August 2014 Almanac

The Magazine for the Orthotics & Prosthetics Profession

AU G U ST 2014

E! Q UI Z M Earn

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Business CE

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Breaking News: District Court Ruling in AOPA v. U.S. Health and Human Services P.11

6 Supplier Standards Affecting Your Site Visits P.18

This Just In: Why O&P Needs Your Voice—Now

Dancing Again Meet the Technology That Got keynote speaker and Boston Marathon bombing victim Adrianne Haslet-Davis Back on the Floor

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Tips for Overcoming Your Tech Fears www.AOPAnet.org

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Exclusive: 2014 AOPA National Assembly assembly ’14 Exhibit Directory and Product Guide AOPA’s

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contents

The Magazine for the Orthotics & Prosthetics Profession

AUG UST 2014 | VOL. 63, No. 8

Features

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

Insights from AOPA President Anita Liberman-Lampear, MA

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

COVER STORY

How to reach staff

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 14

Transitions in the profession

24 | Dancing Machine Get ready for the AOPA National Assembly next month with this behind-the-scenes look at how Hugh Herr, PhD, and his team created a bionic leg that allowed keynote speaker and Boston Marathon bombing victim Adrianne Haslet-Davis to dance again.

By Meghan Holohan

22 | This Just In

P. 22

P. 3o

Get an advance look at the companies and products showcased at the 2014 AOPA National Assembly.

Becker Orthopedic Naked Prosthetics

AOPA News................................................ 56

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 58 Careers.........................................................68

Professional opportunities

P. 54

Calendar......................................................70

Upcoming meetings and events

Ad Index........................................................ 71 Ask AOPA................................................... 72

The O&P community unites to oppose prior authorization.

Product Guide

CE Opportunity to earn up to 2 CE credits by taking the online quiz.

Credits

n

Apprehensive to fit a patient with a new device?

Understanding some of the hurdles to adoption—and how to overcome them—can help you make treatment decisions for your patients.

By Christine Umbrell

38 | 2014 Exhibit Directory and

Supplier Standards updates

n

Take a stand now, or these rules could impact your business and limit patients’ access to care.

By Adam Stone

36 | Creating a Groundswell

Studying Up on 6 Supplier Standards

Member Spotlight................................. 52

A Hard-Line Approach to OTS

30 | Race to Parts Unknown

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

Expert answers to your questions about diagnoses, prescriptions, and documentation

P. 38 AOPA’s

national

assembly ’14

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

O&P Almanac | AUGUST 2014

3

PRESIDENT’s VIEW

AOPA in Motion

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

I

have to ask. What did you think of the July issue of the O&P

Almanac? I call it a timely refreshing of a wonderful O&P institution.

What’s your impression? Do you like it better? Same? Or, heaven forbid, did we miss the mark and you like it less? Your email to me with your reaction at info@AOPAnet.org will be immensely helpful.

Our dear friend and O&P institution in his own right, Sam Hamontree, CP, wrote AOPA in early June before seeing the July issue, saying, “Have had a good day going over the June Almanac. Some very interesting information! Also, noted you are changing the Almanac next month—that should be most interesting to me.” You can be sure I’ll especially be looking forward to Sam’s reaction.

The AOPA board met June 25-26, and the agenda certainly reflected the intensity of the issues piling on top of each other. Time devoted to discussing AOPA’s position on prior authorization resulted in the two free July 8 and July 22 webinars AOPA offered to members. Those prior authorization webinars produced great participation, great discussion, and terrific guidance that helped shape our official comments, which were submitted to CMS by the July 28 deadline. There’s a very thoughtful difference of opinion on this issue, and we came away from the discussions with a better sense of how we could best present the interests of our members—so a special thanks to all who participated. Go to www.aopanet.org to access the comments.

The Mobility Saves—Lives and Money micro website had its soft launch debut at the board meeting. While the site will always be a work in progress, please, please go to www.mobilitysaves.org and see how many tools are available to enable you to be a player in spreading the word that timely O&P services save money for payers and patients over the long run. PowerPoints designed to inform clinicians, payers, and referral audiences are easily accessed on the website.

Whether you use the PowerPoints or just adapt their messages for your own effort to inform these three audiences, it will move the ball forward in our quest to hammer home our message of how special and needed O&P services are to support the battle to deliver cost-efficient health care. You’ll see patient testimonials, a white paper featuring the facts you need to make the case, and patient brochures explaining our services. And that’s just the tip of the iceberg of helpful information on why what you do needs to be viewed separately from durable medical equipment. We have to keep making that case to payers and policymakers.

Next month is the 97th National Assembly, Sept. 4-7, 2014, at the Mandalay Bay in Las Vegas. There are so many new innovations—I urge you to read the Preliminary Program you received in the mail (or access it online on the AOPA website). The number of available CE credits increased to 38 this year. Exhibit hours have been realigned so you won’t miss CE credit opportunities by visiting your suppliers.

Of course, my favorite don’t-miss event, the annual Wine Tasting and Auction, will take place at 6:30 p.m. on Friday, September 5. There’s still time to make your wine donation or cash donation. Please join us for this very special event—and plan to test your tasting skills during our new blind tasting exercise. Contact Devon Bernard at dbernard@AOPAnet.org with any and all questions. Remember, proceeds go to the PAC and to support our legislative efforts on your behalf.

See you next month,

Anita Liberman-Lampear, MA, AOPA President 4

AUGUST 2014 | O&P Almanac

Board of Directors Officers

President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD Vice President James Campbell, PhD, CO Becker Orthopedic Appliance Co., Troy, MI Immediate Past President Tom Kirk, PhD Member of Hanger Inc. Board, Austin, TX Treasurer James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA Directors Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Alfred E. Kritter Jr., CPO FAAOP Hanger, Inc., Savannah, GA Eileen Levis Orthologix LLC, Trevose, PA Ronald Manganiello New England Orthotics & Prosthetics Systems LLC, Branford, CT Dave McGill Össur Americas, Foothill Ranch, CA Michael Oros, CPO Scheck and Siress O&P Inc., Oakbrook Terrace, IL Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

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AOPA CONTACTS

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

The Magazine for the Orthotics & Prosthetics Profession

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

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

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

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

EXECUTIVE OFFICES

O&p Almanac

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

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

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

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

MEMBERSHIP & Meetings Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, manager of membership services, 571/431-0843, landerson@AOPAnet.org Betty Leppin, project manager, 571/431-0876, bleppin@AOPAnet.org

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, cumbrell@contentcommunicators.com Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org Lia K. Dangelico, contributing writer, ldangelico@contentcommunicators.com

Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Devon Bernard, assistant director of coding reimbursement, programming and education, 571/431-0854, dbernard@AOPAnet.org 6

AUGUST 2014 | O&P Almanac

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

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

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

Address Changes Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Copyright © 2014 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.

Cover Photo: Jurvetson, flickr, The Debut of Bionic Ballet, www.flickr.com/photos/jurvetson/13480669224/ in/photolist

AOPA Bookstore: 571/431-0865 Government affairs

Advertising Sales RH Media LLC

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

Learn more at www.mobilitysaves.org.

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

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

Visit http://bit.ly/aopa14media for advertising options!

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NUMBERS

IRFs Improve Patient Outcomes for Amputees Report finds that limb loss survivors benefit from treatment at inpatient rehab facilities

A new study commissioned by the ARA Institute and conducted by Dobson DaVanzo compared the outcomes of patients who underwent rehabilitation in inpatient rehabilitation facilities (IRFs) to those who rehabbed in skilled nursing facilities (SNFs). Researchers found that rehabilitation in IRFs leads to lower mortality, fewer readmissions and ER visits, and more days at home than rehabilitation in SNFs for the same condition.

LESS TIME IN MEDICAL FACILITIES

LONGER LIFESPAN

MORE TIME AT HOME

16 Days 3 Months

Limb loss patients who rehab at IRFs stay alive 78 days longer following discharge than those at SNFs.

Limb loss patients who rehab at IRFs remain home 85 days longer than those at SNFs.

12%

1,756

Limb loss patients who rehab at IRFs have a 12% lower mortality rate than those at SNFs.

The number of matched pairs (IRF and SNF) of amputation patients analyzed in the Dobson DaVanzo study.

FEWER ER VISITS

Limb loss patients experienced the highest percentage of avoided ER visits.

Percent of Avoided ER Visits Per Year for Patients Who Rehab at IRFs for Various Conditions

8

AUGUST 2014 | O&P Almanac

Limb loss patients who rehab at IRFs have 43% fewer hospital readmissions than those at SNFs.

Limb loss patients who rehab at IRFs return home from their initial rehab hospital stay more than two weeks earlier than those at SNFs.

2 1/2 Months

Amputation 16% Neurological Disorders 10% Pain Syndromes 9% Spinal Cord Injury 8% Pulmonary Disorders 8%

43%

Major Medical Complexity 8% Cardiac Disorders 5% Brain Injury 4% Stroke 4% Hip Fracture 4%

“Patients treated for an amputation in an IRF have about 52.3 facility-based care days, compared to 60.0 facility-based care days for patients treated in a SNF.” —“Assessment of Patient Outcomes of Rehabilitation Provided in IRFs and After Discharge,” Dobson DaVanzo Final Report

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Happenings CODING DATA

CELEBRITY O&P

Jurisdiction D Performs Prepayment Review for L5980 Noridian Healthcare Solutions, the Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor, has released the results of its first quarter 2014 prepayment review for code L5980 (all lower-extremity prostheses, flex-foot system).

L5980 Accepted

Denied

16%

84%

For the period of February through May 2014, a total of 39 claims were reviewed, 33 of which were denied, for an overall error rate of 84 percent. The main reasons for denial cited in the announcement included the following: • Documentation does not support the functional level billed on the claim.

• Documentation did not support that the beneficiary will reach or maintain a defined functional state within a reasonable period of time.

• No documentation was received in response to Additional Documentation Request letter.

• Signature requirements were not met.

Questions regarding this issue may be directed to AOPA’s Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.

10

AUGUST 2014 | O&P Almanac

Harrison Ford Sports iWALK Crutch Life in a galaxy far, far away can be hazardous—as was proven by the actor playing Han Solo while in production for “Star Wars VII.” During filming in June, Harrison Ford, 72, broke his leg when the door of the Millennium Falcon reportedly malfunctioned. Instead of a conventional crutch, Ford chose to recover with the assistance of the iWALK2.0 hands-free crutch.

The iWALK replaces conventional underarm or forearm crutches and allows the user to walk unassisted with hands and arms free. Proponents of the technology say the device is less painful than crutches and allows for a more active, functional lifestyle.

“Mr. Ford was eager to get started, and the whole process took about five minutes and was done over the phone,” says Brad Hunter, director of business development for iWALKFree Inc., who worked with Ford in the fitting and training of the device. “Harrison is very mechanically inclined and was easy to teach.”

Let’s hope Han has a speedy recovery and is able to defeat the Dark Side in the forthcoming Episode.

Harrison Ford

TECH UPDATE

Clinical Trial Results in Successful Femur Surgery John McKie, an Australian surgeon, has successfully performed an osseointegration procedure on New Zealander Blair Marriott. A former firefighter, Marriott lost his right leg above the knee during a motorcycle crash in December 2010.

McKie inserted a titanium rod into Marriott’s femur. The rod contains pores that enable it to bind with the bone. The two-part surgery was completed in June as part of a New Zealand trial run.

One month post-surgery, Marriott

reportedly noticed an improvement when pushing weight down on a temporary prosthesis. “It feels like my old real human leg,” says Marriott. “I can feel my old real knee and it feels like I am pushing weight through it.”

The goal is to fit Marriott with a new prosthesis that will enable him to experience “osseoperception,” where he will feel the ground through his nerves and differentiate between surfaces. He also hopes to have an Ottobock Genium knee integrated into his device.

HappeningS

BREAKING NEWS

AOPA Loses a Battle on Audits/Dear Physician But the Fight Goes On

Photo: Beverly Rezneck

AOPA’s case The U.S. District demonstrated to Court for the District of Medicare that we Columbia’s Chief Judge insist that they go Royce Lamberth issued through the proper a decision granting the processes when they government’s motion to seek to change their dismiss the case AOPA filed rules and how they challenging the Medicare operate. It is worth program’s actions relating noting that in the past to prosthetic claims, the 10 weeks, Medicare August 2011 Dear Physician has initiated two new Letter, and the exclusion of rulemakings—on the prosthetist’s notes from Chief Judge Royce Lamberth prior authorization having independent value, and on off-the-shelf orthotics—using separate from the physician’s notes, as documentation in support of claims. The the very formal rulemaking process that it circumvented when Medicare changed court granted the government’s motion the rules via the “Dear Physician Letter.” to dismiss based primarily on technical The first of those comment periods, issues including the court’s finding that on prior authorization, ended on July “AOPA has failed to establish that this 28, and roughly 750 stakeholders from court has jurisdiction over its claims.”

O&P made their voices heard. Medicare This is a disappointing result, and apparently did realize we would not obviously, not the one for which we had hoped. While AOPA informed members go silently into the night. So, while the court has ruled against our case, AOPA before filing suit that the odds are and its members have stood firm in always slim when suing CMS, nevertheinsisting that Medicare follow proper less, the Board of Directors felt no processes, and if Medicare actions in stone should be left unturned in trying recent weeks are an indicator, we have to stop the horrendous RAC audits. won a principle. AOPA felt compelled Despite knowing that the odds would to do anything that it could that might be against us, 347 members voluntarily have helped avoid the more than 100 contributed to the Heritage Club fund business closings that have ensued, to help defray the litigation cost.

Of course, AOPA respects the court’s and secure fairness for members, even knowing the road to success would likely decision but remains unwavering in be difficult. AOPA will continue to use the belief that the case needed to be all available tools, including advocacy filed, and that it has positive outcomes.

AOPA and its members are true patriots in the legislative, regulatory, and judicial sectors to restore fairness for our in the sense of our belief in the proper member health-care professionals and government processes. The fact still the Medicare amputees they serve. stands that Medicare did not follow For more information on the the proper processes to change the court ruling, visit http://bit.ly/ rules on prosthetists and their patients, CourtRulingAOPA. Contact AOPA and though the court concluded that at 571/431-0876 or via email to Steve Medicare had upped enforcement but Custer at scuster@AOPAnet.org. not changed policy, we cannot agree.

DIABETES DOWNLOAD

Two Drugs Better Than One? A clinical trial testing a combination therapy of two drugs in treating patients with type 1 diabetes is showing some promise in preserving beta cell levels. Led

by Alex Ravinovitch, MD, chair of the Sanford Project, a research team explored whether two FDA-approved drugs, sitagliptin and lansoprazole, could regenerate beta cells in humans by improving levels of GLP-1 and gastrin hormones. Type 1 diabetics experience a loss of insulin-producing beta cells and need to inject insulin into their bodies manually.

Sixty-nine participants between the ages of 11 and 36 received either the two drugs or a placebo while continuing their insulin injections. The group receiving the drugs did not experience an improvement in insulin production, but some study participants whose GLP-1 and gastrin levels increased may have better preserved beta cell levels.

“It is promising that some of the participants seemed to have preserved beta cells that may have otherwise died,” says Rabinovitch.

His team will lead another clinical trial to explore why responses to the sitagliptin and lansoprazole differed among participants.

The Sanford Project is an emerging translational research center focused on targeted diabetes research, cures, and care.

Full results from the study are published in the July issue of The Lancet Diabetes & Endocrinology.

O&P Almanac | AUGUST 2014

11

HappeningS

#ICYMI

House Committee Explores Medicare Appeals Reform

MEETING MASHUP

O&P in Madrid The Spanish Federation of Orthopaedics (FEDOP) invites AOPA members to attend Orto Medical Care 2014, Nov. 20-21, 2014 in Madrid, Spain.

FEDOP has created a wonderful agenda that includes airport transfers, tours, dinner with the FEDOP board, and much more. If you are interested in learning more about this special invitation, please contact info@AOPAnet.org or fedop@fedop.org.

This is a great opportunity to attend an international show and visit Madrid, Spain.

12

AUGUST 2014 | O&P Almanac

Rep. Tammy Duckworth (D-Illinois) suggested during the hearing that Medicare audits have been disproportionately unfavorable to the O&P industry, particularly because reviewers at lower levels do not consider an O&P professional’s notes in their determinations. Griswold replied that, as a general rule, OMHA reviews the same documentation as lower-level reviewers.

Visit www.aopanet.org for details and to see a video of the July 10 hearing.

RESEARCH TRENDS

Spinal Stimulation: Treatment for Paralysis?

Patients with severe injuries to their spinal cord have reason for hope: A new study has shown electrical stimulation of the spinal cord may assist patients in moving previously paralyzed muscles.

Four spinal cord injury (SCI) patients are now able to voluntarily move paralyzed muscles as a result of an electrode array implanted over their spinal cords. The patients, who included two individuals with complete motor and sensory paralysis, and two with complete motor paralysis but some ability to experience sensation below their injury, underwent treatment at the University of Louisville’s Kentucky SCI Research Center. Within a few days, patients regained some voluntary control of previously paralyzed muscles and were able

to voluntarily flex their toes, ankles, and knees. Other benefits included better bowel and bladder control and improved blood pressure, even when the device is switched off.

“The fact that the brain is able to take advantage of the few connections that may be remaining, and then process this complicated visual, auditory, and perceptual information … tells us that the information from the brain is getting to the right place in the spinal cord, so that the person can control, with fairly impressive accuracy, the nature of the movement,” says researcher V. Reggie Edgerton, PhD. Additional research is planned.

The research was funded in part by the National Institutes of Health and the Christopher & Dana Reeve Foundation.

