January 2018 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

JAN UARY 2018

Prioritizing Reimbursement for 2018 P.16

Strategies for Running a More Efficient Facility P.28

Preventing Missteps in Complying With Facility Standards P.34

TRENDS in the

NEW ERA OF O&P

FIVE DEVELOPMENTS THAT WILL SHAPE THE FUTURE OF THE PROFESSION P.20

NEW FOR 2018

E! QU IZ M EARN

BUSINESS CE

Principal Investigator column profiles O&P researchers P.38

CREDITS

WWW.AOPANET.ORG

PP.17 & 36

This Just In: AOPA Adds O&P News to its Communications Brand P.18

YOUR CONNECTION TO

EVERYTHING O&P

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

e c n e i r e p Ex

September 26-29, 2018

VANCOUVER CALL FOR PAPERS NOW OPEN! AOPA is accepting clinical, technician, symposia/instructional course, business, and pedorthic abstracts. Submit by March 1 at

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

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

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Experience Beyond Vancouver’s unbeatable location makes it the perfect gateway to the rest of British Columbia and beyond, providing you with outstanding opportunities for pre- and post-conference travel. • Whistler • Okanagan Valley • Jasper • Victoria • Banff • Cruise to Alaska

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contents

JAN UARY 2018 | VOL. 67, NO. 1

COVER STORY

FEATURES

20 | Trends in the New Era of O&P The year 2018 represents a new beginning for the O&P profession, with the start of a second centennial for AOPA and a rapidly transitioning health-care climate. Experts from across the O&P field share their thoughts on the top trends impacting the profession and offer suggestions for adapting to changes stemming from new technologies, a more educated consumer base, the challenging reimbursement climate, valuebased care, and industry growth and consolidation. By Christine Umbrell

18 | This Just In

O&P News Relaunches Under the AOPA Brand This month marks the debut of the first issue of O&P News since the assets of the magazine were purchased by AOPA. The publication serves as a complement to O&P Almanac, offering diverse content including clinical insights from top minds in patient care, research articles, statespecific news, fabrication tips, and more.

JANUARY 2018 | O&P ALMANAC

28 |

Small Steps, Big Effects

O&P businesses can leverage several tools and strategies to spur profitability and productivity in an increasingly challenging health-care climate. O&P stakeholders offer tactical tips for building a team-oriented workplace that fosters facility-wide communication, optimizing internal reimbursement processes, capturing data via patient surveys and software systems, and testing process analysis tools. By Lia K. Dangelico

contents

NEW! O&P Almanac introduces a column for 2018 profiling individuals who lead and take part in O&P research initiatives.

Principal Investigator..................... 38 Tyler D. Klenow, MSOP, CPO, LPO, CPT, focuses his O&P research efforts on biomechanics and literature reviews

DEPARTMENTS Views From AOPA Leadership......... 4 Insights from AOPA Treasurer Jeff Collins, CPA

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

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

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

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

Increasing Efficiency

Adopt smart business practices CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

P.10 Compliance Corner............................... 34

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

Compliance Issues and Facility Accreditation

Transitions in the profession

Avoid common mistakes while adhering to standards

AOPA News.............................................. 44 AOPA meetings, announcements, member benefits, and more

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

Member Spotlight................................ 40 n

Welcome New Members ................. 46 P.16

PAC Update...............................................47

Aspire Prosthetics & Orthotics Inc.

Marketplace............................................. 48

Fabtech Systems

Careers........................................................ 49 Professional opportunities

Calendar..................................................... 50 Upcoming meetings and events

Ad Index....................................................... 51 Ask AOPA...................................................52 P.40

P.42

Reporting facility changes, accepting assignment, and more

O&P ALMANAC | JANUARY 2018

VIEWS FROM AOPA LEADERSHIP

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

The Importance of State Advocacy

Board of Directors

President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO

S I COMPLETE SEVERAL years of service as the president of the California

O&P Association this year, I look back and reflect on the importance of state advocacy. Advocacy is an interesting thing. We all have packed personal and business lives, and as long as something isn’t completely broken, most tend to focus energy and attention on other things. Those of us who have spent time in state and national associations know that there is much work to be done just to keep business as usual, let alone to advance and improve things, and certainly to protect against ever-looming threats. In California, we are fortunate to have a modest state association with enough membership to support an ongoing monthly retainer to provide monitoring and lobbying support when we need it. With this in place, we have been warned early and been given time and direction to react to numerous threats over the years. Some of these threats have included state budget cuts prompting proposed limits to coverage and reimbursement in our state Medi-Cal program and a rewrite of our professional code that would have allowed provision of prosthetics through pharmacy, to name some recent examples. Beyond reacting to proposed changes, our association has been successful in advocating for improvements to coverage in our state. Through effective lobbying efforts, we passed A.B. 2012, which established insurance fairness legislation in our state. Efforts to review and update state-funded reimbursement rates for O&P services also are part of our proactive activities. Participation in a state association also brings multiple opportunities for ongoing educational courses, professional networking, and community building to pursue big efforts to advocate collectively. This professional affiliation joins providers and legitimizes efforts that are more broadly supported. They’re bolstered when we bring the patients we serve in with us to talk about the issues and challenges we face. While many states have established formal associations to promote advocacy, I also have seen effective grassroots efforts of small groups of practices be effective in advocating and implementing change. The important thing is that advocacy is somewhere on your radar, and that it doesn’t get buried in the “busyness” of life. If you aren’t able to contribute financially to your state association or other advocacy efforts, consider investing your time—volunteer organizations always need help. And if you’re not able to provide your time, consider providing financial resources to ensure that someone is. Jeff Collins, CPA, is AOPA treasurer.

JANUARY 2018 | O&P ALMANAC

OFFICERS

President-Elect Chris Nolan Ottobock, Austin, TX Vice President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Immediate Past President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, MPH, PhD Orthocare Innovations LLC, Edmonds, WA Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Thuasne USA, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

PHILANTHROPIC PARTNERSHIPS Working together to improve people’s mobility Össur is committed to serving the limb loss and limb difference community. That's why we're pleased to renew our sole Platinum sponsorships of both the Amputee Coalition and OPAF and will continue to be the exclusive prosthetic provider to the Challenged Athletes Foundation in 2018. Together with these partners, we're working to provide invaluable resources, support programs, and grants so every amputee can pursue a life without limitations.

Learn more about Össur and our philanthropic partners at www.ossur.com/partnerships. The joy of receiving bilateral Össur Flex-Run™ feet at an Össur Running and Mobility Clinic presented by CAF.

FOLLOW ÖSSUR ON

AOPA CONTACTS

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

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

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

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org Don DeBolt, chief financial officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

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

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

JANUARY 2018 | O&P ALMANAC

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email landerson@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2018 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,800 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac18 for advertising options!

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NUMBERS

Company Perks How do your facility’s benefits stack up?

MEDICAL INSURANCE—EMPLOYEE

AOPA’s 2017 Compensation and Benefits Report captured data on how O&P facilities compensate employees, including which benefits they offer and whether employees contribute to the costs of those benefits. This information is based on 2016 data, which captured the financial facts from 88 companies representing 350 full-time facilities and 77 part-time facilities.

24 Percent

5 Percent

Fully paid by company.

Policy varies or fully paid by employee.

63 Percent

8 Percent

Partially paid by company.

Benefit not provided.

MEDICAL INSURANCE—DEPENDENTS

4 Percent

40 Percent

Fully paid by company.

Policy varies or fully paid by employee.

41 Percent

15 Percent

Partially paid by company.

Benefit not provided.

PAID TIME-OFF

RETIREMENT PLANS

Does your company offer full-time employees a combined vacation/ sick/personal leave arrangement often known as paid time-off (PTO)?

33%

Does your company offer a retirement plan? *

22 Percent Percentage of companies that fully pay for dental insurance for employees; another 30 percent offer partial coverage.

9 Percent Percentage of companies that fully pay for vision insurance for employees; another 15 percent offer partial coverage.

PAID LEAVE Yes

67%

DENTAL AND VISION INSURANCE

12%

89%

Eight

Average number of paid holidays provided to full-time employees.

*Numbers add to more than 100 due to rounding.

EDITOR’S NOTE: Details and more information are available in AOPA’s 2017 Compensation and Benefits Report. Visit the AOPA Bookstore at www.aopanet.org. 8

JANUARY 2018 | O&P ALMANAC

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Happenings RESEARCH ROUNDUP

Systematic Reviews Features AOPAFunded Research The November 21 edition of Systematic Reviews features an article written by Michael Dillon, PhD, of La Trobe University, whose research was funded by AOPA. The article, “A Systematic Review Describing Incidence Rate and Prevalence of Dysvascular Partial Foot Amputation; How Both Have Changed Over Time and Compare to Transtibial Amputation," is available through open access at bit.ly/dillonreview. This is the third publication resulting from a 2015 grant awarded to Dillon to review literature on dysvascular partial foot amputation and transtibial amputation.

FAST FACT

Approximately

8.8 million people

SOURCE: Seema Verma, CMS

JANUARY 2018 | O&P ALMANAC

Ultrasonic Sensor Technology Enables Individual Control of Prosthetic Fingers

Jason Barnes lost part of his right arm in 2012. He can now play the piano by controlling each of his prosthetic fingers. Researchers at the Georgia Institute of Technology have developed a “Luke Skywalker hand” using ultrasonic sensors. The device allows upper-extremity amputees to control each prosthetic finger individually, according to the researchers, allowing fine motor hand gestures that were previously unavailable. The Georgia Tech researchers have tested the new technology on amputee Jason Barnes, who lost his right arm below the elbow in 2012 after a workplace accident. Barnes retained the muscles in his residual limb that control his fingers. The new technology has enabled him to play the piano for the first time since his accident. The ultrasonic sensors of the prosthesis offer improved accuracy over electromyography (EMG) sensor technology, according to project leader Gil Weinberg, a professor in the

Georgia Tech College of Design. EMG “can detect a muscle movement, but the signal is too noisy to infer which finger the person wants to move,” said Weinberg. His team initially sought to improve the pattern detection from EMG to improve digit control for Barnes, but they were unable to attain finger-by-finger control. They then turned to ultrasound signals and machine learning, which can detect continuous and simultaneous movements and force of each finger. The new technology allows Barnes to adjust his grip and finger movement “on the fly.” The technology will have applications in assisting amputees with many types of fine motor activities, such as bathing, grooming, and feeding, say the researchers. The team plans to continue their work in providing more dexterous devices.

PHOTO: Rob Felt/Georgia Tech

signed up for 2018 health insurance plans on the federally run HealthCare.gov, which is about a 4 percent decline from signups for 2017.

RESEARCH ROUNDUP

HAPPENINGS

Researchers To Study Motorized Hip Orthoses for Transfemoral Prosthesis Users

PHOTOS: University of Utah Bionic Engineering Lab/Tommaso Lenzi, PhD

Researchers at the University of Utah Mechanical Engineering Department are studying a new approach to improving amputees’ mobility via “motorized hip orthoses.” Principal investigator Tommaso Lenzi, PhD, an assistant professor of mechanical engineering and director of the Bionic Engineering Lab, has received a $972,000 grant from the U.S. Department of Defense Congressionally Directed Medical Research Program toward the project. Lenzi has hypothesized that the motorized hip orthosis will improve kinematic and kinetic gait symmetry and reduce metabolic energy consumption in transfemoral amputee subjects. “We looked at the gait of individuals with amputations and found that most compensatory movements happen at the hip level, which makes walking with a prosthesis really hard, both in terms of balance and effort. Most of the ongoing research in prosthetics aims to address this issue by focusing on what is missing, for example, by developing motorized prostheses that can provide power like biological legs do,” said Lenzi. While the available motorized prostheses can be heavy, “the alternative approach would be to focus on what is remaining— basically trying to empower the residual limbs to do more, for example, by assisting their movements with a motorized orthosis.” Lenzi believes a lightweight hip orthosis may be effective in helping amputees walk using their existing lightweight passive prostheses. The researchers have developed a new controller for motorized hip orthoses that automatically synchronizes with the user to provide assistance in both flexion and extension. “We tested this controller with able-bodied

subjects and found that not only can it reduce effort at the hip level but also at the ankle joint,” said Lenzi. His team found that when users are assisted at the hip, both the hip and the ankle do not need to work as hard, “which may be quite beneficial for amputee users.” Lenzi’s team recently received approval from the Institutional Review Board of the University of Utah and plans to start testing the device with transfemoral amputee subjects. “The ultimate goal of this project is to optimize the motorized orthosis and control attributes to obtain the best possible outcomes for transfemoral

amputee users,” Lenzi said. “One of the main goals of the project is to further understand who will benefit the most from this new intervention.” Lenzi and his team plan to assess the outcomes of using the motorized orthosis with subjects who have different mobility levels. “We expect that this intervention will be helpful to geriatric users, enabling them to remain independent for daily activities like grocery shopping or attending doctor appointments, and even young healthy individuals who want to be able to enjoy activities that require long periods of walking.”

