November 2015 O&P Almanac

FAVORABLE NEWS on Troublesome, Draft LCD for Lower Limb Prosthetics SEE PAGE 12 The Magazine for the Orthotics & Prosthetics Profession

N OV E M B E R 2015

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.19

Keeping Your Reimbursement During Postpayment Audits P.18

Can Your Business Benefit From Ancillary Services?

P.30

Adding Foot Care to O&P Facilities P.32

FOOT CARE

AGES

for the

BETTER COMMUNICATION AND PEDIATRIC INTERVENTION FOR FLATFOOT AND OTHER ISSUES CAN RESULT IN POSITIVE ADULT OUTCOMES P.22

This Just In: AOPA Wine Tasting and Auction Raises More Than $43,000 for O&P Advocacy P.20

YOUR CONNECTION TO

EVERYTHING O&P

THE ONLY THING BETWEEN AMPUTEES AND A HIGHER QUALITY OF LIFE IS MEDICARE’S GLASS CEILING. MICROPROCESSOR KNEE

DARPA

BIONIC PROPULSION ANKLE

POWER KNEE

As seen in The Washington Post and The Hill

MYOELECTRIC

HIGH ENERGY FOOT

Medicare’s glass ceiling moves today’s prosthetic devices out of reach for most amputees.

Decades of technological advancements mean that new levels of mobility, health and

Amputees Who Receive Better Prostheses Save Medicare Money*

Though new, higher quality custom prostheses are widely available, Medicare

independence are possible for amputees.

The only problem? Medicare. The federal

K3 Prostheses (Higher Quality) $79,967

restrictions are a glass ceiling

government makes it highly unlikely that a

that keeps them out of reach

patient will qualify for these devices, and

of most amputees. Even

new regulations will make the situation

K2 Prostheses (Lesser Quality) $81,513

though it’s been shown these devices provide a better

worse, not better.

FIRST 12 MONTHS, ALL HEALTH COSTS.

quality of life.

If Medicare is trying to save money, denying

10.3%

amputees prosthetic devices isn’t the

Who has fewer incidents that require

way to do it. A new study shows patients

expensive care? In most cases, it is the

who receive timely prosthetic and orthotic

amputees who have been given the

devices can actually save Medicare money

prosthetics that kept them active and

over patients who are not treated — more

healthy. And now Medicare and its

than $231 million was saved for Medicare in

contractors are planning to further restrict

2014 alone.

who can get these better prosthetic limbs.

fewer skilled nursing claims for people with high-quality prostheses

It’s an outrage that Medicare would deny amputees the life-changing mobility that comes with prosthetics.

To learn more about the Medicare study

Who Had Fewer Medical Incidents?

Received Higher Quality Prosthetics

Received Lower Quality Prosthetics

and what you can do to stop these policies, visit mobilitysaves.org.

Fewer E.R. Admissions?

Fewer Skilled Nursing Needs?

Fewer Doctor Visits?

Fewer Hospice Admissions?

* Dobson | DaVanzo analysis of custom cohort Standard Analytic Files (2007‐2010) for Medicare beneficiaries who received O&P services from January 1, 2008 through June 30, 2009 (and matched comparisons), according to custom cohort database definition.

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NOVE M B E R 2015 | VOL. 64, NO. 11

contents

FEATURES COVER STORY

DEPARTMENTS | COLUMNS President’s View....................................... 4

Insights from AOPA President Charles Dankmeyer Jr., CPO

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 16

Transitions in the profession

22 | Foot Care for the Ages Foot-care professionals are noting that many adults are presenting with complications from flatfoot and other issues—complications that could had been prevented with intervention during childhood. Pedorthists, orthotists, and podiatrists can do their part to raise awareness among all health-care professionals of the importance of pediatric intervention through better communication and a multidisciplinary approach.

By Christine Umbrell

20 | This Just In Improving With Age

Assembly-goers who took part in the Eighth Annual Wine Tasting and Auction enjoyed drinks and camaraderie while supporting the future of the O&P profession. Proceeds from the event—more than $43,000—will benefit the O&P PAC and Capitol Connection.

P. 18

Strategies for Staying Paid

Follow these tips to prevent payment revocation during postpayment audits

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

CREDITS

Member Spotlight................................. 36 n n

P. 20

Active Prosthetics and Orthotics Makstride

AOPA News............................................... 40

AOPA meetings, announcements, member benefits, and more

Welcome New Members ................... 41

AOPA PAC...................................................42

30 | O&P Almanac Leadership Series

Marketplace............................................. 44

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

Broadening Our Scope In light of reimbursement challenges, some facilities are choosing to expand their scope of practice beyond traditional orthotic and prosthetic services—a strategy that can benefit patients who require related products and services to improve their quality of life. Find out what four senior-level O&P professionals have to say about the “right way” to offer ancillary services to O&P patients.

Reimbursement Page..........................18

Professional opportunities

P. 30

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

Upcoming meetings and events

Ask AOPA................................................... 52 Expert answers to your questions about detailed written orders and more

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

O&P ALMANAC | NOVEMBER 2015

3

PRESIDENT’S VIEW

My Parting Shot

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

I

F YOU ARE AN orthotist, you are so screwed! Medicare data shows us that certified orthotists provided only 25.35 percent of allowed services in 2013 compared with 29.01 percent in 2011. If you think that is a statistical anomaly, think again. The trend has been for fewer and fewer services provided by certified orthotists (COs) year after year.

Those data are for all categories of L code orthoses: off the shelf, prefabricated, and custom. If we ever need to cite an example of a profession that has no respect, certified orthotist should make the list. Not so long ago, only a few patients were referred to anyone but the certified orthotist; now it seems they are referred everywhere except to the certified orthotist.

Considering the current environment, it’s really no wonder! We have certified orthotists, certified assistant orthotists, certified orthotic fitters, certified pedorthists, certified therapeutic shoe fitters, and certified orthotist technicians. What referral source, third-party payor, regulatory agency, or legislative body can be expected to sort out who is “qualified” when each of these certificants is knocking on their doors claiming expertise? A-ha! Those ancillary certificants have a limited scope of practice, you say? Are you naïve enough to believe anyone pays attention to the “scope of practice” in today’s free-for-all environment?

The National Commission on Orthotic and Prosthetic Education (NCOPE) held an Education Summit in April of this year, during which the continuous unbundling of the orthotist profession was a significant topic. Not surprisingly, the overwhelming sentiment of the participants was to reduce the number of orthotic “subprofessionals.”

From my perspective, I believe all of the other certificants diminish the professional status of the certified orthotist and put patients at risk. After all, isn’t the decision determining the correct orthosis for the condition the most important, and isn’t that the role of the CO? Who do you think you are fooling when you compare a 32- or 40-hour training program to become a certified orthotic fitter to the master’s degree and residency required to become a certified orthotist? You, the CO, are much better equipped to educate, train, and privilege your own “helpers” than any of these minimalist education and certification tracks.

“It’ll be good enough” has become the orthotic standard. I recently visited a busy Walmart and watched patrons entering for about an hour. I saw people wearing all manner of cervical orthoses with heads bobbing and tossing. I guess they were neck warmers and fashion wear. I saw knee orthoses with the hinges hanging at the calf, and elbow orthoses merrily sliding up and down swinging arms. I believe if these people had been seen by a CO, I would have observed orthoses that actually did what they are supposed to do.

I think it is time for COs to say, “I’m mad as hell and I’m not going to take it anymore.” Tell the accrediting organizations, federal and state regulators, and payors to look at the mess they have created in orthosis land. When you stand up for your profession, it is not a selfish motive. It is how you ultimately stand up to protect your patients. It is never the wrong time to do the right thing.

This is my final President’s View column. It has been a privilege to work with all of the AOPA team and to help guide the profession. My sincere “thank you” for providing me this privilege. I am very confident that your new president, James Campbell, PhD, CO, FAAOP, and his team will provide excellent leadership for everyone in the profession of O&P.

Charles H. Dankmeyer Jr., CPO AOPA President 4

NOVEMBER 2015 | O&P ALMANAC

Board of Directors OFFICERS

President Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD President-Elect James Campbell, PhD, CO, FAAOP Becker Orthopedic Appliance Co., Troy, MI Vice President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Immediate Past President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis Inc., Rochester Hills, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Scott Schneider Ottobock, Austin, TX Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

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AOPA CONTACTS

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

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

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NOVEMBER 2015 | O&P ALMANAC

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

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

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

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

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

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

Copyright © 2015 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

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

Advertise With Us! Reach out to AOPA’s membership and 15,000 subscribers.

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

Visit bit.ly/aopamedia for advertising options!

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NUMBERS

O&P in San Antonio More than 2,200 O&P professionals took part in the 2015 AOPA National Assembly

Thousands of O&P practitioners, managers, business owners, and related professionals convened in Texas October 7-10 to take advantage of top-notch clinical and business management educational content and to network on the popular trade show floor during AOPA’s esteemed annual event.

JAM-PACKED EXHIBIT HALL

>100,000

Square footage of space on the trade show floor.

162

Number of manufacturers and service providers that exhibited.

19.5

Number of hours exhibit hall was open for visitors.

EDUCATION FOR EVERYONE

133

Number of expert speakers who shared their knowledge with attendees.

48

Number of educational sessions from which participants could choose.

44

Number of manufacturers’ workshop sessions featuring instruction on specific products.

IMPRESSIVE AWARDS

21

Total number of awards presented during the event.

1 Lifetime Achievement Award AOPA’s top honor was presented to Thomas DiBello, CO, FAAOP.

2 Thranhardt Awards

Elizabeth Russell Esposito, PhD, and J. Megan Sions, PhD, DPT, PT, OCS, were the winners during this year’s lecture series.

“I think the world of what [prosthetists and orthotists] do. You’ve made me a better surgeon, not only in the operating room with how I treat patients, but more importantly, in how I counsel patients.

What I’ve learned from the prosthetists and therapists at Walter Reed and CFI is invaluable. My hat’s off to the incredible work that you do.”

—Ret. Lt. Col. Donald Gajewski, MD, keynote speaker, and former director of the Center for the Intrepid

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NOVEMBER 2015 | O&P ALMANAC

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Happenings

Lisa Abernethy accepts the Edwin and Kathryn Arbogast Award for her prosthetic abstract.

Tyler Klenow, MSOP, CPT-ACSM, accepts the Otto and Lucille Becker Award for his orthotic abstract.

Stars Shine Bright in Texas In addition to offering outstanding networking opportunities, cuttingedge clinical education, and dynamic exhibit hall demonstrations, the 98th Annual AOPA National Assembly, October 7-10 in San Antonio, took time to honor O&P professionals and students whose devotion to the field will leave a lasting impression.

AOPA President Charles H. Dankmeyer Jr., CPO, presents the Lifetime Achievement Award to Thomas V. DiBello, CO, FAAOP.

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NOVEMBER 2015 | O&P ALMANAC

Each year, AOPA presents the Lifetime Achievement Award to honor an individual who has made a significant contribution to the profession. This year, the AOPA board of directors presented the 2015 award to Thomas V. DiBello, CO, FAAOP, former AOPA president and board member.

“Mr. DiBello is this year’s honoree because of his relentless passion for patient care, O&P education, and advancing the profession,” said AOPA President Charles H. Dankmeyer Jr., CPO. “Tom is a true visionary who has made a huge impact through his leadership at the Academy, AOPA, O&P educational programs, and his other volunteer work here and abroad.”

DiBello’s career in O&P spans many

Teri and Charles Kuffel, MSM, CPO, FAAOP (above left) and Rick Riley (above right) receive the 2015 Ralph R. “Ronney” Snell Legislative Advocacy Award.

roles, including clinician and patientcare facility owner to university faculty member and international lecturer and volunteer. In 2010, he merged his practice with Hanger Clinic, where he currently serves as Gulf Coast regional director. In addition, DiBello served on the AOPA board of directors for five years, including an unprecedented two terms as the president. He also served on the board of the American Academy of Orthotists and Prosthetists for six years and as its president from 2000 to 2001.

“It has been my distinct pleasure to serve this profession for over 20 years,” said DiBello during his acceptance speech. “And my message for you today is to just say ‘yes’ [to volunteer opportunities].

It will be a wonderful experience.”

Contributions made toward the advancement of the profession’s legislative and regulatory goals also were recognized at this year’s event.

Rick Riley, CEO of Townsend Design; Charles Kuffel, MSM, CPO, FAAOP, president and clinical director at Arise Orthotics & Prosthetics Inc.; and Teri Kuffel, Esq., vice president at Arise Orthotics & Prosthetics Inc. received the 2015 Ralph R. “Ronney” Snell Legislative Advocacy Award.

They were recognized for their efforts to motivate members of Congress,

HAPPENINGS

Technical Fabrication Contest

Thomas McGovern

Elizabeth Russell Esposito, PhD

state legislators, and other decision makers to take action on behalf of O&P patients and providers.

“Rick, Charles, and Teri are O&P industry champions who consistently and unselfishly invest their personal time to inform and educate legislators, regulators, and other professionals, with considerable impact,” said Dankmeyer. “Their voluntary efforts reap benefits for all O&P businesses.

AOPA salutes their advocacy.”

Recognitions in research efforts also were front and center this year, with the 2015 Fall Thranhardt Award.

The award, launched in 1996 by a gift from J.E. Hanger in memory of Howard R. Thranhardt, CP, has become one of the most distinguished honors in the O&P profession. The Thranhardt Lecture Series is considered the “Best of Show” clinical research, and the award recognizes individuals committed to advancing O&P education and research.

Two recipients took home the top honor and $500 prize. Elizabeth Russell Esposito, PhD, a researcher at the Center for the Intrepid at Brooke Army Medical Center, presented “Can Individuals With Transtibial Amputation Reduce the Metabolic Demand of Walking Using Real-time Visual Feedback?” She specializes in lower extremity biomechanics with

J. Megan Sions, PhD, DPT, PT, OCS

a focus on prosthetic technology and secondary injury prevention.

J. Megan Sions, PhD, DPT, PT, OCS, also was honored for her presentation, “Balance-Confidence May Help Explain Physical Function and Community-Integration among Individuals with Unilateral Transfemoral and Transtibial Amputations.” Sions specializes in evaluation and treatment of muscle and joint dysfunction and vestibular disorders with particular interest in the management of spinal pain and disorders.

A counterpart to the Thranhardt Award is the Sam E. Hamontree, CP(E) Business Education Award. It was created to recognize the best business paper submitted for presentation at the AOPA National Assembly.

This year’s honoree, Thomas McGovern, was recognized for his presentation, “Control Your Marketing Message by Controlling the Medium.”

