluded that the incidences of both Type 1 and Type 2 diabetes among youths in the United States increased significantly during the 2002-2012 time period, particularly among youths of minority racial and ethnic groups. The study identified an average of 1.8 percent increase each year in youth with newly diagnosed Type 1 diabetes, and an average of 4.8 percent per year increase of newly diagnosed Type 2 diabetes cases.
Jurisdiction D Releases Quarterly Audit Results for Spinal Orthoses “For both Type 1 and Type 2 diabetes, the increase in the rate of new cases diagnosed was higher for youth of minority race or ethnicity, compared to white youth,” said Mayer-Davis. Hispanic youth saw a rise of 4.2 percent per year of Type 1 diabetes cases compared to 1.2 percent per year for non-Hispanic white youth. These increases in incidence in diabetes rates among children suggest a growing disease burden that will not be shared equally, according to the researchers. The data suggest an increasingly urgent need to reduce race and ethnic disparities in access to the health care, education, and support to best care for youths with diabetes.
REGIONAL O&P
AOPA Submits Comments on Connecticut Medicaid Policy Changes AOPA has submitted comments on two recently announced Connecticut Medicaid policies. The proposed changes include the elimination of some L codes from the Connecticut Medicaid fee schedule due to lack of utilization, as well as a 10 percent reduction in the fee schedule for several custom-fitted or customfabricated orthosis codes from the Health-Care Common Procedure Coding System (HCPCS).
CODING CORNER
Of particular concern is a proposed reimbursement change that would result in a 40 percent reduction in Connecticut Medicaid reimbursement for cranial remolding orthoses, described by HCPCS code S1040. AOPA submitted comments on the March 30 deadline, and also submitted a letter signed by 73 AOPA members who practice in Connecticut plus supplier members. Read AOPA’s comments at AOPAnet.org.
Noridian, the durable medical equipment Medicare administrative contractor for Jurisdiction D, has released the results of its ongoing service-specific review of spinal orthoses (codes L0450, L0452, L0454-L0458, L0460, L0462, L0464, L0466-L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490-L0492, L0621, L0623, L0625-L0643, and L0648-L0651). Between October 2016 and February 2017, Noridian reviewed 680 spinal orthosis claims, and 674 were denied. The results are as follows: • The thoracolumbosacral orthosis review had an overall claim potential improper payment rate of 97 percent. • The lumbosacral orthosis review had an overall claim potential improper payment rate of 100 percent. • The sacral orthosis review had an overall claim potential improper payment rate of 69 percent. • The lumbar orthosis review had an overall claim potential improper payment rate of 100 percent. Based on these results, Noridian will continue its prepayment reviews for the above codes. Complete audit results are available at noridianmedicare.com.
O&P ALMANAC | MAY 2017
11
HAPPENINGS
Presidential Papers To Be Sponsored by ABC at World Congress
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MAY 2017 | O&P ALMANAC
Amputee Runs With U.S. Flag During Marathon One of the most iconic moments of this year’s Boston Marathon, held April 17, occurred when Jose Luis Sanchez carried the U.S. flag across the finish line. Sanchez, a Marine who lost his left leg after stepping on an improvised explosive device in Afghanistan in 2011, chose to carry a large American flag inscribed with messages written in black marker during the race. The flag had been sent to him by his patrol unit as he recovered in the hospital after his amputation. He received an ovation as he crossed the finish line with a time of 5:46:13.
U.S. Sled Hockey Team Awarded Silver Medal The U.S. National Sled Hockey Team earned a Silver medal at the 2017 Para Sled Hockey World Championship in Gangneung, South Korea, in April. It is the third Silver medal in world championship play for Team USA, which finished the tournament with six wins and one loss. The Canadian team took Gold. Andy Yohe, who was part of Team USA during its 2010 and 2014 Gold-medal-winning competitions, was named U.S. Player of the Game.
THE LIGHTER SIDE
PHOTO: Seunghoon KO/POCOG
The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) will sponsor the 2017 World Congress’s Presidential Papers. The papers represent the top-10 clinical education submissions of original research that are backed by a full manuscript. The Presidential Papers will be published in a special supplement of the Journal of NeuroEngineering and Rehabilitation. ABC’s commitment and support will make this research available worldwide through the journal and accompanying search indexes such as Medline. ABC also will be an official partner of the 2017 AOPA World Congress. ABC joins the following organizations as World Congress partners: Orthotics and Prosthetics Association of India, the CharcotMarie-Tooth Association, the Amputee Coalition, ConFairMed, Mexico-National Member Society of International Society for Prosthetics and Orthotics (ISPO), Orthotics Prosthetics Canada, U.S. Member Society of ISPO, and Uniting Frontiers.
O&P ATHLETICS
PHOTO: Army National Guard photo by Staff Sgt. Steven C. Eaton
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PEOPLE & PLACES BUSINESSES ANNOUNCEMENTS AND TRANSITIONS
CORRECTIONS
Össur has announced its third #MyWinningMoment contest, in which people with limb loss are invited to share their stories via the www.mywinningmoment.com website. The contest began April 18 and will run through June 30, 2017. Entrants have a chance to win a four-day, three-night trip to Reykjavik, Iceland. Throughout the contest, Össur will showcase entries on the contest website and via its social media channels. The contest winner will be announced in July.
March 2017 In the Businesses section of “People & Places” in the March 2017 issue of the O&P Almanac, the wrong photo accompanied the text detailing Ottobock’s acquisition of BeBionic prosthetic products and related business. The O&P Almanac regrets the error. Below is the information with the correct photo in place:
Paceline Inc. and Orthomerica Products Inc. have announced that Paceline has acquired Orthomerica’s Seal PVA business, effective March 29, 2017. “Orthotic and prosthetic customers of the Seal PVA will experience very minimal changes because of this acquisition,” said David Glontz, director of sales for Paceline. “Seal PVA item numbers will remain in place, and production of the Seal PVA will continue at its current location. The only change effective immediately is that all new orders will now come from Paceline.” WillowWood has announced that it has achieved ISO 13485:2003 certification. The company, certified by NSF International Strategic Registrations, met all requirements for having a comprehensive quality management system specifically for the design and manufacturing of medical devices. The certification denotes that the company's products meet international standards for quality, safety, and efficiency. The Winkley Company, founded in 1888, has been purchased from its fourth-generation owner, Gregory S. Gruman, CP, by his children, the fifth generation. Alexander P. Gruman, CO, president, and Amalia T. Gruman Laird, CP, vice president, took over the business effective Jan. 1, 2017. Winkley is more than 129 years old, and its corporate headquarters and all Minnesota fabrication facilities Left, Alexander P. Gruman, CO, and are located in Golden Valley, with Amalia T. Gruman Laird, CP clinical offices in Minneapolis, Coon Rapids, Cambridge, Red Wing, and Woodbury, Minnesota. Wisconsin locations include Eau Claire and Rice Lake.
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MAY 2017 | O&P ALMANAC
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.
James Sliwa, DO
April 2017 In the “Role Model” article in the April 2017 issue of the O&P Almanac, the name of the chief medical officer and senior vice president of affairs at the Shirley Ryan AbilityLab was misspelled. The correct spelling is James Sliwa, DO. The O&P Almanac regrets the error.
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REIMBURSEMENT PAGE
By JOE MCTERNAN
Prior Authorization and Competitive Bidding Recent activities offer insight into how these programs may impact the provision of O&P services Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.
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MAY 2017 | O&P ALMANAC
WO ISSUES THAT CONTINUE to
generate significant “buzz” within the O&P community are Medicare prior authorization and competitive bidding. While neither of these issues has, to date, impacted O&P directly, both programs have been authorized to include O&P services in their scope. This month’s Reimbursement Page provides an update on what we can expect in the future regarding prior authorization and competitive bidding.
Prior Authorization
Prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies was authorized by a final rule published on Dec. 30, 2015. The final rule established the basic procedures that would be followed when implementing prior authorization and created a “master list” of Health-Care Common Procedure Coding System (HCPCS) codes that were eligible for inclusion in a Medicare prior authorization program. Of the 135 HCPCS codes on the master list, 84 codes describe lower-limb prostheses.
The final rule indicated that implementation of Medicare prior authorization would occur in phases, beginning with a limited implementation of codes from the master list in limited geographic areas. CMS followed through on this concept when, on Dec. 21, 2016, it announced that the initial implementation of prior authorization would only involve two HCPCS codes (K0856 and K0861), both of which describe power wheelchairs. In addition to limiting the initial implementation to two codes, CMS announced that prior authorization would initially be implemented in one state in each durable medical equipment Medicare administrative contractor (DME MAC) jurisdiction, followed by a jurisdiction-wide implementation at a later date. The limited implementation of prior authorization in one state in each DME MAC jurisdiction began on March 20, 2017. The prior authorization program for K0856 and K0681 will be expanded nationwide in July of 2017. AOPA staff recently took part in a CMS Open Door Forum conference call, during which the status of the prior authorization implementation was discussed. While this session understandably focused on the two power wheelchair codes currently subject to prior authorization, it was a useful source of information regarding how the prior authorization process is working as well as common reasons for nonaffirmation decisions. In general, the most common reasons for nonaffirmation decisions are missing or incomplete documentation, mostly for technical reasons such as invalid proof of delivery or invalid written orders.
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According to CMS representatives on the Open Door Forum call, relatively few nonaffirmation decisions were based on missing medical necessity information. While the CMS representatives did not discuss any potential products or service categories under consideration for future prior authorization, it did provide valuable insight into what is working well under the limited prior authorization implementation to date.
Implementation of prior authorization for the 84 HCPCS codes on the master list does not appear to be imminent, but it is expected that prior authorization will become reality at some point in the future.
The debate on whether prior authorization will be good or bad for O&P continues. On one hand, the prospect of receiving a preliminary coverage decision prior to delivering a service is attractive as it provides relatively reliable guidance on coverage before the service is actually delivered. On the other hand, questions about unnecessary delays in providing medically necessary care remain a major concern with prior authorization, especially when it comes to lower-limb prostheses. Implementation of prior authorization for the 84 HCPCS codes on the master list does not appear to be imminent, but it is expected that prior authorization will become reality at some point in the future. AOPA remains hopeful that CMS and the DME MACs will use the limited implementation of Medicare prior
authorization to identify weaknesses in the implementation process that will be resolved before lower-limb prostheses become part of the equation.
