November 2017 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

N OV E M B E R 2017

E! QU IZ M EARN

How To Prepare for the New Medicare ID Cards

2

BUSINESS CE

CREDITS P.18

P.16

O&P and the Opioid Epidemic P.30

Orthotic Patient Care in Lithuania P.44

Rules for PDAC Verification P.60

WWW.AOPANET.ORG

This Just In: AOPA Launches Orthotics 2020 P.20

PHI in

Critical Condition Expert Advice To Reduce Your Risk of a Devastating Data Breach P.22

YOUR CONNECTION TO

EVERYTHING O&P

THE PR EM I ER M E E T IN G F OR ORT H OT IC, PROSTH ETIC, A N D PED ORTH IC PROFESSION A LS.

e c n e i r e p Ex

September 26-29, 2018

VANCOUVER Vancouver is easy to explore during your time at the downtown Vancouver Convention Centre as there are many nearby top attractions.

• • • • • •

Capilano Suspension Bridge Vancouver Aquarium Forbidden Vancouver Stanley Park Horse-Drawn Tours Harbour Cruises & Events Flyover Canada

• Vancouver Lookout • Dr. Sun Yat-Sen Classical Chinese Garden • Vancouver Art Gallery • Science World • Grouse Mountain

Experience Beyond Vancouver’s unbeatable location makes it the perfect gateway to the rest of British Columbia and beyond, providing you with outstanding opportunities for pre- and post-conference travel.

• Whistler • Okanagan Valley • Jasper • Victoria • Banff • Cruise to Alaska

AOPAnet.org

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Experience all the AOPA National Assembly has to offer while visiting Vancouver.

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contents

NOVE M B E R 2017 | VOL. 66, NO. 11

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COVER STORY

FEATURES

22 | PHI in Critical Condition With data breaches posing an increasing threat to health-care entities, O&P facilities must protect their patients’ personal health information by implementing safeguards and adhering to the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA). O&P compliance officers and IT professionals share tips for ensuring company systems and mobile devices are HIPAA-compliant and discuss how to educate employees about both internal and external threats.

By Christine Umbrell

30 |

Pain, Opioids, & Your Patients

20 | This Just In

Orthotics 2020 Gains Momentum Building on the success of the Prosthetics 2020 initiative launched two years ago, AOPA and O&P stakeholders have initiatied Orthotics 2020—a collaborative effort to establish the value and favorable patient outcomes related to orthotic intervention. Leaders of the initiative met in Las Vegas during the AOPA World Congress and established a list of five areas of focus: osteoarthritis, stroke, scoliosis, traumatic spinal injuries, and plagiocephaly.

NOVEMBER 2017 | O&P ALMANAC

After the recent declaration of the U.S. opioid epidemic as a National Public Health Emergency, it is critical that all health-care professionals understand how opioids are being used and abused. Orthotists and prosthetists encounter many patients who struggle with chronic pain and should learn to recognize signs of opioid abuse and connect patients with therapists, psychologists, and specialists who can help them.

By Lia K. Dangelico

contents

SPECIAL SECTION

DEPARTMENTS Views From AOPA Leadership......... 4

AOPA’S 100TH ANNIVERSARY

Insights from incoming AOPA 2017-2018 Board Member Jeffrey M. Brandt, CPO

AOPA Contacts.......................................... 6

38 | Then & Now

How to reach staff

Changes in how O&P facilities contract with payors

42 | Bridge to the Future

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

Happenings............................................... 10 Research, updates, and industry news

Partnering with hospitals

44 | The Global Professional Q&A with the chief orthotist at a Lithuanian facility

P.10 People & Places........................................14 Transitions in the profession

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

Introducing the New Medicare Cards

Transitioning to Medicare Beneficiary Identifiers CE Opportunity to earn up to two CE credits CREDITS by taking the online quiz.

Member Spotlight.................................46 n

ARTech Laboratory Inc.

n

E&G Prosthetics & Orthotics

P.46

AOPA News.............................................. 50 AOPA meetings, announcements, member benefits, and more

Welcome New Members ..................52 Ad Index......................................................52 Marketplace..............................................54 Careers.........................................................56

P.48

Professional opportunities

Calendar......................................................58 Upcoming meetings and events

Ask AOPA.................................................. 60 Which devices require PDAC verification?

O&P ALMANAC | NOVEMBER 2017

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VIEWS FROM AOPA LEADERSHIP

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

Making the Most of Metrics

L

AST YEAR, as we were anticipating AOPA’s 100th anniversary, I decided to

commemorate this important milestone by throwing my hat into the ring of service, and was elected to the AOPA Board of Directors. Five minutes later, I was asked to chair the Operating Performance & Compensation Committee, which oversees and facilitates the annual collection of and reporting on the financial and operational data from participating O&P companies. I accepted this opportunity because I believe there is no better free report available to participating AOPA members in which to gain insight as to how your company measures up to others of similar size.

Then I asked myself: Is it enough in 2017 for the O&P profession to just evaluate ourselves against each other strictly through financial and operational data? Being more profitable than my neighbor may not secure my future like it once did. Certainly, there is nothing wrong with measuring, comparing, and working toward improving our key financial indicators based on what we learn about one another’s companies in the AOPA Operating Performance Report. Is simply improving the time-honored metrics that apply to all of our businesses enough to move beyond survival, and flourish in the rapidly changing health-care environment?

The metrics of health care have evolved, and we need to evolve with them to remain competitive. We should consider learning about new metrics.

I submit for consideration that we need to start managing clinical operations by reporting on outcome measures and clinical management practices and comparing those results between one another to raise the bar for the profession. We should be learning how companies spot and report trends to their staff. What are those trends? What are we learning about financial projections and operational visibility? How can we more accurately forecast our work in progress? What outcome measures do we utilize? What kind of reporting do we do on administrative law judge and/or audit success rates?

How many follow-up visits are required by certain device types? These are just a few of the many questions that come to mind.

If you use a practice management software system and accounting software and interact with a chief financial officer, accountant, practice manager, or all three, I believe you can and should be utilizing “big data” to the benefit of your practice—and ultimately for the benefit of the patients you serve. As we head toward a “fee-for-value” payment system, those nontraditional metrics we are not reporting on today will become perhaps the most important data in our immediate future.

My commitment to AOPA and its members is to not only maintain the existing reporting metrics but to also listen to your suggestions and drive innovation into the survey, responses, and subsequent reporting to ensure we keep you all ahead of the curve during this very important time in our profession.

Furthermore, I would like to ask all AOPA members to plan ahead by committing the time in your schedules now to complete the Operating Performance & Compensation Survey next spring.

Jeffrey M. Brandt, CPO, is an incoming member of AOPA’s 2017-2018 Board of Directors.

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NOVEMBER 2017 | O&P ALMANAC

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

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AOPA CONTACTS

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

Editorial Management Content Communicators LLC

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

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

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

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

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

Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com

AOPA Bookstore: 571/431-0865

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

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NOVEMBER 2017 | O&P ALMANAC

Publisher Thomas F. Fise, JD

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

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

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

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

Copyright © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

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

Advertise With Us! Reach out to AOPA’s membership and more than 12,500 subscribers.

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

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NUMBERS

Advanced Prostheses Offer Clinical Benefits and Cost Savings RAND study demonstrates value of microprocessor-controlled knees for transfemoral amputees Microprocessor-controlled knees (MPKs) are associated with substantial improvement in physical function and reductions in incidences of falls and osteoarthritis compared to non-MPKs (NMPKs), according to a recent study by the RAND Corp.

The report, titled “Economic Value of Advanced Transfemoral Prosthetics,” documents the results when RAND developed a simulation model to assess the different clinical outcomes and costs of MPKs versus NMPKs.

FEWER FALLS AND DEATHS PER EVERY 10,000 PEOPLE

IMPROVED QUALITY OF LIFE

LOWER DIRECT HEALTH-CARE COSTS

37 Percent

82

62

11

Number of fewer major injurious falls for MPK users.

Number of fewer minor injurious falls for MPK users.

Number of fewer deaths for MPK users.

$2,890

Estimated improvement in quality of life for MPK users using the SF-36 scale.

Average annual health-care cost per MPK user.

$6,566

Estimated improvement in quality of life for MPK users using the EQ-5D scale.

Average annual health-care cost for NMPK user.

Injurious Falls Per 10,000 Person Years MPK

22

NMPK

16 104

0

8

Major injury Minor injury

50

NOVEMBER 2017 | O&P ALMANAC

Amount of reduction in lost wages for MPK users.

$634

Amount of reduction in caregiving expenses for MPK users.

“The RAND Corp. study shows that there is a much higher risk of injury or death when Medicare and private payors refuse to permit access to the only slightly more expensive new generation of artificial knee and lower limb.”

—AOPA President Michael Oros, CPO, FAAOP

78 100

$417

150

200

SOURCE: “Economic Value of Advanced Transfemoral Prosthetics,” RAND Corp.

21 Percent

REDUCED INDIRECT COSTS

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Happenings RESEARCH ROUNDUP

The Office of Naval Research (ONR), Walter Reed National Military Medical Center, University of Michigan, and additional universities are teaming up to develop a “smart” prosthetic leg called the monitoring osseointegrated prosthesis (MOIP).

The leg will feature sensors designed to monitor gait, alert users of wear and tear, and warn of potential infection risk.

The MOIP is an osseointegration prosthesis that features a titanium fixture surgically implanted into the femur. The design is intended to reduce pain, facilitate a fluid walking motion, and achieve a stable, well-fitting limb, according to the researchers.

Infection detection, eradication, and prevention is a key component of the design, and will be achieved via electrochemical sense-and-respond approaches and “smart” skin technologies.

A biocompatible sensor array will be embedded within a user’s residual limb, and additional sensors will be found on the prosthesis itself. The array will track changes in body temperature and pH balance to help detect infections and monitor the fusion of the bone and prosthesis.

Dr. Jerome Lynch (right) an engineering professor at the University of Michigan, discusses the results of an experiment with research fellow Wentao Wang.

“One game-changing application of this technology would be as a tool to inform doctors when prosthetics can be safely loaded after surgery, leading to more accurate determination of when patients are ready for physical therapy after receiving a new prosthetic,” said Jerome Lynch, PhD, a University of Michigan engineering professor who is overseeing the development of the sensor array. “Right now, doctors study X-ray images of a limb when making that determination.”

“This new class of intelligent prostheses could potentially have a profound impact on warfighters with limb loss,” said Liming Salvino, PhD, a program officer in ONR’s Warfighter Performance Department. “MOIP not only can improve quality of life, but also usher in the next generation of prosthetic limbs.”

PHOTO: Courtesy of Joseph Xu, University of Michigan - College of Engineering/Released

Military and Academia Partner To Develop Osseointegration Prosthesis

MAAT I Study Shows Correlation Between Mobility and Quality of Life

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NOVEMBER 2017 | O&P ALMANAC

prosthetic mobility represents a substantial factor that should be addressed by the rehabilitation team.

“Functional mobility is compromised in individuals dealing with lower-limb loss, and this study provides strong evidence that maximizing mobility should be considered a primary goal in providing holistic patient care,” said James Campbell, PhD, CO, FAAOP, chief clinical officer, Hanger Clinic.

The research was driven by Campbell; Shane R. Wurdeman, PhD, CP, FAAOP; and Phil M. Stevens, MEd, CPO, FAAOP, who performed a retrospective review of outcomes data collected within multiple clinics. Included with the data obtained was the Prosthetic Limb Users Survey of Mobility and Prosthesis Evaluation Questionnaire.

Analysis included patients with varying amputation levels, including both unilateral and bilateral lower-limb amputation. The MAAT I study is the first in a series Hanger Clinic is undertaking to build evidence-based care for amputees.

PHOTO:Getty Images/FluxFactory

A clinical study measuring the correlation of mobility to quality of life and patient satisfaction for people living with lower-limb loss, via the Mobility Analysis of Amputees (MAAT I), has been published in the Medline journal Prosthetics & Orthotics International.

The research was conducted by Hanger Inc. and examined a sample size of 509 patients living with lower-limb loss.

Researchers found a statistically significant direct correlation of higher mobility with higher quality of life and patient satisfaction within the sample. Specifically, mobility accounts for approximately one quarter of the variance associated with quality of life and general satisfaction (26.1 percent and 22.6 percent, respectively). The researchers concluded that

HAPPENINGS

PHOTO: Ottobock Inc. and CHART: www.nature.com/articles/s41598-017-14386-w#Ack1/CC BY 4.0

Study Demonstrates Efficacy of Pattern Recognition Control

Representative subject wearing the physical prosthesis with a Greifer terminal device

A new study published in October in Scientific Reports demonstrates that pattern recognition is a viable option and has functional advantages over direct control for upper-limb amputees who have had targeted muscle reinnervation (TMR) surgery. The study, “Myoelectric Pattern Recognition Outperforms Direct Control for Transhumeral Amputees With TMR: A Randomized Clinical Trial,” was conducted by physicians at the Center for Bionic Medicine at the Shirley Ryan AbilityLab. The researchers compared pattern recognition and direct control in eight transhumeral amputees who had TMR in a balanced, randomized cross-over study. The subjects performed a six- to eightweek home trial using the two types of control with a custom prosthesis made from commercially available parts. Participants achieved higher scores on the Southampton Hand Assessment Procedure and the Clothespin Relocation Task using pattern recognition, according to the researchers.

In addition, seven of the eight subjects reported a preference for pattern recognition control.

RULES & REGULATIONS

CMS Withdraws BIPA 427 Proposed Rule CMS announced on October 3 that it has withdrawn the proposed rule that represented the first step in creating regulations that would implement the qualified provider provisions for prostheses and custom-fabricated orthoses legislated in Section 427 of the Benefits Improvement and Protection Act of 2000 (BIPA).

According to the notice published

by CMS, the proposed rule is being withdrawn due to “the cost and time burdens that the proposed rule would create for many providers and suppliers, particularly the cost and burden for those providers and suppliers that are small businesses, and the complexity of the issues raised in the detailed public comments.” CMS indicated it had received more than 5,000 public comments regarding the proposed rule.

The decision by CMS to withdraw the proposed rule that would finally

create regulations to implement a law that was passed more than 17 years ago has been met with disappointment by AOPA. The withdrawal of the proposed rule exposes the Medicare population to no regulation regarding what qualifications are required to provide custom orthotic and prosthetic services.

While the proposed rule was far from perfect, as AOPA expressed in its public comments that were submitted to CMS, it was AOPA’s position that those issues that were of significant concern to several provider groups, who viewed the proposed rule as a threat to their ability to continue to provide services within

their scope of practice, could have been addressed through changes to the final rule rather than through the complete withdrawal of the proposed rule.

The combination of the recent administration change, including the new administration’s philosophy to reduce overall regulatory burden on businesses, the significant opposition from several high-profile provider groups, and the restrictive language that would significantly limit certain providers from continuing to provided custom orthoses and prostheses appears to have led directly to the demise and subsequent withdrawal of the proposed rule.

AOPA will continue its efforts to ensure that all recipients of O&P care receive that care from providers who have been properly educated and trained in the fabrication, fit, and delivery of orthotic and prosthetic devices.

