November 2013 Almanac by AOPA

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O&P NOVEMBER 2013, VOLUME 62, No. 11

CONTENTS Photo: Angie Wong, British Columbia Institute of Technology

Cover Story

20 Best Foot Forward

A recent study by Silvia Raschke, PhD, and a team of researchers concluded via objective measurements that amputees prefer more flexible energy-storing prostheses. This study is just the beginning of a new generation of research that will be used to support treatment choices, as payers and consumers demand solid data on the performance and cost-effectiveness of prosthetic devices.

Feature Photo: Catherine Marinoff, Marinoff Design LLC

26 Common Ground

More than 2,500 professionals and 200 exhibiting companies from 43 countries gathered at the AOPA World Congress in Orlando, Florida, September 18-21, to partake in expert clinical education, live learning demonstrations, a mock audit session, critical discussions regarding health-care reform and global health policies, and more.

SPecial Feature departments

AOPA Contact Page How to reach staff

At a Glance Statistics and O&P data

COLUMN

Reimbursement Page Follow these tips for documenting a valid proof of delivery form

42 2013 Foot Buyers’ Guide The 2013 Foot Buyers’ Guide features all of the products and services you need to meet your patients’ diverse needs.

In the News Research, updates, and company announcements

50 Jobs

AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

52 Calendar

40 AOPA Membership 00 Applications

Opportunities for O&P professionals

Upcoming meetings and events

Ad Index

AOPA Answers Expert answers to your FAQs

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; 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. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

NOVEMBER 2013 O&P Almanac

AOPA IN THE Contact NEWS INFORMATION 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 EXECUTIVE OFFICES

MEMBERSHIP & Meetings

Officers

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

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org

President Tom Kirk, PhD, Member of Hanger Inc. Board Austin, TX

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

Kelly Oâ&#x20AC;&#x2122;Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org

President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI

O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, manager of membership services, 571/4310843, landerson@AOPAnet.org Betty Leppin, project manager, 571/431-0876, bleppin@AOPAnet.org AOPA Bookstore: 571/431-0865 Government affairs

Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com

Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org

Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org

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

Lia K. Dangelico, contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com

Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

directors Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA Scott Schneider, Ottobock, Minneapolis, MN Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Ă&#x2013;ssur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT Eileen Levis, Orthologix, LLC, Trevose, PA Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI

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

O&P Almanac

Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com

Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales M.J. Mrvica Associates Inc. Design & Production Marinoff Design LLC Printing Dartmouth Printing Company BOARD oF DIRECTORS

Copyright 2013 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the 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.

O&P Almanac NOVEMBER 2013

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AT IN THE A GLANCE NEWS

Pedorthics in the United States As of October 2013, eleven states have enacted pedorthic licensure requirements that support the unique needs of each state and its consumers and practitioners.

NJ*

TN AR AL

*In New Jersey, pedorthic licensure is not required, but pedorthists can obtain a voluntary limited orthotics license, or otherwise must be ABC certified to practice pedorthics.

Sources: American Board for Certification in Orthotics, Prosthetics, & Pedorthics, and Board of Certification/Accreditation.

Number of NCOPEaccredited pedorthic education programs.

2,767

Number of ABC-certified pedorthists in good standing as of September 2013.

249 www.bocusa.org

Number of BOC pedortists as of October 2013.

115,000 miles

Distance traveled by the average person by foot in a lifetime.

1950s

Decade during which the pedorthics field emerged.

10,000 Average number of steps each person takes daily.

Sources: American Board for Certification in Orthotics, Prosthetics, & Pedorthics; Board of Certification/Accreditation; www.pedorthicfoundation.org; www.foot.com. 6

O&P Almanac NOVEMBER 2013

IN THE NEWS

Pedorthic Shoe Store Staff Eligible for Scholarship Funds The Pedorthic Foundation has established the Heather Moore Bernard Memorial Scholarship Fund in memory of Heather Moore Bernard, who served as vice president of operations at The PSNE Group, and passed away unexpectedly on Nov. 17, 2011. In celebration of Bernard’s life as a prominent partner in her family’s pedorthic business and a lifelong friend of the pedorthic profession, the Foundation created the scholarship fund to assist persons who work in pedorthic shoe stores with education and training. Bernard worked at The PSNE Group, a pedorthic shoe business founded in 1974 by her father, Jim Moore, C.Ped, who also serves as president of the Pedorthic Foundation’s board of directors. She spent many hours in the Group’s original store growing up, helping wherever she was needed, and continued to work for the company in adulthood. When Bernard passed away in her sleep while recovering from

ankle surgery, she was in the process of taking over the day-to-day and buying operations of the company. The Heather Moore Bernard Scholarship Fund was established soon after Bernard’s death, and contributions have been made by dozens of individuals and companies in her memory.

Scholarship Details The Heather Moore Bernard Scholarship Fund will be used to support students who are working in a pedorthic shoe store for academic classes and/or completing pedorthic continuing education requirements. Potential scholarship applicants must meet the following requirements: • Must be 18 years or older, legal U.S. resident, and high school graduate or equivalent • Must work in a pedorthic shoe store (but does not need to be a credentialed pedorthist) • Must explain why the course/program will benefit their work in a pedorthic shoe store • Must submit two letters of recommendation from nonrelated parties. Scholarship applications must be received at least 60 days prior to the requested event. Recipients will be announced and notified within 30 days of receipt of complete application or earlier. To apply for a scholarship or to donate to the fund, visit http://pedorthicfoundation.org/hmb/.

Scientists Explore Movement in Insects Without Muscles Prosthetic limb technology could see advances triggered by research on insects that move without muscles. In the July issue of Current Biology, neurobiologists from the University of Leicester showed that some insects, such as grasshoppers, move without muscles by controlling their movements using interplay of

O&P Almanac NOVEMBER 2013

neuronal control and biomechanical tricks, according to lead researcher Thomas Matheson. The structure of some insect leg joints causes their legs to move using “passive joint forces” that return the limbs back to a resting position. The researchers believe the insects use a motor control scheme for their joints

in which not all movements are driven by muscles. “We hope that our work on locusts and grasshoppers will spur a new understanding of how limbs work and can be controlled, by not just insects, but by other animals, people, and even robots,” says Matheson.

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IN THE NEWS

Study: Custom Orthoses Prevent Reulceration in Diabetic Patients Custom orthoses reduce plantar pressures and prevent subsequent ulcers in patients with diabetes, according to a study published in the July/August issue of Journal of the American Podiatric Medical Association. Maria Luz Gonzalez Fernandez, PhD, and her colleagues at the Universidad Complutense de Madrid in Spain assessed the efficacy of custom orthoses by comparing reulceration rates, minor amputation rates, and work and daily living activities in 117 patients with diabetes before and after therapy. The researchers followed the patients, who were prescribed therapeutic insoles and footwear, for two years, and compared their peak plantar pressures and peak plantar impulses when wearing and not wearing their prescribed footwear. All of the patients had a history of foot ulcers but had not undergone orthotic treatment prior to the study. With orthotic intervention, reculceration rates decreased from 79 percent to 15 percent, and amputation rates decreased from 54 percent to 6 percent. The findings support the theory that custom foot orthoses are effective in reducing peak plantar pressures in patients with diabetes as well as facilitating healing of existing ulcerations.

Researchers Explore Brain, Neuromuscular Signal Coordination for Prosthetic Control Researchers from North Carolina State University (NC State) and the University of Houston are developing technology to allow amputees to control their prosthetic legs by picking up the neuromuscular control signals from residual muscles in the stumps of their amputated limbs. “Our goal is to improve mobility for people using prosthetics, lay the groundwork for a new generation of prosthetic devices, and improve our understanding of how brain signals and neuromuscular signals are coordinated,” says Helen Huang, lead researcher and an associate professor of biomedical engineering at NC State and the University of North Carolina. The research is being funded by a four-year, $1.2 million grant from the National Science Foundation. The goal of the project is to improve the connection between the prosthesis and the person using it, by reading

O&P Almanac NOVEMBER 2013

the nerve signals in the stump of the amputated limb. Huang is leading a team that will be using sensors to pick up the neuromuscular control signals from residual muscles in the area where a prosthesis is connected to its user. Huang hopes to develop an algorithm that translates those neuromuscular signals into machine language that will control the powered prosthesis, making it easier

for the user to move seamlessly from standing up, to walking across the room, to climbing stairs. The research team also plans to build a prototype power prosthesis that incorporates the new technology. This aspect of the research builds on Huang’s previous experience in designing and fabricating power prostheses. Jose Pepe Contreras-Vidal, who is serving as co-lead principal investigator with Huang, will be exploring ways to use neurological signals from the brain to control prosthetic legs. This research will be useful for amputees who have little or no residual muscle in the area of the missing limb. In such patients, signals picked up directly from the brain may be able to control the devices. “Ultimately, we’d like to combine both approaches, using signals from the muscles and the brain to provide better control of lower-body prosthetics,” says Huang.

IN THE NEWS

Mark Your Calendar for the Winter Games The 2014 Paralympic Winter Games will take place March 7-16 at five athletic venues in Sochi, Russia. The competition is expected to be the biggest Winter Paralympics yet, with approximately 700 athletes from 45 nations scheduled to participate. Athletes will compete in five sports: alpine skiing, biathlon, cross-country skiing, ice sledge hockey, and wheelchair curling. Alpine skiing is the largest sport in the Paralympic Games, and includes four disciplines: downhill slalom, giant slalom, super-giant, and—new this year—standing snowboard cross (parasnowboarding). The new standing snowboard event will only have one division: lower-limb impairments. Several U.S. amputees are looking forward to participating in this new event. The Games will feature 72 medal events (34 men, 34 women, and four mixed). U.S. Paralympians will attempt to defend the Gold medal they won in ice sledge hockey in 2010. During the 2010 Vancouver Games, the U.S. came home with four Gold medals, five Silver medals, and four Bronze medals. This is the first time Russia has hosted the Paralympics, and more than 45 hours of coverage will be broadcast from Sochi. The top priority for the host country has been the creation of a barrier-free environment, ensuring roads and buildings constructed for the Games are accessible. The Sochi 2014 Paralympic Torch Relay, to take place February 26 through March 7, will pass through all eight of Russia’s federal districts. Mascots for the Games are The Ray of Light and The Snowflake, created with the principles of the Paralympic movement in mind; they convey the strength of spirit and the will to win. More information about the upcoming Paralympics can be found at www. paralympic.org and www.sochi2014.com/en/games/sport/paralympic-games/.