Competitive Bidding
Prior authorization appears to be an eventuality, with the question more about when rather than if it will be implemented for lower-limb prostheses. For competitive bidding, which by statute is limited only to off-the-shelf (OTS) orthoses, the future is considerably murkier. When CMS created and released a series of “split” code pairs where the same device is coded according to whether it was custom-fitted by an individual with appropriate education and training or whether it was delivered as an OTS device, competitive bidding for OTS orthoses appeared to be inevitable. Despite signs leading to competitive bidding for OTS orthoses, CMS has yet to include these orthoses in the list of items subject to competitive bidding. Currently, CMS has defined the items subject to competitive bidding through 2019 and has yet to include OTS orthoses in the list of competitively bid services. While the product list for competitive bidding 2019, which is slated to run through 2021, was announced without reference to OTS orthoses, this program has been placed on hold pending review of the competitive bidding program in general by the current administration. While competitive bidding remains a possibility in the future, it appears that CMS is not in any rush to include OTS orthoses in a future competitive bidding process. This remains subject to change, but the fact that OTS orthoses have not been identified as a product category for inclusion in competitive bidding is a positive development for O&P providers. Other providers who have been involved in the competitive bidding program to date have complained that competitive bidding ultimately reduces beneficiary access to care due to relatively low numbers of providers who bid on the services in question, who may or may not be able to serve the full Medicare population within a given geographical area.
While competitive bidding remains a possibility in the future, it appears that CMS is not in any rush to include OTS orthoses in a future competitive bidding process.
Getting Ready
While neither prior authorization nor competitive bidding appears to be an immediate reality, now is the perfect time to prepare for their eventuality. Simple steps—for example, improving your documentationgathering techniques—will help you be prepared when prior authorization becomes a reality for O&P providers. Prior authorization should have a minimal impact on your business if you prepare for it properly. Competitive bidding, on the other hand, may significantly impact how you do business and how certain devices are fit and delivered. While the prospects for prior authorization are currently much higher than for competitive bidding, both programs remain a possibility within the Medicare program. The key to future success is preparation. Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:
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O&P ALMANAC | MAY 2017
17
This Just In
AOPA Meets With New CMS Team
AOPA leaders discuss O&P imperatives at an April meeting with HHS and CMS officials
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ITH A NEW ADMINISTRATION
in office, communicating the value of O&P intervention and the important work of AOPA members is a priority for AOPA. Shortly after the 2017 nominations and confirmations of key health-care positions, AOPA began setting the stage for an early meeting with the new officials. Fortunately, the new administrative team includes some congressional contacts AOPA has worked with over the years on issues such as audits by the recovery audit contractors; HR 1530, the Medicare Orthotics and Prosthetics Improvement Act; and other critical issues affecting O&P patient care. These connections helped facilitate the scheduling of a meeting on April 27. In attendance were John Brooks, JD, counselor to the HHS secretary on Medicare; Amanda Street, policy advisor; and several key AOPA leaders, including AOPA President Michael Oros, CPO, FAAOP; AOPA Executive Director Tom Fise, JD; AOPA President-Elect James Weber, MBA; Scott Schneider; AOPA lobbyists Michael Park and Stephanie Kennan;
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and Peter Thomas, JD, counsel to the O&P Alliance. The meeting provided an opportunity for AOPA to brief key health-care administrators on the full range of issues facing orthotics, prosthetics, and pedorthics providers and their patients. The agenda focused on top concerns as well as activities and solutions that AOPA believes can help achieve better outcomes for patients and deliver economic benefits for Medicare. Foremost among the roughly 10 topics on the agenda were the following: 1. Recognizing the prosthetist’s/ orthotist’s notes as a legitimate part of the medical record; 2. Enacting the Medicare O&P Improvement Act; 3. Finalizing long-awaited proposed regulations on qualified providers under Section 427 of the Benefit Improvement and Protection Act; and
4. Dropping the July 2015 proposed revisions to the prosthetic lower-extremity Local Coverage Determination (LCD). AOPA also called attention to the July 2014 CMS-proposed rule that stretched the definition of “minimal self-adjustment” on off-the-shelf (OTS) orthotic devices to include the ability of caregivers or suppliers to make adjustments. That expansive definition is clearly illegal as the statute’s definition limits OTS items eligible for competitive bidding to those devices made usable solely by the patient’s adjustments. The broader definition also resulted in numerous custom orthotic devices being inappropriately classified as eligible off-the-shelf devices, which poses a risk to patients. It was helpful to point out that when Price served as a member of Congress, he had introduced legislation clarifying the definition of “minimal self-adjustment” as including only those adjustments made by the patient and not by a third party. Before serving in Congress, Price was an orthopedic surgeon; he ran an
This Just In
Issues discussed with HHS Staff orthopedic clinic in Atlanta, served as assistant professor of orthopedic surgery at Emory University, and served as director of the orthopedic clinic at Grady Memorial Hospital. The AOPA participants also discussed the need for formal separation of O&P from durable medical equipment. As to the flawed July 2015 LCD, AOPA pointed out that even though the proposal was suspended pending further study, private payors have adopted some of the restrictive provisions in denying patients appropriate care. The meeting also provided an opportunity for AOPA to brief the HHS and CMS officials on the RAND Corporation’s research efforts that are providing more evidence of the ability of timely O&P intervention to deliver payor savings, and to present the economic value of prosthetic care study expected to result in a 10-year simulation model of all costs and benefits flowing from O&P care, such as how technologically advanced prostheses reduce falls and deaths. Some of the data used in the RAND study resulted from the earlier Dobson-DaVanzo cost-effectiveness study that demonstrated the actual savings of appropriate O&P care of Medicare beneficiaries as compared with a matched cohort with the same diagnosis as Medicare beneficiaries who did not receive O&P care. During the meeting, the AOPA leaders also discussed the progress being made in establishing a prosthetic patient registry, in collaboration with the American Joint Replacement Registry, to provide critical outcomes data on O&P patients. All in all, the April meeting served as a productive first step in communicating the positions of AOPA members to the new administration. Future meetings and communications will build on this initial meeting and set the stage for relations over the next four years. To view the full agenda and briefing paper, visit bit.ly/hhsbrief.
• The “Dear Physician” letter from August 2011, which asserted that the prosthetist/orthotist notes are NOT a legitimate part of the Medicare patient record, led to rampant audits and the Administrative Law Judge backlog. • “Minimal Self-Adjustment”—CMS’s expanded definition has resulted in numerous orthotic devices being inappropriately classified as off-the-shelf, and at risk for competitive bidding. • The 2015 Draft LCD for Lower Limb Prostheses and Study by Interagency Task Force that would have denied amputees access to advanced prosthetic care. The Interagency Task Force convened in October 2015 to study the issue, but without private input. • BIPA 427 Proposed Regulations which instructed CMS to assure that Medicare only pays providers with appropriate credentials. No regulation was issued until January 2017. • The Medicare Orthotics and Prosthetics Improvements Act introduced in 2016 would establish several common sense measures, including legitimatizing the orthotist/prosthetist notes as part of the medical record, and enforcing BIPA 427 regulations. • Cost-Effectiveness Data from Dobson-DaVanzo that proved that timely orthotic and prosthetic care save lives and money, whereas untreated patients have greater co-morbidities and higher costs. • RAND Corporation Study on Comprehensive Economic Value of Prosthetic Care—a comprehensive, independent study to establish the comprehensive economic value proposition for prosthetic services to amputees. • Prosthetic Patient Registry—AOPA has developed a working model and partnership with the American Joint Replacement Registry that will permit all patients and payers to know patient outcomes and integrate it into patient care decisions. • Prior Authorization & Competitive Bidding would almost certainly delay access to care and reduce range of options and sources/patient access to care. • Labor/HHS Appropriations Language—How to Encourage Technological Advancement—“Innovation in Prosthetic Technology and Access to Prosthetic Care.”
O&P ALMANAC | MAY 2017
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COVER STORY
Conditional
COVERAGE
A LOOK AT HOW THE ACA HAS AFFECTED THE PROVISION OF O&P SERVICES AND HOW THE U.S. HEALTH-CARE CLIMATE MAY CHANGE WITH REPEAL-AND-REPLACE LEGISLATION By CHRISTINE UMBRELL
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COVER STORY
NEED TO KNOW • The implementation of the Affordable Care Act (ACA) seven years ago has led to 20 million more people gaining health-care coverage through new insurance markets and expanded Medicaid programs. • While increasing numbers of Americans have become health-care consumers, some O&P providers have experienced difficulties in the wake of management and operations changes for the expanded Medicaid programs and other reimbursement-related challenges. • As the new administration and Republican-controlled Congress debate how to repeal and replace the ACA, O&P professionals are bracing for more insurance-related changes. • Most O&P stakeholders are hoping that the ACA's Essential Health Benefits (EHBs) will continue to be covered under any new legislation because prostheses and orthoses are included in the “rehabilitative and habilitative services and devices” provision of the EHBs. • It is possible that responsibility and oversight of insurance programs will be pushed to the states under new legislation, which could lead to fragmentation and differences in benefit coverages. • For now, O&P professionals are taking a wait-and-see approach and will continue to focus on optimal patient outcomes in a nation that is trending toward a value-based health-care model.
U
NCERTAINTY IS THE BEST WORD
PHOTO: Getty Images?Alphaspirit
new products and services to wait and see what will happen. We went to describe the current climate through a significant health-care envisurrounding U.S. health insurance. With the new administration and ronment change in 2010/2011, with the much of the Republican-controlled advent of the ACA, and we are faced Congress committed to repealing and with a potential about-face.” replacing the Affordable To understand how changes Care Act (ACA), neither to the ACA may impact health health-care providers nor care in general and O&P in consumers know what the particular, it’s helpful to look coming months and years back over the past few years will bring if the ACA is to review how the implemenreplaced, or even amended. Rebecca Hast tation of President Barack “The backdrop for the Obama’s signature health-care health-care environment right now is law has affected the O&P health-care a lot of concern and confusion,” says environment and consider how Rebecca Hast, Hanger senior vice pres- proposed changes to the U.S. health insurance laws could affect the proviident and chief compliance officer. “A lot of health-care entities are delaying sion of O&P services.
Late Breaking News
On May 4, the House of Representatives voted to enact the American Health Care Act, the initial legislative step in a process intended to eliminate major portions of the Affordable Care Act. According to AOPA analysis, the May 4 iteration of the legislation featured significant revisions to the original version. The MacArthur Amendment establishes a permissible state waiver, allowing states to increase the age rating ratio above the 5:1 ratio; specify the Essential Health Benefits that are required to be covered; and implement a health status rating for states operating a risk mitigation program or participating in a Federal Invisible Risk-Sharing Program. The Upton Amendment provides an additional $8 billion over five years to offset or reduce premiums or other out-of-pocket costs for certain individuals with pre-existing conditions. The bill has not gone to the Senate as of press time. AOPA and the O&P Almanac will provide additional information as it becomes available.
