September 2009 O&P Almanac by AOPA

Almanac OP The American Orthotic & Prosthetic Association

SEPTEMBER 2009

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

The Value of

RESPONSIBLE BUSINESS

How good deeds can enhance your practice

Working alone: Is it worth it? Tips for protecting against AIRBORNE PATHOGENS

In Memory…

Dr. Max Näder June 24, 1915 - July 24, 2009 Otto Bock Company President and CEO

He deﬁned an era of growth and foundation-building in the prosthetic and orthotic industry. He will be missed.

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COLUMNS

18 The Value of Responsible Business

By Anya Martin O&P facilities are well positioned to be socially responsible companies— minimizing their impact on the environment, supporting causes that matter, and using their businesses to leave the world better than they found it. These good deeds also can enhance their reputation among employees and customers.

26 The Single Life

By Deborah Conn What does it takes to run a one-person O&P facility? Practitioners from around the country weigh in on the advantages and disadvantages of working alone, and offer tips for handling fabrication, finances, burnout, and more.

32 Daily Dangers

Smart business owners protect employees from on-the-job hazards. But what about unseen risks, such as mold, mildew, and pathogens? John F. Schulte, CPO, FAAOP explains these hidden dangers—and how to prevent their spread.

50 5 Questions… for Robert Frank, CPO

Hanger Prosthetics and Orthotics retiree Robert Frank, CPO, now runs Fundación Protesis Para La Vida, a free clinic he co-founded in Ecuador.

Part 1 of a two-part series on modifiers

Ask the Expert Questions about pending changes to HIPPA

DEPARTMENTS

FEATURES

Reimbursement Page

48 54

AOPA Contact Page How to reach staff

In the News Updates and company announcements

AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

AOPA Membership Applications Marketplace

Products and services for O&P

Jobs

Calendar

Ad Index

Glad You Asked

The challenges of treating stroke patients

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/431-0899; e-mail: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, e-mail: dmather@mrvica.com.

O&P ALMANAC SEPTEMBER 2009

table of contents

Volume 58 Number 9

SEPTEMBER 2009

AOPA contact page

OP Almanac &

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

EXECUTIVE OFFICES

MEMBERSHIP AND MEETINGS (Cont’d.)

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

Erin Kennedy, office, meetings administrator, and associate editor, AOPA in Advance, 571/431-0834, ekennedy@AOPAnet.org

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

Michael Chapman, membership services specialist, 571/431-0843, mchapman@AOPAnet.org

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

Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org

Angela Brady, editorial director, abrady@strattonpublishing.com

Steven Rybicki, communications coordinator, 571/431-0835, srybicki@AOPAnet.org

Josephine Rossi, managing editor, 703/914-9200 ext. 26, jrossi@strattonpublishing.com

AOPA Bookstore: 571/431-0804

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

Kathy Dodson, senior director of government affairs, 571/431-0810, kdodson@AOPAnet.org

Dean Mather, advertising sales representative, 856-768-9360, dmather@mrvica.com Erin Kennedy, staff writer, 571/431-0834, ekennedy@AOPAnet.org MEMBERSHIP AND MEETINGS Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org

GOVERNMENT AFFAIRS

Devon Bernard, reimbursement services coordinator, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of reimbursement services, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a

SEPTEMBER 2009

Vol. 58, No. 9

PUBLISHER Thomas F. Fise, JD EDITORIAL MANAGEMENT Stratton Publishing & Marketing Inc. ADVERTISING SALES M.J. Mrvica Associates Inc. DESIGN & PRODUCTION Marinoff Design, LLC PRINTING United Litho Inc.

BOARD OF DIRECTORS OFFICERS President Brian L. Gustin, CP, BridgePoint Medical Inc., Suamico, WI President-Elect James A. Kaiser, CP, Scheck & Siress, Chicago, IL Vice President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, LLC, Houston, TX Treasurer Mark H. Emery, Ossur Americas, Aliso Viejo, CA Immediate Past President Bradley N. Ruhl, Otto Bock HealthCare, Minneapolis, MN Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA DIRECTORS Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Rick Fleetwood, Snell Prosthetic & Orthotic Laboratory, Little Rock, AR Russell J. Hornfisher, Becker Orthopedic Appliance Co., Troy, MI Marc N. Karn, CP, The Prosthetic & Orthotic Center of New England, Portland, ME

OP Almanac

Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA

2009-2010 EDITORIAL ADVISORY BOARD Rick Bowers, Amputee Coalition of America Rick Fleetwood, Snell Prosthetic & Orthotic Laboratory Steve Hill, Delphi Ortho Russell J. Hornfisher, Becker Orthopedic Appliance Co.

Tabi King, Ossur North America Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center David Rotter, CO, CP, LO, LP, L.Ped, Scheck and Siress Gary Steren, CPO, Cornell Orthotics & Prosthetics Inc.

Fran Varner Jenkins, Fillauer Inc. Joel J. Kempfer, CP, FAAOP, Kempfer Prosthetics Orthotics Inc.

O&P ALMANAC SEPTEMBER 2009

Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI John H. Reynolds, CPO, FAAOP, Reynolds Prosthetics & Orthotics Inc., Maryville, TN Lisa Schoonmaker, CPO, FAAOP, Tandem Orthotics & Prosthetics Inc., St. Cloud, MN Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2009 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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AOPA staff

BIOGRAPHIES THOMAS F. FISE, JD, joined AOPA as executive director in 2007 after serving 19 years as executive director of the American College of Gastroenterology and owner of a management company that conducted business affairs for eight physician/ medical associations. He also spent five years as general counsel of the National Spa and Pool Institute. Tom and his wife, Mary Ellen, have two sons—one just graduated from college, and the other from high school. He is an avid swimmer. DON DEBOLT, chief operating officer, initially joined AOPA as a consultant in 2007 and soon after assumed COO responsibilities. He previously served as president of the International Franchise Association for 10 years after founding the newsletter, CEO Update. He also served as executive director of the International Swimming Hall of Fame, CEO of the National Spa and Pool Institute, and executive director of Menswear Retailers of America. KATHY DODSON is AOPA’s senior director of government affairs. She joined AOPA in 1989 as the manager of reimbursement services after being employed by Blue Cross/Blue Shield of the National Capitol Area (BCBSNCA). During her time at BCBSNCA, she directed fraud and abuse investigations, and oversaw the professional relations staff that worked with physicians. In her off hours, Kathy is a costumer for local theater groups.

TINA M. MORAN, CMP, has served the O&P field as an AOPA employee for more than 13 years. She holds a certification through the convention industry council—a certifying board for meeting professionals. Her hobbies include working with stained glass and gardening. JOE MCTERNAN is director of reimbursement services for AOPA. He was on the AOPA staff from 1995 until 1998 when he joined Hanger Prosthetics and Orthotics Inc. as director of regulatory affairs. He returned to AOPA in 2005 to focus on Medicare policy and the O&P billing and coding system, and to serve as a presenter for AOPA’s Advanced Coding and Billing Seminar. In his free time, Joe enjoys playing ice hockey and spending time with his family. KELLY O’NEILL, AOPA’s manager of meetings and membership, joined the organization in July 2004 as the membership sales coordinator. She previously worked in the hospitality industry, where she spent more than nine years in hotel sales. In her current role, she is highly involved in planning AOPA’s annual National Assembly. O’Neill is a native of the Washington, DC, metropolitan area and resides in Northern Virginia.

O&P ALMANAC SEPTEMBER 2009

DEVON BERNARD joined AOPA in 2007 to work in the membership department. In October of 2007, however, he began working in the government affairs department, where he currently is reimbursement services coordinator. Bernard responds to members’ questions regarding coding and billing as well as writes for the AOPA in Advance and O&P Almanac. He is a graduate of the University of Florida and currently resides in Washington, DC. MICHAEL CHAPMAN joined AOPA in 2007 as a membership services specialist. He is a graduate of Flagler College and enjoys the outdoors, biking, and spending time with his wife, Valarie, and their new puppy, Beaker. ERIN KENNEDY is the associate editor of AOPA in Advance and AOPA’s meetings, conventions, and office administrator. She also writes In the News for O&P Almanac. Kennedy holds a master’s degree in acting from the Catholic University of America and bachelor’s degrees in theatre and communications from Florida State University. Since moving to DC, she has worked in area theatres and came to AOPA because of an acting colleague. STEVEN RYBICKI is communications coordinator for AOPA. He holds a bachelor’s degree in government policy and a master’s degree in philosophy. Prior to working at AOPA, Rybicki was an intern for Commissioner David Mason at the Federal Election Commission. He is originally from Midland, Texas, and his hobbies include reading, writing, crossfit training, running, and swimming.

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in the news

IN MEMORIAM Linda S. Donahue, 58

prestigious Commander’s Cross of the Order of Merit of the Federal Republic of Germany. In 1985, he earned the Georg-Hohmann Award from the German Orthopaedics and Traumatology Society. In 1987, Näder established the Otto Bock Foundation, which is dedicated to promoting orthopaedic technology and interdisciplinary collaboration through continuing education programs for doctors, physical therapists and orthopaedic technicians. In the wake of the flood disaster in eastern Germany in 2002, the foundation expanded its activities to include charitable activities, including organizing relief and fundraising campaigns after the 2004 tsunami and the devastating earthquake in China in 2008. “Näder was extremely proud of the success and the outstanding worldwide reputation of the company to which he dedicated his life,” the statement concluded. “Right up to his last days of his happy, fulfilled life, he had a personal investment in the well-being of the company and the employees, the needs of people with disabilities, and customer satisfaction. The Otto Bock Group and all its employees are mourning the loss of an entrepreneurial spirit whose composure and human values serve as an example for others.”

Linda S. Donahue attended Ohio State University in Columbus, Ohio, and held certifications in the field of orthotics from both the American Board for Certification in Orthotics, Prosthetics and Pedorthics and the Board of Certification/Accreditation, International. Donahue was an executive for Camp International for more than a decade and a vice president of sales and product development for Biomedical Horizons, Inc. In a statement given to O&P Almanac from Fillauer Companies, Inc., Donahue “pioneered the development of many medical products, especially those related to women’s health care, which radically improved the lifestyles for many women all over the world. She was one of the first to bring external silicone breast form technology to market. She introduced designer bras, and designed a line of swimwear, which brought a sense of fashion to women worldwide who had suffered from breast cancer. She also was instrumental in changing the perception of compression therapy with the introduction of Measure to Fit off-the-shelf compression hosiery.” Donahue was an instructor for the Camp Institute of Applied Technology, training and teaching students the correct procedures for fitting post mastectomy, compression therapy, and orthotic soft goods. She retired from the industry in 2000; however, she continued to serve on the board of directors for O&P Design, Inc. in Dallas. “We are thankful to Linda S. Donahue for all the knowledge she contributed in the field of orthotics & prosthetics; for those of us who had the privilege of working with her we consider it an honor,” the statement continued. “This is an enormous loss for all who knew her, and we extend our deepest sympathies to her beloved husband, William J. Donahue, and family.”

John R. Hendrickson, 97 The first Otto Bock foreign branch was founded in Minneapolis back on February 21, 1958, and John R. Hendrickson was appointed vice president and CEO. According to a statement from Otto Bock, “finding the right person in the right place for the right job has always been part of the company philosophy as a guarantee for long-term success. With Hendrickson, Dr. Max Näder had found the best man: A competent expert and reliable partner. It was the start of productive cooperation and decades of friendship between men dedicated to their responsibilities. Hendrickson developed Otto Bock USA with vision and commitment. “On the 50th anniversary of Otto Bock USA in February 2008, Professor Hans Georg Näder, chairman and CEO of the Otto Bock Group, recognized the achievements of the founding generation and thanked them for their decades of dedication. As a special gesture of recognition, he presented Hendrickson with the feathered headdress of an honorary Indian chief. In his letter of condolence to the family, Professor Näder wrote about the occasion: ‘How wonderful that John was able to experience the 50th company anniversary last year, enjoying the tributes, appreciation, and ovations surrounding him with pride and emotion.’” As the first CEO of the Otto Bock branch in the USA, Hendrickson was one of the veterans of the Otto Bock company and made a major contribution to its global success.

Dr. Max Näder, 94 In 1935, Dr. Max Näder applied for a job with Otto Bock, who quickly recognized the young man’s talent and ambition, according to a company statement. Otto Bock gave him the opportunity to train as an orthopaedic technician and sales representative. In 1953, Otto Bock Kunststoff was founded, Näder established Otto Bock’s first foreign subsidiary in the United States, which laid the foundation for the internationalization of the company. Today, Otto Bock HealthCare has 40 sales and service locations around the globe and supplier contacts in more than 140 countries. In recognition of his achievements, Näder received an honorary doctorate from Berlin’s Technical University in June 1985. In 1994, Dr. Bernhard Vogel, then minister president of Thuringia, awarded him the

O&P ALMANAC SEPTEMBER 2009

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in the news

TRANSITIONS PEOPLE IN THE NEWS Thomas Bedsworth, CO, joins Hanger Prosthetics and Orthotics at its patient care facility in Corona, California. Bringing more than 25 years of experience, Bedsworth attended Cerritos College and El Camino College, and earned his orthotic certificate from the University of California. Michael Burton joined the Orthotic and Prosthetic Group of America as vice president, effective July 1. Burton has 30 years’ experience in the orthotic and prosthetic industry. He has held key roles as director of sales and marketing for O&P manufacturers and served as president of the Orthotic and Prosthetic Assistance Fund. Burton holds a bachelor of science degree in business administration from Chadwick University and currently serves on the AOPA National Assembly Advisory Committee and Exhibits Board.

UGA Researchers Move Toward Body-Powered Energy A team from the University of Georgia (UGA) has developed a successful way to grow molecular wire brushes that conduct electrical charges, a first step in developing biological fuel cells that could power prosthetic limbs and pacemakers. The process was developed by UGA chemist Jason Locklin, and graduate students Nicholas Marshall and Kyle Sontag. It’s difficult to harness a fuel source in the body, such as glucose, for use in biofuel cells that could replace the need for batteries in an implanted device. Humans have enzymes in the body that convert chemical energy into electrical energy, but “they aren’t very useful in this application because they have natural, protective insulating layers that prevent good electron transport from active site to electrode,” says Locklin. The team grew polymer brushes, made up of chains of thiophene and benzene attached to metal surfaces as ultra-thin films. The field dealing with assembling circuits by mounting electronic devices on thin films is known as “flexible electronics.” “The molecular wires are actually polymer chains that have been grown from a metal surface at very high density,” says Locklin, who has a joint appointment to UGA’s Franklin College of Arts and Sciences and its faculty of engineering. “The structure of the film resembles a toothbrush, where the chains of conjugated polymers are like the bristles. We call these types of coatings polymer brushes.” Flexible electronics is a large and growing field, but it is still in its infancy. ”We don’t yet understand the fundamental physics involved in how electrical charges move through organic materials,” says Locklin. His next step will be to develop appropriate applications. For example, his polymer brush technique might be used in a range of devices that interface with living tissue, such as biochemical sensors, prosthetic limbs, or pacemakers. For more information, visit www.uga.edu.

Dennis P. Cyr, RTP, is the new president and CEO of Mountainview Prosthetics Inc., a central fabrication facility in upstate New York. Cyr has more than 18 years’ experience as a technician and manager, most recently with Hanger Prosthetics and Orthotics. Audwin Harwell, CO, has joined Hanger Prosthetics and Orthotics as part of its Montgomery, Alabama, team. As an ABC-certified orthotist, Harwell brings more than 30 years of orthotic experience to his new position. Harwell earned his bachelor’s degree from Southern Illinois University. Mildred Mendez-Gonzalez is a new international customer service representative for PEL Supply. Mendez-Gonzalez, who joined PEL in 2008, was a returns specialist. She is bilingual, and will be working more closely with PEL’s Spanish-speaking customers in the United States and abroad. Mendez-Gonzalez also is featured in PEL’s current advertising program. Steven Metzger, CO, has joined Hanger Prosthetics at its Rapid City, South Dakota, patient care center. Metzger received his bachelor’s degree from Colorado Tech University and attended Northwestern University. Eric Ramcharran, CPO, has joined Hanger Prosthetics at its Tallahassee, Florida, patient care center. Ramcharran earned his bachelor’s degree and certificate in prosthetics & orthotics from the University of Texas Southwestern Medical Center.

