May 2016 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

MAY 2016

E! QU IZ M

Tips for Therapeutic Footwear Reimbursement

EARN

2

BUSINESS CE

CREDITS P.18

P.16

Build Your Digital Marketing Acumen P.30

Clarifying POD Requirements P.52

Sustainable

OUTREACH Several O&P humanitarian efforts take a long-term view to restoring mobility and educating local practitioners P.22

BONUS!

WWW.AOPANET.ORG

Amputee Coalition— InMotion Magazine Included With This Issue Exclusive: ‘One Remarkable Week’ for O&P Advocacy P.20

YOUR CONNECTION TO

EVERYTHING O&P

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

#AOPA2016

AOPAnet.org

LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON

Earn more than

32 CE

SAVE THE DATE

CREDITS

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

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

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

REGISTRATION IS NOW OPEN For information about the show, scan the QR code with a code reader on your smartphone

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

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

Questions?

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

Visit www.AOPAnet.org to learn more, register, or to exhibit.

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contents

MAY 2016 | VOL. 65, NO. 5

FEATURES

DEPARTMENTS | COLUMNS

COVER STORY

Views From AOPA Leadership......... 4 Michael Oros, CPO, FAAOP, introduces Prosthetics 2020

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

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

Transitions in the profession

22 | Sustainable Outreach U.S. practitioners who volunteer their time and clinical expertise to aid O&P patients in underdeveloped countries or disaster areas have learned to focus not just on the patients they see, but also on the long-term sustainability of their efforts. Many humanitarian organizations have developed programs to educate local practitioners and to assist clinic liaisons design continuity-of-care plans.

By Meghan Holohan

20 | This Just In

One Remarkable Week

Documentation for Diabetic Shoes

Securing reimbursement for therapeutic footwear

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

CREDITS

Member Spotlight................................. 38

P. 20

n n

Those on the front lines of the battle to ensure appropriate care and componentry for O&P patients made significant progress during an extraordinary oneweek period in April. In addition to the events surrounding AOPA’s seminal Policy Forum, legislators introduced O&P-focused H.R. 5045, and the House Oversight and Government Reform Committee released a letter criticizing the recent actions of CMS and its contractors.

30 | Build Your Following

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

Buckner Prosthetics & Orthotics RS Print

AOPA News................................................42

AOPA meetings, announcements, member benefits, and more

Welcome New Members ................. 44

Marketplace.............................................. 45

P. 30

Expansive websites, social media campaigns, and sponsored links have become a staple of effective marketing strategies for many successful O&P facilities.

Find out how to leverage different platforms to promote your company to patients, referral sources, and the media.

By Christine Umbrell

Careers........................................................ 48

Professional opportunities

Ad Index....................................................... 49 Calendar..................................................... 50

Upcoming meetings and events

Ask AOPA................................................... 52 Valid proof-of-delivery forms

Advertise with Us! For advertising information, contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

O&P ALMANAC | MAY 2016

3

VIEWS FROM AOPA LEADERSHIP

Taking the Long View: Prosthetics 2020

T

EN YEARS AGO, a group of O&P leaders met and took a bold measure in determining a master’s degree would be the educational pathway for entry into the profession. At that time, it wasn’t universally accepted as a change that was necessary, and there were a number of well-respected individuals who were critical of the decision. The leadership vison and plan anticipated there would be some short-term transitional pain in ramping up the educational programs to meet this new standard, but the focus and commitment remained dedicated to meeting the long-term objective.

Today, I think most in the profession would agree that the decision to move forward with the entry-level master’s was the right decision for the profession, despite the short-term pain and uncertainty.

I offer this brief history lesson to rally support for a current AOPA-led initiative: Prosthetics 2020 (soon to be followed with a parallel Orthotics initiative). In much the same way as the movement to the entry-level master’s began, seeds are being sown today that can deliver significant value to the profession in both the near- and long-term future.

What Is Prosthetics 2020?

Prosthetics 2020 can be defined by the following: • It began with the recruitment and charter of a nationally recognized medical advisory board, which included Michael Jaff, DO; Doug Smith, MD; and Paul Pasquina, MD, as well as Kenton Kaufman, PhD. This medical advisory board is now working to engage with the durable medical equipment Medicare administrative contractor medical directors on the substantial issues facing our profession today as well as educate them on current and future research initiatives.

• It’s the hiring of a health economic consultancy group to develop a simulation model that will attempt to quantify the economic as well as quality-of-life value of modern prosthetic technology and service.

• It’s the funding, conducting, and publishing of systematic literature and data reviews.

• In due time, armed with new evidence that demonstrates that O&P care is a valueadd, it will be a rebranding of our profession based on the value of the interventions we bring to the patients we serve, not solely the cost of those services.

• Ultimately, Prosthetics 2020 will serve as a pathway to introduce and attain appropriate reimbursement for new technology and service models.

How can you support this effort? If you’re not currently an AOPA member, sign up and be part of the solution going forward. If you are an AOPA supplier or patient-care facility, irrespective of the size of your company, there are ways for you to become engaged and involved with this critically important initiative. To learn more, contact AOPA Chief Operating Officer Don DeBolt at ddebolt@AOPAnet.org or 571/431-0841.

Remember: The actions we take today are the rewards we will reap in the future.

Michael Oros, CPO, FAAOP, is president and CEO of Scheck and Siress O&P Inc. and president-elect of AOPA. 4

MAY 2016 | O&P ALMANAC

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

Board of Directors OFFICERS

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

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AOPA CONTACTS

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

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

6

MAY 2016 | O&P ALMANAC

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

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

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

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

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

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

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

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

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

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

Visit bit.ly/aopamediakit for advertising options!

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NUMBERS

Characteristics of Successful O&P Facilities How do O&P profit leaders differentiate themselves?

The O&P patient-care facilities with the greatest return-on-asset performance are defined as “profit leaders” in the 2015 AOPA Operating Performance Report. These companies, which were in the top 25 percent in terms of this measurement, stood out from average facilities in a number of ways, from outsourcing habits to inventory turnover to accounting practices.

NUMBER OF YEARS IN OPERATION

INVENTORY TURNOVER

DAYS RECEIVABLES OUTSTANDING

21.5

Number of times per year the average O&P business turned over its inventory in a year.

31.8

Number of times per year the average profit leader turned over its inventory in a year.

27

All respondents

87.5 Percent

14.5

93.8 Percent

Profit leaders

50.8

Number of days the average O&P business had outstanding accounts receivable.

34.9

All respondents

Profit leaders

“For the typical survey participant,

return on assets was 12.9 percent in fiscal year 2014, while profit leaders reported a

median return of 58.4 percent.”

—2015 AOPA Operating Peformance Report

Number of days the average profit leader had outstanding accounts receivable.

Percent of Net Sales by Primary Paying Agents

USE OF OUTSIDE C-FAB FOR SOME CUSTOM WORK

All Respondents Profit Leaders

12.9% All Respondents

Contracted Private Insurance 28.4% 35.1% Noncontracted Private Insurance 5.0% 4.3% Hospitals/Nursing Homes 5.3% 6.5% Medicare 27.4% 22.0% Profit Leaders Medicaid 15.5% 12.7% Workers’ Compensation 3.7% 5.1% U.S. Department of Veterans Affairs 8.4% 8.4% Editor’s Note: The 2015 Operating Vocational Rehabilitation 0.4% 0.8% Performance Report is now available Self-Pay 2.9% 1.8% through the AOPA bookstore. Visit Other 3.1% 3.3% www.aopanetonline.com/store.

58.4%

8

MAY 2016 | O&P ALMANAC

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Happenings RESEARCH ROUNDUP

Emory University researchers find initial success using cryoablation therapy to treat phantom limb pain.

Cryoablation therapy probe

Emory University researchers have found that image-guided cryoablation effectively reduced phantom limb pain for patients during a clinical study. Phantom limb pain has been found to originate in the nerves and scar tissue at the site of amputation.

Using cryoablation, J. David Prologo, MD, and his team at Emory inserted probes through the skin of 20 patients, then lowered the temperature for approximately 25 minutes. The procedure shut down nerve signals. Patients were asked to quantify their pain on a scale of 1 (not painful) to 10 (extremely painful) both before and after undergoing image-guided cryoablation. Before treatment, the average reported pain score was 6.4. Forty-five days after treatment, the average score had declined to 2.4.

“Until now, individuals with phantom limb pain have had few medical interventions available to them that result in significant reduction in their pain,” Prologo says. “Now, with the promise of cryoablation, these individuals have a viable treatment option to target this lingering side effect of amputation.” The full study has been published in the Journal of Vascular and Interventional Radiology.

PHOTOS: Kevin Makowski, RBP/Emory University School of Medicine

Researchers Study ‘Cold Blasts’ To Treat Phantom Limb Pain

California Researchers To Develop Advanced Arm Prosthesis

10

MAY 2016 | O&P ALMANAC

The researchers will capture EMG signals from live subjects using electrodes and analyze how effective they are in representing the proportional and dynamic muscle activities of hand gestures. They will develop a high-performance, real-time computing system to address the computational challenges of applying grid sensing to real-time prosthetic control.

The researchers intend to develop a prosthetic arm that nonprofessionals or prosthetic users can place onto the body and use to control the complex motions of a regular hand.

While a finished product is several years away, Okada and Zhang are currently working with undergraduate and graduate students and engaging in interdisciplinary cooperation to work toward solutions.

PHOTOS: Paul Asper/San Francisco State University

Researchers at San Francisco State University are seeking to develop a prosthetic arm that better understands and interprets the complex electromyogram (EMG) signals necessary for elaborate arm, wrist, hand, and finger movements. Kazunori Okada, an associate professor of computer science, and Xiaorong Zhang, an assistant professor of engineering, have received funding from the Ken Fong Translational Research Fund to solve the challenge of allowing more complex movements, such as eating, drinking, and playing the piano.

Okada and Zhang want to improve current designs, which are based on single-channel EMG recordings on multiple muscles that recognize simple static motions such as hand open or closed. The researchers are building on the concept that arms and hands are highly complex, involving multiple muscles firing at varied intensities, often in a set sequence, to perform basic tasks.

To solve the challenge of allowing more complex movements, Zhang envisions a grid of signal readers capable of capturing richer neural information across both space and time.

LATE

BREA

KING

NEW

S >>

LATE

HAPPENINGS

BREA

KING

NEW

S >>

LATE

BREA

KING

NEW

Insurance Denials in the Spotlight at April Press Conference On April 21, in an effort to secure widespread media coverage for key O&P issues in the days leading up to the AOPA Policy Forum, AOPA scheduled a phone-based telenews event exposing the unfairness of United HealthCare’s denials of appropriate lower-extremity prostheses for two amputees. Cigna was cited in the press event for similar denials.