Researchers at the University of Utah Mechanical Engineering Department are developing a motorized hip orthosis designed to improve mobility for transfemoral amputees. O&P ALMANAC | JANUARY 2018

HAPPENINGS

COMMENT CORNER

AOPA Submits Comments on Proposed CMS Changes Regarding Diabetic Inserts and Essential Health Benefits

Athletes Prep for 2018 Paralympic Games Team USA Paralympic snowboarding advocate Amy Purdy

JANUARY 2018 | O&P ALMANAC

change to the DMEPOS Quality Standards should allow direct-milled inserts to be properly billed using A5513. In addition, AOPA has submitted comments regarding a proposed rule that appeared in the November 2 Federal Register entitled, “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019.” Among the provisions in the proposed rule is a section that would provide individual states with increased flexibility in defining essential health benefits (EHB) for purposes of establishing benchmark plans required by the Affordable Care Act. AOPA submitted official comments on November 27 that reflected AOPA’s consistent position that orthoses and prostheses must remain essential health benefits, and any action by CMS that restricts or reduces access to O&P services is not in the best interest of quality patient care.

THE LIGHTER SIDE

PHOTO: Daniel Gale/Adaptive Action Sports

The 2018 Paralympic Winter Games will take place in PyeongChang, South Korea, March 8-18. Approximately 670 athletes are expected to compete. The International Paralympic Committee has named several “Ones To Watch” for the Games. Included on the list are Americans Andrew Kurka for alpine skiing, Oksana Masters for cross-country skiing, and Amy Purdy, Brenna Huckaby, Evan Strong, and Mike Minor for snowboarding. World Para Ice Hockey has announced the seedings for the Paralympic hockey competition. Canada earned the No. 1 seed after defeating Team USA in the Gold medal game at the 2017 Para Ice Hockey Championships A-Pool in April in Gangneung, South Korea. Canada, as the top seed, will headline Group A in PyeongChang, which also includes Norway, Italy, and Sweden. Team USA, the second seed, will head up Group B, which also features South Korea, the Czech Republic, and Japan.

AOPA recently submitted comments on two proposed changes that could have a significant impact on O&P professionals. AOPA submitted comments on CMS’s proposed change to the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Quality Standards that would expand the definition of the term “molded to patient model” to include customfabricated diabetic inserts that are fabricated using a virtual or digital model. Earlier this year, CMS indicated that code A5513 did not cover virtual models, and later released a proposal that would cover direct-milled inserts but would reduce the reimbursement by 14 percent. AOPA’s comments generally supported the proposed change to the DMEPOS Quality Standards but challenged the CMS proposal to arbitrarily reduce the reimbursement rate for direct-milled inserts. It is AOPA’s position that the manner of fabrication is irrelevant, and that the proposed

HAPPENINGS

NATIONAL ASSEMBLY NEWS

Plan Your Trip to Vancouver— and an Alaskan Cruise

PHOTOS: Getty Images

Plans are underway for the 2018 AOPA National Assembly to be held September 26-29 in Vancouver, Canada. In addition to four days full of the latest in O&P exhibits, education, and networking, AOPA has partnered with AlaskaBySea to offer Alaskan cruise options to meeting attendees who wish to explore the area and visit Alaska before the Assembly begins. Two Holland America cruise options are available, departing from and returning to Vancouver prior to the Assembly. Located along the coast of British Columbia, the Inside Passage is the longest sheltered inland waterway in the world. Cruise passengers may see orcas and humpback whales while traveling to the Alaskan ports of Juneau, Skagway, and Ketchikan.

The two cruise options available are September 19-26 or September 15-22. The Assembly begins on Wednesday, September 26, at 8 a.m., with a full day of manufacturers’ workshops. The Exhibit Hall opens that evening. Exhibitors can begin setting up their booths on Tuesday, September 25. Visit AOPA’s website at www.aopanet.org to view the schedule for the seven-day cruise and additional details.

MEETINGS MASHUP

Össur Hosts Women’s Leadership Conference

PHOTO: Courtesy of Össur

Dozens of O&P professionals attended the Second Annual Össur Women’s Leadership Conference, held at the Össur Academy facility in Orlando. The three-day professional development event featured speakers who addressed critical clinical, practice management-related, and industry issues facing O&P practitioners today. Participants came from 13 states and one Canadian province to take part in the conference. Author Kirsten Plehwe shared her insights on women’s leadership challenges, and leadership coach Jo Miller led a session on brand development. Subject matter experts discussed such topics as the effective use of clinical outcome metrics, understanding the evolving reimbursement landscape, and managing the modern O&P practice. Attendees also took part in a discussion on career development

opportunities for women in the O&P industry during a panel led by Karen Edwards, director of the Össur Women’s Leadership Initiative; Kathleen DeLawrence, chief operating officer

of Ability P&O; Ashlie White, manager of projects for AOPA; and Össur’s Linda Collins, senior director of market access. Three-time Paralympic medalist April Holmes also spoke at the event.

O&P ALMANAC | JANUARY 2018

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

The Board of Directors of the Board of Certification/Accreditation (BOC) www.bocusa.org has announced the election of its 2018 Executive Committee and the election of four new members of the board. The Executive Committee is made up of the officers of the board. The recently elected 2018 officers include the following: • Chair: Wayne R. Rosen, BOCP, BOCO, LPO, FAAOP, prosthetist and orthotist at W.R. Rosen Inc. in South Florida • Vice Chair: Shane Ryley, BOCP, BOCO, area clinic manager at Hanger Orthopedic Wayne R. Rosen, Group in Torrance, California BOCO, • Secretary: David D. Regier, ATC, MS, director BOCP, LPO, FAAOP of rehabilitation at Fort Worth Orthopedic Surgery and Sports Medicine in Fort Worth, Texas • Treasurer: William J. Powers, MBA, LFACHE, retired Air Force Medical Service Corp. officer • Member-at-Large: Mark L. Parris, Pharm.D., RPh, COF, former owner of Parris Medical Services, former president of Parris Pharmacy Inc., Riverstone Pharmacy Inc., and Parris Compounding Services Inc., and staff pharmacist at CVS Caremark Corp. in Blue Ridge, Georgia • Immediate Past Chair: L. Bradley Watson, BOCO, BOCP, LPO, president of Clarksville Limb + Brace + Rehab in Clarksville, Tennessee. The four new board members are Joshua A. Bressler, COF; Daniel Griffis III, Pharm.D.; James H. Mathers, COF; and William Spear, RS, RPh, CCN. Justina (Justi) Appel, CO, BOCP, PhD, has joined Allard USA as director of education and clinical support. Appel will develop and enhance Allard’s continuing education programs for the O&P community and its referral sources. She also will provide clinical Justina (Justi) Appel, CO, BOCP, support and expertise on Allard’s products PhD for O&P practitioners and technicians. Appel has more than 23 years of experience in the O&P industry, and recently served as director of orthotics and prosthetics for the Shreveport area Shriners Hospitals for Children. She also has served as past and current president and education program coordinator for the Louisiana Association of Orthotics and Prosthetics.

JANUARY 2018 | O&P ALMANAC

Coleson Chase has joined SPS as director of marketing. With this new role, SPS looks to partner more closely with suppliers and more effectively engage customers to grow the O&P channel. Coleson joins SPS with marketing and leadership experience in wholesale distribution, most recently with S.P. Richards Co., a $2 billion business products wholesaler, where he was serving as director of merchandising marketing strategies. Emily Gibson is the new senior customer service manager at Ottobock HealthCare’s North American corporate office in Austin, Texas. Gibson is responsible for growing and coaching her teams with efficiency, as well as collaborating with a broader range of cross-functional teams to implement business process improvements and remove barriers for customers. OPAF & The First Clinics have announced new officers and board members for 2018: • President: Lesleigh Sission, owner of O&P Insight • Vice President: Nikki Hooks Driggers, CO, who works in patient care at Carolina O&P in Columbia, South Carolina • Treasurer: Lisa Arbogast, co-owner and director of government affairs at WillowWood • Immediate Past President: Sue Borondy. New OPAF board members include Sourabh Nagale, CPO, a practitioner on staff with Lurie Childrens Hospital in Chicago; Amy Franklin, director of community development, outreach, and training for USTA North Carolina; Peggy Chenoweth, an amputee advocate, blogger, and co-founder of Amped; and Travis Young, an O&P resident.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Dayton Artificial Limb in Clayton, Ohio, was recently featured in a Dayton Daily News article that highlighted the facility’s use of additive manufacturing. The company encompasses three facilities: the Dayton Artificial Limb clinic, Prosthetic Design Inc., and Montgomery Motor Sports, which makes motorcycle parts. The company is leveraging 3D printing technology to make some of its prostheses “faster and stronger,” sometimes fitting patients and providing devices on the same day, according to Brad Poziembo, LO. In addition, the company manufactures 3D printing machines that make prosthetic components.

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ld i r s/T T e xrTAe n ns l er PMrAoTs T he l i FT h e e cWhoArn G’ s i nFG s iFb o iv e T ibcrKAnce e inG

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REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

Increasing Efficiency Boost profits through smart business practices

E! QU IZ M EARN

BUSINESS CE

CREDITS P.17

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

HE YEAR 2018 has arrived, and

much has changed in the business of orthotics and prosthetics. The challenges to running a successful O&P practice are very different than they were five or 10 years ago, but the basic principles of creating a profitable business have remained fairly steady. Since the Medicare annual fee schedule increase is on par or slightly below the annual rise in the cost of living, O&P businesses have had to find creative ways to increase profits through the use of efficient business practices. This month’s Reimbursement Page examines some of the strategies that have translated into successful O&P businesses.

AR is collectible and what is not. If AR is determined to be noncollectible, there is no reason to leave it on the books. While write-offs can be hard to swallow, there is no point in leaving uncollectible AR within your system. Second, you must understand how to quickly turn AR into income. It is no secret that the older the AR is, the harder it is to collect. Strategies to collecting AR efficiently include electronic payment arrangements with payors, collection of coinsurance and deductibles at the time of delivery, the use of third-party credit issuers when appropriate, and maintaining contact with patients when they have a balance due.

Manage Your Accounts Receivables Effectively

Revenue placed on the books is only as good as your ability to collect it. While it is not uncommon to book revenue at the time of delivery of a device, it must be collected to have real meaning. There are several keys to managing your accounts receivables (AR) efficiently and turning revenue into assets. First, you must be organized. Businesses that manage their AR well have defined, repeatable processes in place to collect AR in a manner that best meets the needs of their company. Simple strategies such as classifying AR according to amount, collectability, and age are all important steps to creating efficient collection processes. The old saying that “time is money” is extremely relevant when dealing with AR, especially as it ages. The goal is to convert AR into real revenue as quickly as possible, and strong managers are usually skilled in quickly deciding what 16

JANUARY 2018 | O&P ALMANAC

Finally, efficient collectors know how to reach the correct people in order to facilitate claim payment. Whether you are dealing with a small individual plan or a large group plan, knowing who to talk to will often mean the difference between getting paid and not getting paid. Creating relationships with the key folks at an insurance company will help to ensure fair and proper treatment when dealing with reimbursement issues.

REIMBURSEMENT PAGE

Review Your Contracts

Your success as a business is not always directly related to the number of patients you can treat in a day. A successful business is one that operates in an environment that is as financially favorable as possible. Access to patients is a good thing but can sometimes come at a price that may not be worth the cost of admission. Bad contracts can actually cost your business money, especially if they include terms that are unfair or overly one-sided in favor of the insurance company. Volume-based discounts are a fact of life in todayâ&#x20AC;&#x2122;s health-care environment, but it is important to consider if it is worth signing a contract if there is little to no chance of it being a profitable relationship. Federal antitrust regulations prohibit AOPA from providing guidance to members on specific contractual terms, but it is not hard to spot an unfavorable contract. Contracts are negotiable, but only before you sign on the dotted line. The new year provides a great opportunity to blow the dust off of your existing contracts and determine if their terms are in the best interest of your business. If they are not, there may be an opportunity to renegotiate terms that are more favorable to your business. If you find that you have contracts that are no longer palatable, there may be exit clauses that allow you to cancel the contract with appropriate notice. While it is always a good idea to review your contractual relationships on a regular basis, the start of a new year is a good time to take a step back and make sure that your business is operating as efficiently as possible.

Review Policies and Procedures The business of O&P is not static. Like all things, change is inevitable, and what made sense as a company policy five years ago may no longer be realistic or in the best interest of your company. Policies and procedures are more than just books on a shelf. They are the outline that should be used to run your business on a daily basis. The beginning of the year is the ideal time to review your policies and procedures and initiate

any changes that will lead to greater efficiencies and potentially higher profits. If you find that a policy or procedure is no longer relevant to your business, do not be afraid to make changes. If you do decide to make changes, communication is extremely important. Employees must be made aware of any change, why the change was made, and what the expectations are going forward. While you should never make changes only for the sake of change, updating your company policies and procedures regularly is an important strategy for a successful O&P business.

