October 2021 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

O CTO B E R 2021

TPE Makes a Comeback P.14

Don’t Make the Same Business Mistake Twice P.26

Studying Postamputation Health Behaviors P.34

THE TECH

EFFECT Quiz Me!

EARN 2

DEVICE INNOVATIONS THAT COULD INFLUENCE BUSINESS P.16

BU SIN ES S CE CREDITS

WWW.AOPANET.ORG

P.15

YOUR CONNECTION TO

EVERYTHING O&P

THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.

o i n o t n San A SEPTEMBER 28-OCTOBER 1

Mark

rs a d n e l a Your C

Join us September 28-October 1, 2022, for

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

an ideal combination of top-notch education and entertainment at the 105th AOPA National Assembly in San Antonio, TX.

www.AOPAassembly.org

FABRICATED WITH ACCURACY & PRECISION

CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES

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OCTOB E R 2021 | VOL. 70, NO. 9

contents

COVER STORY

FEATURES 16 | The Tech Effect Advances in technology can be game-changing not only for O&P patients, but for clinicians and business owners as well. Find out how a prosthetic foot emulator and an automatically adjusting socket system could impact clinical decision making—and enable more individualized solutions. By Josephine Rossi

DEPARTMENTS | COLUMNS Views From AOPA Leadership......... 4

A year of accomplishments

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 12

Transitions in the profession

P.10

Reimbursement Page.......................... 14

The Return of TPE

What to expect from the reinstated Target, Probe, and Educate program

26 |

Case Review

Try this step-by-step audit process at your facility to review unsatisfactory business outcomes and examine why processes didn’t work as planned. Hamontree Award winner Rebecca Snell explains how “Adverse Outcomes Reporting,” a process she adapted from Six Sigma, can help reduce losses and improve satisfaction among internal and external O&P customers. By Christine Umbrell

PRINCIPAL INVESTIGATOR

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

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

Transcend Orthotics & Prosthetics Comb O&P

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

AOPA advocacy, announcements, member benefits, and more

Welcome New Members...................42 O&P PAC...................................................... 43 Marketplace............................................. 44 Careers........................................................ 48

Cory Christiansen, PhD, PT............................... 34

Professional opportunities

Meet a physical therapist who seeks to optimize exercise and physical activity outcomes for patients with lower-limb amputation, with a focus on older adults.

Upcoming meetings and events

OCTOBER 2021 | O&P ALMANAC

Calendar..................................................... 50

Ad Index........................................................ 51 State By State........................................... 52

Colorado, Indiana, Kentucky, New York, and Utah

WALKING LONG

distances every day with my dogs and HIKING with my family are things that give meaning to my life! My Allard AFO never lets me down! I can rely on the SUPERIOR function and DURABILITY!

- Wendy, Oregon. Foot Drop as a result of incomplete Spinal Cord Injury and Spinal Syrinx due to serious traffic accident.

VIEWS FROM AOPA LEADERSHIP

Stronger Together, Be Proud of What We’ve Accomplished

HE PAST YEAR-AND-A-HALF HAS certainly brought challenges, but it has been an honor to serve and represent you as AOPA’s president. I have been inspired watching you all react and adjust quickly and nimbly; you didn’t miss a beat and continued to provide quality patient care and services while supporting one another by sharing best practices. To continue to serve you, AOPA has had to react to the changes as well. I sincerely believe while doing this, we honored our mission: Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care. On the advocacy front, the Medicare O&P Patient-Centered Care Act has been introduced in both the U.S. House of Representatives and Senate. A huge thank you to all who have taken action and helped get the legislation to where it is today. To move all our legislative and regulatory priorities forward, we need your advocacy efforts. Please continue to reach out to your members of Congress and ask them to support this important piece of legislation. This year’s Virtual AOPA Policy Forum was a huge success, with more than 100 meetings held. We are planning on an in-person 2022 Policy Forum and hope you will join us. The Policy Forum is our opportunity to have our voices heard, to raise the issues our businesses and patients experience so we can continue to provide quality care. Another tool in our advocacy toolbox is the O&P Political Action Committee. Its fundraising efforts generate the dollars to help keep in office those congressional legislators who support our issues. There is a reason it is called the Political Action Committee—all legislative efforts aimed at advancing O&P care for our patients require your action! Please get involved. Also on the advocacy front, AOPA has been bolstering our support for the statebased efforts our members are involved in. With the support of our new manager for federal and state advocacy, we look forward to further building out these efforts in the coming year. Not to be outdone, our research efforts over the past year have been significant. Through these efforts, we reinforced the clinical efficacy and effectiveness that we, as clinicians, provide. In 2021 alone, AOPA awarded more than $239,537.50 in research dollars through COPL, the Center for O&P Learning. We also launched a partnership with the journal Rehabilitation and Assistive Technologies Engineering. More recently, we brought together the Medical Advisory Board members for a strategic planning process. The outcomes of this initiative will be shared soon. Finally, we recently hired a manager for health policy and research to assist in these efforts. All of this helped elevate the O&P research being conducted, further helping us define our value to healthcare. Given the pandemic, we continued to provide AOPA members a wide variety of educational opportunities virtually (although we plan to return to in-person as appropriate). The staff has been hard at work getting the membership engaged in AOPA Connection, your one-stop-shop for all things AOPA. It has been my honor and pleasure to have supported these efforts alongside the AOPA Board of Directors, staff, members, and O&P partners. Thank you for your commitment and ongoing support of AOPA!

Traci Dralle, CFm, is president of AOPA.

EDITOR’S NOTE: This column is a condensed version of AOPA President Traci Dralle’s remarks during the Annual Business Meeting at the 2021 AOPA National Assembly.

OCTOBER 2021 | O&P ALMANAC

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

Board of Directors OFFICERS President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN President-Elect Dave McGill Össur Americas, Foothill Ranch, CA Vice President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Immediate Past President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary (Nonvoting) Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO Hanger, Austin, TX Elizabeth Ginzel, MHA, CPO Baker O&P, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, LPO, FAAOP Kenney Orthopedics, Lexington, KY Linda Wise WillowWood, Mount Sterling, OH James O. Young Jr., LP, CP, FAAOP Amputee Prosthetic Clinic, Tifton, GA Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX

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AOPA CONTACTS

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

Publisher Eve Lee, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC

Our Mission Statement Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care.

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met. EXECUTIVE OFFICES

MEETINGS & EDUCATION

Eve Lee, MBA, CAE, executive director, 571/431-0807, elee@AOPAnet.org

Tina Carlson, CMP, senior director, education and meetings, 571/431-0808, tcarlson@AOPAnet.org

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 REIMBURSEMENT SERVICES Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

OCTOBER 2021 | O&P ALMANAC

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org HEALTH POLICY & STRATEGIC ALLIANCES Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, awhite@AOPAnet.org Sam Miller, manager, state and federal advocacy, 571/431-0814, smiller@AOPAnet.org O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/520-9632 , bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2021 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2021 for advertising options!

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NUMBERS

U.S. Health Insurance Coverage Trends The latest U.S. Census data show that a slim majority of the U.S. population is covered by employment-based insurance A new report from the U.S. Census Bureau, “Health Insurance Coverage in the United States: 2020,” presents estimates of healthcare coverage in 2020. This snapshot gives insight to trends in O&P patient coverage.

PUBLIC VS. PRIVATE*

66.5 Percent

34.8 Percent

8.6 Percent

Percent with private health insurance

Percentage with public coverage

Percentage who did not have health insurance at any point during 2020

PRIVATE INSURANCE IN 2020 “Overall, Hispanics had the highest uninsured rate Percentage of U.S. Decline in private health Percentage of full-time, (18.3 percent) in 2020, population covered by insurance coverage year-round workers employment-based between 2018 and 2020 with private insurance followed by Blacks (10.4 insurance coverage percent), Asians (5.9 percent), and non-Hispanic Figure 2. Percentage of People Uninsured by Age Group, 2018 and 2020 whites (5.4 percent). Percentage of People Uninsured by Age Group: 2018 and 2020 (Population as of March of the following year) 2020 2018 Blacks had the highest 14.3 14.4 13.9 14.2 12.5 12.4 rate of public coverage (41.4 percent), followed by 9.3 9.6 Hispanics (35.9 percent), 5.5 5.6 non-Hispanic whites (33.8 percent), and Asians 0.9 1.0 (27.0 percent). In the same Figure Under age1. 19 Aged 19 to 25 Aged 26 to 34 Aged 35 to 44 Aged 45 to 64 Aged 65 or older year, non-Hispanic whites ofCoverage Peopleinby Health Coverage and Change From 2018 to 2020 SOURCE: Percentage “Health Insurance theType Unitedof States: 2020,”Insurance U.S. Census Bureau (Population as of March of the following year) had the highest rate of No statistical change between years Types of U.S. Health Coverage in 2020 coverage Change:private 2018 to 2020 Type of Coverage in 2020 (73.9 percent), +0.1 followed Uninsured 8.6 –0.1 With health insurance 91.4 by Asians (72.4 percent), *–0.8 Any Private Plan 66.5 Blacks (54.6 percent), and *–0.7 Employment-based 54.4 Hispanics (49.9 percent).” *–0.3 Direct-purchase 10.5

54.4 Percent

0.8 Percent

87.0 Percent

Note: There were no significant changes between 2018 and 2020 at the 90 percent confidence level. Information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey is available at <https://www2.census.gov/programs-surveys /cps/techdocs/cpsmar21.pdf>. Source: U.S. Census Bureau, Current Population Survey, 2019 and 2021 Annual Social and Economic Supplement (CPS ASEC).

Marketplace TRICARE

Any Public Plan Medicare Medicaid VA and CHAMPVA

3.3 2.8 34.8

0.9

18.4 17.8

SOURCE: “Health Insurance Coverage in the United States: 2020,” U.S. Census Bureau

* Denotes a statistically signficant change between 2018 and 2020 at the 90 percent confidence level. Z Rounds to zero. 1 Includes CHAMPVA (Civilian Health Medical Program of the Department of Veterans Affairs), as well as care provided by the 2021 Department Veterans Affairs (VA) and the military. | O&PofALMANAC OCTOBER Note: The estimates by type of coverage are not mutually exclusive: people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population

*+0.2 —“Health Insurance Coverage in the United States: 2020,” *+0.4 *+0.5 U.S. Census Bureau –0.1 *–0.1

SOURCE: “Health Insurance Coverage in the United States: 2020,” September 2021, www.census.gov/content/dam/Census/library/publications/2021/demo/p60-274.pdf.

*Numbers may not add to 100 percent due to rounding, and some individuals have more than one type of insurance.

FREE CARBON FIBER AFO

w w w. f r e e c a r b o n f i b e r a f o . c o m

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Happenings RESEARCH ROUNDUP

FAST FACT

Study Identifies Disparities for Limb Loss Patients With PAD

Prosthetics Comprises the Majority of O&P Facilities’ Gross Sales/Billings 1.9% 4.0% 3.3%

36.3%

54.6%

Prosthetics Orthotics Pedorthics Durable Medical Equipment Other

—“2020 AOPA Operating Performance Report”

OCTOBER 2021 | O&P ALMANAC

of lower socioeconomic status and Black race were associated with higher rates of major lowerextremity amputation,” concluded the researchers. “Development of community-based tools for peripheral artery disease diagnosis and management targeted to communities with high amputation rates in urban areas may help reduce inequities in peripheral artery disease outcomes.” The study was published in the September 7 issue of JAHA.