PHOTO: www.ortomedicalcare.com

ORTO MEDICAL CARE 2014 FEDOP Cristina Mora Tel.: +34 915 716 640 Email: periodista@fedop.org Web: www.fedop.org

The House of Representatives’ Oversight and Government Reforms Subcommittee on Energy Policy, Health Care, and Entitlements held a hearing in July on Medicare mismanagement.

Part of the discussion focused on the fallout from the January announcement by the Office of Medicare Hearings and Appeals (OMHA) that it had suspended action on new requests for hearings for two years.

During the hearing, Chief Administrative Law Judge Nancy Griswold explained that OMHA was originally established to improve service to appellants and to reduce the average waiting time for hearing decisions.

Griswold maintained that OMHA met the 90-day time frame required for most appeals until FY 2013, when there was a 545 percent growth in appeals.

People & Places Professionals TRANSITIONS

14

AUGUST 2014 | O&P Almanac

Ottobock’s C-Leg 15-Year Anniversary Photo Contest.

Kevin Flatt of Cookeville, Tennessee, has been named the first winner of Ottobock’s C-Leg 15-Year Anniversary Photo Contest. The contest asks users of C-legs or other prostheses to submit photos or videos showing how the device has changed their lives. Flatt’s photo captures him rock climbing with his daughter. Additional winners will be selected once a month through November 2014.

Brian Long will head the new Midwest Region of Ottobock, which will cover Montana, North Dakota, South Dakota, Minnesota, Iowa, Missouri, Kansas, Oklahoma, Texas, Louisiana, Mississippi, and Arkansas. The new region is the Brian Long result of a realignment of Ottobock’s technical orthopedic sales regions from three to four U.S. regions.

PHOTO: Ottobock, Brian Long

Hanger Clinic has welcomed a number of clinicians to its patient-care clinics: Eric Bejarano, CPO, has been hired at the Naples, Florida, patient-care clinic.

David Blaisdell, CPO, has joined the Richland, Washington, patient-care clinic.

Jonathan Bowman, CPO, has been hired at the Pittsburgh, patient-care clinic.

Carl Brenner, CPO, has joined the Waterford, Michigan, clinic.

Joseph Brenner, CP, has joined the Waterford, Michigan, clinic.

Robert Brown Jr., CPO, has been hired as clinic manager at the Panama City, Florida, clinic.

William Cox, CPO, has joined Hanger’s Salinas, California, patient-care clinic as clinic manager.

Paul Dixon, CPO, has been hired at the Sugar Land, Texas patient-care clinic.

Hilary Engelhardt, CPO, has been named area clinic manager of the Seattle patient-care clinic.

Collins Freitas, C.Ped, has joined the staff of the Olympia, Washington, clinic.

Paul Guimond, CO, has been hired at the Nashua, New Hampshire, patient-care clinic.

Bryant Gulde, CPO, is a new hire in the Sheridan, Wyoming, patient-care clinic.

Edgar Hernandez, CP, has joined the Stockton, California, patient-care clinic.

Duane Hoeppner, BOCO/C.Ped, is a new hire at the Jackson, Michigan, patient-care clinic.

Michele Jacobs, CO, has joined the patientcare clinic in Antioch, California.

Karen Kilmer, CO, C.Ped, has been hired at the Richmond, Virginia, clinic.

Linda Kline, C.Ped, has joined the staff at the Mansfield, Ohio, patient-care clinic.

John Laslo, CP, has joined the Williamsport, Pennsylvania, clinic.

Anthony Leier, BOCPO/CO, has joined the St. Louis, clinic.

Michael Link, CP, has been named clinic manager of the Reno, Nevada, clinic.

Melissa Malkush, CPO, is a new hire in the San Diego, California, patient-care clinic.

Andrew Mathias, CPO, has been hired at Henderson, Nevada, patient-care clinic.

Derek McClure, BOCPO, has joined the staff at the American Canyon, California, patient-care clinic.

Phil Meyers, CP, has been hired at the Lancaster, Pennsylvania, patient-care clinic.

Barry Minor, CP, has been hired at the Mayfield, Heights, Ohio, patient-care clinic.

Brian, Moore, CPO, has joined the staff at the Covington, Louisiana, patient-care clinic.

Maureen O’Toole, C.Ped, has joined the Pittsburgh, patient-care clinic.

Danica Reding, CO, has joined the Riverside, California patient-care clinic.

Evelyn Rizzo, CO, has joined the Westlake, Ohio, patient-care clinic.

Douglass Wacker, CPO, has joined the staff of the San Antonio, clinic.

Kevin Warner, CP, has been hired at the Lancaster, Pennsylvania, patient-care clinic.

Alicia Young, CPO, has joined the Columbus, Ohio, patient-care clinic.

Kevin Zang, BOCP/CO, C.Ped, has joined the Portland, Oregon, patient-care clinic.

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PEOPLE & PLACES

BUSINESSES TRANSITIONS

Ability Prosthetics & Orthotics and its president/owner, Jeffrey Brandt, CPO, have endowed the Orthotic & Prosthetic Activities Foundation’s (OPAF’s) Dale Yasukawa Scholarship for 2014. OPAF recently announced the winner of the 2014 scholarship: Brianne Bergeron, who will graduate from Northwestern University O&P Center in March 2015.

OPGA, a division of VGM Group Inc., has announced that VGM Group Inc. and the van Halem Group LLC have merged in an effort to both prevent and respond to audits. The van Halem Group is a Medicare consulting and auditing firm that assists clients with compliance, audits, investigations, medical review, appeals, and more. The group is now a division of VGM.

Aetrex, a comfort and wellness footwear products company, has formed a partnership with Justin Blair & Co., a manufacturer and supplier of foot and shoe care products. The partnership will promote research and the advancement of orthotic and foot wellness technologies and materials.

Brianne Bergeron

The Amputee Coalition has been awarded 2014 Apex Awards of Excellence for its Facebook page and its publication, “First Step: A Guide for Adapting to Limb Loss.” The guide is published by the National Limb Loss Resource Center and is aimed to meet the needs of those who have experienced limb loss and their caregivers.

Curbell Plastics has donated $18,000 of plastic that will be used by Alabama high school students to create lightweight, removable prosthetic limbs for amputees in Honduras.

Hanger Inc. has donated $100,000 to establish the 2014-2015 Hanger Kids Scholarship to Camp No Limits, a nonprofit camp for children with limb loss of limb difference. The donation will fund 100 scholarships of $1,000 each, to cover the cost of attendance, lodging, meals, and activities for 100 participants and accompanying parents or guardians. Scholarship applications are available at www.Hanger.com/CampNoLimits.

PHOTO: The Orthotic and Prosthetic Activities Foundation

The National Commission on Orthotic and Prosthetic Education is seeking nominations to its board of directors for the Jan. 1, 2015, through Dec. 31, 2017, term.

Nomination forms are due by August 31.

The Orthotic and Prosthetic Activities Foundation hosted five wheelchair tennis clinics across the Carolinas.

The Orthotic and Prosthetic Activities Foundation hosted five wheelchair tennis clinics across the Carolinas.

More than 50 participants and 100 volunteers were in attendance at the clinics, which were led by Paralympic player and coach Karin Korb.

Orthocare Innovations and Ottobock have announced a partnership to bring unique, advanced prosthetic technologies to patients worldwide.

Currently, comprehensive laboratory and patient testing are underway in preparation for new products to come to market. Orthocare Innovations has developed lower-limb prosthetic applications, including the first with integrated mobile connectivity features, which are applicable as stand-alone systems or integrated into a larger prosthetic system.

Ossur has partnered with the Challenged Athletes Foundation to present the 2014 Mobility Clinics, a series of six free, specialized workshops to assist participants in walking and running. Renowned amputee gait training experts Bob Gailey, PhD, PT, and Peter Harsch, CP, will lead the clinics. Participants will also learn from local O&P professionals and world-champions athletes.

Scheck & Siress Prosthetics Inc. opened a new Chicago patient-care office in Hyde Park, Illinois, in July. The office is managed by Thomas O’Doherty, CP, and Ashley Zinnamon, CP. O&P Almanac | AUGUST 2014

17

reimbursement Page

by Devon Bernard

Studying Up on 6 Supplier Standards Exemptions and exceptions for some O&P providers

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

After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

E! Q UI Z M Earn

2

Business CE

Credits P.20

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AUGUST 2014 | O&P Almanac

T

he Supplier Standards for

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) are rules that you may only think about occasionally, but they should always be on your mind. The standards have become a tool for Medicare to curb and combat fraudulent activities.

Strengthening the Standards

In 2007, the Office of the Inspector General (OIG) conducted a review of 905 DMEPOS suppliers, who billed $245 million in claims, focusing on only two of the Supplier Standards. The OIG found that 22 percent of the facilities failed to meet one or both of the standards selected for review. Because of these findings, the OIG suggested in its annual report that CMS toughen up its enrollment process to ensure that all suppliers are meeting the standards.

This suggestion to intensify the enrollment procedures and compliance with the Supplier Standards was reinforced with subsequent findings and culminated with the release of the Patient Protection and Affordable Care Act (ACA) in 2010. The ACA strengthened the enrollment screening process for all Medicare, Medicaid, and Children’s Health Insurance Plan providers, including DMEPOS suppliers. The final rule implementing the provisions of the ACA, which established procedures under which screening is conducted for providers and suppliers in the Medicare program, was released in February 2011.

The June 2014 Reimbursement Page article briefly discussed these strengthened Medicare enrollment procedures for DMEPOS suppliers, and focused on those procedures related to “high-risk”

suppliers. This issue’s Reimbursement Page focuses on procedures and enrollment requirements that affect all DMEPOS suppliers, regardless of their designated risk category.

Though there are 30 Supplier Standards, this article will focus on those six that tend to confuse suppliers or site inspectors because they assume these standards always apply to O&P providers. Knowing which standards apply to your particular O&P facility and how they apply to your practice can be the difference between a successful site visit or an unsuccessful site visit—and possibly a delay in receiving a Medicare supplier number or the revocation/suspension of a current Medicare supplier number.

Supplier Standard 1: A supplier must be in compliance with all applicable federal and state licensure and regulatory requirements. This standard ensures that a supplier is in compliance with all applicable federal and state licensure and regulatory requirements.

Therefore, you must obtain all of the proper local and state tax licenses, and make sure you are licensed if you are in a state that requires licensure. Take the time to make sure your insurance is up to date and for the proper amounts.

Review all of your accreditation materials, if required, and certifications, and make sure they are still active.

If you are in a licensure state, check that all of your state licensure information is current. If you are unsure what type of licensure your state requires, you may visit the National Supplier Clearinghouse (NSC), the contractor in charge of enforcing the Supplier

REIMBURSEMENT PAGE

Standards, its website, and the licensure database available at www.palmettogba. com; this will be the information the inspector will be using during his or her visit. Even if you feel confident, you may want to visit the licensure database and double-check the information, just to make sure it is accurate. If the database incorrectly lists that you require a specific license, you will need to get the site updated before your visit, or determine if something has changed and you now require a license.

When the Supplier Standards were modified and expanded in 2010, Standard 1 was updated to officially eliminate the use of contracted employees to provide licensed services; however, the standard does have some wiggle room. CMS and the NSC have stated that contracting is considered acceptable for DMEPOS suppliers unless they are in a state that specifically prohibits contracting. If you use contracted employees, be sure you can demonstrate to the inspector that your state doesn’t prohibit the use of contracted employees.

PHOTO: Thinkstock/Purestock

Supplier Standard 4: A supplier must fill orders from its own inventory or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any state health-care programs, or from any other federal procurement or nonprocurement programs. According to this standard, you must be able to demonstrate that you have an adequate inventory on hand or the ability to obtain an adequate inventory to fill/complete orders, based on what you indicated you are providing to beneficiaries. This does not mean that you have to have formal contracts with all of your vendors; you may have a formal contract, a purchasing agreement, or a credit letter. Whichever document you have, it should contain, at minimum, these specific items: an established credit limit, credit terms, both companies identified in the terms, and the length of the contract or agreement. Be sure that

Prepping for a Site Visit Below are some suggestions to help your facility prepare for a visit from a site inspector:

3

Be sure everyone on staff knows what to do when an inspector arrives: Can any staff member interact with the inspector, or do you have one main contact person? Does everyone on staff know who the main contact person is and how to get in touch with that person? If all staff can deal with the inspector, does everyone know where the pertinent documentation and licenses are located?

3

Make sure that all of your company’s policy and procedure manuals are up-to-date and are being followed. Take a moment to review the company’s policies and procedures with all of your employees.

this agreement is up-to-date and on file, just in case the inspector asks to see it.

Also, this standard states that you may not contract with any entity that is currently excluded from the Medicare program. To ensure that a company you have contracted with is not excluded from Medicare, or any other federally funded program, you should check the OIG exclusion list, www.oig.hhs.gov/fraud/exclusions.asp.

Supplier Standard 19: A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility. To be compliant with Standard

19, you must go beyond just having a log. You must have a written procedure outlining how you handle complaints, or at least be sure that all employees know the protocols for handling complaints. The protocol doesn’t need to be elaborate; it can be simple and straightforward as shown in the below sample text from the NSC website: “The patient has the right to freely voice grievances and recommend changes in care or services without fear of reprisal or unreasonable interruption of services. Service, equipment, and billing complaints will be communicated to management and upper management. These complaints will be documented in the Medicare Beneficiaries Complaint Log. All complaints will be O&P Almanac | AUGUST 2014

19

REIMBURSEMENT PAGE

handled in a professional manner. All logged complaints will be investigated, acted upon, and responded to in writing or by telephone by a manager within a reasonable amount of time after the receipt of the complaint. If there is no satisfactory resolution of the complaint, the next level of management will be notified progressively and up to the president or owner of the company.”

This log and protocol must be kept at each physical location where you are treating patients, or which may be inspected, and should be readily available to the inspector.

Supplier Standard 22: All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services for which the supplier is accredited in order for the supplier to receive payment for those specific products and services. This standard is a little tricky. There is currently an exemption for O&P providers from having to be accredited. However, this exemption only extends to orthotists and prosthetists. If you are a pedorthist, an orthopedic fitter, or a mastectomy fitter working independently of an O&P company, you must be accredited.

This exemption for orthotists and prosthetists only applies to items provided in the normal scope of the supplier’s/provider’s specialty. Any items provided outside of his or her specialty will require accreditation.

If you are providing any type of DME items (e.g., dynamic splinting, the WalkAide, the Bioness, canes, crutches, etc.), you would not be fully exempt and you would have to be accredited for these items. In other words, you would not have to be accredited for the O&P items, but you would have to be accredited for the DME items; there is not a blanket exemption just because you are an orthotist or prosthetist.

Supplier Standard 26: A supplier must meet the surety bond requirements specified in 42 C.F.R. 424.57(c). There is the possibility 20

AUGUST 2014 | O&P Almanac

To view the complete list of all 30 standards and how the NSC and the inspector interpret them, visit the NSC website, www.palmettogba.com/nsc that you may be exempt from having to obtain a surety bond since there is an exemption for certain entities providing custom O&P. How do you know if you are exempt from having to meet Supplier Standard 26?

• You don’t need a surety bond if O&P professionals solely own the facility. This means that anyone listed as having any ownership stake in the company must be a certified orthotist and/or prosthetist.

• You don’t need a surety bond if you are providing custom orthotic, prosthetic, and supply items.

You don’t have to solely provide custom items; you may still provide prefabricated items and maintain the surety bond exemption.

• If you are in a state that requires licensure, you must be licensed.

Keep in mind, for the purposes of the surety bond exception, supply items are those items that are related to the provision of custom-fabricated O&P items. If the supply item is not a part of or related to the provision of a custom O&P item, then it is not a supply and there is no exemption. For example, if you are providing diabetic shoes and they are not part of a custom brace, then you are not exempt from the surety bond requirement.

If you are exempt, you will need to be able to explain why you are exempt in case a site inspector asks to see your surety bond documents.

Supplier Standard 30: A supplier must remain open to the public for a minimum of 30 hours per week.

Supplier Standard 30 is another standard that carries a possible exemption for O&P providers, especially those providing custom-fabricated prostheses and orthoses.

To qualify for the exemption, you must have indicated on your enrollment application that you provide one or more of the following items/ services to Medicare beneficiaries: breast prostheses and/or accessories, cochlear implants, diabetic shoes/ inserts, eye prostheses, facial prostheses, limb prostheses, ocular prostheses, orthoses—custom fabricated, prosthetic cataract lenses, somatic prostheses, and/or voice prosthetics.

The only other items/services that may be provided with these listed exempted services/items and still qualify you for the exemptions are noncustom or prefabricated orthotics and prosthetics. If you are providing any other items/services, the exemption no longer applies and you would have to be open at least 30 hours a week.

Know All of the Standards

The six standards described in this article are only a sampling of the 30 standards and how they may be interpreted during a site inspection—and what you can do to ensure compliance with the standards. To view the complete list of all 30 standards and how the NSC and the inspector interpret them, visit the NSC website, or contact AOPA with a specific question.

Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@aopanet.org.

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This Just In

A Hard-Line Approach to OTS

Take a stand now, or these rules could impact your business and limit patients’ access to care

By Adam Stone

Support your O&P business by responding to CMS. Comments will be accepted through Sept. 2, 2014, and may be submitted at: http://aopavotes.org/ forms/submit-commentson-ots-orthotics-.

A

s we roll into fall, the CMS is

undertaking a new round of rulemaking. The latest proposed changes could once again have a significant impact on the O&P community.

Foremost among the new rules being considered by CMS is an effort to define the scope of individuals authorized to fit orthotic products deemed

by CMS to be off the shelf, or OTS and indirectly the rule limits who can provide custom fitted orthoses. The outcome here will have direct consequences on the way services are billed and reimbursed.

