Breaking News: FDA Releases Final Rule on Unique Device Identifiers Page 8
OP
The American Orthotic & Prosthetic Association
OCTOBER 2013
&
WWW.AOPAnet.ORG
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
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SENIORS ORTHOTIC CARE Clinical data can help practitioners boost awareness and better serve patients
Prosthetists as COUNSELORS MEDICARE POLICY for AFOs and KAFOs
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O&P OCTOBER 2013, VOLUME 62, No. 10
CONTENTS Cover Story
18 Elevating Orthotic Care for Seniors
By Jill Culora As baby boomers continue to age, 20 percent of Americans will be 65 or older, which will lead to increasing numbers of age-related pathologies and musculoskeletal deformities. New clinical data can help practitioners provide better orthotic care for this population and boost awareness among primary-care physicians.
Feature
24
Beyond the Limb By Christine Umbrell Practitioners embrace their roles as health-care providers when they go beyond treating the physical aspect of an amputation to ensure their patients’ emotional needs are being met. Offering resources on mental health education and peer support groups can be an important aspect of O&P patient care.
departments
4
AOPA Contact Page How to reach staff
6
At a Glance Statistics and O&P data
08 COLUMNS
14
28
40 Marketplace 42 Jobs
Opportunities for O&P professionals
In the News Research, updates, and company announcements
44 Calendar
AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
47
Ad Index
48
AOPA Answers Expert answers to your FAQs
Reimbursement Page Reviewing Medicare policy for AFOs and KAFOs
30
Facility Spotlight Rehabilitation Institute of Indianapolis
38 AOPA Membership 00 Applications
Upcoming meetings and events
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.
OCTOBER 2013 O&P Almanac
3
AOPA IN THE Contact NEWS INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org EXECUTIVE OFFICES
MEMBERSHIP & Meetings
BOARD oF DIRECTORS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Officers
directors
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA
Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org
President Tom Kirk, PhD, Member of Hanger Inc. Board Austin, TX
O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org Lia K. Dangelico, contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com
Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org Betty Leppin, Project Manager, 571/431-0876, bleppin@AOPAnet.org AOPA Bookstore: 571/431-0865 Government affairs Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org
President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX
Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Ă–ssur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT Eileen Levis, Orthologix, LLC, Trevose, PA
Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO
Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL
Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA
Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
Scott Schneider, Ottobock, Minneapolis, MN
James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI
O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales M.J. Mrvica Associates Inc. Design & Production Marinoff Design LLC Printing Dartmouth Printing Company
Copyright 2013 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
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O&P Almanac OCTOBER 2013
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AT IN THE A GLANCE NEWS
The Facts on Falls As baby boomers age, O&P practitioners will spend more time treating senior patients with fractures caused by falls.
Rate of nonfatal, medically consulted fall injury episodes by age: Age
Rate per 1,000
11 or younger
42
12-17 18-44 45-64 65-74
61 26 43 55
75 or older
115
Source: “Summary Health Statistics for the U.S. Population,” Centers for Disease Control and Prevention.
1in 3
Number of seniors age 65 and older who fall each year.
20% to 30% Percentage of those who fall who suffer moderate to severe injuries.
2.4 million Number of nonfatal injuries caused by falls among older adults treated in emergency departments each year.
More than
33%
Percentage of nonfatal injuries caused by falls that are fractures.
4 times
Rate at which hip fractures are expected to multiply by 2050.
95%
Percentage of hip fractures caused by falls.
Sources: Amputee Coalition; International Osteoporosis Foundation; “Falls Among Older Adults: An Overview,” Centers for Disease Control and Prevention. 6
O&P Almanac OCTOBER 2013
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IN THE NEWS BREAKING NEWS…BREAKING NEWS…BREAKING NEWS…BREAKING NEWS…BREAKING NEWS…BREAKING NEWS…BREAKING NEWS…
FDA Releases Final Rule on Unique Device Identifiers The Food and Drug Administration (FDA) has released the final rule that establishes the requirement for Unique Device Identifiers (UDIs) on most medical devices. The final rule will be implemented in stages over the next seven years. According to the FDA, the purpose of the UDI is as follows: • Reduce medical errors • Simplify integration of device use information into data systems • Provide more rapid identification of medical devices with adverse events • Provide for more rapid development of solutions to reported problems • Provide for more rapid and efficient resolution of device recalls • Facilitate better focused and more effective FDA safety communications. The final rule, which was released September 24, follows the release of the proposed rule by the FDA on July 10, 2012. At that time, AOPA provided specific comments supporting the proposed exemption of Class I devices from the Good
Manufacturing Practice requirements of 21 CFR 820, the Quality Systems Regulation. At a glance, it appears this exemption has been retained in the final rule. AOPA’s comments can be found at http://bit.ly/170YXEc. The UDI final rule also solidifies AOPA’s successful argument that only the FDA can require product labeling and that other agencies do not have the statutory authority to require specific product labeling. This issue came to the forefront last year when AOPA successfully challenged the proposed Pricing, Coding Analysis, and Coding requirement for product labeling of custom ankle-foot orthoses. AOPA will perform a complete analysis of the provisions of the final rule, including any potential exemptions for O&P devices, and will provide a complete report on the potential impact to O&P manufacturers and providers in the near future. The complete UDI final rule may be downloaded at www.gpo.gov/fdsys/pkg/FR-2013-09-24/pdf/2013-23059.pdf. Contact Joe McTernan, jmcternan@aopanet.org, or Devon Bernard, dbernard@aopanet.org, with questions regarding the final rule.
Research subject Zac Vawter wearing the bionic leg.
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O&P Almanac OCTOBER 2013
A prototype motorized prosthetic leg controlled by nerves in the thigh of an amputee has been developed by scientists at the Rehabilitation Institute of Chicago (RIC). Lead researcher Levi Hargrove says the device allows amputees “to seamlessly transition between walking along level ground and going up and down stairs and slopes.” The prototype has software and electrodes that translate small electrical signals in the leg muscles into more intuitive natural movements. The leg comprises mechanical sensors, two motors, complex software, and a set of electrodes in its socket. The electrodes pick up signals from the hamstring muscle, and other electrodes pick up signals from muscles in the residual limbs. The computer combines this information, along with data about the leg’s position and movement, to infer how the amputee wants to move. The prototype was funded by an $8 million grant from the U.S. Army’s Telemedicine and Advanced Technology Research Center. A full report of the development can be found in the September 26 issue of New England Journal of Medicine.
Photo: Rehabilitation Institute of Chicago
RIC Develops First Thought-Controlled Prosthetic Leg
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IN THE NEWS
CDC Announces Threat Levels for Superbugs
Must Watch: Amputee Soldiers Test Prosthetic Feet The University of South Florida (USF) has released a YouTube video that demonstrates its ongoing Department of Defense-funded study testing prosthetic feet. Wounded soldiers are working with researchers at USF’s School of Physical Therapy and Rehabilitation Services to test different types of high-end lower-limb devices. Twenty-eight physically fit individuals are participating in the study: 14 are soldiers and veterans who wear below-knee prostheses, and 14 are non-amputees from the local law enforcement SWAT team (the control group). During the spring months of 2013, the military amputees were evaluated both in the lab and at the Hillsborough County Sheriff’s Office training facility wearing each of three different high-tech prostheses. They performed tasks such as climbing ropes, slalom running, jumping, crawling, and dodging. USF researchers, led by Jason Highsmith, PhD, DPT, FAAOP, compared the physical performance of both groups, with the aim of identifying which prosthesis may perform closest to an anatomic foot, and which may be bestsuited for military applications. In addition, participants were asked to rate each of the devices. While the research is focused on military amputees, the findings also may benefit civilian amputees with challenging jobs or recreational pursuits. Results are expected to be released later this year. Watch Army Staff Sgt. Brian Beem participate in the study at www.youtube. com/watch?v=0OyPBSPn7B8, or go to YouTube and search “Wounded Warriors + Highsmith.”
TRANSITIONS
BUSINESSES in the news
The American Board for Certification in Orthotics, Prosthetics, and Pedorthics celebrated its 65th anniversary in September. Visit www.abcop.org/about/Pages/ ABC65thAnniversary.aspx for anniversary highlights.
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O&P Almanac OCTOBER 2013
PEL Central Fabrication has become ProLab Central Fab. The change follows the sale of PEL Supply Company to PEL LLC. The new fabrication company will continue to be an independently owned and operated business entity.
The Centers for Disease Control and Prevention (CDC) has released a 114-page report titled “Antibiotic Resistance Threats in the United States, 2013.” Each year, more than 2 million people contract antibiotic-resistant infections, and 23,000 die from those infections. “Antimicrobial resistance is one of our most serious health threats. Infections from resistant bacteria are now too common, and some pathogens have even become resistant to multiple types or classes of antibiotics,” says CDC Director Tom Frieden, MD, MPh. The report categorizes drug-resistant superbugs for the first time. To assist health-care providers and the general public in understanding the various threat levels of certain bacteria, the CDC has prioritized bacteria into levels of concern: “urgent,” “serious,” and “concerning.” According to the CDC, the following bacteria are “urgent”: CRE bacteria (carbapenem-resistant enterobateriaceae), C-Diff (clostridium difficile), and nesseria gonorrhoeae. Many of these antibiotic-resistant infections are spread in hospital settings. The nation will face “potentially catastrophic consequences” if it doesn’t act quickly to combat these infections, according to the CDC. For more information on how O&P practitioners can reduce the risk of spreading superbugs, see “Rise of the Superbug” in the May 2013 issue of the O&P Almanac. For a copy of the full CDC report, visit www.cdc.gov/ drugresistance/threat-report-2013/.