Lower-Limb Loss Patients Benefit From Increased Ambulation Researchers at Columbia University recently conducted a scoping review to map the evidence regarding steps per day as a physical activity measure for individuals with lower-limb loss. The research team, led by Christopher Kevin Wong, PhD, PT, reviewed 21 studies and found that most individuals with limb loss have low activity levels compared with the 10,000 steps per day generally recommended, or 6,000 steps per day recommended for individuals with diabetes. “People with lower-limb loss take fewer steps per day than suggested for general health,” concluded the researchers. “Increasing steps per day may be a useful goal for this population, and this study is a first step in improving knowledge of physical activity levels in people with lower-limb loss.” The study was published in the August 1 issue of Physical Therapy.

PHOTO: Getty Images

Individuals with peripheral artery disease (PAD) located in rural communities with markers of low socioeconomic status experience higher rates of major lower-extremity amputation, according to a study published in the Journal of the American Heart Association (JAHA). Researchers from the University of Pennsylvania estimated rates of major lower-extremity amputation per 100,000 Medicare beneficiaries. Between 2010 and 2018, ZIP codes that experienced the highest levels of amputation rates (top quartile) had a greater proportion of Black residents (17.5 percent Black residents versus an average of 4.4 percent). They also found that, within more populous metropolitan areas, households with lower median household incomes (less than $10,000) were associated with a 4.4 percent higher amputation rate. “In metropolitan areas, where most individuals undergoing lowerextremity amputation live, markers

HAPPENINGS

INTERNATIONAL O&P

Type 1 Diabetes-Related Amputations Drop in Sweden The rate of amputation due to type 1 diabetes has fallen 40 percent over the past 20 years in Sweden, according to a new study from the University of Gothenburg. Researchers studied registry data of individuals in Sweden with type 1 diabetes. Between 1998 and 2001, the probability of amputation was 2.84 per 1,000 people; this number dropped to 1.64 per 1,000 between 2017 and 2019. “We see a trend reversal in the period from 2014 to 2016, and a couple of years before that there were evidently declining long-term blood sugar levels and improving kidney function,” said Sara Hallström, MD, author of the study and a doctoral student in molecular and clinical medicine at Sahlgrenska Academy at University of Gothenburg. “These are the risk factors that, in the study, proved to be the major ones for amputation in people with type 1 diabetes.” Hallström and her colleagues attribute the decline in amputation rate to more advanced diabetes care, the proliferation of multidisciplinary diabetes footcare teams to treat diabetic foot ulcers, and greater use of technologies

such as advanced insulin pumps and continuous blood-glucose measurement machines. “The declining amputation rate for people with diabetes is important,” said Hallström, “given that amputation is a procedure that causes great suffering and disability for those who have to undergo it.” The full study was published in September in Diabetologia.

VIRTUAL MEDICINE

U.S. Telehealth Usage Stabilizes at 38 Times Higher Than Prepandemic Numbers

PHOTO: Getty Images

More healthcare facilities have embraced telemedicine as the country recovers from the pandemic. In April 2020, telehealth spiked to encompass more than 32 percent of office and outpatient visits. In O&P specifically, 44 percent of facilities reported using telehealth in April 2020, according to AOPA’s COVID-19 Patient-Care Facility Survey. Since then, telehealth utilization has stabilized at approximately 17 percent of visits, according to a new report from McKinsey & Co. That equates to approximately 38 times more than the pre-COVID-19 baseline. McKinsey surveyed consumers and found that 40 percent will continue to use telehealth going forward,

up from 11 percent prior to the pandemic. And 58 percent of providers view telehealth more favorably now than before COVID-19, according to the research. The McKinsey researchers noted that virtual healthcare models are evolving, moving from “virtual urgent care” toward a range of virtual services and hybrid virtual/ in-person care models. “Telehealth appears poised to stay a robust option for care,” said the researchers. “Strong continued uptake, favorable consumer perception, the regulatory environment, and strong investment into this space are all contributing to this rate of adoption.” O&P ALMANAC | OCTOBER 2021

PEOPLE & PLACES PROFESSIONALS

BUSINESSES

ANNOUNCEMENTS AND TRANSITIONS

Matthew Gruskin, MBA, BOCO, BOCPD, CDME, has been named chief operating officer of the Board of Certification/Accreditation (BOC). He previously served as BOC’s credentialing director. In his new role, Gruskin Matthew Gruskin, will provide oversight of BOC’s internal MBA, BOCO, systems and external vendor relationships BOCPD, CDME and manage the organization’s operations staff. He retains all previous duties relevant to the direction, strategies, policies, and day-to-day activity of BOC’s facility accreditation and individual certification programs. “Matt’s knowledge and forward thinking continue to enhance BOC’s operations and organizational expertise, which benefits our staff and valued customers,” said Claudia Zacharias, BOC’s president and CEO.

Gillette Children’s Specialty Healthcare has formed a new partnership with the Amputee Coalition to provide education and resources to patients and their families. Through the partnership, the hospital will offer the Amputee Coalition’s Certified Peer Visitor program to Gillette patients and their families. “We are proud to be a powerful extension of the patient-centered care that hospitals and rehabilitation centers provide to the limb loss/limb difference community,” said Mary Richards, president and CEO of the Amputee Coalition. “Before and soon after amputation can be the most vulnerable and influential stages of a patient’s journey. Through our partnership with Gillette Children’s Specialty Healthcare, we are bridging the gaps between care and support to ensure pediatric patients, and their families, have access to vital resources, peer support, and community connections they need to not feel alone and to help achieve outcomes that are necessary to thrive.”

AOPA Executive Director Eve Lee, MBA, CAE, was awarded the O&P Excellence Award from the National Association for the Advancement of Orthotics & Prosthetics. The award was presented during the 2021 AOPA National Assembly in Boston. Seth O’Brien, CP, FAAOP, has been appointed to the Board of Directors of AOPA Executive Director the American Academy of Orthotists Eve Lee, MBA, CAE and Prosthetists. O’Brien replaces Matthew Garibaldi, MS, CPO. O’Brien is the clinical manager and residency director at Artificial Limb Specialists in Phoenix. He also serves as adjunct faculty at Franklin Pierce University Doctor of Physical Therapy Program, hosts a rotation for physiatrist residents, is a Certified Peer Visitor for the Amputee Coalition, and has contributed to numerous research studies and publications. Ashlie White, MA, AOPA’s director of health policy and strategic alliances, has been named the O&P Woman of the Year. The award is presented by the Orthotic and Prosthetic Group of America (OPGA) Ashlie White, MA annually to honor an individual who has made significant contributions to the O&P community, O&P businesses, and the O&P profession throughout her career. Prior to joining AOPA, White was director of operations for Beacon Prosthetics and Orthotics. She served eight years as the director of government affairs for the North Carolina Orthotics and Prosthetics Trade Association, and four years on the Board of Directors for the National Association for the Advancement of Orthotics and Prosthetics.

OCTOBER 2021 | O&P ALMANAC

THE LIGHTER SIDE ”Caption the Cartoon” Contest October 2021 Winner Congratulations to Karl Barner, CPO, LPO, from Children’s Healthcare of Atlanta, for winning the final round of Caption the Cartoon.

“Oh my, I didn’t think roosters like me could lay eggs … oh wait, that’s my new cranial remolding orthosis.”

REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

The Return of TPE What to expect from the reinstated Target, Probe, and Educate program

TARGET

TPE PROGRAM PROBE

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 15 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.15

OCTOBER 2021 | O&P ALMANAC

MS ANNOUNCED A MAJOR shift

in audit strategy in August 2017: the Target, Probe, and Educate (TPE) program. TPE replaced traditional Medicare audit procedures that relied on expansive postpayment reviews, which subjected entire product categories across all providers to significant audit activity. The TPE program was very well received as it significantly reduced the overall number of Medicare audits, shifted much of the Medicare audit activity to prepayment audits, and provided increased education and communication between the provider community and the durable medical equipment Medicare administrative contractors (DME MACs). When the COVID-19 pandemic created unprecedented and unexpected shifts in the operation of the Medicare program, CMS initially suspended most audit processes. CMS announced in August 2020 that while Medicare contractors would once again be authorized to perform claim audits, all audits would be performed on a postpayment basis using the previous process of probe review followed by widespread postpayment review. The TPE program was temporarily suspended, and more comprehensive audit processes were put back in place. Today, the COVID-19 public health emergency (PHE) remains in place,

EDUCATION

but Medicare contractors are slowly returning to some sense of normalcy in how they process Medicare claims. CMS has authorized the contractors to reinstate many of the processes that were temporarily suspended due to the PHE. In August 2021, CMS announced that the TPE program would be reinitiated and would, once again, replace the widespread postpayment review process.

How Is TPE Different From Widespread Review?

The primary difference between the traditional probe review followed by widespread review model and the TPE program is that the TPE program is much more focused—not only in identifying a much smaller pool of claims for review, but also in providing education for providers who do not pass the audit process to improve their compliance with Medicare policy requirements and regulations. The TPE program consists of three rounds of prepayment review. Each round involves 20-40 claims that have been identified for review through detailed statistical analysis, which identifies specific areas of risk for the DME MAC contract area. Additional documentation requests are sent for each of these claims, and a standard prepayment review is performed. If the results of the first round of

REIMBURSEMENT PAGE

prepayment review are deemed acceptable or compliant, the provider receives a notice from the DME MAC that they will be removed from the audit pool for a period of one year. If the results of the prepayment review are not acceptable, the provider is scheduled for a personalized education session with the DME MAC claims review department, where common errors and strategies to improve compliance are discussed. After the personalized education process is complete, a second round of prepayment review takes place, again consisting of 20-40 claims. If, after a second round of targeted review and education is complete, the prepayment review results are still not acceptable, a third round may take place. During each round of prepayment review, providers have the opportunity to be removed from the audit pool if the results are considered acceptable. The goal of the TPE program, as stated by CMS, is not to identify claim errors and punish providers, but rather to assist providers in achieving better compliance when submitting claims to Medicare. While it is too early to measure the impact that the shift in Medicare audit philosophy will have on the overall number of claims subject to prepayment review, it appears that the TPE program will result in a smaller number of overall prepayment reviews but a higher level of scrutiny for claims selected for review through the TPE program.

What Doesn’t the TPE Program Do?

PHOTO: Getty Images

The TPE program is popular with Medicare providers, but it only replaces DME MAC-based audits. The TPE program does not impact other contractor-based audits, such as those performed by comprehensive error rate testing (CERT) contractors, recovery audit contractors, and zone program integrity contractors (ZPICs). These contractors will continue to perform the audits that they always have using their current processes. In fact, providers who do not reach an acceptable level of compliance

after three rounds of claim review and education may be referred to other audit contractors, such as the ZPIC, for additional review and/or investigation.

How Will TPE Be Reintroduced? The CMS announcement on the resumption of TPE audits indicated that the program would be reintroduced gradually so as to not overwhelm providers, and to allow them to continue to focus on providing quality care to Medicare beneficiaries during the COVID-19 PHE. Instead of starting with the typical 20-40 claim sample, the first rounds of TPE audits will involve 10 claim samples.