The 1:30 p.m. telenews event—in effect, a press conference via phone— showcased the challenges faced by two amputees arising from the ill-conceived Local Coverage Determination (LCD) draft proposal for lower-extremity prosthetics. The painful stories of Mark Martin, 40, of Portland, Oregon, and Rob Rieckenberg, 37, from Minneapolis, were just two of many similar coverage denial tragedies: Martin lost his left leg due to an aneurysm that struck him during a workout, leaving him an above-knee amputee, and Rieckenberg lost a leg after he was mugged and left on a train track, where he was struck by a train. These two stories were played out in the telenews event, which was moderated by AOPA President-Elect Michael Oros, CPO, FAAOP, and CEO of Scheck and Siress O&P Inc. “I experienced denials from United HealthCare, even on my initial preparatory prosthetic,” said Martin during the press conference. “Then, when I advanced to the point of being ready for a definitive prosthetic—capable of letting me run after my three young children, play basketball, and return to a more regular travel schedule for my career with a tech company—I was met with wave after wave of denials. These were timed, not coincidentally, after the draft Medicare policy was released.

Denial language began to incorporate the draft policy limitations that ran contrary to actual policy provisions.

“I know that many people would not have the resources to fight this the way I did. Getting needed medical care should not depend on having an amazing employer, dedicated medical professionals, and the personal resources to wage war against an insurance company,” added Martin. “The system did not work for me, and it would have worked even worse for many others in my situation.”

“It is unfair to amputees to see coverage denied by insurance companies that are hiding behind a rule that has not even been finalized by Medicare.”

—Rob Rieckenberg

Rieckenberg also shared his story: “In the wake of the draft Medicare rule, United HealthCare denied me coverage, so I had to buy an individual plan through Blue Cross. I’m paying five times as much for premiums because United won’t extend me the coverage I am due. I had to have a vacuum suspension because of the skin grafts on my stump. Any less-advanced technology would tear up my skin.

“It is unfair to amputees to see coverage denied by insurance companies that are hiding behind a rule that has not even been finalized by Medicare,” added Rieckenberg. “It’s a bad rule, but it’s even worse when it can lower the care for amputees without even being formally enacted.”

S >>

The event gave the press access to the joint letter signed by AOPA and the Amputee Coalition, bit.ly/lcdwarning, warning of the harm to amputees if the proposed LCD, bit.ly/lcdproposal, was adopted in final form. Nine leading researchers wrote the durable medical equipment Medicare administrative contractors (DME MACs) debunking the outdated and inappropriate research, bit.ly/9researchers, subsequently cited by the DME MACs as the basis for the proposed policy.

“We warned last year that this scientifically unjustified Medicare rule would be exploited by insurance companies if it was not withdrawn. We said that this rule would turn back the clock on the quality of care for 2 million amputees. And it has,” said Oros during the call. “It is very difficult to imagine any other aspect of American health care where millions of people would be denied available and appropriate treatment and devices that can speed their return to the fullest and most active possible life. Even worse, there is no medical or other justification for these unreasonable and inappropriate hurdles that would amount to a return to a 1970s standard of care.”

A letter signed by the five members of the O&P Alliance and the Amputee Coalition to Cigna also took the company to task for its unfair exploitation of amputees based on the proposed rule denying coverage for vacuum suspension sockets.

After the press conference, several news agencies picked up the story and published details about the discussion, including the websites of Rehab Management, Pharmacy Choice, HME News, Inside O&P, Insurance News Net, and more.

O&P ALMANAC | MAY 2016

11

HAPPENINGS

DIABETES DOWNLOAD

WHO Calls for Global Efforts To Combat Rising Diabetes Rates Diabetes was the cause of death for 1.5 million people across the globe in 2012, with high blood glucose causing another 2.2 million deaths, according to the inaugural Global Diabetes Report, published by the World Health Organization (WHO). The report, released in April, calls for a “whole-of-government and whole-of-society approach” to tackle the disease, which now affects more than 400 million people and costs an estimated $827 billion annually in patient care and medicine.

The percentage of people suffering from diabetes worldwide has nearly doubled since 1980, growing from 4.7 percent of the adult population to 8.5 percent, according to WHO. One in 12 people in the Americas has the disease, which can lead to blindness, kidney failure, lower-limb amputation, and premature death.

ADULT DIABETES WORLDWIDE

8.5% 2012 4.7% 1980

“Prevalence is growing most rapidly in low- and middle-income countries,” the report says. The biggest estimated percentage rises were in the Western Pacific, African, Southeast Asian,

and Eastern Mediterranean regions, with some areas having an increase from 5.9 percent to 13.7 percent of the population. Adult mortality rates from high blood glucose increased globally over the same period, with the African, Eastern Mediterranean, and Southeast Asian regions most affected.

WHO researchers found that rates of amputation in populations with diagnosed diabetes are typically 10 to 20 times those of nondiabetic populations, and over the past decade have ranged from 1.5 to 3.5 events per 1,000 persons. Encouragingly, several studies have shown amputation rates have declined 40 to 60 percent among adults with diabetes during the past 10 to 15 years in the United States, United Kingdom, Sweden, Denmark, Spain, and Australia. No such data estimates exist for lower- or middle-income countries.

CODING CORNER

12

Jurisdiction D Releases Audit Results for Prosthetic Feet and Spinal Orthoses

Jurisdiction B Releases Prepayment Review Results for Spinal Orthoses

The Jurisdiction D durable medical equipment Medicare administrative contractor (DME MAC) contractor, Noridian Healthcare Solutions, recently released the results of ongoing prepayment audits for spinal orthoses described by Health-Care Common Procedure Coding System (HCPCS) codes L0648 and L0650 and prosthetic feet described by codes L5980, L5981, and L5987.

The ongoing prepayment audits involving these two product categories continue to show high denial rates, ranging from 77 percent to 88 percent. Given these findings, it is expected that the audits will continue. Practitioners are encouraged to include all required documentation when responding to additional documentation requests.

The Jurisdiction B DME MAC contractor, National Government Services (NGS), has released the results of the ongoing widespread prepayment review for spinal orthoses, codes L0450-L0640.

Between Oct. 1, 2015, and Dec. 31, 2015, NGS reviewed 459 claims and 342 claims were denied. This resulted in a 74.5 percent claim denial rate, the lowest denial rate since the widespread review began. The number one reason for the denials was because documentation was not submitted in a timely manner. Out of the 342 claims denied, 36 percent—or 125 claims—were denied because documentation was not submitted in a timely manner.

As a result of the high claim denial rate, NGS will continue with the widespread prepayment review of spinal orthoses.

MAY 2016 | O&P ALMANAC

HAPPENINGS

LIMB LOSS AWARENESS

Amputees ‘Show Their Mettle’

The Amputee Coalition celebrated Limb Loss Awareness Month in April.

Amputee support groups, veterans, prosthetists, rehabilitation centers, and amputees participated in activities in their local areas to raise awareness.

As part of the celebration, hundreds of individuals with limb loss visited Capitol Hill in Washington, D.C., on April 20 to meet with their legislators and present a unified voice on key issues, such as insurance fairness

for amputees, funding for research, and changes to the Local Coverage Determination process for prostheses.

In addition, amputees were invited to “Show Your Mettle” on Saturday, April 23, by wearing their prostheses in public, taking a photo, and posting it on social media to demonstrate their ability to cope well with difficulties or face a demanding situation in a spirited, resilient way.

MEETING MASHUP

Tech Symposium Planned for October The second annual Innovation and Technology Symposium is being planned for October 28-29 in San Francisco. The event, which is sponsored by the Department of Orthopaedic Surgery at the University of California, San Francisco, and the California Orthotic and Prosthetic Association, will feature both business and scientific presentations on a variety of forward-looking, technologyrelated topics. For more information, contact Matthew Garibaldi, MS, CPO, at matthew.garibaldi@ucsf.edu.

PHOTOS: The Amputee Coalition

O&P ALMANAC | MAY 2016

13

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

David Hughes, CPO, has joined the clinical education department of College Park Industries. Hughes will oversee upper-limb clinical education and will be based primarily in the Holliston, Massachusetts, division David Hughes, of College Park. He will provide education CPO and customer support domestically and internationally as a product application expert, as well assist in research projects and new product development.

Jeff Roberts, BOCPO/L, has joined the patient-care team at Fillauer Orthotics and Prosthetics as an orthotist and prosthetist.

Roberts began his work in the O&P industry in 1985 at Durr-Fillauer’s manufacturing diviJeff Roberts, sion in Chattanooga and left in 1991 to join BOCPO/L Southeastern O&P as a custom fabricator of prosthetic devices. In 2005, he moved to Stubbs O&P and took on the role of staff orthotist and prosthetist until 2016.

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

14

MAY 2016 | O&P ALMANAC

IN MEMORIAM John W. Ertl, MD, passed away March 27 at the age of 95. Born and educated in Budapest, Hungary, he was the son of Professor Janos von Ertl, who developed the Ertl osteomyoplastic reconstruction procedure to improve the quality of life for amputees after World War I. The Ertl procedure is a reconstructive surgery that builds a bridge between the tibia and fibula to create a more viable limb for the prosthesis. After the war, John Ertl established a surgical practice with his father and brother in Germany.

Ertl moved to the United States after World War II, and repeated his surgical training at Rush University Medical Center and at St. Anne’s Hospital in Chicago.

He and his brother established a surgical practice in Hinsdale, Illinois, where they helped reintroduce the Ertl procedure. He performed the Ertl procedure on thousands of patients, and was invited by the U.S. government in 2003 to consult on limb amputation casualties in the second Iraq/Afghanistan conflict. He was an active member of many organizations, including the American College of Surgeons and the Barr Foundation.

Henry F. Gardner, CPO, passed away in March at the age of 96. Gardner was a founding member of the American Academy of Orthotists and Prosthetists and served as president during the 1973-1974 term.

After serving in the Marines during World War II, Gardner joined the Department of Veterans Affairs (VA) as a prosthetics technician and attended New York University, where he received a degree in biomechanics. He served as a technical assistant to the director of the New York VA, where he coordinated a joint research and development program, working in conjunction with the National Academy of Science and several universities. Gardner developed and patented numerous prosthetic devices and developed new techniques related to the endoskeletal design of prosthetics.

Donald “Ray” McKinney, CPO, passed away unexpectedly on April 10. McKinney was born and educated in Illinois and served in the U.S. Army. He graduated from Northwestern University’s Prosthetics and Orthotic Program.

Donald “Ray” He owned and operated McKinney Prosthetics McKinney, CPO and, more recently, Paramount Prosthetics.

McKinney was known throughout his career as a leader in the industry. He specialized in elevated vacuum systems. He was a Cubs fan and an avid golfer.

HAPPENINGS

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

A cooperative agreement between the Amputee Coalition and the Administration for Community Living (ACL) has been renewed through 2019.

Under this agreement, the Amputee Coalition will continue efforts to maintain and expand the National Limb Loss Resource Center; increase support and resources available to people with limb loss, their families, and caregivers by enhancing and expanding the suite of peer support programs; expand and enhance marketing and outreach activities to increase awareness and usage of the National Limb Loss Resource Center; and develop, enhance, and expand partnerships and collaborations with federal agencies and other national organizations that have a vested interest in the limb loss community.

Arkansas is the latest state to recognize the Board of Certification/Accreditation www.bocusa.org (BOC) examinations for licensure of providers in the orthotic, prosthetic, and pedorthic professions. The rule change was made by the Arkansas Department of Health in January 2016, following a recommendation from the Arkansas Orthotics, Prosthetics, & Pedorthics Advisory Board. The Arkansas rule change follows recent decisions in Iowa and Pennsylvania where similar licensure rules recognize BOC credentials.