O&P ALMANAC | NOVEMBER 2017

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HAPPENINGS

O&P IN THE SPOTLIGHT

AOPA Press Event Highlights ‘Amputee Tech Gap’

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NOVEMBER 2017 | O&P ALMANAC

CMS Responds to AOPA’s Concerns Regarding Custom-Fabricated Diabetic Inserts

CMS has proposed a change to the Quality Standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that addresses AOPA's concern regarding the recent interpretation of the term “molded to patient model” when used to describe custom-fabricated diabetic shoe inserts. The proposed change to the Quality Standards allows for the creation of a digital positive model of the patient’s foot using CAD/CAM technology that is then used to direct mill a custom-fabricated insert based on the digital model.

In July 2017, the durable medical equipment Medicare administrative contractors (DME MACs) and the Pricing, Data Analysis, and Coding (PDAC) contractor issued a joint bulletin that stated that in order to meet the definition of “molded to patient model” contained in the descriptor for Health-Care Common Procedure Coding System (HCPCS) code A5513, diabetic inserts must be fabricated over a physical model of the patient’s foot. The bulletin went on to state that digital or virtual models that are used to direct mill custom inserts are not considered a positive model, and inserts fabricated using this technique do not meet the code requirements of A5513 and therefore must be billed as A9270, a statutorily noncovered HCPCS code.

On Sept. 28, 2017, AOPA and the American Podiatric Medical Association (APMA) submitted a joint letter to CMS expressing their concern over this bulletin as it represented a significant threat to the use of advanced technology to provide better clinical service. In addition to working directly with APMA, AOPA worked closely with the O&P Alliance, the office and staff of Rep. Brad Wenstrup (R-Ohio), and the House VA Subcommittee on Health to make sure that this issue remained at the forefront of the discussions.

On Nov. 2, 2017, CMS announced a proposed change to the DMEPOS Quality Standards that would include the use of digital or virtual models to direct mill custom diabetic inserts as an acceptable method to meet the definition of “molded to patient model” contained in the code language for A5513. CMS will hold an Open Door Forum call on Nov. 28, 2017, at 2 p.m.

EST to allow experts to discuss the proposed changes to the DMEPOS Quality Standards and will accept comments on the proposed changes through Dec. 11, 2017. Comments on the proposed changes may be sent to CMS via email at ReducingProviderBurden@cms.hhs.gov.

CMS has indicated that it intends to finalize the proposed changes by Jan. 1, 2018. AOPA will participate in the Open Door Forum call and will be preparing comments for submission to CMS.

PHOTO: Getty Images

AOPA hosted a press event at the National Press Club in Washington, DC, on October 18 to share research from the RAND Corp. on the economic value of advanced prosthetics.

Soren Mattke, MD, from RAND presented the findings of this recently published research that concluded that microprocessor knees are associated with improvements in physical function and reductions in falls and osteoarthritis, and that the economic benefits are in line with commonly accepted criteria for good value for money by U.S. payors.

Kenton R. Kaufman, PhD, of the Mayo Clinic, shared his research on health outcomes for those living with limb loss, including the cost of care broken down by K-level, the costs of falls, and the large number of amputees who never receive a prescription for a prosthesis. Prosthetic users Christopher Allen and Peggy Chenoweth discussed how they have benefited from advanced technology in their everyday lives. The video was livestreamed on Facebook and is available at www.AOPAnet.org.

CODING CORNER

HAPPENINGS

VETERANS’ VIEWPOINT

Proposed Rule Includes Provision Restricting Veterans’ Provider Choices The Oct. 16, 2017, edition of the Federal Register included a proposed rule published by the U.S. Department of Veterans Affairs (VA) that intends to “reorganize and update the current regulations related to prosthetic and rehabilitative items, primarily to clarify eligibility for prosthetic and other rehabilitative items and services, and to define the types of items and services available to eligible veterans.”

There is a provision in the proposed rule that is of immediate concern to AOPA. Page 29 of the proposed rule includes a provision regarding how prosthetic, orthotic, and other rehabilitative services will be delivered to veterans. The proposed language states the following: “VA will determine whether VA or a VA-authorized vendor will furnish authorized items and services under § 17.3230 to eligible veterans. When VA has the capacity or inventory, VA directly provides items and services to veterans.

However, VA also may use, on a caseby-case basis, VA-authorized vendors to provide greater access, lower cost, and/ or a wider range of items and services.

We would clarify in regulation that this

administrative business decision is made solely by VA to eliminate any possible confusion as to whether a veteran has a right to request items or services generally, or to request specific items or services from a provider other than VA, and to clarify for the benefit of VA-authorized vendors that VA retains this discretion as part of our duty to administer this program in a legally sufficient, fiscally responsible manner.”

This language, if finalized, will significantly restrict the ability of a veteran to see the VA-contracted provider of his or her choice for prosthetic and orthotic care. This proposed change in VA policy appears to be almost completely contrary to longstanding VA policy regarding veteran provider choice and the intent of the Veterans’ Access, Choice, and Accountability Act of 2014, which empowered veterans to take a more active role in assuring their ability to receive convenient and timely care, whether through the VA directly or through the private sector. AOPA will release additional information on how to engage on this topic in the future. AOPA will be submitting comments and has a template available on AOPAvotes.org for members to easily submit comments.

THE LIGHTER SIDE How often do you think about compliance?

VA Awards Grants for Adaptive Sports Programs

The U.S. Department of Veterans Affairs (VA) will award up to $8 million in grants for adaptive sports programs that will benefit disabled veterans as well as disabled members of the military.

Grant recipients may use the funds for planning, developing, managing, and implementing adaptive sports programs.

“We are honored to partner with so many organizations across the country to provide adaptive sports programs where our veterans live,” said VA Secretary David J. Shulkin, MD. “Adaptive sports provide opportunities for veterans and empower them to believe in themselves and let go of what others may see as limitations.”

The grants will be awarded to several recipient entities, including national governing bodies that prepare high-level athletes for Paralympic competition, veterans’ service organizations, city and regional municipalities, and other community groups, to provide a wide range of adaptive sports opportunities for eligible veterans and service members. The grants will support activities such as kayaking, sailing, cycling, skiing, equine therapy, and equestrian sports, among other activities. Approximately 10,000 veterans and service members are expected to benefit.

PHOTO: Department of Defense

Celebrate AOPA’s Healthcare Compliance & Ethics Week November 5-11, 2017

O&P ATHLETICS

O&P ALMANAC | NOVEMBER 2017

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HAPPENINGS

COMMUNITY OUTREACH

AOPA Donates to Hurricane Relief Efforts

The AOPA 2017 World Congress held in Las Vegas September 6-9 took place one week after Hurricane Harvey caused record flooding and devastation in Texas and on the eve of Hurricane Irma making landfall in Florida. During the World Congress, the AOPA Board of Directors elected to donate $5 to disaster relief efforts for each World Congress registration.

After some research, the AOPA Board of Directors decided to send the donations to the American Red Cross’s Disaster Relief General Fund to ensure that Hurricane Maria relief efforts in Puerto Rico were included.

AOPA’s total donation was $12,500.

NOVEMBER 2017 | O&P ALMANAC

U.S. Congressman Speaks at Prosthetic Manufacturing Plant

Rep. Steve Stivers (R-Ohio) with WillowWood Co-Owner Lisa Arbogast Rep. Steve Stivers (R-Ohio) paid a visit to prosthetic manufacturing company WillowWood on October 16 to take a first-hand look at new prosthetic technology. During his visit, Stivers hosted a question-and-answer session for the company’s employees and industry associates, and fielded questions on topics such as tax reform, investments to the nation’s infrastructure, health-care reform efforts, polarization within Congress, and his evaluation of Ohio Ballot Issue 2.

Lisa Arbogast, who serves as WillowWood co-owner and director of government affairs, and Ryan Arbogast, the company’s president and co-owner, provided Stivers a look at new prosthetic liner technology designed for upper-extremity amputees.

WillowWood, in partnership with Coapt LLC of Chicago, is developing a prosthetic liner with embedded electrodes to offer amputees intuitive control of their myoelectric prosthetic devices.

“It was a great pleasure to host Congressman Stivers at WillowWood, as his time spent with our employees was invaluable,” said Lisa Arbogast.

“Congressman Stivers remains a great supporter of the orthotic and prosthetic industry. We look forward to working together in order to continuously initiate positive change that will improve overall quality care, assist small businesses, and address specific areas within the Medicare program.”

Constituents Mark Groves (left) and Lonnie Nolt with Rep. Steve Stivers (R-Ohio)

PHOTOS: WillowWood

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EYE ON ADVOCACY

PEOPLE & PLACES BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The board of directors of the National Commission on Orthotic and Prosthetic Education (NCOPE) has approved amendments to the residency standards. The minimum education requirement for admission to a residency program is now a master’s degree in orthotics and prosthetics. The new standards will take effect July 1, 2018, and any individual applying to enter a residency program, either domestic or foreign educated, must have a minimum of a master’s-level education after that date.

Effective Jan. 1, 2020, individuals pursuing the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) orthotist/prosthetist certification exams must have a master’s in O&P as the minimum education eligibility requirement. In an effort to ensure that residency program standards are in sync with the certification agency’s eligibility requirement, the board voted in August to change the residency program admission requirements.

The Source for Orthotic & Prosthetic Coding

Össur is co-funding the development of new wearable exoskeletons with robotics maker COMAU at IUVO in Italy. IUVO, a spinoff company of The BioRobotics Institute (Scuola Superiore Sant’Anna) in the field of wearable technologies, recently received a joint investment from Comau and Össur. The objective of IUVO is to create wearable, intelligent, and active tools, such as robotic exoskeletons capable of aiding and improving the quality of life for workers in industrial and service fields and for patients in need of improved mobility.

“The combination of world-class talent, new ideas, advanced robotics, and biomedical expertise bodes well for this new venture,” said Thorvaldur Ingvarsson, PhD, executive vice president of research and development at Össur. “I am convinced that the development of intelligent and adaptive wearable technologies will help shape a better future.”

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

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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.

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O&P ALMANAC | NOVEMBER 2017

15

REIMBURSEMENT PAGE

By DEVON BERNARD

Introducing the New Medicare Cards

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.18

A Medicare Beneficiary Identifier will soon replace the Health Insurance Claim Number Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits.

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

CE

CREDITS

B

Y NOW YOU MAY have received a

letter or notice from CMS informing you of its plans to issue new identification numbers and Medicare cards to all Medicare beneficiaries starting in April 2018. This month’s Reimbursement Page takes a look at the new Medicare identification (ID) cards and numbers and helps prepare you for the implementation. In addition, with the open enrollment period about to begin, this article reviews the methods for changing your participation status with Medicare.

New Medicare ID Cards

Current Medicare card (top) and the new card, which features a Medicare Beneficiary Identifier

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NOVEMBER 2017 | O&P ALMANAC

The current Health Insurance Claim Number (HICN), based on a beneficiary’s Social Security Number (SSN) is used to identify Medicare beneficiaries for the purpose of paying claims, checking claim status, checking eligibility status, etc. The Medicare Access and CHIP Reauthorization Act requires that CMS remove and stop using SSN as HICN by April 2019. The removal of the SSN and HICN is considered a safety issue to address the risks of potential identity theft of Medicare beneficiaries. For this reason, CMS has created a new identification system for all existing Medicare beneficiaries, including deceased and archived beneficiaries as well as new beneficiaries, and will soon begin reissuing Medicare cards.

Going forward, a Medicare Beneficiary Identifier (MBI) will be replacing the HICN on Medicare cards and for all related Medicare transactions.

The MBI will be randomly generated as 11 characters and will include both

numbers and uppercase letters. (The letters S, L, O, I, B, and Z will not be used.) The second, fifth, eighth, and ninth characters of the MBI will always contain a letter, and the first, fourth, seventh, 10th, and 11th characters will always be a number. The third and sixth characters may be either a number or a letter. Each MBI will be unique to each beneficiary; even spouses will have separate MBIs. Since they are unique, MBIs must be treated as personal health information and protected accordingly.

In addition to featuring MBIs, the new Medicare cards will have a slightly different appearance. They will continue to include the beneficiary’s name, but they will no longer have a signature line or list the beneficiary’s gender. The new cards will continue to indicate the beneficiary’s eligibility and effective dates. The cards will be printed on paper—not plastic— and they will be smaller in size, about the size of a credit card. If you have patients who qualify for Medicare under the Railroad Retirement Board (RRB), you will no longer be able to identify them by the number on the new Medicare card.

However, you will be able to identify them by the RRB logo on their card.

So what should O&P facilities do to prepare for the new MBIs? Since MBIs will be used in the same way you are currently using HICNs, you will need to examine and identify where, when, and how you use HICNs. Look at your systems and business processes and determine what changes you may need to make. This may involve simply updating forms to reflect MBI instead of HICN. It also may involve updating systems to allow you to enter alpha characters in addition to numeric characters.

REIMBURSEMENT PAGE

Mark Your Calendar for New Medicare Card Deadlines November 2017–April 2018

Time period during which you may update your business practices to be able to receive and use the new Medicare Beneficiary Identifiers (MBIs) and speak with vendors, such as clearinghouses, billing software, billing agents, etc., to ensure they are ready and able to receive and use MBIs.

April 2018

Medicare will begin geographically based randomized mailings of new cards to existing Medicare beneficiaries, and new Medicare enrollees will only be issued the new cards and MBIs.

April 2018

Beginning of transition period during which you may use either the Health Insurance Claim Number (HICN) or the MBI for all Medicare transactions; Medicare will return correspondences with the same identifier you used.

June 2018

Beginning this month, you will have the ability to look up a patient’s MBI via portals on the websites of the durable medical equipment Medicare administrative contractors.

October 2018

Beginning this month, if you submit a claim using an HICN, Medicare will return both the HICN and the MBI on the remittance advice notice. This will continue through the end of the transition period.

April 2019

Deadline for all Medicare beneficiaries to have new cards and MBIs.

December 2019

End of transition period.

January 2020

Claims must be filed with MBIs, with a few exceptions. Either HICNs or MBIs may be used for claims appeals and related forms, and either may be used to check the status for a claim with a date of service before Jan. 1, 2020.

If you use vendors or third parties such as clearinghouses, software providers, and billing agents for any Medicare-covered transactions, you should contact them to find out about their MBI system changes and their timeline for making those changes. Find out whether there is anything you need to do on your end to remain compatible.

You also should find out how they will share a patient’s new Medicare number with you if they receive it before you do.

Your new systems and business practices should be ready to go by April 18, 2018, when Medicare begins issuing the MBIs. Note that CMS and the DME MACs will not be offering any testing to see if you gathered the correct information or check whether your claim will be processed smoothly. CMS is not providing suppliers and providers with an end-to-end testing option because it will be using a rolling implementation date, meaning there is a transition period during which you may use either the MBI or HICN for your transactions with Medicare. This transition period should be used as your live test, and you should

use this time to make adjustments and work with your vendors to make changes to your systems if there are any issues with claims you have submitted.