What Does the Reintroduction of TPE Mean for O&P?

The TPE program provided welcomed relief to O&P providers. In general, TPE resulted in a significant reduction in the overall number of claims that were subject to prepayment review. AOPA members have reported that, when selected for TPE audits in the past, the opportunity to receive claimlevel education was useful and the opportunity to be temporarily exempt from future audits was a valuable incentive to ensure full compliance with Medicare policy requirements. The reintroduction of the TPE program does not mean that compliance efforts should be reduced or ignored.

The DME MACs and the Pricing, Data Analysis, and Coding contractor are constantly performing data analysis that identifies trends in utilization as well as claim error rates. CERT contractors will remain active during the TPE program and will identify areas of risk where the DME MACs should focus their targeted audit activity. If anything, proper compliance is more important now than it ever has been. The ultimate goal is to avoid TPE reviews entirely through proper claim submission and compliant documentation practices. AOPA will continue to monitor the progress of the TPE program and will communicate feedback regarding potential improvements that will make the program more efficient for both the Medicare program and the provider community. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: www.bocusa.org

O&P ALMANAC | OCTOBER 2021

COVER STORY

TECH EFFECT THE

A LOOK AT JUST A FEW INNOVATIONS THAT COULD CHANGE HOW CLINICIANS WORK By JOSEPHINE ROSSI

OCTOBER 2021 | O&P ALMANAC

COVER STORY

NEED TO KNOW •

Recent technological innovations are changing patients’ lives for the better, and some also have the potential to transform the way O&P professionals make clinical decisions and conduct business.

•

One example is a prosthetic foot emulator that mimics the mechanical characteristics of commercially available passive prosthetic ankles and serves as a tool to systematically explore different clinically available prosthetic foot designs.

•

A team is conducting outcomes research on the emulator and “test-driving” strategies for prosthetic foot prescription with the goal of improving the process for all stakeholders. Trialing feet while assessing outcome measures can produce data to potentially justify prosthetic foot selection during prescription and reimbursement.

•

Another research team is testing a microcontrolled prosthetic socket system that automatically adjusts to maintain consistent prosthetic fit and limb volume during ambulation, allowing for transtibial prosthesis users to wear their device pain-free while functioning at a high level.

•

Preliminary research data is promising. The system has the potential to be applied to other areas of prosthetics and to reduce the historically significant amount of time prosthetists spend optimizing socket fit for patients.

N RECENT YEARS, the rate at which

technological innovations have advanced O&P devices is unprecedented. For many, the benefits to patients are obvious and profound. Meanwhile, some other creations are quietly evolving with the potential to also transform the way O&P professionals make clinical decisions and conduct business. Take, for example, the prosthetic foot emulator developed by Josh Caputo, PhD, president and CEO of Humotech. Inspired by Caputo’s doctorial work at Carnegie Mellon University several years ago, the prosthetic foot emulator is a wearable robotic system that is physically similar to a powered prosthetic ankle; however, its motors, computers, and power components are separate from the wearable portion and connected by a flexible tether. “This enables the device to be extremely lightweight, high performance, and versatile,” Caputo explains. The nature of the tethered components means the user currently cannot take the system outside of the laboratory, so it is typically used with a treadmill or stairmill. “In some new projects, we’re exploring the use of treadmills with uneven surfaces, and even a portable version of the off-board actuation, control, and power components.” O&P ALMANAC | OCTOBER 2021

COVER STORY

The prosthetic foot emulator in use at the DoD Center for the Intrepid study site

OCTOBER 2021 | O&P ALMANAC

Josh Caputo, PhD In advance of commercialization, a multisite research team led by physiatrist David C. Morgenroth, MD, at the Department of Veterans Affairs (VA) Puget Sound Health Care System’s Seattle campus Center for Limb Loss and Mobility (CLiMB), is studying the

predictive abilities of the system. The current process for prosthetic foot prescription is more of a trial-anderror approach, based on a clinician’s knowledge of the patient and his or her knowledge of and experience with certain prostheses, says Morgenroth. “A confluence of factors can limit the success of this process,” he explains: “There is limited existing evidence to effectively guide the process in a patient-specific manner; prosthetic manufacturers do not typically publish objective mechanical property data so clinicians are left to make assumptions about mechanical properties through a combination of their clinical experience and advertising claims; there are hundreds of feet to choose from; … and there is typically little to no opportunity for the prosthetic user to provide experiential input [trialing feet] as part of the process.”

PHOTO: Courtesy of the DoD Center for the Intrepid

By mimicking the mechanical characteristics of commercially available passive prosthetic ankles, the emulator primarily serves as a tool to systematically explore different clinically available prosthetic foot designs, explains Caputo. Through the software interface, operators can select different foot brands and models, stiffness categories, and lengths to trial with prosthetic foot users. “The robotic actuator is controlled accordingly to emulate the stiffness characteristics of the programmed foot,” he says. “In this manner, people with below-knee amputations can test-drive candidate feet without having to acquire physical samples of each specific foot they are interested in. This rapidly accelerates the process of trialing feet, which we believe will help patients and clinicians work together to find the best prosthetic foot solution.”

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COVER STORY

Morgenroth’s research team, which includes VA, Department of Defense (DoD), and university collaborators, is conducting large-scale, rigorous, and clinically oriented outcomes research on the emulator. His team has developed a “test-drive” strategy for prosthetic foot prescription research, which involves “studying parallel strategies—one using the prosthetic foot emulator, and the other using commercial prosthetic feet,” he says. The initial project, funded by the Department of Defense Orthotics and Prosthetics Outcomes Research Program (DoD OPORP), is a multisite clinical trial focused on assessing the predictive validity of these test-drive strategies. “In this project, which we call TeD (short for “Test Drive”), study participants are given a chance to walk with different prosthetic feet under a variety of environmental terrains including slopes, stairs, and on flat ground at different speeds,” Morgenroth explains. After laboratory testing of different commercial feet and the emulated versions of those feet, participants wear each of the commercial feet for two weeks at home and in the community, and then return to the laboratory for re-evaluation. The study assesses correlations between preference for both commercial and emulated feet worn in the lab and used under different walking conditions to their foot preference and performance-based measures after the two-week takehome period with each foot. The team recently completed data collection for the TeD study and is currently analyzing the data and preparing to publish results. They also will be presenting on the study at the 2021 ISPO World Congress in November. More recently, DoD OPORP funded the next step in the “test-drive” strategy research, called TeD Max (Test Drive Multiaxial), which focuses on correlating mechanical properties in both the sagittal and coronal planes with stability and fall-related outcomes in people with transtibial amputation. “We are assessing whether a 20

OCTOBER 2021 | O&P ALMANAC

test-drive strategy for prosthetic foot prescription using commercial feet with a variety of sagittal and coronal plane properties, and emulated versions of these feet—using a multiaxial prosthetic foot emulator—can predict stability and balance-related outcomes,” Morgenroth explains.

David C. Morgenroth, MD By enabling patients to offer experiential feedback during the prescription process, these studies have the potential to provide meaningful benefit to clinicians, as well as to lower-limb prosthesis users. “Both of these projects are examples of the benefits of multidisciplinary and multi-institution efforts,” says Morgenroth, given that the research team includes clinician-scientists, engineers, and biomechanists from VA, military health, and academia. As these studies conclude, and the emulator moves closer to widespread use, Caputo is planning new additions and uses for this technology. “The sky’s the limit as far as what’s possible with emulation, and we’re just getting started,” he says. “We’ve started by focusing on the most common foot types, and what we think are the most important foot characteristics. As the research evolves, we are refining our approach, developing new capabilities to enable test-driving a broader variety of prosthetic foot characteristics that differentiate clinically available feet,

and hopefully validating that with each advancement we are able to generate outcomes data accurately.” For example, Caputo’s team is adjusting the design of the emulator to better understand the role of multiaxial prosthetic foot features and their impact on balance-related outcomes. The current version uses a programmable robotic forefoot component to match the sagittalplane mechanical characteristics of passive commercial foot keels, and it uses swappable passive heel springs to match the heels of those feet. The emulator is worn without a shoe, so the characteristics of a walking shoe are incorporated into the design. “There are some size and weight limitations [26- to 29-centimeter feet and 250-pound body weight] that we are working to expand—we really want to try to accommodate the widest possible range of foot types and users.” Now, Caputo and his team are adding multiaxial characteristics to emulate frontal plane mechanics, by adding a second degree of freedom to the robotic forefoot, and perhaps also to the heel. “We haven’t tackled transverse plane mechanics, although that’s certainly possible, too,” he says. “Emulating microprocessor or powered feet is also certainly possible, but we haven’t been focused on that simply because we’re trying to target the most commonly prescribed feet.” The ultimate goal of the emulation approach is to “help make [the test-drive] process easier, more efficient, and more effective for all the stakeholders in the prosthetic foot prescription and rehabilitation process,” adds Caputo. “We see this as a system that enables [patients] to demonstrate their capabilities and explore their options rapidly and in a scientifically-sound manner.” Trialing feet while carefully assessing outcome measures can produce “a robust individualized dataset that, in theory, could be used to justify prosthetic foot selection during prescription and reimbursement.

BALDWIN BELT (shown on model)

COVER STORY

“There’s a strong desire in this field for evidence-based methodologies,” Caputo adds, “and we believe this type of highly individualized experimentation is essential because the needs of individuals and their response to different types of technologies are so varied and unique.”

Game-Changing Sockets

At the University of Washington (UW), another project is poised not only to improve the comfort and satisfaction for people with limb loss but also to change the historically significant amount of time prosthetists spend optimizing socket fit for their patients. Funded by a four-year, roughly $6 million contract awarded by the DoD’s Defense Health Program (DHP) Joint Warfighter Medical Research Program (JWMRP), UW researchers are testing a microcontrolled prosthetic socket system that automatically adjusts to maintain consistent prosthetic fit

Joan Sanders, PhD throughout the day. While research and development of manually adjustable sockets have grown over the past 10 years, this system is designed to automatically adjust during ambulation, allowing for transtibial prosthesis users to wear their device pain-free while functioning at a high level—and without the inconvenience of pausing their activity to reactively adjust their socket due to discomfort.