O&P ALMANAC | MAY 2017
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COVER STORY
Impact of ACA Enactment
The implementation of the ACA altered the U.S. health insurance climate in several ways. Some of the biggest changes include the following:
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PHOTO: Getty Images/Jirask
• It insured more Americans through new insurance markets. Roughly 20 million more people gained health-care coverage between 2010 and 2016, according to the U.S. Department of Health and Human Services, many of whom purchased insurance from online markets. Some Americans with lower incomes received subsidies to help pay their premiums and deductibles. • It insured more Americans by expanding Medicaid. The law provided federal funds for states to offer Medicaid coverage to low-income individuals. Thirty-one states, plus the District of Columbia, have expanded their Medicaid programs under the ACA, according to the U.S. Census Bureau. • It established protections for consumers of health insurance. The ACA featured guidelines to prevent insurance companies from denying coverage or charging a higher price to someone with a pre-existing condition, and it required insurers to allow adult children to remain on their
parents’ insurance until the age of 26, among other protections. It also required health plans to cover Essential Health Benefits (EHBs), including “rehabilitative and habilitative services”—which AOPA has called “a fairly explicit assurance for O&P care.” • It made health insurance a requirement for individuals, and it required large companies to offer it to their employees. These requirements were put in place to ensure enough healthy people purchased insurance. • It raised taxes related to high incomes, prescription drugs, and medical devices. These higher taxes were deemed necessary to help pay for the law’s coverage expansion. (See the “Summary of the Affordable Care Act” at www.kff.org for details.) • It made major reforms to Medicare payments. The ACA decreased the annual pay raises Medicare gives hospitals as well as the fees Medicare pays private insurers. It also created new incentives for doctors and hospitals to improve quality, and created a special office to run experiments in how Medicare pays doctors and hospitals for health-care services. (See the “Summary of the Affordable Care Act” at www.kff.org for details.)
All of these changes have had a significant impact on the state of U.S. health care. Looking specifically at O&P, perhaps the biggest effect has been a rise in the insured due to the ACA’s expansion of Medicaid programs, says Michael Lovdal, PhD, a noted health-care futurist who has spoken at AOPA’s Leadership Conferences. “The ACA has added a lot of people to insurance,” he says, and, while the influx of insured Michael Lovdal, PhD to the individual market is notable, “the impact on Medicaid has been very big.” (See Numbers on page 8 for specific data about the increase of individuals with Medicaid coverage.) For patients needing orthotic or prosthetic care, increased access to health coverage has been a positive outcome of the act. One of the biggest impacts of the ACA has been “coverage for people with pre-existing conditions—which affects many O&P patients,” says Hast, adding that O&P clinicians are generally seeing an uptick in patients from exchange plans and expanded Medicaid plans. In many of the 31 states that experienced Medicaid expansions, a significant portion of the population gained health insurance coverage. For example, in Illinois, “500,000 people picked up insurance” after the expansion went into effect, says Michael Oros, CPO, FAAOP, president of Scheck & Siress O&P and president of AOPA. “From a patient-base perspective, even in a state like Illinois—which was always a state with a significant Medicaid population—more people were brought in” Michael Oros, to coverage under CPO, FAAOP the ACA, he says. But expanding Medicaid programs also has led to some challenges in how the programs are being
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COVER STORY
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proliferation of new plans has led to insurance verification issues. Some practitioners feel the Medicare rules have had a negative impact on O&P providers. Drygas says the implementation of the ACA has resulted in regulators “aggressively bringing forward the rules” regarding physician notes that led to increased audits and reimbursement challenges for certified orthotists and prosthetists. Unfortunately, even with increased paperwork requirements, many physicians have failed to provide the proper documentation for the prescriptions they write, says Drygas, but the delayed reimbursements are felt by the O&P clinicians, not the physicians. “This delay in paperwork affects patient care, and the doctors are not held responsible or accountable for weak notes. It feels like Medicare is using O&P to educate the doctors,” he says. In general, while coverage may have expanded for O&P patients, Oros says that, for providers, “payments may have gotten worse. It has set up hardships for providers in getting paid by new payors, as well as delays in authorization.” Even in this more challenging reimbursement climate,
O&P clinicians are adjusting to the more stringent requirements and are continuing to provide their services to ensure patients achieve optimal outcomes.
Repeal and/or Replacement
Now that O&P clinicians are adapting to the changes brought about by the ACA, more changes are in the works. Promises by President Donald Trump and the Republican-controlled Congress to repeal and replace the Affordable Care Act have left many O&P professionals wondering how the impending changes will affect healthcare coverage in general, and O&P care in particular. In March, Republicans put forward the American Health Care Act (AHCA). The legislation, which was eventually pulled before a vote came to pass, would have repealed the penalties associated with the individual and employer mandates retroactively to 2016; allowed insurance companies to impose a 30 percent late-enrollment surcharge on applicants who had a lapse in coverage of more than 63 days; phased out the ACA’s Medicaid expansion and transitioned the program to a per capita cap model; and eliminated a number of ACA taxes, according to analysis by Alston & Bird.
PHOTO: Getty Images/Fotografixx
administered, says Oros. “In Illinois, the state outsourced some of the claims processing,” and some of the managed care organizations responsible for the administration “were not fully prepared to do the job effectively,” he says. Ted Drygas, CPO, FAAOP, who owns Care Crafters Prosthetics & Orthotics in Nanuet, New York, Ted Drygas, CPO, says the expanFAAOP sion of Medicaid brought about by the ACA has been a challenge for many practitioners in states where Medicaid reimbursements are insufficient. “We have lots of Medicaid patients, but most of those patients have been pushed into Medicaid health-maintenance organizations, which discount the pre-1987 fee schedule here in New York,” he says. In addition, “Medicaid no longer picks up the 20 percent balance after Medicare.” Hast says that while there has not been a direct pathway that indicates the ACA has affected O&P reimbursement, money was diverted from Medicare and other sources to fund the ACA. As a result, payors apply more scrutiny to provider invoices and are more stringent regarding documentation and medical necessity. “For the past five years, there has been a decline in what payors consider as ‘reasonable’ reimbursement,” she says. Jim Weber, chief executive officer of Prosthetic & Orthotic Care Inc. in St. Louis, Missouri, and AOPA president-elect, also points to a more challenging reimbursement environment. “It began with audits of providers,” he says, adding that the “overall pressure Jim Weber from Medicare on the durable medical equipment Medicare administrative contractors that pay our bills” has led to increased auditing of O&P claims. “There have been significant costs on the administrative staff as the government looks to recoup money on claims,” Weber says. He also notes that, from an administration standpoint, the
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COVER STORY
PHOTO: Getty Images/Mark Wilson
U.S. President Donald Trump speaks to participants in Women in Health Care panel hosted by CMS head Seema Verma, right, in the Roosevelt Room at the White House March 22, 2017, in Washington, DC.
While the AHCA never came to perhaps many, of our patients and a vote, some of the provisions in the would likely have been detrimental proposed legislation—and some of the for O&P…. This action, coupled with last-minute changes to the bill—were the bill’s plan to change the federal troubling to O&P-related organizaMedicaid matching funds provided to the states, could have been expected to tions. On March 24, the Amputee prompt a renewal of more state efforts Coalition sent out an e-blast urging to slice Medicaid, similar to Arizona O&P stakeholders to contact their a few years back dictating legislators, noting that the ‘no microprocessors, and no “last-minute changes raise orthotic coverage for anyone concerns.” Reports on the over 18.’ When Medicaid was eleventh-hour negotiations enacted decades ago, the law noted that protections did not articulate an explicit around the Essential Health assurance of an O&P benefit Benefits included in the Dan Ignaszewski for these patients... the ACA’s ACA would be eliminated. ‘essential health benefits’ did serve “This means regressing to prosthetic as a fairly explicit assurance for O&P coverage that includes arbitrary caps care, which largely blocked such state and restrictions because prosthetic Medicaid O&P cutback efforts.” devices are covered under the ‘rehaAOPA’s statement also noted that bilitative and habilitative services the proposed AHCA would have and devices’ provision of the EHBs, authorized the sale of health insurwhich bars such restrictions,” said Dan Ignaszewski, director of government ance policies across state lines, which relations, in the blast. could have negative repercussions for AOPA released its own statement O&P patients. It “would have resulted regarding the AHCA on March 27, in requiring ‘falling back’ largely on after the vote had been cancelled, what protections are offered via statebringing attention to the last-minute by-state parity law protections. The amendment that would have resulted much-discussed selling of insurance in repeal of the EHBs. The statement across state lines would also have an said “there is a general consensus that important impact, as it would create this action would have posed potena ‘least common denominator’ effect,” according to AOPA. tially significant challenges for some, 26
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What Comes Next
Several members of Congress and President Trump continue to present and discuss options for repealing and replacing the ACA. When the legislation might pass or exactly what it may entail is yet to be determined. Lovdal believes that repeal-and-replace legislation is bound to “push much more back to the states,” likely via block grants or per capita payments. A movement toward state ownership of Medicaid patients will be significant because “70 million Americans are on Medicaid,” says Lovdal. This could create a more fragmented system, he predicts—and, if states are allowed to define EHBs, that could have an impact on O&P. Oros notes that “serious challenges” may be created if there is a movement toward a block grant model of funding for state Medicaid programs. This is especially true “if you’re practicing in a state that is currently in some sort of fiscal crisis,” he says. Weber and Hast also are concerned about some of the changes that have been proposed regarding repealand-replace legislation. “If there are changes in Medicaid, then the battles will be much more local,” says Weber. If Medicaid is funded through block grants, “it could mean the states
COVER STORY
will be more stringent in their benefit coverage,” says Hast. Weber also says that it was a significant achievement that EHBs were included in the ACA in 2010, and he hopes those will remain in place. “Since O&P is such a small percentage of the overall health-care spend, it can be hard to present enough voice and noise” to ensure O&P patients’ needs are met. Thus, the EHB guarantee is an important protection for O&P consumers. Hast agrees that changes to requirements surrounding the EHBs could be problematic for O&P providers and patients. “People understand coverage for kids up to age 26 and coverage of pre-existing conditions, but, when it comes to EHBs, there are some people in Congress who may not understand how far-reaching that could be, particularly if the definition of ‘habilitative and rehabilitative’ benefits are removed or diminished,” she says. “Prior to EHB, our industry was in the throes of the ‘parity’ discussions
with states,” Hast continues. “If EHB radically changes or disappears from new legislation, we may need to revive those discussions.” In addition, she has some concern about how “the number of uninsured will escalate” if the individual coverage mandate is lifted and commercial carriers flee the market. “That could mean an escalation of people who have no coverage,” she says. Oros has a wish list of how he would like to see O&P treated when ACA reform takes place. “I would love to see the orthotist/prosthetist recognized as a health-care provider and not a supplier,” he says. “Then the value of our services, beyond just providing the device, would be recognized.” He also would like to see health-care plans recognize O&P providers as clinicians offering a custom service and treatment plan for an EHB. He notes that if the long-term value of O&P care were recognized at the federal level, then state and commercial plans would follow.