You also may want to talk with your patients so they are aware that new cards are coming. Explain how the new cards will be different and that the changes will not affect their eligibility or coverage, and ask that they bring their new cards with them to their next appointment. CMS will be offering educational materials that can be displayed at your office. Also, verify with your patients that their addresses are current and match the addresses listed in your files and in Medicare’s files. If addresses are different, suggest that your patient contact Medicare to make the proper corrections.

You may choose to begin using the MBIs as soon as your patients get their new cards, beginning in April 2018; however, there is a 21-month transition period during which you may use either the HICN or MBI. At the beginning of the transition, Medicare will respond to your transactions with the identifier you

use. For example, if you submit a claim with an HICN, then the explanation of benefits/remittance advice will use the HICN. This will start to change in October 2018, when Medicare will return both the HICN and the MBI on the remittance advice notice if you submitted only the HCIN. Starting on Jan. 1, 2020, you may no longer use HICNs and will be required to use MBIs for all Medicare-covered transactions, with a few exceptions. For example, there is an exception for any appeals you may file with dates of service prior to Jan. 1, 2020.

In addition, for any claim status inquiries with a date of service prior to Jan. 1, 2020, you may use either the HICN or MBI. CMS and the DME MACs will continue to educate providers and beneficiaries about the new MBI from now until Dec. 31, 2019, which marks the end of the transition period. As part of this education, the DME MACs will be conducting, for the time being, monthly webinars to provide you with up-to-date news about this transition. Information may change periodically, especially as CMS, vendors, clearinghouses, and

O&P ALMANAC | NOVEMBER 2017

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REIMBURSEMENT PAGE

providers update their systems and practices to accommodate the use of MBI in real time. CMS has created a website dedicated to the new Medicare cards: www.cms.gov/medicare/newmedicare-card/nmc-home.html.

Medicare Participation Status

It’s time to start thinking about your Medicare participation status, which you may change only during the open enrollment period—beginning around mid-November. The National Supplier Clearinghouse (NSC) will send all Medicare-enrolled suppliers a letter reminding them of their current participation status. The letter also informs suppliers that if they wish to update or change their current participation status, they must do so before December 31, the end of the open enrollment period.

Participation status doesn’t relate to whether or not you are enrolled with Medicare and have a Supplier Number; rather, it is tied to your ability to collect reimbursement. Your participation status relates to your agreement with Medicare to automatically accept assignment for all Medicare claims—or to not accept assignment on claims.

In short, your decision to be a participating or a nonparticipating provider in the Medicare program hinges primarily on how you wish to handle the assignment of Medicare claims; and the choice to accept assignment relates only to the amount of money you may collect from the patient.

Participating providers agree to accept assignment on all Medicare claims and agree to accept the Medicare allowable for any given item or service as payment in full. Participating providers may not balance bill a patient.

This means that Medicare will forward its payment, which is 80 percent of the approved allowed amount, directly to the participating provider, who may then collect the remaining 20 percent coinsurance directly from the patient.

Nonparticipating providers will have the option to make a claim-by-claim decision regarding whether to accept assignment. The decision to accept assignment must be on a claim-byclaim basis; a provider cannot accept assignment on one claim line and then 18

NOVEMBER 2017 | O&P ALMANAC

not accept assignment on another claim line. When nonparticipating providers elect not to accept assignment, they have the ability to collect their usual and customary charge from the patient, or balance bill the patient, and are not required to accept Medicare’s allowable as payment in full at the time of service. Medicare will send its payment directly to the patient so nonparticipating providers must collect their payment from the patients directly.

18 20

When electing participation status for 2018, remember that it is tied to your tax ID and not to the physical location of your facility. If you have several locations operating under the same tax ID, all locations must be the same status—either participating or nonparticipating. Remember that if you choose to be nonparticipating and elect not to accept assignment on a claim, it doesn’t relieve you of your responsibilities in obtaining all of the proper paperwork and documenting that medical necessity and coverage criteria have been met.

There is no wrong or right decision regarding Medicare participation status.

You should review the options and possible ramifications and make the choice that is best for you and your company.

If you are currently a participating provider and you wish to be nonparticipating in 2018, you must submit written notice to NSC, which may take the form of a letter informing NSC of your desire to change your participation status. The letter must be written on your official

letterhead and signed by an authorized representative of your company. The representative must be the same person who is on file with NSC as an authorized individual—likely a chief executive officer, chief financial officer, president, or board director. If you are unsure who is on file as the authorized individual for your company, review your most recent Medicare enrollment application, the CMS 855S form, and look at Section 15.

Participation status change letters must be received at NSC by Dec. 31, 2017. The letter may not be postmarked by December 31 and arrive at a later date; it must arrive on or by the end of the month. The letter should be sent to the following address: National Supplier Clearinghouse P.O. Box 100142 Columbia, SC 29202-3142 If you are currently enrolled as a nonparticipating provider and you wish to change your status to participating, the process is a bit more formal. You must complete an official Medicare Participation Agreement for 2018 or the CMS 460 form. The one-page CMS 460 form is pretty straightforward and may be filled out by anyone; however, it must be signed by an authorized individual. The completed form must be received at NSC Dec. 31, 2017, or your participation status will remain nonparticipating for 2018.

If you do not wish to make any changes to your Medicare participation status for 2018, simply do nothing and your status will remain the same.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming.

Reach him at dbernard@AOPAnet.org.

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This Just In

Orthotics 2020 Gains Momentum AOPA and O&P stakeholders take steps to study value of orthotic intervention in patients with osteoarthritis, stroke, and other conditions

P

ROSTHETICS 2020 WAS LAUNCHED

in 2015 with the creation of a Medical Advisory Board and a Technical Advisory Committee to help identify and guide research priorities and other actions that would document the value proposition of prosthetic services. Data from the original 2013 “Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries” study by DobsonDaVanzo demonstrated that O&P services save money for Medicare and provided a starting point in underscoring the need for further research.

Stepping up to jointly fund this effort were AOPA, Endolite, Freedom Innovations, Hanger Clinic, Össur, Ottobock, Scheck & Siress, and WillowWood.

In response to some of the priorities established

by Prosthetics 2020, AOPA engaged the RAND Corp. to create a more comprehensive 10-year economic value simulation to further document the efficacy of O&P services to transtibial and transfemoral amputees. The “Economic Value of Advanced Transfemoral Prosthetics” report, which was unveiled at the AOPA Second World Congress and Centennial Celebration in September,

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NOVEMBER 2017 | O&P ALMANAC

demonstrated the value of prosthetic services in saving money for Medicare.

Dobson-DaVanzo research also was presented that expanded the original 2007-2010 report with the addition of 2011-2014 Medicare Services data and Part D prescription information to further measure the impact of O&P services, including drug utilization, in documenting value. The updated Dobson-DaVanzo report also documented a solid case for K3 and K4 prosthetics as delivering greater value when compared with the cost and life quality of those patients limited to K1-K2 prosthetics.

Results of these studies and the growing focus by CMS on reimbursements for orthotic services made clear that a similar Orthotics 2020 project should be explored.

The World Congress and Centennial Celebration offered the opportunity for the first face-to-face meeting with members who have an interest in assuring a strong conceptual and research basis to establish the value and favorable patient outcomes for orthotic intervention through participating in an Orthotics 2020 program, which initially could be modeled on the work done by the Prosthetics 2020 project.

This Just In

During the Las Vegas meeting on September 7, sufficient interest was evidenced by those participating to initiate a process to secure critical appraisals of the available scientific literature with respect to five topics: • Osteoarthritis • Stroke • Scoliosis • Traumatic spinal injuries • Plagiocephaly.

Information gathered during the September meeting will serve as background for follow-up telephone conferences around each of these five topics. The stakeholders who gathered in Las Vegas identified a call coordinator and interested parties to collaborate in identifying subject matter experts for each topic, possible Medical Advisory Board candidates, and “silver bullet” topics that may have major impact insofar as utilization, reimbursement levels, and outcomes.

In addition, AOPA staff has identified

the most relevant codes for orthotic services and the details of code utilization over multiyear periods, by category of provider, to identify any trends on code utilization as well as any shifts in the providers with the greatest stake in each area.

AOPA also undertook, with the help of some researchers, to compile critical appraisals of the literature and existing science in the five identified priority areas. This information was scheduled to be shared with the call

coordinators and interested parties for each topic in late October, with a goal of scheduling follow-up teleconferences.

The funding aspect of Orthotics 2020 will resemble the Prosthetics 2020 model, with companies invited to provide research dollars and financial support for the Medical Advisory Board or boards that may be needed to move the topic areas forward.

Participants in the initial meeting were optimistic and energetic in their support of the Orthotics 2020 project. Stakeholders are embracing the overall goal to protect the orthotic services upon which patients depend from attack by payors, and are taking the initial steps to populate a strong research basis around issues on the value of the orthotic services offered to patients.

Access the RAND economic simulation study and the updated Dobson-DaVanzo study at bit.ly/ randstudy.

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O&P ALMANAC | NOVEMBER 2017

21

COVER STORY

PHI in CRITICAL

CONDITION

Data breaches are the new normal, say experts, who offer tips for complying with HIPAA regulations and protecting patient information

By CHRISTINE UMBRELL

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NOVEMBER 2017 | O&P ALMANAC

COVER STORY

NEED TO KNOW XX With data breaches at health-care companies hitting an all-time high last year, many O&P compliance officers believe it’s not if, but when, their facility will experience a compromise.

XX Preventive measures regarding patient data protection are essential, and O&P facilities must implement safeguards and adhere to the requirements outlined in the Health Insurance Portability and Accountability Act (HIPAA).

XX Training employees to avoid engaging in practices that could lead to accidental exposure of patient information is just as critical as leveraging HIPAA-compliant virus detection software and technology that help protect against phishing and ransomware threats.

XX Many facilities have already installed HIPAA-compliant electronic medical record systems, but security and encryption measures must be implemented for all devices used by clinicians, including mobile devices and laptops.

XX The consequences of noncompliance may include fines and criminal prosecution, as well as the loss of company reputation and accreditation.

XX Routine and robust training for all staff members—which can take the form of reminder emails, phishing/social engineering training exercises, and in-person training—is key to creating a security-conscious environment and facilitating compliance with regulations.

G

IVEN THE INCREASING RISK

of cyberthreats to health-care entities across the United States, many O&P compliance officers believe it’s not if, but when, their O&P facility will experience a compromise. While most O&P professionals prioritize data protection strategies at their facilities, many say that it is more likely than not that a breach will occur at some point down the line.

The best path forward may be to hope for the best but prepare for the worst. “Don’t stick your head in the sand and assume that your facility is immune from a breach,” says Jeffrey Schultz, CIPP/US, a partner at Armstrong Teasdale.

In the current climate, it’s critical that O&P facilities stay up-to-date on the requirements outlined in the

Health Insurance Portability and Accountability Act (HIPAA), which mandate that covered entities implement reasonable safeguards to limit incidental, and avoid prohibited, uses and disclosure of protected health information (PHI). “The diligence and effort applied up front is your best defense for HIPAA risk,” says Rebecca Hast, Hanger senior vice president and chief compliance officer.

“A lot of people don’t want to know” the extent to which they are at risk of a data breach, says Paul Turek, executive director of technology and A4-Access for Wright & Filippis. “But a lot of O&P companies aren’t big enough to survive a significant breach. Smaller companies may think there are a lot of expenses associated with protection—but the cost of a breach is much higher.”

O&P ALMANAC | NOVEMBER 2017

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COVER STORY

In fact, data breaches at health-care companies are more costly than those in other types of industries: The average breach costs U.S. health-care companies $380 per leaked record, compared to $225 per compromised record among all types of U.S. companies, according to a report from IBM and Ponemon Institute titled, “2017 Cost of a Data Breach Study: Global Overview.”

And health-care companies are experiencing more breaches than ever, hitting an all-time high in 2016 with 328 health-care companies reporting breaches, according to a recent report by Bitglass based on the U.S. Department of Health and Human Services’ (HHS) database of breach disclosures. Last year, records of approximately 16.6 million Americans were exposed as a result of hacks, lost or stolen devices, unauthorized disclosure, and other factors.

Jeffrey Schultz, CIPP/US

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NOVEMBER 2017 | O&P ALMANAC

Implementing Safeguards

Adhering to HIPAA involves preventing both internal and external threats, and protecting against both accidental and malicious exposures. Training employees to avoid engaging in practices that could lead to accidental exposure of patient information is just as critical as installing HIPAA-compliant virus detection software and electronic medical record (EMR) systems.

“It’s important that all employees understand the breadth of HIPAA, and understand all the ways it can impact your facility and your patients,” says Stephanie Greene, executive director of compliance for Ability Prosthetics & Orthotics.

Rebecca Hast

Noncompliance may result in exposure of patient data that could lead to monetary and emotional distress for patients, as well as financial and reputational implications for an O&P company, should a breach occur.

O&P facilities should be relaying to all employees the importance of HIPAA compliance, says Rebecca Snell, IT and marketing director for Dankmeyer Inc. “Knowing all the forms of PHI and how and when it can be disclosed is part of following HIPAA regulations,” she explains.

“HIPAA differentiates between ‘required’ and ‘addressable’ standards—knowing what you must do regarding PHI is essential to [developing] an action plan. You must do an analysis as a requirement; that analysis will tell you what you have, and that leads to how to protect it. And there are many ways to protect data.”

A vital step in creating a HIPAAcompliant workplace involves analyzing where and how all patient data is obtained, maintained, and relayed, says Greene. “That tells you where the biggest risks are.” Once that information is known, you can implement a strategy to safeguard against external risks—such as phishing and ransomware threats—as well as internals risks of accidental data sharing.

PHOTO: Getty Images/Zimmytwsr

Breaches at health-care companies are particularly damaging to both patients and the companies themselves. O&P facilities house data that has significant resale value on the black market, rendering them attractive targets for cyberthieves. Whereas credit card information stolen from retail businesses has a short shelf life, with new cards being issued on a regular basis, the PHI taken from health-care companies often contains Social Security numbers and medical data that is much more difficult to change. This makes data stolen from medical facilities attractive to criminals involved in traditional financial crimes, as well as medical insurance fraud schemes.

“PHI can be especially valuable in connection with ransomware attacks because it is critical data,” says Schultz.

“If not backed up, facilities may be

willing to pay significant ransoms to regain access to the information to ensure no disruption in patient care. It also can be valuable in connection with extortion efforts by cyberthieves because PHI is heavily regulated.”

COVER STORY

A Primer on HIPAA and the HITECH Act Any health-care organization that stores, processes, or transmits protected health information (PHI) is required to comply with the Health Insurance Portability and Accountability Act (HIPAA) and safeguard all protected data. HIPAA mandates standards-based implementations of security controls by all health-care organizations that create, store, or transmit electronic PHI. The HIPAA Security Rule governs protection of PHI.

ACCESS CONTROLS:

“Whether system-related or paper records, make sure patient-related information is secured from general access unless there is a need to use the information for patient treatment or other administrative functions, such as billing a payor,” says Hast. Even then, the information access should be limited to a need-to-know basis.