McGovern has 20 years of experience in O&P sales and marketing and is the managing partner of Clinical Education Concepts, a company that specializes in marketing platforms for O&P patient-care facilities and manufacturers. He has taught O&P practitioners throughout the country how to market their practices by positioning them as subject matter experts.

In an exciting test of speed and precision, the 2015 Technical Fabrication Contest timed participants to properly assemble an articulating AFO. First place winners received a $500 prize and second place winners received a $200 prize. Congratulations to the following:

Professional Category

46.98 seconds Tommy Coronado, CPOA

52.41 seconds Brian DeMain, CPO

Technician Category

58.03 seconds Dan Lopez, ROPT

Student Category

1:01 Mary Walsh

1:09.04 Paul Mindenann

1:19 Kenneth O’Mera

O&P ALMANAC | NOVEMBER 2015

11

HAPPENINGS

LATE BREAKING NEWS

Favorable News on LCD for Lower-Limb Prosthetics The White House said on Friday, October 30, as the O&P Almanac was going to press that it will issue an update to the White House petition not to finalize the draft Local Coverage Determination (LCD) and Policy Article governing Medicare coverage of lower-limb prostheses. The email will go to everyone who signed the petition, about 110,000 people, and reportedly to millions of others. It will announce that CMS will be for the present not moving forward with the draft LCD from the CMS website! It appears that the LCD is not actually being rescinded. While it appears to confirm the information that AOPA shared at the recent San Antonio National Assembly that O&P could be confident that the July 16

proposed LCD for lower-limb prosthetics will not be enacted in anything close to its proposed form, it leaves many long-term questions unsettled.

Rumors—from reliable sources— indicate that CMS is in the midst of putting together a committee or panel from multiple federal agencies to review the prosthetic coverage policy as the next step forward. Some of this looks like the good news that we were told to expect. But, the absence of a complete rescission is profoundly troubling. AOPA urges caution and the need to examine carefully what the CMS and DME MAC announcements say—even more than what the White House petition commentary says—to assess any longer-term issues/threats,

beyond what appears, at least in the short term, to be pretty good news.

AOPA’s leadership and legislative specialists will review all government and contractor statements as they arise, and provide a further analysis once that in-depth review is complete.

All of this works to the benefit of amputees and their O&P providers who supported AOPA, the O&P Alliance, and the Amputee Coalition in the all-out effort to stop this LCD from reverting amputees to a 1970s standard of care. More details will be available in the next issue of the O&P Almanac.

RESEARCH ROUNDUP

Upper-Extremity Prosthesis Users May Benefit From Amputee Role Models New research from the Georgia Institute of Technology (Georgia Tech) suggests that upper-limb amputees may be more successful with prostheses if they are taught to use them by fellow amputees. Upper-limb amputees typically learn to use artificial

12

NOVEMBER 2015 | O&P ALMANAC

to limit forearm and wrist movement.

Participants tried various tasks, such as flipping a spatula and rotating a block, while wearing the device, before and after watching three days of videos of someone demonstrating the tasks.

Some of the participants watched videos of people wearing the same device, while the other participants watched videos of people who did not wear anything on their arm. Those who watched a matched-limb participant “did significantly better after three days of training,” says Wheaton. “Their arm movements were more consistent and fluid when they repeated the tasks.

Those who only watched someone without a prosthesis didn’t improve at all.”

Wheaton is currently repeating the study—this time using amputees as subjects. For details, see the October issue of the journal Neurorehabilitation and Neural Repair.

PHOTO: Courtesy Georgia Tech

Lead researcher Lewis Wheaton

arms by watching nonamputees demonstrate the devices during physical therapy and rehabilitation sessions.

The Georgia Tech researchers measured arm movements and analyzed brain patterns to determine whether subjects showed more improvement when they learned from someone who looks like them. “We wanted to see if there was something we could improve in therapy that helps amputees—something to refresh the rehab,” says Lewis Wheaton, the associate professor who led the study and directs the Cognitive Motor Control Lab at Georgia Tech. “If people with a prosthesis can’t figure it out in the first three days, they tend to give up.”

Study participants, who were all nonamputees, were asked to wear an elbow-to-hand split-hook prosthesis with movement sensors embedded onto the elbow. The device was designed

HAPPENINGS

CODING CORNER

Software Designed To Auto-Adjust Prostheses

back when the luggage is set down.

The CES system is in the research stages, with promising results from a recent trial. Currently, Huang’s team is “still working to make it better.”

For more information, see “A Cyber Expert System for Auto-Tuning Powered Prosthesis Impedance Control Parameters” in the September Annals of Biomedical Engineering.

ICD UPDATE

New Diagnosis Codes Take Effect Effective for claims with a date of service on or after Oct. 1, 2015, all Medicare claims must contain a valid diagnosis code from version 10 of the International Statistical Classification of Diseases and Related Health Problems, ICD-10. Claims that contain an ICD-9 diagnosis code or an invalid ICD-10 diagnosis code will be rejected as unprocessable. These claims may be resubmitted with a correct ICD-10 diagnosis code.

While the conversion from ICD-9 to ICD-10 may cause some delays in getting claims paid, these issues should resolve as providers adapt to receiving and reporting ICD-10 diagnosis codes in their correct format. While O&P providers are not responsible for assigning the correct ICD-10 code, they are responsible for reporting the valid ICD-10 diagnosis code assigned by the treating/referring physician.

AOPA has released an ICD-10 resource as a member-exclusive benefit, the AOPA ICD-10 bridge. This resource may be accessed at www. aopanet.org/coding-reimbursement/ icd-10-bridge/ using the username and password for your main facility location. AOPA also recommends that you confirm the correct ICD-10 diagnosis code with the referring physician before you report it on a claim.

PHOTO: Andrea Brandt

A team of bioengineers in the joint department of biomedical engineering at the University of North Carolina/ North Carolina State University has developed a cyber expert system (CES) that may one day replace human experts for the tuning of lower-limb prostheses. The CES system under development uses a software algorithm to tune artificial limbs automatically as the user walks throughout the day.

Led by Helen Huang, lead researcher and associate professor, the research team has developed auto-tuning code that can be embedded into the software of powered prostheses, allowing a prosthesis to automatically adjust as the user moves in real time. For example, the limb could compensate when the user is carrying a heavy suitcase, then adjust

Noridian Awarded Jurisdiction D Contract CMS has announced that the Jurisdiction D durable medical equipment Medicare administrative contractors (DME MAC) contract has been awarded to Noridian Healthcare Services.

The effective date of the contract award is Sept. 14, 2015, and the contract award is for one base year and up to four option years.

The total estimated value of the contract, assuming all four option years are exercised, is $138 million.

Noridian Healthcare Services is the incumbent contractor for Jurisdiction D so a smooth transition is expected.

National Government Services Protests Jurisdiction B Contract National Government Services (NGS) filed a formal protest in September of the recent Jurisdiction B DME MAC contract award to CGS Administrators LLC. CGS, the current Jurisdiction C DME MAC contractor, was awarded the Jurisdiction B contract on Sept. 3, 2015. As a result of the NGS protest, CMS has issued a stop order on the transition of the Jurisdiction B contract from NGS to CGS pending a review of the contract award by the Government Accountability Office.

NGS will continue to serve as the Jurisdiction B contractor until the protest is reviewed and the outcome announced, a process that could take three months or longer.

O&P ALMANAC | NOVEMBER 2015

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HAPPENINGS

INSURANCE INSIGHTS

Number of Insured Americans On the Rise

2014:

JAN.-MAR. 2015:

36

29

MILLION

MILLION

Number of Uninsured Americans

The number of Americans without health insurance is decreasing. During the first three months of 2015, 29 million Americans were uninsured—which is down 7 million from 2014, according to data published in an August report by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics.

The overall uninsured rate for January through March 2015 was 9.2 percent. Younger adults were less likely to have insurance: Adults ages 25 to 34 were twice as likely as adults ages 45 to 64 to be uninsured.

For adults ages 18 to 64, the uninsured rate dropped from 16.3 percent in 2014 to 13 percent for January to

March 2015. For this demographic, the researchers found that the percentage of people with private insurance coverage through the Health Insurance Marketplace or state-based exchanges increased from 6.7 million in the last three months of 2014 to 9.7 million in the first three months of 2015.

Among the states, Hawaii had the lowest percentage of uninsured individuals under age 65 in 2014 (2.5 percent), followed by Massachusetts (3.2 percent), Delaware (5.4 percent), and Iowa (6.4 percent). States with the highest uninsured rates were Texas (21.5 percent), Oklahoma (21.5 percent), Alaska (21.2 percent), and Florida (18.8 percent).

SOCIAL AWARENESS SPOTLIGHT

National Disability Employment Month Celebrated in October The Amputee Coalition took part in National Disability Employment Awareness Month in October. The annual awareness campaign is designed to educate people about disability employment issues and celebrate the many and varied contributions of U.S. workers who have disabilities. The theme for 2015 was, “My Disability Is One Part of Who I Am.” “The Amputee Coalition was proud to be a part of this year’s National Disability Employment Awareness Month,” says Susan Stout, president and chief executive officer of the Amputee Coalition.

The history of National Disability Employment Awareness Month dates back to 1945, when Congress enacted a law declaring the first week in October each year National Employ the Physically Handicapped Week. In 1962, the word “physically” was removed 14

NOVEMBER 2015 | O&P ALMANAC

to acknowledge the employment needs and contributions of individuals with all types of disabilities.

In 1988, Congress expanded the week to a month and changed the name to National Disability Employment Awareness Month.

The Amputee Coalition has specifically researched the issue of people with limb loss and employment. Results from studies that examine return-to-work rates among people with limb loss vary according to level and complexity of amputation. Some studies suggest that the rate of return to work for people with limb loss is around 56 percent, while other studies indicate that 66 percent of individuals with unilateral lower-limb amputation return to work, decreasing to 16 percent for individuals with bilateral lower-limb amputations, according to the Amputee Coalition.

Studies suggest that 22 to 66 percent

My disability is one part of who I am.

At work, it’s what people can do that matters. _______________

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of individuals with limb loss who return to work retain the same job.

“This year’s theme encapsulates the important message that people with disabilities are just that—people,” says Jennifer Sheehy, acting assistant secretary of labor for disability employment policy, U.S. Department of Labor. “And like all people, we are the sum of many parts, including our work experiences.

Disability is an important perspective we bring to the table, but, of course, it’s not the only one.” More information on National Disability Employment Awareness Month is available at www.dol.gov/ndeam.

HAPPENINGS

DIABETES DOWNLOAD

Diabetic Foot Ulcers More Common in Rural Areas Researchers have found that people with Type 2 diabetes who live in rural areas and/or have low incomes are more likely to undergo a lower-extremity amputation than their urban or higherincome counterparts. This finding is likely due to limited access to preventive health care, according to researchers at the University of Arizona department of surgery’s Southern Arizona Limb Salvage Alliance. Led by Grant Skerpnek, MD, from the University of Oklahoma Health Science Center, the research team studied the magnitude and impact of diabetic foot ulcers in U.S. emergency department settings from 2006 to 2010.

The data indicated that patients living in rural areas were 51 percent more likely to have a major (above-the-ankle) amputation than those living in urban areas. In addition, rural patients were 41

percent more likely to die as a result of complications from diabetic foot ulcers.

Medicaid beneficiaries were 21 percent more likely to have a major amputation.

“Diabetic foot complications exact a substantial clinical and economic toll in acute-care settings, particularly among the rural and working poor,” concluded the researchers. “Clear opportunities exist to reduce costs and improve outcomes for this systematically neglected condition by establishing effective practice paradigms for screening, prevention, and coordinated care.”

For details, see “A Diabetic Emergency One Million Feet Long: Disparities and Burdens of Illness Among Diabetic Foot Ulcer Cases Within Emergency Departments in the United States” in the August 2015 PLoS One journal.

WORLDWIDE O&P

Global Compression Therapy Market Expands The global value of the compression therapy market is predicted to increase from $3.84 billion in 2014 to $6.22 billion by 2021, according to a report published in October by research and consulting firm GlobalData. This increase represents a compound annual growth rate of 7.13 percent. The expansion will primarily be driven by an aging global population and an increasing prevalence of conditions such as diabetes.

“While Western nations, such as the United States and Germany, currently dominate the market, emerging economies are expected to see the fastest growth over the forecast period,” says Shashank Settipalli, GlobalData’s analyst covering medical devices. “Despite the United States being the biggest market in the treatment area, with a

value of $1.4 billion in 2014, the AsiaPacific region, which consists of Japan, China, and India, is expected to become the fastest growing market.”

While the outlook for compression therapy is positive, various barriers to further market growth remain. “Insufficient reimbursement is a recurrent obstacle to greater adoption of compression therapy products, especially in countries where comprehensive health care is flawed,” says Settipalli. “For example, access to compression therapy products is limited by both public and private insurers in the United States.” Patient compliance and the overall cost of therapy also may prevent additional growth.

O&P ATHLETICS

U.S. Teams Scout Paralympic Hopefuls Several “Gateway to Gold” events were held by the U.S. Paralympics Committee in September and October to introduce people with disabilities to Paralympic sports and get them in the athlete pipeline for the U.S. Paralympic Team.

The U.S. Paralympics and its community partners, including National Governing Bodies, Paralympic Sport Clubs, and veteran organizations, hosted the “introduction to sport and talent identification” events across the country. Taking part in a Gateway to Gold program can be a prospective athlete’s first step toward competing in the Paralympic Games.

The target population for the program is Paralympic-eligible (classifiable) athletes with a physical, visual, or intellectual impairment. Emphasis is placed on high school to collegiate-aged athletes. However, events are open to individuals of all ages.

Recent Gateway to Gold events were held in Houston, Boston, Minneapolis, and Berkeley, California. Athletes were introduced to a variety of sports, including cycling, swimming, track and field, archery, wheelchair basketball, and more.

Individuals who are not able to attend a talent identification event can learn more about becoming U.S. Paralympic emerging athletes by visiting www. teamusa.org/US-Paralympics/ Sports/Emerging-Athletes.

O&P ALMANAC | NOVEMBER 2015

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Marlies Beerli Cabell, CPO, has joined Ability Prosthetics and Orthotics and assists in the company’s York, Pennsylvania, patient-care center. Cabell, a cranial remolding specialist who has earned several current technology certifications, is expected to transition to practice in the company’s greater Baltimore area facility.