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IN THE NEWS
Congressmen Introduce Medicare ‘Incredible Bionic Man’ Debuts Orthotics and Prosthetics October 20 Improvement Act of 2013 The bipartisan Medicare Orthotics and Prosthetics Improvement Act of 2013 (HR 3112) was introduced in September by Rep. Glenn Thompson (R-Pennsylvania) and Rep. Mike Thompson (D-California). The legislation would prohibit the Centers for Medicare and Medicaid Services (CMS) from making any payments for orthotics or prosthetics to a provider who is not appropriately licensed or certified. These reforms would ensure that only qualified O&P practitioners will be paid for serving Medicare beneficiaries. “Keeping fraudulent providers out of the Medicare program will save money and help make sure that high-quality care is provided,” says Glenn Thompson. “This bill will strengthen Medicare benefits for O&P beneficiaries by reducing fraud and abuse, improving health-care quality, and reducing Medicare spending.” “When unlicensed and unaccredited providers deliver prosthetic and orthotic services, both Medicare beneficiaries and the American taxpayer are shortchanged,” adds Glenn Thompson. “Despite previous congressional mandates, not enough has been done to ensure that legitimate and licensed practitioners are providing these items and services.” Though the Benefits and Protection Act of 2000 mandated that a “practitioner” or “supplier” had to be certified in order to be paid for certain O&P services under Medicare, CMS has not enforced these provisions, resulting in fraudulent payments and leaving Medicare patients vulnerable to substandard care.
TRANSITIONS
people in the news
Scheck & Siress has announced several hirings throughout the Chicago area: • Michael Cavanaugh, CPO, has joined the Lincoln Park office. • Jessica Gissal is the company’s new marketing manager. • Thomas O’Doherty, CP, has joined the Lincoln Park office. • Catherine Pospisil, CO/LO, has joined the Schaumburg office. • Alex Trumper, CPO/LPO, is the new laboratory manager at the Scheck & Siress Rush University Medical Center location. • Jason Wening, CPO/LPO, MS, FAAOP, is the new laboratory manager at the Lincoln Park location.
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O&P Almanac OCTOBER 2013
The Smithsonian Channel will feature the documentary “Incredible Bionic Man” on Sunday, October 20, at 8 p.m. EST. This two-hour special, which originally aired in the United Kingdom, demonstrates how a bionic man—comprised of artificial body parts designed by scientists around the world—was built by robotocists Richard Walker and Matthew Godden from Shadow Robot. The Bionic Man is made from advanced prosthetic arms and legs and artificial organs, and features a silicone face, with a total price tag of approximately $1 million. Though the robot does not possess a nervous system or brain to make the artificial parts work, they can be controlled remotely via computer and specially designed interfacing hardware. A Bluetooth connection is used to operate the prosthetic limbs. a
Jon Sigurdsson, CEO of Össur, was named one of the 20 greatest business thinkers in the Nordics by Nordic Business Report. Ottobock has hired Andreas Kannenberg, PhD, as executive medical director, North America. Hans Georg Näder, president and CEO of Ottobock, received the Honorary Lifetime Achievement Award at the 2013 AOPA World Congress.
IN MEMORIAM Ivan Long, CP(E), passed away August 6. Long manufactured and fit artificial limbs in Denver for 23 years, and then moved his business to Arvada, Colorado, for the next 24 years. Long is credited with developing the ischial containment socket around 1980, when he combined plug socket and quadrilateral socket designs to create a new socket, with the goal of stabilizing the pelvis and femur by controlling the ischium and the femur. His limb design was eventually referred to as “Normal Shape-Normal Alignment” above-knee prosthetic design.
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Reimbursement Page By Joe McTernan, AOPA government affairs department
AFOs and KAFOs: Next in the Medicare Spotlight? The key to reimbursement for these devices begins with a thorough understanding of Medicare policy
S
ince the release of the Health and Human Services Office of the Inspector General report on Medicare payments for lower-limb prostheses in August of 2011 and the subsequent publication of the “Dear Physician” letter by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC), a tremendous amount of time and effort has been invested by the O&P community addressing the increased Medicare audit activity on claims for lower-limb prostheses. Recent events, however, may train the spotlight on a different segment of the O&P world, namely anklefoot orthoses (AFOs) and knee-ankle-foot orthoses An ankle-foot orthosis secured in a tennis shoe. (KAFOs). In July of 2013, Noridian Healthcare Solutions, the Medicare contractor that processes Durable Medical The Policy Is the Key Equipment Prosthetics, Orthotics, and Supplies The Local Coverage Determination (LCD) and claims for Jurisdiction D, published the second Policy Article that govern coverage for AFOs and quarter results for its ongoing prepayment review KAFOs is available for review and download on of claims for AFOs described by L1960. Of the 225 each of the DME MAC websites. While AOPA claims reviewed, 221 were denied, representing an may not agree with every provision of the policy overall error rate of 99 percent. While this denial and continues to communicate with the DME rate is certainly alarming by itself, further analysis MACs when it believes something should be revealed that almost 30 percent of the claims were changed or worded differently, the fact is that, in denied due to lack of detailed documentation in general, the policy clearly outlines the coverage the physician’s medical record that supported the criteria that must be met in order for claims for medical need for a custom-fabricated orthosis rather AFOs and KAFOs to be paid. Here we will focus than a prefabricated orthosis. It is painfully obvious on a review of that policy. While most of the that physician documentation, or lack thereof, is now major points will be covered, it is important that being used to make payment decisions for more than you regularly review the policy as it changes just lower-limb prostheses. The question that must be frequently. A revision history is included at the asked is how can O&P practices protect themselves end of both the LCD and Policy Article that from unnecessary claim denials for legitimate, provides chronological information regarding medically necessary services? changes made to the policy.
14
O&P Almanac OCTOBER 2013
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The first section of the AFO/KAFO LCD addresses coverage of AFOs that are not used during ambulation. The only nonambulatory AFOs that are eligible for coverage are those described by L4396, and they are only covered when they are being used to treat a non-fixed ankle contracture or plantar fasciitis. When being used to treat contracture, the following four specific coverage criteria must be met: 1. The patient has plantar flexion contracture of the ankle (ICD-9 diagnosis code 718.47) with dorsiflexion on passive range of motion testing of at least 10 degrees (i.e., a non-fixed contracture). 2. The practitioner has reasonable expectation that the device can correct the contracture. 3. The contracture is interfering or expected to interfere significantly with the beneficiary’s functional abilities.
4. The device is used as a component of a therapy program, which includes active stretching of the involved muscles and/or tendons.
Documentation of knee instability alone does not meet the coverage criteria for an AFO. All four criteria must be met and documented in the patient’s medical record in order for Medicare to cover an AFO used to treat contracture. The LCD goes on to indicate that a maximum of one replacement soft interface described by L4392 may be covered every six months. When a static AFO is used to treat plantar
Reimbursement Page
fasciitis, the only policy requirement is that documentation supports the diagnosis. The next section of the LCD addresses AFOs and KAFOs used during ambulation. The LCD states that AFOs are covered for ambulatory patients with “weakness or deformity of the foot and ankle, who require stabilization for medical reasons, and have the potential to benefit functionally.” It then goes on to state that “KAFOs are covered for ambulatory patients for whom an AFO is covered and for whom additional knee stability is required.” It is extremely important that the patient’s medical records, including those of the referring physician, contain documentation of the specific medical condition that is causing the weakness or deformity of the foot and ankle for which the AFO or KAFO has been prescribed.
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Reimbursement Page
For KAFOs, the documentation must not only reflect ankle and foot instability but also document additional instability at the knee warranting a KAFO. Documentation of knee instability alone does not meet the coverage criteria for an AFO. The patient must first qualify for an AFO and then have additional, documented instability at the knee.
The Policy Article states that AFOs and KAFOs are covered under the Medicare Braces benefit category and therefore must meet the definition of a brace to be covered.
adjustable torsion-style mechanisms. While this type of joint is eligible for coverage when used to assist joint function in AFOs and KAFOs for ambulatory patients, it must be billed as L2999. When these joints are used for contracture management, they are covered under the DME benefit and may only be billed using the appropriate “E” codes, which are typically only reimbursed as rental items. The LCD then addresses the standard prescription and proof of delivery requirements that exist for all Medicare-covered services. Finally, the LCD reiterates that if a custom AFO or KAFO is provided, there must be detailed documentation in the physician’s records that supports a custom-fabricated orthosis rather than a prefabricated orthosis.