Establish Goals

A strategy for success for any businessâ&#x20AC;&#x201D;not just an O&P businessâ&#x20AC;&#x201D;is the establishment of reasonable goals. Whether they are financially based, clinically based, or based on another factor entirely, the establishment of specific goals provides a direction and a focus for the business, which can be extremely healthy. When establishing goals, be careful that they can be reasonably attained but not assured. Goals are something to strive for, not an expectation of the status quo, and should be established accordingly. Consider setting specific goals, but also establishing incentives for obtaining those goals. Small rewards can go a long way

when motivating employees to take that extra step for the benefit of the company. Motivated employees will likely work hard to achieve the goals that have been established to ensure the success of your company.

Be Proactive

While the strategies discussed above are just a few examples of how you can maximize your profits, there are endless things that you can do to grow your business and ensure your success. The best strategies are developed by those who know the business best: business owners and employees. The start of a new year provides an opportunity to start fresh and make changes to your business that will help you be successful for years to come. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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O&P ALMANAC | JANUARY 2018

This Just In

O&P News Relaunches Under the AOPA Brand Magazine sets focus to educate and inform health professionals who serve the greater O&P patient community

ATE LAST YEAR, AOPA acquired

the assets of O&P News (formerly known as O&P Business News) from Healio. Beginning with the January 2018 issue, AOPA plans to continue publishing O&P News on a monthly basis. The mission of the revamped magazine is to educate and inform health professionals who serve the greater limb-loss community and those using orthotic devices. Each issue will feature clinical insights, research summaries, product news, and more. The newly owned magazine will feature a new format, with a general scope of all things O&P from various perspectives. O&P Almanac remains AOPA’s flagship publication for AOPA members and others in the O&P profession. With O&P News, AOPA will offer more diverse content to reach a larger audience, including therapists, orthopedic and vascular surgeons, rehabilitation physicians, physical medicine specialists, and others in the referral community who work with O&P patients. O&P News is being redesigned to complement the O&P Almanac. For example, in 2018 we will focus on the expanding role of O&P research in both magazines to meet high demand within the community. O&P Almanac will profile the researchers who are impacting the profession (see the new Principal Investigator column on

JANUARY 2018 | O&P ALMANAC

page 38) while O&P News will document and present high-quality research that has not been published previously beyond the initial abstract. This allows for research to be readily available and accessible to the public. O&P News also will offer another avenue for manufacturers to share the value of their research and products in the form of sponsored content opportunities not offered in the O&P Almanac. In addition, each issue of O&P News will feature clinical insights from top minds in patient care, a column for technicians, and insights from leaders with vast experience in the O&P field to share their wisdom, product news, and anything relevant to the related branches of health care. Don’t miss the first issue of O&P News published by AOPA. The January 2018 edition features a cover story on gait salvage, with insights from four industry experts; research articles on a novel interface system and a flexible ankle-foot orthosis; a “King for a Day” column featuring Jeffrey Brandt, CPO, sharing what he would change if he were in charge of O&P; tips on fabrication and design; updates on state-level O&P activity; and much more. O&P Almanac readers will likely find the reformatted O&P News a welcome addition to AOPA’s vast array of products and services.

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COVER STORY

TRENDS IN THE

NEW ERA

O&P

OF O&P EXPERTS CONTEMPLATE THE TOP FIVE DEVELOPMENTS TO IMPACT THE PROFESSION IN THE COMING YEARS

JANUARY 2018 | O&P ALMANAC

By CHRISTINE UMBRELL

COVER STORY

NEED TO KNOW XX This month marks a new year, and the beginning of a new centennial for AOPA. Looking to the future, there are five key trends for O&P professionals to watch and prepare for to ensure long-term success. XX New, high-tech components will be introduced to the O&P market. Sensors may enable more advanced system integration in both prosthetics and orthotics. It also is expected that improved orthoses will be developed, building on the same principles as recent prosthetic technologies. XX Consumers will become even more educated about health care in general and O&P in particular, and will be mining online data about care options before and after visits with their clinicians. XX Reimbursement challenges are expected to continue, and may be exacerbated by the fact that many new products are being billed as “miscellaneous codes.” O&P experts suggest that changes are needed to the reimbursement system to allow for technological innovation. XX O&P facilities will need to expand their data collection initiatives as the transition to value-based care continues. Capturing clinical outcomes and providing evidence-based care will be critical in demonstrating the efficacy of O&P interventions to payors and health-care partners. XX Growth and consolidation may lead to new faces in the O&P profession. While mergers and acquisitions may have an impact on some facilities, O&P stakeholders believe there will continue to be a place for new companies that have strategic and well-defined business plans.

HERE IS NO QUESTION that the

transition of the O&P profession from an art to a science is almost complete. The mom-and-pop shops of the past have been transformed into stateof-the-art facilities, equipped with new scanning technologies that allow master’s-level clinicians to optimally fit patients with, in many cases, hightech devices, such as microprocessor knees, arms that leverage pattern recognition technologies, and more responsive orthoses. Last year, the profession celebrated its rich history as AOPA reached its 100-year anniversary. This year, O&P professionals will mark a new beginning. Given the transition to a more science-focused profession, orthotists and prosthetists must take a close look at the current health-care climate and

decide what changes will be necessary to propel the profession forward. Today’s O&P professionals must learn to navigate the “new normal” to ensure they continue to provide optimal patient care—and remain profitable. Changes in this industry are coming fast and furious. Looking to the future, five experienced O&P professionals convened in Florida during the 2018 AOPA Leadership Conference earlier this month to lead a session called, "Where Are We Headed? A Crystal Ball, Blue Sky Look at the Future of O&P." Here, these five experts—Vinit Asar, Jeffrey Brandt, CPO, David McGill, A.J. Filippis, CPO, and Saeed Zahedi, PhD—discuss the trends that will have a significant impact on the profession and explain how best to prepare for the changes to come. O&P ALMANAC | JANUARY 2018

New technologies will enable more patients to leverage advanced componentry.

While high-tech devices— prostheses in particular—have already become more commonplace, the next 20 years are expected to bring even more innovation and integration. Technologies are advancing every day, and “we’re going to have devices functioning more and more like a normal body part,” says Jeffrey Brandt, CPO, chief executive officer of Ability Prosthetics and Orthotics. “O&P device technologies will undoubtedly continue to become more advanced, connected, and versatile,” agrees Vinit Asar, president and chief executive officer of Hanger Inc. “Restoring a sense of touch and feel to our prosthetic patients will likely become commonplace in our lifetimes. Exoskeletons and similar orthotic technologies will continue to become more functional, lighter weight, and more affordable.”

Vinit Asar In addition, improved orthoses may be developed by building on the same principles as some of the latest prosthetic technologies, predicts Saeed Zahedi, OBE, FREng, BSc, PhD, FIMechE, CEng, RDI, technical director, Chas A. Blatchford & Sons. “We already have established the future direction of integrated prostheses for lower-limb transfemoral [patients], and evidence shows not only a reduction in the risk of falls but also a reduction in risk of future osteoarthritis and … a reduction in low back pain,” says Zahedi, referencing “Economic Value of Advanced Transfemoral Prosthetics,” commissioned by AOPA and conducted by the RAND Corp. “Hence, the total integration at a macro level is the natural direction of development of future advanced devices. We see the transformation 22

JANUARY 2018 | O&P ALMANAC

of this technology from lower-limb prosthetics into lower-limb orthotics. There is also the advancement of totally integrated knee-ankle-foot orthoses and ankle-foot orthoses, which, in cases of blast injuries, can reduce or eliminate the risk of amputation, and that is rapidly growing.” Another game-changer, according to Zahedi: neural implant control. Saeed Zahedi, OBE, FREng, BSc, PhD, FIMechE, CEng, RDI

What’s more, “the addition of sensors enables system integration for complete limb control in both prosthetics and orthotics, which will pave the way for application of power to complete the picture for totally integrated future devices,” predicts Zahedi. “These devices will closely match the user ability.”

TREND 2

TREND 1

COVER STORY

The rise of consumerism will lead to more educated and involved patients.

In the wake of the Affordable Care Act and recent efforts to repeal the legislation, many O&P patients are more knowledgeable about health care in general and O&P in particular. Patients “will continue mining a fair amount of data online about care options prior to contacting or visiting

with O&P providers,” says Asar. O&P patients are “much more educated and knowledgeable about their insurance benefits and commercially available products, and they have their cell phones in the room with them,” says Brandt. It has become increasingly important for O&P facilities to have information available to meet patients’ needs and answer all of their questions. Brandt says that Ability P&O learned a valuable lesson last year when it convened a Patient Advisory Council and discovered that O&P consumers’ No.1 suggestion was that “patients want the ‘selection of components’ to be more transparent to them.” Patients want to understand why particular devices are not being recommended to them. “Our patients were suggesting to us that we have a computer screen or white board in the room to show them all available technologies, and then explain why they are not candidates for certain devices,” he says. “Patients are more aware than ever, and we’ll have to be more transparent and explain rationale and evidence that supports how we rule out technology” going forward. In addition, as patients trend older, consumers will be looking for technologies to help them stay active longer. “They will want an easy way to communicate and be communicated to—phone calls and emails may well be a thing of the past soon,” says Asar.

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COVER STORY

“There will be a clear demand for a higher quality of care at a low cost that generates effective outcomes for our patients.” Asar suggests that O&P care providers will need to understand the needs of the aging population and partner with the manufacturing community to ensure consideration is given to outcomes, economics, and

reimbursement before new products are conceived and developed. “The days of launching an expensive new technology with no clinical or outcomes data and no reimbursement plan are simply over,” he says. “Our patients, as well as our payors, are demanding this change. We should as well.”

O&P professionals also should plan to get involved in initiatives to promote wellness and prevention of diseases such as diabetes and vascular disease, says Zahedi. He suggests that clinicians partner with other health-care providers, manufacturers, educators, academia, and payors to integrate efforts for optimal patient care.

TIPS FOR O&P NEWCOMERS

O&P professionals who are new to the profession are arriving in a health-care climate much different than previous generations experienced. Seasoned professionals offer these words of wisdom to new practitioners hoping to succeed today and into the future:

“Some would say that the chaos in health care today, with the challenges we face in our industry relative to reimbursement and a changing healthcare landscape, should scare some young people and keep them from choosing our profession. But I would say our industry presents an opportunity to impact the life of the individuals we serve immediately. We can provide hope and mobility to those that truly need our services. The demographics indicate a continued growth in demand for the prosthetic and orthotic services we provide. Trust your abilities, and have the confidence to meet those challenges head-on for the benefit of your patients, and you will have a very fulfilling and satisfying career.” —JIM WEBER, MBA, chief executive officer, Prosthetic & Orthotic Care Inc., and AOPA president

“Be technology-driven, from the devices, to how you do your evaluations, to how you produce outcome measures. You have to be in alignment with the data collection. But you have to continue to relate to people. It doesn’t matter how automated or streamlined we get, we still need to shake a patient’s hand, look them in the eyes, and listen to a patient’s story. The patient’s story offers clues that can help us better treat the patient, apply the right device, and accrue the right outcomes measures.” —JEFFREY BRANDT, CPO, chief executive office, Ability Prosthetics and Orthotics

“Prepare to provide health care in the spirit of the Triple Aim. It’s about improving the patient experience of care (including quality and satisfaction) by providing the best outcomes while reducing costs. New O&P professionals can help the industry and their peers by infusing new ideas and concepts from a new generation into our thinking, and that can only make us stronger. In this new era of O&P, we need to explicitly partner with other care providers to be able to provide comprehensive care to our patients.” —VINIT ASAR, president and chief executive officer, Hanger Inc.

“Education remains the key to a better understanding of the underlying science. Continuous education ensures growth in confidence. Fear of technology is in the mind, and can be transcended. This is the digital age, and, based on data, the science of the O&P field is elevated. This is the most exciting time to join our profession, and, through collaborative effort, we can make best utilization of advances in technology.” —SAEED ZAHEDI, OBE, FRENG, BSC, PHD, FIMECHE, CENG, RDI, technical director, Chas A. Blatchford & Sons

“Always, always, always focus on providing your patients the best care you can. It’s easy to get wrapped up in talk about new technology, changes in reimbursement, barriers to access, etc. But if you can continually come back to that simple core value of helping the individuals who rely on you to physically function in the world every day, you’ll figure out a way to manage and deal with everything else.” —DAVID MCGILL, vice president, reimbursement and compliance, Össur

JANUARY 2018 | O&P ALMANAC

O&P professionals should expect continuing reimbursement challenges.