Looking at the bigger picture, the current transition in the U.S. healthcare arena to a more value-based system will eventually have an impact on O&P providers, according to Hast. “O&P reimbursement will eventually be impacted by the value-based reimbursement,” she says. “Value in all aspects of care delivery will remain at the forefront of emerging themes of clinical care. We need to be able to prove our value and raise awareness of the EHBs.” At this point in time, the only certainty regarding the U.S. health insurance climate is that change is coming. Regardless of which regulations are in place dictating who and what must be covered, O&P professionals will continue to do their jobs and provide value by helping patients achieve an improved quality of life. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.
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ByCOVER LIA K. DANGELICO STORY
O&P professionals are taking advantage of opportunities to share insights about prosthetics and orthotics with students in high schools and middle schools NEED TO KNOW • As U.S. high schools and middle schools expand programming related to science, technology, engineering, and mathematics, more O&P professionals are engaging in outreach efforts to explain the profession and mentor students in O&P-related projects. • When younger generations actively engage with and learn from O&P professionals, they gain real-world knowledge they can apply to their careers and lives, and O&P businesses secure greater visibility and awareness of the value of orthotic and prosthetic intervention. • O&P professionals who visit schools or allow students to visit their facilities develop a deeper understanding of the pediatric patient base, and become better equipped to improve branding and messaging efforts to attract young people to both their businesses and the O&P profession. • When speaking with students, O&P stakeholders should tailor their presentations to the age group—but recognize that today’s students may have “done their homework” via online O&P research and could have a long list of technical questions.
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W
HEN ELLIOT WEINTROB, CPO,
PHOTO: Curbell Plastics
visited his children’s high school to make a “Career Day” presentation on his work at Orthotic Prosthetic Center in Fairfax, Virginia, his 15-yearold and 17-year-old told him not to expect a big crowd. So, he was pleasantly surprised when he arrived at the “Slices of Science”-themed event and was met with a packed auditorium of 50 or more students. The presentation was standing room only, with teachers crowded into the mix. It even ran overtime, with students asking questions and wanting to know more. “My kids were blown away,” he says. “But, you start walking into a high school, and you’re holding a microprocessor knee, a running leg, and it is like a forest fire. Kids see it, and instantly they don’t care about the pizza anymore. They Members of the Engineering Design and Development Capstone Prosthetics team really wanted to come to this.” at Wilson High School in West Lawn, Pennsylvania Weintrob’s experience is becoming increasingly common among O&P worked with a group of high that many had friends or professionals. Interest in O&P at the school seniors at the Science, family who used prosthetic middle and high school levels has Technology, Engineering, and and orthotic devices. “They grown over recent years, with facilMath (STEM) Program at care, and caring about the Wilson High School in West patient, helping someone ities seeing a surge in requests from Lawn, Pennsylvania, who were improve their life, is what I students and educators to engage tasked with solving a common think draws them in,” he says. and interact with practitioners and problem in society as part of Experiences like this one manufacturers. In collaborating with their capstone project. also help students practice students before they reach college, Jeff Wilson The students decided to taking risks, develop probmany O&P facilities have found that create a prosthetic device this hands-on profession is resonating lem-solving skills, and learn with today’s young people. While these that was both affordable and comfortto persevere, says Ryan Dennes, the interactions are designed to technology and engineering teacher able for users. As the group benefit the students, they who oversaw the Wilson High contemplated which matealso are advantageous to School students’ capstone project. rials to use, they approached O&P professionals, who are Curbell for guidance. While playing an important role Curbell doesn’t have a formalWilson High School's in increasing awareness of ized O&P-themed student finished foot prosthesis, what’s possible with O&P and outreach program, Wilson and which was manufactured teaching the next generation his co-workers are ready and on a CNC milling machine the trends and technolowilling to engage when asked. Elliot Weintrob, from a solid block of acetal Wilson traveled to the school, gies that are shaping the CPO donated by Curbell Plastics where he gave the students a profession. quick overview of plastics—what he calls “Plastics 101”—and helped them Engaging the ‘Me’ Generation troubleshoot why other applications More than 90 percent of millennials and materials they had tried hadn’t say they like using their professional worked. He also provided the students skills to benefit a good cause, accordwith free samples they could use and ing to a recent study by Achieve guidance on how to machine them. Consulting. Jeff Wilson, business After getting to know the students development manager for Curbell and seeing their interest and passion Plastics, has found this to be true for the project, Wilson came to realize at his company. Wilson recently O&P ALMANAC | MAY 2017
29
information on those multiple levels. It really helps me understand my audience.” This applies not only to the lecture and sales circuits but also to patient interactions. Wilson also uses these student encounters to observe trends, both in material science and in technology, to confirm if he and the company are moving in the right direction. These days, students, just like potential patients or clients, are using the web to do the majority of their research before ever reaching out to a subject matter expert. “That helps us confirm, A Win-Win-Win especially working with the younger By working with younger generations, folks who are more electronically encouraging them to actively engage savvy than someone like myself, that with and learn from O&P professionals, we’re doing the right things” when everyone wins. Students obtain realdesigning their website and marketing world knowledge they can apply to strategies, he says. their careers and lives; the profession When Chris Mowrer, CPO, and businesses gain greater director of clinical and manuvisibility and talent; and communities become more facturing technologies for aware and inclusive places, Scheck & Siress, welcomed a without the stigma attached group of eighth graders to his to amputations, assistive facility for a field trip in late devices, and more. April, he was ready to learn, Through his experiences, too. The field trip was part Wilson says he has learned of the company’s support of Chris Mowrer, to teach and to clearly the John C. Dunham STEM CPO explain O&P to multiple Partnership School in Aurora, audiences. “I’ve given engineering Illinois. Mowrer, the STEM liaison seminars to everyone—from scienfor his company, also lectures for Joliet Junior College’s O&P technician tists and engineers that build aircraft, program and teaches prosthetics and to engineers that build processing biomedical engineering for freshman machinery, to students that don’t engineering at Benedictine University. know anything about plastics,” “It’s not like we’re hoping that half he says. “You’ve got to be able to these kids are going to be working for learn to communicate and relay the 30
MAY 2017 | O&P ALMANAC
PHOTO: Getty Images/DGLimages
“Students are inherently willing to think creatively and are driven to solve real-world problems,” he says. “Once empowered with skills, conceptual understandings, and abilities, students often look to help others and improve society. The O&P field presents an opportunity for students to push their abilities and to learn to create for the benefit of others.” And there are so many different ways to help others, especially in the prosthetic arena, that you don’t have to be a scientist or an engineer, says Weintrob. With O&P, “the reality is you can see a direct and rapid change in a person’s life, and kids in this day and age want instant gratification. When they see someone go from wheelchair to walking or running, that’s pretty darn good.” As a direct result of his experience at the “Slices of Science” Career Day, Weintrob has decided to offer students a summer internship at his facility. The program will start this year and will expose students to all aspects of O&P care. “We are not going to pigeonhole them in any way,” he says. “We want them to see everything.”
us someday. But, really, as much as they’re gaining from us, I think we’re almost gaining just as much back from them,” Mowrer says. He believes that if he can begin to understand middle schoolers’ perceptions of O&P, perhaps he can help the company better tailor its branding and messaging to attract and educate more people on what O&P has to offer. “I think we’re seeing that a lot with the 3-D printing of upper-extremity hands … and I think that’s where we, as a field, really need to emphasize to people that this is a professional skill, an engineering skill,” he says. “This isn’t just something you can pick up overnight or on the weekend, and start making prostheses from your basement.” Eighth grade teacher Elizabeth Kaleta coordinated the visit with Mowrer as part of her class’s unit on robotics. The students, who had completed a prosthetics project the prior year, were able to observe the whole fabrication process from beginning to end, in addition to the clinical side of patient care. The students were enamored with the seven-axis robotic carver and CAD/CAM software, says Mowrer. The connectivity—that more technical roles in design, programming, coding, etc., are possible in the medical field—really opened their eyes, says Kaleta. These days, students have “a lot more exposure to seeing what will be involved in terms of selecting an actual field and then getting a better understanding of what that field looks like… Everything is so integrated now.”
Students work on a project at Dankmeyer Inc.
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MAY 2017 | O&P ALMANAC
Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com.
PHOTO: Dankmeyer Inc.
community. And the facility’s patients Dankmeyer Inc. is another O&P benefit as well. Often, staff will bring company that has evolved its student students into appointment rooms to outreach program. The Linthicum interact with and observe clinical care. Heights, Maryland, facility has “Many patients love to tell their story multiple offerings to accommodate and be able to share their a variety of interests and experience with someone learning levels. It offers who could be going into the both one-on-one and group field eventually or may be educational sessions as well as just developing something mentoring for students who that could be used for them have an interest in the field or one day,” says Bryl. “A lot of are in search of an intriguing our patients want the field to subject for a school project. grow as well and help others, For the past three years, Angie Angie Bryl, CPO so they see it as a way to help Bryl, CPO, Dankmeyer’s clinsomeone in the future.” ical director, has welcomed student interns as part of a local high school program. The interns shadow First Steps staff, receive hands-on training, and While many student outreach efforts learn general knowledge about O&P. are initiated by the schools or teachers, Additionally, the company partners O&P professionals should consider with a local elementary school that being proactive in these initiatives. annually tasks students with a 3-D Bryl says clinicians shouldn’t wait to printing project. While visiting the be approached. “If you’re not getting facility, the students get hands-on the knock on your door, just let people experience with its 3-D printer. know you’re there” and available to Throughout the school year, Bryl and meet with students or host field trips, her team also provide students with she suggests. donated devices. Once a connection has been made, These efforts benefit Dankmeyer Bryl says it’s imperative to get orgain many ways—from fresh ideas to nized. Decide what your staff can increased media exposure from local handle, how many students you can and national news outlets to ties to the accommodate, and what kind of
offering you want to take on. While you may want to start with simple Career Day or STEM program visits, you could decide to become more involved by hosting one- or two-hour field trips or developing a summer-long internship program. Then, make time where you have it. Mowrer finds that most teachers and administrators are flexible and willing to work with your schedule. At times, he has popped into a school in between appointments to give a 10or 15-minute presentation. He also recommends preparing age-appropriate remarks—but advises would-be presenters to recognize that today’s students come prepared. During a recent presentation to a fifth-grade class, Mowrer “was very impressed. They really understood a lot of [the basic science] already,” he says. When it came time for questions, one student asked for his opinion of the new DARPA arm—so don’t underestimate students’ thirst for knowledge, says Mowrer. A lot of information is already out there and readily available to them. Finally, keep an open mind and measure your expectations. “We can get stuck in our ways at times,” says Bryl, and students often bring fresh ideas. “Sometimes we’ll have a simple project that maybe we’re a little stuck on that we throw out to them, and they come up with stuff that we’ve never even thought of, just because we’re so set in our ways of thinking… They’re bringing other things that they learned from the classroom or from their experiences to our work.” Wilson admits that younger generations get “a bad rep” for having short attention spans or for wanting to be doing something different all the time. “Everybody thinks that because [of that] they can’t contribute, which is completely wrong,” says Wilson. “Give students a chance, and let them fail. Let them learn.” And be willing to let them move at their own pace—after all, they are the future.