Organizations must certify their security programs via self-certification or by a private accreditation entity.

Noncompliance can trigger various civil penalties, including fines and/or imprisonment.

As “covered entities” under HIPAA, O&P facilities should pursue compliance in these four essential areas, explains Rebecca Hast, Hanger senior vice president and chief compliance officer:

ELECTRONIC TRANSMISSION OF DATA:

The security rules of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which began enforcement in 2009, require that any transmission of PHI electronically be protected both in transmission and at rest on the server.

Penalties for noncompliance with HIPAA/HITECH can be substantial. In cases of “willful neglect,” a HITECH penalty can be at least $50,000 per violation, up to a total of $1.5 million in a calendar year. Other breach-related costs will be incurred for discovery and containment, investigation of the incident, remediation expenses, attorney and legal fees, loss of customer confidence, lost sales and revenue, and brand degradation.

A summary of various aspects of the law is available on the Department of Health and Human Services website: www.hhs.gov/hipaa/for-professionals/privacy/ laws-regulations/index.html.

PRIVACY NOTICES AND PATIENT ACCESS:

COMPREHENSIVE TRAINING PROGRAM:

HIPAA permits patients to access their own information as well as designate others’ ability to access. “However, information must be maintained by the covered entity about data utilization and access that has been provided,” says Hast. “Additionally, it is a best practice to advise new patients about privacy practices, as well as refresh the patient’s acknowledgement on an annual basis. The privacy notice describes how the covered entity uses PHI and what controls it has in place.”

Covered entities should implement training programs that “raise awareness about the various aspects of HIPAA, why it’s important, and how it translates to the practice’s daily operations,” Hast says. “Training new employees or temporary staff and training that is refreshed annually for all is key.”

In addition, O&P facilities should look for training opportunities available from third parties. “There are many organizations that offer HIPAA training—everything from instructor-led courses to self-taught workbooks,” says Hast. The Office of Civil Rights also offers a free video at www.hhs.gov/hipaa/for-professionals/training/index.html. “The most important thing is to get the information into the hands of your staff and to ensure that your business partners are aware and have privacy programs in place as well,” adds Hast.

O&P ALMANAC | NOVEMBER 2017

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COVER STORY

Fostering a compliant workplace requires a multipronged approach, says Hast, beginning with developing a privacy plan and notice that is compliant with HIPAA and lets patients know how you will use their data. She also notes the importance of building data access controls into your operations and informing patients of your facility’s privacy practices.

Education is crucial to understanding the regulations, and creating a culture of awareness is essential to compliance, says Snell. “The results of noncompliance aren’t just fines and possible jail time, but the good name of the facility, accreditation, and the ability of that practice to deliver the best possible care to its patients and their families in a trusted and secure environment.”

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Digital Diligence

One of the challenges facing facilities in their efforts to abide by HIPAA is knowing how to go about this process.

“HIPAA tells us what to protect, but it doesn’t tell us how to do it,” says Turek. He equates threats from cybercriminals with “the Wild West” and believes that a company’s success at preventing breaches is partially dependent on the effectiveness of its IT department. “You have to be successful at preventing breaches 100 percent of the time, but the bad guys only have to be successful once,” he says.

Like many O&P companies, Wright & Filippis has a cloud-based EMR system from a third-party vendor in place, which is HIPAA compliant and designed to keep all information secure. This type of setup puts a security burden on the vendor, “but you need to follow up and make sure that vendor is engaging in compliance validation,” says Turek.

Paul Turek OPIE Software National Accounts Manager Darren Donnelly, CO, MBA, believes that it’s critical for EMR vendors to stay on top of changes to any laws regarding PHI. “The vendor needs to make sure that their software complies with regulations,” he says.

“It is in the best interest of the vendor to provide a system that is safe and complies with HIPAA laws. Working with the vendor will help you maintain compliance.”

While EMR systems often come with their own protections, such as logins, permissions, and encryption,

all devices used by clinicians must be regulated by a facility’s own systems and protections. “Because HIPAA affects how you gain, share, use, and destroy information, most of the compliance occurs outside of any EMR system,” explains Donnelly.

Darren Donnelly, CO, MBA “Removable media with patient pictures or video or files should be protected as well. Email, texts— there are a lot of things that may not be a part of the EMR system that still contain PHI, and those must be protected equally,” adds Snell.

“Laptops or tablets must be protected with PINs, biometrics if available, and logins,” she says. “In addition, PHI should be encrypted on any drive or removable media. If someone loses a laptop, passwords are at least some barrier to entry. Firewalls and antivirus/malware protection is essential.”

At Ability P&O, clinicians use iPads equipped with technical safeguards that were set up by the company’s compliance office, says Greene. And at Wright & Filippis, employees are equipped with mobile devices that are whole-drive-encrypted, Turek says, adding that employees will soon be able to bring their own devices; the company will be adopting a virtual desktop design, where the data will exist only in the cloud.

Wright & Filippis has taken several additional steps to ensure compliance. The company has instituted new intrusion detection and prevention measures at its firewall, which are designed to help fend off direct attacks. It also has moved its domain name server (DNS) to the cloud, which “allows us to scan traffic before it reaches us and puts a buffer between us and [potential bad actors],” Turek says.

PHOTO: Getty Images/Wavebreakmedia

The most common types of breaches might result from simple actions that occur as part of a facility’s day-to-day operations, such as failing to store or dispose of patient records appropriately, engaging in hallway conversations about patients, or inappropriately displaying patient information, according to Hast. “But the most impactful breaches—and those that can easily involve more than 500 patients—are usually electronic information that has been transmitted inappropriately, lost, or stolen,” she says. “The best defense to a HIPAA breach is to make sure you understand what the law requires and that your systems and processes are set up to be

successful. The second best defense is continued efforts to keep staff aware and well-trained, as well as ensuring your business associates are complying with your practices.”

COVER STORY

In addition to these strategies, the company performs periodic internal validation, and “we are moving to a compliance validation environment, where we will hire outside security companies to try to breach us” to ensure the company’s protections remain effective, according to Turek.

He also is committed to spot-checking all of his company’s processes.

Moving Past Paper

While most facilities have migrated to EMR systems for patient data, some companies continue to use paper documentation in one form or another—but this may be a mistake, as more paper means more opportunity for data exposure. “In the digital age, people forget that good old paper is still lying around—perhaps in paper files or on desktops. Those files may contain PHI,” says Snell.

Donnelly explains that improper destruction of PHI is a common breach of HIPAA. “Using a HIPAAcompliant shredder can be a key component to a successful HIPAAcompliant strategy,” he says.

Wright & Filippis recently upgraded its patient data collection processes by implementing an online patient registration portal—an encrypted portal that sends data directly into the company’s secure EMR system and bypasses the need for paper registration forms. With a secure portal, patients can enter registration data from their home computers or in kiosks located in each facility lobby. “This is much more secure, plus we are saving about 750 hours of labor per month in data entry,” says Turek.

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Stephanie Greene

All Hands on Deck

O&P facility staff members who are responsible for data security must keep their skills sharp and constantly seek information on potential cyberthreats.

“Threats are evolving daily, so you have to be constantly on the lookout for new problems,” Turek says.

To stay vigilant, Turek takes part in webinars, subscribes to publications, attends summits, and participates in groups dedicated to data security. He also makes sure other staff members understand the necessity of ongoing investment in updated technologies.

“Sometimes the toughest thing for an IT department

to do is to move executives in the company” to engage in the necessary preventive activities, says Turek. But the importance of HIPAA compliance and data protection strategies cannot be understated. “You need to tell the executives or owners, ‘Your company is at risk. If you don’t do these things, you may lose your business.’”

Greene says the best way for compliance staff to educate employees and implement compliance processes is to “put yourself in the shoes of employees to see how each one obtains and maintains patient data, so you can put systems in place that will complement your employees’ needs— then you’ll have a higher chance of employees following your plan.”

Schultz advocates using multiple formats to educate employees.

“Everything from ‘best practices’ reminder emails, phishing/social engineering training exercises, and in-person training sessions can be helpful,” he says. “The key is to determine what types of training work best for your personnel.” This is especially important because “breaches in any type of business are most often caused by, or facilitated by, an insider with no malicious motive.”

Snell recommends that facilities create an atmosphere where employees “think before they click” because “the No. 1 cause of breaches is employees who open emails with links they should not click on, or download files that may be infected with malware. … Whenever in doubt, don’t click,” she says. “Find someone who can help you determine if the communication or website is legitimate.”

PHOTOS: Getty Images/LukaTDB/Tomprout

28

Verbal sharing of patient data also poses a HIPAA risk, according to Donnelly.

It’s important to consider to whom you are speaking when sharing patient information. “Patients have to give consent to allow you to talk to their friends or family members about their care. Too often, we assume it is OK to talk to family members,” but securing patient approval is critical.

At Ability P&O, staff have implemented procedures to minimize the amount of time patients spend in the waiting room, which means less exposure to the reception area. “We try to send patients to exam rooms within a few minutes of arriving, which prevents patients from overhearing discussions between practitioners and front-office staff,” she says. “And we position computer screens so patients cannot see them.”

COVER STORY

Snell also suggests limiting employee access to records. “Everyone may not need to know everything—a disgruntled employee can do a lot of damage,” she says. “And a facility should have an excellent firewall to protect the system access from outsiders. Don’t let your guests share the same Wi-Fi as your staff.”

When Breaches Happen

Educating employees will help prepare them for an audit from HHS’s Office for Civil Rights, which could occur at any time. “The requirements are only going to get worse, and there will be audits for compliance,” says Snell. She recommends that all facilities conduct internal assessments.

Despite a facility’s best efforts, an exposure may occur that should be investigated as a potential breach.

What comes next depends on the type of breach and the likelihood that data was actually compromised, says Snell.

“Not every type of beach requires the same plan. There can be a lot of people involved at various levels.”

While this can be a very complicated undertaking, Snell offers the following tips: “First, isolate the equipment.

Understand what you think might have happened, and get your team together to decide what to do and who to call, if anyone, from there— using your plan.” It may be time to call in experts. “Do not investigate any cyber-related breach yourself.”

Schultz agrees that O&P facilities should “resist the urge to self-investigate.”

Instead, facilities that may have been compromised should immediately consult outside legal counsel, who may enlist the assistance of outside technical experts.

“They will work together to ensure that appropriate steps are taken to contain, eliminate, and remediate the breach, document the process, and preserve evidence. Importantly, having a written breach response plan and a team in place before a breach occurs will save you time and money, and help make the breach response process more efficient and effective.”

Rebecca Snell

PHOTOS: Getty Images/Dean Mitchell/Relif

Part of the process involves determining if a breach is a one-time event or an ongoing problem. “If it is a continued process, [O&P facilities] need to stop whatever is causing the breach. The next thing to do is the notification,” Donnelly says. “The HIPAA Notification Rule requires the facility to notify all the affected individuals and HHS.” He also advises looking up and adhering to the Breach Notification Rule relating to business associates of covered entities to ensure all affected parties receive notification.

While not every incident will end up being defined as a breach by HIPAA’s standards, each potential exposure should be taken seriously, says Greene.

She cites the importance of “closing the learning loop”: Every investigation should serve as a learning opportunity to protect against a future breach.

More information regarding the

definition of and requirements for reporting a breach is available at www.hhs.gov/hipaa/for-professionals/ breach-notification/index.html.

Total Patient Care

Ultimately, the more educated facility employees are about HIPAA and data exposures, the more likely a facility is to remain compliant. “Breaches often occur because of insiders who have no malicious motive,” says Schultz.

“Education can go a long way toward preventing breaches.”

As we move into 2018 and beyond, “PHI is going to get even more digital, and technology is going to improve, as will the cybercriminals,” Snell says. “We cannot control any of that, but we have control over knowing what we have, educating our people how to protect those resources, and having a plan in the event of an issue.

Those are essential steps.”

Looking past the data and focusing on the patients themselves can put compliance efforts in proper perspective. “We try to remember that there’s a person attached to every patient record,” Turek says. Protecting PHI and preventing data breaches “is not just about the law—it’s about doing what’s right.”

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

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By LIA K. DANGELICO

Pain, Opioids,

& Your Patients O&P clinicians have a key role to play in patient education, pain management

NEED TO KNOW • In October, President Donald Trump declared the U.S. opioid epidemic a National Public Health Emergency, raising visibility of the rapidly growing problem. In fact, opioids killed more than 33,000 people in the United States in 2015.

• Many O&P patients struggle with phantom limb pain or residual limb pain; others experience chronic pain resulting from a vascular incident, cancer, or failed limb salvage.

For some patients, opioids are an effective and necessary tool to help them live a better life.

• Prosthetists can be a resource for patients in pain because they know how to analyze gait mechanics

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• O&P professionals should ask their patients about opioid use and look for signs that medications are being misused or abused. Symptoms include extreme drowsiness, lack of cognitive ability, nausea, and poor personal hygiene.

• In some cases, physicians are easing patients off of brain-altering medications to allow them to better process and deal with the complicated emotions they face.

• A team-based approach involving physical and occupational therapists, psychologists, physiatrists, and other specialists has been found to be useful in helping patients deal with pain issues.

PHOTO: Getty Images/Megaflopp

• Patients who are in pain often experience depression, anxiety, anger, and poor coping skills and can be prone to “catastrophizing.” This may lead to changes in the nervous system’s reaction to pain medication, rendering it less effective over time.

and the mechanics of the body.

Sometimes patients have pain because they’re not using their body or their device correctly, and clinicians can help patients adjust their mechanics and their devices to increase comfort.

I

F SOMEONE ASKED, could you name

91 people? Ninety-one employees working at your company, 91 parents at your child’s school, 91 people you know through Facebook. Shockingly, that’s also the number of Americans that die every day due to an opioid overdose, according to the Centers for Disease Control (CDC). The agency reported that, in 2015—the last year for which it has released official data—opioids killed more than 33,000 people in the U.S., the highest number on record. Opioid deaths also accounted for more than half of the total number of drug-related deaths that year.

So it’s easy to understand why, on Oct. 26, 2017, President Donald Trump stood in the East Room of the White House, surrounded by families affected by opioid abuse, and declared a National Public Health Emergency to “use all lawful means to combat the drug demand and opioid crisis.” Deaths from drug overdose are up among both men and women, all races, and adults of nearly all ages, according to the CDC. Earlier in the year, the administration also established the President’s Commission on Combating Drug Addiction and the Opioid Crisis, and reports it has allocated or spent nearly $1 billion to address drug addiction and the opioid crisis.

There is no denying the gravity and scope of this deadly epidemic, but it may not be as easy to draw the dotted line from the crisis to the O&P industry—even though O&P has a large

patient demographic of amputees and individuals struggling with chronic conditions, often accompanied by pain. For some, it makes more sense to point to prescribers, pharmaceutical companies, or even Americans’ desire for always faster-cheaper-better—and mind their own business.

But experts say that clinicians in health-care adjacent fields, including O&P, have a responsibility to acknowledge and understand how opioids are being used so they can be better patient advocates and more wellrounded practitioners. As it turns out, it’s much easier to draw that line from patients’ pain to their overall satisfaction with O&P services and business.