“The BOC credential behind someone’s name means they

What are we doing?

Where are we going?

How do we survive?

have gone through rigorous training and testing to prove their competency to provide quality care,” said BOC President and Chief Executive Officer Claudia Zacharias, MBA, CAE. “We are pleased to see Arkansas recognize that BOC’s certification examinations meet or exceed their standards.” Össur has acquired Touch Bionics Limited, a provider of upper-limb prostheses and supporting services. With this acquisition, Össur enters into the upper-limb prosthetic market, enabling the company to offer a complete bionic product portfolio.

The companies will co-exist independently, and the sales force and customer service entities of Össur and Touch Bionics will continue serving their customers. Synergies between the operations of Össur and Touch Bionics are expected to be achieved over the next two to three years.

Phits Insoles received an ISPO Award in the category of Best Innovative Performance Footwear during the ISPO Munich Trade Show in January. The jury praised the innovative combination of directly translating a person’s dynamics into a 3D-printed insole design, as well as the mass customization opportunities.

Vorum, a CAD/CAM software company based in Vancouver, Canada, has partnered with Nia Technologies to deliver 3D-printed prostheses to children in developing countries.

Products & Services

For Orthotic, Prosthetic & Pedorthic Professionals

AOPA 2016 OPERATING PERFORMANCE REPORT

Find the best practices to help you manage your business. Participate in the annual O&P Operating Performance Survey to chart your course.

FREE Report to AOPA Participating Members

Surveys mailed May 1st!

Or go to www.aopa-survey.com to participate. www.AOPAnet.org

O&P ALMANAC | MAY 2016

15

REIMBURSEMENT PAGE

By DEVON BERNARD

Documentation for Diabetic Shoes Tips to help secure reimbursement for therapeutic footwear Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.18

D

ENIAL RATES HAVE DROPPED

Some of these denial reasons are firmly within your control, and can be easily addressed—or prevented altogether. For example, not submitting 16

MAY 2016 | O&P ALMANAC

documentation or responding to an ADR letter is an automatic denial; you can control this problem by always responding to an ADR request.

However, some of these denial reasons are more difficult to control—such as what the physician does or does not document—and can be a bit harder to address.

This month’s Reimbursement Page reviews the basic documentation needed for diabetic shoes and offers five documentation tips to ensure the diabetic shoes you provide will be considered medically necessary and covered by Medicare.

Understanding the Basics

Two basic categories of documentation are required for the reimbursement of therapeutic shoes for individuals with diabetes; however, these two categories of documentation alone, or together, are not enough to support medical necessity.

The first category of documentation covers the order/prescription, the dispensing order, and the detailed written order (DWO). The dispensing order is what will allow you to see the patient, evaluate the patient, and dispense the shoes to the patient, but it does not allow you to bill for the shoes.

The dispensing order must be made by the prescribing physician, who must be a doctor of medicine (MD), a doctor of osteopathic medicine (DO), a nurse practitioner, a clinical nurse specialist, a physician assistant, or a podiatrist. This dispensing order, which may be written or verbal, must contain the following elements: general description of the item, patient’s name, physician’s name,

PHOTO: iStock.com/Nathan Maxfield

over the years; however, therapeutic shoes for individuals with diabetes continues to be an area subject to continued audit activity. Part of the reason for the continued auditing—both prepayment and postpayment—is that the error, or denial, rates have not dropped enough.

Take, for example, the findings of a review conducted between September and December 2015 by the Jurisdiction D durable medical equipment Medicare administrative contractor (DME MAC) of claims for off-the-shelf diabetic shoes with code A5000. During this four-month period, the DME MAC reviewed 3,949 claims, of which 3,354 were denied—a denial rate of almost 85 percent.

The DME MAC provided a list of the most common reasons for the denials: • Documentation of an in-person visit with the supplier at the time of delivery is incomplete.

• Documentation was not received in response to the additional documentation request (ADR) letter.

• Documentation is insufficient to show that the certifying physician has documented in the beneficiary’s medical records one of the specified conditions.

• Documentation is insufficient to show that the physician has certified that the indications are met and he/she is treating the beneficiary under a comprehensive care plan for diabetes.

REIMBURSEMENT PAGE

PHOTO: iStock.com/monkeybusinessimages

date of order, and physician’s signature.

If the dispensing order is a verbal order, the date of the order is the date you were contacted by the physician; in this case, you will not need a signature from the physician, but you must document that you received an order.

The DWO should contain, at a minimum, the following information: beneficiary’s name, prescribing physician’s name, detailed description of the item (including if it is custom or prefabricated), date of the order, and prescribing physician’s signature as well as the date signed. You may create the DWO; however, the signature and date must be in the prescribing physician’s hand.

You typically need to have both a dispensing order and a DWO in your files, but in some instances you may only have and need a dispensing order.

If you receive a dispensing order and it has all of the elements of a DWO, then a separate DWO is not required.

Once signed and dated, a new order is not required for the replacement of any inserts within one year of the date on the order; however, a new order is required for the replacement of any shoe, and a new order is required for the replacement of an insert if the most recent order on file is more than a year old.

The second category of basic documentation is a signed certifying statement for therapeutic shoes, which confirms that the patient is being treated for diabetes and also has a secondary condition that warrants the need for therapeutic shoes or certifies that coverage criteria have been met. The statement by itself does not meet the requirement for documentation in the medical records.

There is no official certifying statement form, just a recommended form, and you may create your own, but it must contain all of the key elements found on the recommended form.

The key elements are the patient’s name; certifying physician’s name and signature; and a statement that indicates that the patient has diabetes mellitus, has at least one approved secondary foot condition, is under a comprehensive plan of care for diabetes, and requires diabetic shoes. You can

create the form, but according to the Social Security Act, the only person who may complete and sign the certifying statement is an MD or DO—it cannot be signed by a nurse practitioner, clinical nurse specialist, physician assistant, or podiatrist. The MD or DO also must be the individual treating and caring for the patient’s diabetes.

Once signed, the certifying statement is valid for 12 months (not a calendar year, but 12 months); however, the initial delivery of the shoes and inserts must be made within three months. If the delivery takes longer than three months, then a new certifying statement must be completed.

The documentation to support the information on the certifying statement may be completed by individuals other than the MD or DO; that information will be covered below.

Policy-Specific Documentation

As stated earlier, the prescription and certifying statement alone are not enough documentation to support your claim. You must include five additional items in your documentation, or make sure they can be made available upon request.

First, the certifying physician (who must be an MD or DO) must document that the patient has diabetes mellitus, and the documented diagnosis should

match one of the more than 200 diagnoses included in the 10th Edition of the International Classification of Diseases (ICD-10) listed in the Policy Article portion of the Medicare medical policy.

Second, the certifying physician must document in the beneficiary’s medical record that the patient has one or more of the six approved secondary foot conditions (previous amputation of the other foot, or part of either foot; history of previous foot ulceration of either foot; history of preulcerative calluses of either foot; peripheral neuropathy with evidence of callus formation of either foot; foot deformity of either foot; or poor circulation in either foot).

Without the presence of a secondary condition that affects the foot, there is no need for diabetic footwear.

This documentation may be handled by the certifying physician directly, or it may be handled by someone else. For example, the diagnosis of the secondary foot condition could be made by the podiatrist ordering the shoes, or it could be made by a nurse practitioner or a physician assistant. If someone else completes the documentation of the secondary foot condition, that individual must forward a copy of the documentation to the certifying physician; and the certifying physician must review, initial, and date the records indicating his or her agreement with the findings. It is important to note that the date the certifying physician initials the documentation must be a date prior to the signing of the certifying statement, and it must be within six months prior to the initial delivery of the shoes and inserts.

Third, the certifying physician (the MD or DO), and only the certifying physician, must document that he or she is treating the patient under a comprehensive plan of care for the diabetes.

There is no one type of treatment plan, such as a restrictive diet or insulin, that is required in order for the patient to be eligible to receive diabetic shoes; the key to meet this criterion is that the physician must document that he or she has discussed the patient’s current condition and the patient’s current treatment plan, as well as the way the patient is to manage his or her diabetes.

O&P ALMANAC | MAY 2016

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inserts, the nature and severity of the deformity must be well documented in the record, and you should indicate why a prefabricated shoe would not be appropriate.

Also, if you intend to provide custom shoes or inserts, be sure to document that you took impressions, made casts, or used CAD/CAM to create your positive models.

Fifth, you must conduct and document an in-person evaluation at the time of delivery of the patient wearing the shoes, and show that the shoes fit properly. This must be an objective evaluation and cannot be solely based on subjective statements made by the patient, such as, “They fit okay,” or, “They are not too tight.” This requirement eliminates the possibility of mailing shoes to a patient, or leaving shoes with a patient in a facility (unless the patient tries them on in your presence).

Other Considerations

Remember that the therapeutic shoe benefit is for a pair of shoes, not an individual shoe. Part of the coverage criteria for a pair of therapeutic shoes is a history of partial or complete amputation of one or both feet. This means that if you have a patient who already has had a lower-limb amputation but meets the criteria for therapeutic shoes, the Medicare benefit is for a pair of shoes, including a shoe on the prosthetic side.

However, there is no medical justification for inserts or a custom shoe on the prosthetic side, so Medicare will typically only cover an off-the-shelf shoe on the prosthetic side—and you should document the need for the shoe (e.g., in order to maintain a proper gait pattern).

Also, remember that you may provide inserts for shoes you did not provide— but you must obtain a written statement from the original supplier of the shoes indicating that the shoes can accommodate therapeutic inserts, and have met the coverage criteria. Be sure to check that the patient has not already received his or her allotted inserts for the year.

In addition, the A5507 can be used to describe an unlisted modification (flared heels, spilt sizes, steel shanks, etc.) or to conduct a repair to a pair of diabetic shoes, but remember that it is in lieu of one of the two or three pairs of inserts a patient is eligible to receive. If you exceed the number of inserts or modifications a patient is able to receive in a year, the additional insert or modifications will be denied.

Finally, remember that eligibility for a new pair of therapeutic shoes under the Medicare program is governed by medical necessity, not by time. While the maximum benefit under the Medicare policy for the coverage of therapeutic shoes is one pair of shoes and inserts per calendar year, if there is no medical need to replace the shoes or inserts, Medicare will not cover it. It is extremely important to document the condition of the shoes and/or inserts you are replacing.

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

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

Earn CE credits accepted by certifying boards:

www.bocusa.org

PHOTO: iStock.com/Pamela Moore

When the documentation is completed and where the documentation occurs is very important. The documentation must be completed during an in-person visit with the patient, rather than second-hand or over the phone. Also, if the certifying physician is the person documenting the secondary foot condition, then this documentation would also be entered during this in-person visit. This in-person visit must occur within six months prior to the initial delivery of the shoes and inserts. For example, if you are set to deliver the shoes and inserts and it has been seven months since the patient last had an in-person visit with the certifying physician, you may not deliver the shoes until the patient has another in-person visit with the certifying physician.

During this in-person visit, the physician may choose to sign or complete a certifying statement; however, it is not mandatory. If the physician does not sign the statement during the in-person visit, he or she must sign it at least three months before the delivery of the shoes and inserts.