Practitioners and others with an interest have until September 2 to voice their comments on the changes. “For the O&P profession, it will be advantageous for people to be engaged in this and to submit comments to CMS,” says AOPA Executive Director Thomas F. Fise. AOPA will hand deliver all of the AOPA member comments to CMS prior to the deadline—submit comments here: http://aopavotes.org/forms/ submit-comments-on-ots-orthotics-.

How We Got Here

To appreciate the potential impact of the new rulemaking, it helps to step back and consider CMS’s previous efforts to direct the O&P landscape.

A decade ago, CMS was given 22

AUGUST 2014 | O&P Almanac

statutory authority to generate competitive-bidding rules with respect to OTS orthotics. This effort generated two important protections for O&P practitioners. First, it was established that CMS would restrict competitive bidding to devices specified on an OTS list. Second, Congress went on to set out a very particular definition of OTS, stipulating that anything designated OTS must be adjustable by the patient, i.e. “with minimal self adjustment.”

In generating the rules in 2006 and 2007, however, CMS sought to significantly broaden this definition.

Rulemakers essentially defined OTS as anything that would be adjustable by the patient, caretaker, or supplier.

AOPA has long considered this an inappropriate interpretation of the will of Congress, one that goes well beyond the statutory definition.

“It became pretty obvious that they were pressing to go beyond what Congress had set forth, and each step that you go makes it a bit more egregious,” Fise says.

In the intervening years, AOPA has lobbied vigorously to keep O&P professionals off of what is clearly a slippery slope. To see how the impact of a definition may ripple out, let’s suppose a 97-year-old Medicare beneficiary is living with her daughter, and the daughter can adjust an orthotic device.

This Just In

In a vacuum, this might be an acceptable use of the term OTS. But such uses could easily set a precedent that sends OTS far beyond the initial meaning of self-adjustable.

In fact, this is just what has occurred over time, so that today’s CMS definition of OTS “goes well beyond what most people—either physicians or patients or orthotists—would consider to be truly off the shelf,” Fise says.

To push back against such steps, AOPA has submitted significant, substantive evidence documenting the inappropriateness of present definition and the device list CMS has generated based on that expanded definition, but CMS has held fast to its positions.

Along the way, CMS has failed to provide any scientific support for its OTS list, and largely ignored the literature citations submitted in comments.

Making a List

CMS’ list of roughly 60 OTS devices includes some two dozen items, which in some instances are considered OTS and in other instances the same device would require custom fitting. This ambiguity sets the stage for O&P to find itself the undeserving subject of scrutiny in its billing practices. “What’s going to happen is, when people bill for the custom-fitted device, CMS is going to challenge them. There is going to be an audit fight over whether the OTS would have been sufficient,” Fise says.

Ambiguity is an enemy here. For example, today CMS generally is paying on the basis of a device plus related services, but it’s pushing to bill an increasingly broad range of devices as OTS, which would likely eventually reimburse at a lower rate. For now, practitioners are paid the same regardless of whether the device is OTS or custom fitted. But that won’t last.

Two years down the road, CMS may be demanding that these same devices be billed as OTS, and many practitioners will take the path of least resistance and bill at the lower rate. This creates a gap—what was once custom is now OTS—and CMS will likely use

this definition to justify audits of past billings, in addition to paying practitioners at the lower OTS rate for the same devices. “They may start paying only the lesser amount, just as if there was no service being delivered,” Fise says.

Who’s Authorized?

Against this backdrop, the latest round of rulemaking seeks to establish a new set of definitions—this time in regard to the types of persons who can provide OTS and custom-fitted devices.

Under the proposed rule, OTS and custom-fitted devices can be fitted by certified orthotists, physicians, physical therapists, and occupational therapists. In addition, CMS intends to preclude all others, whether certified orthotic fitters—individuals who have been trained and certified by the accrediting bodies, orthotic assistants or manufacturer reps and some personnel in physician offices from being paid for providing customfitted devices. These individuals won’t provide custom-fitted devices, but will be able to fit OTS devices.

(Yes, you read that correctly: It makes no sense. Why would a certified or licensed orthotic fitter want to be limited for fitting a device that, by statutory definition, does not require fitting or adjustment? “You have been certified to do something which the law says doesn’t need to be done. Enjoy your career,” Fise says.)

CMS says this regulation is all about defining OTS and “minimal self-adjustment,” but the reality is that these rules would set new strictures on who can

bill for customized orthotics. It also goes beyond a well-established rule that gives accrediting bodies the power to set the standard for practice. In fact, CMS is disregarding statute, taking for itself the right set standards and bypassing both the accrediting organizations and state licensure authorities.

“Certified fitters” are a two-edged sword. Consider this analogy: Nurse practitioners can write prescriptions, which is helpful to physicians. It saves time and money, and it allows doctors to focus on other aspects of their practice. Now suppose payers declared that only nurse practitioners would be paid for writing prescriptions and if the doctor did write them it would be reimbursed at a lower rate? Suddenly the practice is losing money.

Are certified fitters a good thing for O&P practices? Similar to the above, they free up the specialists to do more specialized work. Practitioners can treat more people more efficiently and more cost effectively. But the work when being done with and under the supervision of the certified orthotist should still be billed at the orthotist’s rate. As CMS attempts to define these roles and functions, it has underestimated the importance of that “supervision.” This is a significant and difficult definitional problem, and one that needs to be remedied.

It will likely take several months for CMS to formulate the final version of the rules now on the table. In this period, rulemakers should be taking into account input from various stakeholders, especially those practitioners who work daily to improve patients’ quality of life and who are best positioned to understand the significance of these changes.

With this in mind, it becomes especially important for the O&P community to weigh in before the close of the comment period at http://aopavotes. org/forms/submit-comments-on-otsorthotics-.

Adam Stone is a contributing writer to the O&P Almanac. Reach him at adam. stone@newsroom42.com.

O&P Almanac | AUGUST 2014

23

DANCING MACHINE

AOPA National Assembly speakers discuss the behind-the-scenes making of a personalized bionic device for dancing

By Meghan Holohan

Need to Know Adrianne Haslet-Davis will be the general session opening keynote speaker at the 2014 AOPA National Assembly.

She will present “The Road to Recovery and Discoveries Along the Way” at 7:30 am on Friday, September 5.

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AUGUST 2014 | O&P Almanac

PHOTOS: Hugh Herr, PhD

Together with Mike Corcoran, CPO, Hugh Herr, PhD, will present “Design and Clinical Impact of a Powered Ankle Prosthesis” at 3:30 pm on Friday, September 5.

COVER STORY

AOPA’s

national

assembly ’14

A

PHOTOS: Photo: TED/James Duncan Davidson, AOPA

little more than a year ago, Adrianne Haslet-Davis and her husband Adam Davis were walking to watch the runners competing in the 2013 Boston Marathon. The two had just finished a breakfast at home, enjoying each other’s company. Davis had recently returned from a tour in Afghanistan, and they were happy to have a day together.

They stopped to watch the marathon on Boylston Street when an explosion hit.

“We were walking and all of a sudden the first one went off,” Haslet-Davis says. “And after the second one [I knew something was wrong].”

Shrapnel hit Davis’ legs, causing blood loss, but he realized that his wife’s injuries were more severe and tied his belt around her leg to stanch the bleeding. Despite everything he, first responders, and doctors at Boston Medical Center did, they could not save her left foot.

For Haslet-Davis, the resulting below-the-knee amputation could have been career ending. As a professional ballroom dancer and instructor, she typically danced five or six days a week for up to 10 to 12 hours. How could she maintain such a rigorous schedule after losing part of her leg and foot? But only a week after her amputation, Haslet-Davis told CNN’s Anderson Cooper she would dance again—and she’d teach him.

“It was in that interview with Anderson Cooper when I said I wanted to return to dance. I doubted myself [but] I always wanted to go back to it and be able to return to the thing that I loved,” she says.

“I knew it would be one of the hardest things I have ever done. It still is.”

O&P Almanac | AUGUST 2014

25

COVER STORY

The Science of a Spin

As a researcher and head of biomechatronics at the nearby Massachusetts Institute of Technology, Hugh Herr, PhD, saw many of his neighbors and runners suffering after the bombings, which killed three people and injured 264 others. Of the injured, 15 had limbs amputated and Herr knew that as an expert in bionics—and a double amputee himself—he was in the unique position to help.

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AUGUST 2014 | O&P Almanac

approximately the same weight and size as a biological limb presents many challenges. For one, the battery and motors for these prosthetic devices can be problematic as well. Many times they run out too early, meaning people need to charge them at inconvenient times, he explains.

“Motors today are not typically as good as biological muscle tissue,” he says. “[Bionics] is pushing current technology to its absolute limits.”

When he heard Haslet-Davis’ story on TV, Herr believed that he could help her dance again with a specially designed ankle and calf that move like a biological one.

“I saw some parallels between her life and my life. I was passionate about rock climbing, that [was] my athletic endeavor of choice starting at age 7 until my accident at 17,” Herr says.

“I certainly understood and related to Adrianne’s desire and passion to return to the dance floor.”

Creating such a device is no simple task, but Herr had the experience to do it. Enter the BiOM T2, a commercially available powered ankle-foot prosthetic device. Since 2010, Herr’s company, BiOM, has sold the technology to about 900 people worldwide, including 400 veterans.

PHOTOS: Webb Chappell, Hugh Herr

Hugh Herr, PhD

“These weeks since the bombing, I have been acutely aware of the physical challenges facing the individuals who lost their legs,” Herr wrote in an essay in the Wall Street Journal following the bombings. He recounted how he lost both of his legs to frostbite after being stranded on a mountain in negative 20-degree weather for several days in 1982. “After the accident, I dreamed of mountain climbing again.

But, how?”

Herr’s answer was to design a pair of prosthetic legs to help him scramble across rocks and balance on tough terrain. The feet had “high toe stiffness” to help him balance on small rocks and “titanium spiked-feet,” which allow him to scale ice.

“I was very successful in that after a short time, I climbed at a more difficult level than prior to the accident,” he says.

Since then, Herr has become a leader in the field of bionics, creating assistive limbs that move like biological ones by using technology to work with the body. “Design is always challenging. It takes a lot of thought, a lot of iteration, a lot of patience,” he says.

“Designing hardware that works in the real world is never easy.”

Creating a bionic limb that is

COVER STORY

Developed over many years, the device works through “bionic propulsion,” which uses two microprocessors and six environmental sensors to mimic natural movements. The sensors and microprocessors fire thousands of times per minute to harness ankle stiffness, power, and positioning to create a fluid gait, starting with the heel strike that absorbs excess energy to propel the tibia forward. Algorithms control the power, which changes based on the terrain.

The physical device pairs with Personal Bionic Tuning. This software helps people using the BiOM T2 adopt a natural stance and balance, while enabling them to walk at a pace that matches the speed of an able-bodied person.

“It’s the first leg prosthetic in history that normalized walking speed … [it] eliminates limping,” Herr says.

“It is fairly common in the fitting after receiving the BiOM T2 that the patient says things like, ‘I have my leg back’ … the fittings are often very emotional. It is amazing to witness.”

While the device reduces limping, it also prevents wearers from feeling too

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Hugh Herr, PhD, at TED 2014

when she spun around, logging all the different motions, which were later analyzed to create a limb that moved like a dancer’s biological ankle. “[You] are primarily upright when you walk. Dance doesn’t operate on a single plane. It is more complex than that. It is kind of three-dimensional,” Herr says. “For walking, you don’t do something like spin on your toe.”

As a result, Herr and his team needed to adapt the BiOM T2 and its software to respond to the various leg positions important in dance.

“The dance leg would sense that the dancer is spinning on their toe on a vertical axis,” Herr says. This device makes the ankle stiffer to allow the leg to hold the spin. But creating this movement proved to be a challenge to the researchers who had a device that knew how to control a heel strike, common to walking, but couldn’t sustain a dance move.

“It’s different. It has a different brain,” says Herr. “It was interesting intellectually because we could tackle something that is more diverse in terms of motor pattern. In the long term, we are interested in developing a prosthetic that adapts to [unusual motion].”

Understanding the movements of

PHOTOS: TED/Ryan Lash, TED/James Duncan Davidson

Adrianne Haslet-Davis at TED 2014

fatigued. Additionally, it lessens some of the strain on the knees, reducing secondary muscle problems that often crop up from wearing a lower-limb prosthetic device. Still, it wasn’t quite enough to help Haslet-Davis.

“The BiOM T2 is optimized for walking and walking, of course, is very different than dancing,” says Herr.

Creating a bionic prosthesis that could handle a rumba or a foxtrot required more testing and design. “As a research project, we changed the programming [so] it would be appropriate for certain forms of dance.

A typical strategy is to study how normal physiology moves and the forces they create and… that science informs the design of the prosthetic,” he says.

To do this, one of Haslet-Davis’ ballroom dancing colleagues visited the lab and danced, while wearing sensors.

She was about the same height and weight as Haslet-Davis and displayed commensurate dancing talent. As she danced in the lab, the devices recorded the amount of pressure exerted during different movements. For example, the researchers collected data about how her ankle moved and stiffened

COVER STORY

a waltz, for example, might help Herr to create a leg that naturally adjusts to the challenges of walking over uneven ground or simply enable more natural leg motions.

Dancing Again

After gathering all of the data, the team modified the leg and asked Haslet-Davis to try it on so it could be customized to her body. While it initially fit well, the real test was dancing with it.

As she practiced, she noticed that in some cases the device felt too stiff.

At other times, she’d need it to turn a certain way and it wasn’t able to do it.

Ongoing adjustments were needed.

“It was really incredible. I think the biggest challenge was trying to compliment them without saying it is not my real leg,” says Haslet-Davis, who explains that during the testing she was in the phase of recovery where she felt conflicted because she no longer had her biological limb.

But dance she did.

In March of 2014, during Herr’s TED Talk about the future of bionics, Haslet-Davis and professional dancer Christian Lightner danced a rumba to Enrique Iglesias’ “Ring My Bells” wearing the BiOM T2 leg developed for dance. She ably conquered intricate footwork and even a deep knee dip.

In only 200 days, Herr’s lab created a leg that allowed Haslet-Davis to dance again.

“I find joy out of dancing. There are also frustrating times when I think I have muscle memory there … and it doesn’t work,” she says.

These days, Haslet-Davis now dances about two hours a day with a different prosthetic limb. Her experience with Herr’s limb was to help them develop an experimental limb that can tackle a wider range of motions. If a company opts to develop and produce the dancing limb, she hopes to be one of the first to use it. She wishes she could dance for longer periods of time,

Ferrier Coupler Options!

but it is sometimes difficult on her tibia bone. The dance leg designed by Herr is undergoing further testing and development.

“The reason we designed it was that somebody some day could [dance with] it,” she says.

Herr says the leg shows how far bionics have come and how far they have yet to go. “Bionics are really starting to change how humans interact [with prosthetic devices],” he says.

While some days feel frustrating, Haslet-Davis keeps dancing, joking that she is stubborn and that keeps her motivated. But she also hopes that people learn from her experience.

“I want people to be inspired by my flaws because I am not recovered. I want people to be inspired by the fact that I get up and do what I do,” says Haslet-Davis.

Meghan Holohan is a contributing writer to O&P Almanac. Reach her at meghan.e.holohan@gmail.com.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.

Model A5

Model F5

Model P5

The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component.

The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

Model FA5

Model FF5

Model FP5

NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern.

Female portion of coupler accepts a pyramid.

Model T5

NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.

NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.

The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb.

The unit is waterproof and has a traction base pad.

O&P Almanac | AUGUST 2014

29

Race to Parts

Unknown

New componentry left you flatfooted?

Industry experts offer suggestions for clearing the high-tech hurdles to adoption

By Christine Umbrell

Need to Know

Some manufacturers have begun “bundling” training services into product purchases with new componentry.

A handful of manufacturers are considering initial reimbursement risk sharing, fee-based advanced reimbursement assistance, and device rental programs to assuage practitioners’ cost and reimbursement concerns.

Due diligence in researching a product you are considering, and conversations with other clinicians who may have tested the device, can help ensure you don’t make a guinea pig out of your patient.

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AUGUST 2014 | O&P Almanac

PHOTO: courtesy of Ottobock

Most manufacturers offer training options—website downloads, webinars, or in-person training sessions—to help familiarize practitioners with their new releases, and to explain how the devices should be fit and used properly.

Ottobock trainers work with practitioners to educate them on new products.

FEATURE: RACE TO PARTS UNKNOWN

I

n the race to provide the most appropriate component for your patient, the menu of options has never been wider. While traditional orthoses and prostheses continue to fill the need for many patients and treatment plans, an ever-increasing number of new and higher-tech devices hits the market each year.

So how do you keep up with the latest componentry and decide whether to include new devices in your patient offerings?

“To go beyond status quo, you need to think outside of the box,” says Marc Kaufman, CPO(L), area clinic manager for Hanger Clinic’s Atlanta facility.

“Patients are interested in knowing about the newest technology. To do the best you can and best meet their needs, when they are a candidate for new technology, it’s important to offer them the components that are most clinically appropriate for them.”

“You have to ultimately fit what’s right for the patient,” and sometimes that means a new component that may not be familiar to you, agrees Karen Lundquist, Ottobock’s director of communications. “Clinical appropriateness needs to trump all else.”

But how can you get past the fear of the unknown to fit a patient with a new device? Understanding some of the hurdles to adoption—and how to overcome them—can help you make treatment decisions that are in the best interest of your patients.