IN MEMORIAM

Van G. Miller Van G. Miller, chief executive officer of VGM Group Inc., passed away October 18 after suffering an apparent heart attack. Miller, who was 67, founded VGM nearly 30 years ago with the belief that quality home health Van G. Miller care is best delivered by community-based independent providers. VGM has a significant presence in the area of orthotics and prosthetics.

VGM, headquartered in Waterloo, Iowa, became fully employee-owned in 2008. Miller was known for a management style that allowed others to accomplish their tasks without interference. “I try to stay out of everybody’s way,” he said in a recent interview. “My ultimate responsibility is to make a decision when there is no clear-cut consensus.”

Miller was awarded the Ernst & Young Upper Midwest Entrepreneur of the Year Award in 2014, and was named one of the “Top 10 Most Influential People in the Home Medical Equipment Industry.” VGM was recently named one of the top 25 places to work in Iowa.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The Amputee Coalition hosted a Limb Loss Education Day at Reed College in Portland, Oregon, on October 24. Amputees and their families participated in a day of learning and networking and enjoyed a variety of recreation opportunities. biodesigns inc., located in Southern California, was awarded a $999,822 firm-fixed-price Phase II Small Business

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NOVEMBER 2015 | O&P ALMANAC

Innovation Research contract from the Defense Advanced Research Projects Agency (DARPA) for the delivery of a socket diagnostic tool for the manufacture and fitting of custom sockets for upper-limb prostheses. DARPA’s call for the socket diagnostic tool innovation is intended to find solutions to some of the challenges prosthetists face when designing the socket and suspension systems that hold prostheses on upper-limb amputees.

Delcam Orthotic Insole Solutions has combined its orthotic insole software, along with Crispin production footwear software solutions, to create Autodesk Footwear, a division that will provide software for the creation of the complete custom shoe.

College Park Industries Inc. has announced the acquisition of Liberating Technologies Inc. (LTI), a Boston-based company that created the Boston Digital Arm™. The alliance expands College Park’s product offerings beyond lower-limb prosthetics into upper-limb prosthetics, as well as orthotics and rehabilitation technology. “The strategic merger was the next logical step in College Park’s continued growth,” says William Carver, chief operating officer for College Park Industries. William Hanson will stay on as president of LTI. iWalk, also known as BiOM®, has relaunched itself as BionX™ Medical Technologies Inc. to better reflect its commitment to delivering bionic solutions that address critical unmet needs in the market.

The company unveiled its new name and logo during its presentation at the Ladenburg Thalmann Healthcare Conference in New York City on September 29. The corporate relaunch also reflects a series of significant company milestones, including the addition of an executive team, product enhancements, international commercial expansion, and ongoing support from reimbursement authorities. Össur recently welcomed Patrick Downes and Jessica Kensky, the newlyweds who survived the Boston Marathon bombing, along with Mike Corcoran, CPO, and U.S. Ambassador Robert C. Barber, to the company’s headquarters in Reykjavik, Iceland.

Downes and Kensky met with the company’s research and development team regarding their Össur prostheses, and previewed next-generation prosthetic innovations currently in development. Corcoran, who runs Medical Center Orthotics & Prosthetics in Silver Spring, Maryland, played a central role in supporting Kensky’s recovery while she received care at Walter Reed National Military Medical Center earlier this year.

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REIMBURSEMENT PAGE

By JOE MCTERNAN

Strategies for Staying Paid Follow these tips to avoid losing reimbursement during postpayment audits

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 19 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.19

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NOVEMBER 2015 | O&P ALMANAC

I

N TODAY’S O&P REIMBURSEMENT

climate, getting paid is difficult. Staying paid, however, is an even bigger challenge as audits continue to increase in frequency and size. The days of providing a service, submitting a claim, and getting paid are gone. The hurdles to reimbursement continue to grow taller, and a single mistake, omission, or oversight can mean the difference between claim payment and claim denial.

As both public and private insurers continue to struggle with financial pressures, they constantly refine their processes to reduce fraud, abuse, and waste. One way to do this is to increase audit activity to make sure they are paying only for medically necessary services.

While this may not seem fair to providers who deliver medically needed orthoses and prostheses to patients who pay premiums for health insurance, it is a fact of life.

This month’s Reimbursement Page explores several strategies to help ensure claims have the best chances of being paid—and staying paid when the claims are subject to postpayment audits.

Controlling What You Can Control

Medicare statistics show that more than 30 percent of claim denials are a direct result of two things: invalid proof of delivery documentation and invalid orders. The responsibility to make sure that these two crucial pieces of documentation exist and are complete lies solely with the O&P provider. Claim denials that are a direct result of these two reasons are completely avoidable if you are willing to make sure that your process is in full compliance with Medicare policy and regulations.

Recent changes to Medicare’s proof of delivery requirements have resulted in a significant increase in claim denials for invalid proof of delivery documentation.

This began in February 2015 when the durable medical equipment Medicare administrative contractors (DME MACs) released a joint bulletin clarifying the rules regarding proof of delivery documentation. In this bulletin, the DME MACs stated that simply reproducing the health-care common procedure coding system (HCPCS) codes and descriptors on the proof of delivery form is not sufficient for Medicare claims processing purposes. To be valid, the proof of delivery not only must contain sufficient information to allow a claim reviewer to verify that the Medicare beneficiary received the items or components listed, but also must contain sufficient information to verify that the items provided were correctly coded.

For a proof of delivery form to be considered valid, it must contain the brand name, model number, or serial number for all separately billed prefabricated components. For customfabricated devices or components, the proof of delivery form must include an easily understood narrative description of each device or component that will be billed separately. According to the DME MACs, the narrative description may not be a simple restatement of the HCPCS codes and descriptors.

The February 2015 bulletin represented a significant paradigm shift for O&P providers. What had been acceptable for many years was no longer considered valid. As a result, there was a sudden spike in claim denials for invalid proof of delivery.

REIMBURSEMENT PAGE

While change is never easily digested, the clarification was published almost nine months ago and specifically described the required information that must be recorded on a proof of delivery form in order for it to be considered valid. While we may not agree with the policy change—and AOPA continues to challenge the authority of the DME MACs to require this information on the proof of delivery form—as of now, it remains a requirement for reimbursement, and the DME MAC guidance should be followed. Eliminating claim denials as a result of improper proof of delivery could lower the claim error rate by as much as 20 percent.

Another common reason for O&P claim denials is an invalid dispensing or detailed written order. Like the proof of delivery form, responsibility to ensure that dispensing and detailed written orders contain all of the Medicarerequired elements lies within the control of the O&P provider. Even if the O&P provider does not physically complete the order, he or she has the ability to not deliver or submit a claim for an item until the order is complete and signed and dated by the prescribing physician.

As a reminder, the required elements for a dispensing order include the beneficiary’s name, a description of the item, the physician’s name, the date of the order and start date (if different from the order date), and the physician’s signature or supplier’s signature if the dispensing order is verbal.

Detailed written orders must include the beneficiary’s name, the prescribing physician’s name, the date of the order and start date (if different from the order date), a detailed listing of each item or component that will be separately billed, and the prescribing physician’s signature and date. Putting processes in place to ensure that all of your orders are compliant with Medicare requirements may result in a significant decrease in claim denials.

Another factor in supporting your claim that remains entirely in your control is your documentation. While there is constant debate over whether the prosthetist’s or orthostist’s records play any role in the claim review process,

and CMS has stated that “supplier” records are not considered part of the medical record, your documentation may be the difference in a claim being paid or denied. It is a fact that Medicare will always look to the physician’s record as the primary source for medical necessity documentation, but what you document—and, more importantly, how you document—is equally as important.

Medicare will consider your documentation as long as it is corroborated by what is in the physician record. It is always in your best interest to document what you are doing and why you are doing it in a manner that is consistent with the documentation practices of other health-care professionals.

Influencing What You Can’t Control

Once you have worked on the things over which you have complete control, it is time to focus on influencing those things that you cannot control.

The most important item over which you can exert influence is the documentation of other health-care providers. This is not limited to physicians and includes the documentation recorded by physical and occupational therapists, rehabilitation providers, hospitals, and skilled nursing facilities.

The obvious question is how you exert influence over other providers’ documentation. You can do so by educating your rehabilitation team partners regarding what must be documented in their records to best

support your claims. This is easier said than done but can provide very effective results if done properly.

The best time to provide this education is prior to beginning the process of providing O&P services to the patient.

If you can work with your referral sources and assist them in documenting the information necessary to support your claim prior to beginning treatment, the chances of you getting the documentation you need to support your claim are significantly improved.

Orthotists and prosthetists must work diligently to be accepted as a member of the overall rehabilitation team whose clinical care and professional expertise is equally as important as any other member of the team. Taking control of your own practices and influencing the practices of other health-care professionals will greatly improve your chances of being paid— and staying paid—by Medicare.

Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org.

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

Earn CE credits accepted by certifying boards:

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O&P ALMANAC | NOVEMBER 2015

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This Just In

Improving AOPA’s Annual Wine Tasting and Auction has become a true ‘experience’

&

T

HIS YEAR’S “BIGGER, BETTER,”

&

Alan Lampear and Anita Liberman-Lampear, AOPA’s retiring immediate past president, launch the auction.

Diane Weber

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NOVEMBER 2015 | O&P ALMANAC

Eighth Annual Wine Tasting and Auction was a red-letter day for great fun and increased funding for AOPA’s advocacy. Now viewed as a highlight of AOPA’s National Assembly, this year’s event was held October 8 at the San Antonio Convention Center, and garnered great support for AOPA government relations programs (the O&P PAC and Capitol Connection), with proceeds reaching the $43,000 mark.

Several attending wine aficionados gave kudos to the addition of a professional auctioneer, Oscar San Miguel, who lent a sense of urgency, value, and professionalism to the auction.

Adding humor and more fun were Scott Schneider and Rick Fleetwood, as they provided color and a touch of lightness to the entire evening.

Comments about the wine auction being the “best ever, fun evening, and great way to help make our voices heard,” validated the financial success of the night.

Over the eight-year history of the event, more than $220,000 has been raised to help make sure the O&P community has a place at the table on the important issues that can spell success or doom for the profession. Launched with the wine expertise and enthusiasm of Anita Liberman-Lampear,

AOPA’s retiring immediate past president, along with her husband, Alan Lampear, the Wine Tasting and Auction has been successful as a classic fundraiser opportunity for the advocacy effort, bringing together a great group of O&P professionals for the right cause. The O&P PAC has been able to selectively support those candidates who understand and support the need for orthotists and prosthetists in helping people maintain or regain their mobility, whether from limb loss or limb impairment. The event also offers another pathway for AOPA members to step up and be part of the process, while enjoying an extraordinary evening with colleagues.

The O&P PAC must comply with legal requirements that govern contributions to political candidates.

All contributions to the PAC must be in the form of a personal check or credit card. The PAC makes regular quarterly reports to the Federal Election Commission, as all political action committees are required to do. Contributions made to political candidates, typically incumbents, are regularly published in AOPA’s quarterly staff reports to members.

Capitol Connection is prohibited from contributing to political campaigns but instead provides information

This Just In

From left, Rick Fleetwood, Oscar San Miguel, and Scott Schneider

and tools for AOPA and its members to help educate their legislators about pressing O&P issues. The most popular tool is AOPAVotes, which provides an efficient mechanism for members to contact their legislators with concerns or encouragement related to specific O&P issues. During the recent campaign opposing the revisions proposed by the durable medical equipment Medicare administrative contractors (DME MACs) to the LCD Policy Article on Lower-Extremity Prosthetics, AOPAVotes facilitated more than 2,500

From left, Jim Kaiser, CPO; James Weber, MBA; and Jim Kingsley

letters from patients and nearly 1,400 letters from O&P professionals. Each letter submitted on AOPAvotes was sent to both the DME MAC contractor and the letter writer’s two senators and representative, outlining the harm that would come to patients should the LCD revisions be adopted.

AOPA’s annual event may be billed as a Wine Tasting and Auction, but in further extension, it’s one of the great supporters of O&P advocacy and the future of the O&P profession. That makes it an experience!

AOPA past presidents Ted Snell, CP, and Brad Ruhl

O&P ALMANAC | NOVEMBER 2015

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COVER STORY

Foot Care for the

Ages

Greater awareness of early intervention for pediatric flatfoot and other issues will prevent complications for patients later in life

By CHRISTINE UMBRELL

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NOVEMBER 2015 | O&P ALMANAC

COVER STORY

Need To Know • Too many physicians and pediatricians fail to check children’s feet for early indicators of future problems, meaning there are missed opportunities to treat flatfoot and other problems at an early age.

• If the calcaneus of pediatric patients is very everted at age 5, their flat feet should be addressed—even if they are not experiencing pain. Early intervention may prevent patients from developing bunions, pain, and other conditions requiring surgery during their adulthood.

• Genetics play a role in the shape of our feet, so foot-care professionals can learn a lot about their pediatric patients by asking to see their parents’ feet. In addition, foot-care professionals treating adult patients may suggest that their patients check their children’s feet for signs of flatfoot or other conditions requiring attention.

• Foot-care professionals of all types must work together in ensuring patients receive the most appropriate treatment. Open lines of communication are necessary so physicians provide clear instructions and ample documentation to the pedorthists or orthotists who provide and fabricate shoes and braces.

H

EALTH-CARE PROFESSIONALS WITH EXPERTISE in foot

care—podiatrists, pedorthists, and orthotists—often see patients as adolescents and adults who present with problems that may have been avoided had the patients been treated as children. An increased focus on early identification and prevention—among all foot-care professionals and their referral sources—can result in a better outcome for patients with flatfoot and other foot issues.

LOUIS DECARO, DPM

“Too many people believe children’s pain issues are ‘growing pains,’ or that pain is caused by ‘overactivity’”—but frequently these issues are biomechanical problems, says Louis DeCaro, DPM, owner of DeCaro Total Foot Care Center in West Hatfield, Massachusetts, and president of the American College of Foot and Ankle Pediatrics. Failing to address these issues has led to children

DENNIS JANISSE, CPED

with foot problems being “one of the most underserved populations in the country,” he says.

“Many physicians today just don’t have the mindset to check children’s feet for early indicators of future problems,” says Dennis Janisse, CPed, owner of National Pedorthic Services. “We need to be asking why we haven’t been making sure children’s feet develop better.”

Pedorthist Robert Sobel, CPed, president of the Pedorthic Footcare Association, has treated numerous patients whose adult symptoms could have been alleviated had they been treated earlier. Sobel, who is owner of

ROBERT SOBEL, CPED

O&P ALMANAC | NOVEMBER 2015

23

COVER STORY

One practitioner who is not surprised that so many adults are presenting with complicated, but preventable, foot issues is Dennis Janisse, CPed, owner of National Pedorthic Services.