TRANSITIONS

people in the news

Advanced Anatomical Design LLC has hired Teresa K. Masters, CPO, LPO. Ryan Blanck, CPO, has joined the Hanger Clinic team and will treat patients throughout the greater Seattle region. Blanck, who invented the Intrepid Dynamic Exoskeletal Orthosis (IDEO) while at Brooke Army Medical Center, also will serve as the national IDEO program director.

O&P Almanac NOVEMBER 2013

Scott Williamson, president of Quality Outcomes, and Seamus Kennedy, C.Ped, a partner at Hersco Ortho Labs, have been elected to the Pedorthic Foundation’s board of directors.

Jurisdiction D DME MAC Announces Prepayment Review for L5981 Noridian Healthcare Solutions, the Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor (DME MAC), has announced the implementation of a focused, widespread prepayment review of claims for prosthetic feet described by L5981. According to Noridian, the need for the review has been identified through Comprehensive Error Rate Testing review results as well as previous review results. In the wake of this announcement, it is important for all O&P practitioners to respond to any additional documentation requests from the DME MACs. Failure to respond results in automatic denial and contributes to the error rate that will justify the continuation of the prepayment review. For details about Noridian’s announcement, visit www.noridianmedicare.com.

BUSINESS in the news The Orthotic & Prosthetic Activities Foundation held its inaugural FirstFit clinic in Kissimmee, Florida, in September.

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Reimbursement Page By Devon Bernard, AOPA government affairs department

Providing Valid Proof of Delivery Ensure reimbursement and avoid denials by submitting this important documentation

t has become commonplace to read and hear about all of the Medicare audits and reviews taking place, and most everyone is aware that Medicare is reporting high error ratesâ&#x20AC;&#x201D;in some cases almost 100 percent. Some of the causes for these high error rates are beyond the control of the facility providing care; however, some of the more common and higher denial rate reasons in the pre-payment reviews can be controlled by the facility. With a review of the Medicare policy, you may be able to avoid some of these common denial reasons. To ensure you are obtaining valid orders/prescriptions, here is a quick recap of the five key components of a detailed written order (DWO), the document that allows you to bill Medicare, which was covered in the September 2013 Reimbursement Page column. The first and second components of a valid DWO are the name of the patient and the name of the ordering physician. Third, the DWO must include the date of the order (the date you were contacted by the physician) or the date you started treating the patient if this date is

O&P Almanac NOVEMBER 2013

different from the date you were contacted by the physician. The fourth element of a valid Medicare DWO is the detailed description of the items or services you are providing and intend to bill, including the quantities of items being provided. This detailed description can be accomplished using one of three techniques: by simply listing the name, manufacturer, and model number of the item you are providing; by providing a narrative description of the item(s) you are providing; or by listing all of the Healthcare Common Procedure Coding System codes and their descriptors. The fifth and final component of a valid written order is the legible signature of the ordering physician and the date he or she signed the DWO. For Medicare purposes, a valid signatureâ&#x20AC;&#x201D;either electronic or pen and inkâ&#x20AC;&#x201D;must be legible or able to be authenticated. The other error rate that can be controlled by the O&P provider and facility is completing a proof of delivery form for every item and service (for example, adjustments or repairs) provided, and completing the form in a way that will be deemed valid or satisfactory for Medicare purposes. In the last Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor pre-payment review for lower-limb prostheses, 15 percent of the denied claims were due to providers not providing a proof of delivery or providing an incomplete proof of delivery. These recent results showed a 62 percent overall error rate, the lowest to date, and a 28 percent decrease since the reviews started in 2012. So, if this overall rate decreased by an additional 15 percent, maybe the rate would have been low enough to end the pre-payment reviews for lower-limb prostheses.

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Reimbursement Page

If the DWO contains information on the items/services we are providing and intend to bill for, why do we also need a delivery slip or other types of proof of delivery? The simple answer is because policy and the supplier standards—standard number 12 in particular, which you must adhere to in order to keep your Medicare supplier number—say you have to have a signed delivery slip on file. The other reason you are required to have a proof of delivery on file is because it is a tool for Medicare, its contractors, and your patients to match what was ordered to what was provided and what was billed. It also will verify that the patient has received and is now in possession of the items, which means you may bill Medicare for the items/services rendered. In other words, by examining your proof of delivery and other pieces of

pertinent documentation (for example, your DWO and your claim), Medicare should be able to determine that you have correctly coded and billed the items you provided and that the patient actually received the items that were billed. By not submitting a proof of delivery or by submitting an invalid proof of delivery, Medicare will assume that you did not provide what you billed for or that the patient never received any items or services for which you submitted a claim, so all of the items/services will be denied. Therefore, it is vital that you always submit some form of proof of delivery and that the proof of delivery is valid by Medicare standards, not only because it will possibly keep your claim from being denied, but it also can possibly help avoid bigger problems, like Office of the Inspector General-imposed sanctions.

Delivery Slip Key Components What is considered a valid proof of delivery will depend on the method by which you choose to deliver items to your patients. There are two main methods of delivering items to patients. The first is the direct method, which is the most common and involves delivering the item directly and personally to the patient in an office, clinic, facility, home, etc. The second is using a shipping service and mailing the items to the patient. If you choose to deliver the items using the direct method, the best way to demonstrate proof of delivery is to create a delivery slip for the patient to sign. In order to be considered valid by Medicare, the delivery slip must contain five core components, and these key components mirror the key components of a DWO, with some slight changes. First, the delivery slip must contain the patient’s name. It is a good idea when entering or adding the patient’s name to the delivery slip to make sure that the name matches what is listed on the patient’s Medicare ID card. This

O&P Almanac NOVEMBER 2013

way everything is consistent and limits the possibility of confusion or a mix-up. Second, the delivery slip must contain a delivery address, and this address must not be confused with the place of service. The delivery address that appears on the delivery slip must match the physical address of where the items/services were rendered. For example, if the items were delivered in your office, the delivery address would be your office, but if you delivered the items at the patient’s home then the delivery address would be the patient’s home.

Proof of delivery...is a tool for Medicare, its contractors, and your patients to match what was ordered to what was provided and what was billed. The third core component is the detailed description of the items or services being provided, including the quantities of items being provided. This detailed description may be achieved in one of two ways: first, listing the brand name, model number, serial number, manufacturer, etc., of the item you are providing; and second, providing a narrative description of the item you are providing. With the DWO, you have the third way of providing a detailed description, allowing you to list all of the L codes and their descriptors. This method is not always the best option when you are creating a delivery slip because of the patient. Know your audience: A doctor should be able to understand the technical and anatomical phrases in the L-code descriptors, but not all of your patients will understand the jargon, so keep the descriptions plain and use everyday

language. In other words, the patient should be able to look at the delivery slip and at the item/service he or she is receiving and say, “Yes. That is what I got.” The patient should not have any reason to avoid signing the delivery slip. Next, a valid delivery slip must contain the date the items were delivered, the date that the patient actually took possession of the items, or the date the services were rendered. This also will become the date of service you use when you are completing your billing forms. Keep in mind that the majority of the time your date of delivery will be your date of service, but there are some instances when your date of service will not match your date of delivery. The best example would be when you are billing using the two-day rule. With the two-day rule, your delivery date remains the date you delivered the item, but your date of service/billing date will be the date of discharge, or two days after your delivery date.

The last component of a valid delivery slip is the patient’s signature and date of the signature. The date of signature on the delivery slip must be the date that the item was received by the patient; the date cannot be pre- or post-dated. As with other Medicare documents, the signature must be legible, but there is a little more leeway in what constitutes a legible signature. If you simply note the name of the patient on the delivery slip, type his or her name below the signature line, or handwrite the name on the slip, the signature is then authenticated and is considered valid and legible.

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Reimbursement Page

If the patient is unable to sign the delivery slip, you may find someone to sign on the patient’s behalf, a designee. This designee may be a family member, a floor nurse, a family friend, etc. The only people that may not sign the delivery slip on behalf of the patient is anyone who has a financial stake in the claim, so neither you nor anyone from your company may sign the delivery slip. If you are using a designee, there are some extra steps you should take. First, it is not required but it may be a good idea to document in your records why the patient was unable to sign the delivery slip. Second, you will want to document the relationship the designee has to the patient, and you may want to include this quick description on the delivery slip. It also is a good idea to have the designee print his or her name on the delivery slip as well, so that you are 100 percent sure of the name of the person who signed the slip.

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NOVEMBER 2013 O&P Almanac

Reimbursement Page

Proof of Delivery (POD) Requirements Items delivered by mail (What should be on file)

Items delivered in-person (What should be on the POD)

 Patient’s name

 Delivery address

 Delivery address (location where the item(s) were delivered)

 Tracking number AND supplier invoice

 Detailed description of the item(s), including quantities

 Detailed description of the item(s),

 Date delivered

 Date delivered (shipping date)

 Beneficiary or representative signature and date

number

including quantities

 Evidence of delivery Those are the core components of a delivery slip, but you may add additional information to your delivery slips. For example, you may include information that indicates that the patient has received proper care and use instructions and that the patient was fine with the items at the time of delivery. You also may add a copy of the supplier standards to your delivery slip if you wish. As long as those key components remain, then your delivery slips is still considered valid.

Shipping Guidelines If you choose to use a shipping service like UPS, FedEx, or USPS, the proof of delivery documentation must be a complete and thorough picture of the items provided, plus it must contain a record tracking the items from your facility to their final destination. An example of acceptable proof of delivery if using a shipping service would include both your in-house shipping invoice and the delivery service’s tracking information/invoice. For a shipping invoice or proof of delivery to be considered valid it must contain six key components, one more than if you deliver the items directly to the patient.

O&P Almanac NOVEMBER 2013

Four of the components are identical to the components of a delivery slip and they include: the patient’s name, the delivery address (in this case the address where you are shipping the items), a detailed description of the items being shipped including quantities, and a delivery date (in this case the date the items were shipped). This shipping date also is the date you use as your date of service when billing. The last two components are unique to this method of delivery. First, you must include and record the shipping company’s tracking number along with your own supplier invoice number, if you use invoice numbers. There has to be something on file that connects your delivery invoice with the delivery company’s records. Lastly, you must record evidence of delivery. This could be an email confirmation sent by the shipping company, a printed copy of the signature from the shipping company’s website, or a returned certification of delivery (just like a certified letter). So this means that you must stay on top of your outgoing shipments and be sure you are updating the patient’s record as the items are delivered. That is one extra step that can be easily overlooked.