O&P ALMANAC SEPTEMBER 2009

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in the news

TRANSITIONS

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PEOPLE IN THE NEWS

Supports Wounded Warriors Disabled veterans who had served in Iraq and Afghanistan were featured guests and golfers at the 2nd Annual Congressional Charity Golf Classic, hosted by the United States Association of Former Members of Congress. Held this past summer at the Army Navy Country Club in Arlington, Virginia, the event brought together more than 50 current and former members of Congress with veterans and their families for “scramble” format golf and other activities. Golf club manufacturer PING provided custommade clubs to the severely wounded who completed an eight-week course offered by Disabled Sports USA and the PGA under its Wounded Warrior Disabled Sports Project (WWDSP). The veterans also attended a practice clinic prior to the tournament. The tournament concluded with a silent auction. Hon. John J. Rhodes III, former member of Congress and president of the U.S. Association of Former Members of Congress, praised the WWDSP for its work to enable disabled veterans and their families to begin their healing

Greg Safko stepped down in August as president of the Board of Certification/Accreditation, International. He will become president of the Joanna M. Nicolay Melanoma Foundation, a non-profit public charity, founded in January 2004, after his mother-inlaw lost her struggle against melanoma. John Sytniak was recently named the Orthotic and Prosthetic Student of the Year at Eastern Michigan University (EMU) College of Health and Human Services. Sytniak graduated from EMU in April with a master’s degree in orthotics and prosthetics; he had received a BA in criminal justice and psychology from Michigan State University. At EMU, he completed clinical affiliations at Wolverine Orthotics, Novi, Michigan; ASC Orthotics and Prosthetics, Jackson, Michigan; and the University of Michigan Orthotic and Prosthetic Center, Ann Arbor, Michigan. Sytniak will continue his education during his orthotic residency at Wolverine Orthotics. process. All WWDSP activities of the project are provided free of charge to the veterans and their families. For more information, visit www.woundedwarriorproject. org or www.dsusa.org. a

O&P ALMANAC SEPTEMBER 2009

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reimbursement page

odifiers are an essential, but often overlooked, part of the Medicare claims processing system. I receive numerous calls from AOPA members who are frustrated because they have received an inordinate number of claim denials. A frequent reason is that they’ve omitted modifiers on their claims. Apart from getting claims approved, modifiers are important to include because they provide Medicare with a wealth of information about both the orthotics and prosthetics device being provided and the patient who is using it. Claim modifiers fall into several basic categories. This month, we’ll look at two categories used by O&P providers: directional and informational modifiers, and when they must be included on your claims, and when they should not be included. Next month, we’ll discuss functional and uncommon modifiers.

Directional Modifiers Directional modifiers are the most basic type of modifiers and are used to inform the claim processor where on the patient’s body the device has been fit. Only three directional modifiers are used by O&P providers: • LT to indicate that an item is being worn on the patient’s left side • RT to indicate that an item is being worn on the patient’s right side • LTRT to indicate that the patient is wearing the same device on both limbs.

By Joseph McTernan, AOPA government affairs department

Mastering Medicare Modifiers Modifiers provide a wealth of information about O&P devices and their users

informs Medicare that all policy requirements relative to your claim have been met and that any required documentation is on file in your records. Until recently, the only orthotics and prosthetics services that required providers to include the KX modifier on claims were diabetic shoes and orthopedic shoes attached to a brace. The requirement for the KX modifier was included in a recent revision to the Medicare AFO/KAFO policy as well as in the Medicare knee orthosis policy that went into effect on July 1, 2008. The KX modifier is now required to be added to all KO, AFO, and KAFO base and addition codes before Medicare will consider them for payment.

In most cases, when you provide the same service bilaterally, you will indicate two units of service and include the LTRT modifier.

Informational Modifiers By far the largest category of Medicare modifiers, informational modifiers provide information to the claim processor that is either required to pay the claim or that will ensure that the claim is paid correctly. KX modifier: The most commonly used informational modifier, KX

O&P ALMANAC SEPTEMBER 2009

It is important to note that when you include the KX modifier on your claim, you are attesting that everything required by policy is in place. For claims involving diabetic shoes, this includes a signed certifying statement from the physician treating the patient for diabetes. If you do not have all required documentation in your files or all policy requirements have not been met, the KX modifier should not be added to the codes on the claim form. You should expect the codes without the KX modifier to be denied as not medically necessary. GA modifier: The purpose of including a GA modifier is to inform the payer of two items: You expect

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O&P ALMANAC SEPTEMBER 2009

reimbursement page

the code in question to be denied as not medically necessary, and you have discussed the situation with the patient, who has signed an Advanced Beneficiary Notice (ABN). The ABN is used to notify the patient prior to providing the service that Medicare will most likely deny the claim as not medically necessary. By signing the ABN, the patient agrees to assume financial liability for the codes in question should Medicare deny the claim. Without a GA modifier, Medicare assumes that financial liability remains with the provider. Claims without a GA modifier that are denied for medical necessity will result in showing no patient responsibility on the Medicare Summary Notice. GY modifier: This modifier indicates that the code you are submitting is statutorily excluded from Medicare coverage, which means there is no Medicare benefit for the service. So, why would anyone submit a claim for a service that is not a Medicare benefit? The simple answer is that you may be required to submit a claim. Upon enrollment, Medicare providers agree to submit claims on behalf of Medicare beneficiaries if the beneficiary requests that you do so. Medicare beneficiaries are not usually permitted to submit claims to Medicare themselves, so it becomes the responsibility of the provider. While it is not mandatory to submit a claim to Medicare for a statutorily non-covered service, if the beneficiary requests that you do so, you are required by your provider agreement to comply. The most common reason why beneficiaries will request that you submit a claim is if they have secondary insurance that requires a Medicare denial before the claim will be considered. In this scenario, the claim would be submitted with a GY modifier, Medicare will deny the claim as non-covered, and the secondary insurance will then consider the claim for payment. Another reason why a beneficiary may request that you submit a claim is that the patient does not

believe that the service in question is not a Medicare benefit. The recently revised ABN form now includes a section that you may use to inform a patient that a particular service is not a covered benefit under Medicare. While the ABN form is used to provide this information to patients, it is not mandatory that you notify them that a service is statutorily excluded from coverage in order for them to be financially responsible for your charges. It is a good business practice and highly recommended, but it is different from using the ABN to inform a patient that Medicare may deny the claim for their service due to medical necessity. The GY modifier is commonly associated with claims involving orthopedic shoes that are not attached to a brace. These shoes are not a Medicare benefit but may be payable through a patient’s secondary insurer. Submitting a claim with a GY modifier will trigger a Medicare denial of the claim, thus releasing it for consideration by the secondary insurer. RA and RB modifiers: Just introduced on January 1, these two modifiers replace the “RP” modifier which, for many years, was used to indicate the replacement of an O&P device or replacement of a component of a device. While the RA and RB modifiers both indicate that a service is a replacement of one previously provided, there is confusion as to when to use RA or RB. The RA modifier is defined as “replacement of a DMEPOS item,” while the RB modifier is defined as “replacement of part of a DMEPOS item furnished as part of a repair.” After much research and debate, AOPA believes that the RA and RB modifiers should be taken at face value. Thus, if you are replacing an entire device such as an AFO, KAFO, a complete prosthesis, and so on, then any base and/or addition codes that were used to describe the original device should be submitted with the RA modifier. For example, when replacing a custom AFO with dorsiflexion assist joints on a patient’s left

O&P ALMANAC SEPTEMBER 2009

leg, and the replacement is necessary because the patient lost their original device, the proper way to code the replacement would be 1 x L1970 KXRALT and 2 x L2210 KXRALT. In this scenario, the KX modifier is added to indicate that the replacement of the AFO is not due to wear and tear within the five-year useful lifetime and that all required documentation is on file to support the claim. The RA modifier is included to indicate that the entire device is being replaced. Now, let’s assume that the entire AFO does not need to be replaced, but the patient took a hard step and the dorsiflexion assist joints snapped. In this scenario, the joints are irreparably damaged and must be replaced to make the AFO functional. The proper way to code the replacement of the joints is 2 x L2210 KXRBLT. In the scenario above, the joints are being replaced as part of a repair to the AFO that will return it to a functional state. Because you are not replacing the entire AFO, the RB modifier should be attached instead of the RA modifier. a Joe McTernan is AOPA’s director of reimbursement services. Reach him at jmcternan@AOPAnet.org.

Update to Last Month’s Column DMEPOS providers: Supplying diabetic shoes now negates your surety bond exemption, unless you only provide shoes as part of the provision of custom-made orthoses or prostheses (not including orthotic inserts). If you no longer meet the exemption criteria because of this, you should apply for a bond immediately: Deadline is October 2. Remember, if you are required to have a bond—but have not obtained one by the deadline—CMS will revoke your provider number, and you will not be allowed to reapply for at least one year. To avoid any possibility of this occurring, you should obtain a bond as soon as possible.

O&P ALMANAC SEPTEMBER 2009

BY ANYA MARTIN

The Value of

Responsible Business

FROM HUMANITARIAN SERVICE TO ECO-FRIENDLY OPERATIONS, CSR WORK INSPIRES EMPLOYEES AND CUSTOMERS

ine years ago, plastic surgeon Dr. Jeffrey Meilman asked Campanella Orthotics & Prosthetics, Inc., in Buffalo, New York, for assistance in fitting a 14-year-old Polish boy with a myoelectric prosthesis. The boy had been the victim of devastating injuries: His arm had been chewed off by wild dogs. Moved by the boy’s story, owners Alexander Campanella, CO, and his wife, Ursula, readily agreed to help. “When the boy left here, he was able to write his name with that arm, and we’re still in contact with him,” says Ursula Campanella. “We saw him about five years ago in Poland, and he had graduated high school.” The couple has not just treated foreign patients at their New York office but has also paid their own expenses, about $4,000 per trip, to travel once a year to a variety of foreign countries with the Hope for Tomorrow Foundation. Founded by Dr. Meilman, the organization recruits health-care professionals to treat patients around the world, including Poland, Nepal, Albania, Peru, Ecuador, Panama, and Nigeria.

“We do not get more patients or more recognition; the only thing we get is the pleasure of doing it,” says Ursula Campanella. “Maybe I’m selfish, but it gives you a good feeling when you do something good for someone else.” In the business world, that “good feeling” has been more formally identified as, corporate social responsibility (CSR): It’s when companies step forward to do the right thing such as helping those in need who are unable to pay for services. These days, it also means adopting new business practices such as eco-friendly operations that demonstrate concern for the environment by managing energy and material consumption. For some, CSR is still a buzzword. For many others, however, it’s a business imperative: 82 percent of companies reported that good corporate citizenship improves revenues in a 2004 survey by the Center for Corporate Citizenship at Boston University and the U.S. Chamber of Commerce Center for Corporate Citizenship. Forty percent of

O&P ALMANAC SEPTEMBER 2009

Americans say they are more likely to do business with a company that demonstrates responsible practices, according to a 2005 study by public relations firm Golin Harris. More and more O&P practitioners are focusing on CSR from participation in local and international humanitarian efforts to embracing ways to be more environmentally sustainable. Here’s how some of those practices are putting CSR to work and how their good work also means good business.

Beyond the Brand A company that practices CSR principally for recognition will not be viewed as sincere, but a firm also “should not feel uncomfortable about publicizing its accomplishments,” says Karen Lundquist, director of corporate communications and leader of the Stewardship Committee for Minneapolis-based Otto Bock HealthCare, a subsidiary of the global medical technology company headquartered in Duderstadt, Germany. Otto Bock engages in a wide variety of philanthropic and volunteer

efforts, starting in 1988 when it sent technician teams to the Paralympics, and continuing through the years, including doing relief work in various Asian countries following the 2004 Indian Ocean tsunami; transporting four children seriously injured in the 2004 Beslan hostage crisis to Germany for orthopedic treatment; and helping set-up orthopedic workshops in nations with poor medtech infrastructures such as Ukraine and Benin.

A firm “should not feel uncomfortable about publicizing its accomplishments.” ––Karen Lundquist

While Otto Bock is considerably larger than the average O&P practice with 4,000 employees and 38 branches worldwide, Lundquist believes that many aspects of its successful CSR program can be applied to businesses of any size. She says companies that formalize their CSR activities will be better positioned to make an impact on the communities they serve. For example, because resources and time are limited, in order to make the biggest impact, Otto Bock only supports causes related to O&P. ‘Quality of life’ is our tagline. We feel the things that we support are helping other people have a better quality of life,” she explains. Following the model of large corporations such as The Coca Cola Company, Starbucks, and IBM, Otto Bock publishes a corporate citizenship report outlining its history and company philosophy, and how it gives back to the community through the Otto Bock Foundation. The information helps to inform customers, but has a greater impact

on inspiring its employees and others professionals can now easily find in the O&P industry to take similar opportunities for both domestic actions. Lundquist says the report and global service by visiting the has a definite impact on recruiting Web site for the Digital Resource and retaining talent, especially Foundation for the Orthotics and younger employees. “Lots of people Prosthetics Community, www.drfop. in their 20s value volunteerism, and org. The nonprofit organization has an a company’s philosophy on how it extensive database listing nonprofit is giving back is important to them,” organizations that need O&P services she explains. and supplies. In 2001, the company founded a The advantage of working with Stewardship Committee, composed an established organization is that it of employees from different sectors of makes all travel arrangements either the business and including a C-level for a patient to come to the United executive, Brad Ruhl, vice president States, or for health-care professionals of technical orthopedics and mobility to visit other countries, Campanella solutions, to evaluate projects and says. It obtains governmental permisensure follow-through. Having that sions and interfaces with hospitals executive buy-in and support makes and clinics to alert local doctors and all the difference. patients when the medical profes“As an executive, I can make sure sionals will arrive. that the link to our company mission “People walk for miles because is clear,” Ruhl says. “The process is they know the Americans are more than just a PR exercise or a sales coming,” she adds. “When you giveaway; it’s part of who we are as arrive, you see the look on their an organization.” faces. They don’t complain. They just Volunteer activities also enable say ‘help us.’” Otto Bock employees to hone skills such as leadership, team building, and project manage“The process is ment. Cookouts, which more than just a PR raise about $10,000 annually to send chilexercise…it’s part of dren to the Amputee who we are as an Coalition of America organization.” Youth Camps, are run by employees at local offices. During the Para––Brad Ruhl lympics, participating employees also interact with staff and members of the local The Campanellas also frequently rehabilitation community in various contact other O&P suppliers and locations. These connections also are practitioners to ask for donations of useful for Otto Bock’s business expanany unused braces, corsets, prosthetic sion to areas like the underserved components, splints, socks, and other O&P market in China. materials. They store the equipment “A lot of it is putting a face on the in their garage and may take up to company—building relationships and $20,000 worth of items on a typical connections,” Lundquist says. trip to give to local doctors, she says. David M. Puckett, CPO, president/owner of Savannah, Motivated by Service Georgia-based Positive Image Campanella O&P got involved Prosthetics and Orthotics (PIPO), in international community service Inc., specifically started his practhanks to a chance contact from a tice so he could give back to others. local medical colleague. But O&P

O&P ALMANAC SEPTEMBER 2009

His personal passion for helping the impoverished in Mexico clearly drives his success. At age 18, Puckett’s life was transformed by a six-week mission trip to the Yucatan Peninsula to help impoverished Mayan villagers rebuild some homes and a church. “I had just graduated high school and was recovering from the death of my father,” he says. “I knew at that point that I would be called to return some day and make a difference if I could.” Years later, while driving home after finishing an O&P program at the University of Minnesota, he had his next epiphany. “It dawned on me like a divine revelation that [O&P] is the way in which I can bridge the gap between what I want to do and what I am qualified to do to help the less fortunate in Mexico,” he says. For the next dozen years, Puckett learned how to run an O&P practice working for other companies, but he soon realized that to have the flexibility to take time off for travel and launch his own nonprofit, he would need to open his own practice. In

1999, he left a six-figure job to start his practice, earning a mere $7,000 in his first year. “I had a business degree and had managed a business, but I had no handbook on starting a new nonprofit organization that reached out to an unreached area,” he says.

to the United States to custom-craft needed limbs and braces, and return for fittings. “They said, ‘We’ll organize a few patients tomorrow and you can come see them,’” he recalls. “I showed up the next morning at 7:30, and 100 people were in line.”