A pedorthist for 45 years, Janisse remembers a time when there was a much greater consciousness of children’s foot problems.

“There used to be lots of children’s shoe stores specializing in correctiveorthopedic-type shoes, and we did internal and external modifications to shoes. We did a lot of corrective footwear and devices,” he says.

But then a study came out claiming that most foot problems in young children eventually self-correct.

“After the study, most children’s orthopedic shoe companies went out of business,” says Janisse. “At the same time, the athletic shoe market started to take off” and children resisted wearing unfashionable shoes.

Unfortunately, he adds, not all children’s foot issues self-correct. Many children who would have benefited from corrective footwear or braces over the past 20 to 30 years have been left untreated—and have grown into adults with painful foot issues.

“I’m excited to hear people starting to talk about corrective shoes and orthoses for children again,” says Janisse. “We get optimal results when we treat patients when the foot is still moldable—and when children are young enough that they are not as concerned with fashion in their footwear.”

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NOVEMBER 2015 | O&P ALMANAC

Flatfoot in children 5 and older should be examined and treated.

Sobel Orthotics and Shoes in New Paltz, New York, notes that some pediatricians—perhaps due to insufficient foot training—do not refer patients who present with issues such as flatfoot and high arches to foot-care professionals.

He suggests that more education should be given to pediatricians. He also advocates for a national foot-care awareness program, similar to the scoliosis check children are now given during annual exams. Such a program could lead to fewer foot complications as children grow.

“Unfortunately, the traditional style of treatment in children has been more of a wait-and-see or ‘they’ll outgrow it’ approach,” agrees Bob White, CO, of Prosthetic & Orthotic Solutions in West Springfield, Massachusetts. “Although there are not a great deal of studies proving early orthotic intervention in children prevents problems or deformities in adulthood, we do know that by improving biomechanical alignment we allow improved muscular efficiency and the potential for greater stability and control.”

Until a larger focus on these issues becomes a nationwide reality, foot-care professionals of all types can do their part to identify and treat problems early.

Recognizing Symptoms

One of the reasons so many children go untreated is because some physicians fail to delve deep enough into why children experience foot or leg pain, says DeCaro, who treats hundreds of adult patients—often surgically—for foot issues. In addition, most young children with flat feet—perhaps the

most frequently undertreated foot problem—don’t feel any pain at all. But those children are likely to develop bunions, pain, and a variety of other health issues in adulthood—many requiring complicated surgery.

“If the patient is putting excessive pressure on the medial aspect of the foot (especially with a flexible foot), the hallux can’t function as it should—which ultimately ends up limiting range of motion and causing a range of issues,” explains Sobel.

“This can be especially challenging for the diabetic population; adults with flat feet are putting a lot more pressure on areas where they shouldn’t, which causes ulcers and other problems for diabetics.”

DeCaro emphasizes that flatfoot itself cannot be prevented, but some of its complications can be: “You can slow down the progression,” he says, citing Oprah Winfrey as a famous example of someone whose feet were left untreated in childhood. “Oprah has bad bunions,” he says. “If her feet had been controlled from an early age, those bunions never would have formed.”

Depending on the severity of the issue, flatfoot can be treated by pedorthists, orthotists, or podiatrists.

Although every patient will need an individualized treatment plan, DeCaro emphasizes three “must-haves” in an orthosis: a deep heel cup (at least 25 millimeters in depth), an aggressive medial skive, and a functional lateral wall to control the abduction present in the pediatric flatfoot.

PHOTO: Louis DeCaro, DPM

Circling Back to Pediatric Foot Care

COVER STORY

Of course, flatfoot is not the only issue that may be overlooked in children. Conditions such as in-toeing, out-toeing, and high arches also should be examined early on to decide if intervention is warranted, says Janisse.

Factoring in Genetics

Age-Appropriate Evaluation

To assist other practitioners in identifying whether foot issues should be treated, DeCaro has done extensive research and has developed age-specific guidelines for identifying flatfoot.

For the youngest patients, symptoms other than pain need to be closely monitored. “Kids in the 1- to 4-year-old range don’t typically complain of pain, but they have balance issues, coordination issues, and posture issues,” he says. Looking closely at the calcaneus 26

NOVEMBER 2015 | O&P ALMANAC

Genetics plays a significant role in foot development. is the key to treating this age group.

“All of the control of the foot really comes down to the amount of calcaneal eversion, basically the calcaneal position. If the calcaneus is very everted, there’s probably something there you’re going to want to treat. The forefoot usually doesn’t play a role.”

Evaluating 5- to 9-year-olds is similar to 1- to 4-year-olds, says DeCaro. “In general, you’re treating them mechanically the same way.” The important thing to remember with this age group is that, by age 6, children will no longer grow out of flat feet: “At the age of 5, if they have a poor foundation, that’s bad, and needs to be addressed.” DeCaro emphasizes that if flatfoot is not treated with this age group, these individuals may start to experience pain in their 30s or 40s. “So it’s just waiting to happen—no pain at young ages is an unreliable indicator.”

Finding a Common Language

Once a pediatric patient gets in the door, foot-care professionals need to work together to provide the best

treatment plan. “There really needs to be more communication between physicians and pedorthists,” says Janisse.

“The physicians are the diagnosticians and the prescribers, and the pedorthists have the expertise to provide and fabricate shoes and devices. We need a good referral with a good description” to best serve the patient.

“Too often, an orthotist is making a brace in the dark because there is not enough information in a prescription,” agrees DeCaro. He tries to include videos and photos of patients walking with his prescriptions, to aid orthotists and pedorthists in designing devices.

DeCaro believes that understanding patients’ foot types will help all health-care practitioners effectively educate patients about the relationship between their foot type and their conditions. Podiatrists, pedorthists, and orthotists are trained very differently, so practitioners need to find a common language.

Understanding biomechanics is key to optimal treatment. “It’s important for us all to know it, because whether

PHOTOS: Louis DeCaro, DPM

One easy way to identify children who may have foot problems as adults is to look at the feet of their parents. “Feet are genetically related, just like hair color and eye color,” says DeCaro.

“Apples don’t fall far from the tree. If someone has bad feet, they’re probably going to give them to their kids and their grandkids.”

When treating children, DeCaro asks the parents to show him their feet.

“Everyone in my treatment room takes off their shoes and socks. I don’t care how ugly you think your feet are—I want to know what the genetics are here.”

It also works vice versa—the “single best way” DeCaro grows his practice is by asking his adult patients who require complicated surgery to go home and look at their children’s feet—and bring them to his office for preventive care if the children’s feet are similar to their own.

DeCaro also encourages other footcare practitioners to examine the feet of patients’ family members. “Whether it’s your patient or a patient that was sent to you, ask the people that you’re bracing or the people that you’re helping out, ‘Do you have kids and grandkids?’ As practitioners, it’s our obligation to help all, and so I translate that into helping everyone, even above and beyond your patients.”

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Promoting Collaboration Among Foot-Care Professionals Pedorthists, podiatrists, and orthotists have overlap in their patient bases—but rather than competing with one another, a collaborative approach to treatment can result in more satisfied patents as well as more referrals.

“Remember everyone has their area of expertise,” says Robert Sobel, CPed, owner of Sobel Orthotics and Shoes in New Paltz, New York, and president of the Pedorthic Footcare Association. “We need to have respect for each other and understand where each one’s strength lies. Then everyone stands to benefit—especially the patient.”

Sobel works with a diverse array of podiatry groups. “They utilize my services when they need something they can’t get—they’ll send patients here and let me assess and evaluate and give my recommendation.” Sobel also refers patients who need significant bracing to area orthotists. “We work in tandem with a multitude of different practitioners, including orthopedic surgeons, to get patients the best results.”

Bob White, CO, agrees that a multidisciplinary approach to patient treatment “allows each specialist to combine their individual strengths to help maximize patient outcomes.” White, who works at Prosthetic & Orthotic Solutions in West Springfield, Massachusetts, makes it his goal to be available “to help plan, evaluate, or troubleshoot any problems that arise during the course of treatment. Any time there are complex problems or goals that require a specific outcome, collaboration is necessary to have good success.

“I try to remind myself that everyone’s voice is necessary to reach the common goal,” says White. “The patient, the prescribing physician, the other practitioner, and myself are all usually working toward the same outcome, and we will always need to find a way to work together to get there.”

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PHOTOS: Louis DeCaro, DPM

If the calcaneus is very everted, the patient will likely benefit from intervention.

you’re making a brace for your patient, or you’re filling a prescription from an MD or a DPM, we all want to be on the same page,” says DeCaro.

Informing patients is equally important: “If I send out an order for an ankle-foot orthosis (AFO) for a child, I want the parents to know exactly why there’s a need for the AFO. If I send out an order for a supramalleolar orthosis (SMO), they’d better know why they’re not getting an AFO but an SMO instead. So education is the key.”

Toward that end, DeCaro has worked with Roberta Nole, MA, PT, CPed, to develop a simple algorithm to determine foot type. The patented algorithm consists of four steps:

examining arch height, assessing toesign, evaluating gait, and identifying callus patterns. This can be applied to all patients 10 and older. Based upon these steps, patients are identified as one of 24 foot types, which are classified under six main categories: severe pes cavus, mild pes planus, neutral foot, moderate pes planus, abductovarus forefoot, and severe pes planovalgus.

Ultimately, understanding that foot morphology dictates gait—and therefore causes a particular set of symptoms and calluses—will help practitioners determine how to design the best orthosis, says DeCaro.

Education and Opportunity

Increasing awareness of pediatric foot issues will result in more children receiving the care they need to prevent complications as they age. Physicians and podiatrists need to know it’s their responsibility to identify problem areas and refer patients to pedorthists or orthotists when the situation warrants.

“Pedorthists—and other foot-care professionals—should be promoting pediatric awareness,” says DeCaro.

This is especially important given the fact that pedorthists and orthotists cannot treat patients without direction from a physician, notes Janisse. “Many foot-care practitioners would love to address some of these problems in children, but we have a referral issue,” he says. Janisse says that updated evidence-based research would help convince referring physicians of the need for more preventive care, and it also would assist in reimbursement.

“Ultimately, everyone needs to be better educated so we can prevent some of the problems that may appear later in life,” says DeCaro. “Remember two things: It all comes down to biomechanics, and prevention begets correction.”

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

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LEADERSHIP SERIES

BROADENING

Our Scope

Providing ancillary services may offer benefits for both O&P facilities and patients

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of ancillary services.

Meet Our Contributors

Ivan Sabel, CPO, is chief executive officer of Orthotic Holdings Inc. in Hauppage, New York, a company that specializes in technologies and treatment options for health-care providers who treat conditions associated with the lower extremities.

He previously served as chairman and CEO of Hanger.

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NOVEMBER 2015 | O&P ALMANAC

T

O EXPAND OR NOT TO EXPAND into the world of ancillary services?

That was the question posed to four senior-level O&P executives for this month’s Leadership Series article. While some practitioners may believe it’s important to adhere to the core competency inherent in O&P—strictly defined orthotic and prosthetic services—others trust that tremendous opportunities are available to O&P business owners who broaden their scope of practice. Disciplines such as durable medical equipment, physical therapy, foot care, mastectomy services, and home remodeling are all possible areas of growth.

Here, our experts share their personal thoughts and experiences related to offering additional services at traditional O&P practices, emphasizing that the only expansions that will succeed are those that are well researched, properly staffed, and reimbursable.

Anthony Filippis, CPO, is chief executive officer of Wright & Filippis, a patientcare company focused on prosthetics, orthotics, and custom mobility products and accessibility solutions headquartered in Rochester Hills, Michigan.

Michael Tillges, CPO, is co-vice president at Tillges Certified Orthotic Prosthetic Inc., where he has worked since 2004. The company has facilities throughout Minnesota and western Wisconsin.

Jeff Lutz, CPO, is zone vice president of Hanger Clinic and currently serves on the AOPA and Amputee Coalition boards of directors. He has been a practicing CPO for the past 30 years.

LEADERSHIP SERIES

O&P ALMANAC: Why should O&P professionals consider including ancillary services as part of their practice?

IVAN SABEL, CPO: As the landscape

for O&P continues to evolve and change, it’s becoming more and more difficult to look at it as a pure orthotic or pure prosthetic business. Some people are navigating well around the headwinds that are affecting the profession; others are not faring as well.

A pure O&P practice, which I define as a facility that solely offers custom orthotics and/or prosthetics, will continue to face reimbursement challenges as well as challenges with the orthotic and prosthetic codes. In this environment, ancillary services can be leveraged as bottom-line contributions to offset these challenges and the changes in the headwinds.

ANTHONY FILIPPIS, CPO: There are a lot of synergies of products that patients need. O&P patients are coming into our facilities anyway, so we need to consider the items they may need as rehabilitative—when they can’t use an orthosis or prosthesis, or to use as additional support. For example, items such as canes, grab bars, bathroom aids, and raised toilet seats are examples of things that can make our patients’ lives better and easier. We need to be thinking: “What are the things that are going to help improve our patients’ lives?”

MICHAEL TILLGES, CPO: Ancillary services provide the patients and referral sources a full-service facility—in essence, a “one-stop shop.” They also allow a facility to become better diversified, and to tap into different revenue streams and markets to increase profitability.

JEFF LUTZ, CPO: Consider is the key

word in this question. The possibility of adding services or product lines to an existing O&P practice is intriguing to many. However, owners will need to carefully consider the impacts the addition may have on their core business.

To assist, AOPA has recently formed an Ancillary Service Committee to identify services and products that are related to O&P but not typically provided in an O&P practice. The concept is to be able to provide practices with alternative income and identify what is required to participate, as well as the potential profit. It should be noted that we are also looking at potential value-adds that may not be a traditional revenue stream, but add to the practice’s value proposition to the patient and referral communities, driving our current core competency, O&P. O&P ALMANAC: How can the O&P profession leverage our core competency and core asset to broaden our scope?

SABEL: O&P’s greatest asset is our

ability to identify and provide services to our patient population in a way that traditional business models outside of O&P don’t necessarily provide.

Our referral sources come to us with one specific request—an orthotic or prosthetic device. But we need to look at patients in a much more holistic way; our patients need other services and products to continue to live their lives to the fullest. They come into our

facilities requesting just an orthosis or prosthesis, but they have a number of other needs in their treatment modality.

By offering ancillary services, you’re contributing to a better quality of life for your patients, and you may make a profit to help offset some of the reimbursement and other recent challenges impacting O&P. FILIPPIS: I think it all ties to patient

management. Sometimes we get tunnel vision and focus only on orthotics or only on prosthetics. But we have to look at the activities of the patient before and after they arrive at our facilities. We can meet some of their needs—either with ancillary services, or by serving as a resource.