Lastly, the Medicare A manual, supplier manuals, and the Medicare policies draw a unique distinction and require more documentation when delivering an item to a patient who is in a nursing facility. Whether you are delivering the item directly to the patient or shipping the item to a patient in the facility, there must be documentation from the facility indicating that the items delivered to the patient were received by the patient and are being used by the patient. This documentation is on top of the five key components of an in-person delivery or the six components of a mailed delivery. This additional documentation doesn’t need to be in your files before you submit your claim, but it must be available upon request. For more information on proof of delivery requirements, read your supplier manuals, the Medicare medical policies, and Medicare’s “Program Integrity Manual” (Chapter 4 Section 26 and Chapter 5 Section 8). a Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.

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COVER STORY

Best Foot

Forward New research uses objective measurements to show that amputees walk more steps, more safely, with greater flexibility when using energy-saving prosthetic feet

he demand for solid evidence to back up medical care decisions has never been greater. Payers and the public alike want data that demonstrates the performance and cost-effectiveness of treatment choices. The field of prosthetics and orthotics has been a little late to the party, but solid research studies in O&P are beginning to offer the kind of information that can guide clinicians and payers to the most appropriate choices. As a new generation enters the field, Silvia Raschke, PhD, project leader at the British Columbia Institute of Technology (BCIT), believes that research will play an increasingly important role in substantiating treatment decisions in orthotics and prosthetics. Raschke herself recently completed a study that may lead to more informed choices of prosthetic feet. Research she presented at the AOPA World Congress in Orlando in September sought to find objective performance data to help support the choice of a particular prosthetic foot for a particular patient. The study was funded by AOPA and led by Raschke. The paper also received the 2013 Thranhardt Lecture award. The study was truly international, in the sense that patients were recruited and participated in the study at the BCIT facility in British Columbia as well in Seattle, where a portion of the study took place with the assistance of Michael Orendurff, PhD.

NOVEMBER 2013 O&P Almanac

Stiffer feet, such as those made of carbon fiber, have Photo: Angie Wong, British Columbia Institute of Technology

more energy return. When users step on them with greater force, that force is returned as the toe is lifted, helping the user propel forward.

Behind the Research Timing is sometimes everything. And the study, while already underway, unfortunately was not completed by the time the controversial 2011 report by Inspector General Daniel Levinson questioned billing practices for prostheses, says Orendurff. “The report shocked a lot of people, policy makers, and prosthetists. It was based on a number of assumptions that were not very well founded,” he says. “But it was partly our fault for not providing enough evidence. The medical world demands published results of efficacy.” The Office of Inspector General (OIG) report, in turn, inspired the plethora of Recovery Audit Contractor audits, challenging prosthetic care. In truth, a leading factor in higher costs for prosthetic feet was new technologies that arose in the context of the Iraq/

O&P Almanac NOVEMBER 2013

Afghanistan wars and translated into better results at patient-care levels for ordinary citizens. Had the results of Raschke’s study been available in late 2011, O&P would have been much better equipped to rebut the unfounded assumptions of the OIG report. Another driving factor, notes Raschke, is the patient—one who is far better informed and demanding than ever before. “Patients pick up all kind of information on the Internet and come in with high expectations,” she says. “A lot more people are questioning their physicians, prosthetists, and therapists, saying, ‘Show me, prove it to me.’” Raschke was intrigued by the request for proposal issued by AOPA, but until about a week before the deadline, she didn’t realize how valuable blending gait lab analysis with new measurement tools for activities of daily living, or ADL, fit together to meet the needs of a research study. BCIT offered prosthetists and a clinical setting. At AOPA’s request, Orthocare Innovations agreed to provide in-kind support via the company’s Galileo system, which collects patient activity data in the community, and Europa, which provides real-time information about forces placed on the prosthetic foot as it is used. These systems enable

prosthetists to capture information about the amputee’s behavior and the performance of the prosthesis in the real world, rather than in an artificial clinical setting. The resulting grant proposal was, “an appropriate and rigorous experiment” that benefitted from the different proficiencies and approaches offered by multiple tools and settings for measurements.

Collecting the Data Twelve transtibial amputees volunteered to participate in the trial. Researchers began by using Orthocare’s Galileo monitor to measure the functional level of each amputee wearing his or her prescribed foot. Researchers established a baseline profile of the prescribed foot using force data collected by Europa (installed at the base of the prosthetic socket), portions of the prosthetics evaluation questionnaire (PEQ), and self-reporting by each subject. Each patient’s prosthetic limb was fit with a quick-swap component to enable easy replacement of the foot. Depending on their K-level, or functional ability, subjects tested three to six prosthetic feet, all of which were built to the same alignment, height, and orientation as their original prescribed foot.

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“Patients pick up all kind of information on the Internet and come in with high expectations. A lot more people are questioning their physicians, prosthetists, and therapists, saying, ‘Show me, prove it to me.’” —Silvia Raschke, PhD

O&P Almanac NOVEMBER 2013

Not every subject wore every design and those who were more functional could try more feet in the lab and in the community. The team didn’t want to make the lower K-levels use upperlevel prostheses and they worked with statisticians to ensure they had the right number of samples and steps for each person. A major innovation was figuring out how to “blind” the feet, to make sure that neither the amputee nor the researcher knew which foot they were using. Ultimately, the team solved the problem by using two different prosthetists. The first chose the appropriate number and levels of feet for each individual, based on his or her K-level and using criteria memorialized by AOPA’s “Foot Project Report” to determine the degree of forefoot energy and energy return in each foot. Once that prosthetist selected the feet, he covered each with a black sock zip-tied to the pylon to obscure its make and model. The second prosthetist worked with the subjects, swapping out the disguised prostheses during testing in the lab and for community-wear tests. The premise was that blinding researchers and prosthetists is as important as blinding patients. Even

Photo: Angie Wong, British Columbia Institute of Technology

Researchers made sure both prosthesists and patients were “blind” to which foot they were using.

when unintended, bias can have an effect on outcomes, as patients may sense a preference by the prosthetist, or researchers may inadvertently make adjustments to support their inclinations. Europa collected data on forces affecting the foot as patients walked 40 steps in the gait laboratory on each of the feet they tested. “Each step showed up on the tablet; in a few minutes, we had 40 steps recorded,” says Orendurff. “This was even better than a gait lab, where they have to step on a force plate. We could get every step, from the first one on a new foot, and watch them acclimatize 40 steps in a row.” Subjects wore a randomly chosen foot home to test in the community for a week, using Europa to measure forces and Galileo to measure activity level. Patients at a higher functional level tested a larger number of prosthetic feet in the community. Most subjects tested three feet—one at their prescribed level, one above, and one below that level. When the subjects returned, they completed mobility sections of the PEQ questionnaire, and researchers collected force and activity data from the week. Once the participants had completed their tests and returned to their original feet, Raschke and her colleagues found the data ended up showing feet falling into three different categories. When the results were unblinded, Raschke’s team looked at the mechanical design of the feet and used the AOPA Foot Project’s scale of compliance and energy return, it turned out the results had differentiated the feet into three groups with specific design characteristics: A-feet were stiff; B-feet, intermediate; and C-feet, compliant. Prosthetic feet are all different, because the forefoot is made in different thicknesses, materials, and forms. Raschke explains that when you walk, you apply a force to the forefoot, which makes the foot bend and recoil in a particular way. Stiffer feet, such as those made of carbon fiber, have more energy return.

When users step on them with greater force, that force is returned as the toe is lifted, helping the user propel forward. A more compliant foot, such as the solid ankle, cushion heel foot, has less energy return. Once researchers analyzed the data using the objective measurement tools, it was clear that the class of energy-storing feet outperformed the non-energy storing (SACH) feet, and these also prevailed in terms of patient subjective assessment. The average age of study participants was 57 years old, and in terms of the subjective patient preferences for this specific patient cohort, these individuals preferred the C-compliant feet, those that were more flexible but did have the highest energy-storing properties. Raschke opined that if the group demographics had been younger, it is quite possible the subjective patient preferences may have shifted more toward the stiffer energystoring “A” subgroup. Amputees might be expected to welcome the greater power provided by the stiffer prostheses, but that also means you have to put in more power to get a lot out. “Springs require input to get output, and you have to learn how to control it,” the researchers noted.

Next Steps Raschke and her co-investigators are pleased with the data that resulted from the study, but need far more evidence to make specific recommendations to clinicians. She said that the expense of the study limited the scope of their work, and BCIT invested more than it received. Obviously, these loses did not include the significant value of the in-kind support in measuring equipment provided by Orthocare. Raschke is hopeful the team will be able to secure a larger grant from the National Institutes of Health to run a more comprehensive clinical trial. Simply applying for such funding is a time-consuming and expensive process, which begins by pursuing a $100,000 year-long planning grant. If that phase proves successful, a

Various examples of prosthetic feet.

multi-year study would have a far better chance of achieving funding that would pay the salaries of the researchers involved. “Part of our next proposal is to tie in the mechanical testing of the feet to how those properties affect amputees’ lives,” says Raschke. “AOPA has done a very nice report on mechanical tests that relate to day-to-day activities.” (Read AOPA’s “Prosthetic Foot Project Report” at www.aopanet.org/prosthetic_ foot_project.pdf.) Whatever the results of a future foot study, the value of such research is unquestionable, and Raschke welcomes the active participation of orthotists and prosthetists. “One prosthetist who became a convert to research some years ago told me that he wanted to be involved so he could help direct the work,” she recalls. “He realized that the research could help give him the language and methodologies he needed to justify reimbursement and support the best care possible for his patients.” Raschke believes research and education go hand-in-hand in advancing the profession. The recent introduction of an O&P master’s degree is an important evolution of the field, but “we still need to develop a significant body of research… that will give us the legitimacy as a field that we need to be accepted as equals in the clinic team and not just as ‘purveyors of devices,’” she says. a