Hurdle 1: Complexity

Many practitioners are reluctant to start fitting patients with new products because of the complexity of some of the high-tech devices, says Samuel Hale, director of prosthetics for Fillauer Companies Inc. It can be challenging to fit many of the newer devices if you are not familiar with the technology.

“Learning to use a new product

“We provide helpful tools that include features and benefits of our products to assist with the language that can be used in documentation to explain about medical necessity.”

—Karen Lundquist, OTTOBOCK

and how to troubleshoot it can be an impediment to adopting a new high-end device, especially if a clinician is already getting good results with an existing product,” says John Rheinstein, CP, FAAOP, clinic manager for the New York, New York, Hanger Clinic location. “Software and Bluetooth connectivity can also be a challenge. Too many features and adjustments can make adopting a new high-end device a challenge, especially if the patient is a new amputee.”

What’s more, some clinicians resist new devices when their appearance and weight are very different from traditional versions, says Hale. “Many new devices require large, heavy batteries. Incorporating these things into a socket that already is too heavy and bulky (to the patient) usually gets a lot of resistance,” he says.

Solution: Training

Most manufacturers offer training options to help familiarize

practitioners with their new releases, and to explain how the devices should be fit and used properly. From website downloads to webinars to in-person training sessions to onsite visits, options abound to fit most practitioners’ schedules.

Ottobock has a staff of 29 who support education for its products in North America, and 100 trainers around the world. “The vast majority of these are clinicians and teach formal classes, in person and remotely, as well as consulting case-by-case in person, on the phone, or via tools like Skype,” says Lundquist.

In fact, Ottobock requires training for initial purchase of several of its more complex components, including its microprocessor knees, C-brace, dynamic arm, and E-mag Active electric knee-ankle-foot orthosis. “For example, for our C-brace, an Ottobock clinician provides in-person fitting support” the first time that practitioner orders the brace, says Lundquist.

O&P Almanac | AUGUST 2014

31

FEATURE: RACE TO PARTS UNKNOWN

Becker’s clinical education specialist Gary Bedard, CO, FAAOP, offers education on stance control to students at Georgia Tech’s MSPO program.

Fillauer conducts two training seminars per year focusing on its upper-extremity devices. In addition, the company holds a training seminar at national meetings on its complex foot/ankle systems. And staff members are available to help individual practitioners with initial fittings, says Hale.

Motion Control offers several training options for its Utah arm, says President Harold Sears, PhD. Twice a year, the company runs a five-day fitting course, and it also offers the same curriculum at on-site locations, geared toward practitioners who have patients ready to be fit immediately.

In 2007, Becker Orthopedic introduced a line of stance control orthotic knee joints, known as the Stride Family. “We provide on-site clinical and technical in-services for them and their referral sources,” says C. Rudolph Becker IV, vice president of marketing and information technology. “Whenever a customer wants to purchase a stance control product for the first time, we strongly encourage them to take a webinar with one of our clinical educators to help get them up to speed with the technology. We have full-time and contract educators, all of whom travel to

“Patients are interested in knowing about can and best meet their needs, when they are a candidate for new technology, it’s important to offer them the components that are most clinically appropriate for them.”

—Marc Kaufman, CPO(L), HANGER CLINIC

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AUGUST 2014 | O&P Almanac

Hurdle 2: Cost and Reimbursement Concerns

“Initially, there may be no reimbursement unless it is directly from the patient, says Hale. “Especially now, practitioners are afraid to fit a device that costs tens of thousands of dollars when they cannot find out until after it is out the door whether or not they will be paid.”

Kaufman says he is reluctant to use a device “if the cost is prohibitive, if there aren’t codes that will cover the cost, or if 2999 codes are what the manufacturer recommends, because it can limit accessibility for the patient.”

Dan Bastian, CP, co-owner of Progressive O&P in Albertson, New York, describes it as “a catch-22: We need to fit these devices so enough of them are being used so insurance can create a code for them. But we

PHOTO: courtesy of Becker Orthopedic

the newest technology. To do the best you

practitioners’ facilities to work directly with them and their patients.”

Becker also makes available iPods that connect directly to Becker educators via Facetime. Practitioners can use this technology to “conduct real-time video conference calls with our educators for advice on evaluations, component selection, fitting, and problem solving,” Becker explains.

Some manufacturers are “bundling” training services into product purchases with new componentry. “We do this with our upper-extremity devices and it works very well,” says Fillauer’s Hale. “We bring practitioners and their patients in for a 3.5-day workshop. The patient will come with nothing and leave with a fully functional diagnostic device, which is then fabricated in the next few weeks. The patients are fit by our experts, and the prosthetists learn how our devices work and get a review of fitting techniques and available componentry.”

“Bundling arrangements can work well for learning to use a new device, and can be a good experience for both the patient and the prosthetist, especially if there are a number of patients being fit at the same time,” says Rheinstein.

FEATURE: RACE TO PARTS UNKNOWN

are limited to the number we can fit because most insurance companies don’t want to pay for them.”

Ottobock trainers lead courses to provide the latest education.

Solution: Education

PHOTO: courtesy of Ottobock

Many manufacturers extend training beyond device fitting to include reimbursement information.

“Education means helping practitioners learn the documentation requirements necessary to bill and fit the right products to the right patient,” says Lundquist. “We provide helpful tools that include features and benefits of our products to assist with the language that can be used in documentation to explain about medical necessity” of Ottobock products. She notes this can be particularly helpful for those devices with “Not Otherwise Classified Codes.” She also suggests that all documentation and preparation be done prior to preauthorization of the products to mitigate coverage and payment issues later.

At Fillauer, staff are on hand to assist in coding and ensure proper reimbursement with complex devices.

For example, “We have recently introduced a new hydraulic foot and are currently reviewing coding with all of the practitioners fitting this foot,” says Hale. “We will release official documentation with justification for miscellaneous codes in the near future.”

Another option some manufacturers are beginning to consider is risk sharing in initial reimbursement for new products. “We have done some risk sharing with manufacturers with some of the more expensive components,” says Bastian. “The way it has worked is that Progressive O&P has done whatever was needed to fabricate and fit the device to the patient, and the manufacturer supplies the new componentry.

If we are able to be paid for the device, then the manufacturer gets paid; if we cannot get paid, then we are both sharing the cost and the patient still retains the device.”

Alternatively, some manufacturers are assisting customers with advanced reimbursement services—for a fee—to provide the necessary support from

What’s Your Approach?

Practitioners share their thought processes on deciding when to adopt new products: “I evaluate the features of new products in terms of the benefits they claim to offer patients versus any disadvantages. Benefits might include additional function, stability, durability, improved comfort, ease of use, shorter learning curve, operation that is closer to normal biologic function, better appearance, adaptability to the needs of different individuals, compatibility with existing products, the ability to capture outcomes data, and reduced weight or energy costs. Disadvantages might include increased cost, weight, and maintenance; complexity for user, and difficulty in fitting and troubleshooting. Then, I compare the new product to those already on the market. Does the new product offer significant or just incremental improvement? I also consider available research. I see our professional role as providing care, not just devices. I introduce new products to carefully selected patients.”

—John Rheinstein, CP, FAAOP, clinic manager, Hanger Clinic, New York

“As an above-knee amputee myself, when there is a new product, especially prosthetics, I am always interested in testing the product and determining how we can use it in our practice.

We have a large practice that takes care of people, from pediatric to geriatric, so there is never a shortage of patients in need of new technology. These patients are always on our minds when we see anything new. Our first thought usually is, ‘Who would this work for, or whose life would be better off with using this device?’ We’re looking at the unique qualities of each new device and thinking of how each product could benefit specific patients in our facility: how a fully submersible microprocessor knee will benefit a patient who lives near the water, or how a new knee brace that offers stability will help a patient with back issues.

We’re looking for technology that will help improve each patient’s quality of life.”

—Daniel H. Bastian, CP, co-owner, Progressive O&P, Albertson, New York

O&P Almanac | AUGUST 2014

33

FEATURE: RACE TO PARTS UNKNOWN

experienced coding, billing, clinical, technical, and medical review staff.

For example, Ottobock has “partnered with customers for successful outcomes” in this way, says Lundquist.

Rental programs also are popping up.

Practitioners can testdrive devices without committing to the full purchase price for new products. Motion Control allows certified prosthetists to rent its components when a trial-fit can help to confirm the best prescription, and encourages “trial fittings” for challenging cases, says Sears.

Practitioners should recognize that not all new products face coding Bedard and students. problems: Becker’s latest stance control products, The Stride Solution: Research Family, “are all covered under existing Due diligence in researching a L codes,” Becker says. He notes that product you are considering, and Becker works with AOPA whenever it conversations with other clinicians releases a new product for assistance who may have tested the device, can with coding assignments. help ensure you don’t make a guinea pig out of your patient.

“I will only provide a new prodHurdle 3: “Buggy” Products uct if it offers significant benefits to Since O&P is a small industry, it can patients and isn’t in need of further be challenging for manufacturers to development,” says Rheinstein. “I am conduct large clinical trials prior to fortunate to work with a number of releasing the early versions of a new patients and experienced colleagues product. Thus, “new products are occasionally released without all of the who are willing to give first-hand evaluations of new products. This ‘bugs’ worked out,” says Rheinstein.

“We bring practitioners and their patients in for a 3.5-day workshop. The patient will functional diagnostic device, which is then fabricated in the next few weeks…and the prosthetists learn how our devices work and get a review of fitting techniques and available componentry.”

—Samuel Hale, FILLAUER

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AUGUST 2014 | O&P Almanac

Going the Distance

Practitioners can find information on new devices from several sources beyond their colleagues and manufacturers. AOPA serves as an important resource, given its extensive reimbursement and coding department. The Academy offers scientific societies with extensive information. And “national meetings such as AOPA’s National Assembly, and professional journals, are also both good avenues of information,” says Rheinstein.

The O&P schools are another source for new product information: Though the O&P master’s programs may not offer education on all of the latest devices, some manufacturers work with instructors to update them on new releases. For instance, Becker provides annual education on stance control and orthotic technologies to the O&P schools.

Ultimately, the race to optimal patient treatment is a marathon, not a sprint. Taking the time to plan the best route to an optimal outcome—via training, education, and research—will ensure a win-win for patients and practitioners alike.

Christine Umbrell is a contributing writer for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

Photo: Courtesy of Becker Orthopedic

come with nothing and leave with a fully

feedback is important— while keeping in mind that what works for one person may not work for another.”

Kaufman relies on proven manufacturers to ensure a new release is truly a “final” version: “I will find key people at the manufacturer to give me the specifics on a new product,” he says.

For Bastian, being an amputee himself can work to his advantage: “I can go and test many of the products on myself.”

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eet the standards of ABC’s new voluntary Central Fabrication Accreditation program and prove to your customers that you have met the same high standards they have when it comes to running your business.

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Creating a Groundswell The O&P community unites to oppose prior authorization

T

he O&P community and

patients recently united to send a strong message to CMS. Together, they voiced their opposition to the proposed prior authorization rule in its original form, citing flaws that could be harmful to patients and providers. The proposal contains neither a promise of payment nor a suspension of audits.

Without both, and some additional “fixes,� the likely consequences would be another layer of bureaucracy, a challenge to timely patient access to care, and a further reimbursement muddle for providers.

As of the July 28, 2014, commentfiling deadline, 294 patients had registered their objections to the proposed rule. Another 448 comments were sent to CMS by AOPA members using the

36

AUGUST 2014 | O&P Almanac

AOPAVotes website, making a total of 742 known comments submitted.

Unknown at this time is how many members filed comments separately.

The key points (shown in graphic on page 37) were incorporated into all of the AOPA communications with CMS. AOPA conducted a four-pronged effort to make sure that CMS understood that the O&P community is highly concerned about what may have been a well-intentioned effort to help relieve the backlog in the appeals process caused primarily by RAC audits.

First, more than 400 members were educated on the details of the CMS proposal through two free webinars.

Leading the webinars were members of the AOPA Board of Directors, including AOPA President Anita Liberman-Lampear, MA; PresidentElect Charlie Dankmeyer, CPO; and board members Eileen Levis, Michael Oros, CPO, and Dave McGill, augmented by AOPA staff, Tom Fise and Devon Bernard.

Prong 2 consisted of a series of blast emails to members and articles in the biweekly AOPA In Advance SmartBrief electronic newsletter and the O&P Almanac encouraging members to file individual comments with CMS. AOPA provided a comment template and a simple direct-to-CMS electronic comment letter, which was made available on the AOPAVotes website.

Prior Authorization

key points Prior authorization must constitute a guarantee of Medicare payment.

Elimination of Part B RAC and prepayment audits must be the quid pro quo for instituting prior authorization. Requiring providers to undergo prior authorization and then subsequently deny a claim defeats the purpose of prior authorization.

RAC audits should cease immediately once prior authorization regulations are issued in final form. Once prior authorization regulations are announced as a final rule, RAC audits and prepayment audits of claims across all categories of providers must cease immediately.

There must be certainty in the prior authorization process. As seen in the PME prior authorization demonstration, CMS has five days to approve or to deny with an explanation. To ensure that a decision is made in a timely manner, if a decision has not been made within five days, and accompanied by specific reference and details of the specific beneficiary (no blanket disapprovals as a matter of CMS delay and convenience), the prior authorization request should be deemed approved and final, and patient care may proceed.

Prong 3 was the creation of a postcard that carried the message of potential harm to patients. Each AOPA member location automatically received 10 postcards for distribution to amputee patients. Several members requested additional quantities. AOPA board member Don Shurr, CPO, PT, called on his close relationships with the NCOPE accredited teaching institutions to inform their students, faculty, and patients about the proposed

A threshold for items subject to prior authorization is needed.

The current proposed threshold of $1,000 is no threshold at all, as it would encompass (and thus subject to prior authorization) every prosthetic limb.

Prior authorization should only apply to items that are over a threshold of 167 percent of the average total per patient prosthetic claim by Medicare data for last available year and inflation adjusted to become the current year.

Additionally, there must be an exclusion for any immediate postsurgical and or preparatory prostheses.

CMS must acknowledge that the prosthetist’s notes and records on patient visits are a legitimate part of the medical record, on the same basis as those of the physician, therapist, or other licensed and/or accredited health-care provider. The prosthetist’s clinical documentation and specifically functional assessment (as it translates into appropriate prosthetic design and component selection) are the foundation of his/her education and training. This skill set is unique to prosthetists among all other providers identified as “qualified” in BIPA 427.

prior authorization rule’s shortcomings. This also helped produce the groundswell of opposition to the proposal in its current form. The fact that 294 patients sent CMS a signed postcard registering their concern indicated the widespread understanding of the problems the proposed rule could cause in its present form.

Prong 4 was the process approved by the board to develop AOPA’s own comments. Anita Liberman-Lampear

appointed Eileen Levis, Dave McGill, Michael Oros, CPO, and Don Shurr, CPO, PT, to work with AOPA staff, Joe McTernan and Tom Fise, to ensure the final comments reflected the concerns of AOPA members.

While the proposed rule may take months to finalize, the effort to make sure patients and providers communicated their concerns to CMS was in all ways a huge success for O&P. Thanks to all who participated in the effort.

O&P Almanac | AUGUST 2014

37

2014 Exhibitor AMERICAN ORTHOTIC & DirectoryNATIONAL

AOPA’s

national

assembly ’14

SEPTEM MANDALAY BAY On the following pages is an advance look at the companies that CONVEN LAS V will be exhibiting at the 2014 AOPA National Assembly. You’ll find website information and booth numbers for each exhibitor—use this guide and floor plan to organize your visit to the Exhibit Hall.

Better yet, check out their websites now and plan ahead!

EXITS

EXITS

ENTRANCE

S

2014 Exhibit Hall Mandalay Bay Convention Center Shoreline AS Las Vegas, NV F N.

P

FE

E

Fillauer Companies Inc

OttoBock

Freedom Innovations LLC

FE

S

Freedom Innovations LLC

1521

FHC

W/D

W/D

FE

FE

E

1427

E

1437

1443

EXITS

Floor Plan

S

W/D

6' EXIT

FS

6'

EXIT

6'

6'

EXIT

6'

FHC

6'

S

Össur Americas

23'

Townsend Design

Optec USA Inc.

1321

1333

1343

BENCH

FHC

BENCH

1342 FE

P

PEL LLC

ALPS

W/D

E

W/D

FE

E

1237

1225

1243

1031 ESC-1M4

UP

DN

DN

L2DE

1143

L2DD

ESC-1M3

UP

FHC

OPGA Village

RH2DB H2DB

ESC-1M1

ESC-1M2

DPL2DA

W/D

FE E

P

FE

E

FE

Fillauer Companies Inc

913

1142 W/D

FE

E

1025

921

1043

1024

Streifeneder USA

College Park Industries

P

Becker Orthopedic Appliance Co

1030

1044 Orthomerica

Orthomerica

925

927

931

933

930

932

937

943

945

10' 908

910 DAW

E

W/D

FE

FE

809

E

815

811

Cybertech Medical

934

936 FHC W/D

FE E

825

831

833

835

837

839

843

10' 808

810

820

814

826

836

828

EXITS

38

6'

709

711

715

721

723

727

729

731

842 20'

30'

733

737

739

743

6'

AUGUST 2014 | O&P Almanac

W/D

W/D

FHC

FE

6'BANQ 10

6'BANQ 10

6'BANQ 10

6'

FE E

6'BANQ 10

6'BANQ 10

6'BANQ 10

6'BANQ 10

6'BANQ 10

6'BANQ 10

6'BANQ 10

6'BANQ 10

FE E

2014 Exhibitor Directory Bold listings indicate the exhibitor is a member with the American Orthotic & Prosthetic Association (AOPA). indicates the exhibitor is a Supplier Plus Partner with AOPA. Exhibitors as of July 22, 2014.