Understanding Opioids and Pain

PHOTOS: Getty Images/Paul Bradbury/Nashvilledino2p

Before one can understand opioids and the O&P patient, it’s crucial to comprehend what opioids are and what they do. According to the CDC, “opioids are substances that work on the nervous system in the body or specific receptors in the brain to reduce the intensity of pain.” As a result of the 1970 Controlled Substances Act, drugs are organized into groups based on their risk of abuse or harm—Schedule I (highest risk) through Schedule V (lowest risk). Most opioids are classified as Schedule II, which the Drug Enforcement Administration defines as having “a high potential for abuse which may lead to severe psychological or physical dependence.” Examples of Schedule II opioids include hydrocodone, hydromorphone, oxycodone, methadone, and fentanyl.

Because of their powerful ability to block the brain’s sensation to pain, opioids are among the most widely prescribed medications in the country for moderate-to-severe pain, usually related to surgery, trauma, or chronic diseases. In 2012, the CDC indicated that 259 million prescriptions for opioid pain medication were written. “Essentially, that is enough for every adult living in the United States to have his own bottle of pills,” says Joseph Brence, PT, DPT, FAAOMPT, a spokesperson O&P ALMANAC | NOVEMBER 2017

31

Today, it is widely believed that these Of course, treating amputees’ pain for the American Physical Therapy three factors work to influence the immediately postsurgery also can be Association’s #ChoosePT campaign, brain and the central nervous system difficult, says James Atchison, DO, aimed at promoting physical therapy in determining how it responds in medical director of the Shirley Ryan as a valid means to address pain over sending an output of pain, he says.

AbilityLab’s Pain Management Center addictive opioids. At the same time, in Chicago and professor of physical 100 million American adults say they experience chronic pain, Pain in the O&P Patient medicine and rehabilitation. “The challenge with treating [this patient according to a report Because opioids often demographic] is they often are dealing from the University of are prescribed following with both phantom limb pain and pain Michigan released in late surgery or for disease and from the residual limb.” In the past, September of this year. chronic conditions, it’s he notes, doctors would have tried For Brence, the challikely that O&P patients are opioid and other pain medications taking or have taken a prelenge is finding other ways of addressing pain scribed opioid for pain. O&P to treat either types of pain, but now Atchison and others try to get a closer than with pharmacology. clinicians should underlook at the underlying causes to try to “There are basically two stand and educate their Joseph Brence, PT, address them. models for approaching patients on different types pain,” he says. In the past, DPT, FAAOMPT of pain and experiences of For phantom limb pain, it’s the biomedical model pain and how to address it about helping patients learn how to was widely used. “Essentially, it said in its many forms. change the way their brains work that pain existed at the level of the “The unique challenge of pain today in processing pain through nerve tissue. So if my knee hurt, that indiis that there are many different types messages and pathways. Physical of patients that we see, and therefore, and occupational therapists often cates that something’s going on with many different types of pain,” says use unique interventions to address the tissues around the knee.” Over the Nathan Seversky, CP, clinic manager of this challenge, including mirror box years, as a result of new research, the Hanger Clinic in Stratford, therapy. With the use of thinking has shifted to what’s called Connecticut. Some O&P a mirror, they create a a biopsychosocial approach. “This patients have chronic pain reflection of the patient’s approach indicates that pain likely resulting from a vascular existing limb in place of is influenced by three major factors: incident, cancer, or failed the amputated limb, so it ‘bio,’ the biological tissues of our body; limb salvage and may be appears that the ampu‘psycho,’ meaning our thoughts, our taking opioids for years, mental well-being; and ‘social,’ the tated limb is “back in with mixed results. “Pain social context we put ourselves in.” place,” says Brence. The is not only something that patient then performs can be happening as a result activities and different of inflammation, or from parts of his routine.

James Atchison, DO prosthetic use, or from This visual approach can be quite helpful in helping patients “start postsurgical pain,” he says. “It can also to change what is going on in their be neuropathic pain. … And somebrain and nervous system while they times the amount of pain the patient is are trying to resume activity,” says feeling is based on contextual factors, Atchison. “For an amputee, that would such as psychosocial issues, that the be, ‘How do I walk with less pain? patient is experiencing.”

How do I tolerate the pressure of my prosthesis with less pain?’”

If a patient reports that he is experiencing pain in his residual limb, Atchison’s team members work to drill down on a certain spot where he is feeling the pain or pressure. They look for other underlying problems rather than just prescribe more, or a different, pain medication. While they aren’t against using opioids at the Shirley Ryan AbilityLab, team members understand an all-too-common cycle: 32

NOVEMBER 2017 | O&P ALMANAC

PAIN RESOURCES FOR

Clinicians & Patients

Whether you’re looking to increase your own knowledge, provide additional patient resources, or assist a patient who may be struggling with pain management or drug abuse, check out these sources for information, educational tools, and support: theacpa.org American Chronic Pain Association—theacpa.org—offers pain management tools and guides, including interactive maps to help patients navigate the source of their pain, severity, how it’s affecting their lifestyle, etc.

The association also offers mobile pain management apps.

moveforwardPT.org American Physical Therapy Association—moveforwardPT.org— through its #ChoosePT campaign, is creating awareness around the many available alternatives to opioids, namely physical therapy, which patients can access in all 50 states without a prescription or referral. The campaign website provides symptom and condition guides, tip pages, podcasts, and more to help individuals better understand and manage pain.

• Substance Abuse and Mental Health Services Administration— samhsa.gov—is a federal program providing helpful information, tool kits, guides, and other resources for those struggling with abuse or mental health and/or their loved ones. Its toll-free helpline, 1-800662-HELP, is available 24 hours a day, seven days a week, 365 days a year.

samhsa.gov

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Amputee Coalition—amputeecoalition.org—offers several resources on both limb loss and pain management, including specific guides for managing surgical, residual, and phantom pain and secondary conditions, and more.

amputee-coalition.org

Patients are given pain medication, which turns out not to be effective for them, so they are given more pain medication, and then it starts to change how they think about things because the medication alters their brain chemistry. “When patients don’t respond very well to those pain medicines, part of their underlying pain response may be more related to other psychological issues,” says Atchison.

Patients who are in pain often experience depression, anxiety, anger, and poor coping skills and can be prone to “catastrophizing,” he says.

“These emotional changes will change the nervous system’s reaction to the pain medication, making it worse [less effective] over time.” So, in some cases, it’s necessary to get the patient off of brain-altering medication, such as an opioid, to allow his brain to work better and to better process and deal with the complicated emotions he is facing, says Atchison.

Although O&P clinicians are not prescribers—and should generally avoid making any direct recommendations regarding medications, dosages, etc.—they should be recording their patients’ opioid use and affiliated behaviors, when possible, as a part of their documentation and learn how to listen and talk to patients about pain.

“Despite this epidemic that’s going on, it’s always in the clinician’s best interest to believe a patient’s description of pain,” says Seversky. “Pain is very qualitative. How you and I feel pain is very different, and what we can tolerate and not tolerate is very different.” If an O&P patient is in pain, O&P professionals should be asking leading questions to help the patient describe the pain he/she is experiencing, he says. For example: “Is the pain coming from your ankle-footorthosis? Is it painful when you’re not wearing your prosthesis? Where is the pain?” He recommends encouraging patients to describe their pain, listening intently, and then helping them understand and differentiate between acute, inflammatory injury pain versus neuropathic pain. O&P clinicians also can connect patients

with other health-care professionals and specialists as well as resources that can help them learn to better manage their pain.

Alternatives for Addressing Pain

PHOTO: Getty Images/Megaflopp

Many headlines and sound bites paint all opioid use with the same broad, scary brush. But for some patients, including some in O&P, opioids are an effective and necessary tool to help them live a better life. For such patients, opioid use should be regularly assessed by physicians and should be part of a larger, multimodal pain management program that addresses the bio, psycho, and social aspects of their pain and discomfort.

When patients who are taking prescribed opioids for pain come in for a fitting, “you would expect those opioids to be providing significant relief so that their pain would be very well controlled,” says Atchison.

“They should be able to tolerate these procedures and tolerate wearing the prosthesis” and generally be progressing with their goals. They also should report they are active and taking part in their social and family roles. Make a point to ask them how often they’re getting out to church or their children’s sporting events, he says. If the patient is reportedly taking opioids but still rating his pain at a nine or 10 when walking on his prosthesis and is rarely leaving the house, that should be a red flag that a change to his pain management protocol likely is needed.

As such, it’s helpful to understand some of the signs that patients are misusing or abusing opioids. These patients may experience extreme drowsiness, mental fog or lack of cognitive ability, and nausea, according to Brence. They also can experience poor personal hygiene, difficulty sleeping, and weight loss, and can seem absent, missing lots of appointments, adds Seversky.

It may be difficult to spot abuse because, over a long period of usage, patients can build up a tolerance and signs can become more subtle.

Of course, just because a patient

is experiencing or exhibiting some “Ultimately, it’s a self-management of these behaviors doesn’t mean he program, where patients get back in is abusing or addicted to medication. charge of how they control their pain, This is where trust and communicaand [learn how to] do that while they are trying to develop their desired tion return to the equation, and where mobility and activity levels,” says clinicians should talk to their patients Atchison. “We teach them along the about what they’re going through and way how to do that, and guide them, rally the health-care team to show but they have to do the work.” support and get patients the help they While the Shirley Ryan need. Many in O&P work AbilityLab is a unique to connect patients with situation, Seversky agrees other specialists and alterthat even an orthotist native therapies that may or prosthetist working help them, whether in from a small clinic should place of or in conjunction see him- or herself as “a with opioids. switchboard for patients The Shirley Ryan to other services.” He AbilityLab takes an interregularly refers patients disciplinary approach to out for alternative pain, tapping its many Nathan Seversky, CP approaches to pain specialties to address management, including physiatry, how its patients experience and cope nutrition, physical and occupational with it. Clinical psychologists work therapy, acupuncture, hypnosis, with patients on cognitive behavmassage, and more. “Partner with ioral therapy or mindfulness. They other types of health-care providers, use biofeedback to assist patients in who can help these patients make practicing deep breathing and relaxgood decisions for themselves and ation techniques, which can help to learn alternative ways to manage dial down activity in the brain and the their pain,” he says. “That way we’re nervous system. Physical therapists providing care in a very efficient assist patients in finding an exercise manner that is best for the patient. … component that they can tolerate When we do that, we have patients well enough to exercise regularly who are more successful, and we all and get some benefit from the body’s do better. … Our prostheses even work natural opioids, such as endorphins, better, believe it or not.” that help us handle our own pain.

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New Bill Could Help Physicians Better Connect the Dots on Substance Abuse

Rep. Tim Murphy (R-Pennsylvania)

Rep. Earl Blumenauer (D-Oregon)

As pressure mounts to find solutions to the opioid crisis, two members of Congress have introduced a bill that would enable physicians to access patients’ addiction treatment records, which is prohibited under current law unless patients give written consent to each individual provider on their care team.

The Overdose Prevention and Patient Safety (OPPS) Act, H.R. 3545, introduced by Reps. Tim Murphy (R-Pennsylvania) and Earl Blumenauer (D-Oregon), would align the 42 Code of Federal Regulations Part 2 with rules in the Health Insurance Portability and Accountability Act in order to ensure that patients who struggle with substance abuse receive the best possible care without jeopardizing the security of their personal health data. “You cannot treat the whole patient with half of their medical record,” Murphy said in a statement.

Proponents of OPPS Act say it simplifies healthcare treatment, payment, and operation processes, and also strengthens protections against the use of substance use disorder records in criminal proceedings. This act may help O&P clinicians, as well as other members of the care team, better treat and advocate for patients who may be struggling now or who have struggled in the past with substance abuse.

Clinicians should work to establish strong professional and referral relationships, so when it comes time to advocate for a patient, they have a good idea of whom to call and how to contact them. “We’ve built relationships with a local physiatrist office, so when I’m writing letters to them after our patient’s appointment, there’s an open dialogue with another member of the care team, so they can also monitor the patient’s use of these medications,” says Seversky. “That, in my opinion, has been a huge opportunity for patients.”

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NOVEMBER 2017 | O&P ALMANAC

A Role To Play Whether as a trusted confidant and listening ear or a much-needed referral source, O&P clinicians have an important role to play in the lives and success of their patients, especially those who are suffering.

For example, prosthetists can be a resource for patients in pain because they know how to analyze gait mechanics and the mechanics of the body, says Atchison. Sometimes patients have pain simply because they’re not using their body or their device correctly, so if you can work

with them to correct their mechanics or usage, you may be able to reduce or eliminate their pain—and maybe even get them off of opioids.

O&P professionals also are in a great position to show patients there is another way, says Atchison. “The ways of the world aren’t that everybody who has an amputation has to take a bunch of pain meds all the time,” he says.

He notes that orthotists and prosthetists may choose to take a less formal approach to questioning patients who may be overly reliant on medications.

Clinicians can casually say, “Oh wow, I see you’re still on pain meds. Most of my patients don’t have to take that. I’m sorry to see that. What’s going on? Can I help you with something different?” notes Atchison. In some cases, he says, patients start to realize they can stop taking opioids.

Bottom line, “if you’re not addressing or at least asking about pain, it could negate everything you’re trying to do for your patients,” says Atchison. If, for example, a patient is in too much pain to be able to use the newly fitted prosthetic device, it doesn’t really matter how well constructed the device is.

And although today’s O&P professionals are challenged with shrinking time and resources, “clinicians and practice owners and managers must be as well rounded as they can,” says Seversky. That means being aware of what’s going on with patients, including their pain and opioid use, and advocating for them as needed.

“It’s no longer about just providing the prosthesis. We will be expected to have great outcomes for our patients moving forward. That’s where health care is going. We will be measured on that outcome.

“And why wouldn’t we want to know about pain management?” he says. “It should be [part of ] an interdisciplinary approach to care. … We’re here to help patients. That’s what we’re trying to do.”

Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com.

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& NOW

THEN

Vendor Contracting Getting paid for O&P services has become much more complex over the years

Then & Now is a monthly department for 2017. As part of AOPA’s centennial celebration, O&P Almanac discusses how the orthotics and prosthetics profession has evolved over the years. This month, we focus on vendor contracting.

W

HEN AOPA OPENED ITS doors

100 years ago, getting paid for orthotic and prosthetic care was a much different undertaking than it is today. The growth of private insurance companies and federal health-care payors has had a significant impact on how O&P facilities are reimbursed for their services.

THEN

Between 1910 and 1915, 32 states enacted workers’ compensation insurance, making it one of the earliest payors impacting O&P providers in the United States. Under these programs, employers accepted full liability for workplace injuries and could buy insurance coverage through their state.

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The Veterans’ Bureau was created

by Congress in 1921, and the Veterans Administration was established in 1930; these agencies were responsible for medical services for war veterans.