The Policy Article The next section of the LCD describes the specific criteria that must be documented in the medical record in order for a custom-fabricated or molded-to-patient model AFO or KAFO. One of the following criteria must be well documented: • The beneficiary could not be fit with a prefabricated AFO. • The condition necessitating the orthosis is expected to be permanent or of longstanding duration (more than six months). • There is a need to control the knee, ankle, or foot in more than one plane. • The beneficiary has a documented neurological, circulatory, or orthopedic status that requires custom fabricating over a model to prevent tissue injury. • The beneficiary has a healing fracture that lacks normal anatomical integrity or anthropometric proportions. While only one of these criteria must exist, failure to properly document its existence may result in an unnecessary claim denial. The next section of the LCD addresses the use of concentric
16
O&P Almanac OCTOBER 2013
An often overlooked but very important component of the medical policy for AFOs and KAFOs is the Policy Article. Unlike the LCD, which addresses issues concerning medical necessity, the Policy Article provides important definitions and information regarding situations where an AFO or KAFO is statutorily non-covered. The Policy Article states that AFOs and KAFOs are covered under the Medicare Braces benefit category and therefore must meet the definition of a brace to be covered. This definition
is recorded as “a rigid or semi-rigid device which is used for the purpose of supporting a weak or deformed body member or restricting motion in a diseased or injured part of the body. It must provide support and counterforce on the limb or body part that it is being used to brace.” Devices that do not meet the requirements of this definition are statutorily non-covered, meaning there is simply no benefit available. An example of this situation that is addressed in the Policy Article is AFOs that are used solely to prevent or treat a pressure ulcer. Since these devices do not meet the statutory definition of a brace, they cannot be covered as one regardless of their effectiveness in treating the ulcer. The Policy Article provides clear definitions of prefabricated orthoses, custom-fabricated orthoses, and several specific codes for base AFOs and addition codes. It is important to review and understand these definitions when making decisions on how to properly code the services you are providing to Medicare patients. The key to not only receiving reimbursement for AFOs and KAFOs but preventing overpayment notices and recoupment down the road begins with a thorough understanding of the Medicare policy governing their coverage. Though we covered some of the important components of the policy, a regular review of the policy remains in your best interest. a Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@ aopanet.org.
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O&P Almanac OCTOBER 2013
COVER STORY By JILL CULORA
Elevating Orthotic Care for Seniors CLINICAL DATA CAN HELP PRACTITIONERS IMPROVE CARE AND INCREASE AWARENESS
As
baby boomers continue to age, it makes sense that orthotic and prosthetic practitioners could see an increase in age-related pathologies and musculoskeletal dysfunction arriving at their clinics. But this shift is not a sure bet, as a lack of knowledge at the primarycare level about orthotic services could hold back referrals. The U.S. Census Bureau estimates that by the year 2030, 20 percent of the U.S. population will be aged 65 and older. And while people traditionally aren’t referred for orthotic and prosthetic care simply because of their age, there are a number of ways the O&P community can work with primary care providers and physical therapists to address age-related deficits in patients. Increased
awareness for prospective patients and primary care providers is crucial. “The elderly are seeing their primary care doctors, their internal doctors, their gerontologists, and I’m not sure they are necessarily aware of the all the services that orthotists and prosthetists can provide,” says Chris Robinson, CPO, FAAOP, ATC, MBA, director of orthotics education and assistant professor of physical medicine & rehabilitation at Northwestern University in Evanston, Illinois. “Orthotists and prosthetists have historically looked at orthopedists and rehabilitation doctors as being their primary referral sources, but with the baby boomers aging, primary care and gerontology will see considerably more conditions that are in the scope of practice for orthotists and prosthetists.”
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Addressing the Diagnosis Elderly patients can have a variety of conditions—some of which also can affect younger populations, such as stroke, diabetes, and trauma. However, this older demographic also can have age-related declines that affect somatosensory and vestibular systems, and it can be difficult to pinpoint the problem’s source. Perhaps one of the most common and perplexing elderly patient complaints is poor balance, which is a critical factor in elderly patient falls. “[Falls] could be attributed to several things. It could be a vestibular issue; it could have something to do with their balance mechanisms in their head. It could be an issue with neuropathy where they have problems with the sensation in their feet, the intrinsic muscles in their foot, and their autonomic nervous system,” says Robinson. Identifying the true cause of the deficit is key. “We address the diagnosis more than we address the demographic,” says Phillip Stevens, CPO, MEd, FAAOP, prosthetist/
Photo: Alexander Aruin
For his balance research, Alexander Aruin, PhD, created this custom AFO using commercially available AFOs cut into two parts.
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orthotist with Hanger Clinic in Murry, Utah. “I’m more concerned with the underlining diagnosis—be it multiple sclerosis, stroke, incomplete spinal cord injury—than I am in the demographic, per se.” As uncertain as the deficit cause may be, a lack of product research, particularly regarding a flood of new ankle-foot orthoses (AFOs), makes devising treatment plans more complex. But despite the dearth of clinical evidence, Robinson suggests that practitioners harness their personal experience and apply the best available data: “There is a fair amount of evidence to support that AFOs have demonstrable benefit in patients with stroke and other pathologies that affect seniors. From a clinical standpoint, [I and] many of my colleagues… have had clients who articulated demonstrable improvements to their quality of life and fewer falls.” But there is not a large body of data being compiled by using appropriate outcome measures, says Robinson. Clinicians owe it to themselves, their patients, and the profession, to try to quantify and choose an appropriate goal to measure. For example, clinicians can measure balance pre-AFO and post-AFO and make ongoing assessments to inform their patients’ treatment plans.
Looking to Orthotic Research Despite the absence of product trails and documentation, a significant number of research studies have explored the benefits of AFOs and other orthoses to serve a growing senior population. Widespread dissemination of this information can help bridge the gap of care between primary-care physicians (PCPs) and orthotists. Balance confidence: Angelika N. Zissimopoulos, PhD, biomedical engineering researcher at Northwestern University, studied the self-efficacy effects of AFOs in stroke patients suffering from balance issues to determine that balance confidence improved with AFO use. “[An] anklefoot orthosis may improve walking speed, stride length, and gait pattern; however, the effects on balance, crucial for safe ambulation, are thus inconclusive,” reports Zissimopoulos’ study, “The Effect of Ankle-Foot Orthosis on Self-Reported Balance Confidence in Persons with Chronic Post-Stroke Hemiplegia.” Researchers used the Activities-specific Balance Confidence (ABC) scale to measure balance confidence in 15 participants with chronic post-stroke hemiplegia, with and without their regular AFO. Results showed ABC scores significantly higher with AFO use than without it.
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These diagrams demonstrate how researchers at the University of Illinois used a specially designed AFO to study balance in lower limbs.
Balance with loss of sensation in lower limbs: Alexander Aruin, PhD, DSc, professor of physical therapy and bioengineering at the University of Illinois in Chicago, studied somatosensory cues above the ankle in patients with peripheral neuropathy to determine enhanced postural control. In this study, “Auxiliary Sensory Cues Improve Automatic Postural Responses in Individuals with Diabetic Neuropathy,” researchers observed 12 patients with diabetic neuropathy in static and dynamic balance tests with and without auxiliary sensory cues provided to the lower limbs, but without stabilizing the ankle joint. This was achieved using a specially designed AFO, which was made using commercially available AFOs cut into two parts—the foot bed piece and the shank of the brace—and connected with a spring-like element. “So there was no physical stabilization of the ankle joint, but the results of the study demonstrated that the device was able to provide auxiliary sensory information to the tissues above the ankle joint,” says Aruin. “We demonstrated
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that by using this redesigned AFO. Individuals with peripheral neuropathy improved their ability to react to sudden platform movements.” Osteoarthritis of the knee: Seema Malvankar, researcher at the University College London Medical School, conducted a review of research into the effectiveness of using lateral wedge orthotics in treating patients with medial knee osteoarthritis. The paper, “How Effective Are Lateral Wedge Orthotics in Treating Medial Compartment Osteoarthritis of the Knee? A Systematic Review of the Recent Literature,” notes: “Lateral wedges were originally proposed to manage medial compartment osteoarthritis of the knee, but recent reviews suggest that lateral wedges do not affect disease progression.” Malvankar reports that not enough evidence exists to prove that lateral wedge orthotics are an effective treatment for osteoarthritis of the knee, but there is evidence to suggest they do have some symptomatic effect. “Patients with early osteoarthritis and higher BMI
Image: Alexander Aruin
may benefit to a greater extent than those with a greater extent of degenerative changes and lower BMI.” Plantar heel pain: Daniel Bonanno, BPod, PGDipResMeth, health sciences researcher at LaTrobe University in Victoria, Australia, studied 36 patients with heel pain, aged 65 and older, to determine that a contoured prefabricated in-shoe foot orthosis was the most effective at reducing pressure under the heel. Compared with three other inserts—silicon heel cup, soft foam heel pad, and a heel lift—the prefabricated foot orthosis achieved a fivefold pain reduction compared to the next most effective insert. “The contoured nature of the prefabricated foot orthosis allowed for an increase in the midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure,” reports the study, “Pressure-Relieving Properties of Various Shoe Inserts in Older People with Plantar Heel Pain.”