Editor’s Note: Raschke and her BCIT team expressed appreciation to AOPA for its grant in support of the study; the Center for Orthotics and Prosthetics Learning and Outcomes/ Evidence-Based Practice, for its management role in grant delivery and administration; and to Orthocare Innovations and Michael Orendurff, PhD, for their in-kind support via activity measurement equipment, expertise, and training in use of the equipment. AOPA’s support consisted of a monetary grant (the largest single financial supporter), together with five manufacturers* (listed below, who contributed both money and equipment for use in the study), in strict adherence to a process that ceded all oversight and decision making to the nonprofit, the Center for Orthotics and Prosthetics Learning and Outcomes/Evidence-Based Practice; and that excluded any knowledge, awareness, or input as to grant receipt, content, scoring, evaluation, rankordering, as well as selection and contracting of the selected researcher from any manufacturer personnel, none of whom received contact with or information from the researcher during the study. * Endolite, Freedom Innovations, Össur, Ottobock, WillowWood

NOVEMBER 2013 O&P Almanac

Practitioners from across the globe gathered at AOPA’s World Congress to share perspectives on optimum patient care, sustainable business practices, and the future of the industry

ach year, AOPA and practitioners from the far corners of the O&P industry unite for networking, a wide range of educational sessions, and the chance to learn from and connect with the top leaders and innovators in the field. Attendees at the September 18-21 AOPA World Congress, however, were exposed to “a whole new world” of global innovations and collaboration as they participated in the largest industry meeting in the western hemisphere. More than 2,500 professionals and 200 exhibiting companies from 43 countries gathered in Orlando, Florida, to partake in expert clinical education, live learning demonstrations, critical discussions regarding health-care reform and global health policies, and more. Described by many as influential and inspirational, this year’s four-day event encompassed highly scientific discussions of revolutionary technologies, business survival imperatives, compassionate patient care, and moving testimonials of the effects of O&P on people from around the world—making for a memorable and uplifting event. O&P Almanac recently caught up with some of the participants and speakers who shared their experiences and insights about attending this historic event.

O&P Almanac NOVEMBER 2013

International Appeal In partnership with more than 20 countries and six global organizations, AOPA incorporated a worldwide perspective of clinical and business programs, including internationally focused keynote speakers, workshops, exhibits, and attendee functions. The idea was to connect colleagues from around the world to compare cases and approaches to patient care. “The world of O&P is smaller than I thought,” says Terry Tate, CO, COBP, clinical director at Applied Orthotic and Prosthetic Associates Inc. in Nashville. “It was amazing to see that questions in the United States for clinicians are the same in other parts of the world. [Topics] that we would like to see more research on [in the United States] are the same [topics] in Africa.” Among some of the global speakers who resonated with attendees: • Yoshiuyki Sankai, professor at the University of Tsukuba and CEO of Cyerdyne, discussed the clinical outcomes and implications of using the Hybrid Assistive Limbs robot suit he developed among elderly patients with limited mobility. The lightweight suit’s sensors detect brain signals, while its motors assist the person’s movement with ease.

Paralympian Katy Sullivan and AOPA’s Steve Custer perform a song at the Opening Ceremony.

“I [enjoyed] the international aspect of the event as it [gave] me a better view of patient care. While we have a wonderful health-care system in the United States, it is nice to learn how other professionals from around the world provide care,” says Brett R. Saunders, CPO, FAAOP, Saunders Prosthetics & Orthotics Group LLC in Lady Lake, Florida.

Influence and Advocacy Jan Geertzen, MD, PhD.

• Jan Geertzen, MD, PhD, immediate past-president of the International Society of Prosthetics and Orthotics, delivered an insightful general session on common skin problems of the residual limb among lowerlimb amputees. He examined the prevalence of issues such as eczema, infections, pressure sores, and verrucous hyperplasia, their effects on patients’ prosthetic use and walking distance, and more.

Conversations focusing on the intense political and regulatory challenges facing U.S. business owners also were at the forefront at this year’s event. “It seemed like a new threat emerged daily, whether it be from an Office of Inspector General Report, a CMS action, or another voice calling for expanded competitive bidding,” AOPA President Tom Kirk, PhD, explained in his opening remarks. “There seemed to be no end of threatening issues to test our resilience, nor do I expect this to stop.”

Keynote Yoshiuyki Sankai. O&P World Congress Partners

NOVEMBER 2013 O&P Almanac

Exhibit Hall in Action

Business education session with industry experts.

AOPA President Tom Kirk, PhD, at the Opening Ceremony Ribbon Cutting. Incoming AOPA President Anita Liberman-Lampear, MA, and Rep. Tammy Duckworth (D-Illinois).

Lifetime Achievement Award Winner Professor Hans Georg Näder (far right) during the Exhibitor Sponsored Happy Hour.

Technical Fabrication Contest.

Technical Fabrication Lab.

O&P Almanac NOVEMBER 2013

Session attendees.

To that end, World Congress planners organized several business education sessions addressing the competitive bidding landscape as well as a host of reimbursement issues and audit strategies employed by Medicare and third-party contractors. “The goal of AOPA is [to achieve] a level playing field,” Joseph McTernan, director of coding and reimbursement services for AOPA, told attendees, referring to the organization’s advocacy and litigation efforts to address Medicare’s seemingly biased audit procedures. Together with other AOPA staff and outside experts, McTernan led a series of sessions aimed at helping business owners and staff stay informed and prepared to defend their services. The speakers’ brutally honest explanations and advice resonated with the standing-room-only crowd. “The reimbursement climate is daunting because we as practitioners are being asked to step outside of our comfort zones and do more than we ever have in the past. We are being asked to provide empirical proof that what we do on a daily basis changes the lives of those that we treat…,” says Chris Baschuk, MPO, prosthetics resident at Kootenai Prosthetics and Orthotics in Post Falls, Idaho. “The biggest thing that I took away from the conference is that we need to

take the energy that we put into complaining about how things are and put it into action to make the future what we want it to be. Are the audits going to go away? Absolutely not, at least in the foreseeable future…. We need to be active in speaking with our legislators regarding the state of our industry. We need to follow-up with them and hold them accountable.” Participants also were able to partake in a “mock audit” for the first time this year. The goal of this presentation, says Devon Bernard, manager of reimbursement services for AOPA, was to serve as a tool for attendees to better understand the different types of audits, what the auditors are looking for when they review a chart, and the more common reasons for denials. “I learned there are steps and tools that can assist in a smoother transition and [that can help] avoid any unnecessary delays,” says Heather Cross, manager of orthotics & DME at Barrow Neurosurgical Associates Ltd. in Phoenix. “[The mock audit] was quite informative and gave the kind of information that is useful to all of us. I feel that this session alone was worth the trip. Everyone is always talking about all the obstacles that we face; this [was] a class that instructs you on how to avoid those obstacles.”

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2013 Award Winners Show Their Mettle

Inspiration

Missed the conference?

Bookended by personal accounts of limb-loss and the triumphs of O&P care, the World Congress also left many reminded of the value their work has on patients and the community. “My favorite sessions were the Opening Ceremony and Rep. Tammy Duckworth’s (D-Illinois) keynote address,” says Dennis Dillard, C.Ped, CTO, Comprehensive Prosthetics and Orthotics in Peoria, Illinois. “Both were inspirational, for lack of a better word. It is easy to get lost in the daily routine and sort of lose sight of the tremendous impact the O&P profession is having on the lives of so many people. It was good to get recharged a bit.”

If you or your colleagues weren’t able to attend the World Congress in September, you can still access the wealth of information shared during the global event, including videos of the Opening Ceremony and Congresswoman Duckworth’s presentation, educational handouts, and more. Explore all of the highlights and hear feedback from attendees at http://bit.ly/1i8FHqs.

From left, Edwin and Kathryn Arbogast 2013 Award Winner Darren Bolger, AOPA President Tom Kirk, and Otto and Lucille Becker 2013 Award Winner Kier Book.

Rep. Tammy Duckworth (D-Illinois) gives her keynote address.

The Thranhardt Lecture Series Session. Winners of the Howard R. Thranhardt Award include Kevin Felton, CO, LO; Andrea Giovanni Cutti, PhD, and Emanuele Lettieri, PhD; Silvia Raschke, PhD, and Michael Orendurff, PhD; and Brian Hafner, PhD.

Putt-Putt for the Fun of It sponsored by Arizona AFO Giveaway Winner Erin Cammarata.

O&P Almanac NOVEMBER 2013

The Opening Ceremony focused on patients’ life-changing relationships with their prosthetists and orthotists—including testimonials from a congenital double-amputee actress and Paralympic athlete, a bi-lateral hemipelvectomy Iraq War veteran, an above-the-knee amputee cheerleader and international athlete, and the mother of a young boy with cerebral palsy—and their gratitude toward the profession. “When I look down at my body, I see a patchwork of collaboration between people who may not even know each other and sometimes compete in the same business,” Pedro Pomento, a

Speaker Pedro Pomento at the Opening General Session.

quadruple amputee from Brazil, explained to the audience. “But in the end, they work together creating this great industry, providing patients what we deserve…the possibility to turn our disability into a mere detail that doesn’t stop us from living our lives without limits.” Similarly, Duckworth’s closing keynote address echoed that same message of appreciation and determination as she recounted losing both legs and damaging her right arm following a helicopter crash in the Iraq War. Her experience with O&P during her recovery and subsequent political life has compelled her to become an advocate for the industry, most recently as co-sponsor of the Medicare O&P Improvement Act (HR 3112). “I see my role is to be your cheerleader,” she said during her address. “I couldn’t be here today, and I couldn’t be doing the job I do in Washington, were it not for this organization and your peers.” She continued to explain how her experiences with practitioners were a “lifeline” of hope that offered her a way forward to where she is today. ”Your body should never get in the way of what you are trying to do and the life you want to live.” Duckworth also encouraged all participants to lobby their political representatives on curbing fraud and abuse in the Medicare system as well as the effects of Recovery Audit Contractor audits on the profession. ”I’m here to challenge you. It’s easy for us to meet here and tell some stories…but I need you to not let me off the hook, to not let your representatives off the hook... You need to need to be a loud squeaky wheel so that we can focus on you.” a

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What a World Congress It Was New AOPA leadership announced, important legislation introduced

ore than 300 new international O&P professionals from 42 countries joined the traditional AOPA National Assembly crowd for the AOPA World Congress, Sept. 18-21, 2013, at the Gaylord Palms Resort in Orlando to celebrate the very first western hemisphere global O&P event. With higher attendance and more exhibitors than ever before, as well as a never-ending flow of innovation, inspiration, and education, it truly was a “wow” experience. The World Congress saw a record-breaking 13 percent increase in exhibiting, with 203 companies occupying 461 booths. The next biggest show in AOPA history was in the 2012 Assembly in Boston, with 182 exhibiting companies. Total registration topped the 2,500 mark, again besting Boston Assembly attendance, 2,317. Due to the level of enthusiasm, global interest, and accolades received by AOPA following the event, plans are underway to stage another World Congress in the future.