Under this requirement, the certifying physician must certify that the patient needs diabetic shoes. The need for the diabetic shoes does not have to be specifically stated in the certifying physician’s record, meaning the physician does not have to say the patient needs shoes, or that he or she is ordering the shoes. The fact that the physician has documented that the patient has diabetes and that the patient has a secondary foot condition requiring the shoes, and the fact that the physician has signed the certifying statement indicating the shoes are needed, is sufficient.

Fourth, you must conduct and document an in-person evaluation of the patient, prior to the patient selecting shoes and inserts; you must document that you took and recorded all linear measurements of the patient’s foot (this is more than simply stating that the patient is a size X) prior to the patient selecting his or her shoes. Document the abnormalities that need to be accommodated by the shoes, especially if you are providing custom shoes/inserts.

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This Just In

One Remarkable Week The AOPA Policy Forum and news surrounding the proposed LCD for lower-limb prosthetics made for several busy days in late April Rep. Renee Ellmers (R-North Carolina)

S

OME PRETTY REMARKABLE things

happened in conjunction with the AOPA Policy Forum last month. On Thursday, April 21, an AOPA-sponsored press event underscored the damage caused by the continuing controversy about the proposed Local Coverage Determination (LCD) for lower-limb prosthetics, as private-sector insurers like United HealthCare and Cigna have used the now-discredited LCD as the alleged basis for their newfound decision, unsupported by science or evidence, to deny payment for vacuum technology in prosthetic sockets. (For details on the press event, see page 11 of this issue.)

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MAY 2016 | O&P ALMANAC

On Monday, April 25, Rep. Renee Ellmers (R-North Carolina), together with Rep. Jan Schakowsky (D-Illinois), introduced H.R. 5045 (bit.ly/ellmersbill), a bill that would establish a moratorium on any action on the proposed LCD, at least through spring 2017, as well as remove the LCD from the websites of CMS and the durable medical equipment Medicare administrative contractors (DME MACs). The bill also would establish that, contrary to some legal interpretations at the U.S. Department of Health and Human Services (HHS), CMS indeed can, and is obliged to, manage and instruct its contractors, including the DME MACs, what to do across topics, including LCD issues.

On Tuesday morning, April 26, former Sen. Bob Kerrey (D-Nebraska) led a one-of-a-kind O&P LegislationWriting Congress, where AOPA Policy Forum attendees authored a simple onepage bill that would address most of the problems that are undercutting the quality of life for Medicare beneficiaries who have O&P needs. (Visit bit.ly/kerreybill to see the bill written at the Policy Forum.) Tuesday afternoon, while Policy Forum attendees were learning the ins and outs of a range of government policies and actions, Kerrey had personal meetings with eight senators to explain the new bill, discuss how some simple

steps could rectify the problems and injustices burdening Medicare beneficiaries, and emphasize how O&P professionals are committed to providing care for those patients.

On Wednesday, April 27, about 135 O&P providers and patients spent the day on Capitol Hill in more than 400 meetings with their legislators, seeking their support for the new bill and related proposed legislation—the central, indispensable exercise of citizens’ rights that is the core of every AOPA Policy Forum.

The next day, the first fruits of a months-long effort spearheaded

by AOPA appeared as the House Oversight and Government Reform Committee released a letter it has

Mark Warner (D-Virginia)

This Just In

initiated to HHS Secretary Sylvia Mathews Burwell, criticizing the prosthetic LCD efforts of CMS and its contractors, and launching an oversight inquiry with a request for a substantial collection of documents (see the letter at bit.ly/ogrletter).

It was a truly remarkable week for O&P, though there is much work that remains to be done to deliver on these needed remedies.

Legislative Needs

The O&P community needs a simple bill that would mirror the actions outlined in S. 829, the Medicare Prosthetics and Orthotics Improvement Act, introduced

by Sens. Chuck Grassley (R-Iowa) and Mark Warner (D-Virginia). Specifically, it is extremely important to address by legislation three acutely needed actions:

released today, it would be a tall order to get that done before this administration concludes on Jan. 20, 2017.

CMS needs to recognize that plans of care that include custom-fabricated prostheses and custom-fabricated and -fitted orthoses continue to be completely inappropriate for inclusion in competitive bidding, and that the standards established in the Medicare Modernization Act need to be diligently and narrowly construed and followed.

Nov. 2, 2015, by the White House and CMS that they did not intend to pursue this proposed LCD, CMS has indicated that it has appointed an Interagency Committee comprised solely of federal employees to work on this issue, though CMS has refused to identify the names of any of those appointees. A process that was deemed deficient because it was nontransparent and without stakeholder input has been replaced by another process that is not transparent, and which offers no assurance or method for stakeholder input.

Assure that CMS shall treat prosthetics and orthotics (P&O) separately from durable medical equipment (DME) and shall amend its regulations to define orthotics and prosthetics as a covered service, separate and distinct from the provision of DME. Assure that CMS shall enforce Section 427 of the Benefit Improvement and Protection Act (BIPA) through issuance of federal regulations and only reimburse custom P&O care upon receipt of proof that an appropriately credentialed prosthetist/ orthotist—licensed and/or certified— has clinical notes and documentation sufficient to determine that the P&O care being provided to a patient is a medically necessary plan of care that is corroborated solely by a signed physician prescription. All such documentation is considered part of the patient’s medical record for purposes of determining the medical necessity of P&O care. A rule to implement Section 427 is 16 years overdue. We know that CMS will say that the first proposal ever to implement this provision is poised for release, but even if true, what counts is a fair rule in the form of a final rule on the books; even if this proposal were

Administrative and Legal Action Required

CMS should rescind the LCD. Last month, the House Oversight and Government Reform Committee, in bipartisan action, initiated oversight activities on this topic via a substantial request to the HHS Secretary for documents on this issue. It seems broadly recognized that the proposal issued jointly by the four DME MACs in July 2015 suffered from at least three serious shortcomings: • The draft LCD was developed via a process that was not transparent.

• The process of preparing the draft LCD did not assure or include any stakeholder input.

• There was little, if any, bona fide scientific evidence to support the proposed actions.

In the six months since the contemporaneous announcements on

CMS needs to rescind the July 2015 LCD; have it removed from all websites from entities supported by government funds; and assert that CMS does have the authority to manage all aspects of LCDs and other activities by all of its contractors, including the DME MACs. If CMS cannot accomplish these steps, H.R. 5045, a moratorium on this LCD, needs to be enacted into law to fix this horrendous problem hampering some of our most vulnerable citizens—patients who suffer from either limb loss or chronic limb impairment.

Finally, there continue to be indications that a proposed rule to implement BIPA 427 may be released soon for comments by CMS. The week of the 2016 Policy Forum was a special week, though we can’t rest for a minute on these interim accomplishments. We need to drive hard to the finish line.

O&P ALMANAC | MAY 2016

21

COVER STORY

sustainable

outreach

A look at several O&P humanitarian efforts that go beyond individual patients to educate local practitioners and foster ongoing care in underdeveloped countries

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COVER STORY

Need To Know:

By MEGHAN HOLOHAN

• Many practitioners take part in humanitarian efforts designed to provide O&P care and products to individuals in underdeveloped countries or regions where natural disasters have struck.

• Prosthetists and orthotists involved in such efforts take a long-term view when restoring mobility to the individuals they fit with new devices, and try to introduce prostheses that will be sustainable yet highly functional.

• Nonprofit organizations such as USISPO train local practitioners to continue O&P care for amputees after new clinics have been set up and U.S. practitioners return home.

• Some U.S. practitioners return to the same clinics on a semi-regular basis to follow up with patients, train students, and check in with local health-care providers.

• While most O&P practitioners cite a sense of gratification from providing care for O&P patients, those who are involved in humanitarian efforts say that being able to impact people in great need makes their work feel more fulfilling.

W

HEN ISIS STARTED TAKING

over the Syrian border city of Kobani in 2014, then 17-year-old Maksim and his friend knew they had to flee to nearby Turkey for safety. As they neared the border with dozens of other refugees, ISIS fighters began shelling the civilians. The two teens were so close to the country they could see the Turkish soldiers when artillery hit them. Maksim’s friend died, but the soldiers pulled a badly injured Maksim into Turkey. Although the soldiers saved his life, surgeons could not save his left arm, which they amputated below the shoulder.

Prosthetists, doctors, and therapists at Dicle University Medical Center in Diyarbakir felt strongly that Maksim needed a prosthetic arm. Because of his age, they hoped that a new limb would help him as he continued to recover physically and mentally.

Maksim and his parents insisted on a myoelectric arm; they felt that an advanced prosthesis would offer him the best future.

When John Burger, MS, CPO, a volunteer with Physicians for Peace, met Maksim in February, the prosthetist worried about providing the young man with a myoelectric arm. He thought that it would be too difficult to train Maksim to use such an advanced device in such a short period of time. And, what would the young man do if he experienced problems with the device and needed an adjustment? Because Burger—co-manager and partner at New England Orthotic & Prosthetic Systems in Middlebury, Connecticut— only stays in Turkey for a few weeks each visit, he had limited time to fit and adjust the arm. Few health-care professionals in Turkey are familiar with the advanced upper-limb devices, and leaving Maksim with only several weeks of training could lead to problems.

“I was hesitant to suggest something like that because of the expense, and if there are other issues, three, five years down the road, it would be easier to take care of the problem” with a less advanced device, Burger says.

O&P ALMANAC | MAY 2016

23

COVER STORY

PHOTO: John Burger, MS, CPO

In 2014, Maksim lost his arm while fleeing Syria to escape ISIS.

He warned Maksim that it would take a lot of training to learn to use the prosthesis. Yet every time he stressed the work required to properly use the myoelectric arm, Maksim insisted he could do it. “He said, ‘I am ready. I will do whatever I have to do,’” Burger says.

The pieces soon fell into place.

A nonprofit religious organization, Antioch Network, raised money for the device. Burger also decided to relocate to Turkey to work at the clinic and help with the Syrian refugee crisis. He would be able to oversee Maksim’s progress and to teach other local clinicians and students to work with myoelectric arms. Because the clinic’s leaders feared that Maksim’s situation could set an unrealistic precedent of offering the most innovative prostheses, they decided that future patients needed to pay out of pocket for advanced devices.

With those problems addressed, Burger began to envision how Maksim’s new prosthesis and care would affect his life. Sure, it would help the young man manage daily tasks and perhaps enable him to get a job.

But more importantly, having a fully functioning arm will help Maksim during his mental recovery from his escape from ISIS and adjustment to a new life. “I think it is going to be a tremendous boost for his overall morale and mental status,” Burger says.

Diyarbakir, Turkey

Before he left Diyarbakir in February, Burger casted Maksim’s arm with the help of students from the clinic. He will be returning to Turkey in May with the new myoelectric arm and elbow, fulfilling Maksim’s dream of an advanced prosthesis.

Postcrisis Care

Burger has worked off and on in Turkey since 2000, when he helped Physicians for Peace found the Dicle University O&P clinic in Diyarbakir.

He visited the clinic regularly, helping 24

MAY 2016 | O&P ALMANAC

with complicated fittings and training students and staff as part of continuing education efforts. In 2013 he took some time off, but he returned this year because he wanted to help the people fleeing Syria. During that time, Burger watched the need for prostheses and orthoses in the region increase greatly—no doubt due, in part, to the conflict there.