“Maybe I’m selfish, but it gives you a good feeling when you do something good for someone else.” ––Ursula Campanella

Within six months, Puckett traveled to the Yucatan on his first mission trip. On the first night, he met with doctors, nurses, and therapists at a small clinic outside Merida, explaining how he would work with patients in the village, then go back

Puckett stayed until about 11 p.m. to tend to all the patients, and that experience fueled his commitment. He returned home and developed a program that has since resulted in nearly 55 trips and involved other O&P practitioners and doctors.

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Puckett received a nomination as a Top 10 CNN Hero last year and now hopes to build a permanent medical facility in Chiapas with operating rooms, recovery rooms, and a full O&P lab to fabricate prostheses on

“I develop a strategy and stick to it, but you can’t go down there with a 9 to 5 American mindset.”

ood Deeds, Better Business

––David M. Puckett

Want to make the most of your facility’s CSR program? Marketing consultant Paul Jones offers these tips: • Decide your size. The United States has more than one million nonprofit charities, which are dominated by a few thousand giant causes. But your best match may be with a smaller more nimble charity. So decide first. Do you want to be a minnow or a whale? • Trust but verify. Sponsorship is a partnership. So do the same kind of due diligence you would before entering any partnership. Because of nonprofit reporting rules, it’s easy to check if charities are efficient. Read their tax returns at Guidestar.org. Another key indicator: How long have they been in existence? • Make it make sense for your customers. A logical connection between your business and the cause you’re supporting has to be evident to your customers. If it’s not, customer support will lag. • Promote the relationship. If it’s uncomfortable to promote your social responsibility endeavors or philanthropic work, make the focus of any promotion about the cause instead. The cause you support certainly needs more help than you alone can provide, and your good deeds—properly publicized—will hold your competitors’ feet to the fire and encourage them to do the same. • Make the investment. Cause marketing can be cheaper than other marketing promotions, but it isn’t without cost. Be prepared to spend time and/or money promoting your relationship. Properly developed, cause marketing lends itself to inexpensive word of mouth marketing, which is every small business person’s friend. Paul Jones is owner of Alden Keene & Associates, Inc., a marketing and communications firm in Salt Lake City that specializes in cause marketing and corporate social responsibility for businesses and nonprofits. Reach him at aldenkeene@gmail.com.

O&P ALMANAC SEPTEMBER 2009

site and eliminate the weeks and months that patients must now wait to be fitted. The facility also would provide accommodations for medical staff from the United States and other countries who continue to treat patients and teach O&P techniques to local staff. While the CNN award has opened some doors, Puckett says he still has many challenges—but no regrets. He has received a few large donations, but people have generally been more eager to give in-kind contributions. He continues to self-finance much of his work. Providing medical assistance in underdeveloped nations also requires a great deal of flexibility. “Suitcases or patients might not show up,” he says. “I develop a strategy and stick to it as closely as possible, but you can’t go down with a 9 to 5 American mindset.” And to remind himself to learn from his difficulties, Puckett keeps a journal entitled “Mexico: Medicine, Missions and Miracles.”

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Giving Back by Going Green For a growing number of O&P practices, adopting eco-friendly practices are proving to be both environmentally—and economically—sound. Grace Prosthetic Fabrication in New Port Richey, Florida, is a full-service central fabrication manufacturer of custom O&P devices. About a year ago, Office Manager Cheryl Kelly suggested that e-mailing invoices as PDF files rather than postal-mailing hard copies would save paper and money, as well as reduce staff time. Today, 40 percent of customers have signed onto paperless billing, and the company saved $500 in postage in 2008. The process also has cut down on phone calls from customers who are checking on the status of their invoice, Kelly says.

it’s coming—whether by ground or next-day air—so they can plan the patient visit. This also helps them with insurance billing. They get paid sooner—which means we get paid sooner, too. In this economy, every dollar you shave off helps.” Kelly hopes to further expand the program to include online payments, but she says that most businesses still seem to prefer paper checks. The company also is experimenting with recycling and with replacing light bulbs with compact fluorescent alternatives. “It’s baby steps, and a lot of it is research, finding out what you can do better to help your business and the environment,” Kelly says. “Often, you have to read a bunch of Web sites because they contradict each other. Everyone has an opinion about going green and the best way to do it. You

“Everyone has an opinion about going green. You have to find what works best for your company.” ––Cheryl Kelly

To encourage participation, the company named the program “Help Grace Go Green” and offers $20 off the first e-invoice order. Grace invites practices to join the program in every month’s newsletter and also promotes the effort through information packets handed out at trade shows, Facebook comments, blog postings, and invoices that it continues to mail. An option to join is featured on every credit application. “We tell people that we ship at the end of the day, and as soon as we get through, we can generate an invoice,” Kelly says. “If a customer is on the e-mail list, we can let them know immediately what’s coming and how

have to find what works best for your company.” New England Brace Company in Manchester, New Hampshire, has made a serious commitment to sustainability. When the practice’s long-term headquarters in a 100-year-old building required significant maintenance, the firm decided instead to design and construct a completely new office with energy-efficient features and systems, says Karen Acton, general manager. The company turned to architects and contractors experienced in Leadership in Energy and Environmental Design (LEED) certification, a sustainability stan-

O&P ALMANAC SEPTEMBER 2009

dard developed by the United States Green Building Council. They incorporated many LEED concepts into the new facility, such as nontoxic insulation installed for optimum energy savings, energy-efficient heating and cooling systems, compact fluorescent lights, and plenty of large windows strategically placed for maximum sunlight. (New England Brace decided not to pursue LEED certification due to additional costs for documentation.) “Half the time, I never turn the lights on because it’s bright enough in here without them,” Acton says. She adds that the company has already reduced energy costs by 40 percent since moving to the new building in March 2009. Recycled rubber flooring, which was reasonably priced, also is more comfortable than hard floors for technicians who stand on their feet all day, she adds. Network improvements in the new building will allow the practice to further reduce its carbon footprint by scheduling video conferences for meetings among its eight offices in New Hampshire and one Maine satellite. And like Grace, the firm now recycles as much as possible. “What I’ve learned is not to be afraid to look into things,” Acton says. “A lot of times we think these things are cost-prohibitive, but you can find ways to make it worthwhile and the long-term investment is really worth it.” a Anya Martin is a contributing writer for O&P Almanac. Reach her at anya99@mindspring.com.

O&P ALMANAC SEPTEMBER 2009

The

Single Life One-person O&P practices balance more control with long hours

BY DEBORAH CONN

or the past few decades, the trend in orthotics and prosthetics has been toward larger firms and practices. Small shops have been disappearing as major O&P companies expanded

their reach. But solo practitioners have not yet completely vanished. A number of O&P professionals are working on their ownâ&#x20AC;&#x201D;some by choice, others as the result of unexpected change. Running a one-person business can start a new career or be the culmination of lifelong work. Regardless of how they got there, solo practitioners stress that running a small and successful business takes dedication, plenty of stamina, and smart thinking. 26

O&P ALMANAC SEPTEMBER 2009

HOW TO GO IT ALONE • SUCCESSFULLY • If you’re thinking of starting your own one-person practice, first consider this advice from the experts:

• When setting up your practice, avoid becoming a sole proprietorship. According to Thomas F. Fise, JD, in a sole proprietorship, your personal assets can be tapped to settle your business debts. Even if you work alone, he advises, you can—and should—incorporate your practice and limit your liability. Also be sure to carry adequate coverage for life and disability insurance. • Get active in professional organizations. Working with the American

Solo or Supported? An O&P practice involves a range of business and professional functions, from fitting, fabrication, and coding to billing, marketing, and scheduling. It’s more than even the most skilled solo practitioner can handle alone, so full- or part-time administrative help is typical. And for many one-person businesses, a good source for welcome help is often along the family tree. It’s not uncommon for the practitioner to rely on a spouse or another relative to handle bookkeeping, patient billing, insurance claims, and more. Harry Layton, CPO, LPO, of Lawton Brace & Limb Co., in Lawton, Oklahoma, employs his mother as a secretary. Family connections are familiar for Layton, who is a thirdgeneration practitioner; like many who run their own facilities, he grew up in the business, alongside his father and grandfather. Fabrication is a complex and therefore time-consuming aspect of any O&P business. Solo practitioners say it’s important to weigh how—and who—can most effectively handle this work.

Board for Certification in Orthotics and Prosthetics (ABC) connected Brett Saunders, CPO, to other professionals. “They have provided sage advice and a limitless base of knowledge,” he says. • Form alliances with other O&P facilities. Frank Horvath, BOCP, LP, sends patients who need orthotics to a fellow CO, who, in turn, refers prosthetic patients to Horvath. • Take the long view. Before taking the leap into solo work, look at the big picture over time, advises Richard Jesteadt, CPO. “Think it through. Have a plan for how all responsibilities will be handled,” he says. “For many of us, going into business ended up being a lot more challenging than we anticipated. Once you invest so much time and money and experience, it’s hard to change your path again.” • Be prepared, not complaisant. If you are leaving a larger practice to set up shop on your own, be prepared for the administrative work. “You have probably had the luxury of others handling large amounts of paperwork,” says Harry Layton, CPO, LPO. “And you probably weren’t even aware of much of it.” “Never allow yourself to get comfortable with what you do,” Layton continues. “That can easily happen without colleagues to measure yourself against. Challenge yourself to constantly improve. Go to state, regional, and national meetings; stay in touch with others in the field; write and submit papers. Be accountable for what you do and find your way to give back to the profession that has given you so much.”

O&P ALMANAC SEPTEMBER 2009

Carey Glass, CPO, FAAOP, of C.G. Medical Inc., in North Brunswick, New Jersey, does his own fabrication work. He says he can maintain better control over his costs and get the job done more quickly.

Joel Kempfer, CP, FAAOP

James Fenton, CPO, LPO, of Fenton Orthotics & Prosthetics in Miami, uses an outside source for fabrication for nearly everything. “I still have some equipment to make adjustments, but I make less than one tenth of one percent of what I do,” he says. Outsourcing fabrication work allows Fenton to instead maintain the volume of business he needs to succeed. “Some people say that ‘central fab’ is more expensive than doing it in-house,” says Joel Kempfer, CP, FAAOP, president of Kempfer Prosthetics Orthotics Inc., in Greenfield, Wisconsin. “But when you consider how much you’d pay a technician, including benefits, vacations, and health insurance, versus outsourcing, I think it’s more economical to ‘central fab’ things. Plus, you don’t pay for the technician’s mistakes.”

Michael Moor, CPO

Marketing is another critical area for solo practitioners to manage, though the need for self-promotion can vary. Michael Moor, CPO, of Michael Moor Prosthetics Orthotics LLC, in Portland, Oregon, spent more time on marketing when he launched his private practice four years ago.

His efforts involved activities like lunchtime presentations in doctors’ offices where he provided the food, described his services, and emphasized his willingness to make house calls. Since then, Moor has joined a network of small practices that are on an insurer’s referral list, which generates a steady stream of business. Not everyone needs or even wants to increase their volume of business. “I don’t market,” says Kempfer. “If you market, you get more business, and then you have to work harder. I’m happy with the level of business we have.” “I haven’t had to market [my practice] in a long time,” agrees Dave Janke, CPO, C.Ped, FAAOP, who owns Columbia Prosthetics and Orthotics, also in Portland. He relies on longtime referral sources, including physicians, insurance companies, and rehabilitation centers.

Pete Goller, CP

When work is slow, Pete Goller, CP, of Metro Prosthetics, Inc., in Landover Hills, Maryland, says he can step up his marketing efforts. He visits physician offices, rehabilitation centers, and nursing homes to meet with therapists. He introduces himself and his practice, describes the latest components and procedures, and leaves behind brochures, mugs, and tote bags that advertise his services. Given the wide array of marketing strategies and tactics available today, solo practitioners can choose from a wide menu of solutions, including Web site marketing, running ads in the local telephone directory, sponsoring local athletic teams, or supporting charity events.

O&P ALMANAC SEPTEMBER 2009

More Control, Less Stress With all that needs to be done, why do O&P practitioners choose to work alone? Overwhelmingly, the answer is the ability to be in control— of the number of work hours, the type and quality of work, and even the kind of patients they see.

Dave Janke, CPO, C.Ped, FAAOP

“When you work for someone else, you have to go by their bottom line,” says Moor. “I can take extra time with patients, be creative, and design something if I need to. I’m not bound by someone else’s way of looking at things.” This also makes sense to Brett Saunders, CPO, of Saunders Prosthetics & Orthotics Group, LLC, in Lady Lake, Florida. “I like the freedom to devote attention to my clients in a way that I cannot do in a big practice,” he explains. “I can spend a half hour or an hour with a patient who needs the time. You can’t do that when you have to answer to investors or Wall Street. I know it makes a big difference in their lives and in mine, too. And it’s also good for business.”

Brett Saunders, CPO

Fenton says that working alone means meeting his own expectations. “I don’t have to oversee the work of a half dozen people to make sure things are getting done, and I don’t have to worry about someone else making a mistake that I have to clean up. I am truly my own person. If things are

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slow, I can comfortably close the door and go home. If it’s busy, I do what I have to do.” For Janke, working on his own is “less aggravating” than managing others. He once owned multiple offices, but as leases expired and staff moved on, he didn’t replace them. As his business grew smaller, so did his stress levels. “I can always trust myself,” he says. Being a single practitioner allows Fenton to be selective about which patients he will treat, and that often depends on their level of insurance coverage. The majority of his patients are covered by insurers that provide an “acceptable level” of reimbursement. Insurers with higher reimbursements tend to pay more slowly; Fenton accepts some discounted insurers to maintain his cash flow, but he is careful about the mix. “If I had more employees, I’d have to have the cash flow to pay them,” he says. “This way, I do a good job for people, and I’m paid commensurate to my work.”

Harry Layton, CPO, LPO

Richard Jesteadt, CPO, of Popps Prosthetics in Lake Park, Florida, says that a one-person practice also offers variety. “When you’re smaller, with low volume, you don’t have to do the same tasks over and over, because you’re doing everything,” he says. “It keeps my day diversified, and I am more knowledgeable on all aspects of the business.”

Long Hours, Few Jokes Pluses do have downsides, however. For most solo practitioners, the flip side of having no one to answer to is having no one to cover you when you’re away. Vacations that last more than a few days are rare, and sick days are a luxury.

Frank Horvath, BOCP, LP, who runs Horvath Medical Supply in Concord, Ohio, severely injured two fingers in an accident a few years ago. “I had to work for two months using only my right hand,” he says. “With no backup, you can’t get sick.”

Frank Horvath, BOCP, LP

Some practitioners have been able to design contingency plans and work out coverage with another facility. In Portland, Janke and Moor will cover phone calls when the other is out of town, but it’s not always easy to find this kind of reliable backup. “It’s tough,” says Goller. “When I go away for a week, I let my patients know I’m leaving, and I have friends in the field who can help in an emergency. But when you’re gone, there’s no public relations getting done, no fabrication––everything stops." Long hours are another drawback and a reality. Nearly every practitioner cited in this article works 50 to 80 hours a week. For the most part, while they can control how they put in those hours, they admit that being responsible for every aspect of the business simply requires a lot of time and work. Layton feels there's never enough time to get all the work done. "The bottom line is that more people want my services than I can take care of. There are not enough hours in the day." Nevertheless, to ensure that the work meets his exacting standards, Layton says he still prefers to practice alone. Some practitioners admit to feeling somewhat isolated. While a colleague may be just a phone call away, it's not the same as having someone in the next room. "I miss the camaraderie," says Goller. "There's no one to joke with or discuss things with. You're here by yourself."