Even as more educated and demanding consumers are fit with a growing array of high-tech O&P devices, “the biggest challenge we have is reimbursement—who’s going to pay, and what are they going to pay? What products and services are they going to pay for?” says A.J. Filippis, CPO, chief executive officer of Wright & Filippis. Following a “huge jump in the quality and sophistication of prosthetic devices” that occurred 10 to 20 years ago, there has been an “explosion in scrutiny of prosthetic and orthotic claims by all payors,” says David McGill, vice president of reimbursement and compliance for Össur. “Beginning in 2011 with the ‘Dear Physician’ letter requiring physician corroboration of O&P claims and now, increasingly, on the private payor side as well, the process of getting approval for O&P claims is much more challenging than it was when I first came into the field in 2000.” Part of the problem lies is the advanced age of the Health-Care Common Procedure Coding System, says Brandt. Many new devices coming to market do not fit neatly into the traditional system, so some are being billed as “miscellaneous codes.” This delays or holds up claims from securing reimbursement, explains Brandt. Ultimately, it’s the patient and O&P provider who bear the brunt of that holdup. Jeffrey Brandt, CPO

Brandt believes that technological innovation will “get squashed” if the reimbursement system is not revamped. CMS and the commercial insurers are constantly “pushing back” by refusing to establish new codes or an avenue to secure reimbursement. This “backlog” of technologies without reimbursement pathways is stifling to technological development, according

to Brandt. “If there could be a new pathway whereby both payor and provider are aligned on both clinical and cost-effectiveness, then it could flourish and help provide access to emerging technology to a lot of people. Otherwise, manufacturers have to be careful about their investments in new technology. We’re going to have to find a way for payors to get comfortable with the fact that advances are not egregious—we are on a curve that is approaching normal function,” he says. But “we have to have the evidence behind it in terms of demonstrating improved clinical outcomes.”

TREND 4

TREND 3

COVER STORY

More O&P outcomes data will be needed as the transition to valuebased care continues.

O&P stakeholders are recognizing the importance of data collection and outcomes measures, which will be needed to prove to payors that O&P intervention is a value proposition. This data also will be necessary as the nation transitions to fee-for-value based care. Strategic O&P facilities are adjusting business practices—and practitioner mindsets—accordingly, says Asar. Collecting clinical outcomes data is key to success in a value-based care model. “In the past, we knew anecdotally that what we provided was beneficial. We rested on that anecdotal evidence for too long,” says Brandt. Now the profession has “an opportunity to be more data-driven and evidence-based, and to tell the patient’s story of their everyday activities that they are able to perform. The insurance authorization request can include information about activities of daily living and how the device impacts the patient’s life, but we can also include research evidence to support these benefits and data from outcome measure assessments to support that request. “The more evidence-based we can become, the better it will be,” Brandt continues. He is hopeful that O&P professionals, along with other health-care providers and payors,

will develop a standard, quantitative way to assess patients. “We need to universally adopt outcome measures that everyone can agree to, and have payors recognize the results of those measures as valid,” he says. “Practices that are better positioned to support their requests for devices with evidence and outcome measure data are going to be the practices securing contracts and receiving patient referrals,” says Brandt.

A.J. Filippis, CPO

Filippis, who serves on the boards of two hospitals, agrees that outcomes will become increasingly important and notes that O&P facilities should be watching how hospitals are being judged: by how quickly the hospitals treat patients and how effective their treatments are. “O&P stakeholders should be sending the message to payors that O&P care contributes to rehabilitation and return-to-work or return-to-activities of daily living”— which has been demonstrated by recent studies by Dobson-DaVanzo, such as the recently released report, “The Economic Value of O&P Care to the Medicare Program.” Filippis anticipates that the O&P professional’s place “in the continuum of care is working with the skilled nursing facilities and home-based care companies” in returning patients to a higher quality of life. Asar adds that adopting the principles of the “Triple Aim” of health care may help facilities prosper in a valuebased care climate. These principles include the simultaneous pursuit of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. “Our job is to provide quality patient care with the highest patient satisfaction while generating the best outcomes at the lowest cost,” says Asar. O&P ALMANAC | JANUARY 2018

COVER STORY

AOPA Unveils Next-Century Products and Services It’s a new year, and a new centennial for AOPA. In addition to the well-known advocacy, educational, and communications offerings that have benefitted AOPA members in the past, the association has developed several new products that have recently launched or are planned for the coming months. The focus of AOPA’s work is to “enhance the lives of our patients,” says AOPA President Jim Weber, MBA. “And in serving our patients’ needs to the best of our ability, we enhance the entire O&P profession. Change is constant, James Weber, MBA the future is now, and we must continue to

New Mission Statement. AOPA has redesigned its mission statement to reflect a pivot toward the future: “Through advocacy, education, and research, AOPA improves patient access to quality orthotic and prosthetic care.” O&P Leadership Conference. High-level O&P executives convened this month in Palm Beach, Florida, to hear from healthcare experts and plan for the future of O&P. Guest speakers include Allison Cernich, PhD, director of the National Center for Medical Rehabilitation, and Jason Altmire, former three-term member of Congress and a nationally recognized leader on health-care policy. THE COMMUNITY NEWS SOURCE

O&P News. Be on the lookout for the all-new O&P News, now published by AOPA. Late last year, AOPA purchased the assets of O&P News magazine from SLACK Inc. Beginning with the January 2018 issue, AOPA plans to continue publishing O&P News on a monthly basis. The mission of the revamped magazine is to educate and inform health professionals who serve the greater limb-loss community and those using orthotic devices. The AOPA Co-OP. Need a quick answer to an O&P question? Look no further than the AOPA Co-OP, which launched in 2017 as a “compendium of O&P,” vetted by AOPA staff. The Co-OP, which can be accessed online or via app, serves as

JANUARY 2018 | O&P ALMANAC

collaboratively pursue advocacy, research, and education to improve patient access to quality orthotic and prosthetic care. “AOPA isn’t just playing defense,” explains Weber. “AOPA is running a smart, aggressive offense working to ensure that the essential care that our profession provides is well-documented, supported by research, stands up to scrutiny, and remains eligible for reimbursement. [The] threats are real—but so are the opportunities—and it will be crucial that we respond collectively during this next year.” Here’s a sample of the initiatives AOPA is focusing on to ensure members are prepared for a new era of O&P.

an online reimbursement, coding, and policy resource and features a collection of detailed information with links to supporting documentation for topics essential to AOPA members. Health-Care Compliance and Ethics Week. Demonstrate your facility’s dedication to a compliant workplace by taking part in HealthCare Compliance and Ethics Week. Last year, AOPA partnered with the Health-Care Compliance Association to celebrate Health-Care Compliance and Ethics Week for the first time. AOPA member companies participated with free webinars, fun giveaways, and CE opportunities focused on compliance, ethics, and professionalism, and leveraged AOPA’s resources to craft their companies’ unique celebrations. Mark your calendar for this year’s “week,” scheduled for Nov. 4-10, 2018. Orthotics 2020. Find out how you can contribute to the next big research push, the Orthotics 2020 initiative, which launched during the 2017 AOPA World Congress and Centennial Celebration in September. Key O&P stakeholders have established five central research topics to focus on in conducting critical appraisals of the available scientific literature: osteoarthritis, stroke, scoliosis, traumatic spinal injuries, and plagiocephaly. In the coming months, there will be follow-up telephone conferences around each of these five topics to get the discussions and research initiatives started.

New and Improved AOPA Operating and Performance Report. This year, AOPA will begin revising both the survey used to capture financial information and the final Operating and Performance Report itself. The revamped report will be designed to feature more accurate forecasts of—for example—work in progress, outcomes measures being used at various facilities, and data on administrative law judge and audit success rates. AOPA’s New Apparel Program. AOPA is partnering with Encompass Group, a leading provider of healthcare apparel, to offer members special prices on customized polos, scrub tops, and lab coats. Customized embroidery is available. For more information on products and available colors, visit www. iconscrubs.com. Enter access code: ICON-AOPA. Then enter your AOPA member ID and create your user profile. And More. From ongoing evidencebased research, such as the recently released RAND Corp. and DobsonDaVanzo studies, to the Presidential Papers, sponsored by ABC, that debuted at the 2017 AOPA World Congress, AOPA continues to focus on research, education, advocacy, and the sharing of information that is critical to all O&P stakeholders. Watch for new reports, products, and services throughout the year.

TREND 5

COVER STORY

Growth and consolidation may lead to new faces in the O&P profession.

During the next several years, O&P facilities will be realigning their business strategies to succeed in the value-based care environment. But there will likely be change, depending on which companies adapt and prosper, and which companies do not.

David McGill While the impact of mergers and acquisitions on the O&P industry remains unknown, “it certainly seems like the conventional wisdom in the market at large is that we will see increasing consolidation on the patient-care side of the O&P industry in the coming years,” says McGill. However, O&P stakeholders agree that there will continue to be a place for new companies that come prepared with a strategic business plan. Asar points to startups as critical to the growth of the profession. “I am hopeful that we will always have a startup community and some elements of a startup mentality in O&P. I am a strong believer in free enterprise and competition, because they make the broader industry stronger and elevate the quality of offerings, which ultimately benefits our patients,” he says. Young practitioners with master’s degrees, who are business-minded and outsource most fabrication, often are leading new, successful O&P facilities, according to Brandt. “These new companies are lean and nimble, and they have more resources available to them than ever before—they can get started with less space and more compact equipment” than previous generations. Zahedi similarly says that small startups can “construct their infrastructure based on connected digital technology. That will give them a head start in productivity, and more

accurately and repeatedly satisfying the changing needs of the users,” he says. For any new businesses to succeed, however, they must be driven by “the spirit of entrepreneurship.” But he also notes that “the need for adapting to new technology and the transition phase in this renaissance period will inevitably end up in some consolidation, in my view, so as to benefit from the economy of scale.” Zahedi notes that manufacturers are already going through a transition period, “but we all need to increase the pace of change and preparation, not only to gear up for future technology and modern advance manufacturing … but also gear up to link with the new digital smart supply chain, as well as new smarter products with shorter life cycles, with greater differentiation built in them, which is based on efficacy of user benefits and guaranteed delivery of health economics.” Zahedi also believes that the O&P profession will benefit in the coming years from increased partnerships. “A joining of forces means greater sharing of experiences and know-how, as well as greater transparencies of best practices and lessons learned,” he says. “That may sound idealistic at the current time, but with the current information it may be a way of engaging the health-care payors and providers in O&P to provide the best for users.”

Planning for Change

All of the changes underway can be daunting, but O&P experts agree there is reason for optimism about the future of the profession—which is good news for practitioners and patients alike.

“This transformation that’s been going on in the profession is about working smarter,” says Brandt. “It’s not about having less contact with the patient. Our patients still need a human touch. People are dealing with limb loss or limb disability, so it’s important to continue to relate to patients on a personal level. Practitioners should embrace technology … but you have to continue to relate to people. “We need to become more patient-centric, [adopt] universally accepted outcome measures, and address the specific issues limiting each individual” so patients can have the best shot to get themselves back on their feet, suggests Brandt. McGill agrees. “The best thing that O&P professionals can do is examine their current practices—clinically, operationally, claims processes—and think about how to strengthen them,” he says. He maintains that predicting the future is impossible, “but I do believe that you can identify shortcomings and issues in your current business practices that, if corrected, will place you in a stronger position no matter what specific changes do ultimately occur and whenever they inevitably do happen.” Ultimately, there will continue to be a need for O&P care, says Filippis: “This need is not going to go away.” O&P professionals who take note of the trends and adapt to the changes will be best positioned to fill that need. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com. O&P ALMANAC | JANUARY 2018

By LIA K. DANGELICO

Small Steps, Big Effects O&P business leaders share essential tips for running a more successful facility

NEED TO KNOW • Small changes can have a big impact when adjusting business practices with the goal of creating a more efficient and profitable O&P facility. • Ensure strong leadership is in place, in the form of owners and managers who can motivate staff to think strategically and keep expenses down. • Consider holding regular meetings to discuss important issues, examine work flow, and identify areas of improvement. Be sure to keep the lines of communication open throughout the day. • Educate all staff and referral physicians about reimbursement requirements. It may be beneficial to meet face-to-face with payors to identify ways to improve the authorization process. • Leverage new technologies, such as data collection systems that can generate reports related to coding, clinician time, and payments, and take the time to analyze results and make necessary changes. • Look into process analysis tools, and programs such as Six Sigma, Lean, and 5S, to find ways to streamline processes and reduce expenses.

JANUARY 2018 | O&P ALMANAC

ERY FEW BUSINESS LEADERS

would attribute their success to sheer luck. Instead, careful planning and goal setting have helped many companies get to where they are today. American business magnate, investor, and philanthropist Warren Buffet once said, “Someone’s sitting in the shade today because someone planted a tree a long time ago.” For O&P businesses to succeed in the long term, it’s important to think about how today’s business practices will affect tomorrow’s bottom line. Clinicians must not only be able to deliver exceptional patient care, they also must possess good technical skills, strong administrative capabilities, financial management skills, marketing and relationship building skills, and contract negotiating skills in order to run profitable businesses, says Frank Bostock, MBA, CO, FAAOP, southwest regional vice president for Hanger Clinic. Organizations also “We often have staff who must incorporate processes will say, ‘Well, I got into the that are efficient and techO&P profession to take care of patients, and I shouldn’t nologies that help drive their have to worry about the business. “And then, you need finance side of it,’” says to have good leadership,” Bostock. “What we tell our he says. It takes all of those employees is that it’s not an elements, working together Frank Bostock, either/or [situation]. You simultaneously, to traverse MBA, CO, have to provide great patient today’s O&P landscape. “It’s care, and you have to get not an either/or type of thing. FAAOP good financial outcomes, or To be successful, you need to you won’t be in business. You could do all those things well.” provide the best patient care in the With a new year and fresh slate this world, but if your finances are a mess, month, O&P Almanac offers several you’re going to go out of business—so suggestions from O&P business leaders you won’t be providing any patient for revamping business processes and care at all.” procedures to boost profits and position As an example, Bostock points to O&P facilities for long-term success. device selection as an area where O&P facilities can be more strategic. For Motivate Staff To Drive Change example, he notes that some clini“Success is almost always driven by leadership,” says Joyce Perrone, direccians may have a particular affinity for a brand or product and may not tor of business development at De La Torre Orthotics & Prosthetics, Inc., and be as motivated to learn about other, more cost-effective alternatives consultant at PROMISE Consulting that can provide the same outcome. Inc. “Build your leaders, incentivize But researching outcomes and cost them properly—create excitement and considerations on a continuing basis a clear vision that radiates out to every is important. Bostock sees these hard member of the team.”

conversations as opportunities to learn and grow as a team.