TILLGES: O&P’s core competency includes crafting and fitting of orthotic and prosthetic devices, as well as assessing the needs of the patient to provide appropriate products and services to better their life.

O&P’s core asset includes the patients we take care of, our referral sources, third-party payors, and employees and staff members.

By focusing holistically on the patients’ needs and providing them with the highest quality products and services, we enhance the quality of life for the patients we serve.

O&P ALMANAC | NOVEMBER 2015

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LEADERSHIP SERIES

Adding Foot Care to O&P Facilities

P

EDORTHICS IS ONE OF

the areas that many O&P practices consider when looking to expand their services. There are a number of reasons why it can be advantageous to both patients and business owners to include foot services—especially at those facilities that serve a high percentage of diabetic patients. Many O&P facilities already have built-in referral sources for patients experiencing lower-extremity vascular problems.

“By adding foot care/pedorthics services, you create more of a ‘one-stop shop’ for your patients and referral sources,” says Michael Tillges, CPO, covice president of Tillges Certified Orthotic Prosthetic Inc. For those patients who have already undergone one diabetes-related amputation, care of the remaining limb is critical.

Tillges says his facility recently added two certified pedorthists who have taken the role of managing the bulk of the company’s foot-care area. “In doing so, we have been able to reduce costs and increase our O&P practice to work more on our core business, which is providing orthotic and prosthetic services.”

Tillges notes another “plus” of offering foot-care services is the exposure—and education—it offers to residents or young staff. “Orthotic residents within our practice also focus on this area initially,” he explains. “It is important to build knowledge and understanding of the foot and function and requirements around supporting and bracing, which is the foundation of orthotic intervention.”

But Tillges and others caution that such an undertaking must be carefully considered before jumping in. In particular, facilities need to be prepared for the reimbursement challenges in this area.

“Foot care has become a hot topic with many in the O&P arena,” explains Jeff Lutz, CPO, zone vice president of Hanger Clinic. “Particularly around diabetic foot care, providers have had to step back and evaluate their current business plan and processes due to reimbursement and regulatory documentation challenges. Best practices clearly need to be identified.”

Despite the challenges, some practitioners see pedorthics as an area ripe with opportunity: Perhaps due to the reimbursement challenges foot-care practitioners are facing, Lutz notes that several large private payors are struggling to source access for these services for their members. “I expect we will see changes in delivery models develop over the next few years,” he says.

“The newly formed AOPA Ancillary Service Committee will also be looking at podiatry as a possible adjacent expansion that we can examine to give members the opportunities and risks of the business.”

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LUTZ: As the health-care world

changes, payors and patients may look favorably on providers who can bundle services for particular diagnoses. As an example, O&P providers treat many of the comorbidities that result from diabetes. Could an O&P practice offer diabetic foot care or nutritional classes or counseling for its patients? We are currently investigating what value, if any, payors and patients would place on additional services.

O&P ALMANAC: What are some examples of ancillary services or programs that would provide value to our patients and contribute to our facilities’ bottom line, and how could they be implemented?

SABEL: Many O&P patients are in need

of renovation and adaptive equipment for their homes, such as rails and bathroom accessories.

Another area is footwear—diabetic patients may have lost one limb, but their other foot also may be compromised. Practitioners may want to consider providing accommodative footwear for diabetic patients.

In addition, our patients—particularly new patients—often require physical therapy or occupational therapy services, which we could help provide.

One other area that O&P professionals may be hesitant to explore, but that may be worth a look, is durable medical equipment (DME).

There are still some profitable items in that area, so partnering with a DME provider is a possibility.

Typically, the patients don’t know where to go for these things, so we’re doing them a service by offering them.

FILIPPIS: Rehabilitative aids, ambu-

latory aids, and products related to diabetes are all areas we can focus on.

You can even host an online store on your website.

For diabetes patients—which make up a large part of many O&P practices—we can provide a service

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LEADERSHIP SERIES

for food supplements or nutrition to help improve the overall health of diabetic patients, and also drive revenue for an O&P facility.

Another area to consider is mastectomy product lines. A lot of the bigger companies are getting out of mastectomy services—but if it’s managed right, this can be a profitable area for O&P. TILLGES: With orthotics and prosthetics

being the core foundation of the business, there are several opportunities to explore: A facility could add pedorthics—a shoe and custom foot orthosis division, which could include off-the-shelf items.

For this, you would need to hire certified pedorthists trained in shoe and footwear. This could be a “bolt-on” service from your orthotic and prosthetic division, or might be in the form of a sister company with its own storefront.

A facility also could add vascular/ mastectomy services, which are custom and off-the-shelf compression garments along with postmastectomy products.

This also may include items offered to patients for cash sale. This could be a bolt-on service like pedorthics, or might also be in the form of a sister company with its own unique storefront.

A facility could offer physical therapy, in the form of an on-staff therapist to

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work with patients when it comes to gait training and using their prostheses.

This would involve hiring and training a physical therapist specifically on gait and alignment of a prosthesis. This addition would allow the clinician to focus more on the fitting and alignment of the prosthesis and additional patients while the physical therapist would work on gait training—which will result in billable events.

Another option is central fabrication. Facilities that fabricate the majority of their own products and devices in-house already have the general structure and fabrication capabilities established to offer this service. To make this a profitable area, it would be necessary to streamline processes and create a standardized workflow focusing on lean management. This may also include the hiring of additional staff to keep up with the increased workflow.

A patient-care facility also may want to explore a research and development division or sister company. We all have ideas as prosthetists and orthotists to improve on an existing product or process. It takes that engineering mind and willingness to think outside the box on what could make your job as a practitioner easier while improving patient outcomes and the willingness to bring that new idea or product to the marketplace. In our practice, we did just that with the creation of Tillges Technologies. We sell a product worldwide now that we developed and also offer central fabrication through this sister company.

Finally, some facilities may want to add durable medical equipment, such as canes, crutches, walkers, etc.

LUTZ: The first one that jumps to most

of our minds is adding physical or occupational therapy services in an O&P practice. Physical therapy is a $31 billion market in the United States and is growing at a rate of 2.2 percent per year.

O&P clinicians and physical therapists often treat the same patients.

The Ancillary Service Committee has begun interviewing O&P practices that offer these services and is in the process of gathering more information so our members can look at the opportunities as well as the risks and revenue potential of adding therapy services or other adjacencies. I can tell you it is not a “slam dunk.” Reimbursement, labor/ operating costs, referral reaction, and revenue potential will need to be very carefully considered.

O&P ALMANAC: What types of

additional staff or partnerships should O&P professionals consider hiring/fostering in order to offer ancillary services?

SABEL: These are all things we don’t

necessarily need to be taking on by ourselves. Larger facilities can hire part-time staff. Or, there are great opportunities for joint venturing: We can partner with others, and build business arrangements with various modalities, such as home rebuilding companies for adaptive equipment, or physical therapist services, or pedorthists.

We can subcontract these things out.

FILIPPIS: We have to look as this by product. For many products, existing staff can take on additional duties.

For example, most facilities already have fitters in their facility, which can take on the distribution of ancillary products that need to be fit.

For ambulatory aids such as walkers, canes, and crutches, often customer service staff can take this on. Manufacturers are very willing to come in and train your customer service staff.

For items such as grab bars and other home renovation items, you can subcontract the installation out.

TILLGES: Additional staff or part-

nerships depend on what ancillary services you choose to offer. Staff may include orthotic/prosthetic assistance and/or fitters; pedorthists; vascular/ mastectomy fitters; technicians; and admin staff—including front office, billing, and managerial staff.

Partnerships may include referral sources, vendors, and distributors.

It is very important to have strong partnerships with your referral sources as they are the ones writing the orders for your products and services for the patients’ needs. It is important to keep them abreast on the products and services that you can offer to their patients.

Vendors and distributors are another important partnership to foster. By working together to bring costs down through consolidation of products and purchasing, you can improve each other’s bottom line.

LUTZ: Knowing your particular market

is the best advice I can give. I would encourage O&P facilities to test their respective markets for underserved patient populations or needed services.

Explore the risks and opportunities associated with fulfilling an undermet need in the medical community.

After good market intelligence has been gathered and integrated into a business expansion plan to meet a need in the medical community, O&P facilities should consider fostering relationships or adding additional resources as part of an overall strategy to expand into any ancillary service.

O&P ALMANAC: Should every O&P

practice consider adding ancillary services?

SABEL: I’m not suggesting that an

ancillary program is right for every O&P facility in the United States—it depends on your business, and what you’re willing to take on.

FILIPPIS: I think this question is tied

to location and regional saturation.

You need to know the competition in

your area. If the competition in those ancillary services is already active, you might not want to get involved.

For example, if your facility is located within a hospital that already provides those services, it doesn’t make sense to add them. But in rural areas, you could be providing a much-needed service.

Also, space can be an issue, especially in hospital settings, so it may not be practical to stock a lot of inventory.

TILLGES: Not every O&P practice

should consider adding ancillary services to its business model. Your practice must be in order first from a practical, technical, administrative, billing, managerial, and financial standpoint. Once these areas are strong and perfected, then one can consider offering ancillary services.

Remember the 80/20 rule in business—that is, 80 percent of your revenue should come from your core business and 20 percent from the ancillary services. Ancillary services are not what pay the bills.

LUTZ: There is typically always a

case to be made for sticking to your core competencies in any business environment. However, adding payor or patient value does not have to be a grand undertaking. Adding a patient navigation tool to your website or returning gait analysis reports to referrals are value-adds that involve little risk, but can develop practice value.

O&P ALMANAC: Any other tips

for adding ancillary services to an O&P facility?

SABEL: Ancillary services can be a

great marketing tool. Once we add new services, we can go to physicians and tell them that we can handle these services—that we are a central care coordinator—and that working with us will save patients money while getting better patient outcomes.

You can present your facility as a total solution, rather than a oneproduct solution.

FILIPPIS: You don’t need a huge

showroom, but you can put a few items up on your wall. Ancillary services can provide a good stream of revenue, if managed properly.

An easy way to add a service is to find a quality supplier—they are usually more than willing to come in and help you set up, as well as provide display units. They’ll also help you with the payor side. Use the manufacturers and distributors; they can help you with inventory and display needs.

The bottom line is, you should research what you’re getting into, know what the reimbursements are, and make sure it’s not an oversaturated market. The ultimate goal is better quality patient management, while making a profit.

TILLGES: You already have your

patients’ information and they are in your system so it’s a no-brainer to offer them additional services and products for their needs. Make sure you still focus on your core business when adding ancillary services. Staffing requirements need to meet the demand of the ancillary services as well.

LUTZ: Do your market research.

Understand the reimbursement landscape of the ancillary products or services you are considering. Before investing in expanding the scope of your practice, understand what impact the new offering will have within your referral base. Consider if you have the administrative bandwidth to operate the new offering. Also, have a realistic expectation of your return on investment, and understand what impact the expansion will have on your current employees and practice.

O&P ALMANAC | NOVEMBER 2015

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MEMBER SPOTLIGHT

Active Prosthetics and Orthotics

Reaching the Pediatric Population San Antonio facility boosts awareness of O&P options for pediatric therapy community

D

AVID GERECKE, CPO, FAAOP, launched Active

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Active P&O’s Joel Buckley, Terry Aguilar, and David Gerecke, CPO, FAAOP

FACILITY: Active Prosthetics and Orthotics, Consolidated Prosthetics and Orthotics OWNER: David Gerecke, CPO, FAAOP LOCATION: San Antonio, Texas HISTORY: Six years

David Gerecke, CPO, FAAOP, scans a pediatric ankle-foot orthosis.

increase awareness of prosthetic and orthotic options available to the pediatric therapy community, Gerecke sponsors continuing education courses by O&P suppliers. “Therapists appreciate a way to earn CEUs, and it allows me to educate them on O&P modalities and new technology.”

Pediatric orthotics is the bulk of the facility’s practice, in part because Medicaid coverage for prosthetics and orthotics is limited to patients under 21 years of age in Texas, says Gerecke.

That, and Medicaid’s change in the cranial remolding benefit, has led Gerecke to become more politically active in the state. He took part in a lobbying effort that ultimately influenced the policy being amended to partially restore coverage for cranial remolding orthoses.

Gerecke’s experience as both an independent practitioner and as an employee of larger companies has made him acutely aware of the challenges particular to standalone facilities. “Large companies get better discounts from suppliers, and they have dedicated staff who manage supplier contracts and maximize

economy through rebates, better shipping, and payment terms,” he explains. Smaller, independent practitioners can’t take advantage of this and may find it daunting to manage compliance and cash flow as well.

These issues inspired Gerecke— along with Joel Buckley, Active P&O’s business manager—to launch a new business, Consolidated Prosthetics and Orthotics. The new company will enable independent practices to become part of a bigger entity, yet retain their individuality.

“We aim to grow by trading stock in Consolidated Prosthetics and Orthotics for equity in independent practices,” says Gerecke.

“The company will be owned by the independent practice owners who merge with us. They don’t need to change their names or the way they treat patients, and they will benefit from centralized supplier management, billing and collections, and compliance.

Also, a bigger geographic footprint will give us more leverage with insurance companies.

“Aside from functions that obviously need to be centralized, we won’t mess with anything they’re doing that works,” he stresses. The business structure means practitioners can benefit from one another’s expertise and work together to create improved models of care.

Consolidated Prosthetics and Orthotics has oral or written commitments from practices in six states and is seeking startup capital from corporate and private investors.

“We’re issuing an open invitation to other independent facilities who want to enjoy the benefits of becoming part of a larger, employee-owned organization,” says Buckley.

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

PHOTOS: Active Prosthetics and Orthotics

Prosthetics and Orthotics (P&O) in 2009, after stints as a training consultant for WillowWood and an employee of a Seattle O&P facility that was acquired by one and then another national patientcare company. He also ran his own practice, Seattle Prosthetic and Orthotic Associates, for five years, before being wooed to Texas to be a clinician at San Antonio’s Brooke Army Medical Center (BAMC).

All of that experience influenced the way Gerecke structured Active P&O in San Antonio, a three-person operation that leverages technology to simplify and speed operations.

“We are a plaster-free office,” he says. “I do all of my modeling by CAD, which gives me the opportunity to use a limitless number of fabrication specialists around the country. As a result, I get highquality fabrication at the lowest cost.” In-office laser-alignment devices and force plates “give me quick and accurate data on alignment and weight that I can easily communicate to the fabrication specialists,” he says. Portable CAD units also enable him to make house calls when patients, following discharge from the hospital, are unable to get to his office.