O&P ALMANAC SEPTEMBER 2009

Long hours and few vacations also can easily lead to burnout. "I carry my work home in my head seven days a week," says Horvath. "I think about it when I wake up in the morning until I go to sleep at night. And I spend Saturdays and Sundays documenting L-codes and catching up on progress notes." To manage stress and avoid burnout, many sole practitioners say they’ve developed their own coping strategies. Jesteadt and Horvath, for example, make sure that exercise is part of their routine, and Janke tends a large vegetable garden. Horvath also devotes time to other pursuits, such as marketing the children's books he and his wife have written, which feature animal characters that need prosthetic arms and legs.

Carey Glass, CPO, FAAOP

Moor says he is counting on a new computer system and increased efficiencies to reduce his workload and stress. Carey Glass, an observant Jew, closes early on Fridays to celebrate the Sabbath and does not work on Saturdays unless a hospital emergency arises. "I get to eat with my family on Friday and Saturday," he says. "I don't do anything having to do with work. Things get calmed down that way." For some practitioners, working alone can simply be an interim step. Saunders, for example, started his first small practice in 1994 and then sold it to NovaCare three years later. As for his current business, he says, "I don't expect it to stay small. I may grow it, or I may sell it if the right buyer comes along." a Anya Martin is a contributing writer for O&P Almanac. Reach her at anya99@ mindspring.com.

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DAILY DANGERS

Keeping facilities safe means awareness of environmental risks affecting owners, staff, and patients

or smart businesses, workplace safety means taking appropriate steps to ensure that your employees are protected from risks, hazards, and dangers while doing their jobs. But, today, it also means making certain that patients who visit your facilities, along with your staff, can count on an environment that’s protected against the spread of often unseen dangers, such as mold, mildew, and pathogens. O&P Almanac recently contacted Fillauer Clinical Educator John F. Schulte, CPO, FAAOP, for tips to help practitioners better understand these hidden dangers—and learn ways to prevent their spread to protect both patients and staff.

What is a “dangerous pathogen”?

Where do we find most of these pathogens?

SCHULTE: According to Zone Master (Far East) Pte Ltd, an international firm that distributes and manufactures heating, ventilation, and air-conditioning equipment, and studies internal environments, a pathogen is any microorganism —microscopic organisms such as bacteria, fungi, and viruses—that directly causes disease, or any microbial agent of respiratory irritation. This includes allergens. Pathogens can be either bloodborne or airborne. Respiratory pathogens are either communicable, non-communicable, or primarily nosocomial. Communicable pathogens transmit diseases mainly from human to human, which means they are contagious. Non-communicable or non-contagious pathogens are found mainly in the environment around us. Both types cause disease in humans. The third type of respiratory pathogen is primarily nosocomial, which is any disease contracted by a patient while under medical care and typically means “hospital-acquired.” These pathogens are not usually a threat to most of us, but will cause opportunistic infections in someone whose health or immune system is compromised.

SCHULTE: Most communicable human pathogens have evolved to the point that it is difficult or impossible for them to survive in the external environment for any length of time. Non-contagious pathogens, on the other hand, are able to exist outside the human body. Of these, spores are the most resilient, surviving even in direct sunlight. You are likely to find spores germinating in areas of your house such as damp basements, drain pans, and refrigerator coils. Once present, they will grow and multiply unless removed or destroyed. If left alone, they can generate internally to the point where the spore levels inside the building actually exceed the levels outside. How do these pathogens spread to humans? SCHULTE: All three types of pathogens (communicable, noncommunicable, and nosocomial) have the ability to be airborne, as can some non-respiratory pathogens. Non-communicable pathogens, like mold and fungi, can become airborne through spores and dust. Those that are contagious to humans can be sneezed or coughed into the air and

O&P ALMANAC SEPTEMBER 2009

remain there in tiny droplets. To further explain how simple germs and pathogens can be spread, consider this report from Infection Control Today magazine: Droplets are generally spread within three feet of an infected patient, so “most of the risk to those of us who care for patients comes in that immediate environment, where you get into the breathing zone of the patient. Or you put the patient in your breathing zone if you have influenza, and the more time you spend in that zone, the more likely transmission is to occur. That’s why we use both engineering controls and personal protective gear.”

What kinds of pathogens and infections can practioners be exposed to in their daily practices? SCHULTE: Many infections can be transmitted through contact with blood or bodily fluids, including hepatitis A, B, and C, HIV, staph and strep infections, gastroenteritis salmonella, shingella, pneumonia, syphilis, tuberculosis, malaria, measles, chicken pox, herpes, urinary tract infections, and blood infections. (Continued on page 34)

Careful Planning Reduces Office Risks

Every office should develop and ensure regular implementation of a safety a plan that addresses these key topics and questions:

Management of sharps • How should sharps containers be handled? • Where should sharps containers be located? • What type of container should be purchased to dispose of sharps?

Disposal of regulated waste • What is our procedure for disposal of regulated waste?

Communication of hazards to employees • • • •

When are labels required? What are the required colors for labels? Can there be substitutes for the labels? What are the exceptions to the labeling requirement? • Does OSHA accept Department of Transportation (DOT) labels for waste and specimens to be shipped or transported?

Training • Which employees must be trained in workplace safety? • Should part-time and temporary employees be trained? • Who has the responsibility for training workers employed by agencies that provide personnel (e.g., nurses) to other employers? • What are the qualifications that a person must possess in order to conduct employee training regarding bloodborne pathogens? • Where can information be obtained for conducting training on OSHA’s Bloodborne Pathogens Standard, and who can conduct this training?

What types of precautions can practioners take to better protect staff and patients? SCHULTE: Protective gear should be used constantly throughout your daily office routines. For example, be sure to wear proper eye protection such as glasses or eye shields as need as well as sterile or non-sterile, latex or nitrile gloves. For respiratory protection, a simple dust mask or respirator—depending on environmental concerns—will do. Equally important is to wash your hands after encountering each patient, using the restroom, handling previously worn devices, and before and after eating. Every office also should have an office management plan in place to address these and other hazards (see sidebar). What are some best practices for safe patient visits? SCHULTE: There are routine practices that every office should implement to protect patients from cross-contamination and spread of infections. This scenario is considered a sound health-care business practice: Jane Smith arrives at your office carrying her plastic solid ankle foot orthosis (AFO). Jane places the device on the counter and informs the receptionist that the AFO has rubbed a sore on her ankle and that her physical therapist has marked the spot to be relieved. The receptionist calls the O&P practitioner to the front to speak with the patient. When the practitioner arrives, he puts on latex gloves and examines the area to be relieved. He then places the device in a red plastic bag, and after sealing, labels the bag with the patient’s name or number. The receptionist (or designated front-office safety person) dons latex gloves and sprays the counter with Cidex Solution (or another type of disinfectant) to neutralize any 34

O&P ALMANAC SEPTEMBER 2009

possible contamination. The practitioner carries the sealed bag to the lab and discusses the needed changes to the device with the technician. Before opening the bag and starting any modifications, the lab technician should put on protective equipment, which includes: protective glasses worn when using tools or equipment; a particle mask or respirator; disposable lab coat or smock and gloves; latex or nitrile gloves for sharps protection. When ready, the technician may decontaminate the device with Cidex or another appropriate sanitizing solution. The technician then uses the heat gun to make the required changes to the device and does so in a wellventilated space. (When grinding or heating plastics or commonly used materials in O&P, pathogens can be released into the air and/or deposited on clothing, lab surfaces, or even other devices within your facility). After completing the work, the technician then returns the device to an appropriate container that is properly labeled with what is contained within, along with the patient’s name or number, and takes it to the designated area to be picked up. a EDITOR’S NOTE: John F. Schulte, CPO, FAAOP, is a clinical educator with the Fillauer Companies in Chattanooga, Tennessee, where he presents educational programs and workshops to raise awareness about protection from bloodborne pathogens. He has recently authored a series of board review and study guides specifically for the O&P industry, including a bloodborne pathogens educational program. Schulte, along with Don Pierson, CO, C.Ped, and Ruediger Gerstemeier will be presenting more on workplace safety during their session at the AOPA National Assembly September 20-23. For more information, visit www.aopanet.org.

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n Ask The Expert

Staying Secure and Compliant Changes to HIPAAâ&#x20AC;&#x2122;s security and privacy rules on the horizon By Devon Bernard, AOPA government affairs department

he Health Insurance Portability and Accountability Act (HIPAA) has

not seen many changes since it was introduced in 1996. That is about to change. The following is the first of many resources that AOPA will provide to its membership to ensure that youâ&#x20AC;&#x2122;re updated on the coming changes to the HIPAA regulations.

Q: When were the changes to HIPAA announced?

A: The changes to HIPAA were

mandated in the American Recovery and Reinvestment Act (ARRA). This legislation was signed into law on February 17, 2009, by President Obama. The ARRA, under Subtitle D, directed the Secretary of Health and Human Services (HHS) to amend the security and privacy rules outlined in HIPAA.

years. At this time, the only new rules that are active are the increased amounts for civil monetary penalties, and they are structured into three categories: no knowledge, reasonable cause, and willful neglect. By September, the new regulations on how to handle breaches of protective health information (PHI) may be in effect, too.

Q: How must we handle unsecured breaches of PHI?

Q: When will the changes go into A: If the information of an indieffect?

A: No specific date has been set.

The revised provisions will be phased in over the next couple months and

vidual is breached, you must notify that individual within 60 days of learning about the breach. You also will have to keep a log of all breaches and submit a copy of all breaches to HHS annually. If a breach includes 500 people or more, you must notify the individuals, and you must also notify HHS immediately. HHS is scheduled to release its regulations for breaches of PHI in August 2009, and they will become effective 30 days after their release. Keep an eye out for AOPA In Advance articles regarding this topic. We will provide you with up-to-date information about any changes in breach notification protocol.

Q: What is the biggest change

to HIPAA in regard to privacy and security rules?

A: The biggest change is that the

new HIPAA standards will not only apply to your organization but also to business associates (BA) such as clearinghouses or billing companies that you may use. The new HIPAA will

O&P ALMANAC SEPTEMBER 2009

define a BA as any organization that provides a data transmission of PHI to a covered entity. Your company is considered a covered entity, under the current HIPAA regulations, because you are a health-care provider. This means that your billing company most also meet all HIPAA requirements, including notifying you and HHS of any breaches of PHI. You also will have to create a new agreement between your firm and any BAs to ensure that they have policies in place to protect your patientâ&#x20AC;&#x2122;s information and also have a procedure in place to notify you of any breaches. The new guidelines also will make individuals responsible for any breaches of information. So, if an employee violates the HIPAA statutes, even if they are not considered a covered entity, they may be held responsible.

Q: Are there any other HIPAA-

related changes I should be aware of?

A: Yes. Under the Administra-

tive Simplification Act (ASCA), all HIPAA-covered entities, with some exemptions, were required to submit claims electronically. Currently, claims are submitted using X12 version 4010A1; you will now need to convert to X12 version 5010. Mandatory use of the new version will not begin until 2012. But, you may want to begin talking with your software vendor now to find out when the vendor will be making the transition. One key factor of the new claim format is that you will be able to use the new ICD-10 codes, not yet released.

Q: How else may I learn about the upcoming changes to HIPAA?

O&P ALMANAC SEPTEMBER 2009

A: Beside the information that

AOPA will be providing in future articles and via audio conferences, AARA has mandated that HHS must establish an education officer at each of its regional offices. This education officer will be responsible for providing guidance about changes to any entity covered under HIPAA. Also, AARA has directed the Office of Civil Rights to establish a national education program. Keep an eye out for future O&P Almanac articles, AOPA In Advance articles, and AOPAversity audio conferences to learn more about future changes to the HIPAA regulations. a Devon Bernard is reimbursement services coordinator for AOPA. Reach him at dbernard@ AOPANet.org.

AOPA HEADLINES

THE AOPA NATIONAL ASSEMBLY:

You Can Still Plan To Attend!

he 2009 AOPA National Assembly will take place September 20-23, 2009, in Seattle. If you haven’t yet made plans to attend, you can still register on site at the Washington State Convention and Trade Center (WSCTC), 800 Convention Place. This year’s Assembly is packed with first-rate clinical and business education. Also, as the first-ever in Seattle, this Assembly will feature distinctive special events that make the most of the location: the Taste of

Seattle Welcome Reception featuring local beer and wine, and the Trulife/ AOPA Sunset Space Needle Reception, which will be held at Seattle’s iconic landmark. And you can count on the AOPA Assembly for the largest O&P Exhibit Hall in the country. Come for a day or come to stay. Online registration has closed, but on-site registrations will still be accepted at the registration desk at WSCTC. See you in Seattle!

he final 2009 Mastering Medicare: Advanced Coding & Billing Techniques seminar will be held November 16-17 at the Mandalay Bay Hotel & Casino in Las

Vegas. At this seminar, both practitioners and billing staff will be able to discuss their toughest coding questions with AOPA’s coding and billing experts, members of the AOPA Coding and Reimbursement Committee, and their colleagues. The afternoon session of the first day is devoted to breakout sessions, one for practitioners and one for billing staff, where each can address its own issues and questions. This seminar is an invaluable resource for anyone who works with Medicare coding and/or billing. Register by October 17 and save $25 per registration; member registration cost is just $525. For two or more registrations from the same office, save $50 on the second (and on each additional) registration. For more information, please contact Erin Kennedy at 571/ 431-0876 or ekennedy@AOPAnet.org.

O&P ALMANAC SEPTEMBER 2009

AOPA headlines

CORRECTION

Billing for Repairs/Replacements and Adjustments: REGISTER NOW AOPA’s next audio conference, Billing for Repairs/Replacements and Adjustments, will be held on Wednesday, September 16, from 1 p.m. – 2 p.m. EDT. During this informative call, participants will learn: • the difference between billing for a repair versus a replacement • Medicare coverage guidelines for replacements and repairs • how to distinguish between the new RA and RB modifiers • strategies to get repair and replacement claims paid the first time • how to document the need for repairs and replacements • when it is better to replace or repair an item. This audio conference has been approved for 1.5 CE credits by both the American Board for Certification in Orthotics, Prosthetics and Pedorthics and the Board for Orthotist/Prosthetist Certification. Those seeking credit should complete and return the provided quiz within 30 days and must score 80 percent or better to receive credit. Any number of listeners may participate at each location. The cost to participate is $99 per line for members ($199 for non-members). Download the registration form at www.AOPAnet.org. Or, for more information, contact Erin Kennedy at 571/431-0876 or ekennedy@AOPAnet.org. E-7161-409:E-7161-409

5/1/09

8:56 AM

The exhibitor listing that was featured in the August issue of the O&P Almanac included an error on page 35. Unfortunately, Anatomical Concepts Inc. was listed as non-member, when in fact this company has been a solid contributor, supporter, and member of AOPA for many years. AOPA and the O&P Almanac sincerely apologize for this troublesome typographical error, and thank Anatomical Concepts, Inc. for its longstanding and continued support as an AOPA member.

Page 1

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AOPA headlines

AOPA WORKING FOR YOU

AOPA National Assembly––No Better Way

ow many practitioners do you know who haven’t missed a National Assembly gathering in years? One AOPA member said he has missed only one in 20 years. Clearly, he knows that recharging his batteries with professional development is critical to consistently high performance. In addition to providing cutting-edge professional development, the National Assembly is the once-a-year opportunity to see AOPA in action and working for you. Here are just a few things you can’t miss during AOPA’s 92nd National Assembly in Seattle, September 20-23.

Into the Future,” which showcased the 11 strategic initiatives gleaned from the 2007 member survey. Find out how these initiatives are being implemented and how they are impacting your business and the O&P business today. Then, in the session “Ideal Office of the Future,” enjoy an in-depth look at the one initiative that can deeply affect how you conduct patient care day to day and how you use care-extenders in directing patient care.