Review Successes and Opportunities for Improvement

In a complicated health-care climate, communication and transparency are critical. Bostock has worked to build these elements by implementing 10-minute morning kickoff meetings. In every clinic in his territory, managers or other designated individuals start the day off by gathering the team to discuss any issues they’re experiencing; these issues may relate to patient care, complaints, work flow, material costs, or something else entirely. Such meetings allow management to set the tone and focus for the day, and provide “an opportunity to manage the day versus the day managing us,” he says. “What I find interesting is that if you look at a football team, they play a game and, win or lose, they had some things that didn’t go well during that game,” adds Bostock. “And so, in preparation for the next game, they get together and they practice on their deficiencies.” Bostock’s facility tries to incorporate this concept of ‘practice’ O&P ALMANAC | JANUARY 2018

Get Serious About during the early morning kickoff meetReimbursement ings. “It’s our form of practice where we bring up issues where we’re having One area where team unity is essential challenges and talk about ways that is reimbursement; if you don’t get paid we can get them resolved very, very for the care you provide, it doesn’t quickly.” matter how high-quality or compasWhile Perrone also promotes sionate the care was. Every member staff transparency, she advocates for of the team should understand what “information sharing” rather than a vital role this plays in the success of “staff buy-in.” The term “buy-in,” she your business. says, “reeks of, ‘I make a decision, and When it comes to reimbursement, then convince you to like my decision.’ Bostock says it’s helpful to break the It’s better to get a sense of community issue down into its several facets: How understanding among the teams,” much are you getting reimbursed? Perrone says. “Transparency is key. ... What does it take, in regard to docuSharing information across the teams, mentation, in order to get reimbursed? done properly, can build a sense of And, what’s the most efficient process community within your company as to get authorizations done? opposed to adversity or bad internal Over the years, Bostock has taken competition.” the unique approach of meeting Tom Watson, CP, similarly face-to-face with payors works to unify and energize to discuss the challenges the team he works with—and he and others in O&P are extends that concept out to having—for example, trying include not only in-house staff, to get some of the authoribut also allied health profeszations that may be causing delays in care. “Initially, sionals. “Building trust with the whole team, including Tom Watson, CP when I started doing this, [payors would say], ‘Well, doctors, therapists, counit’s your problem. You’ve got to hire selors, and other patients you have had people to get these authorizations, but success with, tells a strong story about that’s your problem. It’s the cost of having the patients’ best interest at doing business.’ And my response was, heart,” says Watson, who is owner and ‘Well, that’s true, but when our staff president of Tom Watson’s Prosthetics calls to get the authorization they have & Orthotics Lab. “You must have to talk to somebody on your end of the everyone rowing the boat in the same line, so you have to hire somebody to direction to have a good outcome.”

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JANUARY 2018 | O&P ALMANAC

do it, too, which also increases your costs of doing business.’” Through these meetings, the two sides have been able to work together to determine how to increase the dollar amount required for an authorization and have identified more efficient ways to get the documentation to the payor so staff is not wasting time providing extraneous paperwork. For Perrone, training and accountability make all the difference in ensuring the in-house aspects of the reimbursement process run smoothly. “Generally, most managers know who does documentation right and who doesn’t,” she says. “And if the manager does not know, just ask the biller!” She suggests identifying team members who may need more training and guidance as well as those who have a good grasp of the process—and who could serve as trainers. It’s crucial to invest the time and resources into getting staff trained properly and then holding them accountable. Perrone also notes the importance of implementing a proven process—a road map—for staff to follow so they are never left wondering and guessing. The process should incorporate checks and balances to keep you on track, such as spot checks of charts to ensure items are being billed correctly—especially those items that are highly targeted for audits. For Watson, constant education and consistency are key to reimbursement. He recommends taking time to build relationships with other providers on the care team—such as referring physicians—so they can better understand the role O&P clinicians play in a patient’s recovery. “Help [other care providers] understand that an amputation is not an end but a beginning,” he says. “Convince them that the journey begins with them and the earlier we [in O&P] can get involved, the easier it is.” It’s especially important to communicate effectively when working with new referral sources, adds Watson. “With the uncertainty of health insurance, I find that the older physicians are retiring earlier and the referral

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BEFORE

AFTER

De La Torre Orthotics & Prosthetics created a more useful and efficient lab space by following the 5S workplace organization method.

base you cultivated is ever changing,” he says. “You must stay alert for new doctors.” In addition, O&P facilities should look beyond individual physicians and “cultivate a large clinic or hospital to keep your referral base relevant. Doctors’ offices and physical or occupational therapy practices are the next hurdle, if they are not already in the business of providing O&P services.”

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JANUARY 2018 | O&P ALMANAC

PHOTO: De La Torre Orthotics & Prosthetics

Another way that O&P businesses are seeking to streamline processes and uncover efficiencies is by leveraging new tools and technologies. For example, Watson recommends digital scanning, such as a CAD/CAM system, over hand casting whenever possible, as it is a more efficient, less time-consuming approach that saves money in the long run. There are many affordable systems available on the market to choose from, says Watson. Just be sure to “invest in what you are comfortable with and create a system that is consistent.” Similarly, Perrone sees De La Torre’s electronic records system as a treasure-trove of data that can help

decrease waste and improve business practices. “We are great with slicing and dicing the data to get tighter and tighter on seeing where the winners and losers are with respect to profitability,” she says. She recommends clinics identify someone on staff—or hire a contractor—who is able to pull data from their system and set it up in an easily understandable way for staff to digest. “Be sure they know the world of O&P and are really good at Excel,” says Perrone. “For example, they should be able to easily look at any Health-Care Common Procedure Coding System code over any period of time to see what the charge amounts, payments, and write-offs (noncontractual) are for those codes. Comparing them in similar periods and tracking trends, especially in visual charts, is extremely eye-opening and helps to keep away ‘emotional’ decisions and drama. If you let the data talk without judgment, you will often see hidden jewels.” This data also can be very useful in discussion with vendors, she says. “It is best if you have the foreknowledge of your volumes and costs and where they may be able to give you additional savings.”

Additionally, data can help to streamline scheduling and maximize clinicians’ times on the floor. Perrone looks at the types of patient visits and works to be more strategic in scheduling according to appointment types. For example, if a patient needs to see both a pedorthist and orthotist during a visit, schedulers can book each clinician only for the amount of time he or she needs to spend with the patient. So, a 60-minute total appointment for the patient could be broken down to just 20 or 30 minutes for each clinician. “You want to really think about the patients you are seeing and look at that data historically to better plan scheduling efficiencies,” she says. At the same time, you have to be committed to facing the hard data and making the necessary changes, whether it is tough feedback from a patient survey or trends showing your clinicians are spending too much time on a given activity. “A good company is always taking out waste from their systems. But you need to get rid of the ego factor and be willing to sometimes make a sacrifice now and then. If a part of your system is shrinking, look at it with clear eyes, or be willing to bring in a consultant to help you identify waste and ways to streamline processes.” Another area where De La Torre management has worked to cut waste is in its cost of goods. After close analysis, they found that many items, such as feet that were being loaned out for trial, were not being returned in a timely manner. As a result, staff was simply ordering new items to replace them. To address this issue, the facility developed a new process, where a specific staff member was assigned to the task of creating a timeline for each item that is “loaned” out and ensuring its return. “We had other items on the shelf that originally missed being returned or were not able to be returned due to various restrictions,” says Perrone. To help demonstrate that profit was simply “walking” out the door, they created a listing of all the items that were made, along with the associated costs, and

distributed it to all of their clinicians. “This helps to inspire the staff to use up what we already have and not order ‘new,’” says Perrone. This sensible approach is one any owner or manager can implement and almost immediately start seeing results. If efficiencies are what you seek, data is the answer, says Bostock—but you have to take the time to upload information, maintain the system, and build a process that will generate useful data that will lead to actual improvement and change. “We’re driven by data, and we have to make sure that we’re not asking for data that takes a lot of time and effort that we’re never going to use. And, how much time does it take to get that data versus what return you’re going to get off that?” Bostock asks. Process analysis tools are one more option to consider when looking to improve efficiency, says Perrone. According to business research and advisory firm Gartner, “business process analysis tools are primarily

intended for use by business end users looking to document, analyze, and streamline complex processes, thereby improving productivity, increasing quality, and becoming more agile and effective.” Perrone notes that some O&P companies dabble in process analysis, but very few truly incorporate programs such as Six Sigma, Lean, and others. Some time ago, several key staffers at De La Torre went through a workplace organization method called 5S. As a result, they were able to translate this into actual, visible change in the clinic. Using the core tenets of the 5S program, the team worked to sort, straighten, shine, standardize, and sustain the lab space at each office location into highly functional spaces. “I do not understand why more O&P [companies] do not look at what other companies do and realize we can become more efficient by learning these tools,” she says. “Just saying, ‘We do just-in-time inventory,’ is not really doing it. There is so much more

to learn and put into practice. We get so busy with just doing day-to-day work that the real opportunity to improve process flow gets left behind. I believe that every single company can directly improve their bottom line and their employee work life satisfaction by incorporating [these tools and processes.]”

Thinking Strategically

Little changes can have a big impact when adjusting business practices. Motivating staff to contain expenses, educating clinicians and administrative staff about reimbursement, collecting patient satisfaction and outcomes data, and leveraging new technologies and practice analysis tools are just a sampling of steps that can be taken to promote a more strategic—and profitable—O&P facility. Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at liadangelico@gmail.com.

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O&P ALMANAC | JANUARY 2018

COMPLIANCE CORNER

By JIM LAWSON

Compliance Issues and Facility Accreditation ABC representative offers advice for avoiding common mistakes

E! QU IZ M EARN

BUSINESS CE

CREDITS P.36

New this year, O&P Almanac is inviting guest authors to write for the quarterly Compliance Corner column. This month’s column is written by Jim Lawson, outreach development manager at the American Board for Certification in Orthotics, Prosthetics, and Pedorthics.

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 36 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

VER THE PAST FIVE YEARS,

O&P professionals have gleaned a great deal of valuable information from those that live and breathe accreditation compliance—surveyors, compliance experts from AOPA and the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), Medicare representatives, and the many facility owners and compliance officers that attend ABC’s accreditation sessions across the country. Regardless of the perspective, each one of these individuals has shared his or her own examples, suggestions, and pitfalls when it comes to compliance. And while many of you are tired of hearing about the big “C,” we must remember that it’s necessary both for reimbursement and, most importantly, quality patient care. As you know, compliance starts with standards—those required by Medicare and your accrediting organization. As one of the nine deemed accrediting authorities by Medicare, ABC has a total of 142 patient-care facility standards, which include those also required by Medicare. It has been our experience that the most commonly missed or misunderstood standards tend to be the same year after year. These standards fall into three main areas of compliance: patient chart documentation, performance management review, and privileging.

Patient Chart Documentation Patient chart documentation can be a saving grace or a major thorn in 34

JANUARY 2018 | O&P ALMANAC

your side. Everything, from the diagnostic-specific clinical evaluation, to the final outcome measures, to the treatment plan, must be sufficiently documented in the patient’s record. This includes any interactions with or about the patient. Be it your direct care, that of a privileged caregiver, or communications from the prescriber or other health-care team member, all touch points must be documented. So, where should you start? At the end. This may seem odd, but keep in mind that it’s difficult to begin any journey or endeavor without knowing where you want to go—or, in this case, where your patient wants to go. Listen carefully to the patient’s goals for both the short and long term, and document these established patient goals and expected outcomes in your patient’s chart. It’s a good idea to also measure and document patient progress along the way using tools such as surveys, evaluations, and outcome measures. Think of documentation and patient feedback as necessary pit stops along the road to success. Just as photos serve as evidence of your travels for family and friends, documentation serves as evidence of patient interactions for those that weren’t present: surveyors, auditors, and payors. Beyond getting everything documented in the patient chart, can you say that what is documented is clear and detailed? One area where documentation clarity can get particularly rocky is with the delivery of an item—specifically,

COMPLIANCE CORNER

the documentation of that delivery or lack thereof. This lack of documentation in the past has resulted in far too many recovery audit contractor (RAC) audits. Ask yourself this question: Is your documentation detailed enough to allow a Medicare contractor or a third-party payor’s staff to understand exactly what is being delivered? The brands and serial numbers are no longer required but can certainly be helpful. So why not continue including them? The Health-Care Common Procedure Coding System (HCPCS) codes also are acceptable documentation, but remember you must list the entire HCPCS descriptor. Even the smallest details can cause major trouble. For instance, does the delivery receipt address match the location where the beneficiary took possession of the device? Are all signatures legible, and do any designee signatures also include their relationship to the patient? These seemingly minor details can quickly snowball into red flags for surveyors.