“We’re trying to come up with a plan where we can make the university hospital a focal point for rehabilitation and get the word out,” he says. “If there are amputees in other parts of the country or other refugee camps, [we’d] get them to come for a week or so.”

During Burger’s absence from Turkey between 2013 and 2016, the clinic did not flourish as much as he would have liked.

The government provided health care for all of its citizens but excluded university hospitals from coverage. Anyone who visited a university-affiliated hospital had to pay for all of his or her treatment out of pocket.

This represents a common problem faced by prosthetists and orthotists who found clinics in countries hit by natural disaster or conflict: After the visiting clinicians leave, the government struggles to support the clinic and continued development of the professional staff.

Allen Ingersoll, CPO, knows this all too well. After the Haitian earthquake in 2010, he worked in the country off and on for five years, supporting Healing Hands for Haiti. Although the clinic still exists, it might be more successful with increased government support. “In Haiti, the government has not been able to take over rehabilitation like they should have or could have,” says Ingersoll, who serves as chair of education for the U.S. National Member Society of the International Society for Prosthetics and Orthotics (USISPO).

Part of the reason why governments struggle to take over the clinics is that the countries already had great need prior to the conflict or disaster. Most of the organizations that aid in these regions, however, strive to develop the internal capacity and skills of the clinicians in the area.

COVER STORY

Sustainability and Follow-Up

Ingersoll—who has been living in Gaza for the past year because his wife works for Catholic Relief Services— volunteers at the Artificial Limb and Polio Center helping students train for their classes. Because Gaza is experiencing a blockade, nonprofits’ work to educate students and clinicians remains essential. “It is extremely important and one of the few areas where people see there is hope. They see they are giving back. It … builds a capacity,” he says.

Jon Batzdorff, CPO, says building local skills in areas where O&P humanitarian efforts are initiated ensures that care continues after an organization moves to another area. Batzdorff has overseen many O&P relief efforts in his positions as chair of USISPO and founder and president of ProsthetiKa, a nonprofit corporation that fits amputees, sets up on-site training sessions in underdeveloped regions, and responds to natural disasters by providing appropriate assistance.

When working in a new location, 26

MAY 2016 | O&P ALMANAC

“we try to identify who is currently doing the prosthetic work and the kind of help they need to meet the local needs,” says Batzdorff. “We make sure that the initiation has come from the local prosthetists. We are not coming in with a package.”

After helping with Haiti's earthquake recovery, ProsthetiKa has been working in Ukraine during its conflict with Russia. Ukraine has numerous prosthetists, but many of them lack experience fitting upper-limb prostheses and complex lower-limb prostheses. Many of ProsthetiKa’s patients once saw Russian prosthetists for care.

Batzdorff and his team are currently developing a program to better educate the professionals to handle these complicated cases. The team visits once a year, fitting some patients and educating the O&P professionals. “We are not [providing] a basic education.

It’s all experienced prosthetists we are working with,” he says.

Batzdorff visited Kiev in 2015 and Lviv in 2016. He was excited to see that some of the professionals and patients

he worked during his initial visit sought the volunteers out for followup consultations and education during his second trip to the area.

“They were coming back to show us what they had done. In addition to seeing new amputees, we did follow-ups to see how they were doing,” he says.

“We verified the sustainability of what we were doing. It continued from one year to the next.”

It helps organizations when people they once worked with return—their feedback helps the organizations shape the training programs. Their input provides the nonprofits with an idea of what worked, what didn’t, and what needs still exist in the community. The short-term programs help the nonprofits establish more permanent responses.

“One approach is to help them to establish their own school,” says Batzdorff. Sometimes ProsthetiKa helps volunteers in other countries put together a proposal for an O&P school. “That is a long-term solution,” Batzdorff says.

PHOTOS: Allen Ingersoll, CPO

Allen Ingersoll, CPO, works with students in the Artifical Limb and Polio Center in Gaza to prepare them for careers in O&P.

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COVER STORY

(Left) Sarah Don, CPO, and Holly Olszewski, CPO, with inventory at the ARSOBO Nogales, Mexico, clinic

A boy in ARSOBO's Nogales, Mexico, clinic shows off his new leg

Enriching Lives

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MAY 2016 | O&P ALMANAC

PHOTOS: Sarah Don, CPO

prosthesis to get going. That was eyeopening for us.”

While providing care in overseas If residents of Nogales wanted to conflict areas remains important, volsee a prosthetist, they had to travel up unteers are meeting O&P patient-care to four hours to receive treatment. But needs closer to home, as well. many of them cannot make the long, Mexico has experienced skyrockexpensive trip. Instead, some amputees eting rates of diabetes in the last rely on crutches or wheelchairs, or decade. The International Diabetes even fashion their own devices so they Federation estimates there were more can manage the steep, rocky terrain of than 11 million cases of diabetes in the area. One prosthetist saw a limb the country in 2015. It accounts for made of cans and shoes. While this a large percentage of the nation’s makeshift limb helped improve the amputees, explain Sarah Don, CPO, individual’s mobility, it certainly was and Holly Olszewski, CPO. Both work not comfortable. for Hanger Clinic in Tucson, Arizona, Fortunately, the and volunteer with the ARSOBO clinic helps Arizona Sonora Border people where they Project for Inclusion live. Because Don and (ARSOBO). Every two Olszewski visit so fremonths, they visit the city of Nogales to fit people quently, they’re able to folwith prostheses. low up with their patients, “When we started the providing some continuity very first clinic, we had of care. While the steady no idea what we were demand for prosthetic going to see,” says Don. devices, and the ongoing The pair quickly learned backlog of people who A patient's selfthat almost none of the need care, can at times feel constructed prosthesis clinic visitors had ever discouraging, seeing the made of cans, seen a prosthetist, “and success stories keeps Don wood, and a shoe everyone needed a full and Olszewski motivated.

COVER STORY

PHOTO: Sarah Don, CPO

Olszewski, for example, has been working with a young woman who lost both of her legs above the knee and most of her fingers because of a severe infection. Before meeting Olszewski, the woman relied on her mother for care, barely able to complete day-to-day activities. Today, she’s applying to college and hopes to live on her own. “It is great to see her progress, and I’m so happy to provide her devices to help her with her life,” says Olszewski. “[I] put feet and knees under her and [she’s] walking taller and taller, and it’s really neat to see all of the progress she’s made.”

While most orthotists and prosthetists cite a sense of gratification from providing care for O&P patients, those who are involved in humanitarian efforts say that being able to impact people in great need makes their work feel more fulfilling.

“I have been involved for probably 15 years in ISPO, and it’s enriched

my professional life tremendously,” says Batzdorff. “The exciting thing about prosthetics is participating in the transition of new amputees,” who often feel a sense of loss and fear, then are fit with prostheses and become more comfortable with themselves.

Burger agrees. He feels fortunate and enjoys sharing his knowledge with people in other nations who want the additional education and experience.

“Taking a week and sharing a level of education… they appreciate that so much,” he says. “They don’t want us to stay there forever, but they want to train. They want people to be able to be self-sustaining.”

Meghan Holohan is a contributing writer to O&P Almanac. Reach her at meghan.e.holohan@gmail.com.

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By CHRISTINE UMBRELL

Build r u o Following

Y

Expand your digital marketing efforts to attract referral sources, patients, and media coverage

NEED TO KNOW: As today’s health-care consumers turn to their computers and smartphones to research medical issues and find health-care providers, many O&P facilities are developing digital marketing strategies to promote their services.

Consider your audience when deciding which social media platforms to post to. Some facilities have found that intentional, regular posting on Facebook can draw business, while Twitter can be useful for branding news and following industry experts.

A facility’s website can significantly influence a consumer’s decision to call for an appointment.

In addition to mobile-friendly design and useful content, the website should have a high search engine optimization value by featuring keywords that win favor with Google and other search engines.

Blogs provide a space for a facility to demonstrate its expertise, offer valuable information, and create engaging, keyword-rich content that will elevate the website’s status in search engines.

Some facilities may benefit from investing in search engine marketing, or SEM—purchasing ads that appear on the result pages of search engines (such as Google) to capture the interest of web browsers.

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MAY 2016 | O&P ALMANAC

The most important rule when establishing a digital marketing campaign is to realize you can’t do it all, says one expert. Choose the platforms that will best meet your goals, and create a manageable marketing plan that can be carried out by either in-house staff or outside consultants.

R

ECENT STUDIES INDICATE THAT

PHOTO: iStock.com/Erik Khalitov

today’s consumers are turning to their computers, tablets, and smartphones to find health-care providers.

More than 40 percent of consumers say that information found via social media affects the way they deal with their health, and 77 percent of online health-care consumers began their last session at a search engine such as Google, Bing, or Yahoo, according to Pew Internet Research. Young adults are even more swayed by e-health information: Ninety percent of 18- to 24-year-olds say they trust medical information shared by others on their social media networks, according to PwC Health Research Institute.

Some O&P facilities are meeting the demand for online medical information head-on by building mobile-friendly websites, joining social media platforms such as Facebook and Instagram, writing content-rich blogs, and creating facility-specific apps. But others have dedicated fewer resources to these ventures and continue to rely on traditional marketing efforts such as print ads, in-services with referral sources, and conventional word-ofmouth advertising. While old-school marketing methods remain instrumental in drawing business to O&P facilities, future growth and profitability will depend on a more diverse marketing strategy that incorporates an increased digital presence.

Whether your facility has a dedicated marketing staffer, spreads marketing responsibilities throughout several employees, or outsources marketing, now is a good time to re-evaluate your digital marketing strategy and determine how you can increase your online presence and build a social media following.

Setting a Strategy

O&P facilities, with a focus on returning people of all ages to their activities of daily living, are perfectly positioned to share inspirational stories online, says Christina

Throndson, web marketing director for VGM Forbin, a company that designs websites and web applications for health-care companies.

“O&P professionals do amazing things, but often don’t want to selfpromote,” says Throndson. In an increasingly digital world, “it’s OK to share what your facility is doing and to let your community know about you,” she says. Websites and electronic resources should be leveraged to educate and show referral sources, current and potential patients, and even media contacts “the good that you’re doing,” says Throndson. “Give tips, offer do-ityourself suggestions, and share what you’re doing in the community. Give information to help people that will build up their trust in you.”

To ensure you are meeting the online needs of the patient bases in your community, begin by developing a digital marketing strategy to determine what you want to accomplish. Look at the demographics of your patient base, plus the characteristics of the patients you hope to attract. For example, are you

looking to catch the eye of young, athletic patients, who may be searching for high-tech O&P devices on social media? Or are you better positioned to focus on diabetics, who may benefit from a page on your website dedicated to educational resources about healthy eating and foot care?

Christina Throndson

You also should consider whether your digital marketing campaigns should be targeted toward patients, referral sources, or the local community—or some combination of all three.

Once you have a focus, examine the different areas where you can increase your online visibility, take a look at the different social media platforms, and decide how to maximize your staff time and resources to boost your outreach efforts.