Cutting-Edge Clinical Advice Interspersed throughout the four days, 14 clinical PhDs, MDs, and PEs with credentials from the most prestigious global centers of learning in sports medicine, physical therapy, bio-medical engineering, orthopedic surgery, orthopaedic traumatology, prosthetics, and spine surgery, will bring you the latest best practices in all of these areas. Clinical education begins on Monday with the awardwinning Thranhardt lecturers with two “best of the best” presentations. Fifteen clinical programs covering some of the most vexing practitioner treatment challenges provide cutting-edge information you’ll take home to your practice. Tuesday’s clinical programs introduce “Treatment Options Using the Van Ness Procedure” and the three experts who specialize in specific aspects of this procedure. An international track offers expertise on the modern treatments in lower-back pain presented by the German Association of Orthopaedic Technology. More in-depth clinical programs follow, including sessions on pedorthics. Don’t miss the unveiling of the new Outcomes Research and the New Patient Registry, which will begin filling the gap in credible O&P outcomes research. Erin Thomson, MPH, of Jefferson University’s School of Population Health, will explain the framework for the patient registry data collection project AOPA commissioned last spring. You’ll learn how this paves the way for O&P provider reimbursements in the future as the new health-care model demands “effectiveness research” to benchmark treatment outcomes.

Inspiration and Motivation The first real battery charger is the Monday morning, September 21, keynote address by Jim Abbott. Although born with one hand, Abbott’s pitching earned him one of the legendary achievements in major league baseball. He’s one of only 15 players who made it to the majors without first playing in the minor leagues. You will be uplifted by his experiences in overcoming adversity and inspired by a motivational message that will touch your heart. With such a powerful opener, a blockbuster close is a requirement. So on Wednesday in the exhibit hall, AOPA serves up some famous Seattle coffee alongside the renowned Seattle Pike Place Fishmongers, whose story is legendary in the corporate training industry. Be prepared for lots of laughs as this dynamic group doles out generous portions of powerful insights on sales and management that will follow you the rest of your life.

Solid Business Strategies In between the Jim Abbott opener Monday morning and closing program from the Fishmongers on Wednesday, each day and each hour delivers another round of solid clinical and business information worth much more than the 34 CE’s awarded for this meeting. In fact, a second keynote Monday morning moves from the world of inspiration and motivation to the reality of health-care reform. Clem Bezold, chairman of the board and founder of the Institute for Alternative Futures, who has designed projects to study future environments, will translate some of the more confusing aspects of the current healthcare reform effort into what they mean for the O&P community and how you can respond to minimize any adverse impact. Also on Monday, the popular “Top Ten Series” covering topics ranging from Medicare changes to licensure to mastering the art of customer retention marketing returns. Two don’t-miss programs kick off the Tuesday morning business education. “The Future is Now: AOPA Strategic Initiatives Update” is the sequel to last year’s “A Glimpse

Make Plans Now Manufacturers’ Workshops, along with the largest “sold out” exhibit hall in AOPA’s history, round out your opportunities to build a wealth of takeaways—the best information, motivation, and business and clinical expertise ever offered at an AOPA National Assembly. Go to www.AOPAnet.org to register, plan your schedule, and see all of the other rewarding experiences that will truly make this National Assembly the most timely and valuable four days of your 2009 learning opportunities. While you’re at it, register for the O&P Political Action Committee Wine Auction. Don’t miss the buzz!

O&P ALMANAC SEPTEMBER 2009

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AOPA headlines

AOPA RESEARCH & DEVELOPMENT

Andrew Sawers, CPO, MSPO, University of Washington, Seattle • “Functional Outcomes of a Custom, Energy Harvesting, ‘Bullfrog’ AFO,” Geza Kogler, Ph.D., CO, Georgia Tech University, Atlanta

irtually everyone in O&P has had the experience of an insurer refusing to pay because he or she couldn’t demonstrate that a specific device is more effective than some other treatments. We recognize that O&P is playing catch-up to other fields in terms of outcomes research and evidence-based guidelines/ research to support what we do. Huge resources allocated in the country’s economic stimulus package for comparative effectiveness research serves to underscore the need. But the O&P field will soon have the data we need thanks to the Center for O&P Learning (COPL), a new non-profit scientific and charitable entity completely independent from any other O&P organization that is dedicated to advancing the development of, and learning about, outcomes and evidence-based research projects in the O&P field. COPL is governed by a board consisting of one representative from each of the different organizations in the O&P field.

COPL also provides a vehicle for interested parties— companies, foundations, government, and others—to commission answers to important research questions via independent research. COPL will set the parameters for research programs, obtain proposals/identify qualified investigators, award and manage grants, and assist in evaluation and publication of results.

Getting Involved with the COPL COPL offers a range of options for interested parties to support its work to advance evidence-based knowledge in O&P. Individuals involved in the O&P field can become members of COPL with the modest dues of $100 per year. A special patient membership is available to amputee members of ACA, and/or those not involved in the O&P industry but who are members of other patient advocacy organizations like UCP, MS, and MD. Companies and individuals are welcome to become contributors to the support ongoing efforts of COPL. Four contribution categories have been established:

Mission and Research The mission of the Center is to recommend and promote scientifically valid evidence-based research by individuals, manufacturers, or institutions to federal, state, or private agencies, practitioners, and other interested parties and promote quality patient care, fair reimbursement, and efficacy of orthotic and prosthetic intervention. COPL’s first project was to independently evaluate various grant proposals to support new O&P research that were submitted in response to an RFP circulated by AOPA. COPL selected the three proposals, each of which has received a $7,500 grant from AOPA for the 2009-10 period. The following projects and awardees were selected by a vote of the entire COPL board of directors:

Platinum: Gold: Silver: Bronze:

$5,000 and greater $2,500-$4,999 $1,000-$2,499 $500-$999

To commission a piece of research, contact COPL President William Barringer at william-barringer@ouhsc. edu or 405/271-3644 or Thomas Fise, COPL’s Interim Administrator at tfise@aopanet.org or 571/431-0802.

• “Comparison of Liner-Assisted Suspensions in Transtibial Prosthetics: A Pilot Study,” Robert Kristenberg, Georgia Tech University, Atlanta • “Estimation of Axis Rotation Position in NonArticulated Energy Storage and Return Prosthetic Foot-Ankle Mechanisms: Implications for Prosthetic Foot-Ankle Mechanism Efficiency and Motor Control Strategies in Unilateral Transtibial Amputees,”

Member Benefits The COPL board has established a collection of a dozen benefits that will be available to individual members and contributors to COPL in the bronze-platinum ranges. Some of these benefits are presently available to COPL members, while some others are still under construction.

O&P ALMANAC SEPTEMBER 2009

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AOPA headlines

Membership benefits include:

AOPA National Assembly registration bags this year will include an application for membership in the Center. Please visit the Center at Booth 6, located just adjacent to the entrance to the exhibit hall, where applications for individual membership and a full listing of benefits are available. Join us there and learn more.

• Sponsorship of an annual educational webinar relating to “how to write a successful grant proposal.” • An annual overview report on potential funding sources for research grants—clinical research, as well as outcomes/evidence-based research in the O&P field. • Periodic (at least twice yearly) expert briefings on outcomes and evidence-based practice findings that have implications from orthotics and prosthetics.

Center for O&P Learning

BOARD OF DIRECTORS

• E-mail updates on the latest developments in DARPA, VA, comparative effectiveness research.

President William J. Barringer, CO American Board for Certification in Orthotics, Prosthetics & Pedorthics

• Two podcasts produced each year—what’s new in O&P clinical research. • A bimonthly newsletter with content published by the Center, alerting center members to noteworthy research, funding opportunities, and other topics of interest in advancing evidence-based and outcomes principles in O&P.

William J. Barringer, CO

• Free admission to online clinical education units that AOPA is developing for a minimum of one year after joining the Center.

Vice President Brian L. Gustin, CP American Orthotic & Prosthetic Association

• A reception for Center members at the AOPA National Assembly.

Secretary Kendra Calhoun, President Amputee Coalition of America

• Special workshops relative to conducting research or developing a research thesis statement, IRB issues, and issues relating to industry support.

Gary M. Berke MS, CP American Academy of Orthotists and Prosthetists

• Other educational tools, probably Web-based, to disseminate knowledge, information, skills, and experience in outcomes/evidence-based research in the O&P field.

John Kenney, BOCO Board of Certification/Accreditation International

• Individual members of the Center would enjoy benefits accorded to AOPA members, including the O&P Almanac, AOPA-in-Advance, LCodeSearch.com, and reduced fees for attendance at AOPA meetings.

Thomas Guth, CP National Association for the Advancement of Orthotics & Prosthetics

• Individual members of the Center would have access to use the framework from the developing AOPA patient care registry, both for enrolling patients in studies being authorized by AOPA and to use of the framework in any research being conducted by the member.

Bryan S. Malas, CO National Commission on Orthotic and Prosthetic Education Robin Burton Orthotic & Prosthetic Assistance Fund, Inc.

• AOPA discount programs (e.g. Office Depot and others would be available to Center members).

O&P ALMANAC SEPTEMBER 2009

”

YpsilonTM helps me in my daily life!”

”

”ToeOFF ® took me back to Marathons!”

www.allardusa.com

ALLARD USA, INC. 21 Pine Street, Suite 120 Rockaway, NJ 07866-3130

info@allardusa.com Toll Free 888-678-6548 Fax 800-289-0809

AOPA membership applications

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 statelicensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million

Burton Prosthetics Inc.

Rinko Orthopedic Inc.

5329 Center St. Omaha, NE 68106 402/384-1334 Fax: 402/384-1334 Category: Patient Care Facility Russell Burton, CPO

25-09 Broadway Fair Lawn, NJ 07410 201/796-3121 Fax: 201/796-1551 Category: Patient Care Facility Stephen Rinko, BS, CPO

Island Prosthetics

South Coast Orthopedic Technologies

6921 High Point Dr. Clinton, WA 98236 425/776-3316 Fax: 425/776-3316 Category: Patient Care Facility Dave Matthews, CP

Pilgrim Shoes 1817 B Whitehead Rd. Baltimore, MD 21207 410/277-8855 Fax: 410/277-9988 Category: Supplier Level 1

O&P ALMANAC SEPTEMBER 2009

535 Faunce Corner Rd., Ste. 201 North Dartmouth, MA 02747 508/998-7268 Fax: 508/998-7267 Category: Patient Care Facility Randy Penney, CPO

The Foot Performance Center Inc. 3385 Brighton Herietta Town Line Rd. Rochester, NY 14623 585/473-5950 Fax: 585/473-9596 Category: Patient Care Facility David Cardillo, C.Ped.

The SpineCor® Pain Relief Back Brace provides postural rehabilitation to change spinal shape and loading.

Indications: The SpineCor® Pain Relief Back Brace is indicated for mechanical back pain related to:

During a 2-year development process, clinical testing with the SpineCor Pain Relief Back Brace was performed on 200 patients. Some of these patients reported pain relief within hours of the first application. Of all patients treated, 90% reported relief within 6 weeks of use.

• Adult De-novo Scoliosis

Initiall Initially, the brace is worn 8 – 16 hours per day in order to initiate postural changes. After several months of wear, it is often possible to reduce wearing time while maintaining pain relief.

• Chronic Antalgic Scoliosis

• Degenerative Adult Adolescent Idiopathic Scoliosis • Hyper Kyphosis • Postural Scoliosis

• Post Traumatic Scoliosis • Spinal Stenosis related to spinal misalignment

Training: Becker Orthopedic and the SpineCorporation require certified orthotists to participate in our newly designed online training program. Please contact Theresa Mozak at (800) 521-2192, or email her at tmozak@beckerorthopedic.net for information regarding online and group training opportunities. Note: Orthotists who have already completed SpineCor® Dynamic Corrective Brace Training will be able to order the Pain Relief Back Brace after successfully completing a single online training module.

• Poor Posture Treatment with the SpineCor® Pain Relief Back Brace should be prescribed and monitored by a physician. Applicable Lcode L1005. Patented Product US Pat # 5,599,286 Additional Patents Pending.

QUESTIONS FORâ&#x20AC;Ś

Robert Frank, CPO Robert Frank, CPO, has worked in the O&P industry for 23 years. He recently retired from Hanger Prosthetics and Orthotics in Horseheads, New York, to devote more time to the FundaciĂłn Protesis Para La Vida, a free clinic he co-founded in Ecuador.

Frank casting a bilateral BE patient.

What prompted you to start the clinic? I started volunteering in Ecuador almost 20 years ago. At that time, metal and leather bracing was used in the country, and working with a foundation in Quito, we were able to introduce thermoplastics. I returned many times to supply them with parts and to teach different aspects of O&P. Two years ago, I learned that $35,000-worth of fabrication equipment donated by Rotary International had been sitting in crates for three years in Ibarra, and the project was stalled. The prosthetic needs in Ecuador are great,

and I hated seeing this generous donation not being used. My friend Ivan Victoria is an experienced prosthetist, and he asked me to help set up the clinic. In early 2008, I arrived in Ibarra with enough used prosthetic components for about 30 patients, and we unpacked the equipment and began patient care. I have returned four times since then, and on the last trip two CPOs volunteered to work with me.

Who are some of your patients? What are their conditions, and what kind of treatment are they receiving?

Frank and clinic co-founder Ivan Victoria (middle) cast a hip disartic patient.

We are working with the very poorest population in Ecuador. Most of the patients are young and have had amputations secondary to traumatic injury from electrical, car, farming, and construction accidents. A majority of the patients are above knee amputees. We fit our first hip disartic on our last trip, and three more are waiting. A 17-year-old AKA received his first prosthesis 10 years after his amputation. A three-yearold congenital BKA just stood up and starting walking for the first time five minutes after receiving his first prosthesis. There are many upper-limb amputees because very few patients receive limb-saving procedures. Two brothers, both bilateral BE amputees, and a cousin, a unilateral BE, were injured using dynamite to fish in the rivers. They came from the jungle, traveling by bus until their money ran out and then walking the last 40 kilometers. The oldest has been a bilateral BE amputee for 25 years, and we fitted him with his first prosthesis. The others are currently waiting.

What are the biggest challenges you face? Our biggest challenge is deciding who we can fit and who must continue to wait. People travel a long way to the clinic, sometimes wait several days to be seen, and then may hear that we donâ&#x20AC;&#x2122;t have the parts

O&P ALMANAC SEPTEMBER 2009

For 50 years, PEL has offered the O & P practitioner outstanding

VALUE

on the most popular products available from the industry’s leading manufacturers. Contact a friendly PEL CSR, like Mildred, for information – in English or Spanish – on the newest, most dependable products available worldwide. Mildred Mendez-Gonzalez, International Customer Service Rep. • Puerto Rican heritage, born in Boston • Salutatorian of Glenville High Class of 1987 • Bi-lingual – Spanish • Available by email 24/7 • 5 children • Loves basketball and helping people

Orthomerica

Hosmer Sfx

California® LOMBAR™ Orthosis • Low profile, customizable orthosis promotes thoracic extension through targeted vertebral separation • Aluminum spine provides strength while conforming to patient’s body for stability, pain relief • Apron front closes with Velcro® pull tabs for easily controllable, adjustable abdominal compression • Lightweight design, with soft CoolFoam™ liner • Strap lengths are “one size fits all” – easily trimmed

• Adds • Adds adjustable stance flexion feature to most endoskeletal knee-shin systems • Improved stability and balance • Improved • Absorbs shock for smoother gait • Absorbs • Adjustable Stance Flexion Resistance • Adjustable • Maximum • Maximum 10° of stance flexion • 3 • 3 stiffness options • Proximal • Proximal pyramid receiver and distal tube clamp for easy addition to most prostheses • Rated for 275 lbs/125 k

Fillauer

Element™ Foot System • Unique 3rd Element technology • Smooth rollover and superior stability • Natural gait cycle and fluid rollover • Interchangeable heel elastomers for fine tuning heel stiffness • Modular design with superior flexibility • Low profile design requires only 3.75 in. clearance (9.5 cm) • Incredibly lightweight only 310 grams • System kit includes foot, heel bands and elastomers, Spectra® sock and instruction manual. ®

Experience the Power of One.