“Decisions about surgical interventions for highenergy injuries of the foot and ankle should be based primarily on the injury pattern and not solely on the age of the patient.” –DOLFI Herscovici JR., DO
Foot injuries in active seniors: Dolfi Herscovici Jr., DO, orthopedic surgeon with the Florida Orthopaedic Institute in Tampa, examined 494 elderly patients with 536 foot and ankle injuries to conclude that “decisions about surgical interventions for high-energy injuries of the foot and ankle should be based primarily on the injury pattern and not solely on the age of the patient.” Herscovici observes that today’s senior population
is in better health, has more mobility, and lives a more active lifestyle than aged populations in the past. “Given high physical demands, both through an occupation and/or from their recreational activities, it is expected that high-energy injuries of the foot and ankle in elderly individuals will also occur,” reports the study, “Management of High-Energy Foot and Ankle Injuries in the Geriatric Population.” Herscovici cites earlier papers that found surgical treatments afforded to younger patients, especially in the foot and ankle, may be withheld for seniors simply because of an age bias. His research found patients presented with high-energy injuries to the foot or ankle had similar mechanisms of injury to younger patients.
Improving Access In the past decade, the number of off-the-shelf low-profile carbon fiber AFOs has grown exponentially, providing practitioners with a much broader range of options for all clients, but especially senior citizens. “I’m quicker to reach for these devices than I am the bulkier custom devices for this population because if I can get them something that they can don independently, that will fit in their existing footwear, they are more likely to wear it,” says Stevens. An important consideration for treating geriatric patients, who typically can have reduced flexibility and often live alone, is how viable the device is for day-to-day use. “If I create a device that addresses all these biomechanical deficits, but if the patient can’t independently don it, or can’t fit a shoe over the top of it, then I’ve really failed to help them. So a lot of times with this population, I will go with simpler, lower profile devices that
may not be as aggressive in addressing their biomechanical deficits, but are more realistic in terms of the patient managing the day-to-day realities of that device,” he says. Several senior citizen-specific devices have entered the market but may fail to address a specific deficit, says Stevens. “I think what is happening is a diabetic patient is referred to a podiatrist for wound management or toe management or other foot issues, and as part of that assessment they detect a balance challenge and maybe some of them are reaching for [a balance brace]. So they are being caught at that level, but I don’t think they are being referred to clinical orthotists.” Pathways to care remains an issue as University of Florida researcher Jason Kahle, MSMS, CPO, FAAOP, points out in his paper “Barriers Limiting the Geriatric Client from Accessing Orthotic Care.” There is no
single formalized path leading to the orthotist, his paper reports. “In essence, a patient who could benefit from an orthosis may see several practitioners before meeting their orthotist. Therefore, it is not clear at what point the need for an external device will be recognized.” This gap presents an opening for the O&P community to educate PCPs, gerontologists, and internal medicine doctors. But getting access to PCPs is an issue. “It’s tough because you are talking about a small percentage of their clients that are going to be CVAs (cerebral vascular accident) geriatrics… and then you talk about what percentage of those geriatrics would benefit from orthotic or prosthetic care, and so let’s say it’s 5 or 10 percent of their clients, so getting them to care is the first thing,” says Kahle. Organizing in-services is one option that could be run in collaboration with a hospital group or a continuing medical education organization. Simple communication is a must, adds Robinson. Orthotists and prosthetists must make PCPs aware of the skill sets and tools that O&P has to offer to better serve patients of all ages. “But I think the easiest way to get it out there is to work with the physical therapy and occupational therapy communities,” says Kahle. “I think most physicians are savvy enough to say, ‘Well, this person might benefit from physical therapy,’ and once the patient is with the physical therapist or occupational therapist, they can then reach out to an orthotist. It comes full circle back to the physician to write the prescription and supervise that care. So it’s us keeping in touch with physical and occupational therapists—this is the most important step.” a Jill Culora is a contributing writer to O&P Almanac. Reach her at jillculora@ gmail.com.
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By Christine Umbrell
Beyond the Limb Practitioners embrace mental health education, tools to help amputees cope
Scott Cummings, PT, CPO, FAAOP, interacts with a patient during a well-being assessment. Photo: Next Step Bionics and Prosthetics
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O&P Almanac OCTOBER 2013
D
avid McGill, vice president, legal and reimbursement, for Össur Americas, has both a professional and a personal interest in seeing patients get the physical and emotional care they need to deal with limb loss. “Seventeen years ago when I lost my leg, the only mechanism for emotional support was support groups—but I’m not a support group kind of guy,” recalls McGill, who survived a near-fatal car crash in 1996. The types of questions he had as a new amputee “were outside the scope of my prosthetist.” While he was able to get through the recovery and rehabilitation stages without outside support, he doesn’t describe it as an optimal experience. “When you’re struggling with the changes that limb loss brings you, having the ability to locate appropriate mental support that can provide feedback and education you can use” can be a game-changer in terms of adapting to life as an amputee, says McGill. By offering a diverse array of resources to assist both introverted and extroverted patients, practitioners can better serve the physical and emotional needs of every patient.
The Physical-Emotional Connection Just as devices have evolved over the years, so too has the recognition that patient care goes well beyond providing an artificial limb. “We think our job as prosthetists is to make patients a prosthesis—but, really, our job is to solve their problem,” says Paul Armstrong, MS, CP, area clinic manager for Hanger Clinic in Vernon, Connecticut. “We help them gain control of their life back, which goes beyond prosthetics.” Learning to properly and professionally communicate with patients who are having trouble coping is a challenging but important aspect of the profession.
Many practitioners agree that emotional well-being and prosthesis acceptance and use are interconnected: “They’re closely linked,” says Scott Cummings, PT, CPO, FAAOP, of Next Step Bionics and Prosthetics in Manchester, New Hampshire. “We see people who are terrific candidates [for prostheses]—who are physically capable—but if they don’t have their head in the game, they won’t maximize their potential.” Part of the prosthetist’s job today is involvement not only in the clinical aspect of providing a device, but also the “emotional and psychological health of the patient to the best of a clinician’s abilities based on training and available resources,” says Jay Tew, CP, area clinic manager for Hanger Clinic. All of the engineering and computer enhancements in prosthetic limbs over the past 20 years “can’t address how people with limb loss feel about their body, self-image, and well-being,” says Tew. “If a person cannot accept what has happened to them and understand what a prosthetic device can and cannot do for them, the prosthetist and the patient can never really launch from that first step to maximum functionality.” Tew believes an amputation to be as much a psychological event as a physical one, and working through grief is a part of the process. “Limb loss invokes the same grieving process as losing a child, spouse, or someone very close to you. Amputees who get through the stages of acceptance, and even learn to have fun with their prosthesis, seem to do better physically as well as psychologically in their new life with limb loss.”
Lending an Ear For the most part, prosthetists remain on the sidelines as patients work through the grieving process and embrace using prostheses to regain control of their lives. But as practitioners assist with a patient’s physical recovery, they may also contribute to that individual’s emotional recovery by listening when that patient wants to talk, and by sharing helpful information with individuals who may be struggling. For example, Armstrong suggests engaging in “active listening.” Because prosthetists rarely know their patients before they lose their limbs, he recommends asking questions to learn about their abilities and activities in addition to fitting their prosthesis. “I ask them, ‘Are you working?’ ‘Are you dating?’ ‘What activities are you doing?’” he explains. “It’s important to engage them to find out how things are really going.” And if a practitioner identifies a patient who may be in need of additional emotional support, providing a list of peer support groups or professionally trained resources is a logical next step. “It’s not our job to be a counselor, but it is our job to recognize whether our patients are on the right track,” says Armstrong.
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Pointing Patients in the Right Direction
Teaching ‘People Skills’ to O&P Students Introducing O&P students to the emotional side of treating amputees will lead to a better-prepared practitioner base in the coming years. Some O&P educators have already found ways to incorporate “people skills” into coursework. At the University of Hartford, Paul Armstrong, MS, CP, teaches a course on transtibial prosthetics. Toward the end of the semester, Armstrong invites patient volunteers into the classroom and allows students to ask the amputees questions, with no limitation on the types of questions. In this way, the students learn about what it’s like to be an amputee from individuals who are willing to speak bluntly and honestly about their experiences. These discussions educate the students on the importance of peer advocacy groups and patient education within an O&P treatment plan. “Among the amputees who come in to talk to the students, all agree that the moment the light at the end of the tunnel appeared”—the moment when the patient knew life as an amputee would be OK—“was when they met other amputees.” “People skills are hard to teach,” adds Armstrong. “We work in a very rewarding field, but recognizing the challenges that some patients have is something some of the students don’t think about. What we do goes beyond prosthetics.” Thus, the student interactions with amputees during the transtibial amputation course serve as a great introduction to patient care.
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Recognizing when a patient may benefit from additional guidance is essential to ensuring that patient’s long-term success. But not all prosthetists know when or how to provide such information. To address this problem, the Amputee Coalition has partnered with Johns Hopkins University School of Medicine to create the “Improving Emotional Well-Being for Persons with Limb Loss Program.” “Many prosthetists are not adequately trained to be providing psychological care, but we notice a large psychological component with amputee care, which to date has not been addressed adequately,” explains Cummings, who is one of the prosthetists participating in the program. The effort, which began in 2012 and is partially funded by grants from Össur Americas and Hanger Clinics, was inspired by research conducted by Stephen T. Wegener, PhD, associate professor of physical medicine and rehabilitation and director, division of rehabilitation psychology and neuropsychology, at Johns Hopkins. A few years ago, Wegener led a study on the rate of depression among people with limb loss. Results indicated that 30 percent of participants experienced some symptoms of depression after an amputation. Wegener points out the good news in this finding: “It recognizes that most people are very resilient—70 percent did not experience depressive effects.” For the 30 percent of amputees who do suffer from these symptoms, “a large percentage do not access services to get the help they need,” says Wegener. Thus, the Well-Being Program was born with the goal of identifying limb-loss patients experiencing depressive symptoms or negative feelings and offering them the necessary resources. The Amputee Coalition recruited prosthetists who were willing to participate, and began by equipping them with the tools and training to identify such patients.