OPA100 AOPA10 00AOPA 00 AOPA AOPA’s Centennial Commemorative Website
1917
WWW.AOPA100.ORG
1918
1935
The AOPA Centennial Commemorative Website is live! Explore www. AOPA100.org for 100 years of AOPA:
Learn about AOPA’s 100 year history
1946
Listen to AOPA member’s stories and share your own! Enjoy the interactive timeline Peruse the photo gallery
Dream about what’s NEXT—
Your Story is Our Story. YOUR CONNECTION TO EVERYTHING O&P
TELL YOUR STORY TODAY
1951
& NOW
THEN
We’ve Come a Long Way How developments in the O&P industry have impacted AOPA membership trends
O
NE HUNDRED YEARS AGO,
AOPA was incorporated as the Artificial Limb Manufacturers Association (ALMA). While the initial membership roster featured only 12 members, that number has grown exponentially—to more than 2,000 member locations today. The membership numbers throughout the past century serve as a reflection of more than just the increased number of O&P member companies; they also tell the story of the growth and consolidation of different types of O&P businesses throughout the years.
Historical Growth
By 1918—one year after the association’s initial incorporation—33 members gathered at the ALMA Annual Meeting. Membership growth was accelerated by the increased need for orthotic and prosthetic care due to injuries to U.S. service members in World War I. It was not until several decades later—during the 1970s—when membership in the association began its dramatic growth. The greatest increase in membership occurred between 1977 and 1983. Between 1975 and 1985, membership more than doubled. 34
MAY 2017 | O&P ALMANAC
AOPA Membership 1917-2017 2,500
MEMBERSHIP
2,000
NUMBER OF MEMBERS
Then & Now is a monthly department for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will feature a different AOPA product or service and discuss how it has evolved over the years. This month, we focus on trends in AOPA membership.
1946 Budget: $17,500 Dues: Three Tiers Based on Gross Sales— $25/$50/$100
1,500
1,000
500
2017 Budget: $5.8 million Dues: Patient-Care Facility—$1,995; Affiliate—$350; Supplier— Sliding scale based on gross sales volume
1940 Budget: $3,500 Dues: $10
0 1917
1940
1946
1950 1955 1960
1975
Growing membership numbers meant AOPA could strengthen its advocacy on behalf of members. The 1986 AOPA Annual Report noted how the increase in numbers affected the organization: “If AOPA had not had a doubling of membership, the government relations program would not be as viable as it is today,” said the report. Some long-time members may recall an important program from 1986 that also helped build the AOPA membership roster. That year, AOPA’s leadership asked members to take part in the recruiting process. The goal of this recruitment campaign, named “Project 1,000,” was to boost AOPA membership to 1,000. By 1987, membership surpassed 1,000 O&P companies. Today, AOPA’s membership has reached 2,050.
1980 1985 1990 1995 2000 2005 2010 2016
Dues
2017
Along with changes in membership numbers, AOPA also has seen significant changes in annual membership dues. In 1940, annual AOPA dues were $10. In 1941, dues more than doubled to $25. By 1945, all dues were based on three tiers, with gross sales as the basis: $25 for those companies with less than $12,000 in gross sales; $50 for those companies with gross sales between $12,000 and $25,000; and $100 for companies with gross sales greater than $25,000. In subsequent years, dues increased to reflect the scope of activities and priorities of the association. In 1950, the board members reviewed the minimum rate and decided $50 was an unrealistic figure; an increase to $100 was voted unanimously.
THEN & NOW
In recent years, the AOPA Board of Directors has elected to raise dues only a minimal amount each year, so that the increase is not a hardship to members. The bottom line continues to be: The more members on the rolls, the greater the resources available for AOPA to address the concerns of the O&P profession.
a healthy debate led to a five-tiered dues structure based on the gross sales volume of the member, so that the important work of the association could continue:
Dues Established at 1946 Annual Meeting
Company Size, By Gross Sales Volume
Growing Pains
<$25,000
$75
$25,000-$50,000
$100
$50,000-$75,000
$125
$75,000-$100,000
$150
>$100,000
Membership Drives Activities and Accomplishments
Over the years, defining categories of membership has presented its challenges. It was at the 1950 Annual Meeting that the “affiliate” membership category was born, with annual dues of $15. This distinction between a parent and affiliate company came as a result of much research and discussion. President Daniel A. McKeever, CP, remarked, “Brother, we got into more ramifications than a cat has fleas, but we tried to explore all of them. The idea is to get everyone in the association and to be sure that those who should carry the load, so carry it.”
Impact of Industry Trends on Membership
As early as 1997, AOPA began noticing a trend in membership that represented changes in the industry composition. Industry consolidation (where large firms buy smaller firms) meant that a purchased company’s status changed from an “active” member (paying higher dues rates) to an “affiliate” member (paying lower dues rates). Active and Affiliate Membership Trends Active
Affiliate
1,200 1,100 NUMBER OF MEMBERS
All organizations have life cycles and struggle with challenges that come with growth. In 1946, ALMA leaders invited orthopedic brace manufacturers to join them, and ALMA became the Orthopedic Appliance and Limb Manufacturers Association (OALMA). At the 1946 Annual Meeting, leaders engaged in heated discussions, trying to figure out how to take that next step into a bigger, stronger association. Leaders faced tough decisions stemming from growth, such as how to evolve from a volunteer-run organization to one with an office and full-time executive director. The leaders also disagreed on how to address the priority issues of the day, such as negotiating with the U.S. Department of Veterans Affairs, resisting government encroachment into O&P businesses, communicating with the Federal Trade Commission as a cohesive body, and expanding membership—all with a budget of $17,500. Meeting minutes from 1946 detail a heated debate about whether or not to grow, how much, and how to pay for it. Some leaders considered quadrupling dues. Some thought finding 250 to 300 more members would be the solution. And some, labeled as those “stuck in the horse-and-buggy days,” argued, “We are a little association,” and wanted to stay that way. Faced with an impending decision, AOPA President Chester C. Hadden, CPO, remarked, “If [refusing to grow] is the attitude, we may as well entertain a motion and settle it once and for all that we dissolve the association. This might be the time to determine whether or not we want the association.” The following day, armed with more information and cooler tempers,
$50
1,000 900 800 700 600 500 400 1994
1995
1996
1997
1998
1999
Since most of AOPA’s dues revenues come from active members, dues income decreased as well. The 1997 AOPA Annual Report stated, “Industry consolidation is likely to continue to be a fact of O&P life for some time.” This trend of consolidation continues today. In 2016, AOPA initiated an effort to encourage all parent companies to register their satellite locations as AOPA affiliate members.
2000
In the mid 20th century, one of the biggest challenges for the association was collecting dues. R. R. Snell, chair of the 1950 Membership Committee, remarked, “One hundred percent...the hardest job in the industry….is collecting of dues.” Probably no other single subject commands more attention and is of more concern than membership. Without members, the association does not exist. Throughout the years, board members have pondered why there is not 100 percent participation of O&P businesses in the association. During a 1959 business meeting, W. Frank Harmon, CO, noted that “nonmember firms continue to enjoy all the benefits while remaining free-riders.” Present-day leaders are faced with this exact same challenge. In 1956, John Bohankamp, chair of the Membership Committee, said it best: “The more members we have, the stronger OALMA might be, and the more resources we have to work with.” Without members to pay dues and to volunteer their leadership, time, and expertise, the important work of the collective association— the advocacy, the education, and the research—cannot be undertaken to benefit the profession. A century after its initial incorporation, AOPA’s members and its leaders continue their quest to have a positive impact on the O&P profession. For more information on your company becoming an AOPA member and making a difference, visit www.aopanet.org/join, or call 571/431-0810. O&P ALMANAC | MAY 2017
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BRIDGE TO THE FUTURE: THE INTERVIEWS
Technician Tactics The role of the certified O&P technician is evolving 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 Brad Mattear, LO, CPA, CFo, a member of AOPA’s Technical Education Workgroup of the World Congress Planning Committee, on the future of O&P fabrication and the role technicians play on the O&P health-care team.