Sponsors

PROSTHETIC ASSOCIATION ADN/Extremity Games.....................925 L ASSEMBLY Ability Dynamics LLC....................1558 www.adnpage.org Advanced O&P Solutions LLC.... 1376 www.aopsolutions.com

Adaptec Prosthetics/ Smartpuck....................................... 1571

Aetrex Worldwide Inc....................1151 www.aetrex.com

FE

FREIGHT D 24'W x 14

www.abilitydynamics.com MBER 4-7, 2014 NTIONACOR CENTER, SHORELINE A Orthopaedic Inc..................965 VEGAS, NV www.acor.com

AOPA extends special thanks to our title sponsors:

FE

W/D E

Poster Boards

Poster Boards 1670 1674 BIOM

1557

Endolite

Poster Board Lounge

1565

1571 1575

Poster Boards

1556 1558

1570 1574 Vorum FE

Comfort Products 1457

1449

W/D E

1465

1477

1471 1475

EXITS 14'-9" FHC

Medi USA

DN

DN

STAIR #1P1

FE

1365

Amfit Inc.

1257

Proteor

1160

Slot Machine

Cascade Orthopedic Supply Inc

Delcam

1165

FE

1277 1279

1270 1272 1274

Trulife

1161

1055

20'

E

1271 1273 1275

1177

1171 1173 1175

1089

1170 1174 FE

1049

W/D

1265

Proteor 1157

1154

Spinal Tech

1376 1378 1380

FREIGHT DOOR 24'W x 14'-8"H

1151

1370 1372 1374

1059 1061

W/D E

1065

1071 1075

1064 1066 1068

1072

965

973

AOPA

FE

1080

FREIGHT DOOR 24'W x 14'-8"H

1256

Aetrex Worldwide Inc

c

1377 1379 1381

1077

10' Rodin 4D & TechMed3d

1076

OPIE Software

949 948

957 950

954

956

958

967

969

975

977

979

981

964 FE

EXITS 14'-9"

W/D

DN

E

849

Poster Boards

1249

FE

1371 1373 1375

DN

FREIGHT DOOR 24'W x 14'-8"H

1357

SPS

1476

FREIGHT DOOR 24'W x 14'-8"H

Steeper USA

SureStep

DN

14'-9" EXITS

1480

1470 1472 1474

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753

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767

ST AG

749

DN

EXITS 14'-9" DN

6'BANQ 10

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6'BANQ 10

6'BANQ 10

6'BANQ 10

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DN

14'-9" www.bocusa.org EXITS

Product Preview Theater

E

852

8'X 16 '

FHC

STAIR #1V1

FE

W/D E

DN

STAIR #1V2

6'BANQ 10

6'BANQ 10

6'

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O&P Almanac | AUGUST 2014 DN

DN

14'-9" EXITS

39

2014 Exhibit Directory

Algeos USA.......................................759 www.algeos.us Allard USA.................................1030 www.allardusa.com

ALPS.................................................1225 www.easyliner.com

Alternative Prosthetic Services Inc.......................................................973 www.alternativeprosthetics.com American Academy of Orthotists & Prosthetists.................................... 1670 www.oandp.org American Board for Certification in Orthotics, Prosthetics & Pedorthics..............1374 www.abcop.org

American Plastics, A Division of Curbell Plastics............................ 1474 www.americanoandp.com American Prosthetic Components LLC........................... 1076 www.apcomponents.com AMFIT Inc...................................1257 www.amfit.com Amputee Coalition.........................1377 www.amputee-coalition.org AON................................................... 933 www.insurance4op.com AOPM................................................936 www.aopmcenter.com

American Central Fabrication......956 American Orthopedics Manufacturing Corp.......................739 www.americanomc.com American Orthotic & Prosthetic Association................. 1077 www.aopanet.org

Apis Footwear Co.............................931 www.apisfootwear.com Aqualeg Inc....................................... 743 www.aqualeg.com Arizona AFO Inc............................ 1279 www.arizonaafo.com

ARTech Laboratory Inc.................. 761 www.artechlab-prosthetics.com Aspen Medical Products................958 www.aspenmp.com Atlantic Rim Brace Mfg. Corp.......977 www.spinalbraces.com Becker Orthopedic Appliance Co..1143 www.beckerorthopedic.com biodesigns inc................................. 1475 www.JoinHiFi.com BiOM................................................ 1565 www.BiOM.com BioSculptor Corp............................ 860 www.biosculptor.com Bledsoe Brace Systems...................948 www.bledsoebrace.com Board of Certification/Accreditation, Int’l (BOC)........................................967 www.bocusa.org

www.bocusa.org

Bort-Swiss Orthopedic Supply....1061 www.bort-swissortho.com 40

AUGUST 2014 | O&P Almanac

!

EW

N

Just 2 Joint Sizes CORRECTIVE JOINTS

Small

Regular

Dynamic corrective joint system for contracture management.

Low Profile & Simple

Just 3 Simple Adjustments 1

FLExION/ExTENSION

2

RANGE OF MOTION

3

FORCE CONTROL

Find trigger point and scale back

CONTACT US TODAY!

2014 Exhibit ProductDirectory Showcase

Boston Brace....................................843 www.bostonbrace.com

Delcam.............................1165 & 1277 www.delcam-healthcare.com

Bowman Enterprise Services Inc...851 www.opHUB.com

Dicarre LLC...................................... 964 www.dicarre.com

Bracemasters International LLC.... 950 www.bracemasters.com

DJO Global........................................ 833 www.djoglobal.com

Bremer Group Company, The..... 1570 www.bremergroup.com

Dr. Comfort.......................................842 www.DrComfort.com

Fillauer LLC - A Fillauer Co.......... 1025 www.fillauer.com

BTS Bioenginerring Corp.................. 835 www.btsbioengineering.com

Drew Shoe Corp...............................1071 www.drewshoe.com

Fillauer Orthotics & Prosthetics...................................... 1025 www.fillauercompanies.com

Endolite.......................................1449 www.endolite.com

Footmaxx............................................ 727 www.footmaxx.com

Bulldog Tools Inc............................. 814 www.bulldogtools.com Cailor Fleming Insurance.............. 1174 www.cailorfleming.com

Cascade Dafo Inc...................... 1065 www.cascadedafo.com Cascade Orthopedic Supply Inc..1177 www.cascade-usa.com Centri - A Fillauer Co................... 1025 www.centri.se College Park Industries Inc............ 913 www.college-park.com Comfort Products Inc................... 1457 www.comfortoandp.com Coyote Design & Mfg Inc........... 1031C www.coyotedesign.com Cybertech Medical.......................... 825 www.cybertechmedical.com Dav Mar Inc....................................1031H www.davmarshoes.com DAW Industries Inc..........................815 www.daw-usa.com

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AUGUST 2014 | O&P Almanac

Fillauer Companies........1025 & 1521 www.fillauercompanies.com

Freedom Innovations LLC.......................................1437 & 1443 www.freedom-innovations.com

ESP, LLC.............................................. 811 www.wearesp.com Fabtech Systems LLC...................... 723 www.fabtechsystems.com

Friddle’s Orthopedic Appliances Inc.............................1031D www.friddles.com Futura International Inc...............1064 www.futuraintl.com Grace Prosthetic Fabrication Inc..... 715 www.gpfinc.com Hersco Ortho Labs............................767 www.hersco.com

POWER COUPLE.

PreStride™

FullStride™

PreStride demonstrates stance control’s capability and FullStride delivers it to the patient The formula for success in the application of a Stance Control Orthosis (SCO) is tied to a thorough assessment of the patient. The PreStride stance control assessment orthosis allows the orthotist to evaluate their patients in various component configurations to determine the optimal setup before fabricating the definitive FullStride SCO.

The Power Couple: Your formula for success with Stance Control Characteristics of Successful SCO Candidates: • • • • •

Patients who demonstrate lack of knee stability in single limb stance Patients who no longer demonstrate safe gait with a ground reaction AFO Patients who require improved gait stability for occupational/environmental needs Patients with a history of stumbling, falling or fatigue who require stability to improve confidence KAFO patients who desire improved function

Call our customer service department to learn more.

800.521.2192 • 248.588.7480 BeckerOrthopedic.com

2014 Exhibit Directory

National Commission on O&P Education...............................1372 www.ncope.org New Options Sports........................ 910 www.newoptionssports.com New Step Orthotic Lab Inc........... 1371 www.newsteporthotics.com nora systems, Inc............................. 932 www.nora-shoe.com North Sea Plastics............................ 908 www.northseaplastics.com

Hosmer Dorrance Corp.— A Fillauer Co................................... 1025 www.hosmer.com iFit Prosthetics LLC..........................731 www.ifitprosthetics.com iWALKFree, Inc..............................1044 www.iwalk-free.com Janco................................................. 1175 www.janco-inc.com JMS Plastics Supply........................ 810 www.jmsplastics.com Kinetic Research...............................831 www.KineticResearch.com KISS Technologies LLC................. 1342 www.kiss-suspension.com KLM Labs.......................................... 1173 www.klmlabs.com

Life-Like Laboratory LLC............. 1243 www.lifelikelab.com LIM Innovations............................ 1026 www.liminnovations.com Martin Bionics Innovations..........1471 martinbionics.com MD Orthopaedics Inc................... 1072 www.mdorthopaedics.com Med Spec (ASO EVO).................... 849 www.medspec.com Medex International Inc................749 medexinternational.com Medi USA.........................................1557 www.mediusa.com MIH International LLC/M-Brace.....733 www.m-brace.com

Knit-Rite Inc..................................1031E www.knitrite.com

Motion Control Inc.— A Fillauer Co................................... 1025 www.UtahArm.com

Levy & Rappel..................................836 www.LevyandRappel.com

Nabtesco Proteor - USA... 1154 & 1157 www.proteor.com

Liberating Technologies, Inc...... 1031I www.liberatingtech.com

Naked Prosthetics...........................865 www.nakedprosthetics.com

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AUGUST 2014 | O&P Almanac

O&P Almanac...................... 729 & 1077 www.AOPAnet.org O&P Business News and Helio.com

by SLACK Inc................................. 1059 oandpbiznews.com O&P EDGE/Amplitude Media Group....................................839 www.oandp.com/edge O&P Solutions/Optimus Prosthetics....................................1031G www.oandpsolutions.net OP Marketing/OP Solutions.........1375 www.opmarketing.com OPAF & The First Clinics...............859 www.opafonline.org OPIE Software..................................957 www.oandp.com OPTEC USA, INC...........................1333 www.optecusa.com Orfit Industries America.............. 1556 www.orfit.com Orthofeet..........................................1171 www.orthofeet.com Orthomerica Products Inc..937 & 943 www.orthomerica.com

2014 Exhibit Directory

Orthotic & Prosthetic Equipment Corporation.................................... 1470 www.optable.com

Ottobock......................................... 1427 www.ottobockus.com

Orthotic & Prosthetic Group of America (OPGA)...........1031 www.opga.com

Pro-Tech Orthopedics.................. 1075 www.protech-intl.com ProtoKinetics LLC......................... 1265 www.protokinetics.com Provel Inc......................................... 709 www.provel.us

Orthotics and Prosthetics One................................................. 1031B www.oandp1.com

Paceline Inc.................................... 1055 www.paceline.com

Quality Outcomes..........................1031F www.qualityoutcomes.org

Össur Americas Inc........................ 1321 www.ossur.com

Pedorthic Footcare Association (PFA)............................ 866 www.pedorthics.org

Renia GmbH Chemische Fabrik.................................................930 www.renia.com

PEL....................................................1237 www.pelsupply.com

Restorative Care of America Inc...................................... 852 www.rcai.com

Pine Tree Orthopedic Lab Inc..... 1043 www.pinetreeorthopedic.com OTS Corp. - A Fillauer Co............. 1025 www.ots-corp.com

Prosthetic Orthotic Solutions International (POSI)......................1274 www.physiocorp.com

Revolimb.......................................... 1161 www.revolimb.com

www.LCodeSearch.com

24/7

Expert Coding Advice 24/7 •

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

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

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This exclusive service is available only for AOPA members.

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

Log on to LCodeSearch.com and start today.

Not an AOPA member? GET CONNECTED

Visit AOPA at www.AOPAnet.org.

Manufacturers: Get your products in front of AOPA members!

Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811.

O&P Almanac | AUGUST 2014

45

2014 Exhibit Directory

Roboticom - Fabrica Machinale Srl..................................1068 www.roboticom.it Rodin 4D.......................................... 949 www.rodin4d.com Royal Knit Inc................................. 1270 www.royalknit.com Silipos Inc..........................................826 www.silipos.com Simona America Inc.......................1275 www.simona-america.com Soletech Inc.....................................1160 www.soletech.com Spinal Technology Inc..............1049 www.spinaltech.com

Giant Slot Machine

Back by popular demand.

As you attend educational sessions, be sure to get your token for the giant slot machine located in the exhibit hall. Test your luck and play your tokens to win fabulous prizes from exhibitors and AOPA—including several chances to win an iPad! SPS.................................................... 1249 www.spsco.com

ThyssenKrupp AIN Plastics........1066 www.ainplastics.com

Vorum.............................................. 1477 www.vorum.com

ST&G USA Corp............................. 1465 www.stngco.com

Tillges Technologies, LLC.............1170 www.pressureguardian.com

WBC Industries Inc......................... 737 www.wbcindustries.com

SteeperUSA.................................... 1365 www.steeperusa.com

TiMed Inc..........................................1575 www.ti-med.com

Streifeneder USA............................ 921 www.streifenederusa.com

Top Shelf Orthopedics................. 1370 www.pacmedical.com

SureStep...........................................1357 www.surestep.net

Touch Bionics...................................828 www.touchbionics.com

Tamarack Habilitation Technologies Inc............................. 1142 www.tamarackhti.com

Townsend Design.......................1343 www.townsenddesign.com

TechMed 3D Inc........................... 949A www.techmed3d.com Teh Sen Technology Inc............... 1476 www.tehsen.com

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AUGUST 2014 | O&P Almanac

WillowWood.....................................820 www.willowwoodco.com

Trulife.......................................... 1256 www.trulife.com US Member Society - ISPO.............975 www.usispo.org

AOPA’s

national

assembly ’14

AOPA’s

national

assembly ’14

2014 Product Showcase

On the following pages, you’ll see a sampling of the products that will be displayed at the 2014 AOPA National Assembly, Sept. 4-7, 2014. Visit www.AOPAnet.org to register.

RUSH™ foot

Booth #1558

Innovative thinking, coupled with the Flexeon™ glass composite, has resulted in the RUSH™ foot design.

Carbon fiber has been the standard in prosthetic feet for decades, but carbon fiber is not optimal due to limited flexibility and composite failures.

The RUSH™ foot’s superior engineering delivers the most realistic and responsive foot and ankle motion available today.

It is more flexible than carbon fiber and stress points won’t fail when subjected to pressure, water or impact.

The RUSH™ foot helps maintain a natural, smooth gait even in rugged or uneven terrain. Virtually indestructible; even in the most extreme conditions.

For more information, visit Ability Dynamics at www.abilitydynamics.com.

Vista® 639 LSO 4 Panel

Booth #958

The new Vista® 639 LSO 4 Panel is Aspen’s most substantial LSO, offering multiple layers of support around the entire torso. With coverage from the symphysis pubis to the xiphoid process coupled with overlapping lateral and anterior panels, this clinically effective brace provides maximum motion restriction in all three planes of motion.

Designed to be easily modified, the xiphoid extension can be adjusted to contour and conform to varying anatomies. This one-size adjustable brace offers both modularity and versatility and can be seamlessly stepped down to a Vista 637 LSO, to a Vista 631 LSO LoPro, and ultimately to a Vista 627 Lumbar to provide the needed support as the patient recovers. The Vista 639 LSO 4 Panel is code L0639 approved.

For more information, please call Aspen Customer Service at: 800/295-2776, or visit us at aspenmp.com.

New Tempo Foot from College Park

Booth #913

New for 2014! Our latest K2 foot provides a good range of motion and high weight limit in a light weight and affordable product. This service-free design also has a full length toe lever for excellent stability and performance.

For more information, call 800/728-7950 or visit www.college-park.com.

Coyote Composite

Booth #1031C

Coyote Composite is made from the melting of basalt (volcanic rock), which is then extruded into a filament that is braided to our proprietary specifications for use in prosthetics and orthotics.

Basalt has many applications in fields that demand extremely tough, lightweight material that retains flexibility, including the aerospace and hockey equipment industries.

• Non-carcinogenic and Non-toxic • Because of the inert nature of basalt (the primary ingredient in Coyote Composite), it is not a carcinogen.

In addition, basalt fibers are too large to be inhaled.

• Less itch than carbon • Tough and durable • Basalt is extremely tough, more so than fiberglass, while still offering the lightweight strength and rigidity needed for prosthetics and orthotics.

• Lightweight • High saturation • Cost-effective • Easy to use for rigid or flexible lay ups • All prosthetic resins are fully compatible with basalt.

• Because of its superior saturation Coyote Composite finishes as good or better than carbon laminations For more information, call 800/819-5980 or visit www.coyotedesign.com.

O&P Almanac | AUGUST 2014

47

2014 Product Showcase

Coyote Lamination

Booth #1031C

Coyote Composite is made from the melting of basalt (volcanic rock) which is then extruded into a filament that is braided to our proprietary specifications for use in prosthetics and orthotics.

Basalt has many applications in fields that demand extremely tough, lightweight material that retains flexibility, including the aerospace and hockey equipment industries.

• Non-carcinogenic and Non-Toxic • Because of the inert nature of basalt (the primary ingredient in Coyote Composite), it is not a carcinogen. In addition, basalt fibers are too large to be inhaled.