“The impetus for the project is that prosthesis users’ socket fit can change during the day and affect the comfort and quality of life of people with limb amputation,” explains Joan Sanders, PhD, professor of bioengineering and the project’s principal investigator. “Most often, these changes in fit are due to a change in limb volume.” To begin the project, the team needed a socket that would allow them to control and monitor fluid volume and record data. They expanded upon a previously developed cabled-panel, adjustable socket system with a motor mounted beneath the socket and connected to the cable using tubes in the wall of the socket. The new system adjusts each panel individually and is more lightweight. Users manually adjust the fit using a mobile phone app and Bluetooth technology to send commands to a microcontroller. Then, “the motor moves in

UW’s auto-adjusting socket system

PHOTO: Joan Sanders, PhD

OCTOBER 2021 | O&P ALMANAC

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COVER STORY

discrete steps (in either direction), which causes the three socket panels (anterior lateral, anterior medial, posterior midline) to displace radially,” according to the UW Prosthetic and Orthotic Science & Technology Laboratory website. Through careful observation of the panel motion, the researchers determined socket volume changes caused by the radial movement of the panels. The new, automatically adjusting system uses a series of custom sensors developed in the UW lab that are placed within the socket at the posterior medial, posterior lateral, and anterior locations. They measure the distance to the user’s liner. “The liner has a thin layer of magnetic powder, deep in the elastomer next to the fabric backing, that serves as a target for the sensors,” Sanders explains. The microcontroller in the socket continuously samples the sensors, and when the sensed distance changes, the socket expands or contracts automatically to accommodate the increase or decrease

in limb volume. While sitting, “the user can release the panels, which may increase limb volume, and that volume may be retained during subsequent walking, helping to stabilize limb volume,” she notes. To develop the automatic system, the team conducted a number of studies. In one study, they fit 12 participants with the adjustable socket and monitored the effects of socket size change on limb fluid volume. On average, users accepted a socket size range of 2.2 percent larger than their normal socket volume to 3 percent smaller than their normal socket volume. The average optimum size was 0.7 percent smaller in volume than their normal socket. Most recently, the researchers were in the process of quantifying socket fit data collected from clinical testing in participants’ at-home environments; however, the pandemic slowed their efforts. “Hopefully, with COVID restrictions decreasing, we will be able to test a lot more people soon,” Sanders says.

Josephine Rossi is editor of O&P Almanac. Reach her at jrossi@ contentcommunicators.com. 24

OCTOBER 2021 | O&P ALMANAC

PHOTO: Getty Images

During the at-home tests, participants wear each of three socket configurations for about one week: auto-adjusting, using the microcontroller; manual-adjusting, using a mobile phone app to control socket size; and “locked” (no adjustment). “We compare socket fit measured over the course of the day for the three configurations,” says Sanders. “We also look at activities and bodily positions, and we compare socket comfort scores collected from the participant each day of testing.” Preliminary results are promising. “The auto-adjusting socket is performing consistent with expectation,” according to Sanders. “Some users are thrilled to let the auto-adjusting socket do all the work, and they are very positive on using it. Others want to participate more, and they use the phone app to make adjustments when they want.” In addition, Sanders says that some participants are eager for a commercial version of the autoadjusting system to become available. “We were contracted to make a system to work on any type of adjustable socket,” Sanders adds. “Our innovations are primarily the sensors and the control system algorithms. Hopefully, those will be applied to many types of adjustable sockets in the future. “We are also enthusiastic about the effectiveness of the socket fit sensor that we developed,” Sanders continues, “because we see opportunity to apply it to other areas of prosthetics and orthotics.” The congressionally directed JWMRP contract that provided the funding for the project came as an honor to the team. “As they hoped, we accomplished a huge amount in a short time,” Sanders concludes. “We are hopeful that our efforts will launch forward auto-adjusting socket technology in prosthetics.”

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N O I T A C U

By CHRISTINE UMBRELL

w e i v e R

HAMONTREE AWARD WINNER REBECCA SNELL SHARES

A STEP-BY-STEP AUDIT PROCESS FOR REVIEWING ADVERSE BUSINESS OUTCOMES—AND PREVENTING RECURRENCES

Rebecca Snell, 2021 Hamontree Award Winner, left, with AOPA President Traci Dralle, CFm

OCTOBER 2021 | O&P ALMANAC

N MEDICINE, HOSPITALS study

adverse patient outcomes at morbidity and mortality conferences— traditional, recurring conferences involving the analysis of adverse outcomes in patient care through peer review. But what if we applied this model to adverse business outcomes at O&P facilities? That’s the question Rebecca Snell, director of IT and marketing at Dankmeyer Inc., posed in September at the 2021 AOPA National Assembly, during her award-winning Hamontree presentation on “Adverse Outcomes Audits: Using Simplified Six Sigma as a Loss Control Measure.” A variety of events can be classified as an adverse business outcome, according to Snell—for example, losing a patient to a competitor, having to refund money to a payor or patient, remaking a device at your

own cost, responding to a complaint to Medicare, missing an audit deadline, or even experiencing a data breach (see “Managing Cyberthreats” in the August O&P Almanac). Each undesired outcome is the result of something gone wrong in a company’s process—the series of actions taken to reach a desired outcome, according to Snell. Identifying exactly what happened during the process that caused the adverse outcome can help O&P facilities pinpoint problem areas and prevent recurrences. Snell looked to the principles of Six Sigma—a method that provides tools to improve the capability of organizations’ business processes— and adopted a simplified Six Sigma approach to systematically review adverse outcomes. This modified approach works well for companies

Snell presented her Hamontree lecture in person during the AOPA National Assembly in September.

that have limited resources, such as many O&P facilities, because participants can “forget measuring, forget testing, forget the graphs and charts, and make it accessible,” Snell explains. “There might be a point later for you to do [a more scientific review]—but don’t let that stop you from the problem analysis.”

Defining the Process

Snell instituted the simplified method, which she calls AOR, or “Adverse Outcomes Reporting,” at Dankmeyer, with positive results. Each quarter, Dankmeyer chooses an adverse outcome event that occurred within the past year and schedules a two-hour meeting to review the case, identify what went wrong, and make changes to prevent repeat scenarios. This process involves six distinct steps,

which any O&P facility could follow to reduce losses and improve satisfaction among both internal and external O&P stakeholders: Make a Pre-Audit Checklist. Before each AOR meeting, Snell follows a checklist with specific tasks to prepare for the conference. She starts by working with the leadership team to identify one negative outcome to audit. “It could be a patient service, a front-office issue, a billing error, or something else.” The audit process works well with any type of problem, according to Snell. Next, she works with leadership to determine the audit “team.” Snell recommends finding a process “champion” to oversee the program. Then, for each quarterly meeting,

STEP 1

identify a moderator or facilitator to serve as an impartial group leader to guide discussion and keep people on track. You also will need a scribe/ recorder to document key activities, and subject matter experts who were involved in the case you’re considering or who understand the process you’re auditing. Then, Snell schedules the meeting, which should last approximately two hours. To develop her agenda, she adapted the Six Sigma 4W/2H/1C tool that involves discussing the “who, what, when, where, and why” of the outcome, as well as “how often and how much” it occurred, and the consequences. Finally, she invites the team to the meeting, and asks that each participant come prepared—and ready to adhere to the agenda. O&P ALMANAC | OCTOBER 2021

AOR Process in Action

HEN Dankmeyer Director of IT and Marketing

Rebecca Snell introduced the “Adverse Outcomes Reporting” (AOR) process at her facility, the company decided to review a recent case with a negative outcome: A complicated orthosis for a pediatric patient had to be remade at the company’s cost. Here’s how the process worked, and what the team members learned. Who and what? The family—a return customer that had been previously extremely satisfied with the company—took delivery of the device, but when adjustments could not be completed before a move out of state, they returned the device; the payor was refunded; and the patient’s needs were not met. When and where? During the audit, the Dankmeyer AOR team identified dates of contact with the patient’s family in chronological order and established which staff member was involved at each step. They looked at documentation from eight appointments over a three-month period and reviewed phone calls and emails between the patient’s family and employees. Why? Although it appeared as if all employees were following correct processes, the AOR team found that the patient didn’t keep the last appointment to get delivery of the adjusted orthosis. The team examined several “why” questions. First, “Why didn’t we know earlier in the service that the patient’s family was moving and required a short turnaround time?” asks Snell. “We asked more questions and learned via the process timeline that there were several communications with the patient’s family via phone and email that were not recorded in the patient record.” The team looked deeper, and asked more questions: “Why did we lose track of this as an active service until we got the request for a refund?” Snell asks. She notes the staff thought the service was closed after the delivery receipt was signed, and they did not reactivate the service once the additional adjustments were needed—which was not following their own process. Finally, “why did we have to refund the payor?” Snell asks. Ultimately, when the patient’s family wanted to restart the service at a new facility after their move, Dankmeyer refunded the payor as an “act of goodwill,” says Snell. How often and how much? Looking closely at the communication breakdowns, the AOR team realized that communication outside of the patient record via phone and email happens quite often—but can lead to missed opportunities because the whole team doesn’t have access to potentially crucial information. In addition, “how

OCTOBER 2021 | O&P ALMANAC

often do we neglect to set appropriate expectations with patients for a service [at the time] they are experienced?” Snell asks. “When we look at outcomes, do we think about the cost of extra labor, parts, and shipping when we don’t get it right the first time?” Consequences? When reviewing the actions that led to the adverse outcome, the Dankmeyer team realized the client expected delivery of a working device, with some adjustments required, within a very tight timeline, during the COVID-19 pandemic. With a normal timeline and setting of expectations, this would have been possible. However, in this instance, “if we had known at the beginning of the shortened timeline, we never would have started” making the device, Snell says. “While other things contributed to the loss, this was the key element to the failure in this specific case.”

Finally, the team discussed a plan to prevent future failures. “Our operations group looked at employee training and education to make sure all patient communications are recorded,” Snell explains. Plus, “we decided to investigate a warranty policy with each of our fabricators to see that we completely understand what is our cost and what is not.” Finally, Dankmeyer renewed its dedication to setting appropriate expectations with the patient every time, because time and circumstances change. The Dankmeyer team did an outstanding job with the AOR process on their first try, conducting careful, thoughtful analysis, then coming up with an executable action plan, according to Snell. “And they were ready to use the method again, for a new case.”

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STEP 2

Start the Meeting By Asking Questions. During the AOR meeting, it is the facilitator’s job to ensure participants are objectively focused on the process, without finger pointing. “The facilitator should remain neutral to guide the process,” Snell explains. “Be ready to shine an open and transparent light on some things that may be uncomfortable.” The facilitator should ensure that each team member is prepared to answer questions in their area of expertise. “We try to analyze the information to reach any conclusion as to what part or parts of the process are broken,” Snell explains. She recommends going through the agenda carefully, which—at Dankmeyer—focuses on five “Ws,” two “Hs,” and consequences. Each team member should share their experience in relation to the following agenda items: • Who? Who was involved, both on staff and external parties, such as patients, payors, or referral sources. Also ask “who else” should have been involved, if applicable. • What? What happened, and what should have happened? • When? Go through the chronology of the adverse outcome, and look at what occurred at each distinct point in time. • Where? Where did each action related to the adverse outcome take place? • Why? Why did the adverse outcome occur? Why wasn’t a positive outcome possible, given the circumstances? • How often and how much? How often did the adverse outcome occur, and how much of an impact did it make? • Consequences? Dive into the consequences of the outcome—how it affected the facility, employees, patients, payors, and/or referral sources, and the bottom line. When discussing these questions, “You don’t come in with assumptions. Anything is fair game,” says Snell. 30

OCTOBER 2021 | O&P ALMANAC

Going around the room and asking each question allows the team to analyze the information. Discussing these points empowers team members to identify specific points where breakdowns in the process occurred. Then, the team can discuss how to ensure those breakdowns won’t happen again. Conclude the Meeting With Specific Action Items. At the end of the meeting, the goal is to propose a corrective plan of action, says Snell. Your team should apply creative thinking to discuss how big of a problem the adverse outcome is, what can be done to correct it, and what steps should be taken to solve it. “By fixing those defects, we’re going to increase the bottom line somewhere, or we’re going to please a customer— whether that customer is internal, a patient, or a clinical partner. Somebody needs to come out better for this.” If possible, Snell suggests delineating a plan to fix a single point of the process that will produce the biggest impact on reducing or eliminating the error. “Sometimes you can decide to change one thing,” then turn that task over to the staff members responsible for that area of operation to initiate the change. However, if the problem is too big

STEP 3

or unwieldy, “you may have to spin off a workgroup” and expend more resources to develop an action plan. Task a Staff Member With Follow-Up. Even if your audit meeting goes well, your business will not reap any benefits if no one follows up. “Someone needs to be the champion who guides and keeps track of the plan of action, to ensure the action items are carried out, after the meeting,” says Snell. That employee should check in with the individuals responsible for making the change to ensure they are on track—and make adjustments if necessary. Plan the Next AOR Meeting. As Snell notes, Dankmeyer reviews one case per quarter—but that frequency can vary, based on what works best for each facility. “Be consistent,” and schedule the next meeting after one has concluded, says Snell. Snell suggests that one month before your next audit meeting is the best time to select a new case to review, prepare the agenda, and send a reminder. And you may need to change the team—to include different stakeholders—depending on the specific case and outcome.