When the Great Depression began in October 1929, local hospitals were among those most affected by the turn of events, according to the American College of Healthcare Executives (ACHE’s) “History of Health Insurance in the United States.” In 1933, Blue Cross plans were established, and in 1934, commercial carriers started offering hospital coverage but not physician coverage. Surgical coverage began in 1938 when surgeries were recognized as “definite events.”

Employer-sponsored health insurance plans first became popular as a result of wage controls imposed by the federal government during World War II; they continued to expand in the decades following, says ACHE. Private health insurance grew rapidly during the 1940s and 1950s. Only 9 percent of the population had insurance on the eve of World War II, but that percentage had more than doubled to nearly 23 percent by the end of the war, according to ACHE. It more than doubled again by 1950, and was close to 70 percent by 1960.

The 1960s introduced a gamechanger to the U.S. health-care system with the establishment of Medicare. Prior to 1965, only half of seniors had health-care coverage, and they paid three times as much as younger adults while having lower incomes, according to ACHE. On July 30, 1965, President Lyndon B. Johnson made the legislation to enact Medicare official by signing H.R. 6675 in Independence, Missouri. In 1965, the budget for Medicare was approximately $10 billion, and 19 million individuals signed up for Medicare during its first year. Coverage took effect in 1966, and the program opened access to orthotic and prosthetic care to many Americans who had previously “gone without” due to cost—leading to growth for the O&P profession.

The 1980s saw rapid increases in health insurance premiums, driven by new medical technology and costbased reimbursement systems used by insurers and the Medicare program, reports ACHE. At about the same time, managed care made inroads with the rise of health maintenance organizations, preferred provider organizations, and point-of-service plans. During this time, Medicaid for children and pregnant women also expanded.

In the 1990s, managed care plans began engaging in “selective contracting” by entering into contracts with selected providers in a local market, thereby negotiating lower prices. This led to provider consolidation, with many physicians joining larger medical groups or entering into joint marketing arrangements. These actions “arguably had the effect of reducing competition in local provider markets and reducing the ability of managed care plans to negotiate lower prices,” according to ACHE. Medicare Advantage plans, created under the Balanced Budget Act of 1997, increased health insurance options for people with Medicare. These plans were designed with the intent to better control the rapid growth in Medicare spending, as well as to provide more choices to Medicare beneficiaries.

President Barack Obama signed the Patient Protection and Affordable Care Act at the White House in March 2010.

But many Medicare Advantage plans proved to be more costly than traditional Medicare, according to ACHE. The Affordable Care Act, which took effect in 2010, took steps to align payments to Medicare Advantage plans with the cost of traditional Medicare.

All of these changes have had a significant impact on O&P providers’ compensation. As recently as 20 years ago, “there were more opportunities to negotiate your [insurance contracts], especially with non-Medicare contracts,” says Joyce Perrone, director of business development for De La Torre Orthotics & Prosthetics Inc. in Pennsylvania, and a consultant for PROMISE Consulting Inc. Two decades ago, “you could get a relatively vague prescription from a physician, fill it, and get paid,” she says. This process is no longer that simple.

NOW

Today, the majority of payments to O&P providers are made via contracts through private insurance companies, contracts with managed care organizations, and via Medicare payments.

In addition, physician documentation rules have become more stringent, meaning more work for orthotists and prosthetists—“but the rate we are paid

hasn’t changed very much upward, and in some cases is less,” says Perrone.

“It’s become much more competitive as insurance companies have merged and become larger,” says Joseph McTernan, AOPA’s director of reimbursement services. “The negotiating power of the larger companies forces O&P providers into unfavorable negotiating positions.”

Navigating Medicare has become a complex undertaking, given the more recent emphasis on the Local Coverage Determinations (LCDs) and Policy Guidelines. First and foremost, it’s necessary to follow the rules to get paid, says Teri Kuffel, Esq., vice president of Arise Orthotics & Prosthetics in Minnesota.

Perrone notes that CMS has “gotten stricter and more restrictive with ankle-foot orthoses, knee-anklefoot orthoses, and spinal bracing from the orthotic side and, of course, on the majority of prosthetic devices.”

The prices of prosthetic devices, in particular, have increased significantly as more complex and elaborate componentry has hit the market, “but we’re still using the same codes,” says Perrone. “The devices have changed drastically, but we’re literally using the codes from the last century.”

O&P ALMANAC | NOVEMBER 2017

39

With regard to state Medicaid offices, “establishing and maintaining relationships with key administrators is invaluable to working with state programs,” says Kuffel. For example, in Minnesota, Kuffel and her team “have worked for the past 10 years through three managers to foster a continuous relationship with those that govern O&P policy guidelines and reimbursement schedules.”

pretty clear-cut. You do have to be competitive to get contracts, and you do have to be able to read proposals and respond appropriately with great attention to every detail.”

Kuffel emphasizes the importance of establishing relationships with people at the regional VA offices. “We are registered with the VA, but it’s up to each VA clinic itself to relay to us its process to evaluate, fit, and deliver,” she says.

“You used to have some power to do negotiating, to do some carve-outs, or work with payors on otherwisenot-specified codes [when dealing with private insurers].

You can still do this today, but it’s much more complicated.”

–JOYCE PERRONE

40

NOVEMBER 2017 | O&P ALMANAC

“They all have different people and different layers.”

Many private payors have both open and closed networks—and those with closed networks will allow only a limited number of orthtotists/prosthetists to be included in their plans.

This increases the competition among providers for spots in-network, says McTernan.

With private insurers, “you used to have some power to do negotiating, to do some carve-outs, or work with payors on otherwise-not-specified codes,” says Perrone. “You can still do this today, but it’s much more complicated.”

Another challenge that has evolved with commercial carriers is an increase in the amount of “offload to the patient,” says Perrone. “We have to explain to patients their out-of-pocket expenses,” which are often more costly than patients expect.

In addition, dealing with private payors has become “very impersonal,”

PHOTO: Getty Images/PeopleImages

It also is more challenging to capitalize on opportunities to treat veterans within the U.S. Department of Veterans Affairs (VA). In years past, one national contract for lower-limb prosthetics existed, and many O&P clinicians from various regions were able to win contracts to treat patients.

But 15 years ago, the VA decentralized the process, creating 23 Veterans’ Integrated Service Networks (VISNs).

“Essentially, those VISNs were authorized to draw up individual contracts that only applied to their region,” resulting in some extremely competitive regions, with some O&P clinicians unable to continue contracting, according to McTernan.

While each VA region works differently, Perrone says one of the continuing benefits of VA and government contracts is their clarity. “One of the things I love about Medicare and government contracting is you know where the guardrails are, for the most part,” she explains. “With the VA, it’s

says Kuffel. “For example, I used to have a Rolodex filled with direct contacts for payors whom I could call at the drop of a hat with questions or concerns. Now, many have been replaced with an ‘800 number’ to provider services or a dump email address to generic administrative services,” she says. “It makes the simple task of changing an address exceedingly difficult.”

Success when contracting with payors and ensuring reimbursement now requires a specific skill set, amounting to “at least double, if not more, time and effort” compared to 20 years ago, says Perrone. The staff who work at the front desk and handle billing “must be a lot sharper. You need someone who is extremely organized, who can look up the correct information, look up the deductible and co-insurance amounts across a variety of online systems,” and file all claims appropriately. “We have to do a lot more work now.”

These changes in insurance contracting also have had a significant impact on profitability. “The price of an item is up, but reimbursement hasn’t changed,” Perrone says. “And it takes you more labor to get that reimbursement.”

Kuffel says that success in the current climate requires that O&P facilities “follow the rules and get to the right people.” Doing so will “make things less burdensome as you have changes down the road.” She predicts that O&P facilities will need to learn to navigate the changes that will come with the rise of accountable care organizations (ACOs).

As we move toward the future, Perrone foresees even more constriction with regard to navigating payor systems. “We’re moving toward Medicare conducting preauthorizations with more elaborate prosthetic items,” she says. She also believes the rise of ACOs will lead to a “different, but fully integrative, environment. … We will have to prove in a consistent manner what our outcomes are.

Ultimately, in at least some contracts, we will be paid based on outcomes.”

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BRIDGE TO THE FUTURE: THE INTERVIEWS

Partnering With Hospitals Some O&P facilities should consider forming partnerships with hospitals to succeed in today’s shifting health-care environment

By CHRISTINE UMBRELL

Bridge to the Future: The Interviews is a monthly column for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will look to the next 100 years—by interviewing noted experts in the O&P field to learn their vision for the future of O&P. This month, we speak with Andrew Meyers, CPO, managing partner of AHM Healthcare Strategies and president of Eschen Prosthetic and Orthotic Labs in New York City.

NOVEMBER 2017 | O&P ALMANAC

EALTH-CARE ENTITIES ACROSS

It is a service they need to offer patients and, therefore, they seek strategic relationships with organizations that can provide services. Health care is moving toward a bundled system of payments.”

O&P will not be a major cost in a bundle package or to an accountable care organization (ACO). “But you need to create the relationships with hospitals and institutional networks so they will look to you to satisfy their O&P needs when required. O&P is never going to be a lead; it will have to come from another discipline.

As hospitals are acquiring physician services, they will be controlling the financial chain.

“O&P cannot just wait for business to come to us; we Opportunities have to think about how busiand Obstacles Partnering with hospitals ness will be done in the future.

Andrew Meyers, You have to look at your own may be a necessary next CPO step for O&P facilities in individual environment to some areas where hospidetermine how partnering with a hospital will benefit you,” says tals are seeking to identify a limited Meyers. Ultimately, he believes hospinumber of main providers of O&P services—and a way for O&P providers tals eventually will control a lot more to ensure continued control over their O&P dollars. own destiny, Meyers says.

“We’re seeing more and more “Hospitals want someone else to hospitals looking to outsource O&P manage O&P since it’s such a small and durable medical equipment component of what they provide. The (DME) products and services,” says ones that have their own department Meyers, whose company, Eschen, has have recognized it is not a profit center. an exclusive inpatient contract for

the nation are searching for ways to streamline processes, reduce expenditures, and increase savings—and hospitals are no exception. Many are outsourcing activities to boost profits and are partnering with third parties to open urgent care facilities and surgical ambulatory care centers, notes Andrew Meyers, CPO, managing partner of AHM Healthcare Strategies and president of Eschen Prosthetic and Orthotic Labs. Some hospitals also are looking for ways to partner with ancillary care providers—including orthotic and prosthetic services.

PHOTOS: Getty Images/Christopher Futcher

42

H

O&P services with the Hospital for Special Surgery (HSS) in Manhattan and serves as a preferred provider of outpatient care for the hospital.

As opportunities arise, it’s important to recognize that both O&P facilities and the hospitals must understand how the other operates so that they can move forward with potential partnerships. “This is new territory for some of the hospitals,” says Meyers. These institutions may not understand how O&P is different from DME and even unrelated soft goods such as breast pumps, he notes. Hospitals are trying to find large groups to contract with—and O&P facilities should understand the specific needs of any institution it may work with in the future.

Opportunities exist for O&P to look at partnering with other facilities, or even DME companies, to meet the outsourcing needs of a hospital.

O&P facilities should consider partnering when they need to—or competing, if necessary—to try to establish formal partnerships.

Cultivating Contacts

PHOTO: Getty Images/Paul Burns

O&P facilities that have already established relationships with staff members or physicians at specific hospitals, such as referral sources, may have the best chance of forming more established partnerships with a hospital, according to Meyers. But conducting research to identify the key players within hospitals who make the contracting decisions is critical.

“Every single hospital has an innovation team or an excellence team that is tasked with looking at ways to save money or make money,” says Meyers.

O&P facilities should do their research to find out which staff members have this responsibility to engage them in productive discussions of potential partnership opportunities.

“You can be proactive or reactive,” Meyers adds. “It can be hard to find the right person to talk to at hospitals—a lot of times they don’t want to talk to O&P until it becomes a real need.”

Hospitals may choose to engage in partnerships with O&P facilities in several ways, says Meyers. “Most

hospital contracts are for inpatient services. So if the hospital is responsible for payment, the hospital pays the O&P vendor directly,” he says.

“But we also have some arrangements where a hospital will pay me directly if I can’t get approval for an inpatient quickly enough.” Some contracts are specifically designed for outpatient services.

Regardless of the type of partnership, consulting legal experts should be a central part of the process before any formal relationship is finalized, says Meyers. “O&P companies need to be well-versed and hire health-care attorneys,” he says. “Don’t believe that hospitals know the right way to do it.

Be educated and understand what you legally can and cannot do.” For example, all entities are required to abide by the rules and regulations regarding contractual joint ventures.

All parties also need to understand O&P’s role as a designated health service, he says.

Meyers cautions O&P providers on negotiating the financial aspect of partnerships. “You have to make sure you don’t under-price yourself or put yourself in a position that will not be profitable for your facility. You need to sell your services and the value of your services—timely response to

orders, your professional staff, and quality of the products provided.

Reinforce your part as a component of the rehabilitation team.”

But Meyers also recommends that O&P facilities enter negotiations with their defenses down. Partnerships “need to be a win-win for both sides— you can’t only look for your own win,” or the partnership will not get off the ground.

Testing the Waters

Partnerships will become increasingly important as more money is funneled toward institutions and networks.

“It’s important that we create associations with the right institutions that have the infrastructure to manage health-care dollars,” Meyers says.

Ten years from now, he predicts larger O&P groups and significant regional consolidation. “And more O&P dollars will be controlled by hospitals,” so partnerships will be critical for some O&P facilities.

“There’s a paradigm shift,” says Meyers. “You need to react to it while you can, or you’ll be left behind.”

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

O&P ALMANAC | NOVEMBER 2017

43

THE GLOBAL PROFESSIONAL

Linas Areskevicius Kaunas, Lithuania Chief orthotist at a Northern European facility shares experiences in patient care O&P ALMANAC: Describe a typical

work day for you.

LINAS ARESKEVICIUS: My day as the

In honor of the Second O&P World Congress, held in conjunction with AOPA’s 100th anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a question-and-answer section with international O&P experts.

Each month, we spotlight an O&P professional from a different part of the world to find out how O&P is practiced across the globe.

chief orthotist at Ortho Baltic is usually split into two parts: clinical service and fabrication. Here at Ortho Baltic, we not only serve patients locally but also provide central fabrication services to customers worldwide. So part of my day I see patients and later I am at the workshop where I do both—work on orthoses for my patients and fabricate prepreg carbon orthoses for patients who can be thousands miles away and are treated by the fellow CPOs working at our international partners.

Part of my job is working with our research and development team, developing and testing new designs of prefabricated ankle-foot orthoses (AFOs) from carbon fiber. One of our latest projects is application of 3-D printing technology for custom-made orthoses.

O&P ALMANAC: Describe the location

where you provide services.

ARESKEVICIUS: I mostly see patients

Linas Areskevicius Kaunas, Lithuania

NOVEMBER 2017 | O&P ALMANAC

O&P ALMANAC: What types of

patients do you typically see, and what types of devices do you fit for these patients?

ARESKEVICIUS: I specialize in

custom-made orthoses from prepreg carbon fiber, the majority of them being AFOs and knee-ankle-foot orthoses (KAFOs). Application of carbon fiber in orthopedics also is one of the focus points for our company, and I have fitted our carbon KAFOs for patients coming to us from Japan and Australia. I serve some of the most complicated patients forwarded to me

by Lithuanian orthopedic surgeons and traumatologists.