O&P ALMANAC | MAY 2016

31

Search Engine Marketing T

AKING ADVANTAGE OF “FREE” social media channels can be a great way to post content and increase awareness of an O&P facility. In addition, many O&P facilities may profit from harnessing the power of search engine marketing (SEM)—purchasing ads that appear on the result pages of search engines (such as Google) to capture those web browsers who may benefit from your facility’s services.

By advertising with Google and other search engines, your ads will appear above or below Google search results or as image advertisements on popular affiliate websites.

“Don’t forget to utilize the tools available within the advertising platform to target your audience based on previous engagement, audience behavior, interaction, and location. These are all tactics that can help provide the biggest bang for your buck,” says Christina Throndson, web marketing director for VGM Forbin, a company that designs

websites and web applications for health-care companies. “For a small facility, it’s actually one of the best investments your company can make.”

Pay-per-click advertising can take the form of paid ads through Google Adwords, Facebook Local Awareness Ads, and others.

These can range from $0.30 per click with Adwords, to $1 per day with Facebook.

“I’m a big fan of SEM and focusing on who your audience is, and where they are online and geographically,” says Throndson. She suggests finding ways to re-engage users that have been to your site, started to engage on a form, and left: “Stay in front of them and catch their attention before they move on to a different site.”

Throndson also encourages O&P business owners to make sure they have claimed and own directory listings for their companies, such as those included on Yelp and Google (My Business Listing). Assign staff to monitor company reviews on these types of sites: “It’s not just making sure you have good reviews, but making sure you respond to all reviews—the good, the bad, and the indifferent,” she says.

Building a Better Website

One of the first communications tools to review when upgrading your digital marketing efforts is your website. A website is a window to your facility, and often, the content found there significantly influences a consumer’s decision to call for an appointment.

Your website should appeal to your particular audience and provide easy access to the information you want them to know once they are engaged, says Throndson. “Ask yourself, ‘If I push my audience to my site for more information, does my site allow them to do or find what they need to accomplish my goals?’” For example, your site should feature highly visible contact and location information. Throndson also 32

MAY 2016 | O&P ALMANAC

suggests finding a way to measure your goals, such as call tracking or online analytics for conversions and interactions.

Your website should be designed to have a high search engine optimization (SEO) value. To encourage SEO performance, strategically place the most commonly searched keywords relevant to your facility throughout your site, so they win favor with Google and other

search engines. These search engines rank pages based on two primary metrics: authority (a measure of how many people share or link back to your content) and relevancy (a measure of how well you create content that relates to the keywords users type into search engines). A high Google ranking means more browsers will be led to your website.

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Reach Orthotic & Prosthetic Services (OPS), with four locations in Virginia, recently redesigned its website to appeal to a wider audience. “With the power and ease of the Internet, many people are doing a lot of research and discovery on their own,” says Anne Sych, the company’s marketing coordinator. “Health-care services are no different. Patients and physicians alike want to learn about the practices and clinicians that will be serving them. We want to make it easy for them to learn about Reach OPS when making these decisions.”

Anne Sych

Reach’s new Wordpress site has a built-in blog tool and is mobilefriendly, says Sych. It features, among other sections, a patient resource area with educational materials and a dedicated section for referral sources “to help them understand the best way to refer services and manage timelines for their patients,” she says.

While larger companies such as Ability Prosthetics & Orthotics (P&O) Inc., a 10-location facility based on the East Coast, benefit from hosting a

dynamic website that features patient information, news and events, resources, and outcomes research, even small facilities can see an increased return on investment with a significant web presence. Sunshine Prosthetics and Orthotics in Wayne, New Jersey, is a solo facility with a dynamic website, complete with educational information and biweekly blog posts. Owner Brooke Artesi, CPO, LPO, manages a spectrum of digital marketing efforts by outsourcing this work to a freelancer. She credits her vibrant website with attracting new customers and educating existing patients. “I get a lot of comments, even from older patients, that it’s very easy to navigate,” she says.

When determining whether it’s time for a website revamp at your facility website, keep in mind that it’s becoming increasingly important for sites to be mobile-friendly. For your O&P facility to receive maximum visibility in terms of SEO, your website should translate well to all mobile devices, which means text should be large, links should be easy to access, and you should never have to scroll sideways to see all of the content. “In April of 2015, Google announced an update focusing on mobile design, and even more mobilefocused updates have been made

Your website should

Brooke Artesi, CPO, LPO

since,” says Throndson. “If your site is not meeting the mobile standard, besides proving a poor experience for your mobile visitors, you are most likely also experiencing a drop in your search rankings.” Throndson suggests running a test to see if Google deems your website “mobile-friendly” by visiting goo.gl/A1uLBR.

Social Media Strategies

While a dynamic website is the centerpiece to a digital marketing strategy, it’s important to tie social media into the plan and consider posting to Facebook, Twitter, Instagram, or other platforms. Social media is a critical component when marketing to young adults: Those in the 18- to 24-year-old age group are more than twice as likely as 45- to 54-year-olds to use social media for health-related discussions, according to Allied Health Worlds.

Increasing numbers of adults of all ages, including seniors, however, are embracing these platforms.

Keep your message and your audience in mind when determining which platforms to focus on. “Your social media efforts should be based on where the audience is engaging,” says Throndson.

be designed to have a

high search engine optimization (SEO) value.

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MAY 2016 | O&P ALMANAC

Katie Kolcun

At Ability P&O, Katie Kolcun, the facility’s marketing specialist, works closely with the company’s chief executive officer and founder, Jeffrey Brandt, CPO, to post information on several platforms. Because Facebook is the company’s best-received platform, Ability posts as often as three times a day to “very interactive patients and referral sources,” says Kolcun.

Facebook allows for long, text-heavy

posts as well as pictures, so “it’s great for telling a patient story with a really nice photo, or sharing all company news,” she says.

Kolcun says Ability’s dedication to Facebook has been a boon to business: “We’ve had patients go to their providers and ask their physicians to refer them to us because they’ve seen how we use the most advanced and innovative prosthetic and orthotic devices.”

Facebook also has been a success story at Reach OPS: Last year, Reach quadrupled its Facebook page “likes” through “intentional, regular posting,” says Sych. She and other staff post to Facebook three to four times each week, with messages of curated industry news, motivational messaging (which may include a stock image with a quote and subtle logo), and staff and activities pictures, says Sych. In addition, Reach occasionally posts pictures of patients wearing new technology—if the patients have signed media consent forms, in compliance with guidelines mandated by the Health Insurance Portability and Accountability Act. Beyond Facebook, there are several social media options that may work for O&P facilities. Ability P&O posts to Instagram and Twitter two or three times a week. “Twitter is great for branding news and networking,” says Kolcun. “The more you interact and stick to your brand, the more your posts go viral,” she says.

At Reach, Sych posts “newsworthy” content on Twitter, mainly using it “to follow our vendors and industry experts to see what’s new in the O&P world.” Reach also has a Pinterest page, where “there is not a ton of activity, but we think it’s a good idea to be found there,” says Sych. The page has three boards: one for prosthetic news, one “About Reach” board with photos, and one board featuring encouraging quotes.

Sych notes that social media is a great way for an O&P facility to connect with the community: “O&P is a niche market. People do not need us until they need us,” she says. “When they do, we want them to be familiar with the Reach name. Social media

Last year, Reach

quadrupled its Facebook page “likes” through “intentional, regular posting.

—Anne Sych

helps us to engage with our community and likewise helps people become familiar with our services.”

Reach’s social media efforts have been particularly well received by patients who frequent the facility’s Chesapeake location—located near a military hospital. “Younger soldiers use social media more and are more familiar with the O&P technology available now,” says Sych. “They see it on Facebook, and they want to know more about it.”

Benefits of Blogging

Some O&P facilities are finding their audiences appreciate fresh content via regularly posted blogs. Blogs provide a space for a facility to demonstrate its expertise, offer valuable information to gain trust and loyalty, and create engaging content that can be re-shared via social media and email. Just as important, blogs provide a place to feature keyword-rich content that will elevate the website’s status in search engines such as Google.

At Sunshine O&P, Artesi sees blogging as a vital component of her marketing plan. The facility’s website features biweekly posts on an “Inspirations Blog,” which often focus on O&P patients who are positive role models, as well as news about the facility and staff.

Similarly, the blog at Reach OPS is an “Ask the Clinician” resource.

“Anyone can submit questions from the website. The blog also is a great way for people to ‘meet’ our clinical staff,” says Sych. “Not only are you sharing your expertise with the world, but the search engines reward fresh content, so your visibility on the World Wide Web improves.” Sych admits that blogging can be a challenge for many organizations due to the time commitment required for developing fresh content, but she has been able to drive

O&P ALMANAC | MAY 2016

35

Reach’s blogging effort by involving several staff practitioners and setting a schedule: “It is better to start with a manageable content calendar and grow from there; otherwise, it can be overwhelming. If you can get four staff to write one blog post per month each, you will have weekly posting. Getting everyone on board is essential to blogging success.”

Interest in Apps

With smartphones becoming a musthave for most Americans, the use of apps continues to grow. Statistics indicate that 19 percent of smartphone owners have at least one health app on their phone, according to research

by Demi & Cooper Advertising and DC Interactive Group. A few O&P

businesses have taken advantage of this trend by developing facility-specific apps that appeal to both referral sources and patients.

Ability P&O recently debuted an app that features instructions for devices, a facility locator, Ability’s quarterly Lifenhanced publication, and information about company events and courses, says Kolcun. “Ability practitioners, or referrals, can use the app to educate patients or send a device recommendation form, and patients can learn about their options prior to their initial Ability evaluation,” she says.

Did You Know?

A

NOTHER IMPORTANT ELEMENT to consider when forming a digital marketing strategy is the latest Web Content Accessibility Guidelines, which are enforced by the Department of Justice

for publicly held companies and will become the standard for private companies as soon as 2017 or 2018. These guidelines specify how to make content accessible, primarily for people with disabilities, but also for all user agents, including devices such as mobile phones. Forbin, a company that designs website and web applications for health-care companies, is currently working on tools businesses can use to test their site for compliance and to strategize how to become compliant, says Christina Throndson, the company’s web marketing director.

Hanger Clinic also recently created an O&P mobile reference app that features, among other things, searchable O&P device information, including photos and descriptions, and a “findthe-nearest” Hanger Clinic location function.

No “One-Size-Fits-All” Approach

Many practitioners acknowledge that digital outreach efforts may never be accessed by significant segments of the O&P population, such as older Medicare patients. But it has become increasingly important to promote O&P facilities in a way that captures the attention of e-health seekers.

Artesi, for example, has patients who have never seen her website—but her more tech-savvy clients and colleagues appreciate the information she posts on social media. In addition, having a technology-heavy presence helps support her standing as a “stateof-the-art facility.”

For those facilities that cannot hire a full-time staffer or outsource marketing entirely, there are ways to split up the tasks among current employees. “If you can’t get a dedicated marketing person, create a manageable marketing plan you can delegate and manage in-house,” says Sych. “Pick one or two social media channels you think your patients will enjoy.”

The most important rule when establishing a digital marketing campaign is to realize you can’t do it all, says Throndson. There are simply too many platforms available, so pick-andchoose those that will help meet your goals: “Do you want prospects? Do you want brand awareness? Or do you want people to know about a new location?