STEP 4

STEP 5

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Review Your Accomplishments at a Year-End Meeting. After you have a system in place to review adverse outcomes at regularly scheduled meetings, plan a year-end wrap-up

STEP 6

meeting to go over each adverse outcome that was studied that year. “Talk to the people responsible for implementing the changes” on a case-by-case basis, Snell says. “What was taken care of, and what has

happened since? How well did our intervention work? Was the intervention successful? If not, should it be revisited? Our goal is to look at all our cases, look at our action items, and see how things played out.”

Ensuring Success

Don’t Wait! View the 2021 Hamontree Presentations Online Before It’s Too Late The Sam E. Hamontree, CP(E), Business Education Award was created to recognize the best business education paper, idea, or proposal submitted for presentation. This award is a counterpart to the Thranhardt Award given each year to the best clinical abstracts. Presentations by the 2021 Hamontree Award contenders took place September 10, during the AOPA National Assembly in Boston. Registered Assembly participants can view all three of the 2021 Hamontree presentations on the conference’s virtual platform: • “Adverse Outcomes Audits: Using Simplified Six Sigma as a Loss Control Measure,” Rebecca Snell, 2021 Hamontree Award winner • “Technology Readiness for Orthotists and Prosthetists,” Gerald Stark, MSEM, PhD, CPO, LPO, FAAOP(D) Rebecca Snell • “Evidence-Based Practice: Make It a Business Opportunity,” Andreas Kannenberg, MD(GER), PhD. The presentations—and all other educational sessions and additional content—on will remain available to registered Assembly participants on the virtual platform until December 18. Andreas Kannenberg, MD(GER), PhD

Gerald Stark, MSEM, PhD, CPO, LPO, FAAOP(D)

Better outcomes and a healthier bottom line are among the benefits of implementing an audit process similar to AOR, according to Snell. She offers advice to facilities interested in launching similar programs. First, ensure all team members are dedicated to the process. It’s important to have a high degree of confidence that everybody involved is invested and wants to find solutions by using the agreed-upon methodology, according to Snell. Each facility also should designate an employee to keep a running list of adverse outcomes as they come up and to follow up after meetings. Doing so will make it easier to decide which outcome to focus on when it’s time for the next AOR meeting. Preparation for each meeting is key—for every participant. This is especially important given everyone’s limited time constraints. In addition, avoid blaming individual employees. “This is about analyzing the process,” Snell emphasizes. “If one person took a misstep, then there was something within the process the led to that misstep.” Understand that any facility can do this, and that there is value to it, says Snell. For smaller facilities that may find it more challenging to devote staff time to quarterly meetings, Snell suggests “keeping it simple and accessible,” and involving fewer staff members, if necessary. Finally, don’t be afraid to try this process. If nothing else, try it at least once, says Snell. “I think there’s a lot of value in the things that you’ll learn.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

OCTOBER 2021 | O&P ALMANAC

At Renewal, Remember

CAILOR FLEMING

Contact Us Today • 800-796-8495 www.Cailorfleming.com/OandP.asp Orthotics and Prosthetics Program Application 4610 Market Street, PO Box 3989 Youngstown, Ohio 44513

1. Download the O&P Program Application at:

bit.ly/cailorflemingOandP

Policy Effective Date:

I. ACCOUNT INFORMATION 1. Business Name: 2. Mailing Address: 3. City: 5. Contact Name and Phone Number:

The Exclusively Endorsed AOPA Insurance Agency

7. Coastal State: Yes

State:

Zip:

4. Phone: 6. Fax: 8. Number of locations:

(If yes, distance to body of water):

9. Do you have a website? Yes 10. Email address:

(If yes, URL):

II. DESCRIPTION OF OPERATIONS 1. FEDERAL TAX ID #: 2.Corporation:Yes 3. Provide a brief description of operations including years in business:

Individual: Yes

4. If new venture, please explain your prior experience, how many years, and what position and field this experience is in: 5. Practitioner for Patient Care Certified by ABC or BOC? Yes 6. Any business conducted other than Orthotics & Prosthetics? Yes 7. Current Insurance Carrier:

AOPA’S INSURANCE PROGRAM

AAOP

GENERAL LIABILITY

Pedorthic Footwear Association

Is the facility accredited? Yes

AOPA

(If yes, please describe):

Years with carrier:

Other:

III. CLAIMS HISTORY 1. Have you had any losses in the past 3 years? Yes

(If yes, please describe below):

Description of Loss

Practitioners trust us most because we know your O&P business and we know insurance unlike any other program.

PROFESSIONAL LIABILITY

No No

Premium:

8. Prior Insurance Carriers and policy dates: 9. Check off if you are a member of any of the following:

Date of Loss

Amount Paid

IV. PLEASE INDICATE ESTIMATED SALES FOR EACH CATEGORY Last Term’s Sales

$ $ $

Retail Sales: Sales/ Revenue includes pre-fab items that you rent/sell to others. Off-the-shelf items that you do not repackage. Includes ‘prefab’ custom fit braces.

Medical Equipment Repair: Sales/ Revenue of Medical Equipment that is repaired, installed (no retail sales)

No direct sales to patients.

Est. updated sales for current term

$ Manufacturing: Items manufactured by you and sold to others to distribute. There is no patient care for this class $ $ Wholesale Distribution: Includes all items purchased from others that you resell to other facilities. Practitioner Patient Care: Includes all items fabricated for patients. Custom Products.

PROPERTY

2. Fill out the form. 3. Email the form to dfoley@cailorfleming.com Cailor Fleming Insurance will quickly provide your individual program quote.

AUTO

UMBRELLA

WORKERS COMP & MORE

PRINCIPAL INVESTIGATOR

Improving Postamputation Rehabilitation for Seniors Researcher applies movement science principles and addresses health behaviors to optimize outcomes

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

OCTOBER 2021 | O&P ALMANAC

OR PHYSICAL THERAPIST AND

researcher Cory Christiansen, PhD, PT, working closely with colleagues early in his career led him down the path of O&P research. He recalls collaborating with local physical therapists and prosthetists in Colorado to identify why rates of community reintegration for older adults who had undergone lower-limb amputation were very low. “As we studied this problem, we identified a link between the lack of community reintegration and very poor physical function outcomes following rehabilitation,” Christiansen says. His doctorial training in exercise science from the University of Northern Colorado guided him to initially examine biomechanical mechanisms. However, “it was becoming clear to me that many issues beyond movement mechanics explained, at least in part, the poor function and high levels of disability we saw in the rehabilitation clinic,” he says. He expanded his research to assess potential factors of disability, such as chronic poor health behaviors, the influence of multiple comorbid health conditions, and limited continuity of care related to

lower-limb amputation rehabilitation. Today, Christiansen focuses on optimizing exercise and physical activity outcomes for a variety of populations with movement dysfunction, including patients with lower-limb amputation, in his roles as a professor in the Department of Physical Medicine and Rehabilitation at the University of Colorado (CU) in Aurora, Colorado, and as co-director of the Interdisciplinary Movement Science Lab at CU’s School of Medicine, where he leads a clinical trial research team. Christiansen also works with the Department of Veterans Affairs (VA). In his appointment as rehabilitation researcher at the VA Eastern Colorado Healthcare System, he directs the Movement Analysis Lab for the Rocky Mountain Geriatric Research Education and Clinical Center. “In this lab, we work with older veterans in rehabilitation clinical trials,” he explains. More specifically, he leads the research arm of the Regional Amputation Center—one of seven such VA centers nationwide—where his team studies both in-person and telehealth rehabilitation interventions.

PHOTO: Cory Christiansen, PhD, PT

PRINCIPAL INVESTIGATOR

Paul Kline, PhD, PT; Matthew Miller, PhD, PT; Emily Hager, MS; Cory Christiansen, PhD, PT; and Chelsey Anderson, CPO PHOTO: Cory Christiansen, PhD, PT

Ongoing Investigations

Much of Christiansen’s current work centers on improving quality of life for people with major lower-limb amputations due to complications of severe diabetes mellitus and severe peripheral artery disease, or a combination of these two pathophysiologies. “When I first

began research in lower-limb amputation rehab, much of the exercise evidence was based on studies of people with traumatic amputation. However, lower-limb amputations are mostly due to vascular, nontraumatic causes,” he explains. He sought to better serve people with nontraumatic amputation—an approach

that fit well with his clinical research expertise in working with older adults with complex health conditions. One recent line of research focuses on ways older adults can sustain walking exercise and physical activity after nontraumatic lower-limb amputation, Christiansen explains. “It has been demonstrated by our lab and others that conventional physical rehabilitation and prosthetic care for people with lower-limb amputation results in their improved functional capacity,” including improved walking speed and walking distance. “However, walking—both intentional exercise and habitual walking activity—is not sustained at a therapeutic level for many older adults after they complete their initial postamputation rehab.” Christiansen’s research team helped identify critically low levels of walking after lower-limb amputation, linked low walking levels to poor health self-management behaviors, and then developed and piloted a walking exercise self-management intervention.

O&P ALMANAC | OCTOBER 2021

PRINCIPAL INVESTIGATOR

Christiansen presented a poster session on “Exploring Patient Rehabilitation Experience After Lower-Limb Amputation.”