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MAY 2017 | O&P ALMANAC
C
HANGE IS OCCURRING AT
What’s more, many clinicians and manufacturers also are testing 3-D printing methodologies and additive manufacturing. Technicians of the future need to be aware of these innovations and become even more tech-savvy to succeed in their careers and best meet the needs of O&P consumers.
lightning speed throughout the U.S. health-care arena—and O&P is no exception. While some O&P facilities remain committed to traditional fabrication methodologies and processes, others are embracing new techniques and remodeling their facilities to participate in the evolution currently underway. “Fifteen or 20 years ago, it was Technicians 2.0 considered ‘cutting-edge’ to modify Technicians who are just launching a device on the computer, carve it, their careers “need to be forward-thinkfabricate a check socket, and repeat ing, but also need to be hands-on,” says until the device was perfect,” says Mattear. “CAD/CAM skills and 3-D Brad Mattear, LO, CPA, CFo, managing printing familiarity are a must.” director in the United States A few years ago, of Nabtesco & Proteor in applications for 3-D USA and chair of AOPA’s printing began spreading Technical Education throughout the medical Workgroup of the World community, with a vast Congress Planning array of health-care fields Committee. “And there are adopting the technology to still a lot of O&P profesmake surgical instruments, medical implants, and sionals who say hand skills Brad Mattear, LO, surgical guides. Some 3-D are what separates them CPA, CFo printing early adopters from computers.” While it’s began creating basic prosthetic true that computers can’t replace the devices, such as hands for children tactical skills of qualified O&P profesmade via the e-NABLE organizasionals, it is important to acknowledge some of the new technologies that tion, and primitive devices for O&P could impact O&P fabrication in the patients in third-world countries coming years. without access to other options. “We are continually evolving with More recently, some O&P stakeprosthetic component manufacturing— holders have experimented with 3-D with new knees, feet, and upper-limb printing—which offers the advantages devices,” says Mattear. “Manufacturers of speed-to-use and cost-effectiveare investing in lighter-weight, longerness—for rapid prototyping in the lasting materials.” research and development stages of
BRIDGE TO THE FUTURE: THE INTERVIEWS
PHOTO: Getty Images/Izusek
product design. In addition, some companies are leveraging 3-D printing technology to complement other manufacturing processes, says Mattear. But O&P is still in the “infancy” of the 3-D printing movement, he says. O&P clinicians and manufacturers are beginning to explore possibilities, but some of the rules and regulations have yet to be determined. 3-D printing technology is improving by the day—in terms of both printer capabilities and material strength. “The printers will keep getting better, and we’ll be able to create more complex geometric shapes,” says Mattear. “At one time, the material science couldn’t keep up with printer development. But the material science is getting so much better— because that’s where the future is.” Advances in new materials will result in lighter components, and better patient outcomes, he says. O&P currently stands “at the cross section of knowledge and assumptions— and that intersection is very important,” according to Mattear. And the next few years will prove critical to the advancement of the profession. “We’re looking for more education about 3-D printing—more opportunities, more data, and more successes and failures. We need to collect those experiences so we can put all of that information into the hands of practitioners.”
Going forward, technicians also will need to be knowledgeable about the intersect between electrical technology and mechanical designs, says Mattear, who notes that the disciplines are beginning to overlap. “We are going at lightning speed with 3-D printing, and combining fabrication technology and mechanical design, and bringing them together,” he says. “The technicians of tomorrow need to be able to separate themselves from their peers by being able to run and understand how to use 3-D printing and have an understanding of CAD/CAM.”
Elevating the Technician Role
In the future, Mattear believes some technicians may take on a dual role of technician/assistant and become certified to “move from the back of the house to the front of the house” in working with patients. As more O&P businesses see the value of the care extender model as a way to reduce costs, “we’ll see more dual-credentialed lower-level O&P technician/assistants,” he says. “More and more businesses are realizing they can’t afford lots of square footage in their facilities anymore. They are adjusting their business models”—and some are following the examples of physical therapists, who are relying more on physical therapy assistants, as well as dentists, who are expanding the
number of dental hygienists, he says. Mattear foresees a future in which small O&P facilities “expand” not by adding CPOs but by hiring more certified O&P assistants—“one or two of which also are technicians, who can handle in-house fabrication or adjustments and repairs,” while the majority of fabrication is outsourced. “That frees up the CPO to see more patients and increase billing experiences.” While business owners can’t justify three or four CPOs, they can justify assistants who also are technicians. Along the same lines, a shift in central fabrication (c-fab) may be coming, with “regional c-fab” becoming a trend within the profession. Mattear predicts regional c-fabs will provide services for several O&P facilities in locations that may be more convenient than c-fabs today. “The 3,500-square-foot clinics of the past were a luxury,” and many business owners are giving up the extra facility space to contain costs by outsourcing, creating a growing need for regional c-fabs that are reachable by ground service shipping, says Mattear.
A Changing Role
As O&P fabrication evolves and new materials allow for different fabricating techniques, O&P technicians will need to hone their skills and learn to leverage new technologies—with the ultimate goal of providing optimal patient outcomes. Technicians who learn the science of 3-D printing, keep up with other technological advances, and adapt to facility cultures that embrace care extender models will have an increased opportunity to set themselves apart. Looking to the future, Mattear has several words of advice to future technicians. “Don’t be just another technician graduate—learn to differentiate yourself from the pack,” he says. “New technology will drive this industry. How we direct that, is up to us.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com. O&P ALMANAC | MAY 2017
37
THE GLOBAL PROFESSIONAL
Alana Stonehouse, BP&O (cOP) Parkville, Victoria, Australia Prosthetist at the Royal Melbourne Hospital discusses O&P care in Australia
O&P ALMANAC: Describe a typical
O&P ALMANAC: Describe the loca-
ALANA STONEHOUSE, BP&O (COP):
STONEHOUSE: Our workshop and
work day for you.
As the O&P profession prepares for the Second O&P World Congress, to be held in conjunction with AOPA’s 100th anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a question-and-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.
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MAY 2017 | O&P ALMANAC
fitting/gait training rooms are located in the hospital’s outpatient services building, adjacent to the rehabilitation ward. This allows for easy and timely provision of services to both inpatient and community-based clients and helps to fully integrate our prosthetics team into the broader rehabilitation team.
O&P ALMANAC: What types of
patients do you typically see, and what types of devices do you fit for these patients?
STONEHOUSE: I see mainly adult
patients with lower-limb musculoskeletal or neurological deficiencies, for which I fit a range of off-the-shelf and custom-fabricated devices. In my facial prosthetics practice, I routinely provide high-definition silicone devices for deficits resulting from cancers. O&P ALMANAC: How are the devices
you provide paid for?
STONEHOUSE: Clients injured in
transport or workplace accidents are supported by an insurer, while the majority of our other clients have access to a state-funded grant, which is currently in transition to a national insurance program aimed at giving the consumer greater choice and control over the services provided. A small number of clients elect to pay privately.
PHOTO: Alana Stonehouse, BP&O (cOP)
Australia
My daily tasks vary considerably. I am a senior prosthetist at the Royal Melbourne Hospital, so I work as part of an interdisciplinary team within the rehabilitation and aged care setting of a busy public hospital. I am involved with both inpatients and outpatients, attending ward rounds, case conferences, family meetings, and organizational meetings. I work with clients across the full continuum of prosthetic care, participating in preamputation consultation, providing postsurgery care and information, and then working with the client all the way through rehabilitation to when he or she becomes a client with definitive components. In many cases, I will continue with a client’s care for life. I am involved in multiple prosthetic clinics and work closely with our rehabilitation physicians. I see a large variety of clients of all amputation levels with varying socket designs, including myoelectric and osseointegration. I also am part of our maxillofacial prosthetics team one day a week, gaining and improving my skills in high cosmesis silicone prostheses. Education and research are important roles in our department, and I serve as our student coordinator for La Trobe University, taking on placement of students as well as lecturing and running tutorials.
tion where you provide services.
THE GLOBAL PROFESSIONAL
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?
STONEHOUSE: Where
PHOTOS: Alana Stonehouse, BP&O (cOP); Aerial view: www.wikipedia.com
there is an insurer involved, auditing may occur; my records are expected to be compliant, and the client will have received all services and goods requested in a timely and effective manner. All claims made to insurers are required to be specific about the prosthetic components, warranties, and outcomes expected. The insurer will often seek advice from an independent clinician, who may discuss the specifics of the treatment plan and prosthetic design with the provider before giving approval to proceed. In the case of public prosthetics funding, our hospital is responsible for the management of a capped block grant. Activity is tracked on a monthly basis, and an annual report of services is provided to the state Department of Health and Human Services. Both insurance and public funding systems aim to fund services that are consumer directed and of a high clinical/professional standard in a way that is fair to both the client and the provider.
by the Australian Orthotic Prosthetic Association, keeping up my CPD points. I have attended international conferences of the International Society for Prosthetics and Orthotics. We also work closely with manufacturers of prosthetic components doing education sessions to ensure we are up-to-date with new products. Our organization has credentialing and competency standards that are supported by a supervision structure and mandatory training for competencies such as hand hygiene, falls, and pressure injury prevention. O&P ALMANAC: What’s the biggest
challenge you face as a practitioner, and how do you deal with it?
STONEHOUSE: Consumer demand
and competency requirements mean
that keeping current with changing prosthetic technologies and evidencebased practice is a constant necessity. I keep up by attending conferences and workshops and working closely with our component providers. When determining prescriptions, including using new technology, I am always conscious to work with the client to provide care that meets his or her needs and complements his or her overall management plan. O&P ALMANAC: Describe any charitable
work you or your organization does.
STONEHOUSE: As part of a medical
outreach team led by our professor of rehabilitation—Fary Khan, MD—we have participated in shared seminars with the Armed Forces Institute of Rehabilitation Medicine in Pakistan and carried out aid work in Nepal. Our department has sent refurbished components to Malawi and is working with an Australian charitable organization to send equipment to prosthetists in Syria.
O&P ALMANAC: Describe your
educational background and any certifications you have. How do you keep your skills sharp?
STONEHOUSE: I have a bachelor of
prosthetics and orthotics from La Trobe University. To keep my skills sharp, I attend professional development sessions and conferences run
Aerial view of Royal Melbourne Hospital O&P ALMANAC | MAY 2017
39
MEMBER SPOTLIGHT
Cypress Adaptive LLC
By DEBORAH CONN
Strategic Startup Chicago company partners with innovators to supplement its prosthetic product line
W
HEN CYPRESS ADAPTIVE WAS launched in January
2016, its owners had a vision: to bring innovative, high-quality prosthetic products to market but at more affordable prices. One way to accomplish that goal was to collaborate with outside inventors and pass along savings gained from lower overhead costs. “A lot of innovative people are looking for ways to bring their ideas to fruition,” says Matthew Doering, Cypress’s vice president of sales and marketing. “We work with them to create new products and to improve existing ones.” Doering, along with Lynn Snyder, PT, operations manager, and Laszlo Dallos, manager of product development, brought a combined 50 years of experience in O&P manufacturing and distribution to their new venture. Cypress Adaptive’s line includes standard items such as expulsion valves and suspension John Arnold, CP, of SRT Prosthetics takes a cast of a patient’s limb using the Symphonie Aqua System.