Gerecke uses O&P office management software and outsources billing functions, which, he says, has minimized problems with reimbursement.

Active P&O focuses on pediatric patients, a population he believes is underserved. To

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MEMBER SPOTLIGHT

Makstride, Makstride Prosthetics

STEM Prosthetics O&P designer leverages a mechanical engineering background to develop artificial feet

M

ONTY MOSHIER FIRST BECAME interested in

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NOVEMBER 2015 | O&P ALMANAC

COMPANY: Makstride, Makstride Prosthetics LOCATION: St. George, Utah OWNER: Monty Moshier HISTORY: 10 years

The prostheses are made of carbon fiber with titanium fasteners and adaptors, all ISO tested to current standards, says Leach. “Tests show the shank on two models, the NaturalStride and ComfortStride, can accommodate up to 500 lbs, and there are not many of those on the market,” he said noting also that the prosthesis is lightweight, so it doesn’t place undue pressure on the socket and amputee’s residual limb.

Jennifer McCarthy, CP, a clinical consultant at Makstride, assists with product testing on patients and offers clinical feedback to improve prosthetic design. “I also provide clinical support to customers and product training to our sales staff and to customers,” she says. Facing the pylon toward the back, in contrast to traditional shanked feet, she says, “allows patients to feel less resistance when loading the pylon, which makes their gait more efficient and requires less effort to walk.”

Makstride introduced the next generation of its prosthetic foot—the Trekk and Trekk LP—at the AOPA National Assembly

in October. The Trekk offers improved vertical shock absorption, says Claudino. “Its anteriorfacing calf shank with multiplicity of elongated struts upon initial heel contact has plantarflexion and eversion movement. This movement is crucial to replicating more normal physiological shock absorption,” he explains.

“With the addition of the new keel and independent heel, at midstance, the Trekk has little resistance to movement, so the ankle can move freely. This allows the plantar weight-bearing surface of the foot to stay compliant with the ground, creating more stability. Also, the overall increase in movement with less resistance greatly reduces inner socket shear forces. This means more socket comfort for the amputee,” says Claudino. “As the toe continues to load in late-stance phase, the anterior-facing shank gets longer and helps keep amputees’ center of gravity at a more even level. It takes out the vertical movement, so you spend less time going up and down like a pogo stick and more time moving forward.”

The company has received positive feedback from several users, including Scott Faulkenburg, an amputee who used the Trekk while climbing Kilimanjaro. The foot “performed really well all the way to 19,340 feet,” says Faulkenburg. “The foot was stiff enough to handle pack weights up to 60 lbs, yet was comfortable on the downhills. The new heel felt like a shock absorber coming down the mountain, which was a welcome change from the usual pounding heel strike.”

Perhaps the most important satisfied user is Moshier’s own father: In spite of owning a bionic prosthesis, he wears the foot his son designed nearly every day.

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

PHOTOS: Makstride, Makstride Prosthetics

prosthetics at age 11, when his father lost his leg below the knee in a lumber milling accident. While Moshier was earning his PhD in mechanical engineering from Purdue University, his father’s prosthetist asked for help with a new prosthetic foot he was developing, and Moshier’s path was set.

He began consulting on prosthetic design and manufacturing, and in 2006, he launched his own company, Makstride. In addition to running Makstride, Moshier teaches aeronautical engineering and serves as chief technologist for a company that develops inspection systems to identify metal fatigue cracks.

At first, Makstride designed and manufactured feet for distribution by another company, but in March of this year, Moshier formed a sister company, Makstride Prosthetics, to assume sales and marketing functions for its own products.

Makstride makes the BioStride series of prosthetic feet, a carbon fiber design that uses a reverse J shape for the shank, according to senior engineer Dallin Leach. “When you load the heel, it actually propels you forward instead of down or even backwards, as in other devices.”

“The BioStride foot doesn’t have an independent heel mechanism,” explains the company’s prosthetic technician Byron Claudino, a 25-year veteran of the industry and co-designer of Makstride feet. “It derives all plantarflexion at initial heel contact from the calf shank itself, simulating more normal human biomechanical ankle movement.”

Mountain climber Scott Faulkenberg

By DEBORAH CONN

National Partnership. Local Identities.

BCP Group is pleased to announce the newest partner in our expanding national network of high-quality O&P practices.

Clinic Support Operations BEACON

Prosthetics & Orthotics

2 1 3 5

6 1

3

# = Clinic Locations

New Member Clinic: BCP Group is an O&P management company based in Nashville, Tenn., dedicated to enhancing the viability of the independent, clinician-driven O&P practice model. We make ownership investments in high-quality clinical practices and then provide behind-the-scenes business support and resources that enable our partners to focus on patient care and practice growth.

Visit bcpgroup.net for more information about BCP Group and partnership opportunities.

AOPA NEWS

Join the Coding Experts in Las Vegas November 9-10

GET CONNECTED TO THE NEW AND IMPROVED

AOPAversity Online Learning Center Get Connected with AOPAversity • Set up your free online account • Peruse education by credit type or topic • Preview videos to determine interest • Low rates, and discounts for AOPA members • Instant quiz results • Access your account anytime to review CE credits earned • Print certificates on demand for state licensure boards Visit www.AOPAnetonline.org/aopaversity for more information.

Brought to you by

Top 10 Reasons To Go to Vegas: 1. Get your claims paid.

2. Increase your company’s bottom line.

3. Stay up to date on Medicare billing.

4. Code complex devices.

5. Earn 14 CE credits.

6. Learn about audit updates.

7. Overturn denials.

8. Submit your specific questions ahead of time.

9. Advance your career.

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

Along with some of the best educators in the world!

40

The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you!

The Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of both O&P practitioners and O&P billing staff.

The seminar will feature hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff.

Join your colleagues November 9-10 in Las Vegas.

NOVEMBER 2015 | O&P ALMANAC

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more at bit.ly/2015billing.

AOPA NEWS

Have You Read the O&P Almanac’s Leadership Series?

Find out what senior-level O&P professionals have to say about the most critical issues facing the O&P profession.

Several 2015 issues of the O&P Almanac have featured a new Leadership Series, showcasing Q&As with O&P experts on targeted topics of importance to the profession. Visit www. aopanet.org/publications/ digital-edition to access past issues of the magazine and read what executives have shared, in their own words, on these important topics:

HOSPITALS— WHAT’S THE HYPE? Andrew Meyers, CPO; Jim Kingsley; and Rebecca Hast detail their success strategies.

June 2015 O&P Almanac, page 34

A PLACE IN THE CONSOLIDATION CONTINUUM Pam Filippis Lupo, CO/LO; Mike Sotak; and Rick Riley weigh in. September 2015 O&P Almanac, page 36

TECHNOLOGY SMARTS David Boone, PhD, MPH; Jan Saunders, CPO; and Stephen Blatchford share their insights. July 2015 O&P Almanac, page 36

DISSECTING DISEASE TRENDS Thomas DiBello, CO, FAAOP; Phil Stevens, MEd, CPO, FAAOP; and Rudolf B. Becker offer their thoughts.

October 2015 O&P Almanac, page 48

LEADERSHIP SERIES

LEADERSHIP SERIES

O&P ALMANAC: What is the difference between consolidation and vertical integration?

A Place in the

CONSOLIDATION Continuum?

Experts weigh in on the future of independent O&P facilities amid evolving economics

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession.

This month, we investigate the topic of consolidation and vertical integration.

Meet Our Contributors

Pam Filippis Lupo, CO/LO, is a member of the board of directors at Wright & Filippis and at Carolina O&P. She also is a surveyor for the facility accreditation program of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, and an industry consultant.

A

S O&P PROFESSIONALS GRAPPLE with reimbursement challenges and dwindling profit margins, it’s impossible to ignore the industry consolidation trends taking place within the greater health-care arena. The number of “independent” health-care providers across medical specialties is falling. In fact, the number of U.S. physicians in independent practice has dropped significantly, from 57 percent in 2000 down to 37 percent in 2013, with a predicted decline to 33 percent by the end of 2016, according to data published by Accenture.

The same report finds that those independent physicians who have sold their practices or sought employment directly with health systems have done so largely due to disruptive market conditions, such as reimbursement pressures. Some of the independent physicians who have kept their practices are coping by experimenting with other models to remain competitive—for example, 17 percent of U.S. independent physicians are participating in accountable care organizations (ACOs).

Today’s O&P practitioners are facing similar reimbursement challenges and increasing costs. Several independent O&P facilities have recently consolidated with larger O&P practices, or have aligned themselves with suppliers or distributors on the O&P production pathway.

What do these consolidation and vertical integration trends mean for today’s typical O&P provider and the outlook for the O&P profession? O&P Almanac recently spoke with three O&P experts, who shared their insights on the current business climate and the pros and cons of industry consolidation.

Mike Sotak is president and chief executive officer of PEL in Cleveland, Ohio. Sotak acquired PEL two years ago, after a diverse business career managing distribution and manufacturing businesses in pharmaceuticals, wound care, durable medical equipment, and related health fields.

Rick Riley is chief executive officer of Townsend Design in Bakersfield, California, a company with more than 150 employees. He worked in hospital administration before joining Townsend in 1995 as vice president of marketing, then took on duties as the company’s vice president of sales and marketing in 1997.

He assumed the role of CEO in 2003.

PAM FILIPPIS LUPO, CO/LO:

Consolidation is a merger or acquisition of smaller companies into a larger company. Vertical integration is when the supply chain or manufacturer owns the company to which it supplies products.

MIKE SOTAK: Consolidation is gener-

ally driven by the need or objective to realize economies of scale; it’s fewer companies getting bigger to leverage costs and gain efficiencies. With vertical integration, the goal is usually different—diversification, to spread risk, or to gain control upstream or downstream across the continuum of care. Examples of vertical integration include aligning with referral sources and partnering with physical therapists or other service providers, such as ACOs. Many O&P facilities right now are vertically integrated with c-fabs, which are technically custom manufacturing operations.

O&P ALMANAC: What types of

consolidation and/or vertical integration are occurring in O&P right now?

LUPO: There are a number of differ-

ent ways O&P facilities are consolidating and being integrated into larger companies. For example, O&P companies are buying other O&P companies. Several O&P companies have made acquisitions, including Hanger, Wright & Filippis, Level Four O&P, and New England Orthotics and Prosthetics.

Some O&P companies are combining with physical therapy. Some hospitals are buying O&P and durable medical equipment (DME) facilities.

Some physician groups are acquiring prosthetists.

On the manufacturing side, some manufacturers are working together,

or are working together with O&P as a provider, potentially under competitive bidding. There are numerous configurations.

SOTAK: We’re seeing some consolidation on the patient-care side. Some larger regional players are looking to acquire other practices—facilities that are looking to get bigger for efficiencies of scale. For example, many organizations are feeling a need to hire compliance officers—but how can you afford to hire someone on staff as a compliance officer if you’re a two-person staff? So they’re looking to consolidate to justify hiring professionals necessary to consistently meet regulatory requirements.

We’re also seeing consolidation at the manufacturer level, and I think we will see a lot more as manufacturers face new challenges in meeting expected financial performance.

RICK RILEY: There is an emerging

model, especially in larger markets, where hospitals, physician clinics, and ancillary services—including

38 SEPTEMBER 2015 | O&P ALMANAC

LUPO: Mergers and acquisitions can

lead to decreased costs due to the consolidation of redundancies. They may also allow O&P companies to expand into different scopes of practice—for example, foot care or DME.

LEADERSHIP SERIES

DISEASE TRENDS Understanding disease prevalence and forecasts can help O&P professionals adapt their practices

A

S THE O&P PROFESSION begins to collect patient data to demonstrate the effectiveness of orthotic and prosthetic intervention in restoring function— data that is increasingly important to payors—it’s a good time for O&P practitioners to take a look at those disease trends that are emerging from data generated by other health-care sectors.

Many medical disciplines already have a vast array of patient information—data that could prove useful to orthotists and prosthetists as they consider patient demographics and set business plans. With reimbursement challenges on the rise and profit margins on the decline, it has become more important than ever for O&P businesses to understand which types of patients may be in greatest need of services in the near- and long-term future. Those O&P business managers and clinicians who follow disease trends will be best positioned to treat the patients most likely to visit their offices in the coming years.

Here, O&P experts share their thoughts on the importance of following disease trends, such as diabetes and cerebral palsy, and offer suggestions for staying current on relevant medical advances.

Thomas DiBello, CO, FAAOP, is clinic regional director at Hanger Clinic; honorary adjunct faculty at Texas Women’s University; and chairman of the Advisory Committee of the Baylor College of Medicine Masters Program on Orthotics and Prosthetics. He is past president of both AOPA and the Academy of Orthotists and Prosthetists.

39

O&P ALMANAC: Why should O&P professionals pay attention to disease trends?

DI SSECTING

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of disease trends.

O&P ALMANAC: What types of opportunities do these mergers present for the O&P profession and its patients?

O&P ALMANAC | SEPTEMBER 2015

LEADERSHIP SERIES

Meet Our Contributors

O&P—are vertically integrated to create increased synergy and efficiency. In some cases, a local O&P facility is purchased by a large medical provider, and in other cases the network is hiring in-house orthotists and prosthetists.

Among suppliers and manufacturers, there is also increasing consolidation. The companies that have the financial capital to make acquisitions can amass a vast range of products.

This creates a strategic advantage in terms of offering one-stop-shopping to group purchasing organizations and integrated provider networks.

Phil Stevens, Med, CPO, FAAOP, is immediate past president of the American Academy of Orthotists and Prosthetists and is in clinical practice with Hanger Clinic in Salt Lake City, Utah.

Rudolf B. Becker is chairman and president of Becker Orthopedic, a supplier of orthopedic component parts and central fabrication services located in Troy, Michigan.

THOMAS DIBELLO, CO, FAAOP:

As we evolve as a profession, it’s important that we be very involved in understanding and appreciating the changes occurring in the diseases that we treat.

For instance, if there were an effective way to completely cure diabetes, then there may be a diminished number of amputations for diabetes patients, and that would reduce the need for prosthetic devices for diabetic amputees.

On the orthotics side, if physicians begin performing more prenatal intra-uterine surgeries to repair spinal insults that occur in unborn infants with spina bifida, and research shows that these patients are then more cognitively alert but still have neuromuscular limitations that require bracing, that may have an impact on orthotics treatments—and we would need to be aware that further advances could ultimately eliminate the need for those types of orthoses.