OCTOBER 2021 | O&P ALMANAC

who had either diabetes mellitus or peripheral artery disease. “We enrolled participants at the end of their conventional prosthetic training,” explains Christiansen. The intervention included 12 weekly telehealth sessions between participants and an interventionist; each session involved a discussion to promote participant motivation and exercise behavior change. The intervention sessions comprised six primary components: self-monitoring (with use of a step-count monitor), tailored feedback, barrier/facilitator identification for reaching exercise goals, problem-solving, action planning, and encouragement. The overall goal was to have the participant use this behavior change framework to direct the sessions by the final week, according to Christiansen. In an early clinical trial of the intervention, participants demonstrated a high level of adherence, and the results showed improved daily walking activity. Average daily step count in the intervention group increased by approximately 1,100 steps per day from baseline to the three-month time point, according to Christiansen. “Based on established cut points, the improvement in steps was clinically meaningful and represented a nearly 90 percent increase in overall daily steps.” One of the biggest lessons learned

Promoting Teamwork

Christiansen notes that the success of his investigations depends on collaboration with allied health professionals. “As the Interdisciplinary Movement Science Lab name suggests, we intentionally focus on interdisciplinary work to maximize the clinical relevance of our research trials,” he explains. His research team comprises multiple professionals, including prosthetists, physical therapists, occupational therapists, psychologists, physiatrists, surgeons, nurses, engineers, and even patient-stakeholders. “We work within a framework that values the need for considering all rehabilitation disciplines to best address the complex nature of rehabilitation after lower-limb amputation.” Christiansen believes it’s necessary for prosthetists to understand the value of addressing health behaviors to optimize physical health and disability outcomes. “This is particularly important for people with multiple comorbidities,” he says. “Our research

PHOTO: Cory Christiansen, PhD, PT

Specifically, his team has used both quantitative and qualitative research methods to determine how health self-efficacy—the ability of a person to cope with their health condition— affects physical function capacity and disability. “Prior work had identified self-efficacy as a predictor of health outcomes for people living with chronic disease,” Christiansen explains. His team identified relationships between self-efficacy and functional capacity, as well as self-efficacy and disability for people with lower-limb amputation. “We demonstrated that a person’s level of self-efficacy partially explains, or mediates, the relationship between functional capacity and disability,” he says. “These findings show a potential critical role of self-efficacy in managing personal health for older adults in the causal path to disability after lower-limb amputation.” In addition, Christiansen’s team has developed and tested a walking exercise self-management intervention—a tool that aims to improve exercise behavior and includes outcomes of walking, exercise, and health selfmanagement, he says. The intervention was developed from evidence-based health behavior approaches used with other chronic disease populations. The project included only participants with unilateral transtibial amputation

from the research is that improving health self-management behaviors after lower-limb amputation requires focus on promoting self-efficacy and motivation, according to Christiansen. “In addition, our research results indicate that telehealth walking exercise selfmanagement intervention may help people with lower-limb amputation and vascular comorbidities be more physically active, potentially decreasing disability.” The findings of Christiansen’s clinical trials provide outcome data that will inform not only patients and clinicians, but payors as well. “As our lines of research move from early phases conducted in our local region, to national multisite trials, we will be able to provide rationale for or against implementing and funding the novel interventions we study,” he says. His team has worked with implementation scientists to ensure they design interventions that can be easily translated to clinical practice. “In doing so, we have designed outcomes that can directly support the necessity of the interventions for all rehabilitation stakeholders, including payors.”

PRINCIPAL PRINCIPAL INVESTIGATOR INVESTIGATOR

demonstrates that we must, as rehabilitation clinicians, address health behaviors to optimize rehabilitation and reverse some of the historically poor functional outcomes for older adults with nontraumatic amputation.” Looking to the future, Christiansen hopes to examine ways to promote shared decision making between prosthetists and patients. One of the prosthetists on his team, Chelsey Anderson, CPO, is leading a study to inform development of a shared decision-making tool that addresses prosthesis design decisions for first-time prosthesis users. “This is an exciting line of research, as it blends qualitative and quantitative research in a manner to develop a novel tool that could be directly translated into O&P practice,” he says. The goal is to address gaps in knowledge for how to best support prosthesis design decisions and better incorporate patient-specific values and preferences. “Chelsey is leading her current study as the first PhD student on our team who is also a CPO, and I hope to have other prosthetists join our team as PhD students in the future.”

Added Responsibilities

Christiansen wears many hats and appreciates the many opportunities

Christiansen at Yellowstone National Park he has been afforded. In addition to research duties, Christiansen teaches movement science and amputation rehabilitation in the CU Doctor of Physical Therapy program and professional topics and research methods in the CU Rehabilitation Sciences doctoral program. He also mentors PhD students. Before settling into a clinical research career, Christiansen, who is married with three active children, worked a variety of jobs. “I grew up in a family of blue-collar workers and spent much of my time working in

physical labor jobs growing up,” he explains. To help fund his education, he worked as a fast-food employee, homebuilder, grocery-store clerk, tutor, and several other jobs. “In doing so, I learned the value of hard work. There is clear purpose in my work,” he says. “I honestly love my job and find an academic research career to be very rewarding,” Christiansen adds. “It is exciting to work with people who are focused on advancing knowledge with the common goal of helping to improve the lives of others.”

Notable Works Cory Christiansen, PhD, PT, has been involved in dozens of important published studies, including the following: • Anderson, C.B., Wurdeman, S.R., Miller, M.J., Christiansen, C.L., Kittelson, A.J. “Development of a Physical Mobility Prediction Model To Guide Prosthetic Pehabilitation.” Prosthet Orthot Int, 2021; 45(3): 268-275. PMID: 33840752.

PHOTO: Cory Christiansen, PhD, PT

• Miller, M.J., Mealer, M.L., Cook, P.F., Kittelson, A.J., Christiansen, C.L. “Psychometric Assessment of the Connor-Davidson Resilience Scale for People With Lower-Limb Amputation.” Phys Ther, 2021; April 4; 101(4): pzab002. PMID: 33421074. PMCID: PMC8023555. • Miller, M.J., Blankenship, J.M., Kline, P.W., Melanson, E.L., Christiansen, C.L. “Patterns of Sitting, Standing, and Stepping After Lower-Limb Amputation.” Phys Ther, 2021; 101(2): pzaa212. PMID: 33336706; PMCID: PMC7921296.

• Miller, M.J., Cook, P.F., Magnusson, D.M., Morris, M.A., Schenkman, M.L., Christiansen, C.L. “SelfEfficacy and Social Support Are Associated With Disability for Ambulatory Prosthesis Users After Lower-Limb Amputation.” PM & R, 2021; 13(7): 737-745. PMID: 32926546; PMCID: PMC7873129. • Christiansen, C.L., Miller, M.J., Murray, A.M., Stephenson, R.O., Stevens-Lapsley, J.E., Hiatt, W.R., Schenkman, M.L. “Behavior-Change Intervention Targeting Physical Function, Walking, and Disability After Dysvascular Amputation: A Randomized Controlled Pilot Trial.” Arch Phys Med Rehabil, 2018; 99(11): 2160-2167. PMID: 29746823; PMCID: PMC6215727.

O&P ALMANAC | OCTOBER 2021

MEMBER SPOTLIGHT

Transcend Orthotics & Prosthetics

Culture of Caring Well-established facility focuses on pediatric orthotics and more

N JANUARY 2000, Bernie

OCTOBER 2021 | O&P ALMANAC

Myra Coleman, CO, works with a patient. without their brace while we work

FACILITY: on it,” she adds. “We set up the Transcend Orthotics vans outside therapists’ offices, & Prosthetics schools, or clinics, and patients can wait for modifications and

OWNERS: go home with their brace.” Bernie Veldman, CO, The mobile vans offer advanand Pam Veldman tages to the practice, as well. “In LOCATIONS: Indiana, Illinois, Texas, Michigan, Kentucky, Missouri, and Ohio HISTORY: 21 years

Adam Waugh, CPO, sees a patient.

a city the size of Indianapolis, for example, with our mobile labs, we don’t need five offices,” explains Bernie. “We can see patients at therapy clinics and hospitals, so we can cover a much larger area with fewer brick-and-mortar locations.” The company focuses on education as a primary marketing tool. “We are known for having excellent education and great rapport with our referral sources,” says Suzi Klimek, Dienen’s executive vice president of sales and marketing. “We provide CEU courses for our referral sources, mostly physical therapists, and offer lunch-and-learns in doctors’ offices and therapy gyms.” Because of Transcend’s focus on pediatric orthotics, physical therapists often serve as a key link to patients. Many of the facility’s

pediatric patients have mobility issues and are referred to therapists for improving gross motor skills. “Therapists who understand what we do can recommend us to doctors,” Klimek says. The Veldmans pride themselves on their commitment to their team as well as to their patients. In 2016, Dienen transitioned to a 100 percent employee stock ownership plan, or ESOP, which is a qualified retirement benefit that holds company stock. The move was unusual in any industry and particularly in O&P. “Everyone who is full time and has been with the company for more than a year receives shares of stock every year,” explains Bernie. “So the stock accumulates and grows in value, and when employees are ready to retire, the company is obligated to buy back their shares. It’s a great way to build a huge retirement without investing any money.” Another company benefit is an annual retreat, which brings together employees from every office for a week of training and celebration. “It’s an expensive investment,” Bernie says, “but it’s well worth it.” Looking ahead, the Veldmans want to grow their ESOP and expand their patient reach, while striving to achieve their “CULTURE,” an acronym that highlights compassionate care, unparalleled service, life-changing outcomes, tremendous team spirit, unrelenting drive, remarkable quality, and extreme innovation. “We want to take care of a ton of patients and see this operation continue to flourish,” Bernie says. “When we think of the lives we’ve helped on the patient side and through Surestep, it’s an amazing thing.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Transcend Orthotics & Prosthetics

Veldman, CO; his wife, Pam Veldman; and a technician opened Midwest Orthotic Services in Fort Wayne, Indiana. “It was Y2K, when people were worried that computers and infrastructure wouldn’t transition to a new century, so we were wondering if we’d even have electricity,” recalls Bernie. One of Midwest’s offerings was the Surestep supramalleolar orthosis, a device the company designed for children with hypotonia. In addition to fitting some of Midwest’s own patients with the orthosis, the facility made the device available to other practices. Over the years, Midwest expanded into several states and split Surestep off into a separate entity in 2008. The Veldmans formed a parent company, Dienen, under which both the patient-care and manufacturing sides operate. As the patient-care division continued to expand, it outgrew the term “Midwest,” and in 2019, the facility became Transcend Orthotics & Prosthetics. Pediatric orthotics remains the facility’s core business, but both orthotic and prosthetic services are offered. Today, Transcend O&P has 13 offices in seven states and offers mobile services as well. “We have 34 mobile labs that cover about a 90-minute radius around our offices,” says Pam. Each van contains a mini-lab in the back, with grinders, dust collectors, and all the equipment needed to modify devices. “The benefit is that patients don’t have to come into the office for multiple appointments and be

By DEBORAH CONN

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MEMBER SPOTLIGHT

Comb O&P

By DEBORAH CONN

Smart Scanning New technology allows for scanning via app as part of the digital workflow

ONATHAN NAFT, CPO,

OCTOBER 2021 | O&P ALMANAC

A clinician scans a patient’s foot using an app created by Comb O&P.