Once you figure out your goal, you can decide which platform will work best.”

Expanding your digital marketing plan should be an integral component of your facility’s long-term strategy. “Your partners and your competition are all investing in digital marketing,” says Sych.

“It has become a necessity.”

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

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MAY 2016 | O&P ALMANAC

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Buckner Prosthetics & Orthotics

Measured Growth Mississippi facility expands staff to meet growing—and varied—patient needs

M

ARTIN BUCKNER, CPO, founded Buckner Prosthet-

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MAY 2016 | O&P ALMANAC

Stephen Singleton, CP, works with a patient.

FACILITY: Buckner Prosthetics & Orthotics OWNERS: Stephen Singleton, CP, and Zachary Myrick, CPO LOCATION: Jackson, Mississippi, with a satellite office in Hattiesburg, Mississippi HISTORY: 22 years

Buckner P&O's mobile unit

rooms, two rooms for casting, and administrative areas. “Mr. Buckner designed the building,” says Singleton, “and we are blessed to be in a great location, near hospitals and referral sources.”

Buckner’s satellite office in Hattiesburg, Mississippi, has a lab for modifications and adjustments, but primary fabrication facilities remain in Jackson. The practice uses both traditional fabrication techniques and computer-aided design.

The practice provides a full range of orthotic and prosthetic services, including a large proportion of upper-extremity work.

Two clinicians, Rick Psonak, MS, CPO, FAAOP, and Richard Boleware, BSIE, CP, specialize in arm and hand prostheses, and their reputations are so sound, says Myrick, “we get patients from out of state who gladly travel for upper-extremity care.”

Buckner P&O also uses a mobile unit to serve hospitals and patients who can’t make it in to one of its offices.

As the facility has grown, its patients have become more

varied, including traumatic and vascular amputees, as well as geriatric and pediatric orthotic patients. The facility gained approval from the National Commission on Orthotic and Prosthetic Education for a residency program two years ago, and its first resident just completed his boards.

“We enjoy the teaching aspect,” says Myrick, “not just with residents, but also doing educational presentations to the entire health team to make sure everyone understands the expected standard.”

In fact, much of Buckner P&O’s marketing efforts focus on educating fellow health-care specialists on the orthotics and prosthetics profession. “We consider ourselves part of the treatment team,” says Myrick.

“And I believe what distinguishes us is that we take a team approach right from the start.

When we meet a new amputee or an orthotic patient, we reach out to the doctor and the physical therapist and plan an educational in-service.”

Myrick and Singleton believe that offering pro bono care is an important part of their business.

They often contribute fitting and fabrication time in collaboration with Limbs for Life, which provides donated components to those who cannot afford them.

Looking ahead, neither owner has specific plans for expansion— yet. “We never intended to get this big, this fast,” says Myrick.

“Our goal continues to be to provide timely, consistently great patient care. It sounds simple, but that’s our business model, and we’ll see where it takes us. And if we find more people with a real passion for patient care, we may have a spot for them.”

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

PHOTOS: Buckner Prosthetics & Orthotics

ics & Orthotics (P&O) in 1994 in Jackson, Mississippi. Three years ago, two of his clinicians, Stephen Singleton, CP, and Zachary Myrick, CPO, purchased the business, and they haven’t looked back.

“Three years ago, it was just me and my partner and a very minimal staff,” says Myrick. “Today we have 14 people working as a team.” These include five clinicians, technicians, administrative staff, and a marketing/public relations specialist.

Myrick and Singleton are brothers-in-law. Singleton spent most of his life in Jackson and, after starting a prosthetic clinic for a vascular surgery group in Texas, he decided to move back to Mississippi to be closer to family.

Myrick, who served as an O&P resident in Fresno, California, and then Birmingham, Alabama, joined Singleton soon after. They both admired Buckner—“a cool, kind, compassionate man with a diehard following,” says Myrick— and were delighted to continue his particular style of care. Myrick and Singleton both worked their way through school in the service industry, and they take great pride in keeping that mentality with respect to patient care.

“Even though we’ve grown the business considerably, we’ve stayed true to Mr. Buckner’s slogan, ‘technology with a human touch,’” Myrick adds.

The Jackson facility occupies a 6,000-square-foot space, of which half is dedicated to in-house fabrication. The other half includes six patient-care rooms, two gait

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European Influences Belgium-based companies partner to offer 3D-printed orthotic insoles

I

N 2014, TWO BELGIAN

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MAY 2016 | O&P ALMANAC

An orthotics specialist uses the footscan software to guide patients through analysis and design of Phits insoles.

Footscan analysis protocol: static scan (left) and dynamic scan (right)

COMPANY: RS Print BRAND NAME: Phits Orthotics OWNERS: Joint venture of RSscan and Materialise LOCATIONS: Beringen, Belgium, and Plymouth, Michigan HISTORY: Two years Ultralightweight 3D-printed structure of Phits insoles

stiffness to add flexibility or rigidity intrinsically to specific areas of the insole without increasing its depth or weight.

“Traditional manufactured orthotics use different materials or add thickness to the orthotics, which doesn’t necessarily have a functional impact,” says Tom Peeters, head of marketing at the company’s Belgian headquarters.

“You start with a base, and then add on to make it stiffer or more flexible. With Phits, we can control that density in the base itself and fine-tune different areas without having to use additional materials,” he says. “And because we control the lasts, Phits can go in athletic shoes, dress shoes, and women’s shoes. There’s no ‘one size fits most.’ These are completely customized for the individual and the shoe.”

Phits products also are designed for endurance. “You can compare these to carbon fiber in terms of durability,” says Peeters. The company offers

PHOTOS: RS Print

companies—RSscan, which specializes in dynamic gait analysis systems, and Materialise, a 3D-printing company—joined forces to launch a new venture.

RS Print, based in Belgium, but with a U.S. manufacturing site in Plymouth, Michigan, creates customized 3D-printed orthotic insoles called Phits Orthotics.

RS Print uses data from its proprietary Dynamic Footscan software to generate the insoles, unlike other companies that use static or dynamic scans primarily as a diagnostic tool, says Blake Norquist, CO, OT, director of North American sales and business development.

“We use a gait analysis plate to capture anatomical differences in the foot during the gait cycle,” he says. “When someone just stands on a pad or crush box, you only get a static view of the foot. But when someone walks or runs, additional pressures and moments, like supination and pronation, appear.”

The scan provides a risk analysis for patients, noting any existing problems as well as identifying areas of the foot that are at risk for injury, based on the way they are walking or running.

Even with scanning technology, physical casts or impressions of the foot must typically be sent to the manufacturer. RS Print uses a cloud-based system, which means practitioners can upload scan results from anywhere to order Phits and receive them within two weeks.

The 3D-printing process, which uses nylon powder, allows RS Print to modify directional

a two-year guarantee on the insoles and says most are still useful after three years.

RS Print seeks to increase the involvement of trained professionals in the process of fitting insoles, and a large part of Norquist’s role in the United States is to develop relationships with orthotic clinicians, physicians, and hospitals.

The company also has a strong interest in research. A 2010 study looked at an earlier 3D-printed orthotic insole produced by RS Scan. Four hundred British military officer trainees were identified as high, medium, or low risk for sustaining an injury, based on readings obtained from a pressure plate during walking.

Random trainees from each risk category were fitted with the insoles, and all groups were reassessed after seven weeks.

Only 25 percent of the high-risk group using the insoles suffered an overuse injury, compared to 60 percent of the control group. The study, published in the American Journal of Sports Medicine, identified a positive, preventive role of orthotics inserts. A new study using Phits is now underway, says Peeters.

The company may be young, but it already is expanding, with orders coming in from 15 countries on four continents, printing facilities in Belgium and the United States, and additional printing sites planned worldwide. “In our short time in the States, we have made a direct impact in the medical realm as we have partnered with Walter Reed and Johns Hopkins hospitals and professional sports organizations,” says Norquist.

Judging by the success so far of their joint venture, you could say that RSscan and Materialise are a good fit.

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

At last, an insurance program

you’ll feel good about.

AOPA’S INSURANCE PROGRAM— Practitioners trust us most because we know your business and we know insurance unlike any other program.

Call Cailor Fleming today and we’ll gladly customize a specific plan for you.

We’ve been a trusted insurance company for years, let our experience and lasting service speak for itself.

800-796-8495 http://cailorfleming.com/OandP.asp

An Endorsed Member of AOPA

PROFESSIONAL LIABILITY | GENERAL LIABILITY | PROPERTY

| AUTO | UMBRELLA | WORKERS COMP & MORE

AOPA NEWS

When Things Go Wrong: Making Lemonade Out of Lemons Register for the May 11 Webinar

Physician Documentation: How To Get It & How To Use It Register for the June 8 Webinar Learn to make lemonade out of lemons and earn 1.5 credits during the hour-long webinar on May 11. AOPA experts will be on hand to explain how to handle the following situations: • When a patient refuses an item/service • When a patient returns an item • When you have a disgruntled patient • Other instances when things don’t go as planned AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line.

Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2016webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

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

42

MAY 2016 | O&P ALMANAC

Join AOPA experts for the June 8 webinar, and learn important details about physician documentation: • Learn how to obtain the required documentation from your referral sources.

• Learn how physician documentation can augment your claims.

• Learn how to use physician documentation in your appeals process.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent.

Register at bit.ly/2016webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

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

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR

SAN ANTONIO

EARN

JUNE 13-14 | 2016

AOPA Coding Experts Are Coming to San Antonio Grand Hyatt San Antonio, 600 East Market Street, San Antonio, TX 78205 The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The June 13-14 Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of O&P practitioners and billing staff.

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

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

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

14 CEs

Top 10 reasons to attend: 1.

Get your claims paid.

2.

Increase your company’s bottom line.

3.

Stay up-to-date on billing Medicare.

4.

Code complex devices

5.

Earn 14 CE credits.

6.

Learn about audit updates.

7.

Overturn denials.

8.

Submit your specific questions ahead of time.

9.

Advance your career.

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

Find the best practices to help you manage your business.

Participate in the 2016 Coding & Billing Seminar!

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

www.AOPAnet.org

WELCOME NEW MEMBERS

T

Austin Prosthetic Center Inc. 5656 Bee Caves Road, Ste. G200 Austin, TX 78746 512/937-9310 Patient-Care Facility Tracey Russ

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

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

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

Coapt LLC 222 W. Ontario Street, Ste. 220 Chicago, IL 60654 844/262-7800 Supplier Level 1 Blair Lock

Is Your Facility Celebrating a Special Milestone in 2016?

Standard Cyborg 715 Bryant Street San Francisco, CA 94107 844/429-2674 Supplier Level 1 Garrett Spiegel Westlake Orthotics and Prosthetics 360 Sherman Street, Ste. 160 St. Paul MN 55102 651/291-9000 Patient-Care Facility Holly Westlake

Mile High Orthotics Lab Inc. 4970 Monaco Street Commerce City, CO 80022 303/289-1534 Supplier Level 1 Erica Jamieson

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

EXTRAORDINARILY SIGNIFICANT FINDINGS: Medicare data proves the economic value of an O&P intervention.

O&P CARE is COST EFFECTIVE The Study that Started MobilitySaves.org

5

Reasons to visit MobilitySaves.org

Learn about the study proving orthotic and prosthetic care saves money

1.