One example of the importance of following disease trends can be seen in the case of a well-known rehabilitation hospital. During the course of a decade during the 1980s and ‘90s, the hospital transitioned from being primarily a spinal cord injury center to a hospital that primarily treats stroke patients. They were watching trends and recognized that the number of spinal cord patients was diminishing—mainly because the majority of spinal cord injuries occurred secondary to motor vehicle injuries. As cars became safer, there were fewer spinal cord injuries. A change in focus to stroke patients helped ensure the hospital’s longevity.

We, as a profession, need to be equally aware of trends that may affect the work we do.

PHIL STEVENS, MED, CPO, FAAOP:

Every industry has to forecast its future. Are the demands for their

48 OCTOBER 2015 | O&P ALMANAC

services going to increase or decrease?

For orthotics and prosthetics, disease trends constitute a big part of that forecasting.

RUDOLF B. BECKER: It’s important to follow disease trends so the profession and the companies that supply practitioners can prepare for the future needs of patients and offer viable treatments to referral sources.

O&P ALMANAC: What do individual practitioners, or the O&P profession as a whole, need to do to ensure we follow disease trends?

DIBELLO: I know there is a lot of uncertainty in the profession these days related to possible Local Coverage Determination (LCD) changes and downward pressures on reimbursement, but we need to devote human and financial resources within the O&P profession to look at these trends, as so many other professions do.

In the past, we have not studied the changes occurring in general medicine related to our patients whose diagnoses

we encounter the most. At times, we have been caught by surprise.

We have to face this as a profession.

We know very little about these areas of medicine we are most affected by, and we are at risk of being caught in a situation for which we are unprepared.

STEVENS: I think individual practitioners will continue to be dependent on larger entities within the profession to follow disease trends. Individual practitioners don’t have the time or means to access the kinds of data that tell those stories. However, organizations like AOPA and the Academy do.

Journalists within the profession can also do so. Once these entities create secondary knowledge sources that summarize these trends, then it’s up to individual practitioners to consume them and include those findings in their decision making.

BECKER: AOPA does a fine job of publishing data and the appropriate links in its biweekly AOPA in Advance Smart Brief and monthly O&P Almanac. They couldn’t be easier to access, and if you want more data, just use one of the search engines available online.

O&P ALMANAC | OCTOBER 2015

49

WELCOME NEW MEMBERS

T

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publiwww.AOPAnet.org cation, 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.

GrafTech International Holdings Inc. 982 Keynote Circle Brooklyn Heights, OH 44131 216/676-2321 Category: Education & Research Institution Ryan Paul

Pedorthic Services LLC, dba The Healthy Foot Center 371 Southland Drive Lexington, KY 40503 859/266-0420 Category: Patient-Care Facility Bonnie Moore

Pillet Hand Prostheses 888C 8th Avenue, PMB 234 New York, NY 10019 212/307-0927 Category: Supplier Level 1 Annie Pillet Prescott’s Orthotics & Prosthetics 6715 San Pedro San Antonio, TX 78216 210/224-0726 Category: Patient-Care Facility Gary Prescott Sterling Podiatric PC 737 Nostrand Avenue Brooklyn, NY 11216 718/783-4780 Category: Patient-Care Facility Marva Butters-Adams

Welso Medical LLC 6401 S. 33rd Street, Bldg. H, Ste. 18 McAllen, TX 78503 631/871-4388 Category: Supplier Level 1 Archana Vasudevan

Is Your Facility Celebrating a Special Milestone in 2016?

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

O&P ALMANAC | NOVEMBER 2015

41

AOPA O&P PAC

T

HE 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*:

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

Michael Allen, CPO, FAAOP Mehdi Arani Thierry Arduin Vinit Asar Rudy Becker Kel Bergmann, CPO Frank Bostock, CO Haley Branch, CPO Daniel Busch, CO Erin Cammaratta James Campbell, PhD, CO, FAAOP Matt Carroll Jeff Collins, CPA Kenneth Cornell, CO Charles Dankmeyer Jr., CPO Joseph DeLorenzo, CP Thomas DiBello, CO, FAAOP David Edwards, CPO, FAAOP Rick Fleetwood, MPA Wesley Haygood, CP Robert Hellner, CPO Ralph Hooper, CPO David Hughes, CPO Alfred Kritter, CPO, FAAOP

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

Charles Kuffel, CPO, FAAOP Teri Kuffel, Esq. Sam Liang Anita Liberman-Lampear, MA Pam Filippis Lupo, CO/LO David Mahler, CPO Brad Mattear, CPA Catherine Mize, CPO Chris Nolan Michael Oros, CPO, FAAOP Mark Porth, CPO, FAAOP Walter Racette, CPO Ricardo Ramos, CP, CPed Jack Richmond, Cfo Rick Riley David Ritchie, CPed, CPO John Roberts, CPO Bradley Ruhl Scott Schneider Lisa Schoonmaker, CPO Donald Shurr, CPO, PT Sean Snell Ronald Snell, CP Jack Steele, CO, FAAOP Gordon Stevens, CPO Frank Vero, CPO James Weber Ashlie White Eddie White, CP Shane Wurdeman, PhD, MSPO, CP, FAAOP • Jim Young, CP, FAAOP • Pam Young 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.

42

NOVEMBER 2015 | O&P ALMANAC

O&P PAC Challenge at the 2015 AOPA National Assembly

The O&P PAC also would like to acknowledge and thank the following AOPA members for their recent support of O&P PAC-sponsored events and/or Capitol Connection: • • • • • • • • • •

Kent Baker Tim Bulgarelli, CPO Matt Carroll Michael Curtin Jehan de La Brosse David Dillion, CP Bill Moore, CPed Martin Moore Chris Nolan Jim Young, CP, FAAOP • Pam Young

*Due to publishing deadlines this list was created on Oct. 19, 2015, and includes only donations/contributions made or received between Aug. 31, 2015, and Oct. 19, 2015. Any donations/contributions made or received on or after 10/19/2015 will be published in the next issue of the O&P Almanac.

LIMITED TIME PRICE REDUCTION

CONTACT COYOTE OR YOUR DISTRIBUTOR FOR DETAILS

COYOTE COMPOSITE Tough Uses typical prosthetic resins Less itch than carbon Easy to cut and finish Not an inhalant risk Inert, non-carcinogenic and non-toxic

NOW AVAILABLE IN 10 FOOT LENGTHS!!!

LESS ITCH Phone (208) 429-0026 www.coyotedesign.com

MARKETPLACE

Feature your product or service in Marketplace.

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

Visit bit.ly/aopamedia for advertising options.

ALPS Thinner Seamless Suspension Sleeve Formulated with the ALPS GripGel, the new SFB seamless suspension sleeve provides superior comfort with a singlepiece construction. The SFB sleeve features a new blackknitted fabric that allows the user excellent freedom of knee flexion. This new sleeve seals with the skin without restricting circulation, while the GripGel sticks to the patient’s skin without causing shear forces. With a thinner profile of 2 mm, the SFB is an ideal choice for those concerned about bulk.

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

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

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

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

44

NOVEMBER 2015 | O&P ALMANAC

DAFO® 4 TURNS 30 Happy Birthday DAFO! The original DAFO® (Dynamic Ankle-Foot Orthosis), the SMO-style DAFO 4, is turning 30 years old this year!

One of our most popular brace styles, the lightweight and comfortable DAFO 4 was developed to meet the needs of children who exhibit strong low-tone pronation, and led to the creation of numerous other dynamic brace styles for pediatric patients. Since its introduction in 1985, thousands of practitioners have trusted us to custombuild this effective solution for their low-tone patients.

Like all Cascade Dafo orthoses, the DAFO 4 is backed by a full (90-day) warranty. For more information, visit www.cascadedafo.com or call 800/848-7332.

Coyote Composite Limited Time Price Reduction

TEN FOOT LENGTHS ARE NOW AVAILABLE! It’s a great alternative to itchy, expensive carbon fiber braid! Coyote Composite, made from basalt filament, is a safe, tough material for composite sockets and ankle-foot orthoses.

Also easy to cut and finish compared to other materials.

• Less expensive • Less itch than carbon • Extremely durable • Strong and lightweight • Finishes smooth and easily • Uses typical prosthetic resins • Not an inhalant risk • Inert, noncarcinogenic, and nontoxic.

For more information, call your distributor or Coyote Design at 208/429-0026 or go to coyotedesign.com.

Our proprietary braid was designed to be used in equivalent amounts to carbon. Coyote Composite is more flexible than carbon (we consider this to be an advantage).

MARKETPLACE New Sure Stance Knee by DAW

Coyote Design’s New Solid Brass Pins Coyote Design has introduced two new heavy-duty solid brass pin options for its Air-Lock and Easy-Off Lock lines. Coyote found the new brass pins are more durable, have less deflection, and have exceptional wear characteristics. These pins increase the Air-Lock weight capacity from 265 lbs to 350 lbs. Like most Coyote products, the pins are noncorrosive and water resistant, making them great for active people and heavier weight patients. The pins help eliminate noise issues.

• CD103P8H (Eight-Click Brass Pin) • CD103P11H (11-Click Brass Pin) • CD103H (Air-Lock With Brass Pin) For more information, contact Coyote Design at 208/429-0026 or visit coyotedesign.com.

Coyote Design’s Easy-Off Lock

• Airtight “suction” or vacuum suspension with the safety and security of a pin • Easy donning and doffing with lever with lever release • Self-lubricating materials reduce wear • Water-resistant • Can be used with elevated vacuum.

For more information, contact Coyote Design at 208/429-0026 or visit coyotedesign.com.

Coyote Design’s Coyote Quick Adhesive We use Coyote Quick Adhesive in fabrication of our prosthetic locks, socket adapters, and valves.

• Attaching componentry • Repairing sockets • Very quick to set with no sag • Ships nonhazardous • Safe to use and has no odor.

Coyote Quick Adhesive works in any situation when you need something glued quickly and easily.

For more information, contact Coyote Design at 208/429-0026 or visit coyotedesign.com.

This ultralight, true-variable cadence, multiaxis knee is the world’s first four-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients.

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

DawSkin New Mega Stretch

DawSkin New MegaStretch is the most durable tear-free skin in the world. It is the ideal skin for your patient to shower on both legs (definitely the safer way). DawSkin MegaStretch provides the vertical ankle stretch required for multiaxis feet and energy restitution feet.

“Heat-shrink” skins limit the ankle movement and will tear.

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

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

ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the ground-reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information.

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

O&P ALMANAC | NOVEMBER 2015

45

MARKETPLACE

Feature your product or service in Marketplace.

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

Visit bit.ly/aopamedia for advertising options.

Introducing the Stronger, Smarter, Submersible Plié® 3 MPC Knee Stronger construction makes the new Plié 3 Microprocessor Controlled (MPC) Knee both submersible and more rugged than ever.

Yet it’s still the fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees.

With the most responsive stumble and fall protection, users can instinctively move at their own pace in any direction...even if it’s taking small short steps or pivoting in confined spaces. And with a more streamlined, intuitive set-up, the Plié 3 MPC knee makes it even easier for prosthetists to help patients expand their freedom.

To learn more about the Plié 3 MPC knee, contact Freedom Innovations at 888/818-6777 or visit www.freedom-innovations.com.

Freedom Foot Products Just Got Better

Now, with the broadest range of sandal-toe options available anywhere, you can focus first on performance and rest assured that your patient’s desire to wear sandals can be easily satisfied.

Achieve improved clinical outcomes by delivering a product designed to meet your functional objectives. Whether it’s shock absorption, hydraulic ankle motion, heel height adjustability, or multiaxial ground compliance, the new sandal-toe product line delivers form and function—unrestricted.

Choose from 13 high-performance designs: • Highlander® • Kinterra® • Pacifica® & Pacifica® LP • Renegade® & • Runway® & Runway® HX Renegade® LP • Thrive® • Agilix™ • WalkTek® • DynAdapt™ • Sandal-Toe Foot Shell • Sierra® Our second-generation Sandal-Toe Foot Shell is available in sizes 22-28 cm and in three different skin tones (light, medium, and dark).

For additional information, contact customer service at 888/818-6777 or email us at info@freedom-innovations.com.

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NOVEMBER 2015 | O&P ALMANAC

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

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

Orthomerica: Prosthetic Custom Fabrication Orthomerica Products Inc. is pleased to introduce Prosthetic Custom Fabrication.

First-stage and second-stage sockets.

Check, BK, and AK sockets are available with a three- to five-day turnaround time.

All modifications and fabrications available.

Most scans and casts accepted.

For more information, visit www.orthomerica.com.

Register To Attend the Össur® International Prosthetic Symposium Please join us for our first International Prosthetic Symposium at our state-ofthe-art Össur Academy facility in Orlando. The three-day Symposium, which will focus on rehabilitation and prosthetic solutions for the low-active amputee, will be held November 19-21.

The program will feature a variety of experts—George Hipp, MD; Jeffry Pirofsky, DO; Chris Ireland, PT, DPT, OCS; and Glenn Crumpton, LPO—and the agenda will cover several important topics, including postoperative solutions, rehabilitation, prosthetic technology, elevated vacuum, osteoarthritis, and diabetes.

Contact your Össur® representative today, or visit www.ossur.com/ips5 to download the full agenda and register.

SHOWCASE

MARKETPLACE New AxonHook From Ottobock

2015 AOPA Coding Products

For maximum versatility, precision, and power, look for this latest addition to the AxonBus Family—the AxonHook. The AxonHook is the perfect complement to the Michelangelo Hand. It includes titanium with polyurethane coated fingers so the AxonHook can provide superb precision and power, making it the perfect companion to the Michelangelo Hand.

For more information, contact your local sales reps at 800/328-4058 or logging onto www.professionals. ottobockus.com.

Silicone, Urethane, and Copolymer Liners The Skeo family of silicone liners includes an internal matrix to reduce pistoning plus a slick outer surface to aid in donning and doffing.

Choose from a variety of options that include preflexed for enhanced fit, and SkinGuard protection to reduce odor. Our copolymer liners are ideal for lower activity patients, and our Anatomic 3D Urethane liner is preferred for Harmony vacuum or valve systems. Whether your patients need a silicone, urethane, or copolymer solution, Ottobock can help you find the right fit.

Call your local sales rep to find out more.

Get your facility up to speed, fast, on all of the O&P Introducing the Stride4 Shadow HCPCS code changes with an array of 2015 AOPA coding Oregon products.from EnsureBecker each member of your staff has a 2015 The Stride4™ is a lightweight KAFO thatreference Quick Coder,Shadow a durable, easy-to-store desk strength and cosmetic appeal ofcombines all of thestructural O&P HCPCS codes and descriptors.