COMPANY: Comb O&P OWNER: Jonathan Naft, CPO LOCATION: Cleveland, Ohio HISTORY: Less than two years

Scan of a knee

A patient’s foot

yearly license fee. Clinicians may select the shape that is being fabricated, such as a below-knee prosthesis, thoracolumbosacral orthosis, upper-extremity prosthesis, ankle-foot orthosis, knee brace, or any other O&P device except for cranial orthoses. The user glides the phone around the patient to capture the anatomy. Once the clinician reviews the scan on screen and enters a few details, it can be saved to the cloud, where it can be downloaded to a laptop or desktop computer. “The process is all HIPAA compliant,” says Aaron, “and it uses industry-standard file formats with .stl and .obj extensions, so the data can be easily exported to a central fabricator (c-fab) or imported into a user’s favorite software.” Another benefit, he notes, is that the Comb app is not dependent on a cellular connection or wifi to capture a scan. “If you are in a rural area, or a hospital or nursing home where you can’t get a signal, the scan will automatically save in the background of the app and upload to the cloud automatically once you are in range again.” C-fabs are essential to the process, and Aaron says Comb has relationships with a growing

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

PHOTOS: Comb O&P

founder of Geauga Rehabilitation Engineering and consultant to Myomo, needed 3D scanners for all of his clinicians. Existing scanners were too expensive, with some costing thousands of dollars, and none were designed specifically for the O&P industry. He believed the O&P profession needed a portable shape capture tool that had no wires and could fit in an O&P clinician’s pocket, without being shared throughout an office. Naft also wanted the ability to scan in tight spaces, close to a patient, unlike some scanners that require distance or are hard to fit behind a leg. Working with Vince Baroni, CPO, clinical director at G.R.E. Orthotics & Prosthetics, Naft set out to create a less expensive alternative that was accurate, easier to use, and specific to O&P. He formed a company, Comb O&P, in 2019; the company’s name pays homage to a bee’s honeycomb, because shape capture in O&P is the center of workflow, Naft explains. He and Baroni, who became president of Comb, partnered with Knockout Concepts, a tech company in Columbus, Ohio, with experience in app development. During its development, the app underwent rigorous testing in the field. “Not only did they test the app on G.R.E. patients, they rolled it out to other clinicians to make sure it filled their needs,” says Aaron Naft, global director of sales and marketing. Satisfied with its performance, Comb officially released the app in May 2020. The software is free to download on an iPhone, and users pay a $750

number of companies that work with digital shapes, including Cascade Dafo, Spinal Tech, Boston O&P, HiTek, O&P Solutions, WIllowWood, and others. In addition to co-marketing efforts with its partners, Comb focuses heavily on O&P-specific training and education. “Because we do the scanning part of the digital workflow process, a big part of our footprint is to promote other tools our customers can use with the scanner,” Aaron says. “A lot of my job is pointing people to c-fabs that can accept a raw scan.” Comb offers instructional webinars on its website and is active on social media, including LinkedIn, Facebook, and Instagram. Comb representatives have started attending conferences and are “winning over” some clinicians who previously relied on hand casting or were hesitant to embrace this type of technology, says Aaron. “But digital scanning and workflow is the biggest topic in O&P right now,” he adds, “so practitioners are definitely curious about it. We try to help them understand how easy it can be.” Comb has aggressive plans for the future. Unlike existing hardware-based scanners, Aaron notes, Comb can push out updates and features to the app. The cloud-based portal will offer more options, too. For example, importing scans directly into a patient management system, such as OPIE and others, can help show changes over time to a body shape to satisfy medical necessity on a replacement device. “Comb’s volume of users brings creative ideas, and we’re listening,” says Aaron. “Digital workflow is here to stay, and we’re so excited to be a part of this growth for the benefit of the patients and the industry as a whole.”

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AOPA NEWS

Webinars

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provide the most reliable business information and CE credits for your staff at a single office location. Visit www.AOPAnet.org/education/monthly-webinars for details and registration information.

Orthotics Clinician’s Corner

Don’t miss this installment of AOPA’s Clinician’s Corner series. This month, we will debut an orthotics-focused topic. Plan now to log on November 10 at 1 p.m. ET.

UPCOMING WEBINAR

Don’t Miss the Virtual Programming From the 2021 AOPA National Assembly

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AOPA National Assembly in Boston is available on the virtual platform for viewing until December 18 for paid registrants. In addition, don’t miss the bonus education only available on the Virtual Assembly Platform. Visit AOPA’s website and access the AOPA National Assembly Program for a full list of bonus online education.

OCTOBER 2021 | O&P ALMANAC

WEDNESDAY

DEC. 8

Year-End Review and What Is Ahead

Did you miss any updates, coding guidelines or announcements? Are there any new codes or fee increases for 2022? This webinar will provide a recap of the important Medicare announcements, updates, and changes that took place in 2021, and will preview some updates and changes that may take effect in 2022 and beyond.

UPCOMING WEBINAR

NEW MEMBERS

Welcome New AOPA Members

HE OFFICERS AND DIRECTORS of

the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. Chicago State University 100 N. University Street Normal, IL 61751 Raj Sam 309/438-2185 Education & Research

Stability Prosthetics 1918 University Business Drive, Ste. 505 McKinney, TX 75051 Randall P. Duncan, CPO 469/461-1515 www.stabilityprosthetics.com Patient-Care Facility

O&P PAC

O&P PAC Update The O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: Jeff Brandt, CP Erin Cammarata Jeff Collins John Chad Duncan, PhD, CPO Arlene Gillis, CP Paul Gudonis Kimberly Hanson Aaron James, CO The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates

John Kenney, CPO, FAAOP Charles Kuffel, CPO, FAAOP Jonathan Naft, CPO Matthew Nelson, CPO Scott Schneider Dennis Williams, CO, BOCO Scott Williamson, MBA Shane Wurdeman, PhD, CP that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/aopapac. *Due to publishing deadlines this list was created on Oct. 11, 2021, and includes only donations and contributions made or received between Sept. 9 and Oct. 11, 2021. Any donations or contributions made or received on or after Oct. 11, 2021, will be published in a future issue of O&P Almanac.

Welcome to AOPA Connection, the one-stop-shop for all things AOPA. Logging into AOPA Connection you will instantly have access to all your AOPA benefits, including: • AOPAversity • Your Membership Record • Your Individual Profile • Event Calendar • Bookstore • Co-OP But, it doesn’t stop there! We are pleased to introduce a new benefit accessible through AOPA Connection, My O&P Community. In this online community of your O&P colleagues you can get guidance, share advice, have one-on-one and group conversations, and access resources.

MyAOPAConnection.org O&P ALMANAC | OCTOBER 2021

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2021 for advertising options.

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ALPS Gel Making the Difference As liners are in direct contact with the skin of the residual limb, they act as a second skin for the amputee. Therefore, it is essential that the liner’s material is gentle and skin-friendly to avoid irritating the skin and minimize any issues related to amputation and the need to wear a prosthetic device. ALPS South’s expertise in the field of chemistry and its position as a leading manufacturer of advanced gel-based medical devices have led to the development of a wide range of prosthetic liners over the years, characterized by an innovative and unique product: ALPS gel. To learn more about ALPS gel liners and how they can benefit your patients, visit www.easyliner.com or call 727/528-8566 or 800/574-5426.

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Coyote’s New Dynamic Strut AFO Designed to flex and move with the patient creating a more natural gait. It’s strong enough to climb stairs and offloads the foot and ankle. • Natural gait • Works great with thermoformed braces • Provides energy response. Our unique varying thickness creates a comfortable natural gait. For more information, call Coyote at 208/429-0026 or visit www.coyote.us.

Trautman Expansion Arbors From Fillauer Fillauer’s Trautman Expansion Arbors are designed to prevent the sanding cone from flying away. When the expansion arbor spins, it expands and applies pressure to the inside of the sanding sleeve—holding the sleeve on the arbor. Features and benefits: • Provides a smoother grinding surface for straighter lines and higher quality finish • Eliminates grinding chatter that hard grinding surfaces give • Available in three sizes and as a kit of three • Available in 1/2-13, 5/8-11, and M16 threads to fit most O&P machinery. For more information, call Fillauer at 423/624-0946 or visit www.fillauer.com.

OCTOBER 2021 | O&P ALMANAC

MARKETPLACE The Original Preflexed Suspension Sleeve

Naked Prosthetics

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Hersco 3D Printing Hersco is delighted to offer HP’s advanced 3D printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90 percent! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90 percent reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a bio-based renewable material that has been tested and proven in research and industry. Call today 800/301-8275 for a free sample.

New and Improved EZ Stride APO for 2021 New and improved EZ Stride APO for 2021! • Optional five-year warranty • Trimmable footplate • High-gloss finish • Washable liner-strap combo • Tibia tuberosity relief. Contact O&P Solutions (formerly Spinal Solutions) at spinalsolution@mindspring.com , call 800/922-5155, or fax 800/813-8139. For more information, visit http://spinal.solutions or http://oandpsolidarity.com.

It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit www.npdevices.com.

The Xtern, a Life-Changing Solution for Foot Drop Patients by Turbomed Orthotics Say goodbye to your painful and stiff in-shoe orthosis! This revolutionary brace, specifically designed for people suffering from foot drop, has one thing in mind: movement. The Xtern sits entirely outside the shoe (and, to add to that, to any shoe!), and is so flexible that it allows maximal range of motion and calf muscle strength. No more rubbing injuries or skin breakdowns: you’ll barely notice it’s there. Walking, running, mountain climbing, skiing? Not a problem! The Xtern will follow you as far and as long as you want. Turbomed’s innovative products are designed in Quebec, Canada, sold in more than 30 countries around the world, and distributed by Cascade in the United States. Visit turbomedusa.com, and think outside the shoe!

O&P ALMANAC | OCTOBER 2021

MARKETPLACE Ottobock Professional and Clinical Services: Here for You Ottobock Professional and Clinical Services is the largest and most experienced team of clinical specialists in the industry. We’re here to provide the best possible information, accessibility, and support for you and your customers. It is our mission to improve the quality of life of those with mobility needs by empowering people through clinical education, training, and technical support with skill and compassion. Visit our website for online education and enjoy our Experts on Demand webinar series for the latest in prosthetic and orthotic clinical information. Visit professionals.ottobockus.com/Education.

Introducing the Waterproof Trias Foot by Ottobock We’re excited to introduce the waterproof 1C30-1 Trias, designed to give moderately active K3 individuals the confidence to go new places. The updated Trias features a robust titanium adapter and water runoff channels along with drainholes in the footshell to allow for water submersion. Updated with new branding visuals, whether your patients are at home or on the way to one of their favorite places outdoors, the Trias gives your patients a sense of safety. Visit professionals.ottobockus.com or speak with your sales rep for more information.

OCTOBER 2021 | O&P ALMANAC

PDI 3D Central Fabrication

The 4th Gen Squirt Shape 3D Printer is now available for purchase! Test sockets, definitive sockets, custom liners, and more! Deliver quicker, with a 24-hour socket turnaround. Have a difficult fit or extreme size? Don’t struggle with fabrication, let us print a check or definitive socket for you. Email: fab@prostheticdesign.com Call for a quote today! 800/459-0177

800/459-0177 | WWW.PROSTHETICDESIGN.COM

Freedom QUATTRO™ Microprocessor Knee by PROTEOR Now available, the PDAC-verified Freedom QUATTRO™ microprocessor knee (MPK) by PROTEOR is designed to give users the freedom to live their lives without interruption. With PROTEOR’s innovative H.A.R.T. Control Technology, Quattro is the first MPK to provide a unique customized experience that captures users’ distinctive gait patterns. Boasting 20 user modes, remote data capture, outcome measure reporting, and independent resistance for stairs/ramps and sitting, it challenges and drives the status quo for MPKs to the next level. For more information, visit www.FreedomQuattro.com.

WELCOME That’s how you’ll feel when you join our team of residents. You can accomplish anything here with clinics nationwide, a strong sense of collaboration and teamwork, and unsurpassed opportunities to advance your career. Learn from the best clinicians, explore specialties, and work with the very latest technology. We have an unrivaled team of clinical talent that’s growing and we’re looking for people like you. Let us welcome you here at Hanger. Empower your career. Apply today.

Hanger.com/Welcome

Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state, or local law.