Practitioners from five facilities (Bulow BioTech, Dankmeyer Inc., Maryland O&P, Next Step O&P, and Wright and Filippis) participated in Phase 1 of the Well-Being Program, according to George Gondo, director of research and grants for the Amputee Coalition. Practitioners at those facilities were given a “well-being screening tool”—a questionnaire composed of existing, validated tools in the public domain that assess an individual’s risk of depression and satisfaction with life. Practitioners offer the questionnaire to patients who opt in to the project. After answering the questions and tallying their “scores,” patients are given a copy of a “wellbeing resource guide”—customized to the O&P facility’s location—that directs them to convenient, local mental health support, as well as support groups and area clergy. Phase 2 of the project began in September with a wider dissemination of the effort. The second phase adds resource support staff, and some of the participating facilities are collecting data to demonstrate program efficacy in the hopes of funding a large-scale clinical trial.
Applying Lessons Learned to O&P Patient Care One of the surprising findings during Phase 1 of the Emotional Well-Being Program was that appearances can be deceiving. Practitioners were often surprised by the scores of patients who self-administered questionnaires to evaluate their risk of depression. “There’s no particular pattern in who will have higher scores for success and who will need more support to prevent depression,” notes Gondo. “On the assessments, some of the patients that practitioners thought were doing OK actually scored lower and needed more support, and some patients they were worried about scored higher,” he explains. “Some of the patients were even surprised with their scores.” Such findings underscore the need for all practitioners to offer a list of resources,
such as peer support groups, and counselors, to all patients—regardless of how they appear to be coping. Long-term goals for the Well-Being Program include adding more facilities to the list of participants. Over time, “Hanger is committed to implementing the program nationally across the other Hanger Clinic locations,” says Vinit Asar, Hanger Inc.’s president and CEO. In addition, Gondo and Wegener hope the effort leads to increased education on this topic at prosthetic schools. “We would like to develop a curriculum on emotional wellbeing to add into the master’s degree curriculum,” says Gondo (see sidebar, Teaching ‘People Skills’ to O&P Students). Prosthetists who are not currently participating in the effort may still benefit from collecting information from area mental health supports and local peer support groups to offer to patients. In addition, all practitioners are invited to learn more about the training the Amputee Coalition is conducting on this topic. “You don’t have to be in the study to learn the training,” says Wegener. “For practitioners, an emotional wellness program allows them to provide resources that their patients want,” emphasizes McGill. “It just adds to the toolkit of resources to help patients with their recovery.”
Working Toward a Common Goal Prosthetists are bound to encounter patients who may be in need of emotional healing in addition to physical treatment. This responsibility should never be taken lightly. Cummings recommends that practitioners be more alert to the emotional needs of patients. “Understand how the psychological/emotional component reflects their ability to rehabilitate. Really pay attention and recognize the relationship between physical and mental.” And Wegener encourages prosthetists to start conversations with their patients about their emotional frame of mind. “Our initial studies showed us patients feel very comfortable talking to prosthetists about these types of issues,” he says. “Practitioners shouldn’t be concerned that bringing up the subject of emotional adaptation will offend patients—patients don’t view this topic as inappropriate. “Don’t be afraid to embrace a broader health-care role—recognizing your limitations since you’re not a psychologist,” he adds. “Learn to point your patients in the right direction.” a Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@strattonpublishing.com.
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Facility Spotlight By Deborah Conn
Caring for Indy
A sturdy family business finds success in embracing new and old technologies
A Left to right: James E. Goff Sr., CP; a patient; and James E. Goff Jr., CP.
Facility: Rehabilitation Institute of Indianapolis Location: Indianapolis, Indiana, and a satellite office in Terre Haute Owner: James E. Goff Jr., CP History: 22 years in business
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fter becoming a below-knee amputee in the Vietnam War, James E. Goff, CP, decided to create prostheses as well as wear one. He worked as a prosthetist for 20 years and in 1991 opened his own practice, the Rehabilitation Institute of Indianapolis. Goff took on a partner, David Bokma, CPO, a fellow amputee, in 1993. Bokma died in 2010, and today, Goff’s son, James E. Goff Jr., owns the facility, where his father continues to work on a part-time basis. “I doubt that he’ll ever really retire,” says Goff Jr. “He likes what he does, and now I’ve taken away the administrative stress.” The Rehabilitation Institute of Indianapolis owns its own building, a 5,500-square-foot facility on the north side of the city. After a recent renovation, the building includes two measuring rooms, one set up specifically for computer-aided design and manufacturing. One of two walking
rooms features microprocessor computers for knee fittings, and another has a ramp and stairs for gait training and diagnostic activities. Clinicians see patients in two consultation rooms, one of which is primarily devoted to upper-extremity cases, and the remainder of the facility includes a 2,000-square-foot fabrication area and four administrative offices. The practice opened a satellite office in Terre Haute, Indiana, in September 2012. Clinicians spend one day a week at that office, which is open by appointment. The building comprises about 2,000 square feet and includes a multipurpose patient room with examination tables and walking bars, a lobby area, and a shop for adjusting and fine-tuning devices. In addition to the two Goffs, the Rehabilitation Institute of Indianapolis has a certified prosthetic assistant, Jeffrey Hartley, who has worked with the elder Goff since 1985. In addition
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Facility Spotlight
James Goff Jr. fitting a patient.
Photos: Rehabilitation Institute of Indianapolis
Jeffrey Hartley in the facility’s fabrication shop.
James Goff Jr. in Africa.
to seeing patients, the clinicians, along with a staff technician, fabricate everything but hip disarticulation sockets on site. Two administrative staffers handle appointments and billing, and the practice has just welcomed a new resident, Samantha DeVries, from Northwestern University. The facility prides itself on its ability to work with older devices as well as embrace new technology. “We’ve been doing CAD since early 2011 and it transformed our practice, made us far more efficient,” says James Goff Jr. “It was just amazing.” Yet, recently, Goff Jr. was just as willing to fabricate an old-fashioned exoskeletal leg for a Honduran woman. “It was basically a wooden knee with lamination over the exterior. It’s hard to get components for them anymore, but we do the best we can. Some older patients don’t want to change what they’ve been using for years, and we have the knowledge and capabilities to work with them.” Unlike many facilities, the Rehabilitation Institute of Indianapolis
Intern Samantha in Africa.
handles a relatively large number of upper-extremity cases. “Years ago, Dad worked extensively with the Indiana Hand to Shoulder Center, writing training materials,” explains Goff Jr. “So we continue to get a lot of referrals from them. We also do a considerable amount of work with the VA.” The institute also does upperextremity work with infants. “We’re probably the only facility in Indy that participates in the upper-limb clinic at Riley Children’s Hospital [part of Indiana University],” says Goff Jr. “We see around three infants a year, beginning when they’re about six months old, and help them with crawling and getting their balance, getting used to wearing a prosthesis.” The Rehabilitation Institute of Indianapolis established and funds a nonprofit organization called New Life with Limbs, which provides prostheses to war victims overseas. Goff Jr., DeVries, and a patient who
James Goff Jr. fits a patient in Sierra Leone, Africa.
wears a below-elbow prosthesis travelled to Sierra Leone last year and made 18 prostheses for amputees there, including low-cost, rapid-fit upperlimb devices developed by engineers at the University of Illinois. Goff Jr. is planning a return trip in January and a mission to Haiti in February. He is uncertain if either of his children, a 21-year-old daughter and a 16-year-old son, will want to follow him into the family business. Nevertheless, Goff Jr. is still an active force in developing the next generation of practitioners. As part of a local university program, he regularly talks with local high school students about pursuing a career in prosthetics. a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net.
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AOPA HEADLINES
AOPA WORKING FOR YOU
How Do You Stack Up? AOPA releases the results of its latest compensation and benefits report
G
etting the compensation program right in your O&P business is the key to attracting and retaining the best possible talent. AOPA’s bi-annual “Compensation & Benefits Report” is one of the best measurement tools to make sure you are on track. The 2013 report is based on 2012 data with responses from 98 patient-care companies operating 1,011 full-time locations and 62 part-time facilities. More than 20 percent of the respondents generated up to $1 million in annual revenue; 34 percent recorded $1 to $2 million; 28 percent generated $2 to $5 million; and 16 percent recorded more than $5 million. Annual revenue for a mediansized facility was $1.7 million—meaning 50 percent generated more than that and 50 percent generated less—but the average size when dividing number of companies by total dollars for all respondents registered $4.3 million.