You’ve determined the goals, developed a treatment plan, and delivered the item, but does your patient and/ or his or her caregiver know how to use and care for the item? Instructions, both verbal and written, are extremely important regardless of how simple the device may be. You must document that you have provided and reviewed all instructions for the use of the device and explained what, if any, supplies are necessary to maintain and clean it. Has your patient been taught how to adjust (if appropriate) the device, inspect his or her skin, and report problems if and when they occur? If you are following the standards for compliance, then the answer should be a resounding, “Yes!” The patient chart documentation missteps don’t stop there. Surveyors

find that some of the items most often missing from the patient’s record involve patient feedback on the effectiveness of the device or services received. Most of you are already getting this input when you see your patients; just remember to document it in the patient’s record. Making sure that your patient charts have clear and detailed documentation not only serves as evidence of the care and items you provide, but it also helps you remember crucial events and treatment. By recording all patient encounters, you can identify trends that will help guide you in developing the most effective and successful treatment plan.

Performance Management Review

Performance management standards regularly make our “Top 10 Most Overlooked Standards” list, accounting for four of the 10. Most facilities meet ABC’s requirement to implement an effective, company-wide, and documented performance management and improvement program, but some fall short when it comes to the review and follow-up process. The goal is for you to design processes that effectively measure, assess, and improve your facility’s organizational performance as well as related patient outcomes that affect the level and quality of patient care. You can achieve this not only by having written processes for collecting and analyzing data, but by supporting

a culture of continuous improvement through identifying, resolving, and documenting any patient-care-related issues on an ongoing basis. That means you must seek input not only from your patients but also from your employees and referral sources to understand the full scope of your performance. The results from all feedback, including patient satisfaction surveys, must be documented and evaluated. When opportunities to improve are identified, actions must be taken and monitored to assess their effectiveness. ABC surveyors request a variety of documentation related to performance management during their onsite visit. This can include: • Any changes you made to policies and procedures as a result of identified issues • Minutes from meetings outlining improvements to your facility’s level of care • Returned patient satisfaction surveys and the analysis of the results • Documented feedback from employees and referral sources • Patient complaint logs and documentation of complaint handling and resolution • Billing and coding error logs and identification of issues that may require training or retraining • Documentation of adverse events related to malfunctioning devices and what actions were taken to ensure nonrecurrence. O&P ALMANAC | JANUARY 2018

COMPLIANCE CORNER

Keep in mind that ABC also requires you to document your formal review and analysis of your performance management program at least annually. The review can include an overview of accomplishments, success in meeting identified goals, as well as a future outlook to help guide your practice in achieving its vision and mission. An ongoing review of your performance management and improvement processes will support your practice’s commitment to quality patient care.

Privileging

Privileging has been an accepted practice model for many practitioners, allowing them to extend their patient care and overall efficiency. But privileging can be confusing and that’s why it is important to get it right to protect both your credential and your patients. It is particularly important given the upcoming changes to ABC’s privileging rules. If you are participating in privileging or plan to do so in the future, please be aware that beginning Jan. 1, 2019, the ABC Scope of Practice eliminates the practice of privileging noncertified individuals to provide patient care. Only certified individuals may continue to be privileged beyond their scope of practice with this change. In addition, changes are being made to the definitions of “Direct Supervision” and “Supervision of a Credentialed Caregiver,” and a new category has been added for “Support Personnel.” This change by the ABC Board of Directors represents its viewpoint that those delivering patient care should be educated and certified. Privileging of credentialed individuals to provide services beyond their defined scope must ensure appropriate, effective, ethical, and safe delivery of patient care. The credentialed caregiver may be privileged under Indirect Supervision based on Written Objective Criteria. The new definition of Direct Supervision still requires the credentialed supervising individual to be available for consultation throughout the patient-care process; however, the supervisor must now be physically on site while the care is being provided. 36

JANUARY 2018 | O&P ALMANAC

What is the role of Support Personnel? An ABC credential holder may delegate certain tasks in the provision of any custom-fabricated or custom-fitted orthosis, prosthesis, or pedorthic device to noncredentialed support personnel. Those delegated tasks must be within the ABC credential holder’s scope of practice. The tasks cannot include patient assessment, formulation of a treatment plan, final fitting and delivery, or any follow-up care that modifies the function of the device as originally prescribed. Any tasks delegated to Support Personnel must be supervised under Direct Supervision.

Beginning Jan. 1, 2019, the ABC Scope of Practice eliminates the practice of privileging noncertified individuals to provide patient care.

is being privileged to provide, and/or documented specific work experiences participating in patient-care activities. A log or checklist is not adequate by itself. Substantiating documentation that supports what is described in the log must be documented. As always, the credentialed supervisor (whether through Direct or Indirect Supervision) must review the work and notes of the privileged personnel and co-sign and date the record. All of this must happen within 15 days of the date the care was provided. Be sure that you understand what co-signing implies. As the credentialed supervisor (using your credential as validation), your signature says that you approve the work performed. The responsibility is now yours if any future problems arise. If you don’t feel comfortable with the care provided, or if you feel you don’t have sufficient documentation for privileging an individual, we advise that you hold off until you are confident you have the appropriate required documentation.

Committing to Compliance

In order to privilege an individual outside his or her scope of practice, you must establish Written Objective Criteria. This trips a lot of facility owners up when it comes time to produce the appropriate documentation during the onsite survey. So, what are Written Objective Criteria, and how do you document them? Written Objective Criteria are defined as the ways in which a caregiver has gained the necessary knowledge and skills to be able to provide a specific patient-care service. These criteria must be clear and related to the diagnosis involved and the device being provided. Examples of required documentation may take different forms including, but not limited to, proof of completion of continuing education courses related to a specific diagnosis or device, documented in-house training/in-services that are specific to the patient-care service the caregiver

If there’s one thing you take away from this article, it should be that compliance, though sometimes challenging, is necessary to protect you, your staff, your business, and, most importantly, your patients. And as we all know, we wouldn’t be here if it weren’t for our patients. Just remember that you don’t have to tackle the big “C” alone. Make it a team effort. Get your staff involved, and reach out to those ready to share their knowledge and experiences. ABC is here to help. Jim Lawson is outreach development manager at the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2018billing.

Top 10 reasons to attend: 1.

Get your claims paid.

Increase your company’s bottom line.

Stay up-to-date on billing Medicare.

Code complex devices

Earn 14 CE credits.

Learn about audit updates.

Overturn denials.

Submit your specific questions ahead of time.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience. Doubletree by Hilton Atlanta Airport 3400 Norman Berry Dr Atlanta, GA, 30344

Book by February 2 for the $119 room rate.

Find the best practices to help you manage your business.

Participate in the 2018 Coding & Billing Seminar!

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

www.AOPAnet.org

PRINCIPAL INVESTIGATOR

Clinician Embraces Secondary Research Role How Tyler D. Klenow, MSOP, CPO, LPO, CPT, contributes to the O&P research pool For 2018, O&P Almanac is introducing individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and health-care professionals who have carried out studies and gathered quantitative and/or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

NLIKE MANY O&P professionals,

Tyler D. Klenow, MSOP, CPO, LPO, CPT, did not have a personal or familial connection to orthotics and prosthetics when he made his career choice as a teenager. Instead, he was matched to O&P by a career-matchmaking service in high school. “I had never heard of it at the time, so I did some research on it and it looked cool,” Klenow recalls. “I then shadowed Ted Trower, CPO, of ASC Orthotics & Prosthetics, liked it even more, and decided that's what I wanted to do for a career. I haven't changed my mind since.” It turns out that career-matching service was a good predictor of career aptitude. Today, Klenow works as a fulltime prosthetist/orthotist at Orthotic & Prosthetic Centers Inc. (OPC), headquartered in St. Petersburg, Florida, treating a rural patient population that trends toward the elderly. “The thing I most enjoy about patient care is watching people stand for the first time since their amputation in a prosthesis I designed,” he says. “That moment provides me with a lot of satisfaction.”

JANUARY 2018 | O&P ALMANAC

But clinical results are not the only aspect of his work that brings him satisfaction; Klenow has taken on a secondary role as an O&P researcher. Beginning with his early days in O&P school, Klenow has found many ways to engage in O&P-related studies. “Being involved in research allows me to stay on the cutting edge of patient care—through the professionals I collaborate with and also through my regular attendance at national conferences when I present research findings,” Klenow explains. “It is at these conferences that I gain exposure to the latest methods through other presenters and the latest device offerings in the exhibit hall. So, I continue to perform research to keep my clinical care and expertise at a high level.”

A Natural Progression

Klenow first became involved in research through Frank Fedel, MS, PhD(c), CES, who is the research director for the O&P program at Eastern Michigan University (EMU), where Klenow attended O&P school. Fedel “allowed me to get involved with the Motion Analysis Laboratory while I was an undergraduate at EMU, which developed into my running the lab for the program while in graduate school. It is this experience that gave me a skill set in research that allowed me to sit at the table with many other great researchers in our field and further drove my growth as a researcher.” Since then, Klenow has been involved in many aspects of research—not only at EMU but also with a Tampa-based research group when he was completing

his clinical training at the Tampa Department of Veterans Affairs (VA) and via additional collaborations. He regularly presents his research findings at national O&P conferences, including the 2017 AOPA World Congress. His company, OPC, does not currently perform any formal research functions, “as we are a rapidly growing clinical provider and are wholly focused on issues related to that growth,” says Klenow. However, he continues to conduct research on his own and notes that “developing a research program [at OPC] is one of the next natural steps in our growth process.” The majority of Klenow’s research participation has been in either biomechanics or literature reviews. While at the EMU Motion Analysis Laboratory, he set up a project that led to an article published in Clinical Biomechanics titled, “The Dead Spot Phenomenon in Prosthetic Gait: Quantified With an Analysis of Center-of-Pressure Progression and Its Velocity in the Sagittal Plane,” co-authored by Klenow, Jason Kahle, MSMS, CPO, FAAOP, and Jason Highsmith, PT, PhD, CP, FAAOP. While at EMU, Klenow also met Randall Alley, CP, LP, FAAOP, through a professor. Alley is chief executive officer and chief prosthetist at Biodesigns Inc., a prosthetic facility specializing in upper- and lower-limb patient care and product development. Klenow worked with Alley to conduct some preliminary work on the efficacy of Biodesigns’ High Fidelity Interface (HiFi)TM system. “We were able to find that the transfemoral system does indeed influence the position of the thigh into more adduction

PRINCIPAL INVESTIGATOR

than traditional sockets,” says Klenow, who uses the system in clinical practice. In addition, Klenow has dedicated some of his research time to literature reviews. “During my time in Tampa, I was educated in systematic literature review methods by [Highsmith and Kahle], while participating in their group, which is affiliated with the University of South Florida and the VA through Dr. Highsmith's appointment there,” Klenow says. “We published a review of the IDEO, an ultradynamic AFO developed at the Center for the Intrepid, and also performed a review commissioned by AOPA to investigate factors contributing to prosthetic candidacy.”

Staying Busy in His ‘Off’ Hours

When he is not busy with patients or research, Klenow spends his down time with his wife, Mandi, who recently completed a graduate program and has been working as a nurse-anesthetist (CRNA) for about a year. He also tries to stay physically active and enjoys many forms of resistance training. “I have competed in a few raw powerlifting meets through the Revolution Powerlifting Syndicate, where I am a three-time amateur champion,” he says. “My routine also includes swimming in our pool and some very basic yoga. My wife and I try to kayak in the canal system where we live on the weekends as well.” But Klenow also is focused on continuing his work in research and is currently concentrating his efforts to help develop clinical practice guidelines (CPGs). CPGs are standards developed to offer recommendations intended to optimize care, which are informed by a systemic review of evidence and an assessment of the benefits and harms of alternative care options, according to the Institute of Medicine. “A recent trend in health care has been to use results of literature reviews to develop clinical practice guidelines,” explains Klenow. “A current interest of mine is to apply this practice to prosthetics in order to help bring our field up to speed with many other allied health professions.” He recently headed up a project in collaboration with Highsmith and others, including Phil Stevens, MEd, CPO, FAAOP, of

Hanger Clinic, regarding the role of exercise testing in the population with lower-extremity limb loss. “We were able to complete a systematic review and develop a CPG on the topic, which will be published in an upcoming special edition of the Journal of NeuroEngineering and Rehabilitation,” Klenow says. He expects to keep on performing literature reviews and developing CPGs related to O&P “to continue to raise the overall quality of our research base,” he says. Klenow also has an interest in outcome measures and is working on validating some of those for application to O&P. “There is a lot of work regarding outcome measures being done at the national level that I plan on participating in as well,” he says. “Overall, my research interests are very open. I am currently enjoying participating in a variety of research functions with many experienced individuals while also focusing on my work as a full-time clinician and working on my MBA.”