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

North Central HIRING WITH RELOCATION ASSISTANCE AVAILABLE

Job Location Key:

Prosthetist, Orthotist, CPed, Resident Prosthetist

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge. Refer to www.AOPAnet.org for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, 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. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board 50 or less

Member $85

Nonmember $280

For more opportunities, visit: http://jobs.AOPAnet.org. SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.

Columbia, Missouri HiTek Limb & Brace has opportunities in our teaching and research facility, providing trauma and patient-care services at the University Hospital and Clinics in Columbia, Missouri. We are seeking innovative clinicians who possess a curiosity to explore new possibilities in design and techniques and the will to make them a reality. Learn more at www.HiTekFab.com then select Career Opportunities. We have the following openings available: • ABC/BOC prosthetist • Resident prosthetist • ABC/BOC orthotist • CPed. Salary and/or commission is best in the industry. We offer moving expense assistance, and our complete benefits package includes PTO, health, dental, vision, accident insurance, 401k, and many other optional programs. Contact: Email: DrSuzBright@gmail.com

Mid-Atlantic CP/CPO

Euclid, Ohio Orthotic and Prosthetic Specialties Inc., located in Euclid, Ohio, is looking to add a dynamic experienced practitioner to our team. This position has potential to grow into a management position for the right candidate. If you are compassionate about providing the best care for your patients and have a strong work ethic, come join our team! We have developed a positive culture that results in long-term employee retention and consistent growth. We offer on-site fabrication with a blend of pediatrics, sports medicine, geriatrics, postsurgical, and traumatic event exposure in both orthotics and prosthetics. The practitioner must be eligible for Ohio state licensure. This is a full-time position Monday–Friday 8:00 a.m. – 5:00 p.m. with rotating on call. Full-time benefits include individual/family health insurance, company pays 80 percent of premium for employee and dependents. Benefits also include generous holiday, sick, and vacation pay. See how you can contribute to our team’s success. Contact with résumé: Jeffery M. Gerl, CO Email: jgerl.ops@gmail.com

OCTOBER 2021 | O&P ALMANAC

CAREERS

WANTED!

Finding your Finding your next job n easiereasier with the AOPA with th

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pane-view job search page. Set up job alerts, upload your resume or Barry Smith Job searching is easy with thean anonymous career proﬁle create Telephone: (O) 323/722-4880 • (C) 213/379-2397 pane-view job search page. Set upemployers to you. that leads

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Reach 4,500+ O&P professionals through the Job Flash™ email. For Employers: Ensure high visibility for your open positions through this highly Reach 4,500+ O&P professionals engaging email.

create an anonymous career proﬁle or job alerts, upload your resume that leads employers to you.

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For Employers:

Reach 4,500+ O&P professionals For Employers: through the Job Flash™ email. Ensure high visibility for your open Reach 4,500+ O&P professionals positions through this highly through the Job Flash™ email. engaging email.

Ensure high visibility for your open positions through this highly engaging email.on recruitment options, contact Customer For more information

through the Job Flash™ email. Log in at jobs.ao Ensure high visibility for your open Service at clientserv@communitybrands.com or (727) 497-6565. positions through this highly For more information on recruitment options, contact Customer engaging email. Log in at jobs.aopanet.org to get started! Service at clientserv@communitybrands.com or (727) 497-6565. For more AOPA_PrintAd.indd 1 information on recruitment options, contact Customer Log i Service at clientserv@communitybrands.com or (727) 497-6565. For more information AOPA_PrintAd.indd on recruitment1 options, contact Customer Service at clientserv@communitybrands.com or (727) 497-6565.

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Career Opportunities... California

CPO-Modesto CPO- Salinas CPOA-Walnut Creek Oregon CPO –Portland CPO –Bend

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services.

Washington CPO-Richland CO Resident-Richland CPO-Tacoma CPO-Yakima To apply, submit resume to: www.pacmedical.com/careers

The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others. A competitive salary, benefits and profit sharing are offered based on position/experience.

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremost as demonstrated by our positive attitude, teamwork and professionalism.”

O&P ALMANAC | OCTOBER 2021

CALENDAR

November 10

Orthotics Clinician’s Corner. 1 PM ET. For more information, visit www.AOPAnet.org.

WEBINAR

December 1

ABC: Application Deadline for January/February Written & Simulation Exams. Applications must be received by December 1 for individuals seeking to take the January/February Written and Simulation certification exams. Contact 703/836-7114, email certification@ ABCop.org, or visit ABCop.org/individual-certification.

December 1

2021 October 16

One-Day Pedorthic, Orthotic, and Prosthetic Program. POMAC is pleased to announce a one-day pedorthic, orthotic, and prosthetic program to take place at The Marriott New York LaGuardia Airport Hotel (across from LaGuardia airport in East Elmhurst, NY). Contact Drew Shreter at 800/ 946-9170, ext. 101, or dshreter@pomac.com, for more details.

October 29–December 11

Pediatric Gait Analysis and Orthotic Management: An Optimal Segment Kinematics and Alignment Approach to Rehabilitation (OSKAR). Shirley Ryan AbilityLab, Elaine Owen. Online (on-demand and live), 31.5 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/PedsGait.

ABC: Practitioner Residency Completion Deadline for Winter CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

December 6–11

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 350 locations nationwide. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

December 8

Year-End Review and What Is Ahead. 1 PM ET. For more information, visit

WEBINAR

www.AOPAnet.org.

November 1

ABC: Application Deadline for Winter CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

November 1

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

November 1–4

ISPO 18th World Congress. Now virtual. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

OCTOBER 2021 | O&P ALMANAC

2022 January 9–11

U.S. ISPO Pacific Rim Conference. Waikoloa, Hawaii (Big Island). For more information, visit www.usispo.org.

January 30–February 3

Hanger Live. Dallas, TX.

March 2–5

AAOP. Atlanta. For more information, visit www.oandp.org/events/event_list.asp?DGPCrSrt=&DGPCrPg=2.

May 10–13

OT World. Leipzig, Germany. For more information, visit www.ot-world.com/index-en.html

CALENDAR

May 18–20

September 28–October 1

New York State Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Rivers Casino & Resort. Schenectady, NY. For more information, visit nysaaop.org/meeting.

AOPA National Assembly. San Antonio, TX. For more information, visit www.AOPAnet.org.

May 20–21

Orthotic & Prosthetic Innovate Technologies Conference. Minneapolis. For more information, go to http://cecpo.com/documents/OrthoAndProstheticTech_2022_1up.pdf.

Calendar Rates

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@ AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Words/Rate 25 or less 26-50 51+

Member Nonmember $40 $50 $50 $60 $2.25/word $5.00/word

Color Ad Special 1/4 page Ad 1/2 page Ad

$482 $634

For information on continuing education credits, contact the sponsor. Questions? Email info@AOPAnet.org.

$678 $830

AD INDEX

Advertisers Index Company

Page Phone

Website

Allard USA Inc.

866/678-6548

www.allardusa.com

ALPS South LLC

800/574-5426

www.easyliner.com

Amfit

25 800/356-3668

www.amfit.com

Becker Orthopedic Appliance Co.

800/521-2192

www.beckerorthopedic.com

Board of Certification/Accreditation

877/776-2200

www.bocusa.org

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

Coyote Prosthetics & Orthotics

800/819-5980

www.coyote.us

ESP LLC

888/WEAR-ESP

www.wearesp.com

Fillauer

19 800/251-6398

www.fillauer.com

Hanger

47 877/442-6437

www.hangerclinic.com

Hersco

1 800/301-8275

www.hersco.com

Naked Prosthetics

888/977-6693

www.npdevices.com

800/922-5155

www.spinal.solutions

O&P Solutions (formerly Spinal Solutions) Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

29 855/450-7300

www.proteorusa.com

TurboMed Orthotics Inc.

www.turbomedorthotics.com

888/778-8726

O&P ALMANAC | OCTOBER 2021

STATE BY STATE

Advocacy in Action Updates from Colorado, Indiana, Kentucky, New York, and Utah

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/ resources/co-op.

Colorado

In response to the advocacy of providers in the state, the Colorado Department of Healthcare Policy and Financing issued a statement September 8 announcing that the rate would be reverted to the original rate prior to the July 1, 2021, reduction. The department also announced that a rate-setting project is being completed to determine the appropriate rate for cranial remolding orthoses. To view the statement and the latest updates, visit the Colorado page of the AOPA Co-OP. 52

OCTOBER 2021 | O&P ALMANAC

Indiana

The newly formed Indiana Association of Orthotics and Prosthetics (IAOP) has elected new leadership. Eric Schopmeyer, CO, of Transcend Orthotics & Prosthetics will serve as president, and Tim Ruth, CPO, of Kenney Orthopedics, will serve as vice president. IAOP is focusing its efforts in the coming year on educating O&P professionals in Indiana about the goals of the organization, increasing membership, and building awareness of the organization. IAOP has a group on LinkedIn and will begin conducting outreach to Indiana’s O&P community soon.

Kentucky

Kentucky Gov. Andy Beshear (D) has reappointed Billy Ray Campbell and Aaron Royster as members of the Kentucky Board of Prosthetics, Orthotics, and Pedorthics. Campbell, a Louisville resident, is a pedorthist at the Center for Orthotic and Prosthetic Care, and Royster, a La Grange resident, is a prosthetist and orthotist at Hanger Clinic. Both will serve terms expiring July 1, 2024.

New York

A coalition of O&P providers in New York continues to push for a budget resolution to increase the Medicaid fee schedule and protect patient access to O&P care in the state. The efforts of the group have gained momentum, supported by the introduction of

Become an AOPA State Rep.

If you are interested in participating in the AOPA State Reps network, email awhite@AOPAnet.org.

bicameral legislation (S 7023/A 7892) that, if passed, would direct the New York commissioner of health to conduct a study on rate adequacy for orthotics and prosthetics. Visit the AOPA Co-OP for links to take action.

Utah

In August, AOPA members reported the removal of more than 50 A and L codes from the Utah Medicaid fee schedule, including those for cervical, spinal, and upper-limb orthoses, as well as external power for upper-limb and terminal devices. Analysis of the issue indicates that the removed codes may be needed for outpatient claims. AOPA is looking into this member-reported issue. For additional information and continued updates, visit the Utah page on the AOPA Co-OP.

NEW MEMBER RESOURCE ALERT

AOPA has invested in a new resource that allows us to track legislative and regulatory activity related to O&P in every state. We will be updating the state pages on the AOPA Co-OP with alerts as they arise.

Submit Your State News To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org.

C-Leg®

More than 55 published studies prove why C-Leg is the world’s leading microprocessor knee, selected more often than any other MPK. It’s no wonder why most prosthetists trust Ottobock and recommend C-Leg. •

C-Leg users experience up to an 80% reduction in stumbles and falls.

•

94% of users prefer C-Leg over their previous prosthetic knee joint.

•

As many as 70% of users have reported improved safety and comfort thanks to C-Leg’s Intuitive Stance feature.

professionals.ottobockus.com

Trusted. For good reason.

October 2021 O&P Almanac

Articles inside

State By State

Calendar

Marketplace

O&P PAC

Member Spotlight

Reimbursement Page

People & Places

Cory Christiansen, PhD, PT

Views From AOPA Leadership

AOPA Contacts

Happenings