More than half of our local patients are children with muscular dystrophy, cerebral palsy, spina bifida, and similar conditions. I really like working with children; they are friendly, honest, and full of good emotions despite their disabilities. And it’s so great to observe the improvements while they grow and observe the role that orthoses play in their progress.

Some patients require combined solutions—orthoses with custommade orthopedic shoes. In such cases, I work hand-in-hand with one of my colleagues from the orthopedic shoe department.

PHOTO: Linas Areskevicius

44

in our main facility in Kaunas, the second-largest city in Lithuania. Here we have a team of CPOs, orthopedic shoe technicians, CAD/CAM engineers, and an orthopedic surgeon, which is particularly helpful in more complicated cases. And all my tools are at hand here, be it a 3-D scanner, a gait analysis system, or equipment and materials required for adjustments.

Also, I periodically see patients in local hospitals and rehabilitation centers, as well as in our branch in Vilnius, the capital of Lithuania.

View of Kaunas, Lithuania O&P ALMANAC: How are the devices

you provide paid for?

ARESKEVICIUS: Like most EU [European Union] countries, Lithuania has a compulsory health insurance system, which means that residents are paying health insurance contributions and the state guarantees that health-care services are reimbursed.

For orthopedic products, patients may have to pay a fixed co-payment that can differ in the range of 5 to 20 percent.

O&P companies have to sign annual contracts with the National Health Insurance Fund (NHIF) for the devices they will be providing to the patients. Assistive devices are classified by the disease/type of injury, and the state will cover the fixed cost of the device that meets the given specifications. If the patient would like a more advanced product, such as a carbon-fiber KAFO instead of plastic or a KAFO with an intelligent hinge system, the patient would need to pay for that additionally.

PHOTO: David Iliff/License: CC-BY-SA 3.0

O&P ALMANAC: If the payor is other

than the patient, do nonpatient payors have an audit process? If there is an audit process, do you consider it to be fair?

ARESKEVICIUS: Yes, representatives from NHIF carry out general audits periodically, and they also can request the service history of any particular

product a company has supplied. It is quite a lot of paperwork for us, and surely there is room for improvement, but we consider this process “a must” in order to ensure the proper quality of patient care.

O&P ALMANAC: Describe your edu-

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

ARESKEVICIUS: I got my CPO certifi-

cation in Lithuania after four years of studies with two years of internship.

Since 2002, when I started at Ortho Baltic, I have specialized in orthoses, with the majority of them being from prepreg carbon fiber.

To keep track of the new developments, we are constantly in connection with the manufacturers of orthotic components and attend their education courses.

Another great resource is international congresses and trade fairs, where we usually have a booth as well.

Last but not least is the experience I have with our international partners worldwide. We brainstorm and exchange our ideas on what would work best for particular patients or sometimes even come up with a technical solution of a required function in a way that we have not seen before.

O&P ALMANAC: What’s the biggest

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

ARESKEVICIUS: One of the biggest

challenges is dealing with patients’ preconceptions about any particular product or functional solution. This is a particular challenge with children—for example, when parents rely on a doctor’s recommendation, from a doctor who may not always be up-todate with the latest possibilities, or they were referred to us by happy parents whose child has a similar problem and [for whom we] provided a solution that worked well. Even if the problem looks similar, there are a number of important factors to take into account, and it requires quite a bit of patience at that time “to prove” why the proposed solution is actually best for their child. But this quickly transforms to satisfaction when the patient comes back and you see that the efforts have paid off in full.

O&P ALMANAC: Describe any charitable

work you or your organization does.

ARESKEVICIUS: “Talk less. Do more.”

That’s our company motto in this regard as well. We have long-term cooperation with a local charity fund for children with orthopedic problems.

There are a number of projects going on, like consulting or inviting wellknown specialists in specific areas to make sure these kids are treated using the most modern techniques. One of the biggest international projects for our company was participation in a charity mission to the Ukraine in 2015.

O&P ALMANAC | NOVEMBER 2017

45

MEMBER SPOTLIGHT

ARTech Laboratory Inc.

By DEBORAH CONN

Full Coverage Texas company offers lifelike cosmetic prostheses and coverings

A

RTECH LABORATORY MAKES CUSTOMIZED

46

NOVEMBER 2017 | O&P ALMANAC

Preparing for the toenails and painting

COMPANY: ARTech Laboratory Inc. OWNER: Mike Holt LOCATION: Midlothian, Texas HISTORY: 22 years

Sculpting a hand

“The prosthetist meets with the patient and makes a positive mold of the injured member on the sound side, takes photos, and matches the skin tone to a color chart we provide,” he explains.

“Our artists sculpt the prosthesis using the sound side member as a model. Our techs create a mold and we use silicone to create the final product.”

At any given time, ARTech has between 40 and 50 prostheses somewhere in the manufacturing process, which takes about six weeks. The company makes prostheses or covers for nearly every part of the body, from full and partial nose and ear reconstructions to lifelike covers for hands, arms, legs, feet, and toes. However, upper-extremity prostheses, including fingers and partial hands, seem to dominate their business.

“We’ll make a glove with prosthetic fingers for the missing digits and holes for the sound fingers to slip through,” says Holt.

ARTech is deeply involved in the community, offering

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

PHOTOS: ARTech Laboratory Inc.

upper- and lower-extremity cosmetic prostheses and prosthetic covers. Each product is hand made to match the patient’s skin tone and sound limb.

The company’s origin story is a familiar one, at least for technology startups. Mike Holt and his late brother, Dale, started the company in Mike’s garage in 1995. Dale had been working at another prosthetic fabrication company and realized he had a talent for biomechanical sculpting. When he and Mike decided to go out on their own, they spent a couple of weeks in the garage creating silicone prosthetic covers—Dale sculpting and Mike tinting and adding fingernails and toenails.

“After that, we turned a woodshop behind my house into a lab, and then we got so busy we had to hire some university art students to work part time—and then full time once they graduated,” says Mike Holt. The company continued to expand and eventually purchased a former doctor’s office, where Holt and 12 employees have been located for the past 14 years. His brother, Dale, passed away about a year ago.

Dale’s son, Chris, is a mold maker for ARTech, and Mike’s wife, Diana, is the office manager, while his daughter, Cori, is one of the company’s artists.

Holt says he and his team work as extensions of the prosthetist.

“They send us all the information we need, we make the product, and we send it back to them.

discounts on pediatric prostheses for patients at local children’s hospitals, including Shriner’s Hospital for Children and the Texas Scottish Rite Hospital in nearby Dallas. “Scottish Rite patients can actually come here for the final tinting,” says Holt.

“Kids sit there while we paint their prosthesis. It’s something to see their expression when it’s finished and it seems like part of their own body.”

The company also works with local prosthetists who take part in mission work in South America, donating their services to produce prostheses and covers.

Most of ARTech’s business is handled remotely; only about 10 to 15 percent of patients come to the lab. After attending an international convention a few years ago, Holt and his team now work with prosthetists in Africa, South America, and the Middle East in addition to those throughout North America.

Holt prefers to promote his services to prosthetists in person, so trade conventions are ARTech’s primary means of marketing. The company also runs occasional ads in magazines.

“When my brother first described what this business was, I couldn’t envision it,” recalls Holt. “He said it was one of the most rewarding things he ever did. He was right. When we take a piece of rubber and make it come alive in front of a patient, it’s incredible.”

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MEMBER SPOTLIGHT

E&G Prosthetics & Orthotics

World Traveler New O&P facility owner journeyed from New York to Greece and back again

V

ASILIOS (BILL) KEHAGIAS, CPO, completed a long

journey to become the owner of an O&P facility—a journey that encompassed some family history, three countries, lots of studying, and the pursuit of a dream.

Vasilios’s father, Konstantinos (Gus) Kehagias, is a Greek immigrant who founded a custommolded shoe and orthotic insert business in Brooklyn in 1982.

The shop, E&G Custom Molded Shoes, was named after Gus and his wife, Elefteria. When Gus retired in 1992, he and his family— including a young Vasilios, his sister, and his brother—moved back to Greece. After living in New York for 16 years, Vasilios says the adjustment was difficult.

He attended school, where the language spoken and written was predominantly Greek, but with guidance from his mother, Vasilios learned how to speak, read, and write the language fluently.

Vasilios (Bill) Kehagias, CPO

FACILITY: E&G Prosthetics & Orthotics OWNER: Vasilios (Bill) Kehagias, CPO LOCATIONS: Queens, New York

The original E&G Custom Molded Shoes in Brooklyn in the 1980s (left) and the new E&G Prosthetics & Orthotics in Queens today

48

NOVEMBER 2017 | O&P ALMANAC

time to launch a new practice.”

Kehagias worked for East Coast Orthotics & Prosthetics for just over a year, and then opened E&G Prosthetics & Orthotics in the Astoria neighborhood of Queens, New York, in 2016. In keeping with tradition, he decided to keep the E&G name to honor his parents.

“At first it was terrible,” says Kehagias. “There was a delay getting my Medicare number and we struggled to stay afloat.”

But once his number came through, business followed, and he feels his facility has achieved sound footing.

E&G’s facility features a waiting area, a patient room, and a small room with a bench for assembly and minor adjustments. A full basement gives E&G space for a lab, which Vasilios is setting up for in-house fabrication of basic O&P components, custom orthotic shoe inserts, and custom laminations.

E&G provides a full range of O&P services, including diabetic, ankle-foot, knee-ankle-foot, and knee orthoses. The facility fits a lot of upper-extremity orthoses, including elbow and wrist devices and spinal orthoses.

A large proportion of E&G’s orthotic mix is cranial helmets, followed by ankle-foot orthoses and custom shoe inserts. In terms of prosthetics, E&G offers lower- and upperextremity devices ranging from partial-foot to shoulderdisarticulation prostheses.

It’s a little soon to be looking at future plans, says Kehagias, but he knows he wants to stay in Queens and keep it local. He and Kathy have two young daughters, so it’s not impossible that his family business will continue for another generation. “But we have a long way to go,” he says.

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

PHOTOS: E&G Prosthetics & Orthotics

Vasilios attended college, earned a master’s degree in physics, and decided to pursue a career in O&P. He earned a four-year bachelor’s degree in prosthetics and orthotics at the University of Salford in the United Kingdom, completing his residency in Manchester

HISTORY: One year

and Dublin. Armed with his new credentials, Vasilios returned to Greece to open an O&P facility with his father and his brother, Takis Kehagias. But the timing couldn’t have been worse, as the Greek economy imploded in 2008. Four years later, Vasilios decided to return to New York City.

To gain his American credentials, he completed another residency with Arimed Prosthetics & Orthotics in Brooklyn and became an ABC-certified prosthetist/orthotist. His journey to certification had another benefit, Kehagias says. “While I was studying and taking exams, I met the love of my life, Kathy.

“It was always my plan to open my own facility,” he says, “but we had gotten married and we were about to have our second child, so it wasn’t a great

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Sign up for the half-year series and get three sessions FREE! This includes two bonus webinars added for Health-Care Compliance & Ethics Week Nov. 5-11. All webinars that you missed will be sent as a recording. Register at bit.ly/2017billing.

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NOVEMBER 2017 | O&P ALMANAC

AOPA NEWS

NOW AVAILABLE:

2017 Operating Performance Report AOPA Releases Results From Member Benchmarking Survey Are you curious about how your O&P business is performing compared to others? Have you been asking questions like these: • How does our spending on materials, advertising, or other expenses compare with other companies similar to ours?

• Is our gross margin better or worse than other facilities of the same size?

• Are our employees generating enough sales?

Copies of the 2017 Operating Performance Report are now available. The annual report provides a comprehensive financial profile of the O&P industry, including balance sheet, income statement, and payor information organized by total revenue size, community size, and profitability. This year’s data was submitted by more than 88 patient-care companies representing 350 full-time facilities and 77 part-time facilities.

Copies of the 2017 Operating Performance Report are available electronically or print in AOPA’s bookstore: • 2017 Operating Performance Report (Electronic)— Member/Nonmember: $185/$325

Make Your First Impressions Count

NE

W

!

With Customized Polo shirts, Scrub tops and Lab Coats for your O&P staff

Create an attractive business image, promote your brand, and foster team spirit with AOPA’s new Apparel Program.

To order your apparel, go to

iconscrubs.com

AOPA Polo Shirts–Now for Sale

Celebrate AOPA’s Centennial with us by ordering AOPA polo shirts for your office! The shirts are black with a white AOPA logo. Moisture wick, 100 percent polyester. Rib knit collar, hemmed sleeves, and side vents. The polos are unisex but the sizes are men’s M-2XXL. $25 plus shipping. Order in the bookstore.

Enter access code: ICON-AOPA Enter your AOPA member id Create your user profile AOPA is partnering with Encompass Group, a leading provider of health care apparel, to offer members special prices on customized polos, scrub tops, and lab coats.

POLO TS SHIR

B SCRU TOPS

LAB COAT

O&P ALMANAC | NOVEMBER 2017

51

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 publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

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

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

Apex Foot Health Industries 414 Alfred Avenue Teaneck, NJ 07666 Member Type: Supplier Affiliate Orthotic Holdings OHI 800/252-2739

Campbell County Health 508 Stocktrail Gilette, WY 82716 Member Type: Patient-Care Company 337/688-8000

Cranial Technologies Inc. 1500 S. Dobson Road, Ste. 315 Mesa, AZ 85202 Member Type: Patient-Care Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 480/610-4553 Cranial Technologies Inc. 6055 Rockside Woods Blvd., Ste. 170 Independence, OH 44131 Member Type: Patient-Care Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 216/524-1839 Cranial Technologies Inc. 4030 Smith Road, Ste. 105 Cincinnati, OH 45209 Member Type: Patient-Care Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 513/631-0330

Cranial Technologies Inc. 10907 Memorial Hermann Drive, Ste. 410 Pearland, TX 77584 Member Type: Patient-Care Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 713/340-3217 Cranial Technologies Inc. 4244 Riverwalk Pkwy., Ste. 180 Riverside, CA 92505 Member Type: Patient-Care Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 480/403-6392 Cranial Technologies Inc. 1600 N. Randall Road, Ste. 145 Elgin, IL 60123 Member Type: Patient-Care Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 480/403-6392

ADVERTISERS INDEX

Company

Website

ALPS South LLC

5

800/574-5426

Amfit

37

800/356-3668 www.amfit.com

Amputee Coalition

C3

800/267-5669

www.amputee-coalition.org

ComfortFit Orthotic Labs Inc.

33

888/523-1600

www.comfortfitlabs.com

Coyote Design

7

800/819-5980

www.coyotedesign.com

Custom Composite

27

866/273-2230

www.cc-mfg.com

Hersco Ottobock

52

Page Phone

1 C4

www.easyliner.com

800/301-8275 www.hersco.com 800/328-4058 www.professionals.ottobockus.com

Spinal Technology Inc.