• Less itch than carbon • Tough and durable • Basalt is extremely tough, more so than fiberglass, while still offering the lightweight strength and rigidity needed for prosthetics and orthotics.

• Lightweight • High saturation • Cost-effective • Easy to use for rigid or flexible lay ups • All prosthetic resins are fully compatible with basalt.

• Because of its superior saturation Coyote Composite finishes as good or better than carbon laminations For more information, call 800/819-5980 or visit www.coyotedesign.com.

ePAD: The Electronic Precision Alignment Device

Booth#815

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

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

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AUGUST 2014 | O&P Almanac

New Sure Stance Knee by DAW

Booth# 815

This ultra-light, true variable cadence, multiaxis knee is the world’s first 4-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion.

The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K-3 patients.

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

New Raize Remote App

Booth#1025

Now available in the App Store and at Google Play for amputees wearing the Raize Foot.

The app features resistance adjustments, lock and unlock modes, as well as step counts.

For more information, visit www.fillauer.com.

SOFTIE™ and SOFTIE-TF™ Sockets A new level of postoperative, prosthetic rehabilitation! When minimizing the effects of injury at bed rest holds a greater priority than early ambulation. The SOFTIE™ and SOFTIE-TF™ sockets are soft, nonconstricting, and easy to remove at any time to address limb treatment. The incision area is shielded to reduce the occurrence of micro tears which occur as the patient repositions himself in bed. Our sockets reassure vascular surgeons’ concerns of applying a socket or cast to their dysvascular patients. The SOFTIE™ and SOFTIE-TF™ fits any patient at a moment’s notice.

Call FLO-TECH® at 800-FLO-TECH or visit us at www.1800flo-tech.com.

2014 Product Showcase

New—Knit-Rite 4-Way Stretch Shrinker With Rounded Toe

Booth #1031E The new 4-Way Stretch Shrinker offers superior fit qualities, is extremely soft, and is easier to don. Core-spun construction provides a wider range of stretch for a reduced number of sizes to fit more limb variations.

• Silicone dot suspension band to help keep shrinker in place. AK available with or without waist belt.

• Black version features X-Static to help prevent odor in the garment and provide wicking and thermal properties.

• Available in Medium (20-30 mmHg) and Heavy (30-40 mmHg) compression, Transtibial and Transfemoral sizes.

For more information, contact Knit-Rite at 800/821-3094 or e-mail customerservice@knitrite.com.

EASE by Therafirm® Gradient Compression Hosiery

Booth #1031E The new Ease by Therafirm® premium opaque gradient compression line complements KnitRite’s patented CoreSpun by Therafirm® compression socks— both engineered using ultra stretchy yarns for compression garments that are easier to put on and more comfortable to wear.

• A very innovative premium line that is also affordable for patients.

• Super soft, breathable material offers superior comfort for all-day wear.

• Moisture wicking CoolMax fibers provide dry, comfortable coolness.

• Delivers lab-tested true gradient compression to promote better blood flow, prevent mild to moderate swelling, and relieve tired, achy legs and feet.

Orthomerica Introduces the New Custom Edema Gauntlet

Booth #937 & 943

Orthomerica’s Custom Edema Gauntlets—a valuable addition to our latest Spectrum™ AFO Product Line—are uniquely designed with posterior opening that allows for fluctuating edema. Easy for the patient to tie both the anterior and posterior laces from the front. These high-quality, custom gauntlets are lightweight, hypo-allergenic, and heat-adjustable and offer optimal fit without compromising patient comfort and function. Available in leather or synthetic material and your choice of plastic inner shell.

Anterior closure can be ordered with laces or Velcro® closure.

For more information, contact us at 877/737-8444 or visit www.orthomerica.com.

Orthomerica Introduces the New Fuzion™ AFO

Booth # 937 & 943

Orthomerica’s Fuzion AFO was developed to allow greater fit, function, and freedom for challenging foot deformations compared to traditional AFOs. The circumferential wrap of the Fuzion firmly and comfortably holds the foot in a more structured biomechanical position instead of trying to seat the foot with two or three straps. The Fuzion’s design and materials ensure greater patient compliance for a variety of challenging clinical indications. Available for both select adult and pediatric patients.

For more information, contact us at 877/737-8444 or visit www.orthomerica.com

For more information, contact Knit-Rite at 800/821-3094 or e-mail customerservice@knitrite.com.

O&P Almanac | AUGUST 2014

49

2014 Product Showcase

The Triton Family of Feet from OttoBock

Booth #1427

The search is over!

Now your highmobility patients can choose from a variety of superb options to fit their active lifestyles. The Triton Low Profile (LP) and the Triton Heavy Duty (HD) are especially robust and waterproof, ready for the most challenging conditions. Or, choose the lightweight Triton carbon fiber foot; the Triton Vertical Shock (VS); or the Triton Harmony® with integrated vacuum technology for outstanding flexibility and support.

Each foot features a split carbon toe, multi-axial terrain conformance, heel stiffness adjustment, and a weight limit up to 330 lbs.

Call 800/328-4058 or visit www.ottobockus.com.

Ottobock is located at 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447. www.professionals.ottobockus.com.

Microprocessor Knees

Booth #1427

Fit with confidence! The first fully microprocessor-controlled knee, today’s third-generation C-Leg®, is the most clinically evaluated prosthetic knee in history and PDAC-verified, too.

The intuitive Genium® knee opens up a whole new realm of mobility—it’s the closest technology has come to a natural, physiological gait. Together with the Compact (for lower mobility patients), Ottobock’s family of microprocessor knees brings its proven advantages to all your patients. Your business gets the advantage of Ottobock’s unmatched reimbursement support.

Call 800/328-4058 or visit www.ottobockus.com to learn more about the benefits of Ottobock’s advanced microprocessor knees. Ottobock is located at 2 Carlson Parkway N, Suite 100, Minneapolis, MN 55447. www.professionals.ottobockus.com.

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AUGUST 2014 | O&P Almanac

Orthomerica® California® Catalina™ Custom Fit Spinal Orthosis From PEL

Booth #1237

• • • •

The California Custom Fit Spinal Orthosis restricts motion while providing effective compression for relief of lower back pain throughout the rehabilitation process.

Key Benefits: • Mechanical advantage two-pull string closure system with ergonomically designed pull tabs • Modular components make it simple to reduce from LSO to LO Easy circumferential adjustment for waists up to 50” (Standard) or 66” (Extended). No cutting needed.

Custom individualized design allows personalized fit by the Orthotist Heat moldable removable posterior panel PDAC Approved—HCPCS Codes L0637/ L0650, L0631/L0648, L0627/L0642

For more information, contact PEL at 1-800/321-1264 or visit www.pelsupply.com.

Lower Limb Technology

Booth #1049

Lower Limb Technology is a division of Spinal Technology Inc. We are a leading central fabricator of upper- and lower-limb orthotics and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality custom products and prosthetic devices, fast delivery time, as well as unparalleled customer support to our customers.

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

2014 Product Showcase

Spinal Technology

Booth #1049

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

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

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

PressureGuardian™ Developed

by Tillges Technologies LLC

Successful Liner Retrofitting Yields Versatility

Booth #820

In order to provide versatility to amputees, Alpha® Liners may be successfully retrofit for a socket provided the liners are of the same gel thickness, profile, and umbrella, if locking.

Retrofit options exist for transtibial and transfemoral applications: • Uniform profile, 6 mm thickness: Alpha Classic™, Alpha Hybrid™, WillowWood Express, and the NEW Alpha SmartTemp™ Liners • Progressive Profile: Alpha Hybrid, Alpha Silicone™, Alpha SmartTemp Liners • Symmetrical AK Profile: Alpha Hybrid, Alpha Silicone, Alpha SmartTemp Liners For a hands-on retrofit demonstration, visit WillowWood at AOPA booth #820. Call 800/848-4930 or visit willowwoodco.com for more information.

Booth #1170

PressureGuardian™ technology combines instantaneous pressure load measurement with a compatible data collecting and storing app.

PressureGuardian helps clinicians manage their patients’ challenging diabetic wounds with astonishing results and is able to advance the healing process, along with improving patient compliance.

PressureGuardian can also be used to measure pressure loads inside prosthetic sockets and orthotic devices to ensure that they are being fit properly.

PressureGuardian has been updated to enable a four-sensor lead to monitor up-to-four sites on the body instantaneously with additional patient report options available within the app.

To learn more about PressureGuardian, visit pressureguardian.com or call 855/484-5832.

O&P Almanac | AUGUST 2014

51

MEMBER SPOTLIGHT

Becker Orthopedic

by Deborah Conn

Bracing for the Future A long history and family tradition have set the foundation for Becker Orthopedic

O

tto K. Becker emigrated

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AUGUST 2014 | O&P Almanac

C. Rudolf Becker IV, Rudolf Becker III, and Thomas Becker

COMPANY: Becker Orthopedic Location: Troy, Michigan OwnerS: Rudolf B. Becker III, his three children, and his sister, Ingrid B. Haughton History: 81 years

Mr. and Mrs. Otto K. Becker

component parts and central fabrication, says Otto Becker’s son, Rudolf Becker III. He and his sister, Ingrid Haughton, and Rudy’s three children are the principal owners of Becker Orthopedic, and he has been president since 1980.

“It is very much a family business,” he says. His older son, Christian Rudolf, is vice president of marketing and IT, and his younger son, Thomas, is director of sales. Becker expects his daughter, Kristin, to get involved once her three small children are in school.

The company has grown significantly since Rudolf Becker took control. “We had 16 employees when I came on,” he says, “and now we have 150.” He feels the patient-care division serves an additional function by allowing the company to see firsthand the needs of

orthotists, orthopedic surgeons, and patients as well as provide a site for clinical testing.

Becker cites the company’s line of stance control orthotic joints as its most recent accomplishment. “We began with an electronic system, but we quickly started adding mechanical joints that provided equal function more cost-effectively,” he says. “We now have five different stance control knees that give the orthotist the ability to perfectly match the component to the needs of his or her stance control patient.”

The company invented an evaluation orthosis, the PreStride, which allows practitioners to trial walk patients with different stance control knee joints to determine optional function.

Becker technicians offer real-time evaluation and recommendations via Skype during the process.

PHOTOS: Becker Orthopedic

from Germany to the United States in 1929. It was not a particularly auspicious time for most people living in this country, with the beginning of the Great Depression, but by 1933 Becker had learned how to make braces and opened his own orthopedic patient-care facility in Huntington, West Virginia. A Detroit branch followed soon after, and by the mid-1930s, Becker was offering central fabrication services to others in the orthotics industry.

After World War II, the company moved its West Virginia operations and consolidated them in Detroit. Becker began manufacturing component parts, and by the time he died, prematurely, in 1960, Becker Orthopedic had a full line of orthotic knee, ankle, and hip joints available in the United States.

Becker’s wife, Lucille, a certified orthotist, assumed control of the business and served as president for 20 years.

During her tenure, Becker Orthopedic developed the double-action ankle joint, in 1963, and a modified drop-lock knee joint, in 1965. Additionally, she began to open international markets to the company and significantly grew the manufacturing side of the business.

True to the company’s roots, the company maintains five patient-care locations in the Detroit area, but most of its revenue comes from orthopedic

member spotlight

Additional educational efforts include seminars and even personal visits by Becker staff to assist with fittings.

Becker Orthopedic uses stainless steel investment castings in many of its products. But Rudy Becker found his suppliers’ wait time of up to six months to be too long to provide his customers with the service they needed, so in 1986 he established Becker Metal Works to produce his own castings. The wait time has been cut to three to four weeks, and the company has greater control over both inventory and quality. In addition to supplying Becker Orthopedic, Becker Metal Works has expanded to other industries, including machine tools, food processing, and energy.

The Becker family and the company’s employees have a strong interest in the health of O&P as an industry and have been significantly involved in AOPA. Rudy Becker served as AOPA president in 1994-1995 and received a Lifetime Achievement Award in 2011. Becker

Executive Vice President Jim Campbell, Ph.D., CO, FAAOP, currently serves as vice president of AOPA and will become president-elect December 1 of this year. And Russ Hornfisher, director of marketing and sales at Becker, served as chair of the AOPA National Assembly Planning Committee for six years.

Clearly, the experience and longevity of the company has had a positive impact not only on its customers, but on the industry as a whole.

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

Earn Your Certificate in O&P Business Management For more information on the program, please visit bit.ly/BizCertProgram.

How to get started:

O&P BUSINESS MANAGEMENT: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company.

PHOTO: Becker Orthopedic

1.

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

2.

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

■ REFRESH YOUR KNOWLEDGE

3.

Complete a Module specific quiz for each program.

■ ADVANCE YOUR CAREER

4.

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

■ DEVELOP BETTER BUSINESS PRACTICES

■ CREATE ONGOING RETURNS FOR YOUR COMPANY

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

O&P Almanac | AUGUST 2014

53

MEMBER SPOTLIGHT

Naked Prosthetics

by Deborah Conn

Double Digits Newly formed Naked Prosthetics offers innovative finger prostheses

A

fter Colin McDuff lost his right middle finger

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AUGUST 2014 | O&P Almanac

Patient using a biomechanical prosthetic finger.

COMPANY: Naked Prosthetics Location: Olympia, Washington Owners: C. Colin McDuff, Bob Thompson, Jon Bengtsson History: 3 years

requires just a half inch of residual finger to activate, says Bengtsson.

“Users put it on just as they would slide on a ring, and the device articulates at the top joint as they move their residual finger.”

The biomechanical prosthetic finger, or BPF, is available in carbon black as a default, as well as many other patterns; in a nod to users who want something a little less noticeable, a wood-grain pattern that is more akin to the user’s skin tone also is available. The company offers two versions of the BPF, depending on the length of the residual finger, and has plans to release a prosthetic thumb. A full-finger prosthesis is in beta testing.

Naked Prosthetics also offers an upgrade that enables users to interact with electronic touch screens on phones, tablets, and computers. Engineers integrate conductive material into the fingertip to activate touch-screen

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

PHOTOS: Naked Prosthetics

in a 2010 hunting accident, he had what he calls a “postsurgery epiphany”—an idea for a better finger prosthesis. McDuff, who was unemployed at the time, had professional experience in architectural design and bicycle welding. He made a prototype device in his garage using spare bike parts and approached his friend, Bob Thompson, for advice on how to market and sell it.

Thompson and McDuff formed a company, RCM Enterprises, in 2011 and continued to refine the design. They replaced the metal components with medical grade nylon and found a way to build rapid prototypes so that each prosthesis could be customized for its user.

Chief Operating Officer Jon Bengtsson joined the company in 2013, helping to guide its growth and search for a new name.

“We went through a fairly extensive naming process,” he says. “We thought about the industry in general and the trend to uncovered, noncosmetic prostheses. We wanted our device to be functional and not try to hide the fact that someone had a finger amputation. We settled on ‘Naked Prosthetics,’ which is not offensive, but it is easy to remember and it does get attention!”

The first iteration of the company’s prosthesis was a partial finger that attached above the proximal interphalangeal joint, the first joint above the knuckle. The finger is biomechanically controlled, using no motor or battery power, and

technology that uses naturally occurring electrical currents generated by human touch.

Other products include a partial prosthetic fingertip, for those with functional finger joints, which protects against hypersensitivity. The company is working on a therapeutic hand orthosis that will stabilize broken fingers or other hand injuries and help rehabilitate joint function.

At first, Naked Prosthetics marketed its device directly to consumers, who could download complete instructions from the company website addressing every step, from photocopying both hands with a color copier to filling out insurance authorization forms. After approval, customers received a sizing kit in the mail. Today, Naked Prosthetics primarily works with prosthetists and surgeons, and Hanger is one of its main distributors.

The company, which tripled in size since last year, uses outside contractors in the United States to code, engineer, and manufacture its devices, although they are assembled and tested in its offices in Olympia, Washington.

Wearing Naked Prosthetics’ finger device has made a huge difference to amputees, says Bengtsson. “Our customers have been able to go back to work, play the piano and the guitar, pick grapes—even climb mountains,” he says. “Not only that, it has a profound psychological impact. It makes them feel whole again.”

REGISTRATION IS NOW OPEN. Visit www.AOPAnet.org for updates and additional information.

AOPA’s

national

assembly ’14

The premier meeting for orthotic, prosthetic, and pedorthic professionals

Sept. 4–7, 2014 Mandalay Bay, Las Vegas

OF THE AOPA NATIONAL ASSEMBLY

Exhibits. Education. Networking. CE Credits.

The AOPA National Assembly is already the most talked about event for 2014—It is the premier destination for the world-wide orthotic, prosthetic and pedorthic community. Register today to participate in the National Assembly.

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

AOPA NEWS

THE AOPA BULLETIN

Big Goings-On in Washington AOPA and the O&P industry continue to make their voices heard during hearings and via proposed legislation

O In our quest to deliver maximum return on investment to you the reader and AOPA member, each issue of O&P Almanac will summarize recent actions AOPA has undertaken in making a difference in solving problems or meeting challenges faced by the O&P community and deliver a greater ROI on the AOPA investment for all of O&P.

56

&P has long been seeking congressional attention for O&P issues—particularly since the flawed Office of Inspector General (OIG) report in August of 2011 erroneously raised questions about lower-limb prosthetic payments by CMS. So it was good news that an intensive series of congressional hearings recently shed light on O&P.

Russell Senate Office Building

Congressional Committees Capture O&P Concerns.

Testimony was provided for the Way and Means Health Subcommittee on April 30, 2014, and again on May 20, 2014.