In the 2011 survey findings, the non-owner practitioner count per facility was 37 percent of the mix compared with 29 percent in the 2013 survey. The number of employees at each facility tracked with revenue ranges, with 14 percent of facilities employing five or fewer employees; 30 percent employing five to 10; 32 percent employing 10 to 20; and 24 percent employing more than 20 employees.
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Administrative/office and marketing employees were the largest segment at 38 percent of the number of employees in the typical facility; owner/ practitioners were 3 percent of the mix; non-owner practitioners were 29 percent; technicians were 12 percent; non-clinical owners/managers were 3 percent; practitioners/assistants/extenders were 2 percent; and other accounted for 14 percent. Two categories showed interesting variations from the 2011 survey that might reflect the chaotic conditions related to Recovery Audit Contractor audits and other challenges. In the 2011 survey findings, the non-owner practitioner count per facility was 37 percent of the mix compared with 29 percent in the 2013 survey, based on 2010 and 2012 data respectively. The other significant change was the size of the technician segment, with 20 percent in 2010 compared with 12 percent in 2012. These changes suggest fewer technicians and non-owner practitioners were on the payroll in 2012. Eight of the 15 positions tracked experienced compensation increases or were about the same in 2012 as in 2010, but there were seven position categories where compensation decreased. Marketing positions showed a $9,000 decrease in annual compensation in 2012 compared to 2010.
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Trends in Benefits Fringe benefits also showed some downward trends, with medical insurance fully paid by 35 percent of the respondents in 2012 compared with 42 percent fully paid in 2010. There was an upward trend in the number of companies asking employees to pay a portion of the coverage, going from 46 percent of the companies asking employees to pay a portion in 2010 to 54 percent requesting participation in 2012. That would seem to reflect the pressures of rising health-care costs. The number of companies that fully pay for life insurance for employees increased from 40 percent of companies in 2010 to 45 percent in 2012. The detailed employee benefits section of the 50-page report shows that 56 percent of the companies provide full-time employees a combined vacation/sick/personal leave arrangement known as paid
Companies Providing PTO to Full-Time Employees
56%
time off (PTO). The length of service required for various levels of PTO was recorded, with 37 of the 95 responding companies providing six to 10 days after a median of one year of service; 33 companies offering 11 to 15 days after three years of service; and 28 respondents providing 16 or more days after five years of service.
The “2013 Benefits & Compensation Report” provides detailed information on most ABC- and BOC-certified positions (where number of responses are sufficient) by size of company and community size. It also provides information on the type of health benefits provided, with 40 percent offering PPO arrangements; 33 percent offering HMO, and 34 percent offering Blue Cross-type programs. The numbers add up to more than 100 percent because a company may offer coverage options to employees. To obtain the answers that you need to get your compensation program on the right track, order your copy from the AOPA bookstore at www.aopanet.org. The “2013 Benefits & Compensation Report” member price is $85 for the electronic version or $185 for the hard copy. Non-members may purchase the electronic survey for $185 and hard copy for $325. a
www.LCodeSearch.com
24/7 Expert Coding Advice 24/7 •
The O&P coding expertise you’ve come to rely on is now available whenever you need it.
•
Match products to L codes and manufacturers— anywhere you connect to the Internet.
•
This exclusive service is available only for AOPA members.
Contact Lauren Anderson at 571/431-0843 or landerson@AOPAnet.org.
Log on to LCodeSearch.com and start today. Not an AOPA member? GET CONNECTED
Visit AOPA at www.AOPAnet.org.
Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811.
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O&P Almanac OCTOBER 2013
Going the Extra Mile CAILOR FLEMING INSURANCE—
COVERING YOU EVERY STEP OF THE WAY
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AOPA HEADLINES
Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques Mirage Hotel & Casino October 22-23, 2013, Las Vegas Join your colleagues October 22-23 at the Mirage Hotel & Casino in Las Vegas for AOPA’s “Mastering Medicare: Advanced Coding & Billing Techniques” seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Designed for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. Register online for the “Mastering Medicare: Advanced Coding & Billing Techniques” seminar in Las Vegas at http://bit.ly/aopaLV13. Questions? Contact Devon Bernard at dbernard@aopanet. org or 571/431-0854.
O&P Almanac Magazine— Don’t Miss an Issue! If you aren’t receiving and reading AOPA’s official magazine every month, you don’t know what you’re missing. The O&P Almanac is the most respected source for industry insight and association news in the O&P industry. Featured topics include emerging technologies, coding and reimbursement education, premier meetings, people and businesses in the news, and industry modernization.
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O&P Almanac OCTOBER 2013
As a member of AOPA, or a credentialed practitioner with ABC or BOC, you receive a print copy of the O&P Almanac monthly. Your print issue features all of the latest O&P news, regular departments, and special features on hot topics. A digital version of each issue also is available on AOPA’s website at www.aopanet.org under “Publications.” If you are not a member of AOPA, or a credentialed practitioner with ABC or BOC, you may purchase a year subscription of the O&P Almanac at AOPA’s Online Bookstore, www.aopanetonline.org/store.
AOPA HEADLINES
Advocacy: A Potent Weapon for Change—Join the Audio Conference November 13 Advocacy can be a great tool to effect change—if you know how to use it properly. Taking an active role in controlling the future treatment of O&P professionals has never been more important. Join AOPA on November 13 for an Audio Conference on this important topic, when an AOPA expert will address the following topics: • How to effectively lobby for fair treatment of O&P on the local and national level • How to work with patients to help them become advocates for their own cause • How to effectively communicate with representatives in Washington, DC • How the wrong message can have a negative impact on advocacy efforts.
AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions. Register online at www.bit.ly/2013audio. Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876 with registration questions.
New in the AOPA Bookstore: ‘2013 Operating Performance Report’ & ‘2013 Compensation & Benefits Report’ Are you curious about how your business compares to others? These updated surveys will help you see the big picture. AOPA’s “2013 Operating Performance Report” provides a comprehensive financial profile of the O&P industry including balance sheet, income statement, and payer information organized by total revenue size, community size, and profitability. The data was submitted by more than 130
patient-care companies representing 1,050 full-time facilities and 68 part-time facilities. This report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2012 operations. AOPA’s “2013 Compensation & Benefits Report” represents the most complete, accurate, and up-to-date compensation information for the O&P industry. This report is designed to allow industry members to easily compare their compensation levels and benefits policies with those of similar facilities. The report is divided into two major sections: average salaries and ranges of key employee positions, and benefits offered, including holiday and vacation policies. Both reports may be purchased in the AOPA Bookstore at www.aopanetonline.org/store.
OCTOBER 2013 O&P Almanac
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AOPA HEADLINES
Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.
AOPA also offers two sets of webcasts: • Mastering Medicare: Coding & Billing Basics. These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series. These courses are designed for those establishing a new O&P practice. Register online by visiting http://bit.ly/AOPAwebcasts.
Welcome to AOPA Jobs AOPA’s Online Career Center gives you access to a very specialized niche. The Online Career Center is an easyto-use, targeted resource that connects O&P companies and industry affiliates with highly qualified professionals. The online job board is designed to help connect our members with new employment opportunities. • Job Seekers: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers. • Employers: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you. • Recruiters: Create and manage your online recruiting account. Post jobs 36
O&P Almanac OCTOBER 2013
Coding Questions Answered 24/7
to our site and browse candidates interested in your positions. The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at http://jobs.aopanet.org. In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations! Regardless of your staffing needs or budget, we have an option that is right for you. For more advertising opportunities, please contact Dean Mather, advertising sales representative, at 856/768-9360 or dmather@mrvica.com.
AOPA members can take advantage of a “click-of-the-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.
24/7
AOPA HEADLINES
Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0835 with social media and content questions.
Top 5 Reasons To Follow AOPA: • Be the first to find out about training opportunities, jobs, and news from the field. • Build relationships with others working in the O&P field. •
Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.
• Hear from thought leaders and experts. • Take advantage of special social media follower discounts, perks, and giveaways. a
O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • Kel Bergmann, CPO • Thomas DiBello, CO, FAAOP • Mark Hopkins, CPO • Thomas Kirk, PhD • Jon Leimkuehler, CPO, FAAOP • Ron Manganiello • Clyde Massey, CPO • Frank Vero, CP
The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@ AOPAnet.org. *Due to publishing deadlines this list was created on Sept. 3, 2013, and includes only donations received between July 1, 2013, and Sept. 3, 2013. Any donations received on or made after Sept. 3, 2013, will be published in the next issue of the O&P Almanac.
OCTOBER 2013 O&P Almanac
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AOPA Applications
Welcome new members! The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999
Adaptive Prosthetic & Orthotic Technologies Inc.
Ozark Prosthetics & Orthotics
190 Quincy Ave. Brockton, MA 02302 508/587-7300 Fax: 508/587-7330 Category: Patient-Care Member Amanda Butler, CPO
3250 S. Delaware Ave. Springfield, MO 65804 417/889-3222 Category: Patient-Care Member Jeff Messenger
Perkins Orthotic, Prosthetic, & Pedorthic Lab Inc.