9

800/253-7868

www.spinaltech.com

Touch Bionics

19

855/694-5462

www.touchbionics.com

NOVEMBER 2017 | O&P ALMANAC

NEW RELEASE!

How Does Your Business Measure Up? Use AOPA’s Benchmarking Survey Results to Find

YOUR COMANY’S SCORECARD based on 2016 data:

BENCHMARKING: the process of comparing one’s business processes and performance metrics to industry bests.

Performa

COMPANY REPORT A VALUABLE RESOURCE FOR BUSINESSES IN THE O&P INDUSTRY

erated Sales Gen e ye lo p m Per E oods Sold

Cost of G

tion &

Compensa Benefits

AOPA Products & Services

OPERATING PERFORMANCE

For Orthotic, Prosthetic & Pedorthic Professionals AOPA PRODUCTS

COMPANY REPORT A VALUABLE RESOURCE FOR BUSINESSES IN THE O&P INDUSTRY

REPORT

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

BENEFITS REPORT AOPA COMPENSATION AND

AOPA

Good

rgin

AOPA PRODUCTS

AM ERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Best

ork Needs W

Gross Ma

C SCORE

ARD

: nce Area

Fair

2017

(Reporting on 2016 Results)

2017

PUBLICATIONS. EDUCATION. SERVICES. Everything you need to manage a successful patient care facility.

2017 Annual Operating Performance Report

2017 Operating Performance Report member/nonmember $185/$325

and

2017 Compensation and Benefits Report member/nonmember $185/$325

2017 Bi-annual Compensation and Benefits Report

ORD

E

DAY O T R

To order, visit www.aopanetonline.org/store. For more information contact bleppin@aopanet.org or call 571-431-0810.

MARKETPLACE

Feature your product or service in Marketplace.

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

Visit bit.ly/almanac17 for advertising options.

ALPS Extreme AK/BK Gel Liner Designed with the end user in mind, the Extreme liner is the perfect fit for transfemoral and active transtibial patients. Offered in 3-mm and 6-mm uniform thickness, the Extreme offers 80 percent less vertical stretch than our other gel liners, and allows for more control and stability during increased activity. This liner also is formulated with both our ALPS GripGel and our all new HD Gel; these gels contain properties that help facilitate donning as well as reduce pistoning and bunching behind the knee.

For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com.

Custom carbon-fiber foot orthotics—and boy, are they pretty.

And strong. And lightweight. Trusted to protect the feet of our service members, this beauty goes more than skin deep. Fabrication available from foam boxes or Amfit digital files in two rigidities (firm or flex).

Corrections and adjustments are molded into the carbon fiber to eliminate movement of pads and edges during wear. EVA heel counter maintains stability in the shoe or boot.

Contact our customer service team to learn more today, orders@amfit.com or 800/356-FOOT(3668), x250.

Foam Box Lab Services for Diabetic, EVA, and Rigid Orthotics FootPrinter allows you to send your own boxes or use ours. Standard EVA orders manufactured in three to four business days; diabetic A5513, carbon fiber, and polypro in three to five days.

PDAC-approved A5513 diabetic pricing includes shipping costs for bi-lam and tri-lam styles. EVA available in soft, medium, dual, firm, and cork blend. Carbon-fiber fabrication offered in flex or firm to best suit your patient. Milled polypropylene available in three widths and thicknesses for excellent fit and wear.

Get started right away by emailing orders@amfit.com for an account form, or call 800/356-FOOT. 54

NOVEMBER 2017 | O&P ALMANAC

Coyote Composite Basalt Fiber is tough yet flexible. Ideal for anklefoot orthoses and prosthetics.

• Costs less than carbon fiber • Less itch than carbon fiber • Tough, durable, and lightweight • Edges finish smooth.

Learn more at www.coyotedesign.com.

Coyote Design Adhesives We now have two glues to choose from: • Coyote Quick Adhesive— 30-second set time.

• Coyote Smooth Adhesive— New 60-second set time option.

COYOTE ADHESIVES Quick Adhesive Quick Set Time

NEW GLUE!!!

Custom Stealth Foot Orthotics

Coyote Composite Basalt Fiber

Smooth Adhesive Longer Work Time

Coyote’s glues are great for attaching componentry and multiple repairing uses. They ship nonhazardous and are safe with no odor.

Learn more at www.coyotedesign.com.

CureVentions’ Pectus emBrace™ CureVentions’ Pectus emBrace™, invented

by Joseph S. Pongratz, CPO, FAAOP, is designed exclusively for the treatment of pectus carinatum. The device works through implementing pressure gradients with Dynamic Force Plate technology to provide corrective compression over the pectus prominence. The Pectus emBrace™ was built with patient comfort in mind and promotes a new and more effective method of treating pectus carinatum.

• 100 percent nonmetal components • Moisture-wicking KoolFlex™ fabric • Patent-pending Dynamic Force Plate • Latex-free and nonslip pads • Magnetic BOA™ closure for easy-on/easy-off • Allows 20+ hours of wearing time • Discreet low-profile design.

For more information, call 480/897-2207 or visit www.cureventions.com/pectus-embrace.

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

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

Ottobock’s ProFlex™ Plus Sealing Sleeve Countdown to flexibility for you and your patients with Ottobock’s ProFlex™ Plus Sealing Sleeve • Three colors and sizes • Two lengths • #1 choice.

ProFlex Sleeves—delivering proven performance for the last 10 years.

This soft, yet tough, sealing sleeve is designed with a more flexible fabric and smoother proximal seam. It features 15 degrees of flexion for easier bending and less bunching behind the knee; a preformed knee cap for lower stress on the patella; and a conical shape proximal for improved thigh fit and tighter distal shape for enhanced sealing on socket.

Check out professionals.ottobockus.com for details.

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

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

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

Introducing New Titanium Digits for All i-limb® Hands!

• New titanium material increases the maximum carry load at the proximal segment by 50 percent • Titanium material improves the protection of the motor from impact forces • Titanium digits add 1 oz of weight to the i-limb hand • Available for i-limb™ quantum, revolution, ultra, and access hands—sizes S/M/L. Contact us to learn more! Call Touch Bionics at 855/MYiLimb or visit www.touchbionics.com.

2017 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HealthCare Common Procedure Coding System (HCPCS) code changes with an array of 2017 AOPA coding products. Ensure each member of your staff has a 2017 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

O&P ALMANAC | NOVEMBER 2017

55

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific

CPO, CO, CP, and CPed

Job location key:

Chino and Temecula, California

- 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.

We are a growing well-established, privately owned, multioffice, ABC-accredited O&P corporation providing services in Southern California looking to add to our team.

We are currently looking for experienced CPO, CO, CP, and CPed clinicians who will support the company’s vision, mission, and values and provide premier prosthetic and orthotic patient care. Employment opportunities for practitioners currently in Chino and Temecula. Candidates must be energetic and motivated individuals who possess strong clinical, technical, and interpersonal interaction skills. They also must be patient oriented and innovative, and desire a long-term career with a growing company. A rewarding place to take the next step in establishing a great career and make a difference. We offer competitive salaries and benefits. Salaries are commensurate with experience. Local ABC-accredited practitioners preferred. Send résumé to:

Human Resources Fax: 951/734-1538 Email: careers@inlandlimbandbrace.com

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

Member $482 $634

Nonmember $678 $830

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

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

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

Job Board

Member Nonmember $85 $150

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

SUBSCRIBE

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

56

NOVEMBER 2017 | O&P ALMANAC

Inter-Mountain: For Sale

Small Community O&P Business for Sale

Mid Texas CPO working about 16 hours per week desires sale of seven-year-old P&O practice in small mid-Texas city.

Approximately 100,000 people live in primary market area (city and surrounding communities). 188-bed regional medical hospital with 53+ physicians and 600 employees in community as well as a stand-alone day surgery center managed by a large community hospital in another city.

1,700-square-foot facility with one year left on a three-year lease renting for $700/month. Using OPIE medical office management software. Could be a good satellite office or start-up practice for young practitioner. Gross billings are $180,000 to $220,000 per year with net cash income of $150,000 to $175,000. Multiple up-side potential possibilities for increasing sales including myoelectric upper-limb and microprocessor lower-limb services as well as hightech orthotic services. Very reasonable price and terms.

For more information, email info@aopanet.org and reference “November ad—Texas practice.”

CALENDAR

2017

November 9

November 5-11

Health-Care Compliance & Ethics Week 2017.

AOPA is celebrating Health-Care Compliance & Ethics Week and is providing resources to help members celebrate.

November 6-7

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

Phoenix. Sheraton Grand Phoenix, 340 N. Third Street, Phoenix.

Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

November 6-11

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 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

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

November 20

Inaugural Gavin Scoliosis Program Certification Course. SERC at the North American Spine Society Headquarters, 7075 Veterans Blvd., Burr Ridge, IL 60527.

Convenient housing next door at the Spring Hill Suite, Marriott. ABC credits available.

• Learn how to get in brace corrections appropriate to curve types.

• Learn how to maintain balance.

• Learn proper follow-up and how that affects outcomes.

Contact GSP@gavinorthoticsconsulting.com.

ABC: Practitioner Residency Completion Deadline for January Written & Written Simulation Certification Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency.

Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Let us

your next event!

Free Online Training

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

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

Questions? Email landerson@AOPAnet.org.

Calendar Rates

58

Teaching Professionalism and Ethics During Residency.

For more information, email Ryan Gleeson at rgleeson@ AOPAnet.org.

Apply Anytime!

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

SHARE

November 10

December 1

November 8

www.bocusa.org

“Three Amigos” of a Compliance Program— Compliance Officer, Legal, and Human Resources— Can Work Together To Support and Advance an Effective Compliance Program. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

CREDITS

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

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

NOVEMBER 2017 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR January 19-20

December 7-9

Shirley Ryan AbilityLab: Elaine Owen—Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management.

Chicago. 25.5 ABC credits. For more information, contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/education.

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

January 26-27

December 13

New Codes and Other Updates for 2018.

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

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

February 23-24

2018

PrimeFare Central Regional Scientific Symposium 2018.

Renaissance Hotel, Tulsa, OK. Contact Cathie Pruitt, 901/359-3936, email primecarepruitt@gmail.com; or Jane Edwards, 888/388-5243, email jledwards88@att.net; or visit www.primecareop.com.

January 5-7

AOPA Leadership Conference. The Breakers, Palm Beach, FL. Top executives at each AOPA member company are invited to this exclusive event.

Contact landerson@AOPAnet.org for more information.

April 26-28

New York State Chapter Annual Meeting (NYSAAOP).

Rivers Casino & Resort, Schenectady, NY 12308.

For more information, visit www.NYSAAOP.org

January 8-13

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assisants and technicians in 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

September 26-29

AOPA National Assembly. Vancouver Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0876 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

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: Revised 10/17/17 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 938, Purcellville, VA 20132. 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 2017 Avg. No. Copies Each Issue During Preceding 12 Months 15. Extent and Nature of Circulation: a. Total number of Copies (Net Press Run) b. Paid and/or Requested Circulation

(1) Paid or Requested Outside-County Mail Subscriptions

(2) Paid In-County Subscriptions

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

Counter Sales, and other non-USPS Paid Distribution

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

(1) Outside-County as Stated on Form 3541

(2) In-County as Stated on Form 3541

(3) Other Classes Mailed through the USPS e. Free Distribution Outside the Mail f. Total Free Distribution g. Total Distribution h. Copies Not Distributed i. Total (Sum of 15g and h) Percent Paid and/or Requested Circulation

Actual No. Copies of Single Issue Published Nearest to Filing Date

12,861

15,193

12,213 0 43

11,813 0 44

0 12,257

0 11,857

0 0 7 490 496 12,753 108 12,861 96%

0 0 7 3,327 3,334 15,191 2 15,193 78%

O&P ALMANAC | NOVEMBER 2017

59

ASK AOPA CALENDAR

PDAC Policies Which items require coding verification by the Pricing, Data Analysis, and Coding contractor?

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

Do all spinal orthoses require a PDAC coding verification in order to be billed to Medicare?

Q/

No, not all spinal orthoses are subject to verification.

However, a large majority of lumbosacral orthoses and thoracolumbosacral orthoses do require a PDAC coding verification. These include prefabricated spinal orthoses described by codes L0450, L0454-L0472, L0488-L0492, L0625-L0628, L0630, L0631, L0633, L0635, L0637, and L0639, as well as any custom-fabricated spinal orthoses fabricated by a central fabrication facility or manufacturer described by codes L0452, L0480-L0486, L0629, L0632, L0634, L0636, L0638, and L0640.

A/

collar described by code L0174 , a double-upright knee orthosis described by code L1845, a multiligamentous support described by code L1906, and an endoskeletal ankle-foot or ankle system described by code L5969 all require a PDAC coding verification.

Functional electric stimulators (E0770) and compression wraps (A6545) also require a PDAC coding verification in order to be billed to Medicare.

If I custom fabricate an item (for example, A5513 or L0629) in my own facility and don’t order it from someone else, is it required that my product be reviewed and approved by the PDAC?

Q/

If you fabricate a custom device in your own facility and provide it directly to the patient, you are not required to have your item verified by the PDAC. However, you must be able to provide a list of materials used and a description of your fabrication process if requested.

A/

Are manufacturers required to have their items reviewed and verified by the Pricing, Data Analysis, and Coding (PDAC) contractor?

Q/

No, manufacturers are not required to have their items verified by the PDAC unless a specific Medicare policy or coding directive requires that those items be verified.

Once an item has been reviewed and verified by the PDAC, the coding determination is binding for any and all Medicare claims. In addition, a PDAC coding verification will typically be both product- and model-specific, and may not apply to all model variations.

A/

60

NOVEMBER 2017 | O&P ALMANAC

If an item requires PDAC verification and the product I wish to provide has not been reviewed and approved by the PDAC, how do I bill Medicare for the item?

Q/

Aside from spinal orthoses and diabetic inserts, are there any other orthotic or prosthetic devices that require PDAC coding verification in order to be billed to Medicare?

Q/

Yes, there are a few additional O&P products that require a PDAC coding verification. A cervical

A/

The answer depends on the specific Medicare medical policy or PDAC coding guidelines announcement that required the item to be verified and listed on the PDAC website. Typically, you would have to use code A9270 (noncovered item or service).

A/

amp Sean’s story is an example of a successful fight for access to prosthetic care.

If you and your patients are experiencing Insurance challenges, visit AmplifyYourself.org to tell insurance executives and legislators that no is not an answer.

The Amplify initiative is turning up the volume to make sure everyone has access to the care that they need.

Sean told his insurance company that “No” was not an answer. Read his story at AmplifyYourself.org and share yours today.

14309 - 09/17 ©2017 Ottobock HealthCare, LP, All rights reserved.

3R67™ knee joint for children Exceptional support for active children

Whether chasing a ball, playing tag, or being the first to the ice cream truck—children test their limits and want to match the capabilities of their peers. To provide young explorers with the best support for achieving a more active lifestyle, we have equipped the 3R67 knee joint for children with a large flexion angle, hydraulic swing phase control for different walking speeds, and a robust design. professionals.ottobockus.com