The April 30 hearings provided a forum for AOPA to once again stress the importance of enacting H.R. 3112, the Medicare O&P Improvement Act, which among other provisions would help fight waste and fraud by limiting reimbursements to only qualified providers. Under H.R. 3112, qualified providers would include certificants of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) and the Board of Certification/ Accreditation (BOC) (or other certifying organizations with equivalent standards) or properly licensed providers in licensure states. Qualifications of the provider would relate to the complexity of patient needs.

At the May 20 hearing before the House Ways and Means

AUGUST 2014 | O&P Almanac

Health Subcommittee, AOPA addressed the unintended consequences of recovery audit contractor (RAC) audits and the massive backlog of administrative law judge (ALJ) Medicare appeals.

In the a separate May 20 hearing before the Oversight and Government Reform Subcommittee on Energy Policy, Health Care, and Entitlements, AOPA again urged enactment of H.R. 3112 to combat waste and fraud. Rep. Tammy Duckworth (D-Illinois) took CMS to task for RAC audits aimed at curbing fraud and abuse, noting, “This well-intentioned effort of CMS to accomplish this is not working.”

She went on to outline the specific harm to the O&P community and their patients, and explained that small businesses are going out of business—which limits care choices for O&P patients.

The May 21 statement for the House Energy & Commerce Health Subcommittee hearings addressed issues related to Medicare site of service and related issues of cost effectiveness. AOPA’s Dobson DaVanzo cost-effectiveness research commissioned by the Amputee Coalition and funded by AOPA was the basis for AOPA’s effort to prove to Medicare and other payers that timely O&P care pays off in the long run. AOPA’s new public relations outreach, “Mobility Saves—Lives and Money,” is a further reinforcement directed at policy makers, referral sources, patients, and payers.

The July 10 hearings by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care, and Entitlements called “Medicare

AOPA NEWS

THE AOPA BULLETIN

Mismanagement Part II: Exploring Medicare Appeals Reform” focused on a single witness: Nancy Griswold, chief administrative law judge. No clear solution emerged for the unconscionable three- or four-year delay on ALJ appeals, but Duckworth suggested that Medicare audits have been disproportionately unfavorable to the O&P industry, particularly because reviewers at the lower levels do not consider an O&P professional’s notes in their determinations.

Duckworth said that in many cases reviewers at pre-ALJ levels make invalid determinations because the notes of O&P professionals are not recognized as a legitimate part of the medical record. Griswold replied that “as a general rule,” the Office of Medicare Hearings and Appeals (OMHA) reviews the same documentation as lower-level reviewers.

Duckworth asked whether CMS and OMHA reviewers are communicating and sharing best practices when they identify trends, such as the consistently high rate of sustained O&P-related appeals. Griswold suggested she was not aware that O&P providers were unfairly treated as a group. Duckworth replied that more than 100 industry professionals have been put out of business while “waiting to be reimbursed.”

Prior Authorization Debate Continues.

CMS published its proposed rule on May 22 to establish a prior authorization process for virtually all lower-limb prosthetics. At first blush, many in the O&P community welcomed the proposal, thinking anything would be better than the current situation.

What’s missing from the CMS proposal is the guarantee that a prior authorized (or “affirmed”) claim by Medicare represents a promise to pay. It does not.

Another concern is the promised 10-day processing turnaround. Based on the three- to four-year time lag

to secure an ALJ appeal hearing, a 10-day turnaround on affirming coverage certainly seems optimistic.

And even 10 days represents another layer of bureaucracy and a delay in patients receiving their prostheses.

AOPA has conducted an aggressive education campaign within the O&P community to raise awareness of the shortcomings of the CMS proposal and what fixes are needed to make it a positive, rather than a negative, solution. To be workable, AOPA requests several alterations: that prior authorization serve as a promise to pay, and RAC audits be immediately suspended; that the prosthetist’s notes be considered part of the medical record; that a more appropriate value threshold must be established for determining which devices require prior authorization (a $1,000 threshold is too low); and that claims be automatically affirmed if there is no decision in five days.

AOPA hosted two free webinars in July on the topic of prior authorization. Moderated by AOPA President Anita Liberman-Lampear, MA, the webinars reached more than 400 O&P providers. A special June Executive Director Letter fleshed out the AOPA position so members could have a more complete understanding of why AOPA opposes prior authorization in its present form. AOPAVotes featured a click-and-send letter addressed to CMS on prior authorization that members could use directly or as a guide to fashion their own comments.

Members also were provided a minimum of 10 postcards addressed to CMS for distribution to amputee patients. Patients were asked to sign and mail the cards, which pointed out the prior authorization proposed rule in its present form could jeopardize timely prosthetic care by delays in the approval process, extend wheelchair time while approval is pending, and potentially result in a patient receiving a downgraded device rather than one that embraces his or her full potential.

Proposal Exempts O&P From Post-Acute Care Bundling.

Another “save” emerged after AOPA and the O&P Alliance held several meetings with House Energy and Commerce staff prior to introduction of H.R. 4673 by Rep. David McKinley (R-West Virginia). The bill, called the Bundling and Coordinating Post-Acute Care Act of 2014, exempts O&P providers, physical therapists, and physicians from post-acute care bundling (PACB).

Bundling and Coordinating Post-Acute Care Act of 2014

ION

PT M E X PE

O&

PACB offers a single entity an opportunity to aggregate care providers for hospitalized patients for the first 90 days after discharge with this single entity (usually a hospital) managing care and parceling out payments to various participating providers.

AOPA made the case that orthotic and prosthetic patients often need lifetime care, and PACB would harm O&P patients. This issue will be ongoing and will require a watchful eye over the next few years as policy makers continue identify cuts within the Medicare program. PACB is just one of several pathways to secure those savings.

AOPA Supports Proposed Legislation.

Rep. Renee Ellmers (R-North Carolina) introduced H.R. 5083, the Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014, on July 11 after a collective effort to seek legislation that would help reduce the harm to patients caused by overzealous CMS RAC audit contractors.

AUGUST 2014 | O&P Almanac

57

AOPA NEWS

THE AOPA BULLETIN

While AOPA has reservations about certain language in the bill, the following provisions prompted AOPA to support the legislation: “(B) Documentation created by orthotists and prosthetists. For purposes of determining the reasonableness and medical necessity of prosthetic devices and orthotics and prosthetics, documentation created by orthotists and prosthetists shall be considered part of the medical record.”

Two additional sections were included in the bill as a result of AOPA’s intervention, with assistance from AOPA’s lobbying team at Alston and McGuireWoods, working in conjunction with Peter Thomas and the O&P Alliance: 1. When compiling and publicly reporting information on appeals filed and success of appeals for providers at ALJ level, HHS shall create separate categories for orthotics

and prosthetics and for durable medical equipment and supplies.

2. In calculating error rates, CMS shall exclude claims for payments that have been denied and are being appealed by a provider or supplier.

CMS Redefines “Minimal Self-Adjustment.”

A proposed rule that further clarifies the term “minimal self-adjustment off-the-shelf” as it relates to customfit and off-the-shelf orthoses was published July 11 in the Federal Register

by CMS. “Individuals with special training” would be added to the current definition that includes certified orthotists as qualified individuals to provide custom fitting of orthoses.

The new definition specifies physicians, treating practitioners (physician assistants, nurse practitioners, and clinical nurse specialists), physical therapists, and occupational therapists.

The proposed rule states that orthotic

assistants, fitters, and manufacturer’s representatives are not considered to have specialized training for the purposes of providing custom fitting of orthoses; any devices fit or adjusted by these individuals will be considered off-the-shelf. AOPA will submit comments by the Sept. 2, 2014, deadline.

No Rest for the Weary

There is no let-up in the efforts to find solutions to the untenable situation O&P providers have coped with for almost three years; providers have endured clawed-back monies by CMS, appeal delays, and further aggravations.

AOPA’s lawsuit against CMS was dismissed by the court, but a similar lawsuit filed by the American Hospital Association against CMS over the RAC audit injustice is still pending.

AOPA will continue to use every tool at its disposal to bring about a favorable resolution of the RAC audit situation and related issues.

WElCOME NEW MEMBERS

T

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

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

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

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

Active Life Inc. 124 Alvarado Drive SE Albuquerque, NM 87108 505/266-1700 Category: Patient-Care Member Spencer Doty, CPO Atlantic Prosthetic Services 1142 Shipyard Blvd.

Wilmington, NC 28412 910/350-0067 Category: Patient-Care Member Jeffrey McDonald Boas Surgical Inc. 90 N. Claude Lord A. Blvd.

Pottsville, PA 17901 570/481-8862 Category: Affiliate Member

Brunswick Orthotics & Prosthetics Inc. 3501 Altama Avenue Brunswick, GA 31520 912/261-8117 Category: Patient-Care Member Shannon Thompson Mid State Artificial Limb Inc. P.O. Box 31092 Jackson, MS 39286 601/981-2229 Category: Patient-Care Member Troy Luster

Is Your Facility Celebrating a Special Milestone This Year?

O&P Almanac would like to celebrate the important milestones of established AOPA members.

To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@contentcommunicators.com.

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AUGUST 2014 | O&P Almanac

LL A O

T N

E P O a

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wit

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The AOPA Wine Tasting & Auction will be held on Friday, September 5, from 6:30 – 8:00 PM at Mandalay Bay.

FRIDAY, SEPT. 5 / 6:30 – 8:00 PM

NEW Blind Tasting Challenge

Everyone knows that the Wine Tasting and Auction is an important component to support AOPA’s government relations programs and the legislative activities of the profession. What everyone does not know is:

The Wine Tasting and Auction is a fun event for everyone!

Spend a fun evening with colleagues and industry leaders learning about and tasting different wines. A special guest auctioneer will be present to lead the festivities. Get ready for the excitement of both a silent and live auction.

• Sample wines from various wineries as well as partake from an open bar.

• Enjoy the camaraderie as members from all aspects of the profession unite for an important cause.

Registration is required. For more information, visit the AOPA Booth #1077.

There is much more to bid on than just wine, previous items have included:

JEWELRY

VACATIONS

CIGARS

BOURBON

EXPERIENCE THE OF THE AOPA NATIONAL ASSEMBLY

WINE SETS

TIFFANY CRYSTAL

BIG BONUS: Receive a $100 credit towards your first winning bid(s), with each $150 special event registration fee.

Supporting quality patient care and the O&P legislative agenda

Mastering Medicare:

LIVEY

EVERTH MON

Webinar Education The brand new and improved team-building & money-saving, educational experience!

AUG

13

AFO/KAFO Policy: Understanding the Rules*

SEPT

10

Urban Legends in O&P: What to Believe*

Obtaining Medicare reimbursement for AFOs and KAFOs can sometimes be a challenging and often frustrating experience. Join AOPA for an AOPAversity Mastering Medicare Audio Conference that will focus on the nuances of AFO/ KAFO LCD and Policy Article and help you to better understand the rules.

Attendees will learn:

Rumors run as rampant in O&P as any other industry. Just because you hear the same things from different people does not always mean they are true. AOPA will attempt to dispel some of the bigger myths surrounding O&P billing. Some of the topics discussed will include:

; What documentation must exist in order to use the KX modifier on your claim ; What are the coverage rules for AFOs with ambulatory vs. non-ambulatory patient ; How to bill for repairs to AFOs and KAFOs ; When is it okay to use a custom fabricated AFO/KAFO ; Basic review of the major component of a Medicare medical policy

; Billing for diabetic shoes involving amputees; ; Financial liability on non-assigned claims; ; Proper use of the KX modifier; ; Prostheses and Power Wheelchairs; ; Billing for unlisted procedure codes

AUGUST

SEPTEMBER

AOPAversity Webinar Series

OCT

08

Medicare Enrollment, Revalidation, and Participation*

Will focus and cover the basics of Medicare Enrollment Procedures and topics for discussion will include: ; Reviewing new Medicare Enrollment Standards ; Reviewing the Medicare Enrollment Application ; PECOS vs. the 855S Form ; Difference between a participating Medicare provider and a non-participating Medicare provider ; When you must revalidate and reenroll your Medicare number ; When/How you may change your participation status

OCTOBER

During these monthly one-hour sessions, AOPA experts provide the most up-to-date information. Perfect for the entire staff—one fee per conference, for all staff at your company location.

Complete the accompanying quiz to earn 1.5 CE credit for each conference.

2 NOV

12

nd

Wednesday of each month!

Gifts: Showing Appreciation without Violating the Law*

DEC

Medicare has very specific rules about what you can and cannot do .What is and is not considered a kickback and how to acknowledge referral sources without getting into trouble. Also a general discussion of other types of activity that can be interpreted as a kickback. ; When gifts to referral sources are acceptable ; When gifts to patience are acceptable ; Federal Anti-Kickback regulation prohibitions ; Doing something nice vs. doing something illegal

NOVEMBER

New Codes and Changes for 2015*

A discussion of any new codes and modifiers for 2015, including information on how the codes are created and how the DMEPOS fees are established. The call will also cover any new changes in medical policies. ; Learn about new HCPCS codes effective January 1, 2015. ; Discuss verbiage changes to existing codes and how they may affect your business. ; Find out which codes will no longer be used as of January 1, 2015. ; Discover other changes to the HCPCS system. ; Find out AOPA’s interpretation of why the changes took place.

10

DECEMBER

AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. For content questions, contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854.

Register online at http://bit.ly/aopa2014audio. For registration questions, contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876.

EARN CREDITs

1.5 CE PER CONFERENCE

Register online at http://bit.ly/aopa2014audio.

AOPA NEWS

O&P

Let’s Make a Movie!

Submit Your Videos for AOPA’s Public Relations Campaign

L

ast year, many of AOPA’s supplier members and exhibitors generously shared video footage to help create the World Congress Opening Ceremony. This year, AOPA is creating a public relations campaign to promote the costeffectiveness study funded by AOPA and commissioned

by The Amputee Coalition (www.aopanet.org/wp-content/ uploads/2014/04/January-2014-ED-Letter.pdf). The study proves that orthotics and prosthetics saves lives and money.

Specifically, AOPA is seeking examples of patient care in action; how orthotics and prosthetics help people achieve independence; and/or video clips showing people doing things that they would not be able to do without an O&P device.

If you have a video clip for AOPA to include in the campaign, please send the video or video link to Tina Moran at tmoran@aopanet.org.

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AUGUST 2014 | O&P Almanac

Mastering Medicare: Advanced Coding & Billing Techniques Renaissance St. Louis Grand Hotel | October 20-21, 2014 | St. Louis, Missouri

J

oin your colleagues for AOPA’s Mastering Medicare: Advanced Coding & Billing Techniques seminar in October. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group.

AOPA has reserved a block of hotel rooms at the Renaissance St. Louis Grand Hotel for the rate of $129 per night for reservations made before September 24, based on availability. For hotel reservations, call 800/468-3571.

Basic material that was contained in AOPA’s previous coding and billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage, www.aopanet.org.

Register online for the Mastering Medicare: Advanced Coding & Billing Techniques seminar in St. Louis at http://bit.ly/ aopa2014stlouis.

Questions? Contact Devon Bernard at dbernard@aopanet.org or 571/431-0854.

AOPA NEWS

Log On for Free at the AOPAversity Online Meeting Place

Education Programs for 21st Century Entrepreneurs—

Education does not get any more convenient than this. Busy professionals need options—and

web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you.

For a limited time, AOPA members can learn and earn for free at the AOPAversity Online Meeting Place: www.AOPAnetonline.org/education.

Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.

AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management.

Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare.

Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice.

Register online by visiting http://bit.ly/WebcastsAOPA.

Survive and Thrive: Bottom-Line, Profit-Oriented O&P Business Programs

I

f you missed the 2013 O&P World Congress, don’t let this opportunity to participate in these important programs pass you by:

• Everything You Need to Know to Survive RAC and Prepayment Audits in a Desperate Environment • Competitive Bidding: Devastation to Orthotic Patient Care, Or Just a Passing Storm?

• Food and Drug Administration Compliance for Patient-Care Facilities, Manufacturers, and Distributors • Your Mock Audit: Are You Ready for the Auditor to Examine Your Claims Record?

You and your staff can now have a private viewing of business saving strategies and earn continuing education credits at the same time. Learn more about each session by visiting http://bit.ly/CreditCEpromo.

AOPA members just $59 per session B O NUS BUY 3 ($99 per session for nonmembers), and the GET ONE FREE price covers your entire staff. Take advantage of a special offer to buy three, get one free.

Review the videos as many times as you like.

Register at http://bit.ly/aopabusiness. For more information, contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876.

O&P Almanac | AUGUST 2014

63

AOPA NEWS

Earn CE Credits by Reading the O&P Almanac!

E! Q UI Z M Earn

2

Business CE

Credits P.17

Coding Questions Answered 24/7

AOPA members can take advantage of a “click-ofthe-mouse” solution available at LCodeSearch.com.

AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways—by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions.

Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions.

Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

Welcome to AOPA Jobs Because of the highly educational content of the O&P Almanac’s Reimbursement Page and Compliance Corner columns, O&P Almanac readers can now earn two business continuing education (CE) credits each time you read the content and pass the accompanying quizzes. It’s easy, and it’s free.

Simply read the Reimbursement Page column (appearing in each issue) and Compliance Corner column (appearing quarterly), take the quizzes, and score a grade of at least 80 percent. AOPA will automatically transmit the information to the certifying boards on a quarterly basis.

Find the digital edition of O&P Almanac at: • http://www.aopanet.org/publications/digital-edition/ Access previous monthly quizzes at: • http://bit.ly/OPalmanacQuiz The July 2014 quizes are located at: • https://aopa.wufoo.com/forms/ op-almanac-july-2014-reimbursement-page/ • https://aopa.wufoo.com/forms/ op-almanac-july-2014-compliance-corner/ Be sure to read the Reimbursement Page article in this issue and take the August 2014 quiz.