Find ads and videos on Medicare’ costcutting to share on your website or social media

A major study, commissioned by the Amputee Coalition with support from the American Orthotic & Prosthetic Association, shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. Mobility Saves Lives And Money!

See healthy lives affected

by O&P care

2.

Follow us on social media!

MAY 2016 | O&P ALMANAC

3.

Visit MobilitySaves.org.

“Search Mobility Saves” on Facebook, Twitter, and LinkedIn

44

Find resources to share with your patients

4.

Learn how much Medicare has saved this year by providing O&P care

5.

MARKETPLACE New AFO Gauntlets From Acor!

A custom ankle-foot orthosis (AFO) gauntlet is prescribed to assist in stability and allow functional mobility without demanding excessive energy. For 2016, Acor is offering our refined-design AFO gauntlets hand-made in our Cleveland, Ohio, facility.

Also known as a “leather lacer” and our most popular AFO gauntlet, the G9110 offers a choice of color, polypro reinforcement, and a leather or optional X-Static®covered NeoSponge™ lining.

See our ad on page 33 of this issue for information regarding our new Custom Products catalog or just call Acor at 800/2372267 to get a copy.

ALPS Superior Performance Liner The Superior Performance (SP) liner features a new black fabric that allows for additional comfort and stability for active patients.

This liner is formulated with both ALPS GripGel and High-Density Gel, which contain properties that help facilitate donning as well as reduce pistoning and bunching behind the knee. The SP liner provides superior comfort and diversity and is offered in 3-mm and 6-mm uniform thickness to accommodate most users.

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

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

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

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

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

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

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

O&P ALMANAC | MAY 2016

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/aopamedia for advertising options.

The K Is Silent. The Style Is Loud and Clear.

New Knits For Spring From Apex.

The Apex FitLite™ Collections—the Men’s Bolt and the Women’s Breeze—are the ultimate in eye-catching, vibrant knit athletics. Featuring consummate style, superior comfort, and industryleading construction, each pair is meticulously crafted with the highest quality materials and designed for agility and ultimate durability.

For our new catalog or to place an order, call Apex Foot Health Industries at 800/252-2739 or visit our website at www.apexfoot.com.

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

The positive lock of the stance control activates up to 35 degrees of flexion. Unlike single-axis knees, there is no need to shorten the pylon, which produces undue strain on the lower spine. All of the above, combined with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K2 patients.

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

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

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

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

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

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

46

MAY 2016 | O&P ALMANAC

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

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

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

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

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

• So safe it can ship overnight.

• The “no smell” resin.

• Ultralight, ultrastrong, and ultrathin.

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

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

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

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

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

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

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

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

Contact Martin Bionics at 844/MBIONIC.

3S80 Fitness The 3S80 Fitness forms a strong, dynamic combination with the 1E90 Sprinter carbon spring foot, providing high-energy return.

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

Touch Bionics Unveils App Control and Apple Watch Compatibility!

Bikini Socket—One Third the Size, One Third the Weight, Three Times the Comfort Instead of encapsulating the pelvis with a bucket, our patented, lightweight Bikini Socket and Iliac Crest Stabilizers provide a direct biomechanical link between the device and its user, resulting in superior control, comfort, and functional outcomes.

Fitting a hip or hemipelvectomy level has never been so simple.

The Bikini Socket Hammock Casting Stand allows you to microadjust the socket shape using our NASA-based mesh fabric hammock—eliminating point-specific ischial loading and providing an ultra-comfortable hammock fit. The casting shape becomes the final socket shape. It’s that simple.

View the free Bikini Socket Hammock Casting Stand training at MartinBionics.com. Contact Martin Bionics at 844/MBIONIC.

Triton Smart Ankle The Triton smart ankle lives up to its name: With 34 degrees range of motion, this microprocessor ankle responds to changes in terrain and speed.

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

• Tap the screen for quick grips™ • Change selected quick grips™ using my i-limb™ app • Compatible with all i-limb™ hands manufactured after June 2013.

For more information, contact Touch Bionics at 855-MYiLimb or visit www.touchbionics.com.

Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry.

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

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

O&P ALMANAC | MAY 2016

47

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Northeast

Job location key:

ABC/BOC Orthotic Fitter

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

Upbeat practitioners need only apply.

Please apply by email: Email: mgpolab@gmail.com

- 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

CPO/BOCPO

Louisville, Kentucky At Center for Orthotic & Prosthetic Care (COPC), our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, New York, and Pennsylvania. Due to an opening at one of our patient-care facilities in Louisville, Kentucky, we are seeking a CPO, or Kentucky-licensed BOCPO, with a minimum of five years’ clinical experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest-quality patient care. This position offers a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your résumé, in confidence, to:

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

Mid-Atlantic

MAY 2016 | O&P ALMANAC

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

CAREERS

Pacific

Pacific

CPO

ABC-Certified Practitioners Wanted!

Tri-Cities, Washington Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for patient-care products and services. With the heart of the company dedicated to helping and serving others, we are currently seeking a certified prosthetist/orthotist that is a seasoned practitioner with experience in clinical expertise in outpatient and inpatient settings, organization and maintenance of an O&P facility, fabrication, fitting, and a willingness to work within a dynamic team. This position is an excellent opportunity for a candidate who is self-driven/ motivated with an entrepreneurial spirit that is focused on market growth. Competitive salary, benefits, and profit sharing offered based on experience. Interested candidates should email inquiries/résumé to:

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

We are seeking CPOs and CPeds to be a part of our team, providing patient-centered care with expert knowledge and compassion. Bilingual applicants are encouraged to apply.

We offer a competitive salary and benefits including paid vacation and holidays, medical, dental, and 401k.

Send résumé to:

Pacific Medical Prosthetics and Orthotics Email: careers@pacmedical.com Fax: 209/834-0690

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

ADVERTISERS INDEX

Company

Page Phone

Website

ABCOP - American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc.

39

703-886-7114

www.abcop.org

ACOR Orthopedics Inc.

33

800-237-2276

www.acor.com

ALPS South LLC

9

800-574-5426

www.easyliner.com

Amfit

19

800-356-3668

www.amfit.com

BCP Group

37

615-550-8774

www.bcpgroup.com

Cailor Fleming Insurance

41

800-796-8495

www.cailorfleming.com

DAW

1

800-252-2828

www.daw-usa.com

Hersco

2

800-301-8275

www.hersco.com

Martin Bionics

25

844-BIONICS

www.martinbionics.com

OHI - Apex

5

877-780-8382

www.ohi.net

Ottobock

C4

800-328-4058

www.professionals.otobockus.com

ROMP

C3

Touch Bionics Spinal Technology

www.rompglobal.org

7

855-694-5462

www.touchbionics.com

27

800-253-7868

www.spinaltech.com O&P ALMANAC | MAY 2016

49

CALENDAR June 1

2016 May 9-14

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

ABC: Practitioner Residency Completion Deadline for July & August 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.

June 8

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

Webinar Conference

May 11

When Things Go Wrong: Making Lemonade Out of Lemons. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

June 9-10

MOPA: Michigan Continuing Education Meeting.

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

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

May 11- 13

New York State Chapter Annual Meeting. Albany Marriott, Albany, NY. For information, email Marx4NYSAAOP@aol.com, or visit www.NYSAAOP.org.

May 19-20

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

May 19-21

International African-American Prosthetic & Orthotic Coalition.

Memphis, TN. For more information, visit www.iaapoc.org.

June 13-14

AOPA Mastering Medicare: Essential Coding & Billing Techniques Seminar.

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

Seminar

June 23-24

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

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

www.bocusa.org

Calendar Rates Let us

SHARE

your next event!

50

MAY 2016 | O&P ALMANAC

Online Training Cascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free ABC-approved online courses, designed for pediatric practitioners. Visit www.cascadedafo.com or call 800/848-7332.

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

Questions? Email landerson@AOPAnet.org.

CREDITS

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

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

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR June 24-25

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

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

September 14

Fill in the Blanks: Know Your Forms.

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

Webinar Conference

July 1

ABC: Application Deadline for Certification Exams.

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

October 12

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

Webinar Conference

July 13

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

November 9

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

Webinar Conference

August 4-6

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

December 14

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

Webinar Conference

August 10

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

Webinar Conference

August 11-12

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

August 12-13

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

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

August 18-20

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

September 8-11

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

Ottobock 360˚ Education and Events

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

O&P ALMANAC | MAY 2016

51

ASK AOPA CALENDAR

Proper PODs Compliance questions for proof of delivery forms

T

HERE HAS BEEN some

confusion concerning the type of information that must be included on a proof of delivery (POD) form in order to be considered valid by Medicare. To determine the required information, you must examine two sources of information: the Medicare Program Integrity Manual (PIM) and the durable medical equipment Medicare administrative contractors (DME MACs).

The PIM provides the groundwork and outlines the Medicare requirements, and the DME MACs interpret, clarify, and enforce the rules and requirements laid out in the PIM. This month’s Ask AOPA examines the requirements for a POD, based on the information found in these two resources.

AOPA receives hundreds Q 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.

52

MAY 2016 | O&P ALMANAC

Q/

Whose name should be listed on the POD?

The PIM and the DME MACs agree that the POD must include the beneficiary’s name, or the name of the person who will be receiving and using the orthoses and/or prostheses. You don’t need to include the beneficiary’s Medicare number, but it is a good idea to make sure the beneficiary’s name on the POD matches the name on the Medicare identification card.

A/

Q/

What address should be used as the delivery address?

The address listed on the POD should be the address where the item is being delivered and where the patient is taking possession of the orthosis or prosthesis. If the item is delivered in your office, then your office address should be listed on the POD. If the item is delivered at the patient’s home, the patient’s address should be listed.

A/

What type of information should be used to provide a “sufficiently detailed description”?

Q/

According to the PIM, “suppliers are encouraged to include as much information as necessary to adequately describe the delivered item.” This description could be a narrative; the PIM now states the official Health-Care Common Procedure Coding System (HCPCS) code descriptor may be used as a means to provide a detailed description, or a brand name and model number, or a

A/

brand name and serial number, or a manufacturer name and part number.

In essence, you have a choice, and either option is acceptable and would not result in a denial of a claim due to an invalid POD. You could simply use the Medicare L-codes and descriptors, or you may provide the manufacturer information (make, brand name, model number, etc.).

What date do I enter as the delivery date, and does the patient have to enter the delivery date?

Q/

The delivery date, or the date the item was delivered to the patient or the date of service, under most circumstances, will be the date that the item was received by the patient. The delivery date can be pre-entered on the POD by you, or may be entered by the patient. However, if you entered the date and the patient enters a date on the POD, most likely when he or she signs the POD, then the date entered by the patient is considered the date of service.

A/

Q/

Does the patient have to sign and date the POD?

Yes and no. The patient or his or her representative must sign the POD; however, the POD delivery date is not required to be personally filled in by the patient.

A/

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

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

Support relief efforts by donating the following: •

Feet (pediatric and sizes 21-26)

•

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

•

Liners (all sizes and types, preferably new)

•

Knees (functional, all types)

•

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

•

Prosthetic socks (all sizes, new socks only)

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

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

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

It’s almost here

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