Laszlo Dallos; Lynn Snyder, PT; and Matthew Doering
COMPANY: Cypress Adaptive LLC OWNERS: Matt Doering; Lynn Snyder, PT; and Laszlo Dallos LOCATION: Chicago HISTORY: 17 months
MAY 2017 | O&P ALMANAC
Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
PHOTOS: Cypress Adaptive LLC
40
sleeves, as well as products unique to the O&P field. “We offer the first autonomous vacuum ankle, a universal ankle that can be used with a range of prosthetic feet,” says Doering. “Mechanical and electric vacuum systems have become popular over the last five or six years, but most have to be used with feet from a single company. Our ankle can be integrated with any K2 or K3 low-profile foot, which gives prosthetists a good option without limiting them to one specific product line.” The product also is cost-efficient, says Doering. Cypress is partnering with a German firm, Romedis GmbH, founded by a prosthetist who invented the Symphonie Aqua System for casting amputees to consistently produce a comfortable, well-fitting socket. Cypress Adaptive is the exclusive North American distributor for the system, which allows practitioners to use full weight-bearing mode to cast for a socket. The device uses hydrostatic pressure
to create an impression of the residual limb, reflecting the actual position of bone and soft tissue under load. The system recognizes scarred and sensitive areas as well as bony prominences. Prosthetists form the first plaster impression while the patient is fully weight bearing on the residual limb. “The takeaway is that the prosthetist will get consistent, reproducible results and won’t have to spend time with multiple check sockets and modifications,” says Snyder. Cypress is promoting the Aqua System through a series of workshops across the country. “We ask prosthetists to bring us their most difficult cases to fit, and if a lab is nearby, we’ll make the socket,” says Doering, adding that patients tend to be “floored by the results.” Northwestern University is working with other institutions both domestically and abroad to coordinate clinical trials and develop quantitative outcome measures on the system. “Insurance companies want consistent, measurable outcomes,” says Snyder. “This will help that effort.” Cypress is developing instructional videos for the system and collecting patient testimonials. The company has several other new products in the pipeline, some developed in conjunction with its partners and a few, including a new concept in expulsion valves, originated by Cypress. Connecting to inventors hasn’t been difficult, says Doering. “I’ve been in the industry for 19 years, so I know the tinkerers, the innovators,” he says. “And word travels fast in this industry, so many people are finding us. Things are going well. We are new, so of course we have challenges. But it’s all going in the right direction, and we’ve gotten nothing but positive responses.”
www.bocusa.org
Learn and earn with the NEW
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70+ TOP-QUALITY ORTHOTIC, PROSTHETIC AND PEDORTHIC EDUCATION COURSES.
EARN SCIENTIFIC, BUSINESS AND PEDORTHIC CE CREDITS BY STUDYING THE COURSE MATERIAL AND PASSING THE QUIZ.
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Discover the new and improved AOPAversity Online Learning Center Brought to you by AOPA, in partnership with ABC, BOC and some of the brightest educators in the world
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Get instant quiz results and access your account 24/7 Your CE credits will automatically be sent to ABC and BOC quarterly Print certificates for state licensure and other certifying boards 70+ courses to choose from No matter what your area of interest—there is a learning opportunity for you! 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
MEMBER SPOTLIGHT
LimBionics
By DEBORAH CONN
Early Expansion Four-year-old facility has four locations across North Carolina
T
HE DRIVING FORCE BEHIND Brittany Stresing’s
interest in orthotics and prosthetics was her own experience. Diagnosed as a child with a leglength discrepancy, scoliosis, and other spinal issues, Stresing was unsatisfied with both her surgical and her orthotic care and wanted to help others have a better experience. She started volunteering at an O&P practice in Gainesville, Florida, at the age of 15 and fell in love with the blend of art and science involved in the profession. “I was fascinated,” she says. “They couldn’t get rid of me.”
Brittany Stresing, CPO, FAAOP, with patient
Stresing works on a lower-limb device.
Eventually she was hired as a technician, and subsequently attended the O&P program at the University of Texas— Southwestern. After a residency at the University of North Carolina Hospital, she managed a private O&P practice. “After a while, I decided I wanted to start my own facility so I could treat patients with the time I wanted to take and the components I wanted to provide,” she explains. In 2013, at the age of 26, Stresing launched LimBionics. Being a young, energetic, and motivated business owner worked to her advantage, she says. Today, LimBionics has four offices in North Carolina; Stresing 42
MAY 2017 | O&P ALMANAC
Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
PHOTOS: LimBionics
leads the company’s practices in Durham and Henderson, with business associates handling the Raleigh and Sanford locations. OWNER: “A fun part of opening the Brittany Stresing, practice was that I could ask CPO, FAAOP my patients and friends, ‘What would you like to see?’ They LOCATIONS: didn’t want to look at typical, Durham, Henderson, white clinic walls decorated Raleigh, and Sanford, with anatomy and prosthetic posters, so we put up art to make North Carolina it more of a soothing experience. People don’t want to feel like HISTORY: they are in a doctor’s office all Four years the time; we make it a warm, inviting, friendly environment.” LimBionics uses nearby central fabrication facilities to make devices, which also keeps unpleasant odors away from patients who might be sensitive to the smell of epoxy or other materials. Stresing’s experience managing an O&P office served her well when she opened her own Stresing, right, with facility, exposing her to such a patient
FACILITY: LimBionics
issues as accounting, accreditation, liability insurance, and compliance. “Most of us who own O&P facilities are practitioners, so we have to learn the business side. I have a whole new respect for accountants,” she says. Stresing made it a point to assemble a large binder filled with relevant regulatory standards and guidelines, including those issued by Medicare, Medicaid, and the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. Each year she updates the contents to ensure compliance. She credits personal relationships as key to her marketing efforts. “Many of the doctors in our area were stuck in a routine, and we had to convince them that there were other options, new technology, and better materials out there,” she says. LimBionics also works closely with physical therapists, who are eager to try new products, according to Stresing. Building relationships with referral sources means following through, she emphasizes. “The power of doing what you said you would do, and when you said you would do it, is underestimated,” she notes. “I try to schedule days that are not completely full so I can respond quickly to a therapist. If I say I can do something the same day, I do it. After a few times, they see I mean it.” Looking ahead, Stresing envisions adding practitioners to the business and increasing patient volume. She is committed to retaining the high quality of care LimBionics offers: “If you base your business on reliability and personality, you have to get the right people to carry it on—people who will go above and beyond what is required.”
Products & Services For Orthotic, Prosthetic & Pedorthic Professionals
AOPA MASTERING MEDICARE:
ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR
PITTSBURGH
EARN
JULY 17-18 | 2017
AOPA Coding Experts Are Coming to Pittsburgh, PA
14 CEs
Top 10 reasons to attend: 1.
Get your claims paid.
2.
Increase your company’s bottom line.
3.
Stay up-to-date on billing Medicare.
4.
Code complex devices
5.
Earn 14 CE credits.
6.
Learn about audit updates.
7.
Overturn denials.
8.
Submit your specific questions ahead of time.
9.
Advance your career.
The DoubleTree by Hilton Hotel and Suites Pittsburgh
Join AOPA July 17-18 in Pittsburgh 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:
NOVEMBER 6-7
Phoenix, AZ Sheraton Grand Phoenix 340 North 3rd St, Phoenix, AZ
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
MAY 10
JUNE 14
Internal Audits: The Why and the How of Conducting Self-Audits
Modifiers: What Do They Mean, and When Should They Be Used? Don’t miss the May webinar! Hear the experts discuss the most important modifiers and how they should be used to ensure your coding is as accurate as possible. The following topics are a small sample of what will be covered during the webinar: • What is the difference between the RA and the RB modifier? • Which modifier allows you to provide services to a patient under hospice care? • What is the true meaning of the KX modifier? • What modifiers are used for upgraded and deluxe features? 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 two 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.
44
MAY 2017 | O&P ALMANAC
The best way to prevent external audits is by conducting self-audits. Increase your chances for a favorable reimbursement climate at your facility by taking part in the June 14 webinar, where experts will address the following topics: • How do you create an in-house audit/self-audit? • Where do you start when building a self-audit? • How often should you conduct self-audits? • What can self-audits tell you about your business?
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 two 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.
O&P PAC UPDATE
O&P PAC Update
T
HE O&P PAC UPDATE provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: • J. Martin Carlson, CPO • Jim Kingsley • Steve McNamee, CP, FAAOP
The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level, which have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate, and other officials running for office, to educate them about the issues, and
help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo. com/forms/op-pac-authorization, or contact Devon Bernard at dbernard@AOPAnet.org. You also may complete and return the authorization card at the bottom of this page. *Due to publishing deadlines this list was created on April 18, 2017, and includes only donations/contributions made/ received between March 1, 2017, and April 18, 2017. Any donations/contributions made/ received on/or after April 18, 2017, will be published in the next issue of the O&P Almanac.
O&P PAC Authorization I authorize the O&P PAC to share information with me, executive, administrative, and professional personnel associated with the company designated by me below. Name: __________________________________________________________________________ Company: _______________________________________________________________________ Address:_________________________________________________________________________ Telephone: ______________________________________________________________________ Email: __________________________________________________________________________ AOPA must obtain the signature of a corporate officer, or a person that can authorize for their company. Signing multiple dates eliminates the need to contact you for authorization approval in upcoming years and reinforces your commitment to the O&P PAC. 2017____________________________________________ 2018____________________________________________ 2019____________________________________________
Return completed form to: AOPA Attn: O&P PAC 330 John Carlye Street, Suite 200 Alexandria, VA 22314 Or fax to: 571/431-0899
As required by federal law, my company has not authorized a federal PAC solicitation by another trade association during any calendar year in which this “authorization” is granted to O&P PAC. Signing this card in no way obligates me or others to contribute; it just gives them the opportunity to do so.
O&P ALMANAC | MAY 2017
45
MARKETPLACE
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 Anterior Posterior Tapered Liner ALPS’ new AP Tapered Liner is gradually tapered from the anterior to the posterior to provide superior comfort. This liner is available in a pin-andlocks system or suction suspension. The AP Tapered Liner features our black high-performance fabric with gel to assist in reducing bunching in the popliteal region. 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. 46
MAY 2017 | O&P ALMANAC
Exos Free Motion Ankle Reduce Pain. Restore Mobility. Decrease Cost. The Future of Ankle Bracing is Here Exos Free Motion Ankle is the first prefabricated anklefoot orthosis that can be fully customized and formed to the patient, providing functional stabilization of the ankle-foot complex addressing bony abnormality, chronic instability, and post-trauma rehabilitation. The Exos Free Motion Ankle presents a new orthopedic choice with a treatment option that is moldable, reformable, removable, and adjustable. Learn more at www.djoglobal.com/exosfreemotion.
LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com.