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

Earn CE credits accepted by certifying boards:

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AUGUST 2014 | O&P Almanac

www.bocusa.org

AOPA’s Online Career Center gives you

access to a very specialized niche. The Online Career Center is an easy-to-use, targeted resource that connects O&P companies and industry affiliates with highly qualified professionals. The online job board is designed to help connect our members with new employment opportunities.

Job Seekers: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers.

Employers: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you.

Recruiters: Create and manage your online recruiting account. Post jobs to our site and browse candidates interested in your positions.

The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at http://jobs.aopanet.org.

In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations!

Regardless of your staffing needs or budget, we have an option that is right for you. For advertising, call Bob Heiman, Advertising Sales Representative at 856/673-4000 or email bob.rhmedia@comcast.net.

AOPA NEWS

If You’re Paying More Than 1.9%, You’re Paying Too Much AOPA has partnered with Bank of America Merchant Services to offer credit card processing rates as low as 1.9 percent to AOPA members.

Many members are paying more than 2.5 percent, and if you’re handling $500,000 a year in credit card transactions, the 0.6 percent savings is like getting a 200 percent return on your membership dues investment.

To enroll, contact 888/317-5402 or email tellmemore@ bankofamericamerchant.com. AOPA encourages members to request an audit of a recent processing statement to identify the savings they would enjoy.

UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa!

Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster.

AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air® All this with the peace of mind that comes from using the carrier that delivers outstanding reliability, greater speed, more service, and innovative technology. UPS guarantees delivery of more packages around the world than anyone, and delivers more packages overnight on time in the US than any other carrier. Simple shipping!

Special savings! It’s that easy!

www.savewithups.com/aopa

AOPA’s 2014 Coding Products Are Available in the Bookstore 2014 Illustrated Guide

This easy-to-use reference manual provides an illustrated guide to the coding system in use for orthotics, prosthetics, and shoes, including HCPCS codes, official Medicare descriptors, and illustrations.

2014 Coding Pro

The Coding Pro is O&P’s comprehensive guide to Medicare codes, reimbursement, and medical policies.

This is the single-source reference for all of your coding needs!

The Coding Pro CD-ROM provides updated Medicare fee schedules for all 50 states and allows you to customize and import other fee schedules used by your office. Illustrations of the codes allow you to quickly sort codes. And writing prescriptions just got easier with the prescription writing tool. Network Version for use on multiple office terminals.

2014 Quick Coder

Stop searching through numerous pages to find a code! AOPA’s redesigned Quick Coder provides a speedy reference to the HCPCS orthotic, shoe, and prosthetic codes and modifiers. These laminated cards are durable, long-lasting, and convenient to store.

2014 Coding Suite

Save $50 when you purchase the newly updated Coding Suite, which includes all of the coding products discussed above: 2014 Illustrated Guide, 2014 Coding Pro (SingleUser CD Software), and the 2014 Quick Coder.

Go to the AOPA Bookstore and order your Coding Products today, visit http://bit.ly/BookStoreAOPA. O&P Almanac | AUGUST 2014

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AOPA O&P PAC

T

he O&P PAC advocates for legislative or political interests at the federal

level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form contact Devon Bernard at dbernard@AOPAnet.org .

AOPA also would like to thank those individuals who have donated directly to a candidate’s fundraiser or to an O&P PAC-sponsored event, as they, too, are valuable supporters in achieving the legislative goals of AOPA and the O&P PAC*.

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

Kel Bergmann, CPO

James Kaiser, CP, LP

Ron Manganiello

Gordon Stevens, CPO

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AUGUST 2014 | O&P Almanac

• • • • • • • • • • • • • • •

Daniel Bastian, CP Jim Cahill, CPO James Campbell, Ph.D J. Martin (Marty) Carlson, CPO Rikki Cheney Glenn Crumpton, CPO Charles Dankmeyer, CPO Paula Doherty Susi Ebersbach Jeff Erenstone Michael Fenner, CP Rick Fleetwood, MPA Lisa Guichet Frank Ikerd, CPO Lori Jack

• • • • • • • • • • • • • • •

Jim Kaiser, CP Jim Kingsley Anita Liberman-Lampear, MA Tom Loposer Ken Meier, CPO Ricardo Ramos, CP Kurt Schlau, CP Donald Shurr, CPO Christopher Snell Gordon Stevens, CPO Peter Thomas, Esq. John Tyo, CP Frank Vero, CPO Jim Weber, MBA Elliot Weintrob, CPO

*Due to publishing deadlines, this list was created on July 15, 2014, and includes only donations and contributions made or received between June 1, 2014, and July 15, 2014. Any donations or contributions made or received after July 15, 2014, will be published in the next issue of the O&P Almanac.

Extraordinarily significant findings show Medicare data proves the value of an O&P intervention based on economic criteria.

Get Involved and Spread the Word About The Valuable Benefits of O&P Care

You Know Mobility Saves— But How Do You Spread The News?

Simple! Visit MobilitySaves.org.

Find All the Tools You’ll Need at MoblitySaves.org:

Access the Full Study

Review the White Paper

Share this information with clinicians, practitioners, and insurance providers

Educate others with informative slide shows

Healthy Lives

Follow Mobility Saves on Facebook and Twitter

Watch the News Release

O&P CARE IS COST EFFECTIVE—It is a SAVER, not an expense to insurers!

O&P professionals have learned the positive outcomes from the Dobson DaVanzo study, which proves that timely O&P intervention results in fewer co-morbidities and lower healthcare costs for both patients and payers. Share this significant news by using the educational tools provided at MobilitySaves.org.

Dobson DaVanzo’s study commissioned by the Amputee Coalition, funded by AOPA and publicly released August 27, 2013, makes the cost effective case for O&P intervention and proves that “Mobility Saves.” O&P professionals knew that intuitively and now Medicare’s own costs and figures prove it irrefutably:

Mobility Saves Lives And Money!

Watch Queen’s story and more experiences.

Get Involved, Spread the Good Word

MobilitySaves.org

AOPA NEWS

CAREERS

MID-ATLANTIC

PACIFIC

CPO

Here We Grow Again…

Openings: CPO, CP, CO, C.Ped, and Lab Technicians

Roanoke, Virginia Well-established multi-office ABC-certified O&P company looking for certified individual with excellent orthotic and prosthetic skills to provide comprehensive treatment for patients.

Excel offers competitive salary and bonus opportunity with full benefits package. Salary to be determined on experience.

Send resume to:

Email: sethwalters@excel-prosthetics.com

Southeast CPO or CO

Chattanooga, Tennessee Fillauer Companies Inc. is seeking a CPO or CO to join its team as the director of orthotics at its headquarters in Chattanooga, Tennessee. In this role, the qualified candidate will manage the product development and clinical education for Fillauer’s orthotic product lines.

Requirements: • Education minimum: Bachelor’s degree in O&P. Engineering degree and/or a master’s degree in O&P a plus.

• ABC certification, preferred.

• Minimum of five years of recent patient care experience with emphasis on orthotics.

• Licensed or ability to be licensed in the state of Tennessee.

• If not currently living in Chattanooga or the surrounding area, candidate must be willing to relocate.

• Engineering experience preferred. Proficient in CAD and SolidWorks a plus.

• Must work well in a team environment.

• Excellent communications skills, including oral and written, are necessary.

• Must have the ability to travel up to 30% or as needed.

Fillauer Companies Inc. offers a competitive benefits package, including 401K and medical, dental, and vision insurance. Please apply at:

Website: Fillauer.com/careers 68

AUGUST 2014 | O&P Almanac

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

Send resumé to: Attention: Human Resources Inland Artificial Limb & Brace Inc. Fax: 951/734-1538 Email: ialb720@hotmail.com

O&P HISTORY

A Look Back in Time

A digital archive of issues ranging from 1975 to 1988 of O&P Journal, predecessor of the O&P Almanac.

Get your fill at www.oandplibrary.org/op!

CAREERS

Opportunities for O&P Professionals Job location key: - Northeast - Mid-Atlantic

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

Member $482 $634

Nonmember $678 $830

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

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

- Southeast - North Central - Inter-Mountain - Pacific

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

Include your company logo with your listing free of charge.

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

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

Job Board

Member Nonmember $80 $140

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

Discover new ways to connect with O&P professionals.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit http://bit.ly/aopa14media for advertising options.

“The most gratifying piece of what I do

every day is to get up early in the morning, get to the office and know that we are going to make a difference.�

- Kevin Carroll, MS, CP, FAAOP

Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic.

Join Hanger Clinic and make a difference today.

AVAILABLE POSITIONS CLINIC MANAGER Ardmore, OK Lynchburg, VA

Corvallis, OR Zanesville, OH

ORTHOTIST

Auburn, CA Evansville, IN Havertown, PA Johnston, IA Kansas City, KS La Mesa, CA Olivette, MO

Orange, CA Salisbury, MD Valdosta, GA Wethersfield, CT Cincinnati, OH Somersworth, NH Wichita, KS

PROSTHETIST

Overland Park, KS

Riverside, CA

Albuquerque, NM Brunswick, GA Carson City, NV Columbus, OH Dayton, OH Denver, CO Englewood, CO Lansing, MI Las Vegas, NV

Macon, GA Montrose, CO Oklahoma City, OK San Jose, CA Santa Rosa, CA Tallmadge, OH Thomasville, GA Tulsa, OK Springfield, IL

PROSTHETIST/ORTHOTIST

To view available positions and apply online visit: www.hanger.com/careers or scan the QR code.

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.

Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.

O&P Almanac | AUGUST 2014

69

CALENDAR

2014 August 13

AOPA: AFO/KAFO Policy— Understanding the Rules. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Audio Conference

August 14

OTS Orthotic Regulations—What CMS’s Proposed Rule Could Mean For You. Register and RSVP online at https://attendee.gototraining. com/r/7958445841915917313. For more information, contact Lauren Anderson at 571/431-0843 or email landerson@aopanet.org

August 14-15

Spinal Technology Scoliosis Orthotic Symposium— Scoliosis Management, Spinal Trauma Management, and Lower-Limb Orthotics Management. Spinal Technology Inc. hosts our annual Scoliosis Symposium in Boston. Course will cover full-time scoliosis bracing protocol for adolescent idiopathic scoliosis; the Providence Nocturnal Scoliosis System; measurement techniques and brace options for lower-limb orthotics; with hands-on demonstrations in each segment. Presenters include Tufts Medical Center orthopedic surgeons, a Tufts neurosurgeon, and ABC-certified practitioners. Eligible practitioners can earn 16.25 ABC credits for attending the full presentation. Contact Nancy Francis at nancy_f@spinaltech.com or call 508/775-0990 x8374.

September 1

ABC: Application Deadline for Certification Exams.

Applications must be received by Sept. 1, 2014, for individuals seeking to take the November 2014 ABC

Year-Round Testing BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiple-choice and clinical-simulation exams.

Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

www.bocusa.org

Calendar Rates Let us share your upcoming event!

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

AOPAnet.org for content deadlines.

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AUGUST 2014 | O&P Almanac

September 4-7

97th AOPA National Assembly.

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

September 10

AOPA: Urban Legends in O&P: What To Believe. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Audio Conference

September 13-14

The Foot and Ankle: From Athletic to Decrepit.

Durham, NC. Study pathology-based treatments, orthotics, shoe modifications, and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

September 15-20

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was July 1, 2014. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Online Training

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

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

Questions? Email scuster@AOPAnet.org.

Credits

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

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less $40 $50 1/4 page Ad $482 $678 26-50 $50 $60 1/2 page Ad $634 $830 51+ $2.25/word $5.00/word

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

CALENDAR September 27-28

The Foot and Ankle: From Athletic to Decrepit.

Asheville, NC. Study pathology-based treatments, orthotics, shoe modifications, and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

November 6-7

COPA 2014 Northern California Educational Event.

Hilton Garden Inn. Emeryville, CA. For more information, visit www.regonline.com/builder/site/?eventid=1567170.

November 8-9

October 8

AOPA: Medicare Enrollment, Audio Conference Revalidation, and Participation. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

The Foot and Ankle: From Athletic to Decrepit.

Durham, NC. Study pathology-based treatments, orthotics, shoe modifications, and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

November 12

Bio-Mechanical Composites, Inc.

October 10

Fall 2014: Learning and Leisure—“Dynamic Response Orthotic System” Certification Course. Join us at the LaGuardia Airport Marriott in New York the day prior to the POMAC meeting. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.75 CEUs. For registration information, visit www. phatbraces.com. For more information, call 515/554-6132.

October 11

POMAC (Prosthetic and Orthotic Management Associates Corporation) Continuing Education Seminar, co-sponsored with PEL. New York. LaGuardia Airport Marriott. Contact Drew Shreter at 800/946-9170 or visit www.pomac.com.

October 16-18

Virginia Orthotic & Prosthetic Association. Glen Allen, VA. Wyndham Virginia Crossings Resort & Conference Center. For more information, visit www.vopaweb.com or email vopainfo@gmail.com.

November 5-7

New Jersey Chapter AAOP Educational Seminar. NEW LOCATION: Revel Atlantic City Resort Casino, NJ. For more information, visit www.njaaop.com or email director@njaaop.com.

AOPA: Gifts—Showing Appreciation Without Violating the Law. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Audio Conference

November 15

Midwest Chapter AAOP—One-Day Fall Symposium.

Hickory Hills, IL. For more information, visit www.mwcaaop. org/meetings-events.html or email mwcaaop@gmail.com.

December 10

AOPA: New Codes and Changes for 2015. Register online at http:// bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Audio Conference

2015 OCTOBER 7-10

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

ADVERTISERS INDEX Company

Page Phone

Website

Ability Dynamics Allard USA ALPS South LLC American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc. Becker Orthopedic Cascade Dafo College Park Industries Coyote Design DAW Industries Dr. Comfort Ferrier Coupler Inc. Fillauer Hersco Ottobock PEL Spinal Technology

21 41 7, C3

www.abilitydynamics.com www.allardusa.com www.easyliner.com

35 43 27 2 16 1 5 29 C2 13 C4 9 15

855/450-7300 888/678-6548 800/574-5426

703/836-7114 www.abcop.org 800/521-2192 www.beckerorthopedic.com 800/848-7332 www.cascadedafo.com 800/728-7950 www.college-park.com 800/819-5980 www.coyotedesign.com 800/252-2828 www.daw-usa.com 877/713-5175 www.drcomfort.com 810/688-4292 www.ferrier.coupler.com 800/251-6398 www.fillauer.com 800/301-8275 www.hersco.com 800/328-4058 www.professionals.ottobockus.com 800/321-1264 www.pelsupply.com 800/253-7868 www.spinaltech.com O&P Almanac | AUGUST 2014

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ASK AOPA

Final Diagnosis Answers to your questions regarding diagnoses, prescriptions, and documentation

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

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

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

Is the patient’s diagnosis required on the final detailed written order?

Q/

According to the Medicare medical policies and the Medicare program “Integrity Manual,” the diagnosis is not required; it is optional and you may include it if you choose.

The only information required to be included on the detailed written order is the following: • Beneficiary’s name • Physician’s name • Date of the order and the start date, if start date is different from the date of the order • Detailed description of the item(s) • Physician signature and signature date

A/

Can a nurse practitioner or physician assistant write/sign a prescription and document the need for treatment?

Q/

Yes, a nurse practitioner or a physician assistant may document the need for treatment, but there are some restrictions on when they may write and sign orders.

Nurse practitioners may write and sign a Medicare order for O&P items and services as long as they meet the following criteria: They are treating

A/

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AUGUST 2014 | O&P Almanac

the patient for the condition for which the item is ordered; they are practicing separately from a physician or not directly under a physician’s supervision; they have their own national provider identifier (NPI) number and use that number to bill Medicare for other covered services; and they are allowed to practice in the state where the items/services are being ordered.

Physician assistants may write and sign a Medicare order for O&P items and services as long as they meet the following criteria: They are treating the patient for the condition for which the item is ordered; they are practicing under the direct supervision of a medical doctor or doctor of osteopathy, they have their own NPI number; and they are allowed to practice in the state where the items/services are being ordered.

Q/

What is the useful lifetime of a prosthesis?

The Benefits Improvement and Protection Act of 2000 legislatively exempted prosthetic devices from the useful lifetime restrictions that are associated with orthoses and durable medical equipment items.

However, the legislation does provide some restrictions.

For example, if you are replacing a prosthetic device or item that is less than three years old, additional confirmation that the device or item is medically necessary may be required.

A/

ALPSTM new Guardian Suction Liner features raised Grip GelTM bands that grip against the socket wall to form a secure interface. The low modulus bands stretch against the socket wall, while the inner wall conforms easily to the residual limb. This ensures there is no restriction of blood flow or stiffening to inhibit donning.

Grip GelTM bands are strategically placed for both transtibial and transfemoral applications.

R

2895 42nd Ave. North St. Petersburg, FL. 33714 Tel: 1-727-528-8566 Fax: 1-727-528-8862 www.easyliner.com info@easyliner.com

Responsive. Powerful. Dynamic.

The DynamicArm elbow prosthesis

The incredibly responsive DynamicArm elbow gives your patients the power and speed to get things done! The powerful electric motor and VarioDrive clutch go from zero to full flexion in half a second, and provide quick, precise positioning.

Now with a high lifting force of up to 13 lbs and a more natural appearance, the DynamicArm is a great way to lift your patient to the next level.

Attend the workshop qualification course at Academy. If you’d like more information—or to have your patient trial the DynamicArm—please contact your sales rep at 800 328 4058. www.professionals.ottobockus.com