Allied Orthotics & Prosthetics LLC 100 Yorktown Plaza, Ste. 203 Elkins Park, PA 19027 215/576-1888 Fax: 215/576-1840 Category: Affiliate Member Parent Company: Jack Gold Surgical Appliances dba Allied OP Inc., Randolph Township, NJ
910 N. 32nd Street Fort Smith, AR 72903 479/783-1110 Fax: 479/783-1112 Category: Patient-Care Member Morgan Cowett
Revolimb LLC
DavMar 1111 W. San Marnan Drive Waterloo, IA 50701 800/214-6742 Category: Supplier Affiliate Member Parent Company: Orthotic & Prosthetic Group of America (OPGA), Waterloo, IA
Mid-Mo O&P LLC 1101 Lakeview Ave. Columbia, MO 65202 573/817-1782 Category: Patient-Care Member Tracy Ell, CP, CFo
470 Simpson Ave. Salt Lake City, UT 84106 801/641-3398 Fax: 801/606-7346 Category: Patient-Care Member Tamerin Smith
RPS Medical Service Corp. PMB 289, P.O. Box 30500 Manati, PR 00674 787/854-1479 Fax: 787/854-1124 Category: International Member Edward Moran a
Level 4: more than $5 million.
MEMBER VALUE GUIDE www.AOPAnet.org
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)
Member Benefits
Experience the Benefits of AOPA Membership Membership in AOPA is one of the best investments that you can make
•
•
•
Challenging RAC and CERT audit policies implemented this past year by overly aggressive CMS contractors is AOPA’s number one priority. All options are on the table to eliminate these burdensome and patient harming practices. Your Voice in Washington. AOPA’s staff and the lobbying team of former CMS Administrator, Tom Scully of the Alston & Bird law firm and Nick Littlefield, former chief of staff for Sen. Ted Kennedy and now a partner in the Foley Hoag law firm bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain financial times to ensure quality patient care. Making Your Voice Stronger. The O&P Political Action Committee supports candidates who understand the unique contribution the O&P community makes to restoring lives and hope.
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MISSION
Experience the Benefits of AOPA Membership
in the future of your company.
The mission of the American Orthotic and Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.
•
Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level briefings and to deliver the O&P story personally to their members of Congress.
•
Expert Reimbursement and Coding Guidance. AOPA’s reimbursement specialists provide coding advice and keep you up-to-date on the latest Medicare quality standards, billing rules and regulations. Answer all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.
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O&P Almanac OCTOBER 2013
Cost Effectiveness Research. The changing climate of health care is moving to a patient driven process and is demanding more and more evidence of cost effectiveness to measure outcomes. AOPA has funded the first in a series of research projects that will measure the cost effectiveness of timely O&P treatment of patients with the same diagnoses as patients who did not receive treatment. More cost effectiveness research projects will be necessary and are simply too expensive for individual O&P businesses to undertake. AOPA can aggregate the resources of the field to conduct this vital research.
2013 AOPA Annual Membership enrollment is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.
Join today!
The O&P Business Management Certificate Program addresses skills that are fundamental to the success of an O&P business.
O&P Business Management: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company. ■ REFRESH YOUR KNOWLEDGE ■ DEVELOP BETTER BUSINESS PRACTICES ■ ADVANCE YOUR CAREER ■ CREATE ONGOING RETURNS FOR YOUR COMPANY
Earn Your Certificate in
O&P BUSINESS MANAGEMENT
Through a joint partnership between AOPA and the University of Virginia School of Continuing and Professional Studies
How to get started: 1.
Complete the online sign up form: https://aopa.wufoo.com/forms/earn-acertificate-in-op-business-management/
2.
Select and complete four required core modules and four elective modules within three years.
A NEW AOPAversity OPPORTUNITY! Another addition to the valuable education, products and services offered by AOPA that you need to succeed.
3.
Complete a Module specific quiz for each program.
4.
Participants that successfully complete the program will be awarded a certificate of completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.
Marketplace
Vari-Flex® XC Rotate™ by Össur®. Go anywhere. Do anything. Increasingly, many amputees desire a prosthetic foot that can keep up with their busy lifestyle. Whether they’re at the office or the gym, they want the convenience of using a single foot throughout the day. By combining smooth rollover and dynamics with vertical and rotational shock absorption, Vari-Flex XC Rotate offers the flexibility that these active individuals require to pursue a life without limitations. To learn more about Vari-Flex XC Rotate by Össur, call 800/233-6263 or visit www.ossur.com today.
Guardian Suction Liner from PEL The new ALPS™ Guardian Suction Liner features a high-performance knitted fabric cover created by integrating ALPS proprietary in-house knitting techniques with GripGel™ technology. The resulting material not only increases functional improvement and ensures durability, but also inhibits skin breakdown and surface discoloration. Raised GripGel™ bands form a secure interface between the socket and the liner to prevent slippage or premature release. Low modulus GripGel™ bands stretch against the socket wall while the inner wall conforms easily to the residual limb to ensure there is no restriction of blood flow or stiffening to inhibit donning. Suitable for both transtibial and transfemoral amputees, the new liner is rated for K2, K3 and K4 activity levels. Call PEL at 800/321-1264.
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O&P Almanac OCTOBER 2013
KISS® WrapStrap-R® Now available in brown, the Wrapstrap-R by KISS is residue-free and offers removable linkage. This product prevents: • Sleeve doffing inversion • Sleeve doffing dislodging • Under sleeve air leakage This product provides: • Reliable and strong support • Low profile, full adjustability • Tapeless, removable linkage. Wrapstrap-R by KISS available: • CMP24/G: Single brown • CMP24/H: 10-pack brown. For more information, call 410/663-KISS (5477) or visit www.kiss-suspension.com. U.S. Patent 8,182,546, and Patent-Pending Worldwide. a
JOBS CALENDAR
Find your region on the map to locate jobs in your area.
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to scuster@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
Mid-Atlantic CPO Bowling Green, Kentucky Growing O&P facility in southern Kentucky is looking for an orthotist/prosthetist. Must have five years of experience minimum as well as ABC and/or BOC certification. Send resume to:
Email: llawrence.fsp@insightbb.com.
Inter-Mountain Certified Prosthetist/Orthotist Twin Falls, Idaho Rehab Systems is an established and successful business, which is continuing to grow and looking to expand. We are in search of an additional practitioner for our Twin Falls, Idaho, location. We have structured the business to be practitioner owned. If you are interested in owning and growing with a successful practice, this job is for you. Practitioner also will have opportunities to be on the forefront of product development and education, in working closely with sister company, Coyote Design, in its efforts to create new products and new educational formats for the industry. We are looking for a motivated, enthusiastic CPO with at least three years of experience. Send resumes to:
Matt Perkins Email: perk@coyotedesign.com
Certified Prosthetist/Orthotist Corpus Christi, Texas Immediate opening for an experienced CPO. Based in Corpus Christi, Texas, with travel to satellite offices. Must be ABC-certified and licensed by the state of Texas. Competitive compensation package! Send resume to:
Barbie Baker Fax: 361/888-7424 Email: Barbie@ccprosthetics.com
Pacific Orthotic & Prosthetic Business for Sale San Diego, California In the San Diego area for 32 years. Good customer base! A small business with great growth potential. Contact us today.
Carlos Valenzuela, CO Phone: 619/992-9174 Email: Progressivepo@yahoo.com
aOPa marketing
Be served a bigger
media kit
slice of the pie!
dollar of of the 3.5 billion AOPA Find your slice begin with an O&P business— opportunity today! advertising
rates effective
American Orthotic Promoting O&P
& Prosthetic
Since 1917
Association
Jan. 1, 2014
(AOPA)
Anet.org www.AOP
net.Org
www.AOPA
42
DISCOVER more AOPA advertising opportunities. Call Dean Mather, Advertising Sales Representative at 856/768-9360 or email dmather@mrvica.com
20 14
OPPOrtunities
AOPA 2014
MediA Kit
www.AOPAnet.org YOUR resource
1
O&P Almanac OCTOBER 2013
for the O&P Community
CALENDAR JOBS
Live and work, where you can play.
CPO/BOCPO At Center for Orthotic & Prosthetic Care (COPC) our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in KY, IN, NC and NY. Due to an opening at one of our patient care facilities in Kentucky, we are seeking a CPO, or KY licensed BOCPO, with a minimum of 5 years clinical experience. Candidates must possess excellent communication, organizational and interpersonal skills, and the demonstrated ability to provide the highest quality patient care. This position offers a competitive salary, relocation assistance and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your resume, in confidence, to: via fax at 502/451-5354 or via email to dkoch@centeropcare.com.
Orthotist/Prosthetist-Certified Evaluate, design, fabricate and fit devices for patients that have a limb or segment of a limb missing due to congenital or traumatic reasons, or with disabling conditions of the extremities and spine. Must be a graduate of Orthotic or Orthotic/Prosthetic Practitioner Program. BA/BS preferred. Formal training must include basic design principles and fitting skills in lower and upper extremity prosthesis and orthoses. Thorough knowledge of anatomy, kinesiology, developmental philosophy, mechanics and biomechanics. ABC Certification in Orthotics or Orthotics/ Prosthetics. A minimum 3 years of experience as a CO or CPO preferred. Experience in Pediatric Orthotics would be helpful.
Apply online at: www.marshfieldclinic.jobs Search by position number MC130328 1000 North Oak Avenue, Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.