Challenges and Opportunities

While taking part in O&P-focused research is important to Klenow, he acknowledges that funding these efforts can be a challenge. “Many of my projects have been unfunded, as is often the case in this stage of a researcher’s career,” he says. “However, some projects have been commissioned through professional organizations such as AOPA or through manufacturers.” He notes that funding also may be available through such agencies as the U.S. Department of Defense, the National Institutes of Health, and the U.S. Department of Health and Human Services. But Klenow also cites many benefits to dedicating time to research efforts. Not only does it enable him to contribute to the profession in a substantial way; it also offers him the opportunity to collaborate with some of the “great minds” in O&P. Over the years, he has teamed with Highsmith, Kahle, Stevens, Fedel, and Alley, as well as Kenton R. Kaufman, PhD; Michael Orendurff, PhD; Brian Kaluf, CP; Anton Johansson, PhD, CPO; Hans Schaeper, M.Div, CPO; and others. “My education in research is limited, and I have learned nearly everything I know about research from these

innovators,” he says. “I also have made several connections through various research-related activities,” many of whom he plans to work with in the future. Klenow also has worked with several manufacturing companies, either directly or indirectly, including Ability Dynamics, Fillauer, Ottobock, Endolite, College Park, Biodesigns, and Lim Innovations. “These relationships allow research to be possible and push research quality ahead,” he says. Klenow believes that increased scrutiny from payors, and the national movement to value-based care, means that more O&P professionals should get involved in O&P data collection and research studies. “Outcomes data will eventually be directly tied to reimbursement for O&P interventions and therefore to the ability to provide care,” he explains. To raise awareness of this need, he has become involved in professional organizations, for example by participating in, and serving as the current co-chair of, the Outcomes Research Committee of the American Academy of Orthotists and Prosthetists. “I am also working to provide clinicians with the ability to objectively measure our work,” he says. He is involved in a project aimed at validating common functional performance tests for the ability to measure cadence, with the goal of reliably documenting variable cadence for determination of K3 functional level. Klenow admits the research aspects of his work as an O&P professional bring him a sense of satisfaction, stemming from the ability to contribute to the advancement of the profession. “I most enjoy the relationships and opportunities conducting research provides,” he says. “I also enjoy contributing to a knowledge that helps people in their daily lives.” He encourages other O&P clinicians to learn how they can contribute to the growing O&P research pool. “Research is a merit-based profession,” he says. “Obviously, obtaining advanced education helps, but it is a process of starting at the bottom and working upward. If someone is interested in research, they should contact someone around them doing research and volunteer to help. It’s not often a fun thing to do, but the benefits and outcomes outweigh the work, I think.” O&P ALMANAC | JANUARY 2018

MEMBER SPOTLIGHT

Aspire Prosthetics & Orthotics Inc.

By DEBORAH CONN

Customization in the Keystone State President Angela Ansa oversees staff.

Owners at growing Pennsylvania facility offer targeted services to promote mobility

NGELA ANSA AND HER

JANUARY 2018 | O&P ALMANAC

Ribbon-cutting ceremony at Aspire Prosthetics & Orthotics Inc.

Knittel Ansa, CPO, works on a prosthesis.

FACILITY: Aspire Prosthetics & Orthotics Inc. LOCATION: York, Pennsylvania OWNERS: Angela Ansa and Knittel Ansa, CPO HISTORY: Two years

including scoliosis, trauma bracing, and lower-extremity prostheses. He also specializes in diabetic foot wound management and such varied devices as cranial remolding helmets; microprocessor arm, knee, and ankle prostheses; and advanced socket technologies. The company treats patients of all ages in its 2,400-squarefoot facility, offering a wide range of customized O&P services. Patients are often those seeking another option or who need pre- or postamputation consultations, Angela Ansa says. The facility also works closely with other practitioners as part of the health-care delivery team. She stresses that Aspire, which outsources all fabrication, does not provide standardized care, but seeks to offer customized O&P services that are conducive to the lifestyle and needs of its patients. Evaluation and education are as critical as fitting an appropriate and functional device. Aspire’s slogan is, “It’s not about the device, but the advice.”

“We have a strong social media and community presence to stay connected with our patients,” Angela Ansa says. “We are involved in local events in York and surrounding counties. This also provides us an opportunity to educate the public on the benefits of appropriate O&P care.” In addition, Aspire provides in-service programs to local health-care facilities and practitioners to educate them on O&P interventions. Angela Ansa says that getting into the insurance networks was Aspire’s biggest challenge when the facility first opened. Many insurance companies said their networks were closed to new facilities, “but we knew there was demand because we had patients lined up to see clinicians,” she says. “Insurers tend to lump O&P in with DME [durable medical equipment]; however, after we showed them the effectiveness of our care, they were eager to partner with us,” Angela Ansa adds. Today, Aspire works with almost all insurance carriers in Pennsylvania. “Our passion is to enhance quality of life by improving mobility through technology,” she says. “It’s such a joy to see someone come in and then walk out with a device they feel comfortable with, and know will make a difference. We can see the change in their attitude and overall outlook in life.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Aspire Prosthetics & Orthotics Inc.

husband, Knittel Ansa, CPO, were visiting his mother in 2015 when they saw a man who was wearing a prosthesis and limping badly. “I didn’t even have the background in O&P and I could tell it was a terrible fit,” she recalls. She told Knittel, “If I were him, I would not want to be defined by my limitation. I would want my device to help me get to the next level.” That moment led to the couple’s decision to form a company named “Aspire.” “We are both entrepreneurs—I have a master’s in health policy and management and he has the clinical expertise, so it was a perfect match,” Angela Ansa says. “I could see how a wellfitted prosthesis could improve mobility and overall quality of life. Knittel totally supported that—he is the best in the business. “I see things differently from the clinicians,” she continues. “I have a different appreciation for health care as a whole, where it is going, and the role public health and O&P play in the health-care space. With the rise of healthcare costs, we want to ensure devices will be useful in helping patients live an active lifestyle.” Today, Angela Ansa is president of Aspire Prosthetics & Orthotics in York, Pennsylvania. In the beginning, the company consisted of just Angela and her husband, but it has expanded to include additional staff. Knittel directs clinical operations, with a special expertise in pediatric orthotic management,

Who is an innovator? Who is held to the highest O&P standards? Who is committed to life-long learning? I AM. I am a big part of great possibilities.

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MEMBER SPOTLIGHT

Fabtech Systems

By DEBORAH CONN

Smart Solutions Washington company takes a Lean manufacturing approach to O&P design and fabrication

ABTECH SYSTEMS, BASED IN Everett, Washington, has

JANUARY 2018 | O&P ALMANAC

Fabtech’s manufacturing floor

A Fabtech technician works on a socket.

FACILITY: Fabtech Systems LOCATION: Everett, Washington OWNERS: Greg Mattson, CTPO, CPA; Scott Wimberley, RTPO, CPA; and Dave Hughes, CPO, LPO HISTORY: 17 years

Customized central fabrication services, using CAD/CAM techniques and a commitment to “100 percent quality out the door,” remain in the company’s business mix. But Fabtech also has been branching out with its own specialized high-tech products. Fabtech, for example, manufactures advanced composite fibers for the O&P industry, notably a laminating epoxy, RESTECH+, and a military-grade composite fiber called Synthex. One of the company’s latest products is the Posterior Dynamic Element, or PDE modular spring system, which provides dynamic ankle-foot orthosis bracing. “We have a modular system with a dynamic element that a clinician can change out and dial in the patients’ needs. For example, a patient may want a softer spring for normal walking, but a stiffer spring for backpacking.” Another popular Fabtech offering is its CrossOver Extensible Knee, says Mattson. The initial idea for the product came from a member of the U.S. Ski Team who

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

PHOTOS: Fabtech Systems

evolved from a small central fabrication lab to a growing business that has expanded into the design of unique high-tech O&P products. The company also manufactures adhesives, resins, and other composite materials. What once was a modest 545-square-foot plant is now a facility of 10,000 square feet, 3,000 of which are devoted to manufacturing, with the rest for research and development, distribution, and administration. The company’s focus on innovation and customization, however, hasn’t changed over the years. “Like any organization, we always want to grow,” says Greg Mattson, CTPO, CPA, president and chief executive officer. “Our goal is creating unique products with smart solutions that help our industry and our patients. Because of that, we are always looking for new products that are unique.” Mattson shares that vision with the other founding members of Fabtech: Scott Wimberley, RTPO, CPA, the company’s operations manager; and Dave Hughes, CPO, LPO, clinical partner at Fabtech and president of a closely allied company, Cornerstone Prosthetics and Orthotics. Mattson worked as a tech manager at Cornerstone before he, Wimberley, and Hughes decided to form a central fabrication company, with an emphasis on composites. “When testing products,” says Mattson, “it’s great to run them through our sister company, Cornerstone.”

had lost a leg in an accident but still wanted to ski with two legs. “Ten years later, we have a great product—an ambulatory knee that, with some additions and adjustments, can be used for skiing and all kinds of high- and low-activity sports like bike riding, swimming, and surfing. Once it’s set up, the user can make quick changes to suit low- or highactivity sports,” says Mattson. Along with custom design, manufacturing, and product distribution, Fabtech has implemented Lean manufacturing principles, an effort led by Wimberley. Both Wimberley and Mattson have participated in intensive Lean manufacturing training, and studied in the United States and Japan with such companies as Omron, Denso, Ricoh, and Toyota. Fabtech, in turn, has provided Lean manufacturing consulting services to several other O&P companies. Fabtech regularly participates in trade shows and other traditional marketing activities, but the company also has been heavily involved in the technical education side of the business. Mattson is a founding member of the Fabrication Sciences Society and the Orthotic and Prosthetic Technological Association, and Wimberley helped create tech examinations when he served on the board of American Board for Certification in Orthotics, Prosthetics, and Pedorthics. Ultimately, the company’s relationship with patient-care companies is crucial, Mattson says. “Working with Cornerstone allows us to see what’s happening in clinics. And then we can say, ‘Wouldn’t it be great if we could improve this and cut out half the production time?’ The result is that we come up with really neat solutions for practitioners.”

amp Sean’s story is an example of a successful fight for access to prosthetic care. If you and your patients are experiencing Insurance challenges, visit AmplifyYourself.org to tell insurance executives and legislators that no is not an answer. The Amplify initiative is turning up the volume to make sure everyone has access to the care that they need.

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

AOPA NEWS

2018 WEBINARS

Call for Papers for the AOPA National Assembly

Clinical, Business, Technical, Pedorthic, and Symposia Presenters Wanted

2018 Webinar Topics Announced Mark your calendars for AOPA’s 2018 monthly webinars. These informative sessions take place on the second Wednesday of each month at 1 p.m. Eastern Time. 2018 Webinars • January 10: Lower-Limb Prosthesis Policy: A Comprehensive Review

BEST

• February 14: Inpatient Billing

ABSTRACT

• March 14: Medicare Coding Guidelines: MUEs, PTPs, PDAC, and More

BUSINESS

• April 11: Enhancing Cash Flow and Increasing Your Accounts Receivable • May 9: Coding: Understanding the Basics • June 13: Audits: Know the Types, Know the Players, and Know the Rules

BEST of SHOW

• July 11: Administrative Documentation • August 8: Outcomes & Patient Satisfaction Surveys • September 12: Medicare as Secondary Payor: Knowing the Rules • October 10: Year-End Review: How To Wrap Up and Get Ready for the New Year • November 14: Evaluating Your Compliance Plan and Procedures: How To Audit Your Practice • December 12: New Codes, Medicare Changes, and Updates

AOPA is seeking high-quality educational and research content for the 2018 AOPA National Assembly, September 26-29 in Vancouver, BC, Canada. AOPA is accepting these topics: • Clinical Free Papers • Technician Program • Symposia/instructional course • Business Education • Pedorthic Program All submissions are due March 1, 2018. Learn more about presenting at bit.ly/present2018. 44

JANUARY 2018 | O&P ALMANAC

During these one-hour sessions, AOPA experts provide the most up-to-date information on a specific topic. Webinars are perfect for the entire staff—they’re a great team-building, money-saving, and educational experience! Sign up for the entire series and get two conferences free. Entire Series ($990 Members/$1,990 Non-Members). Register at bit.ly/2018webinars.

AOPA NEWS

AOPAversity Webinars FEBRUARY 14

MARCH 14

Medicare Coding Guidelines: MUEs, PTPs, PDAC, And More

Having trouble with all of the acronyms in the coding guidelines? Plan now to take part in the March 14 webinar, when AOPA experts will explain the following: • Medically Unlikely Edit (MUE) charts • Procedure-To-Procedure (PTP) edit charts • Recommendations from the Pricing, Data Analysis, and Coding (PDAC) contractor • And others.