Welcoming New Leadership The World Congress was a great event on its own but also included familiar elements of the AOPA National Assembly, which AOPA will stage again Sept. 4-7, 2014, at the Mandalay Bay Hotel & Casino in Las Vegas. The AOPA Annual Business Meeting was held Friday, September 20 during the event. Instead of the cumbersome voter registration, verification, and on-site ballot casting, AOPA moved into the 21st century with electronic voting, permitting the election to be held in advance of the meeting and streamlining the process.

With higher attendance and more exhibitors than ever before, as well as a never-ending flow of innovation, inspiration, and education, it truly was a “wow” experience. Last year, bylaws changes were approved permitting electronic voting on AOPA business matters as well as the election of new Board members and officers. So instead of the laborious election procedures of the past, AOPA President Tom Kirk, PhD, was able to simply announce results of the electronic voting. Effective Dec. 1, 2013: Anita Liberman-Lampear, MA, moves into the role of AOPA president; current President Kirk automatically becomes immediate past president; vice president Charles Dankmeyer, CPO, becomes president-elect; and Jim Campbell, PhD, CO, joins the Executive Committee as vice president. Jim Weber, MA, has one more year to serve of his two-year term as treasurer.

O&P Almanac NOVEMBER 2013

AOPA HEADLINES Maynard Carkhuff and Don Shurr, CPO, will join the AOPA Board for three-year terms as at-large director 2 and clinical director, respectively, and Eileen Levis will serve another three-year term on the AOPA Board representing the 1 to 5 location membership segment. Tom DiBello, CO, FAAOP, who served as immediate past president this past year and previously as president for two successive one-year terms, leaves the Board with a legacy of greatly expanded research efforts by AOPA and the Center for O&P Learning, a solid AOPA financial picture, and a plan of work for the Survival Imperatives that tilts AOPA resources toward longer-term research and payer education efforts.

Incoming AOPA President Anita Liberman-Lampear and current President Tom Kirk.

released Dobson DaVanzo final report is a major first effort in the direction of cost-effective research projects. The report shows timely O&P intervention saves—not costs—Medicare because beneficiaries receiving timely treatment

develop fewer costly co-morbity conditions than those beneficiaries who do not receive O&P care. Liberman-Lampear concluded her acceptance remarks at the meeting noting, “My commitment to you

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Tom Kirk and AOPA Past President Tom DiBello.

AOPA’s incoming President Anita Liberman-Lampear paid special tribute to both Tom Kirk and Tom DiBello for their “collaborative effort that gave birth to basically Six Survival Imperatives, which have been the operative road map for your Board and volunteer efforts these last 15 months.” She also described her involvement with Stream 3 of the Survival Imperatives, which focused on developing cost-effective research data measuring the payer and patient benefits when timely O&P intervention occurs and avoids subsequent co-morbidities that can escalate payer costs on the non-O&P-treated patients. Funded by AOPA and commissioned by the Amputee Coalition, the recently

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AOPA HEADLINES

AOPA WORKING FOR YOU

Tom Kirk speaks during the AOPA Annual Business Meeting.

and our colleagues is to use all of my energy and enthusiasm to carry through on what we started this past year. We need to build a stronger capability so each and every one of you will survive and continue to serve our patients. The commitment I ask from each of you is your unswerving support for AOPA.” She urged the audience to “proactively seek out colleagues whose companies may not be members of AOPA and convince them they need to pay to play as well. The last time we were in Orlando, I picked up a copy of Harry Potter’s wand—one of my favorite book series ever. I cannot wave this wand and magically expect our O&P fortunes to change, and folks who are not members cannot afford to be on the sidelines assuming ‘Harry or Hermione’ will do it for them. Everyone has to be ‘Harry or Hermione’ if we’re going to survive in the years ahead. There is no real magic wand—that’s just wishful

Anita Liberman-Lampear speaks at the meeting. 34

O&P Almanac NOVEMBER 2013

thinking—we need everyone to work hard and support these incredible efforts. So, watch for those folks who do not have a member ribbon attached to their badges. They are the ones you need to seek out. They are the ones that need to be a player like you. They are the ones that can help ensure that we all have a future, a future together, a future worth saving.” In his closing remarks, outgoing President Tom Kirk recounted the almost daily challenges confronting the O&P community in the past years, particularly noting the lawsuit AOPA filed against CMS and the resulting outpouring of support. He paid tribute “to the more than 200 members who stepped up to the plate and became members of the Heritage Club. Their generous support provides nearly $100,000 toward the litigation expense. The other gratifying aspect of this accountability effort is that AOPA made the decision to file the lawsuit knowing that we could pay the bills. We did not have to delay our actions until we passed the hat. You had already provided a ‘rainy day’ fund, as our treasurer refers to it, that could underwrite this expense. The fact that you are helping replenish the fund gives us even more wherewithal to meet challenges of the future. And of that we can be sure—there will be more and possibly even bigger challenges to face in the days and years ahead, in terms of outcomes, changing health-care benefit plans, competitive bidding, and possibly more litigation.” Other major news during the World Congress included the exquisitely

timed introduction of the Medicare Orthotics & Prosthetics Improvement Act of 2013 (HR 3112) by Rep. Glenn Thompson (R-Pennsylvania) and Mike Thompson (D-California) on Tuesday, September 17. President Kirk and Executive Director Tom Fise ducked out of the Board of Directors meeting to lead a press webinar announcement of the bill’s introduction, which also included Rep. Glenn Thompson and former CMS Administrator Tom Scully. Bloomberg News, The Washington Post, several payer publications, and general health-care media picked up the story with headlines ranging from “Orthotic Suppliers Criticize CMS Enforcement” to “Trade Group Says CMS Failing to Enforce Laws Against Unlicensed Orthotics, Prosthetics Providers.”

During the World Congress, AOPA member attendees were urged to use the special kiosks in the registration lobby area to send a message to their member of Congress urging support of HR 3112. AOPA members only needed to enter their zip code, and the stock letter accessed on www.AOPAVotes.org could be personalized. The letter also requested Congressional members to co-sponsor this bipartisan bill that would help curb Medicare fraud and abuse. HR 3112 would mandate CMS to enforce requirements that payments only be remitted to licensed providers in licensure states or, in unlicensed states, to providers who are certified by ABC, BOC, or organizations with equivalent requirements. a

AOPA HEADLINES

AOPA Board of Directors To Begin 2013-2014 Term

Results of the election for AOPA’s Board of Directors were announced during the 2013 O&P World Congress. AOPA members elected new officers to its executive committee and welcomed two newly elected members to the Board. The 2013-2014 term will begin December 1. The new officers and directors include the following: • Anita Liberman-Lampear, MA – President • Charles Dankmeyer, CPO – President-Elect • Thomas F. Kirk, PhD – Immediate Past President • James Campbell, PhD, CO – Vice President • Maynard Carkhuff – Director • Donald Shurr, CPO, PT – Clinical At-Large Director

“This team that has been elected by AOPA’s membership is comprised of professionals who have extensive business and clinical experience and have demonstrated their commitment to the O&P industry,” notes current AOPA President Tom Kirk, PhD. “I look forward to serving with this distinguished panel as we begin a year that will demand hard work confronting threats on the state and national levels, and fighting to protect our patients and their access to quality care.”

O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2013 test standards.

Introducing our NEWEST Study Guide in PEDORTHICS

The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics James Weber, MBA, continues as Treasurer. Currently serving board members include the following: • Alfred E. Kritter, CPO, FAAOP – Director • Eileen Levis – Director (Re-elected to three-year term) • Ronald Manganiello – Director • Dave McGill – Director • Michael Oros, CPO – Director • Jeff Collins, CPA – Supplier Director • Scott Schneider – Supplier Director

Now Offering Customizable Orthotic and Prosthetic Patient Device Instruction Sheets in English AND Spanish

Our Products NOW available for IMMEDIATE DOWNLOAD! No need to wait, BEGIN your STUDIES NOW!

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NOVEMBER 2013 O&P Almanac

AOPA HEADLINES

Advocacy: A Potent Weapon for Change—Join the Audio Conference November 13 Advocacy can be a great tool to effect change—if you know how to use it properly. Taking an active role in controlling the future treatment of O&P professionals has never been more important. Join AOPA on November 13 for an Audio Conference on this important topic, when an AOPA expert will address the following topics: • How to effectively lobby for fair treatment of O&P on the local and national level • How to work with patients to help them become advocates for their own cause • How to effectively communicate with representatives in Washington, DC • How the wrong message can have a negative impact on advocacy efforts.

AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions. Register online at www.bit.ly/2013audio. Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876 with registration questions.

What’s on the Horizon? New Codes for 2014— Join the Audio Conference December 11 HIPAA requires all payers to use Healthcare Common Procedure Coding System (HCPCS) Codes. The end of the year marks the beginning of new codes and modifier changes that will take effect Jan. 1, 2014. Do you have a plan in place? Ensuring your practice is sound may prevent unnecessary audits down the road. To prepare for the new year, join AOPA December 11 for an AOPAversity Mastering Medicare Audio Conference that will focus on new codes and medical policy changes for 2014. Find out why coding correctly in 2014 will be an important part of your business operation. The following topics will be discussed: • New HCPCS codes effective Jan. 1, 2014 • Verbiage changes to existing codes and how they may affect your business • Which codes will no longer be used as of Jan. 1, 2014 • Other changes to the HCPCS system • AOPA’s interpretation of why the changes took place.

O&P Almanac NOVEMBER 2013

AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions. Register online at https://aopa.wufoo.com/forms/2012telephone-audio-conferences/. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.

AOPA HEADLINES

New in the AOPA Bookstore: ‘2013 Operating Performance Report’ & ‘2013 Compensation & Benefits Report’ Are you curious about how your business compares to others? These updated surveys will help you see the big picture. AOPA’s “2013 Operating Performance Report” provides a comprehensive financial profile of the O&P industry including balance sheet, income statement, and payer information organized by total revenue size, community size, and profitability. The data was submitted by more than 130 patient-care companies representing 1,050 full-time facilities

and 68 part-time facilities. This report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2012 operations. AOPA’s “2013 Compensation & Benefits Report” represents the most complete, accurate, and up-to-date compensation information for the O&P industry. This report is designed to allow industry members to easily compare their compensation levels and benefits policies with those of similar facilities. The report is divided into two major sections: average salaries and ranges of key employee positions, and benefits offered, including holiday and vacation policies. Both reports may be purchased in the AOPA Bookstore at www.aopanetonline.org/store.

Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0835 with social media and content questions.

Top 5 Reasons To Follow AOPA: • Be the first to find out about training opportunities, jobs, and news from the field. • Build relationships with others working in the O&P field. •

Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.

• Hear from thought leaders and experts. • Take advantage of special social media follower discounts, perks, and giveaways.

NOVEMBER 2013 O&P Almanac

AOPA HEADLINES

Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.

AOPA also offers two sets of webcasts: • Mastering Medicare: Coding & Billing Basics. These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series. These courses are designed for those establishing a new O&P practice. Register online by visiting http://bit.ly/AOPAwebcasts.

Welcome to AOPA Jobs AOPA’s Online Career Center gives you access to a very specialized niche. The Online Career Center is an easyto-use, targeted resource that connects O&P companies and industry affiliates with highly qualified professionals. The online job board is designed to help connect our members with new employment opportunities. • Job Seekers: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers. • Employers: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you. • Recruiters: Create and manage your online recruiting account. Post jobs 38

O&P Almanac NOVEMBER 2013

Coding Questions Answered 24/7

to our site and browse candidates interested in your positions. The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at http://jobs.aopanet.org. In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations! Regardless of your staffing needs or budget, we have an option that is right for you. For more advertising opportunities, please contact Dean Mather, advertising sales representative, at 856/768-9360 or dmather@mrvica.com.

AOPA members can take advantage of a “click-of-the-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

24/7

AOPA HEADLINES

O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Diana Almodovar Vinit Asar Matt Bailey, CPO, LPO, FAAOP Ed Bannister Kel Bergmann, CPO Paul Boland, CPO Frank Bostock, CO Alan Burke, BOCO, C.Ped Michael Burton Erin Cammarata, CTO James Campbell, PhD, CO James Claiborne, CPO Zach Coker Thomas Colburn, CO, C.Ped, FAAOP Jeff Collins, CPA Bill Cornell, BOCP Kenneth Cornell, CO, FAAOP Christina Cox Charles Dankmeyer, CPO Thomas DiBello, CO, FAAOP Bernadette Douroux, CPO Charlie Eaton Susi Ebersbach Michael Fenner, CP, BOCOP, LPO Anthony J. Filippis, CPO Jim Fitzpatrick, CP Micha Gaspar, CO, C.Ped Richard Gingras, CPO

• • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Bill Gustavson Cynthia Henderson, CO Michelle Henslee, CO Joseph Huntsman, MBA, MA Joe Jessen, CPA David Johnson, CO Reggie Jones, BOCO, CO David Kerr Jim Kingsley Thomas Kirk, PhD Alfred Kritter, CPO, FAAOP Alan Lampear Jon Leimkuehler, CPO, FAAOP Robert Leimkuehler, CPO, LPO Tom LeTourneau, CPO Eileen Levis Robert Maniere, CPO, FAAOP Mohamad Mansoori, CPO Ann Mantelmacher, PD Brad Mattear, CFo, CPA Kevin Matthews, CO Sean McKale, CO Robin Merriam, CPO Timothy Meyer, C.Ped Rex Miller, CP John Mooney, CPO Jonathan Naft, CPO James Neumeyer, BOCP Michael Oros, CPO, FAAOP

The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@AOPAnet.org.

• • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Rodney Pang, CPO Walter Racette, CPO Joseph Ramicone, CPO Eric Ramos Ricardo Ramos, CP, LP Timothy Rayer, CP, LP Walt Raynor, CO John Roberts Jr. Brad Ruhl Michael Schlesinger Scott Schnieder Roxiann Schurman, CO Don Shurr, CPO, PT Mark Silva, BOCO, CO Christian Smith, CPO William Snell, CPO Gordon Stevens, CPO Chrissy Thomas Peter Thomas, Esq. Stacy Toner Bernie Veldman, CO Laurel Voss, BOCPO, CFom James Weber, MBA Jeffrey Wensman, CPO Paul Werner, CPO, LPO Jaisen Westbrook CPO Ashlie White Dennis Wood Mike Wright, CPO

*Due to publishing deadlines this list was created on Oct. 3, 2013, and includes only donations received between Sept. 3, 2013, and Oct. 3, 2013. Any donations received on or made after Oct. 3, 2013, will be published in the next issue of the O&P Almanac.

NOVEMBER 2013 O&P Almanac

AOPA Applications

Welcome new members! The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. 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:

Bulow OPS

Texas Artificial Limb Lab

1601 E. 19th Ave., Ste. 5200 Denver, CO 80216 303/831-6326 Fax: 303/831-6295 Category: Affiliate Member Parent Company: Orthotic Prosthetic Solutions LLC, Fort Collins, CO

2900 Pershing Drive, Ste. D El Paso, TX 79903 915/562-6100 Fax: 915/562-6103 Category: Patient-Care Member Dulcinea Sharma

RGV Prosthetics LLC

Tri-County Orthotic Prosthetic Institute

1610 E. Harrison Ave., Ste. B Harlington, TX 78550 956/421-4996 Fax: 956/421-4998 Category: Patient-Care Member Patsy Hernandez

1411 NW 23rd Ave. Chiefland, FL 32626 352/493-0360 Fax: 352/493-0369 Category: Patient-Care Member Irene Boyd a

Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million.

MEMBER VALUE GUIDE www.AOPAnet.org

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Member Benefits

Experience the Benefits of AOPA Membership Membership in AOPA is one of the best investments that you can make

•

Challenging RAC and CERT audit policies implemented this past year by overly aggressive CMS contractors is AOPA’s number one priority. All options are on the table to eliminate these burdensome and patient harming practices. Your Voice in Washington. AOPA’s staff and the lobbying team of former CMS Administrator, Tom Scully of the Alston & Bird law firm and Nick Littlefield, former chief of staff for Sen. Ted Kennedy and now a partner in the Foley Hoag law firm bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain financial times to ensure quality patient care. Making Your Voice Stronger. The O&P Political Action Committee supports candidates who understand the unique contribution the O&P community makes to restoring lives and hope.

MISSION

Experience the Benefits of AOPA Membership

in the future of your company.

The mission of the American Orthotic and 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.

•

Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level briefings and to deliver the O&P story personally to their members of Congress.

•

Expert Reimbursement and Coding Guidance. AOPA’s reimbursement specialists provide coding advice and keep you up-to-date on the latest Medicare quality standards, billing rules and regulations. Answer all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.

•

Cost Effectiveness Research. The changing climate of health care is moving to a patient driven process and is demanding more and more evidence of cost effectiveness to measure outcomes. AOPA has funded the first in a series of research projects that will measure the cost effectiveness of timely O&P treatment of patients with the same diagnoses as patients who did not receive treatment. More cost effectiveness research projects will be necessary and are simply too expensive for individual O&P businesses to undertake. AOPA can aggregate the resources of the field to conduct this vital research.

O&P Almanac NOVEMBER 2013

2013 AOPA Annual Membership enrollment is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.

Join today!

They’re not only our hours of operation. They’re yours.

Spinal Technology: your central fabrication resource.

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Extended Service Hours 8:00PM – 8:30AM Monday EST

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800 253 7868

spinaltech.com

Buyersâ&#x20AC;&#x2122; Guide to

Contents 43

Footwear

43 Custom Footwear

Foot-Care

43 Diabetic and Extra-Depth Footwear

The annual one-stop resource for O&P foot-care products and services

44 Insoles 44 Lower-Limb Devices and Orthoses 46 Lower-Limb Prostheses 46 Socks 48

Miscellaneous

48 CAD/CAM Casting and Fabrication

O&P Almanac NOVEMBER 2013

Footwear Custom Footwear APIS Footwear South El Monte, CA 91733 888/937-2747 www.apisfootwear.com Charcot Deformity? Lymphedema? Pes planus? Mt. Emey shoes are designed for hard-to-fit patients or one with a larger orthotics need. This category offers variety of closures for ease of fit adjustability, broad range of widths (AA-14E) and sizes (4.5-20) to accommodate mild or severe deformities. Our goal is to give the most comfort and protection. No matter what the medical needs are, you will find one off-the-shelf. Accommodate, NEVER correct! Whether for Depths, Widths, Sizes or even for Shape, select from variety of styles to fit that special foot of your patient. Call us at 888/937-2747 for information or free samples.

PEL Supply Co. Cleveland, OH 44135-2638 800/321-1264 www.pelsupply.com Diabetic Footwear Program PEL now offers a diverse selection of diabetic footwear for those who need diabetic foot care products quickly. Featuring Orthofeet products, these are typically in stock in popular sizes for same day shipment. Choose from five different styles of diabetic shoes; two styles of inserts; and three types of diabetic socks. All shoes offer: • Seamless protective lining of soft breathable fabric, padded with cushioning foam • Non-binding leather upper construction • Ergonomic cushioning sole • Removable spacers

Cascade Orthopedic Supply Inc.

Mens sizes: 7-12, 13 and 14. Womens sizes: 5-12 Widths: Medium (M=D), Wide (W=EE) and Extra Wide (XW=EEEE) Styles: 410—Mens Black Tie 510—Mens Black Strap 701—Womens Black Leather Lace Athletic: 640—Mens White Lace 641—Mens Black Lace 651—Mens Black Strap 940—Womens White Lace

Chico, CA 800/888-0865 www.cascade-usa.com

For more information, call PEL 800/321-1264 or order online at www.pelsupply.com.

Diabetic and Extra-Depth Footwear

2013 Buyers’ Guide to Foot Care NOVEMBER 2013 O&P Almanac

2013 Buyers’ Guide to Foot Care

Insoles Amfit, Inc. Vancouver, WA 98665 360/573-9100 www.amfit.com Where Technology Fits, Perfectly Since 1977 Amfit has offered custom milled foot orthotics and foot orthotic technology. From one pair to thousands each month, we have a program for you. Foam or digital Amfit records; our lab technicians return consistently excellent results that win rave reviews. Patented, true contact 3D technology offers casting and orthotic design in just minutes using the Contact Digitizer. A5513 insoles start at 3 pair for $60 + free shipping plus a wide variety of EVA, Carbon Fiber and Polypropylene styles. Designed, built and manufactured in the USA, we specialize in custom. Get started today- call 800/356-FOOT (3668) x266.