OCTOBER 2013 O&P Almanac
43
CALENDAR
■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org. ■ On-site Training Motion Control, Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fit immediately. For more information, call 801/326-3434, email info@ UtahArm.com, or visit www.UtahArm.com.
■■
2013 ■ OCTOBER 3-5 The Virginia Orthotic & Prosthetic Association 2013 Annual Meeting and Scientific Sessions. Hyatt Fairfax at Fair Lakes, Fairfax, Virginia. Online registration and hotel reservations will be available beginning Friday, May 18. Calling for papers for the orthotics, prosthetics, and technical tracks as well as for the Compliance Clinic. Abstract submission deadline is June 15. Send abstracts to vopainfo@gmail.com. ■ OCTOBER 9 AOPAversity Audio Conference–What’s the Word: A Healthcare Reform Update and What You Can Expect. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words
Member Rate
Nonmember Rate
25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email scuster@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor. Questions? Email scuster@AOPAnet.org. 44
O&P Almanac OCTOBER 2013
■ OCTOBER 12 POMAC (Prosthetic and Orthotic Management Associates Corporation) Continuing Education Seminar, Co-Sponsored with PEL Supply Co. New York LaGuardia Airport Marriott. Contact Drew Shreter at 800/946-9170 or visit www.pomac.com. ■ OCTOBER 22-23 AOPA: Essential Coding & Billing Seminar. Mirage Hotel & Casino. Las Vegas. To register, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.
■ NOVEMBER 1 ABC: Application Deadline for Certification Exams. Applications must be received by Nov. 1, 2013, for individuals seeking to take the January 2014 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114, email info@abcop.org, or visit www.abcop.org/ certification. ■ NOVEMBER 6-8 The New Jersey Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Bally’s Hotel and Casino. Atlantic City. For more information, visit www.oandp.org/ membership/chapters/new_ jersey/. ■ NOVEMBER 11-16 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was Sept. 1, 2013. Contact
703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■ November 13 AOPAversity Audio Conference—Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.
■ NOVEMBER 15 National Pedorthic Services Educational Course— Therapeutic Shoe Fitters Course. Milwaukee. For more information, contact Brian Dalton at 414/438-6662, email bdalton@npsfoot.com, or visit www.npsfoot.com. ■ NOVEMBER 21 Bio-Mechanical Composites, Inc. Fall 2013: Learning and Leisure “Dynamic Response Orthotic System” Certification Course. Holiday Inn at the Orlando International Airport, Orlando. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.25 CEUs. For registration information, visit www.phatbraces.com. For more information, call 515/554-6132. ■ DECember 11 AOPAversity Audio Conference—What’s on the Horizon: New Codes for 2014. For more information, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.
■ DECEMBER 12-14 Rehabilitation Institute of Chicago—Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. Featuring Elaine Owen. 21.50 ABC credits. Contact: Melissa Kolski at 312/238-7731 or visit www.ric.org/education.
For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.
CALENDAR
2014 ■ JANUARY 26-29 U.S. Member Society of ISPO: Pac Rim 2014: Learning Beyond Our Horizons—A Biennial Symposium on Prosthetics, Orthotics, & Rehabilitation. Wiakoloa Beach Marriott Resort and Spa on the Big Island of Hawaii. Learn about progressive treatment options and innovations and hear from recognized physical rehabilitation professionals while enjoying attractions on the Big Island. Contact Dianne Farabi at 614/659-0197 for more information. Submit abstracts at www.usispo.org/pacrim14.
■ AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Marriott Halifax Harbourfront. Halifax, Nova Scotia. Visit www. prostheticsandorthotics.ca/ for more information. ■ SEPTEMBER 4-7 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org.
2015
2016
■ OCTOBER 7-10 98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.
SEPTEMBER 15-18 99th AOPA National Assembly. Orlando. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.
Motion Control
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)
SUPERCOURSE FALL 2013
Join AOPA
Today
OCTOBER 7 - 11, 2013
at Fillauer Headquarters, Chattanooga, Tennesee • In-depth training of Utah Arm / U3+ / Hybrid Arm / ProControl 2 • Hands-on experience with UI software - bring your Windows laptop • CEUs: 34 (estimated) awarded by ABC
Overview of: NEW LI-Ion Battery for Utah Arm / U3+ / Hybrid Arm NEW MC Wrist Rotator NEW TRIAD Preamps PLUS Karl Lindborg, CPO from Touch Bionics - Interfacing i-limb hands with Motion Control Products
The 5-day SuperCourse is $1,350.00 For more information or to register for the SuperCourse, email: info@UtahArm.com
115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801.326.3434 • FAX: 801.978.0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com
46
O&P Almanac OCTOBER 2013
www.aopanet.org/join
Top 10 Reasons to Join Today 1.
Unlimited access to on-staff reimbursement experts—just a phone call or email away!
2.
Legislative and regulatory advocacy on your behalf. Support our litigation efforts against CMS
3.
Cost-effectiveness research to measure outcomes and prove the value of timely O&P care
4.
LCodeSearch.com, AOPA’s members-only online coding resource
5.
O&P product finder to streamline your search for products and services
6.
Significant discounts on O&P products, educational seminars, and the 2013 O&P World Congress
7.
Earn continuing education credits with our online webcasts and FREE online videos
8.
Complimentary subscriptions to O&P Almanac and AOPA in Advance SmartBrief
9.
Recognition in the AOPA online directory
10. Members-only access to AOPAnet.org with Medicare policy updates, reimbursement advice, compliance, issues, and more. FOLLOW US
@AmericanOandP
Since 1917, AOPA has been committed to providing high quality, unprecedented business services and products to O&P professionals. Join the more than 2,000 O&P Patient Care Facilities, Suppliers, and Institutions today!
AD INDEX
Company
Page
Phone
Website
Dr. Comfort
5, C3
800/556-5572
www.drcomfortdpm.com
Allard USA Inc.
11
888/678-6548
www.allardusa.com
Orthotics, Prosthetics & Pedorthics
21
703/836-7114
www.abcop.org
ALPS
7
800/574-5426
www.easyliner.com
Cailor Fleming Insurance
33
800/796-8495
www.cailorfleming.com
Cascade Dafo
C4
800/848-7332
www.cascadedafo.com
College Park Industries Inc.
2
800/728-7950
www.college-park.com
DAW Industries
41
800/252-2828
www.daw-usa.com
and Review Guide
15
www.oandpstudyguide.com
Hersco Ortho Labs
1
800/301-8275
www.hersco.com
KISS Technologies LLC
17
410/663-5477
www.kiss-suspension.com
Össur® Americas Inc.
9
800/233-6263
www.ossur.com
Ottobock
C2
800/328-4058
www.ottobockus.com
PEL Supply
31
800/321-1264
www.pelsupply.com
Spinal Technology Inc.
13
800/253-7868
www.spinaltech.com
American Board for Certification in
Orthotic and Prosthetic Study
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: 9/25/13 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, Stratton Publishing & Marketing, Inc., 5285 Shawnee Road, Suite 510, Alexandria, VA 22312. 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 2013
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
Avg. No. Copies Each Issue During Preceding 12 Months
Actual No. Copies of Single Issue Published Nearest to Filing Date
12,722
14,034
12,251 0 0
11,626 0 0
0 12,251
0 11,626
0 0 0 313 313 12,563 416 12,979 98%
0 0 0 2,250 2,250 13,831 439 14,270 84%
OCTOBER 2013 O&P Almanac
47
AOPA Answers
Signature Please Answers to your questions regarding who can write and sign Medicare prescriptions
AOPA
receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.
Q.
Is a physician assistant eligible to write and sign prescriptions for Medicare beneficiaries?
A.
Yes, for the most part Medicare accepts physician assistants’ signatures on prescriptions/orders. However, there are a few criteria that must be met: • The physician assistant must meet the definition of “physician assistant” found in the Social Security Act.
• The physician assistant must be treating the patient for the condition for which the item or service ordered is needed. • The physician assistant must be working under the supervision of a doctor of medicine or doctor of osteopathy. • The physician assistant must have his or her own NPI number. • The physician assistant must be allowed to practice in the state where he or she is working.
Q.
Can a nurse practitioner write and sign orders/prescriptions for Medicare beneficiaries?
A.
Yes, for the most part nurse practitioners, or clinical nurse specialists, may write and sign prescriptions/orders for Medicare beneficiaries. However, there are several caveats for their orders/prescriptions to be considered valid for Medicare purposes: • The nurse practitioner must be treating the beneficiary for the condition for which the item or service is required. • The nurse practitioner must be practicing independently of a physician. • The nurse practitioner must have his or her own NPI number and be billing Medicare for other covered services using that NPI number. • The nurse practitioner must be permitted to practice in the state in which he or she is providing services.
Q.
Does the diagnosis or ICD-9 code have to be on the detailed written order for that detailed written order to be considered valid?
A.
48
No. Including the diagnosis code is optional, and it does not have to be on the final detailed written order. The only information that must appear on the final detailed written order is the beneficiary’s name; a description of the item ordered; the name of the ordering provider (doctor, physician assistant, nurse practitioner, etc.); the signature of the ordering provider (doctor, physician assistant, nurse practitioner, etc.); and the date of the order. a
O&P Almanac OCTOBER 2013