Inpatient Billing

Billing the correct entity can be confusing when patients spend time at inpatient facilities. AOPA’s experts will demystify the process and offer advice during the February 14 webinar, discussing the following topics: • Proper use of the “Two-Day Rule” • Skilled nursing facility prosthetic exemptions • Part A rules for hospitals and hospice • Statutorily noncovered services • Billing responsibility • Review of the rules and outlier exemptions.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2018webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Sign up for the entire series and get two conferences free. All webinars that you missed will be sent as a recording. Register at bit.ly/2018webinars.

O&P ALMANAC | JANUARY 2018

NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the companyâ&#x20AC;&#x2122;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 AOPAâ&#x20AC;&#x2122;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.

Achilles Prosthetics & Orthotics 1435 State Street Santa Barbara, CA 93101 Member Type: Patient-Care Affiliate Parent Company: Achilles Prosthetics & Orthotics, Bakersfield, CA 805/869-1200

Center for Orthotic & Prosthetic Care 2 Atrium Court, Ste. B Selinsgrove, PA 17870 Member Type: Patient-Care Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY 570/284-4294

Carolina Orthotics & Prosthetics LLC 10 Enterprise Blvd., Ste. 206 Greenville, SC 29615 Member Type: Patient-Care Affiliate Parent Company: Carolina Orthotics & Prosthetics LLC, North Charleston, SC 864/552-1840 Center for Orthotic & Prosthetic Care 130 Oakdale Road Johnson City, NY 13790 Member Type: Patient-Care Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY 607/770-4400

Center for Orthotic & Prosthetic Care 790 Pre Emption Road, Ste. B Geneva, NY 14456 Member Type: Patient-Care Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY 315/325-0024 Center for Orthotic & Prosthetic Care 3901 N. Roxboro Street, Ste. 112 Durham, NC 27704 Member Type: Patient-Care Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY 984/219-7542

JANUARY 2018 | O&P ALMANAC

Complete Orthopedic Services 387 Linden Blvd. Brooklyn, NY 11203 Member Type: Patient-Care Affiliate Parent Company: Complete Orthopedic Services Inc. 347/889-6732 Complete Orthopedic Services 53 E. 124th Street New York, NY 10035 Member Type: Patient-Care Affiliate Parent Company: Complete Orthopedic Services Inc., East Meadow, NY 212/410-8483 Geisinger Orthotics 1175 East Mountain Blvd. Wilkes Barre, PA 18702-7906 Member Type: Patient-Care Affiliate Parent Company: Geisinger Medical Center Orthotics Dept., Danville, PA 570/808-4779

OPA 1 Ltd. 11301 Fallrook Drive, Ste. 101 Houston, TX 77065-4232 Member Type: Patient-Care Affiliate Parent Company: OPA 1 Ltd., Bellaire, TX 832/912-4321 Specialty Prosthetics & Orthotics Technologies 2019 W. Broadway Street Muskogee, OK 74401-2759 Member Type: Patient-Care Affiliate Parent Company: Fenner Inc./ dba Specialty Prosthetics & Orthotics of Tulsa 918/537-2001 Mike Fenner, BOCPO, COO, LPO

O&P PAC UPDATE

Update the O&P PAC Authorization Form for 2018 The O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and

other officials running for office to educate them about the issues, and help elect those individuals who support the O&P community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online at bit.ly/aopapac, or you may complete and return the authorization card below. For more information, contact Devon Bernard at dbernard@AOPAnet.org.

O&P PAC Authorization I authorize the O&P PAC to share information with me, executive, administrative, and professional personnel associated with the company designated by me below. Name: __________________________________________________________________________ Company: _______________________________________________________________________ Address:_________________________________________________________________________ Telephone: ______________________________________________________________________ Email: __________________________________________________________________________ AOPA must obtain the signature of a corporate officer, or a person that can authorize for their company. Signing multiple dates eliminates the need to contact you for authorization approval in upcoming years and reinforces your commitment to the O&P PAC. 2018____________________________________________ 2019____________________________________________ 2020____________________________________________

Return completed form to: AOPA Attn: O&P PAC 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Or fax to: 571/431-0899

As required by federal law, my company has not authorized a federal PAC solicitation by another trade association during any calendar year in which this â&#x20AC;&#x153;authorizationâ&#x20AC;? is granted to O&P PAC. Signing this card in no way obligates me or others to contribute; it just gives them the opportunity to do so.

O&P ALMANAC | JANUARY 2018

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options.

ALPS Flex Sleeve

Ottobock’s ProFlex™ Plus Sealing Sleeve

ALPS’ new Flex Sleeve (SFX) is a new seamless knitted construction. It features ALPS HD Gel, which has a relatively firm nature and provides maximum comfort while providing a great degree of control. The SFX has a 30-degree pre-flexion that allows for ease of bending and reduces bunching behind the knee. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com.

Coyote Design Adhesives We now have two glues COYOTE ADHESIVES to choose from. • Coyote Quick Adhesive— Quick Adhesive 30-second set time. • Coyote Smooth Adhesive— Smooth Adhesive new 60-second set time option. Coyote’s glues are great for attaching componentry and multiple repairing uses. They ship nonhazardous and are safe with no odor. For more information, contact Coyote Design at 208/429-0026 or visit www.coyotedesign.com. Quick Set Time

NEW GLUE!!!

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LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com.

JANUARY 2018 | O&P ALMANAC

Countdown to flexibility for you and your patients with Ottobock’s ProFlex™ Plus Sealing Sleeve • Three colors and sizes • Two lengths • #1 choice. ProFlex Sleeves—delivering proven performance for the last 10 years. This soft, yet tough, sealing sleeve is designed with a more flexible fabric and smoother proximal seam. It features 15 degrees of flexion for easier bending and less bunching behind the knee; a preformed knee cap for lower stress on the patella; and a conical shape proximal for improved thigh fit and tighter distal shape for enhanced sealing on socket. Check out professionals.ottobockus.com for details.

Ottobock’s WalkOn® Carbon-Fiber AFO WalkOn ankle-foot orthoses (AFOs) are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally. WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return. WalkOn offers a full range of AFO sizes and designs, including the WalkOn Reaction Junior pediatric sizes. Fast and easy to fit, the WalkOn footplate is trimmable and can be shaped with scissors, often requiring only one office visit. Contact us at 800/328-4058 or professionals. ottobockus.com for details.

AOPA Compliance Guide CD—Updated This Compliance Handbook helps patient-care facilities follow the fraud and abuse prevention guidelines recommended by the Office of the Inspector General. This product will assist you in developing a compliance plan for your facility, including guidelines for developing a standard of conduct, billing policies and procedures, and much more. With the help of the AOPA Compliance Handbook CD, you will be able to create an effective audit/quality assurance program to monitor compliance and conduct introductory training sessions for employees. • AOPA Compliance Guide CD—Updated: $159 AOPA members, $318 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

CAREERS

Opportunities for O&P Professionals

Southeast

CPO, CO

Job location key:

South Carolina

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

Floyd Brace Company Inc. is currently seeking hard-working, skilled, certified prosthetic/orthotic practitioners for our South Carolina territory. CPOs and COs must possess a strong clinical background. Compassion, quality, and timeliness of care are important aspects to provide our patients. We offer competitive salary, medical, dental, and vision benefits. Additionally, retirement plan options are available. Candidates must possess ABC certification and experience for each discipline.

Contact: Human Resource Department Email: niki@floydbrace.com

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

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O&P ALMANAC | JANUARY 2018

CALENDAR

2018

January 26-27

January 1

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

Leadership Conference O&P

January 5-7

AOPA Leadership Conference. The Breakers, Palm Beach, FL. Top executives at each AOPA member company are invited to this exclusive event. Contact landerson@AOPAnet.org for more information.

January 8-13

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

January 10

Lower-Limb Prosthesis Policy: A Comprehensive Review. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

January 19-20

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

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

February 1

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

February 1

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

February 14

Inpatient Billing. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

February 14-17

Academy Annual Meeting & Scientific Symposium. New Orleans. Visit academyannualmeeting.org.

February 23-24

PrimeFare Central Regional Scientific Symposium 2018. Renaissance Hotel, Tulsa, OK. Contact Cathie Pruitt, 901/359-3936, email primecarepruitt@gmail.com; or Jane Edwards, 888/388-5243, email jledwards88@att.net; or visit www.primecareop.com.

Apply Anytime!

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

your next event!

Cascade Dafo Institute. Cascade Dafo Institute offers eight free ABC-approved online continuing education courses for pediatric practitioners. Earn up to 12.25 CE credits. Visit cascadedafo.com or call 800/848-7332.

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

Calendar Rates Let us

Free Online Training

CREDITS

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

JANUARY 2018 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR February 26-27

2018 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars. Doubletree by Hilton, Atlanta. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

July 11

Administrative Documentation: The Must Haves and the Sometimes Needed. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

March 1

Call for Papers deadline. Deadline to submit your clinical, business, technical papers or symposia at bit.ly/present2018 to present at the 2018 National Assembly.

August 8

Outcomes & Patient Satisfaction Surveys. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

March 14

Medicare Coding Guidelines: MUEs, PTPs, PDAC, and More. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

September 12

Medicare As a Secondary Payor: Knowing the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

April 11

Enhancing Cash Flow & Increasing Your Accounts Receivable. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

September 26-29

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

April 26-28

New York State Chapter Annual Meeting (NYSAAOP). Rivers Casino & Resort, Schenectady, NY. For more information, visit www.NYSAAOP.org.

May 9

Coding: Understanding the Basics. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

June 13

Audits: Know the Types, Know the Players, and Know the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

October 10

Year End Review: What Should You Do to Wrap Up the Year & Get Ready for the New Year. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

November 4-10

Health-Care Compliance & Ethics Week. AOPA is celebrating Health-Care Compliance & Ethics Week and is providing resources to help members celebrate. Learn more at bit.ly/aopaethics.

WEBINAR

ADVERTISERS INDEX Company ALPS

Page

Phone

Website

7 800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics, and Pedorthics

www.abcop.org

Amfit

19 800/356-3668

www.amfit.com

703/836-7114

Amputee Coalition

800/267-5669

www.amputee-coalition.org

Cailor Fleming

800/796-8495

www.cailorfleming.com

Coyote Design

800/819-5980

www.coyotedesign.com

Fabtech Systems

800/FABTECH

www.fabtechsystems.com

Hersco

1 800/301-8275

www.hersco.com

Naked Prosthetics

www.npdevices.com

Ă&#x2013;ssur Ottobock

888/977-6693

5 800/233-6263 C4 800/328-4058

www.ossur.com www.professionals.ottobockus.com O&P ALMANAC | JANUARY 2018

ASK AOPA CALENDAR

Reporting Facility Changes When and how to notify Medicare of changes, tips for accepting assignment, and more

AOPA receives hundreds Q of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

When must we notify Medicare of changes in our business?

According to Supplier Standard 2, Medicare requires you to notify the National Supplier Clearinghouse within 30 days of any changes to your business. These changes must be reported using the paper Form 855S or the online Provider Enrollment, Chain, and Ownership System.

What types of changes must be reported within 30 days?

Any change must be reported within 30 days. This would include a change in ownership, a new phone number, or a new address. It also would include the choice to add or remove new product lines or services you provide to Medicare patients, and it would include any changes related to your specialty type.

If we are a nonparticipating provider with Medicare and we choose not to accept assignment on a claim, are we still required to obtain all of the documentation and paperwork required by Medicare?

Yes, you still must collect all of the required documentation and paperwork. Being a nonparticipating provider and not accepting assignment on a claim does not release you from the

JANUARY 2018 | O&P ALMANAC

obligations of meeting Medicare policy requirements; it only affects how much money you may collect from the patient and who is responsible for paying you on the claim. May we provide a brace to a patient prior to a hospital admission and still bill Medicare, instead of receiving a purchase order from the hospital?

Yes, but you will have to document and show that the brace was required or medically necessary prior to the hospital stay. For example, you may want to make sure that referring physician has indicated that he or she requires the patient to wear the brace prior to the hospital stay, i.e., to stabilize the patient for surgery or to get the patient ready for surgery.

Is a difference in cost considered an upgrade?

No, cost by itself is not considered an upgrade. An upgrade is based on what is considered medically necessary for the patient. An upgrade is an item or feature that is medically unnecessary because it exceeds the patient’s needs or requirements and/or will typically be above what is found in the official descriptor of an item or service.

www.bocusa.org

EARN CREDITS AT YOUR OWN PACE www.AOPAnetonline.org/aopaversity

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Visit www.aopanetonline.org/aopaversity.

Empower

Control The system uses high resolution sensors to determine the correct amount of ankle power and ankle position in real-time, putting the user back in control of their daily activities. Power Mimics normal muscle function of the lower limb by matching the ankle joint power output of a biological limb throughout daily walking ranges.

Stability Settings customized to each individualÂ provides a more natural gait pattern and reduced joint impact.Â The large range of motion and energy return restores balance and allows the user to confidently negotiate even the most challenging terrain.

professionals.ottobockus.com

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