4 mechanical stance control the new Stride(includes • with Coding Suite CodingPro single user, orthotic knee joint from Becker Orthopedic.

Illustrated Guide, and Quick Coder): Stride4 features include: $350 AOPA members, $895 nonmembers K Three operation modes: stance control, free • CodingPro CD-ROM (single-user motion, and locked with stance phaseversion): knee $185 AOPA members, $425 nonmembers flexion.

• CodingPro CD-ROM (network version): K Four-bar linkage mechanism to afford stability and mimic anatomical knee motion. $435 AOPA members, $695 nonmembers K Integrated Guide: extension assist.

• Illustrated $185 AOPA members, $425 nonmembers inherent rigidity the Stride4 Shadow • The Quick Coder: $30 of AOPA members, $80ensures nonmembers that optimal joint alignment and or function is AOPA Order at www.AOPAnet.org by calling throughout the gait cycle. atmaintained 571/431-0876.

Patent Pending

Ottobock • 800.328.4058 www.professionals.ottobockus.com

Becker Oregon • 800.866.7522 www.beckerorthopedic.com Circle # 178

medi USA Introduces the 4Seal TFS Liner

Hersco Ortho Labs Announces the New Tri Lam Custom Foot Orthotics

The new medi 4Seal TFS Liner combines a revolutionary sealing technology with a unique self-gliding surface, providing extraordinary suspension, comfort, and ease of use for those with transfemoral amputations.

Features and benefits include: K Integrated seals for easy inversion and a highly secure fit.

K Easy Glide PLUS outer surface—no donning aids or sprays required.

K Excellent tissue control due to a highly effective, full-length matrix.

K Optimal radial stretch for greater comfort.

K Simple to use gel-grip spacer socks for easy application (available separately). medi USA • 800.633.6334 www.mediusa.com Circle # 196

Hersco has a new line of Tri Lam custom foot orthotics with several material choices. Tri Lam technology layers materials of different durometers, giving the practitioner the ability to vary thickness and shock absorption. Hersco Tri Lams include Plastazote and PPT for accommodative devices, or more durable Sky for active patients. You can also choose the base layer of firmer cork or softer EVA. More information and pictures are available on our website.

Certified pedorthists are ready to answer any questions you may have regarding our custom products.

Hersco Ortho Labs • 800.301.8275 www.hersco.com Circle #O&P 225ALMANAC | NOVEMBER 2015 47

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

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

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

Nonmember $678 $830

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

Job Board

Member Nonmember $80 $140

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

SUBSCRIBE

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

48

Pacific

NOVEMBER 2015 | O&P ALMANAC

Orange County, Riverside County, and San Bernardino County, California Here we grow again: A reputable, well-established, multioffice, Southern California O&P company is looking for energetic and motivated individuals who possess strong clinical skills and experience to provide comprehensive patient assessments to determine patient needs, formulate and provide treatments, perform necessary protocols to ultimately deliver the best orthotic/prosthetic services, and provide follow-up patient care. Candidates must have excellent communication, patient-care, and interpersonal interaction skills, and always abide by the Canons of Ethical Conduct instilled by ABC. We offer competitive salaries and benefits. Salary is commensurate with experience. Local candidate preferred.

Send résumé to:

Attention: Human Resources Inland Artificial Limb & Brace Inc. Fax: 951/734-1538

Northeast Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Watertown, New York A well-established, multioffice practice has immediate openings for residents and ABC-certified CPOs/ CPs/ COs. Candidates must be motivated individuals who possess a strong clinical presence, technical experience, the ability to document all aspects of patient contact, and the desire to improve the quality of life for those who require our services. Northern Orthopedic Laboratory is based in Watertown, New York, located on the outskirts of scenic Lake Ontario and St. Lawrence River. We offer a competitive salary (commensurate with experience), medical, dental, vision, 401K, and profit sharing. Send résumé to:

Northern Orthopedic Laboratory Inc. 1012 Washington Street Watertown, NY 13601 Office: 315/782-9098 Email: nolcpo@aol.com www.northernorthopediclaboratory.com

Morning, noon, or night— LCodeSearch.com allows you access to expert coding advice—24 hours a day, 7 days a week.

The Source for Orthotic & Prosthetic Coding

T

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

Log on to LCodeSearch.com and start today.

Need to renew your membership?

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

NEW

Manufacturers: for 2015!

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

www.AOPAnet.org

ADVERTISERS INDEX

Company

Page Phone

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

37

703/836-7114

ALPS South LLC

9 800/574-5426 The Source for Orthotic & Prosthetic Coding

Website

Morning, noon, or night— LCodeSearch.com allows you access towww.abcop.org expert coding advice—24 hours www.easyliner.com a day, 7 days a week.

Amfit

29

800/356-3668 www.amfit.com

BCP Group

39

615/550-8774

ComfortFit Labs Inc. Coyote Design

T

21 888/523-1600 HE O&P CODING EXPERTISE the

www.bcpgroup.com www.comfortfitlabs.com

7, 43 www.coyotedesign.com profession has come to rely on is 800/819-5980 available online 24/7! LCodeSearch.com 25 866/273-2230 www.cc-mfg.com allows users to search for information that DAW Industries 1 800/252-2828 www.daw-usa.com matches L Codes with products in the Dr. Comfort 27 877/713-5175 www.drcomfort.com orthotic and prosthetic industry. Users rely Freedom Innovations 17 888/818-6777 www.freedom-innovations.com on it to search for L Codes and manufacHersco 2 800/301-8275 www.hersco.com turers, and to select appropriate codes Orthomerica

800/446-6770 www.orthomerica.com for specific products.

This exclusive service is 33 available only for AOPA members. Össur Americas Inc. 5 800/233-6263 www.ossur.com Custom Composite

Ottobock

C4

Log on to LCodeSearch.com and start today.

Need to renew your membership?

800/328-4058 www.professionals.ottobockus.com

NEW

Manufacturers: for 2015!

AOPA is now offering Enhanced Listings O&P ALMANAC | NOVEMBER 2015 49 on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your

CALENDAR

2015

November 11

How To Make a Good Impression: Marketing Yourself to Your Referrals.

Register online at bit.ly/aopawebinars. For more information, contact Ryan Gleeson at 571/431-0876 or email rgleeson@AOPAnet.org.

Webinar Conference

November 4-6

NJAAOP. The New Jersey Chapter of AAOP presents the 21st Annual Continuing Education Seminar. Harrah’s Atlantic City, NJ. For more information contact Lisa Lindenberg at 973/6092263, email director@njaaop.org, or visit www.njaaop.com.

November 13-14

The Academy’s One-Day Seminar Certificate Programs. Hyatt Rosemont, Rosemont, IL. For more information, visit www.oandp.org/education/seminars/one-day.

November 6

COPA & UCSF: Orthotic and Prosthetic Innovation & Technology Symposium. Driving the Future of O&P—Connecting Innovators and Investors. Millberry Union Event & Meeting Center, University of California—San Francisco.

Register at www.californiaoandp.com/Education. For more information, contact 415/206-8813, or email erin.simon@ucsf.edu.

November 14

10th Annual Academy Golf Invitational & Wine Tasting. ASU Karsten Golf Course, Phoenix, AZ. For more information, visit www.oandp.org/golf.

November 9-10

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. The Flamingo, Las Vegas.

Register online at bit.ly/2015billing. For more information, contact Ryan Gleeson at 571/431-0876 or email rgleeson@AOPAnet.org.

December 1

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

November 9-14

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

December 3-5

R.I.C: Elaine Owen. Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. 22.0 ABC credits.

Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education.

Year-Round Testing

Online Training

BOC Examinations. BOC has year-round testing for all of its exams and no application deadlines. Candidates can apply and test when ready and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

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

www.bocusa.org

Calendar Rates Let us share your upcoming event!

Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.

AOPAnet.org for content deadlines.

50

NOVEMBER 2015 | O&P ALMANAC

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

Questions? Email landerson@AOPAnet.org.

CREDITS

BONUS! Listings will be placed free of charge on the “Attend O&P Events” section of www.AOPAnet.org.

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less 26-50 51+

$40

$50

1/4 page Ad

$482

$678

$50

$60

1/2 page Ad

$634

$830

$2.25/word $5.00/word

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

CALENDAR December 5-6

ABC: Prosthetic Clinical Patient Management (CPM) Exam. Caruth Health Education Center, St. Petersburg College, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Membership has its benefits:

BUILD A

Better

December 11-12

ABC: Orthotic Clinical Patient Management (CPM) Exam. Caruth Health Education Center, St. Petersburg College, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

December 9

Bringing in the New Year: New Codes and Changes for 2016. Register online at bit.ly/aopawebinars. For more information, contact Ryan Gleeson at 571/431-0876 or email rgleeson@AOPAnet.org.

Webinar Conference

2016 September 8-11, 2016 99th AOPA National Assembly. Boston.

For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org.

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

BUSINESS WITH AOPA

Visit www.AOPAnet.org/join today!

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

Statement of Ownership, Management and Circulation (required by U.S.P.S. Form 3526) 1. Publication Title: O&P Almanac 2. Publication No.: 1061-4621 3. Filing Date: 10/15/15 4. Issue Frequency: Monthly 5. No. of Issues Published Annually: 12 6. Annual Subscription Price: $59 domestic/$99 foreign 7. Complete Mailing Address of Known Office of Publication (Not Printer): American Orthotic & Prosthetic Association, 330 John Carlyle St., Suite 200, Alexandria, VA 22314 8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not Printer): Same as #7 9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor: Publisher: Thomas F. Fise, address same as #7. Editor: Josephine Rossi, Content Communicators LLC, PO Box 223065, Chantilly, VA 20153. 10. Owner (Full Name and Complete Mailing Address): American Orthotic & Prosthetic Association, same as #7 11. Known Bondholders, Mortgagees, and Other Security Holders Owning 1 Percent or More of Total Amount of Bonds, Mortgages, or Other Securities: None. 12. The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During the Preceding 12 Months. 13. Publication Name: O&P Almanac 14. Issue Date for Circulation Data Below: September 2015 Avg. No. Copies Each Issue Actual No. Copies of Single Issue During Preceding 12 Months Published Nearest to Filing Date 15. Extent and Nature of Circulation: a. Total number of Copies (Net Press Run) 13,341 12,794 b. Paid and/or Requested Circulation

(1) Paid or Requested Outside-County Mail Subscriptions 12,973 12,511

(2) Paid In-County Subscriptions 0 0

(3) Sales Through Dealers and Carriers, Streeet Vendors, 0 0

Counter Sales, and other non-USPS Paid Distribution

(4) Other Classes Mailed through the USPS 0 0 c. Total Paid and/or Requested Circulation 12,973 12,511 d. Free Distribution by Mail

(1) Outside-County as Stated on Form 3541 0 0

(2) In-County as Stated on Form 3541 0 0

(3) Other Classes Mailed through the USPS 0 0 e. Free Distribution Outside the Mail 104 0 f. Total Free Distribution 104 0 g. Total Distribution 13,077 12,511 h. Copies Not Distributed 500 488 i. Total (Sum of 15g and h) 13,577 12,999 Percent Paid and/or Requested Circulation 99% 100%

O&P ALMANAC | NOVEMBER 2015

51

ASK AOPA

Rules and More RULs Guidelines for detailed written orders, reasonable useful lifetime determinations, and more

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry.

Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Q

If the patient’s diagnosis is not required to be on the final detailed written order, what is required?

Q/

According to the Medicare medical policies and the Medicare Program Integrity Manual, only the following information is required on the final DWO: • Beneficiary’s name • Physician’s name • Date of the order and the start date, if the start date is different from the date of the order • Detailed description of the item(s) • Physician’s signature and signature date.

A/

Which address should be reported as the delivery address on my proof of delivery forms?

Q/

The address reported on the proof of delivery form should be the physical address where the items were delivered and/or where the services were provided. For example, if you delivered a knee-ankle-foot orthosis to a patient in his or her home, then the delivery address listed on the proof of delivery form should be the patient’s home address. If you delivered an ankle-foot orthosis to a patient in your office, then your office address is the delivery address.

A/

I have a detailed written order (DWO) with a date prior to Oct. 1, 2015. It lists a diagnosis code from version 9 of the International Statistical Classification of Diseases and Related Health Problems (ICD-9), but my delivery will be after Oct. 1, 2015—the date when ICD-10 codes took effect.

Do I need a new DWO?

Q/

No, you are not required to obtain a new DWO. The diagnosis code is not required to be on a DWO, and its presence will not alter the documentation in the files. However, if your date of service is after Oct. 1, 2015, you will have to report the appropriate ICD-10 code on your claim.

A/

52

NOVEMBER 2015 | O&P ALMANAC

What is Medicare’s reasonable useful lifetime (RUL) for orthotics and prosthetics?

Q/

The RUL for orthotics and prosthetics is determined by program instructions from Medicare.

When there are no program instructions,

A/

the durable medical equipment Medicare administrative contractors (DME MACs) may establish RULs for orthotics and prosthetics, but in no case may a RUL be longer than five years. In other words, if Medicare does not establish a RUL for an item, the DME MACs may then create a RUL through policy; if the DME MACs do not create a policy, the RUL for an item is set at five years.

Prosthetics has a RUL that is less than five years. Medicare, through the Benefits Improvement and Protection Act (BIPA) 2000, provided program instructions for the RUL for prosthetics.

Medicare stated in BIPA that “prosthetic devices which are artificial limbs” may be replaced at any time regardless of useful lifetime, as long as the replacement is reasonable and necessary.

In the external breast prostheses policy, the DME MACs established a RUL that is less than five years. A silicone breast prosthesis has a RUL of two years, and a foam, fiber, or fabric breast prosthesis has a RUL of six months.

Since there are no direct program instructions from Medicare for orthotics, the RUL for orthotics is set at five years. Knee orthoses are an exception to this RUL: In the knee orthoses policy, the DME MACs have established a RUL ranging between one and three years, depending on the type of knee orthosis you are providing. Knee orthoses described by codes L1810 through L1830 have a RUL of one year, and L1831, L1832, L1833, and L1850 have a RUL of two years; all other knee orthoses have a RUL of three years.

BOSTON 2016 AOPANET.ORG

Mark your calendars September 8-11, 2016, for an ideal combination of top-notch education and entertainment at the combined 99th AOPA National Assembly and New England Chapter Meeting in Boston, MA. We look forward to seeing you in 2016!

EXCELLENCE in EDUCATION Prosthetic

Orthotic

Pedorthic

Technical

Business

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

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