The Infinite Socket® System by LIM Innovations® The Infinite TF and Infinite TT are the first custom-molded, modular, and dynamic prosthetic socket systems, offering adjustability at each component in response to volume and shape change of the residual limb. The Infinite Socket product line offers a holistic improvement in patient comfort and freedom through its unique, dynamic design. Contact us for more information at LIMInnovations.com.
MARKETPLACE TaiLor Made (TLM) foot The TaiLor Made (TLM) foot is designed with toe and heel elements that move independently along with a vertical shock mechanical spring pack. The TLM Control Hub provides superior vertical shock that can be adjusted to suit patients’ needs, and it is lightweight to help users remain nimble enough for higher level activities. Features and benefits: • Independent movement between the heel and forefoot to create a smooth rollover and simulate plantarflexion/ dorsiflexion, especially on inclines and declines. • Shock absorption and comfort at heel strike from compression of the springs. • Energy return at toe-off from release of the springs and the carbon-fiber forefoot. • Exchange the heel and forefoot springs for different stiffness levels to customize performance for your patient. • Provides great terrain conformance to help patients navigate uneven surfaces more safely. • One of the lightest vertical shock feet available at just 16 oz (453 g). Call your local sales rep at 800/328-4058 or go to professionals.ottobockus.com.
precision. power. intelligent motion.
Now available in 4 sizes! Call us today to learn more about our new i-limb™ quantum. For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.
The FS3000 Foot Drop AFO From TurboMed Orthotics This unique ankle-foot orthosis was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe. In the past 24 months, more than 7,500 units of the FS3000 have been sold worldwide. TurboMed innovative products are now available through distributor partnerships in more than 20 countries. Its unique design and material composition give another meaning to walking and running. For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the FS3000 in less than five minutes. Available in USA from Cascade Supply, SPS, and Lakes Medical Innovations. For more information, call 888-778-8726, or visit www.turbomedorthotics.com.
VQ OrthoCare® Introduces Custom Knee Brace App VQ OrthoCare® introduces its newest custom brace measurement system: the eCast™ app, which uses image capture technology to provide precise anatomical details for a more accurate measurement and fit. The app guides the user to the proper height, distance, and tilt of the iPhone camera and auto-captures a picture when the image is correct. Orders are sent directly from an iPhone to manufacturing, reducing paperwork and eliminating the need for additional measurements. Faster ordering, faster delivery. Available at the Apple iTunes store. For more information, call VQ OrthoCare at 800/652-1135 or visit www.vqorthocare. com/ecast.
O&P ALMANAC | MAY 2017
47
AOPA NEWS
CAREERS
Opportunities for O&P Professionals Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad
Member $482 $634
Nonmember $678 $830
Listing Word Count 50 or less 51-75 76-120 121+
Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word
ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board
Member Nonmember $85 $150
For more opportunities, visit: http://jobs.aopanet.org.
SUBSCRIBE
A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.
48
MAY 2017 | O&P ALMANAC
North Central
Orthotic Technician Chicago, Illinois The Ann & Robert H. Lurie Children’s Hospital of Chicago is committed to providing the highest level of patient care and has an open position for an orthotic technician. At Lurie Children’s we take a team approach to orthotic/prosthetic care and work closely with other members of the medical team. To access information about benefits and resumé submission, please visit www.Luriechildrens.org.
Website: www.Luriechildrens.org
Northeast
Certified Orthotist/Certified Prothetist-Orthotist Long Island and Queens, New York Wanted: CO/CPO for busy Long Island and Queens practice. Excellent pay and comprehensive benefits package. Must be professional, knowledgeable, and caring. Upbeat practitioners need only apply. Please apply by email to careers@ mgpolabs.com. Email: careers@mgpolabs.com
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
AOPA NEWS WELCOME NEW MEMBERS
r
FREEMfoBERS
T
HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of 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 patientcare 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.
ME AOPA n . Log o s u to e today!
The Source for Orthotic & Prosthetic Coding
Marketing Opportunity Enhanced Listing
AOPA members ONLY $1,000 per year! An enhanced listing on LCodeSearch.com enables you to add as many products as you wish, with descriptions, images, and links to your website.
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The Source for Orthotic & Prosthetic Coding
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Included in Search Product Name
O&P buyers
Manufacturer Name
with product info, a link to
Up to 2 Photos
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OrtoPed ULC 373 McCaffrey Street Montreal, Quebec, Canada H4T 1Z7 Cascade Orthopedic Supply Inc. 800/363-8726 Member Type: Supplier Affiliate
Basic Listing (Free)
Link to website
*This offer is only available for current AOPA members. It is offered independently of the Supplier Plus program.
In a typical year, AOPA’s LCodeSearch.com reaches:
10,000+
Spokane Prosthetics & Orthotics 7942 Noble View Lane NW Olympia, WA 98502 360/791-2207 Member Type: Patient-Care Facility
UNIQUE USERS
55,000+
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VISITS
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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. www.AOPAnet.org
www.AOPAnet.org AOPA 2016 PRODUCTS AND SERVICES DIRECTORY
5
ADVERTISERS INDEX
Company
Page Phone
Website
ALPS South LLC
13
800-574-5426
Amfit
7
800-356-3668 www.amfit.com
Cailor Fleming Insurance
5
800-796-8495
www.cailorfleming.com
Custom Composite
15
866-273-2230
www.cc-mfg.com
DJO Global
23
800-336-6569
www.djoglobal.com
Hersco Ottobock
1 C4
www.easyliner.com
800-301-8275 www.hersco.com 800-328-4058 www.professionals.ottobockus.com
Touch Bionics
9
855-694-5462
www.touchbionics.com
TurboMed Orthotics
25
888-778-8726
www.turbomedorthotics.com
VQ Orthocare
31
800-652-1135
www.vqorthocare.com/ecast O&P ALMANAC | MAY 2017
49
CALENDAR
2017
June 8-9
May 8-13
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.
May 10
Modifiers: What Do They Mean and Webinar Conference When Should They Be Used? Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
Michigan Orthotics & Prosthetics Association Continuing Education Seminar. DoubleTree by Hilton Hotel Bay Cityâ&#x20AC;&#x201D;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
June 16-17
PrimeFare East Regional Scientific Symposium 2017. Renaissance Hotel & Convention Center, Nashville. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.
July 1
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 1
ABC: Practitioner Residency Completion Deadline for July Certification Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
www.bocusa.org
July 1
ABC: Practitioner Residency Completion Deadline for August Clinical Patient Management (CPM) Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
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.
Calendar Rates Let us
SHARE
your next event!
50
ABC: Application Deadline for September Certification Exams. Applications must be received by July 1 for individuals seeking to take the September ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
MAY 2017 | O&P ALMANAC
Free Online Training
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.
CREDITS
Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.
Words/Rate
Member
Nonmember
25 or less
$40
$50
26-50
$50 $60
51+
$2.25/word $5.00/word
Color Ad Special 1/4 page Ad
$482
$678
1/2 page Ad
$634
$830
CALENDAR July 10-15
ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and technicians in 250 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
July 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
July 17-18
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. Coding & Billing Seminar
August 4-5
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.
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
September 6-9
100th AOPA National Assembly and Second World Congress. Las Vegas. Mandalay Bay. For exhibitors and sponsorship opportunities, contact Kelly Oâ&#x20AC;&#x2122;Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.
September 13
ABC Inspections and Accreditation. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
October 11
AFO/KAFO Policy. Register online at Webinar Conference bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
October 26-27
International African-American Prosthetic Orthotic Coalition Annual Meeting. Atlanta Marriott Suites Midtown, 35 14th Street NE, Atlanta, GA, 30309. For more info, visit www.iaapoc.org or contact Tony Thaxton Jr. at thaxton.jr@comcast.net or 404/875-0066.
November 5-11
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.
December 13
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.
2018 September 26-29
AOPA National Assembly. Vancouver, Convention Center. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.
2019 September 25-28
AOPA National Assembly. San Diego, CA, Convention Center. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.
2020 September 9-12
AOPA National Assembly. Las Vegas. Mandalay Bay. For general inquiries, contact Betty Leppin at 571/4310876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org. O&P ALMANAC | MAY 2017
51
ASK AOPA CALENDAR
Forms and Benefits Answers to your questions regarding ABNs and billing for skilled nursing facility patients
AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.
Q
I recently saw that Medicare released a revised advanced beneficiary notice (ABN) form. When must we begin using the revised form?
Q/
The revised ABN form was released by Medicare in mid-March; however, the effective date of the new form is June 21, 2017. You may continue to use your current stock of ABN forms, but you must use the new forms starting June 21, 2017.
A/
What was revised on the new ABN form, and how do I know I am using the correct form?
Q/
The revised ABN now contains a statement informing the beneficiary of his or her rights to obtain the form in an alternate format, and explains that CMS does not discriminate. Here is the complete statement: “CMS does not discriminate in its programs and activities. To request this publication in an alternative format, please call: 1-800-MEDICARE or email: AltFormatRequest@cms.hhs.gov.” Besides checking for this statement, you also will be able to determine if you are using the correct form, starting June 21, 2017, if in the lower left corner you see this numbering: Form CMS-R-131 (Exp. 03/2020).
A/
Sometimes I am asked to see a Medicare patient in a skilled nursing facility (SNF). Can I submit my claim directly to the durable medical equipment Medicare administrative contractor (DME MAC) if the patient has been there for more than 100 days?
Q/
52
MAY 2017 | O&P ALMANAC
While the Medicare Part A SNF benefit is limited to 100 days of coverage per benefit period, just because a patient has been in an SNF for more than 100 days does not necessarily mean he or she has exhausted his or her Part A Medicare benefit. There are multiple scenarios where a patient may remain eligible for Medicare Part A SNF coverage including, but not limited to, interruptions in Part A coverage during the stay, failure to qualify for Part A benefits, and periods of hospitalization during the SNF stay. The best way to determine who is responsible for paying your claim is to confirm, in writing, the individual patient’s Medicare coverage status with the business office at the SNF.
A/
Who is responsible for payment of a custom device delivered to a patient in an SNF when the item was ordered prior to the patient’s admission to the SNF?
Q/
This will depend on where the patient was when the device was ordered. If the patient was residing at home when the device was ordered, you may bill Medicare directly, and your delivery date will be your start date. If the patient was in a hospital when the device was ordered, you must seek payment from the hospital. Keep in mind that these requirements apply only to custom orthotics and prosthetics. Traditional billing guidelines apply to noncustom items and diabetic shoes.
A/
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. HOST HOTEL: Ritz Carlton, 1250 South Hayes Street, Arlington, VA 22202
Meet your member of Congress and tell them how, through orthotics and prosthetics:
REGISTER TODAY
2017
Visit www.AOPAnet.org to learn more.
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