50 years of one stop shopping for all your O&P needs.

Phone: 800-321-1264 Fax: 800-222-6176 E-mail: customerservice@pelsupply.com Web: www.pelsupply.com

they need. Collecting parts here in the United States and transporting them to Ecuador is only sustainable as long as there are volunteers to do so. I am always looking for prosthetists and orthotists to join me. Finding the funding to keep the clinic operating takes a tremendous amount of energy and focus, and it is difficult to continually ask the same individuals and organizations for donations. I am working to get more people involved, both to assist with parts and funding, and to experience what it is like to work in a developing country. The Andes Mountains are beautiful, and the work is always interesting and technically challenging without the support we have in this country. I canâ&#x20AC;&#x2122;t just pick up the phone and order parts; we have to improvise. The work is all about patient care. We do keep good records but nothing as extensive as we do in the United States.

How do patients receive follow-up care after your visit? Unlike many volunteer efforts, we have set up a clinic that is ongoing, run by Ecuadorians, and staffed by a prosthetist and a technician. The clinic operates 50 weeks a year, and follow-up care is available. The patients are unfamiliar with the concept of follow-up care, and maintain their prostheses the best they can on their own. They come to the clinic with broken feet and knees and ill-fitting sockets that they have been using for years, literally held together with tape and wire. These patients have tolerated poor fitting sockets out of necessity, but we are having success spending time with the patients, explaining prosthetic use and the necessity of returning to the clinic if there is a problem. We also are working on a system of rechecks every six months, especially for children.

O&P ALMANAC SEPTEMBER 2009

What are your long-term goals for the clinic? My goal is to increase the availability of prosthetic care and availability of components. There are fewer than 20 prosthetists in Ecuador serving a population of 12 million. I am currently developing a prosthetics course to be taught next year at the Technical University of Ibarra. We also are working with the Ecuadorian government for funding for its disabled population. In addition, we will be evaluating inexpensive components that have been developed in Vietnam: A $5 foot and a $35 knee unit may someday be fabricated in Ecuador. The ultimate goal is to have a clinic that will be sustainable without so much help from the U.S., but professional collaboration and communication between countries should always take place. a Reach Frank at bfrank@htva.net.

from immobilization through support

PATENTED* SYSTEM ENABLES A FULL SPECTRUM OF CARE

from The Bremer Group Company

• Comprehensive system for external spinal support in your office: Rigid, molded plastic TLSO and LSO components Application training for your staff by a Certified Orthotist Reimbursement training and support

• Ideal for nonsurgical and surgical treatment regimens • Superior fit and patient education material help assure compliance • Available as CT / MRI compatible†

See us at AOPA, booth #237

Embracing Innovation www.bremergroup.com

The Bremer Group Company, 11243-5 St. Johns Industrial Parkway So., Jacksonville, FL 32246

904-645-0004

904-645-0990 Fax

bremergroup@bremer.net

For more information or to request a system, see your VertAlign representative or call 800-428-2304. * U.S. Patent No. 5,718,670. † Artifact-free CT and MRI images. MRI tested to 1.5 Tesla. VertAlign® is a registered trademark of The Bremer Group Company. © Copyright The Bremer Group Company, 2009. All rights reserved. 78-3107 08/09

marketplace

COLLEGE PARK’S NEW ONYX FOOT Integrating a dynamic pylon, the multi-axial Onyx Foot allows active users to demand more. Highly customizable, with four degrees of plantardorsiflexion Angle Control and adjustable Onyx Foot Stride Control for fine-tuning gait, the sleek Onyx Foot delivers balanced energy with ideal comfort and enhanced terrain compliance. Key benefits include: • Dynamic Pylon foot • Superior terrain compliance • The only Dynamic Pylon foot with four degrees of plantar-dorsiflexion Angle Control • Precision gait matched for out-ofthe box performance • Adjustable Stride Control to finetune foot stiffness from heel strike to heel off • Three-year warranty • Onyx–Balanced Energy, Ideal Comfort. For more information, call 800/728-7950 or visit www.collegepark.com.

INTRODUCING THE KISS SUPERHERO™ REUSABLE TEST SOCKET PLATE. The unique design of this plate allows for easy casting tape removal without damage. Damage-free casting tape removal allows this plate to be reused, saving costs. Available direct and from SPS, Pel, Knit Rite, and Cascade. For more information, call 410/663-KISS or visit www.kiss-suspension.com.

BRIGHTEN UP 2009 WITH OPTEC’S STEALTH AND VERTAMAX

Now you can have a choice. OPTEC is offering the revolutionary Stealth and Vertamax orthoses in new appealing colors. The Stealth and Vertamax will be offered in white and beige respectively. Both spinal systems will continue to be available in black. The Stealth and the VertaMax continue to offer superior support and comfort, which your patients deserve. Call 888/982-8181 for a free 30-day trial sample of the Stealth and Vertamax.

REDESIGNED STEPLOCK HANDLE FROM OTS CORP. OTS Corp. has redesigned the StepLock handle to allow the use of a special bail kit. In the past, a stiff connection between Redesigned StepLock the two joints Handle risked one side locking, while the other was not completely locked, causing the last ratchet tooth to be worn away. The new bail kit has rubber grommets inside the connection, allowing some play between the two sides. The kit attaches through two spaces in the redesigned handle, which also allows for a better lever release kit connection. The new handle also is less obtrusive and less likely to catch on clothing. It is now standard on all StepLocks ordered. For more information, call 800/2214769 or visit www.ots-corp.com.

O&P ALMANAC SEPTEMBER 2009

FILLAUER SFX The all new Sfx from Hosmer adds adjustable stance flexion to most endoskeletal kneeshin systems. This compact and light weight stance flexion device provides added stability, increased balance, and moderate shock absorption in a modular configuration. Sfx offers 10 degrees of adjustable stance flexion resistance and three different load levels. The Sfx comes with a proximal pyramid receiver and distal tube clamp making it easy to add to most prostheses. • Improved stability and balance • Absorbs shock for smoother gait • Adjustable up to 10 degrees • Three stiffness options • Rated for 275 lbs / 125 kg • Available with Weight Activated Locking Knee (W.A.L.K.) For more information, contact us at 800/251-6398 or visit www.fillauercompanies.com.

FILLAUER TRANS-FEMORAL ROTATOR The Trans-Femoral Rotator 300 (TFR) from Hosmer is a welcome addition to any aboveknee prosthesis. It allows the amputee to rotate the shin section of the prosthesis relative to the socket, making entry and exit of tight spaces, such as automobiles, much easier. • Allows cross-legged sitting • Facilitates entering and exiting cars • Smooth, one-handed, push-button operation • Robust spring-loaded lock • Automatic relock • Low profile and lightweight For more information, contact us at 800/251-6398 or visit www.fillauercompanies.com.

AOPA National Assembly Booth # 215

marketplace

FILLAUER’S ELEMENT FOOT SYSTEM FROM KNIT-RITE

This new foot from Fillauer features a unique three element design that offers smooth rollover and superior stability. It has interchangeable heel elastomers for fine tuning heel stiffness and a modular design with superior flexibility. The low-profile design requires only 3.5” clearance. Durable; complies with the new ISO 22675 test standard. In credibly lightweight at only 310 grams. The innovative foot shell is flexible with realistic features. Indications: Moderate to Active B/K or A/K amputees as defined by Functional K3 and K4 levels. Unilateral or Bilateral patients that would benefit from increased flexibility and smooth rollover. Patients weighing up to 275 lbs. (125 kg). Contraindications: Clearance below 3.5”. Patients weighing over 275 lbs. (125 kg) The Element Foot System includes foot, heel wedge elastomers, Spectra sock, and instruction manual. Shell selection requires left or right and foot size. Custom colors available as special order with three weeks lead time. For more information, contact your friendly Knit-Rite representative TOLL-FREE today at: 800/821-3094. See us at booth 901 during the AOPA National Assembly.

LIMBLOGIC VS FOR THERMOPLASTIC SOCKETS The new Thermoplastic Drop-In Adapter maintains an airtight seal with LimbLogic VS and permits the system to be used with thermoplastic sockets. For added comfort the Thermoplastic Drop-In Adapter allows for a custom distal cup that replicates the user’s correct anatomical shape. Average build height of adapter is .6250” with custom distal end. The adapter is suitable for adjusted body weight of 250 lbs (115 kg) for U.S. Activity Levels 2 & 3. A reusable thermoplastic adapter tooling kit is available and sold separately. For more information, contact Ohio Willow Wood at 800/848-4930 or www.owwco.com.

OSSUR’S NEW ICEROSS CUSHION LINER AND ICEROSS SLEEVE The Iceross Cushion Liner and Iceross Sleeve offer three of the most sought after features: durability, comfort and flexibility. Vascular patients and those with sensitive skin will appreciate Ossur’s Active Skin Care ingredients, while the DermoGel Silicone and elastic Supplex cover offer excellent durability and security when using a vacuum system. Iceross Cushion is available with the Wave Feature for additional knee flexion. For a more intimate fit add the Cushion Liner’s counterpart: the Iceross sleeve. Improved mobility, a more secure fit and optimal comfort—an unrivaled liner and sleeve solution. For more information, call 800/233-6263 or visit www.ossur.com.

O&P ALMANAC SEPTEMBER 2009

OTTO BOCK NEW STANCE CONTROL KAFO: E-MAG ACTIVE Easy to fit with extraordinarily simple onboard programming, the E-MAG Active controller actually calibrates itself to capture the user’s unique gait pattern. The E-MAG Active also can be easily reprogrammed for changes in the user’s gait. That unique feature adds a whole new dimension of functionality for people who previously have had limited bracing options, such as a locked knee brace or a manual device. For more information, contact Otto Bock Healthcare at 800/328-4058 or visit www.ottobockus.com.

OTTO BOCK THE SENSOR WALK Meet the next generation of electronic stance control orthotics–– the Sensor Walk. Developed by Otto Bock in conjunction with the Mayo Clinic, the Sensor Walk delivers superb stance control in a heavy-duty custom KAFO. Unique sensors in the footplate know when the patient is in late stance phase and trigger the knee joint to unlock allowing for a more natural gait. The Sensor Walk’s robust design can handle patients who weigh up to 300 lbs (136 kg) and can accommodate a 15 degree knee flexion contracture so you can fit patients who have few options for sophisticated stance control. For more information, contact Otto Bock Healthcare at 800/328-4058 or visit www.ottobockus.com.

TOOLS AND EQUIPMENT

PROSTHETICS

ORTHOTICS

ORTHOTIC TEXTILES

PROSTHETIC TEXTILES

FABRICATION SUPPLIES

Fillauer CylindriCal loC

Fillauer Cy • Dependable Fillauer shuttle design • Retrofits other cylindrical lock sockets • Strong, lightweight, fiber reinforced body • Standard 4-hole attachment pattern • Includes two Fillauer 1" plungers

The Cylindrical Lock incorporates the Fill body with a 4-hole attachment base. Fe deep pin well for easy insertion, and stro cylindrical lock sockets and is optimized fit with two 1" Fillauer shuttle pins and a

1.800.821.3094

3M-1252-40 3M-1252-41

Cylindrical Shuttle Lo Cylindrical Shuttle Lo

3PP-097-22 3PP-097-25 3PP-097-27 3PP-897-20 3PP-897-21 3PP-897-22 3PP-897-25 3PP-897-27

Plunger 1", with .25" Plunger 1.50", with .2 Plunger 2", with .25" Plunger 10mm Threa Plunger 10mm Threa Plunger 10mm Threa Plunger 10mm Threa Plunger 10mm Threa

3PP-898-64

Cylindrical Fabricatio

3PP-898-67

Cylindrical Housing D (Kit includes: 809864 Fabrication D 880275 M6–1 x 16m 880494 5/16–18 x 3" 809791 Button Shield Fabrication Kit 12520

marketplace

NEW SARO AVAILABLE FROM PEL SUPPLY

The Lerman Pediatric Shoulder Abduction Rotation Orthosis (SARO), from Becker Orthopedic, has been revised with enhanced features and sizes. It’s in stock and available from independent wholesale distributor PEL Supply. The low-profile SARO is applicable for pre- and post-operative management of the shoulder joint and paralysis or damage to the brachial plexus (Erb Palsy), as well as for prevention of upper-extremity joint contractures, for brachial plexus exploration and nerve repair, and for soft tissue surgery, including tendon transfers. Easily adjustable and lightweight, the SARO incorporates a universal design for application on the right or left shoulder. The newest version of the orthosis features increased adjustability at the shoulder and elbow joints. In addition, it now has a raised posterior wall on the humeral cuff for additional support. As always, the SARO comes with removable, washable, liners. The newly revised SARO is also available in Large and XL sizes. Offering a generous discount program, PEL Supply stocks over 45,000 products, components, tools and accessories, with most available for same day shipment. For information on the Becker SARO and any other products in the 2009 PEL Pediatric Products catalog, contact any helpful PEL customer service specialist at 800/321-1264, by fax 800/222-6176, or e-mail customerservice@pelsupply.com. Or order online at www.pelsupply.com.

POLYGEL LAUNCHES THERMOTECC: THE HOTTEST PROFIT CENTER FOR YOUR PRACTICE.

ThermoTecc is the new heat moldable orthotic system that saves you time and money. ThermoTecc orthotics provide maximum performance with a thin, full length anatomically designed shell. The very dense 75 durometer lightweight EVA combines a flat bottom for stability with an extended longitudinal arch for mid-stance control and a lateral wall for better control. A deep heal seat with minimal heel raise allows for better biomechanical function while the cuboid support minimizes lateral foot pain. The very thin and durable forefoot provides added control and is great for use in all types of footwear. ThermoTecc can be purchased as moldable shells or as a complete device with the addition of a PTecLT cushioning mid layer and antiodor, anti-microbial and anti-fungal BambooTecc top cover. Firm 70 durometer posting strips and heel pads are available for further customizing your device. ThermoTecc footbeds are easy to cut, grind and glue and easily trimmed to sulcus or proximal to met heads minimizing the need for additional inventory. ThermoTecc is the most versatile and flexible orthotic system available. For more information, call toll free: 866/438-2297, visit www.PolyGel.com, www.ThermoTecc.com, or e-mail Hal@PolyGel.com.

O&P ALMANAC SEPTEMBER 2009

NEW MATRIX CURVE AVAILABLE FROM PEL SUPPLY The new Matrix Curve AFO from Trulife is now available for same day shipment from PEL Supply. This new orthosis— for low to high activity level wearers with unilateral or bilateral drop foot— offers the following: • Slim, lightweight, carboncomposite AFO • Dynamic, low profile design • Optimal energy efficient gait • Custom fit calf band and footplate • Lateral strut • Four sizes, from S to XL For more information on the new Matrix Curve AFO— well as the full line Trulife products—contact any helpful PEL customer service specialist at 800/321-1264, by fax 800/222-6176, or e-mail customerservice@pelsupply.com.

Shoes Specially Designed for O&Ps

to Accommodate Mild or Severe Foot Problems Off-the-Shelf and at Low Prices

502-C Casual Dress Shoes (Charcot)

Medicare Approved

502-X, 502-E Feather Light Casual Dress Shoes (Expandable padded collar available as modification)

(Build-in Medial Charcot, Laces available) Built-in medial charcot Long hook/loop strap Mis-matches 502 or 502-x, 502-e Charcot Boots also available with laces and hook & loop strap

Supra depth & extraordinary volume Accommodate to severe edema Covering width to 14E

Medicare Approved

502-X

502-E

708, 718 Paul Bunion / Bunionette Shoes (Cut-off flex area for more release, come in black and beige) Flexible Lycra to fit hammer toes/claw toes Extra Long hook/loop strap

502-C

708

718

Medicare Approved

801, 802 Heavy Duty Supra-depth Shoes Extended width to 9E 3 Layers of Removable Inserts Extended strong medial & lateral counters 801

802

(Laces available)

9205, 9209 Women's Premiere Comfort Shoes Extremely light 7 ounces per shoe Added depth(8mm or 5/16") deeper Three widths (M/W, WW, XW) 9209

9205

(Other colors also available)

Apis Footwear Company 2239 Tyler Ave. South El Monte, CA 91733 Tel: 888-937-2747 Fax: 888-990-2245 www.bignwideshoes.com

Footwear Co.

marketplace

SPS PREVIEWS NEW ADVENTURE SERIES SHOES

Over the last several months, many customers have told SPS how important fit and value are when it comes to Diabetic Shoes. We are pleased to preview the collection inspired by you––SureFit’s Adventure Series. SureFit’s new footwear collection marries originality with classically inspired styling. Constructed with our new Origins last, these beautifully tailored shoes are designed to fit like a dream. Our extremely lightweight, fashion right designs have hardware accents and touches of natural beauty that will provide your diabetic patients with lasting value––the value of looking and feeling fabulous. SPS invites you to take an exclusive look in the SPS Booth #413 at the AOPA National Assembly in Seattle, WA, or call SPS Customer Service at 800/767-7776 for more details.