Cascade Orthopedic Supply Inc. Chico, CA 800/888-0865 www.cascade-usa.com

Lower-Limb Devices and Orthoses Allard USA Inc. Rockaway, NJ 888/678-6548 www.allardusa.com

Becker Orthopedic Appliance Co. Troy, MI 248/588-7480 www.beckerorthopedic.com

Cascade Dafo Inc. Ferndale, WA 800/848-7332 www.cascadedafo.com

Cascade Dafo, Inc. created the original DAFO® (Dynamic Ankle Foot Orthosis) in 1985. Today they manufacture the most complete system of pediatric lower-extremity bracing in the industry, including custom and prefabricated devices. Cascade believes better mobility gives all children a wider range of experiences, greater success in their activities, and more control over their lives. To that end, the company is committed to providing innovative orthoses unmatched in quality, fit, and function—complete with a full 90-day warranty. At Cascade Dafo product design, technical support, education, and research and development have a sole focus: helping kids lead healthier, happier lives. For more, visit www.cascadedafo.com.

Cascade Orthopedic Supply Inc. Chico, CA 800/888-0865 www.cascade-usa.com

O&P Almanac NOVEMBER 2013

Fillauer Companies

Orthomerica Products Inc.

Chattanooga, TN 423/624-0946 www.fillauercompanies.com

Orlando, FL 877/737-8444 www.orthomerica.com

Dynamic Walk The Dynamic Walk is an AFO made of a lightweight moldable carbon fiber composite material. The open heel construction allows for optimal fit and comfort with various shoe types. The Dynamic Walk provides dorsiassist with subtalar inversion and eversion control. This high activity design enables freedom of motion and allows for walking, running, and climbing stairs. Features: • High quality dorsiflexion assist technology • Lightweight • High strength • Fits easily into normal or narrow shoes • Flexible for multi-plane action • Dynamic medial/lateral control • Enables athletic activity such as moderate running

Heat Adjustable Spectrum AFO Products by Orthomerica® Orthomerica gauntlets are now able to be worn throughout the patients’ volume changes via unlimited heat adjustments to the plastic material sandwiched between the leather or synthetic material. A unique plastic allows for a dynamic orthosis, saving both time and money for all concerned. Our innovative designs have been tested and refined in high volume orthotic centers. The resulting high-quality custom AFOs and gauntlets offer optimal fit and are less expensive in today’s ultra cost-conscious environment —without compromising comfort. Orthomerica’s experienced custom fabrication team deliver prompt and exceptional service at highly competitive prices. For more information, call Orthomerica at 877/737-8444 or visit www.orthomerica.com.

For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com.

Med Spec (ASO EVO) Charlotte, NC 704/573-4040 www.medspec.com

M.J. Markell Shoe Co., Inc.

MD Orthopaedics Wayland, IA 877/766-7384 www.mdorthopaedics.com

Foothill Ranch, CA 800/233-6263 www.ossur.com

PEL Cleveland, OH 44135-2638 800/321-1264 www.pelsupply.com PEL Offers ToeOFF Line of AFOs PEL offers the complete line of ToeOFF® products from Allard USA--the original and still the leading carbon composite, dynamic response floor reaction AFO. Products include: • Ypsilon™--Mild to moderate footdrop only • ToeOFF®--Mild to moderate involvement accompanied with mild to moderate ankle instability. • BlueROCKER™--Footdrop, severe ankle instability, and/or proximal neuromuscular weakness/deficits • KiddieGAIT™ and KiddieROCKER™--Newest products, now available to meet your pediatric needs. For more information call PEL 800/321-1264. Registered customers may order online at www.pelsupply.com.

NOVEMBER 2013 O&P Almanac

2013 Buyers’ Guide to Foot Care

Yonkers, NY 914/963-2258 www.markellshoe.com

Össur Americas Inc.

2013 Buyers’ Guide to Foot Care

Lower-Limb Prostheses

Socks Cascade Orthopedic Supply Inc. Chico, CA 800/888-0865 www.cascade-usa.com

Fillauer Companies Chattanooga, TN 800/251-6398 www.fillauer.com

Comfort Products Inc.

Prosthetic Feet from Fillauer • K2 • Element DS • Wave Sport • Ibex XD • Aeris Performance • Raize Microprocessor Ankle For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com.

Element DS

Wave Sport

Ibex XD

Aeris Performance

Raize Microprocessor Ankle

O&P Almanac NOVEMBER 2013

Croydon, PA 800/822-7550 www.comfortoandp.com

Knit-Rite Inc. Kansas City, KS 800/821-3094 www.knitrite.com SmartKnit® Seamless Socks SmartKnit® Seamles Socks are ideal for diabetic, arthritic and sensitive feet. Core-spun, high-stretch fibers HUG your feet comfortably like a protective second skin reducing risks from wrinkling and bunching. Patented SmartKnit ® socks are truly seamless to eliminate pressure points found in other diabetic or traditional socks. Non-Binding Halo-Top™ fits comfortably to minimize indentations. Superior moisture wicking fibers and antimicrobial to inhibit odor in the sock help to keep feet dry and healthy. Enhance the effectiveness of recommendations for protecting patients’ feet with foot display and detailed patient brochures, explaining the important role diabetic socks play in management of diabetes. For more information contact Knit-Rite today at 800/8213094 or customerservice@knitrite.com.

The New Standard!

FUZION AFO ™

The Fuzion AFO was developed to allow GREATER FIT, FUNCTION and FREEDOM for challenging foot deformations compared to traditional AFOs. The circumferential wrap of the Fuzion firmly and comfortably holds the foot in a more structured biomechanical position instead of trying to seat the foot with two or three straps. The Fuzion’s design and materials ensure greater patient compliance for a variety of challenging clinical indications. Orthomerica — the source for truly custom product solutions — 100% custom, 100% of the time.

KEY BENEFITS • New treatment options for patients historically not candidates for orthotic intervention & management • Design encapsulates the foot and leg with greater control and comfort resulting in better compliance • Optional heat adjustable plastic makes patient management much easier versus traditional AFOs • Bi-valved and tongue options allow for better management of patients with fluctuating edema • Available for both select adult and pediatric patients

INDICATIONS Pediatric Patient • Flaccid Drop Foot • Spastic Plantarflexion Control • Hind Foot Varus or Valgus Instability • Nocturnal Positioning Control • Pressure Sensitive Patients Adult Patient • Spastic Plantarflexion Control • Progressive Hindfoot Deformity Control

Call for more details to see if your patient is a candidate for the Fuzion AFO.

• Progressive Forefoot Deformity Control • Pressure Sensitive Patients

877-737-8444 | orthomerica.com

2013 Buyers’ Guide to Foot Care

Miscellaneous

PEL Cleveland, OH 44135-2638 800/321-1264 www.pelsupply.com

CAD/CAM Systems

SmartKnit® Seamless Diabetic Socks from PEL Made with X-STATIC® silver fibers, these socks combine the patented SmartKnit seam-free design with hi-tech antimicrobial silver fibers. Antimicrobial to inhibit odor in the sock, X-STATIC® is safe, all-natural and lasts the life of the product. Unmatched in its conductive properties, silver is simply the best at wicking away excess moisture; it keeps feet warmer in winter, cooler in the summer. Perfect for people with diabetes or sensitive feet who are looking for luxuriously soft, non-irritating socks. Available in black, navy or grey, these are great casual socks for work or play. Latex free, 97% Polyester X-STATIC® blend, 3% Spandex. Contact PEL at 800/321-1264, fax 800/222-6176; email customerservice@pelsupply.com or order online at www.pelsupply.com.

Amfit, Inc. Vancouver, WA 98665 360/573-9100 www.amfit.com If a picture is worth a thousand words, what is true data worth? There’s no digital guesswork with Amfit true contact 3D digital casting. Since 1977 Amfit has designed and built equipment and software for the casting, design and fabrication of custom foot orthotics. Clinicians worldwide embrace the user-friendly software; technicians appreciate the speed and accuracy of the milling process. One phone number provides technical support on Amfit equipment and software for as long as you own it. From Laboratory Services to in-house Fabrication Systems; our staff will help you choose the right program for your office. Impress your patients and increase your profitability; call today for details on current programs. a

www.LCodeSearch.com

24/7 Expert Coding Advice 24/7 •

The O&P coding expertise you’ve come to rely on is now available whenever you need it.

•

Match products to L codes and manufacturers— anywhere you connect to the Internet.

•

This exclusive service is available only for AOPA members.

Contact Lauren Anderson at 571/431-0843 or landerson@AOPAnet.org.

Log on to LCodeSearch.com and start today. Not an AOPA member? GET CONNECTED

Visit AOPA at www.AOPAnet.org.

Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811. 48

O&P Almanac NOVEMBER 2013

JOBS CALENDAR

Find your region on the map to locate jobs in your area.

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color

Pacific CO/BOCO Bakersfield, California Exceptional opportunity for a CO/board-eligible orthotist to work in our main Bakersfield office in Californiaâ&#x20AC;&#x2122;s beautiful San Joaquin Valley. Bakersfield is a great place for a family and is located within two hours of the Pacific Ocean, the Sierra Nevada mountains, and a lot of fun. We are a well-established, 30+ years, multi-facility company with an immediate opening for a hardworking and energetic practitioner (CO or board-eligible orthotist) to help continue our growth. This individual must be self-motivated, and patient-oriented, and possess sound clinical, organizational, and interpersonal skills. We are a fast paced company, so clinical skills in office and hospital environments, as well as skilled facilities and rehabs, are vital. Familiarity with OPIE software and chartless environment is a huge plus. We offer a highly competitive salary and outstanding benefits package. If you are ready to take the next step in your career and have what it takes to be part of a well-organized team, then we would love to speak to you. Please contact or send resume to:

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to scuster@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

Joanna Chavez-Romero, Practice Manager Email: jchavez@vipoinc.com Fax: 661/322-0528 www.vipoinc.com

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140

aOPa marketing

Be served a bigger

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dollar of of the 3.5 billion AOPA Find your slice begin with an O&P businessâ&#x20AC;&#x201D; opportunity today! advertising

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American Orthotic Promoting O&P

& Prosthetic

Since 1917

Association

Jan. 1, 2014

(AOPA)

Anet.org www.AOP

net.Org

www.AOPA

DISCOVER more AOPA advertising opportunities. Call Dean Mather, Advertising Sales Representative at 856/768-9360 or email dmather@mrvica.com

20 14

OPPOrtunities

AOPA 2014

MediA Kit

www.AOPAnet.org YOUR resource

O&P Almanac NOVEMBER 2013

for the O&P Community

CALENDAR JOBS

Live and work, where you can play.