SUREFIT… INSERTS THAT FIT AT SPS Differentiate your practice from pharmacies and DME suppliers selling over the counter inserts that do not provide sufficient protection for your diabetic patients. It is estimated that 1/3 of all diabetic patients will develop a foot ulcer. You need a custom solution that will fit the needs of these high risk patients. SureFit is dedicated to providing your patients with the highest quality custom and prefabricated inserts that are 100 percent Medicare Compliant. Provide your patients with: • Custom molded inserts that provide maximum pressure reduction • Prefabricated inserts that require no trimming • Wide selection of Custom Accommodations • Free inbound shipping • Exclusive fitting system to determine the correct shoe style and size • Fit Guarantee on custom insert orders SPS invites you to take an exclusive look in the SPS Booth #413 at the AOPA National Assembly in Seattle, WA or call SureFit® at 800/298-6050 today.

O&P ALMANAC SEPTEMBER 2009

WALKAIDE® LARGE BLUE ELECTRODES AT SPS

WalkAide’s Large Blue Gel Electrodes (2x2), available exclusively through SPS expand treatment options, simplifies positioning and ease fitting. These electrodes are made with a double layer skin friendly PolyHesive® blue gel and offer the following benefits: • Increased surface area (2”x2” or 4 in2) allows for current dispersion and increased comfort • Removes cleanly without leaving a messy residue • Removes easily without pulling hair • Conductive silver layer provides uniform current distribution and comfortable stimulation • Extra thick PolyHesive blue gel provides superior adherence and reusability • Provides high moisture content to enhance skin conductivity Visit the SPS Booth #413 at the AOPA National Assembly in Seattle to view the NEW Blue Gel Electrodes or call SPS Customer Service at 800/767-7776 x 3. a

jobs

Run your ad in the O&P Almanac and on jobs.AOPAnet.org.

Northeast

CP/CPO Long Island, New York A Step Ahead Prosthetics has an immediate opening for CP/CPO in our expanding prosthetic facility in Long Island, New York. Competitive salary, benefits include health insurance, vacation, 401(k), potential for profit sharing/equity interest. Fax or e-mail resume to:

Fax: 516/681-3464 or E-mail: erik@astepaheadonline.com

- Northeast - Mid-Atlantic - Southeast

CPO CO Board-Eligible Orthotist or Prosthetist BOCO or BOCPO C.Ped CFO

- North Central - Inter-Mountain - Pacific

Maine • Are you looking for something more? • Do you want to be more than a number? • Do you want a great life and a great job? • We are a terrific practice looking for some nice people. Is this you? We are a well-established, patient-oriented, ABC-accredited facility seeking to strengthen our staff. Competitive salary offered, with bonuses commensurate with productivity, and renumeration for required educational credits. Offices located in picturesque Maine, just a short distance from our coast and mountain regions. Learn more about joining our team of dedicated specialists by contacting:

Use our map to find which region you fit into!

Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, e-mail and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member rate      Non-member rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color $482 $678 1/2 page, color $634 $830

O&P Ad 25356, O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or e-mailed to srybicki@AOPAnet. org., along with a VISA or MasterCard number, the name on the card and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711.

Inter-Mountain

Orthotic/Prosthetic Technician Albuquerque, New Mexico Experienced technician needed in enchanting Albuquerque, New Mexico for a multi-state, ABC accredited, family owned business. Lamination, thermoplastic, modification and metal bending skills are required. Competitive salary with benefits. Contact:

Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

Job board rates Visit the only online job board in the industry at jobs.AOPAnet.org!

Member rate $80

Non-member rate $140

Save 5 percent on O&P Almanac classified rates by running your ad both in the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.

Deane Doty, CPO Phone: 505/266-1700 Dial 0 E-mail: ddoty@4activelife.com

O&P ALMANAC SEPTEMBER 2009

Which one is wearing her spinal orthosis?

Spinal Technology,Inc. INTRODUCES

Lower Limb Technology,LLC. The same commitment to quality and service is now extended to our lower limb central fabrication company. Call for product information.

The answer is, neither. The girl on the left wears the Providence orthosis only while she’s sleeping, which studies show is just as effective in the treatment of adolescent idiopathic scoliosis as full-time orthoses. That eliminates the embarrassment of being different at just the time in a girl’s life when she wants most to fit in. The night-time Providence increases compliance and can be effective for obese, juvenile and neuromuscular scoliosis patients.

Spinal Technology is proud to be the exclusive manufacturer of the Providence. It’s custom fit. So she can fit in. Call us for a copy of the published clinical study proving the efficacy of the Providence.

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jobs

A Healthy Career Is A Growing Career While we concentrate the majority of our focus on increasing the health and wellness of our patients, we never forget the source of the highquality care that we provide is the hearts and minds of our staff. That’s why we do everything we can to help them develop and improve the knowledge and skills they need to move forward in their career.

Bulow BioTech Prosthetics, based in Nashville, TN with satellite practices in Cookeville and Clarksville, TN, is expanding to other locations. We are currently seeking energetic, caring, and talented prosthetists to open facilities in selected cities in the southeastern United States. A successful candidate will work under the clinical direction of our founder, Matt Bulow, a 1991 graduate of the Northwestern Prosthetic Certificate Program with over 18 years of clinical experience. Matt is a BK amputee, 3 time paralympian, and former long-jump world record holder. A minimum of 3 years experience and a passion for prosthetic patient care excellence is required. Prior 04689700 management experience and / or the ability to market 7.25” and x 4.5” develop new areas is required. Our company is MC unique in that we specialize in prosthetic patient care services only, allowing us to provide customized, one-onone care for each of our amputee patients. Position includes excellent benefits and pay based on salary plus performance. For more information on our company please visit www.bulowbiotech.com.

CO or CPO

Opportunity in Marshfield, WI The candidate we are seeking must be a graduate of an Orthotic Practitioner program and/or a Prosthetic and Orthotic Practitioner program, and certified by the American Board of Certification (ABC) in Prosthetics and Orthotics. An undergraduate degree and a minimum of 3 years of experience as an Orthotist and Prosthetist desired. Experience in Child Orthotics desired. For a more detailed job description and to apply online, please visit our website at www.marshfieldclinic.jobs and refer to job number MC090202. Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

Interested individuals please e-mail resume to info@bulowbiotech.com

1000 N.Oak Ave., Marshﬁeld, WI 54449

Director – center for Prosthetic anD assistive technology research Provide scientific leadership and execute investigator550develop Heritage Drive Suite 200, Jupiter, FL 33485 Recourse Communications Inc. to

At the Rehabilitation Institute of Chicago, we don’t

Date Phone: 561.687.3737 Fax: 561.687.2180 www.rci-together.com 07/29/09 initiated and industry-sponsored research in prosthetics, orthotics Ad Number Publication Section

measure success in terms of our #1 status alone.

MRC113214 AOPA Sept. issue and other assistive technologies. The center will be the first of its kind Run Folder Run Date(s) Size Our success is measured by each employee’s Barbara Burr 09/01/09 (3.5x4.5) to combine the newest advances in research 3x5 methods, functional 09/06/09 Client Rep.

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Visit www.ric.org/jobs or email aohara@ric.org today to learn more about the details of this career opportunity and bring your strengths to our team.

Requirements:

• Certified prosthetist or orthotist, PT, OT, BME or MD with a PhD • Assistant, associate or full professor in related fields of study • Record of scientific accomplishment and innovation in research evidenced by peer-reviewed publications, patents, symposia invitations, training and contributing to or obtaining scientific grants

• 5 years’ post-graduate experience in research preferred #1 Rehabilitation Hospital in America www.ric.org

Equal Opportunity Employer

O&P ALMANAC SEPTEMBER 2009

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San Antonio, Texas Now is your chance to work with a dynamic private practice, with multiple locations, in San Antonio. We are seeking experienced, self-motivated practitioners, assistants, and technicians. Three years’ experience preferred; pediatrics a plus. We offer a competitive salary with full benefits package, and an excellent bonus structure commensurate with productivity. Practitioners must be eligible for Texas licensure and have current certification with ABC. All inquiries will be kept strictly confidential. E-mail resume to:

Memphis, Tennessee Ready for a change? Memphis is the second largest city in Tennessee boasting Blues, Gospel and Rock n’ Roll music roots, the Memphis Zoo, Carnival Memphis and arts festivals to mention a few. While considered the South, Memphis has four distinct seasons and sits on the eastern bank of the Mississippi River. It offers several professional sports teams; and, who could forget famous Beale Street? We offer a very competitive salary and benefit package accompanied by relocation assistance and sign on bonus plus much more. If, interested, please contact, in confidence:

E-mail: hr@mkprosthetics.com

Certified Orthotist and/or Orthotist/Prosthetist

Sharon King Director, Recruitment Hanger Prosthetics & Orthotics, Inc. 678/455-8865 678/455-8885 Fax E-mail: Sking@hanger.com www.hanger.com/careers

Texas El Paso is the sixth largest city in Texas and stands on the Rio Grande with the Juarez Mountains as its skyline. It has 13 hospitals, multiple parks, museums and has been the filming site for 20+ movies. Dallas offers it all: Anchored by downtown, the center of the city is the epicenter of urban revival along with shopping, barbecue, authentic Mexican and Tex-Mex cuisine. Dallas has its share of football, basketball and hockey teams. Don’t forget NASCAR, the parks and lakes and the massive State Fair of Texas. We offer a very competitive salary and benefit package accompanied by sign on bonus and relocation assistance. If you are ready to make a change and desire the security of working for the oldest orthotic and prosthetic patient care company in the world, contact, in confidence:

Prothetist/Prosthetic Technician Louisiana Louisiana based company seeking certified prosthetist and prosthetic technician. Prosthetist must have the clinical experience, rehabs and hospital settings. Marketing skills would be appreciated. Prosthetic technician requires good fabrication skills. Salary commensurate with experience. Employee benefits, paid continuing education and other opportunities. Send resumes to:

Bias Orthotics & Prosthetics P.O. Box 4571 Lake Charles, LA 70606 E-mail: lapobias@suddenlink.net

Sharon King Director, Recruitment Hanger Prosthetics & Orthotics, Inc. 678.455.8865 678.455.8885 Fax E-mail: Sking@hanger.com www.hanger.com/careers

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jobs

ABC – BOC Orthotist/Prosthetist For Multiple Facility Locations Yankee Medical has immediate openings available in one of our six locations. We are a “family friendly,” privately owned company with a 58-year history of providing high-quality patient care throughout Vermont and its border communities. We are looking for an experienced practitioner who desires a long-term relationship with our progressive company. We would also consider a motivated resident with prior O&P work experience. Yankee Medical offers a generous benefit package, including fully paid health insurance, 401K matching, profit sharing, bonuses, life insurance, short- and long-term disability insurance, as well as remuneration for your required education credits and help with relocation expenses. Come join the family of lifelong Yankee Medical people. Call, fax, or e-mail inquiries to:

Linda Wells, Operations Manager Yankee Medical Inc. 276 North Avenue Burlington, VT 05401 Phone: 802.863.4591  Fax: 802.658.3101 E-mail: ljw@yankeemedical.com

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Contact, in confidence:

Sharon King, Director, Recruitment 5400 Laurel Springs Pkwy., Suite 901 Suwanee, GA 30024 Tel: 678-455-8865, Fax: 678-455-8885 sking@hanger.com www.hanger.com Hanger Orthopedic Group, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any

other basis prohibited by federal, state or local law. Residency Program or Certificate Primary Education Program Info, contact: Robert S. Lin, CPO/Dir. of Academic Programs. Hanger P&O / Newington O&P Systems, Ph. 860.667.5304 • Fax 860.667.1719

O&P ALMANAC SEPTEMBER 2009

Beverly Hills, CA

Las Vegas, NV

Cameron Park, CA

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Alexandria, VA

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calendar

New calendar additions appear in color AOPA-sponsored activities appear in a color box

2009 SEPTEMBER 18: OPGA: Bioness Training Course, Chicago. One-day course covers the NESS L300 system evaluation and hands-on training. Instructed by Keith McBride, MPT, DPT and John Michael, MEd, CPO/L, FAAOP, FISPO. The NESS L300 is a userfriendly neuroprosthetic designed to improve gait for individuals experiencing foot drop. 7 CEUs. Register at 800/214-6742 or www.opga.com.

SEPTEMBER 18

friendly neuroprosthetic designed to improve gait for individuals experiencing foot drop. 7 CEUs. Register at 800/214-6742 or www.opga.com.

Ultraflex: Pediatric UltraSafeGait Continuing Education Course, via WebEx, Noon – 1:00 pm ET, course covers clinical assessment and compensating for pediatric gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO, Register at www.ultraflexsystems.com, 800/220-6670.

SEPTEMBER 20-23:

AOPA National Assembly. Seattle. Washington State Convention & Trade Center. Four days of education, exhibits and networking. Contact Kelly O’Neill, 571/431-0852, or koneill@ AOPAnet.org. Visit www. APOAnet.org for details.

SEPTEMBER 19 OPGA: Bioness Training Course, Seattle. One-day course covers the NESS L300 system evaluation and hands-on training. Instructed by Keith McBride, MPT, DPT. The NESS L300 is a user-

SEPTEMBER 29-30: ALLARD USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Philadelphia. Three courses: Gait Biomechanics and Orthotic Applications: Management of Hip and Foot/Ankle Complex for Tone-Involved Pediatrics; Mold-To-Patient Custom Orthotics. Approved for 18 CEUs. Call 888/678-6548, e-mail info@allardusa.com.

LIST EVENTS IN THE O&P ALMANAC Telephone and fax numbers, e-mail addresses and Websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words

Member rate

Non-member rate

25 or less $40 $50 26-50 $50 $60 51+ $2.25 per word $3.00 per word Specials: 1/4 page, color 1/2 page, color

SEPTEMBER 30: $482 $634

$678 $830

Mandatory Accreditation Deadline for Pedorthic and Post-Mastectomy Organizations. The Center for Medicare and Medicaid Services (CMS) has announced that September 30, 2009 is the deadline for all DMEPOS patient care organizations to obtain accreditation. Exemptions have been granted to many

Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Make checks payable in U.S. currency to:

American Orthotic & Prosthetic Association Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or E-mail srybicki@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. For information on continuing education credits, contact the sponsor. Questions? E-mail srybicki@AOPAnet.org.

O&P ALMANAC SEPTEMBER 2009

providers, including O&P facilities. All organizations providing post-mastectomy products and pedorthic services in any capacity are not exempt from the accreditation deadline. For more information on the exemptions, deadlines and ABC accreditation, please visit www.abcop.org/accreditation. Contact: Christine Michael at cmichael@abcop. org or 703/ 836-7114, ext. 250. SEPTEMBER 30 Ultraflex: Pediatric UltraSafeGait Continuing Education Course, via WebEx, 11:00 am - Noon ET, course covers clinical assessment and compensating for pediatric gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO, Register at www.ultraflexsystems.com, 800/220-6670. OCTOBER 2: OPGA: Compas Course, Chicago. Northwestern University. One-day course covering patient evaluation with computerized prosthetic alignment system. Instructed by David Boone, CP, MPH, Ph.D and John Michael, MEd, CPO/L, FAAOP, FISPO. Compas™ provides practitioners with real-time, dynamic gait analysis to assess and achieve optimal prosthesis alignment. 7 CEUs. Register at 800/214-6742 or www.opga.com.

The iPecs* (Intelligent Prosthetic Endoskeletal Component System) is a wireless prosthetic gait lab without floors or walls to limit your research goals. It is destined to change the type of prosthetics research possible and allow for measuring things in a â&#x20AC;&#x153;real wordâ&#x20AC;? environment like never before. The iPecs accurately measures all the forces & moments experienced by an amputee while performing nearly any activity in a variety of settings. The precision data is collected and transmitted wirelessly to your PC or onboard memory. iPecs is considered a vital tool for developing evidenced based outcomes. And, the iPecs unit easily integrates into a finished endoskeletal prosthetic with the use of an industry standard 4-hole adapter. Once again, College Park continues to lead the way with innovative ideas and products. * The project described was supported by Award Number R43HD059285 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health.

17505 Helro Drive â&#x20AC;˘ Fraser, MI 48026 800.728.7950 | FAX: 800.294.0067 586.294.7950 | FAX: 586.294.0067

www.college-park.com

calendar

OCTOBER 7-11:

OCTOBER 9-10:

Applied Technology Institute (ATi) Orthotic Fitter School. Nashville, TN. Gaylord Opryland, Independent comprehensive course to prepare for certification exam. Participants are eligible for 42.75 credits from BOC when also taking the Therapeutic Shoe/Diabetic Foot Course. ABC has granted ATi approved education status. For information visit www. kasseledu.com or contact Lois Meier at 888/265-6077 or e-mail lois@kasseledu.com.

American Academy of Orthotists & Prosthetists One-Day Seminars. Hyatt Regency O’Hare, Chicago. Visit www.oandp. org/education/seminars/ one-day/ for details. Contact: Matt Beierschmitt at 202/380-3663, ext. 206 or mbeierschmitt@oandp.org. OCTOBER 10-11: OPGA: Maximize Upper Extremity Care, Ypsilanti, MI. Eastern Michigan University. Two-day course covers techniques for humeral and shoulder disarticulation levels. Discuss case scenarios with demonstrations of body-powered, externally powered, hybrids and bilateral devices. Instructed by Randy Alley BSc, CP,

LP, CFT, FAAOP, Diane Atkins, OTR, FISPO, and Bill Hanson of LTI. CEUs applied for. Register at 800/214-6742 or www. opga.com. OCTOBER 14-15: ALLARD USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Ft. Lauderdale, FL. Three courses: Gait Biomechanics and Orthotic Applications: Management of Hip and Foot/Ankle Complex for Tone-Involved Pediatrics; Mold-To-Patient Custom Orthotics. Approved for 18 CEUs. Call 888/678-6548, e-mail info@allardusa.com.

OCTOBER 14-16: New England Chapter of AAOP Annual Meeting. Manchester, NH. Radisson Hotel. Contact Szeller@ Bostonbrace.com or Erin Cammarata at 978/835-3084. To register online visit www. regonline.com/707308. OCTOBER 15 Ultraflex: Pediatric UltraSafeGait Continuing Education Course, via WebEx, 10:00 – 11:00 am ET course covers clinical assessment and compensating for pediatric gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO, Register at www.ultraflexsystems.com, 800/220-6670.

LimbLogic VS™ Applications Practitioner Course: October 8, November 5, December 3 Course covers the various clinical aspects of LimbLogic VS applications: static & dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, & troubleshooting. (Note: comprehensive socket fabrication instruction is provided in technician course.) Credits: 7.25 ABC; 7.0 BOC

Webinar Courses*

LimbLogic VS Applications Technicians Course: October 9-10, November 6-7, December 4-5 Learn all aspects of fabricating the LimbLogic VS system for various applications: recommended socket materials, controller configurations & care, fob operation, & troubleshooting. Attendees fabricate sockets following recommended techniques for airtight socket designs. Credits: 11.75 ABC; 11.5 BOC

Discover LimbLogic VS: It’s What You’ve Been Missing October 6, November 3, December 1: 1:30pm Critical components and operation usage of LimbLogic VS. Covers interpreting feedback from the LimbLogic VS fob & basic fabrication processes for the system. Credits: 2.5 ABC; 2.0 BOC

Optional 3-Day Course: October 8-10, November 5-7, December 3-5 Available to individuals who are both clinicians and technicians. Attendees for the 3-day course will smoothly progress from the clinical aspects of LimbLogic VS into the manufacture and fabrication process.

To register, visit the education section at www.owwco.com. Take the Guesswork Out of Elevated Vacuum Suspension September 30, November 24: 1:30pm Course covers background information and theory to the concept of elevated vacuum. Appropriate clinical applications and components available on market discussed. Credits: 1.5 ABC; 1.0 BOC

Clinical Tricks & Techniques: Increase Your Success with LimbLogic VS October 7, November 4, December 2: 1:30pm Covers clinical treatment plans for using LimbLogic VS, the application of fabrication processes, in-depth review of the diagnostic process, & recommended methods to educate patients using LimbLogic VS. Credits: 2.5 ABC; 2.0 BOC *All webinars are held on Eastern Standard Time.

No registration fee. Hotel and meals paid. To register, call Kathy Kennedy at 1-877-665-5443 or visit www.owwco.com. Almanac-1-2 Summit_0809.indd 1

8/12/09 9:31 AM

O&P ALMANAC SEPTEMBER 2009

How do you measure your success?

Successful Years in the U.S.

20+

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20+ Studies

30,000+ Knees in Use

One smile at a time. We measure our success based on your satisfaction. We know that the C-Leg® is just part of what gets you and your patients smiling—and that the key to success is your skillful clinical determination. Knowing that the numbers are on your side with proven results can make it easier to get a grin, too. We want to thank you for 10 years of C-Leg success, too, and invite you to celebrate with us. Visit www.ottobockus.com to get a free poster and brochures—or call your Sales Representative for more details. w w w.ot tobockus.com

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New calendar additions appear in color AOPA-sponsored activities appear in a color box

calendar

OCTOBER 16

OCTOBER 27

NOVEMBER 16-17: DECEMBER 10-12:

OPGA: Bioness Training Course, Orlando, FL. One-day course covers the NESS L300 system evaluation and hands-on training. Instructed by Keith McBride, MPT, DPT and John Michael, MEd, CPO/L, FAAOP, FISPO. The NESS L300 is a userfriendly neuroprosthetic designed to improve gait for individuals experiencing foot drop. 7 CEUs. Register at 800/214-6742 or www.opga.com. OCTOBER 19-23 Trulife Fitters Course 2009. Trulife Institute of Applied Technology (TIAT) St. Petersburg College. St. Petersburg, FL. To register contact Emily Swain at 800/248-6463 or www.spcollege.edu/ac/ce. OCTOBER 23 Ohio Orthotics and Prosthetics Association Annual Fall Meeting. Doubletree Hotel, Columbus, OH. Contact Dianne Farabi 614/659-0197 or dfarabi@ columbus.rr.com. OCTOBER 24 Ohio Chapter, American Academy of Orthotists and Prosthetists (AAOP) Annual Fall Scientific Meeting. Doubletree Hotel, Columbus, OH. Contact Richard W. Butchko 614/659-0197 or butchko1@ columbus.rr.com or go to www.ohiochapteraaop.com.

Ultraflex: Pediatric UltraSafeGait Continuing Education Course, via WebEx, Noon – 1:00 pm ET course covers clinical assessment and compensating for pediatric gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO, Register at www.ultraflexsystems.com, 800/220-6670. OCTOBER 29-31 Annual North & South Carolina AAOP Meeting. Ballantyne Golf Resort, Charlotte NC, 13 CEUs. For hotel/meeting reservations and information go to www.ncaaop.com.

AOPAversity Mastering Medicare: Advanced Coding and Billing Techniques. Las Vegas. Mandalay Bay Hotel. To attend contact Erin Kennedy at 571/431-0876 or e-mail ekennedy@AOPAnet.org.

NOVEMBER 16-21: ABC Certification Written Exam Dates. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, technicians, and fitters; the application deadline for these exams is Sept. 1. Contact: ABC at 703/8367114.

NOVEMBER 4-5:

Rehabilitation Institute of Chicago: Pediatric Gait Analysis and Orthotic featuring Elaine Owen. Chicago. 23 ABC Credits. For more information visit www.ric.org/education or contact Melissa Kolski at 312/238-7731.

2010 FEBRUARY 19-20: PrimeFare West Regional Scientific Symposium 2010, Salt Lake City. Salt Palace Convention Center. Contact Jane Edwards at 888/388.5243 or visit www.primecareop.com. MARCH 24-27:

DECEMBER 3-4: ALLARD USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Detroit. Three courses: Gait Biomechanics and Orthotic Applications: Management of Hip and Foot/Ankle Complex for Tone-Involved Pediatrics; Mold-To-Patient Custom Orthotics. Approved for 18 CEUs. Call 888/678-6548, e-mail info@allardusa.com.

ALLARD USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education). Denville, NJ. Three courses: Gait Biomechanics and Orthotic Applications: Management of Hip and Foot/Ankle Complex for Tone-Involved Pediatrics; Mold-To-Patient Custom Orthotics. Approved for 18 CEUs. Call 888/678-6548, e-mail info@allardusa.com.

O&P ALMANAC SEPTEMBER 2009

36th Academy Annual Meeting & Scientific Symposium. Hyatt Regency Chicago. Visit www.academyannualmeeting.org for the latest information. Contact: Diane Ragusa at 202/380-3663, ext. 208 or dragusa@oandp.org. MAY 12-15: International Trade Show for Prosthetics, Orthotics and Rehabilitation Technology: “Orthopadie + Reha-Technik 2010” Leipzig, Germany. Visit www.ispo-2010-leipzig.de.

calendar

New calendar additions appear in color AOPA-sponsored activities appear in a color box JUNE 2-5:

JUNE 10-11:

Association of Children’s Prosthetic-Orthotic Clinics 2010 Annual Meeting. Clearwater, FL. Sheraton Sand Key Resort. For more information contact call 847/698-1637 or email acpoc@aaos.org or visit www.acpoc.org.

Michigan Orthotics & Prosthetics Association (MOPA) Continuing Education Seminar. Mt. Pleasant, MI. Soaring Eagle Casino & Resort. For details visit www.mopa.info or contact Mary Ellen Kitzman at 248/615-0600 or MOPA_ meeting@MOPA.info.

SEPTEMBER 29OCTOBER 2

2011 MARCH 28 - APRIL 2:

AOPA National Assembly. Rosen Shingle Creek Resort. Orlando, FL. Exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/431-0852, or koneill@AOPAnet.org.

JUNE 4-5:

Association of Children’s Prosthetic-Orthotic Clinics 2011 Annual Meeting. Park City, UT. The Canyons. For more information contact call 847/698-1637 or e-mail acpoc@aaos.org or visit www.acpoc.org. a

PrimeFare East Regional Scientific Symposium 2010, Nashville Convention Center, Nashville, TN. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

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O&P ALMANAC SEPTEMBER 2009

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www.beckerorthopedic.com

The Bremer Group Company

904/645-0004

www.bremergroup.com

Cascade Dafo

800/848-7332

www.cascadedafo.com

College Park Industries Inc.

31, 71

800/728-7950

www.college-park.com

Cybertech Medical

800/220-4224

www.cybertechmedical.com

Daw Industries

1, 61

800/252-2828

www.daw-usa.com

Dr. Comfort

7, 79

800/556-5572

www.drcomfortdpm.com

Ferrier Coupler Inc.

37, 52

800/437-8597

www.ferrier.coupler.com

Fillauer Companies Inc.

800/251-6398

www.fillauercompanies.com

KISS Technologies LLC

33, 75

410/663-5477

www.kiss-suspension.com

KNIT-RITE

800/821-3094

www.knitrite.com

Lohmann & Rauscher

800/279-3863

www.lohmann-rauscher.com

Med Spec

800/582-4040

www.medspec.com

Motion Control Inc. - A Fillauer Company 39

888/696-2767

www.utaharm.com

Ohio Willow Wood

800/848-4930

www.owwco.com

OPTEC

888/982-8181

www.optecusa.com

Orthomerica Products

17, 77

800/637-4500

www.orthomerica.com

OssurÂ® Americas Inc.

800/233-6263

www.ossur.com

OTS Corp.

5, 15

800/221-4769

www.ots-corp.com

Otto Bock HealthCare

C2, 73

800/328-4058

www.ottobockus.com

PEL Supply Company

800/321-1264

www.pelsupply.com

Poly-Gel LLC

866/438-2297

www.thermotecc.com

RSLSTEEPER(c/o Liberating Technologies)

800/437-0024

www.liberatingtech.com

Spinal Technology Inc.

9, 63

800/253-7868

www.spinaltech.com

SPS

13, 23

800/767-7776 x3

www.spsco.com

Ultraflex Systems Wear Ease

11 21

800/220-6670 208/424-0512

www.ultraflexsystems.com www.wearease.com

American Board for Certification in

O&P ALMANAC SEPTEMBER 2009

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glad you asked

Glad You Asked… About Stroke-Related Care “What has been your most challenging stroke-related care issue?”

Getting physicians, therapists, and orthotists to understand the importance of transverse rotation control in the foot and ankle. Many times patients are referred to us for orthotic assistance after several months have gone by. A high percentage of them bring in an OTS or custom plastic AFO with no rotational control design to maintain the foot and ankle in a neutral and acceptable weight bearing position. As a result, we have to deal with plantar flexion tightness as will as the tone. Mark K. Taylor, MLS, CPO, FAAOP University of Michigan My most challenging situation was working with an elderly lady who was a right above-the-knee amputee and had a stroke affect her left leg and arm. She had decreased strength and stability in bearing weight on her sound limb (left), and at the same time, she had to force herself both physically and mentally to apply and trust her weight shifting over to her prosthetic side. She also wore an AFO on her left leg and had very little use of left arm, so her right arm was her most dominant extremity. Definitely a tough situation. Scott Waite, MPT Fourroux Prosthetics

The biggest challenge I have encountered in providing stroke-related care is the lack of recognition of the opportunity for continuous change. After a CVA, there is the expectation of some rapid, immediate improvements and functional gains. Often, the long-term changes that occur in the years following stroke are just as dramatic but may be overlooked because the stroke survivors are no longer in formal rehabilitation programs. Positive changes and improvements can be found many years after the stroke by survivors who pursue a variety of physical activities such as walking, swimming, Tai Chi, fitness programs, and other hobbies. Deanna Fish, MS, CPO Hanger Orthopedic Group

DEAL

The biggest challenges I see are at two ends of the spectrum. When fortunate to see the patient within a few weeks after they have had their accident, you can be part of a team that may help them start to walk safely again and may help to prevent any contractures from forming. The challenge in an acute-care setting is that you don’t want to over manage them with an orthosis that will not fit or function properly after a short period of time. You also don’t want to restrict them from getting back to ambulating on their own by fitting them with a bulky, restrictive orthosis. The other common challenge I have with patients soon after they have had a stroke, is knowing how to address any knee instability. There are many options, but again, you don’t want to over manage at this stage. At the other end of the spectrum, being referred a patient a year or more after they have had a cerebrovascular accident (CVA) presents other problems (especially if they have not been getting proper medical care). We often see patients with rigid deformities that are hard to manage with an orthosis. Trying to accommodate the deformity often leads to skin breakdown and difficulty in tolerating the device. I believe it is important for us to educate our referral sources on how we can help this patient population during the early stages of their rehabilitation in order to prevent long-term problems. Mark Clary, CO, Prosthetic Resident Berke Prosthetics

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Often, my personal biggest challenge in stroke-related care is how soon I should begin orthtotic care to balance the needs and desires of the patients, physicians, therapists, and payers (sometimes hospitals, sometimes insurance). Gary Steren, CPO Cornell Orthotics & Prosthetics Inc.

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O&P ALMANAC SEPTEMBER 2009

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