CPO/BOCPO 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 KY, IN, NC and NY. Due to an opening at one of our patient care facilities in Kentucky, we are seeking a CPO, or KY licensed BOCPO, with a minimum of 5 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 resume, in confidence, to: via fax at 502/451-5354 or via email to dkoch@centeropcare.com.

Orthotist/Prosthetist-Certified Evaluate, design, fabricate and fit devices for patients that have a limb or segment of a limb missing due to congenital or traumatic reasons, or with disabling conditions of the extremities and spine. Must be a graduate of Orthotic or Orthotic/Prosthetic Practitioner Program. BA/BS preferred. Formal training must include basic design principles and fitting skills in lower and upper extremity prosthesis and orthoses. Thorough knowledge of anatomy, kinesiology, developmental philosophy, mechanics and biomechanics. ABC Certification in Orthotics or Orthotics/ Prosthetics. A minimum 3 years of experience as a CO or CPO preferred. Experience in Pediatric Orthotics would be helpful.

Apply online at: www.marshfieldclinic.jobs Search by position number MC130328 1000 North Oak Avenue, Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

NOVEMBER 2013 O&P Almanac

CALENDAR

■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

2013 ■ November 6 WillowWood OMEGA® Workshop, New Jersey Annual Meeting. Bally’s Hotel & Casino, Atlantic City, NJ. Course covers the all-new O&P software as well as shape capture with the OMEGA Scanner 3D. Visit www.willowwoodco.com.

■■

■ NOVEMBER 11-16 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was Sept. 1, 2013. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification.

November 13 AOPAversity Audio Conference—Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org. ■

■ November 18, 2013 WillowWood: Intro to OMEGA®, via WebEx, 1:30 PM ET. Potential CAD

PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words

Member Rate

Nonmember Rate

25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email scuster@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. For information on continuing education credits, contact the sponsor. Questions? Email scuster@AOPAnet.org. 52

O&P Almanac NOVEMBER 2013

users have opportunity to investigate the new OMEGA software & find out how the system benefits a growing O&P practice. Credits: 2.5 ABC/2.5 BOC. Visit www.willowwoodco.com. ■ November 20, 2013 WillowWood: Alpha DESIGN® Liners, via WebEx, 1:30 PM ET. This webinar is the customization of Alpha Liners when off-the-shelf options do not suffice. Session educates attendees on how to use OMEGA software individually or in conjunction with WillowWood staff for creating a custom Alpha® Liner. Credits: 2.5 ABC/2.5 BOC. Visit

www.willowwoodco.com ■ November 21, 2013 WillowWood: LimbLogic® Technicians, via WebEx, 1:30 PM ET. Learn the essential elements for elevated vacuum socket fabrication. Learn unit operation features and diagnostics that keep the LimbLogic system optimal for patient use. Credits: 2.5 ABC/2.5 BOC. Visit

www.willowwoodco.com ■ NOVEMBER 21 Bio-Mechanical Composites, Inc. Fall 2013: Learning and Leisure “Dynamic Response Orthotic System” Certification Course. Holiday Inn at the Orlando International Airport, Orlando. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.25 CEUs. For registration information, visit www.phatbraces.com. For more information, call 515/554-6132. ■ DECEMBER 1 ABC: Practitioner Residency Completion Deadline for January 2014 Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114; certification@abcop.org; www.abcop.org/certification.

■ DECember 11 AOPAversity Audio Conference—What’s on the Horizon: New Codes for 2014. For more information, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.

■ December 10-12, 2013 WillowWood: OMEGA® Training, Mt. Sterling, OH. Covers the all-new OMEGA software and shape capture using the OMEGA Scanner 3D. Shape creation, shape modification, and software customization discussed. Extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 19.25 ABC/19.25 BOC. Visit www.willowwoodco.com. ■ DECEMBER 13-14 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health Education Center, St. Petersburg, Florida. The application deadline for this exam was Sept. 1, 2013. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/ certification.

2014 ■ JANUARY 1 ABC: Application Deadline for Certification Exams. Applications must be received by Jan. 1, 2014, for individuals seeking to take the March 2014 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.

For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.

CALENDAR

2014 ■ JANUARY 3-4 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health Education Center, St. Petersburg, Florida. The application deadline for this exam was Sept. 1, 2013. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification. ■ JANUARY 13-18 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these

exams was Nov. 1, 2013. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Regency Chicago. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■ JANUARY 26-29 U.S. Member Society of ISPO: Pac Rim 2014: Learning Beyond Our Horizons—A Biennial Symposium on Prosthetics, Orthotics, & Rehabilitation. Wiakoloa Beach Marriott Resort and Spa on the Big Island of Hawaii. Learn about progressive treatment options and innovations and hear from recognized physical rehabilitation professionals while enjoying attractions on the Big Island. Contact Dianne Farabi at 614/659-0197 for more information. Submit abstracts at www.usispo.org/ pacrim14.

■ MAY 15-17 Western Mid-Western Orthotics and Prosthetics Association—WAMOPA Annual Meeting. Reno, Nevada. Peppermill Resort & Casino. 24 CEUs. Visit www. wamopa.com for program and golf tournament updates. Contact Sharon Gomez at 530/521-4541 or Steve Colwell at 206/440-1811.

■ FEBRUARY 26-MARCH 1 40th Academy Annual Meeting & Scientific Symposium. Chicago. Hyatt

■ AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Marriott Halifax Harbourfront. Halifax, Nova Scotia. Visit www. prostheticsandorthotics.ca/ for more information. ■ SEPTEMBER 4-7 97th AOPA National Assembly. Las Vegas.

Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org.

2015 ■ OCTOBER 7-10 98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.

2016 ■ SEPTEMBER 15-18 99th AOPA National Assembly. Orlando. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org. a

Ad Index

Company

Page

Phone

Website

Ability Dynamics ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics Becker Orthopedic Board of Certification/Accreditation Cailor Fleming Insurance Cascade Dafo DAW Industries Dr. Comfort Dycor Manufacturing Hersco Ortho Labs KISS Technologies LLC Motion Control Orthomerica Products Orthotic and Prosthetic Study and Review Guide Össur® Americas Inc. Ottobock PEL Supply Spinal Technology Inc.

11 9

(855) 450-7300 (800) 574-5426

www.abilitydynamics.com www.easyliner.com

23 2 19 29 1 49 5, C3 17 7 15 C4 47

(703) 836-7114 (800) 521-2192 (877) 776-2200 (800) 796-8495 (800) 848-7332 (800) 252-2828 (800) 556-5572 (800) 301-8275 (410) 663-5477 (888) 696-2767 (800) 446-6770

www.abcop.org www.beckerorthopedic.com www.bocusa.org www.cailorfleming.com www.cascadedafo.com www.daw-usa.com www.drcomfortdpm.com www.dycormfg.com www.hersco.com www.kiss-suspension.com www.utaharm.com www.orthomerica.com

35 13 C2 31 41

(800) 233-6263 (800) 328-4058 (800) 321-1264 (800) 253-7868

www.oandpstudyguide.com www.ossur.com www.ottobockus.com www.pelsupply.com www.spinaltech.com

O&P Almanac NOVEMBER 2013

The O&P Business Management Certificate Program addresses skills that are fundamental to the success of an O&P business.

O&P Business Management: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company. ■ REFRESH YOUR KNOWLEDGE ■ DEVELOP BETTER BUSINESS PRACTICES ■ ADVANCE YOUR CAREER ■ CREATE ONGOING RETURNS FOR YOUR COMPANY

Earn Your Certificate in

O&P BUSINESS MANAGEMENT

Through a joint partnership between AOPA and the University of Virginia School of Continuing and Professional Studies

How to get started: 1.

Complete the online sign up form: https://aopa.wufoo.com/forms/earn-acertificate-in-op-business-management/

Select and complete four required core modules and four elective modules within three years.

A NEW AOPAversity OPPORTUNITY! Another addition to the valuable education, products and services offered by AOPA that you need to succeed.

Complete a Module specific quiz for each program.

Participants that successfully complete the program will be awarded a certificate of completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.

AOPA Answers

Debating Diabetic Feet Answers to your questions regarding prescribing and billing for diabetic shoes and inserts

AOPA

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

Can a different entity, other than the certifying physician, document the secondary foot condition and need for the diabetic shoes?

Yes. The certifying physician must be a doctor of medicine (MD) or a doctor of osteopathic medicine (DO). However, a podiatrist, another MD or DO, a physician assistant, a nurse practitioner, or a clinical nurse specialist may document the need for the diabetic shoes and the secondary foot condition. Whichever entity documents the secondary foot condition must send his or her notes to the certifying physician, and the certifying physician must sign and date the notes, indicating agreement with the findings, and then place the notes into his or her own chart.

O&P Almanac NOVEMBER 2013

How do we bill for repairs to diabetic shoes?

You may bill for repairs using code A5507. Remember that each unit of A5507 billed counts toward the total number of inserts/modifications a patient is eligible to receive each year. If the patient has already received his or her allotted amount of inserts/ modifications, the repairs will be noncovered and you must bill the patient.

If we custom fabricate our diabetic inserts in-house, do we have to have them reviewed and certified by the Medicare Pricing, Data Analysis, and Coding (PDAC) contractor?

No. If you are custom fabricating inserts in-house and providing them directly to your patients, you don’t have to have them reviewed by the PDAC contractor; however, you must be able to provide a list of the materials you used and a description of your fabrication process, if requested by the Durable Medical Equipment Medicare Administrative Contractor. a

Plays well with others

Utah arm from Motion Control

• Autodetect allows “plug and play” with other manufacturers’ terminal devices • Interchangeable with ETD and nearly all hands • Available wrist rotator and Flexion or Multi-Flex Wrist • Utah Hybrid Arm: lightweight option • Bluetooth® connectivity

Motion Control • 888.MYO.ARMS (696.2767) • 801.326.3434 • www.utaharm.com