September 2017 O&P Almanac by AOPA

COVER STORY: UNCOMMON O&P CLINICIANS EXPLAIN THEIR ONE-OF-A-KIND ORTHOTIC AND PROSTHETIC SOLUTIONS P.28 The Magazine for the Orthotics & Prosthetics Profession

S E P T E M B E R 2017

Deadlines for Applications, Appeals, and Overpayments P.20

Are You Cultivating an Ethical Workplace? P.38

Centennial Celebration AOPA 1917-2017

Treatment Protocols for Cranial Deformation P.68

and WORLD CONGRESS

Q&A With a CPO in Saudi Arabia

WWW.AOPANET.ORG

P.74

E! QU IZ M EARN

BUSINESS CE

CREDITS P.24

This Just In: House Passes Bill Legitimizing O&P Notes P.26

YOUR CONNECTION TO

EVERYTHING O&P

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

e c n e i r e p Ex

September 26-29, 2018

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

Capilano Suspension Bridge Vancouver Aquarium Forbidden Vancouver Stanley Park Horse-Drawn Tours Harbour Cruises & Events Flyover Canada

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

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

AOPAnet.org

#AOPA2018

Experience all the AOPA National Assembly has to offer while visiting Vancouver.

contents

SE PTE M B E R 2017 | VOL. 66, NO. 9

FEATURES

COVER STORY

The Medicare Part B Improvement Act of 2017, H.R. 3178, was acted by consent of the House of Representatives on July 25. This bill is the first step in the legislative process to achieve recognition of the orthotist’s/ prosthetist’s notes as part of the medical record. Next up is the Grassley-Warner bill in the Senate.

38 | Do the Right Thing 28 | Uncommon O&P Every O&P patient is unique—but some patients require orthotists and prosthetists to take “custom fabrication” to a whole new level. Clinicians well-versed in designing one-of-a-kind devices share their experiences treating patients of various ages and ability levels—from elite athletes to patients with comorbidities. By Christine Umbrell

PHOTO: Hanger Clinic

26 | This Just In Note-Worthy O&P Legislation

A clearly defined code of ethics can position an O&P facility as a reputable healthcare company focused on providing high-quality, appropriate, and unbiased patient care. Establishing and following an ethical code can yield positive results for a facility, including reducing waste, fraud, and abuse and promoting a more structured and efficient workforce. By Lia K. Dangelico

SPECIAL SECTION

2017 AOPA WORLD CONGRESS & CENTENNIAL CELEBRATION

SEPTEMBER 2017 | O&P ALMANAC

46 | International Exhibition Find out what’s new in the 2017 Exhibit Hall, and meet the title sponsors of this year’s event.

56 | Exhibit Hall Map Plan your route on this two-page aerial view of the trade show floor.

56 | Exhibitor Directory See the full list of international companies exhibiting at the World Congress & Centennial Celebration.

contents

SPECIAL SECTION

DEPARTMENTS Views From AOPA Leadership......... 4

AOPAâ&#x20AC;&#x2122;S 100TH ANNIVERSARY

Insights from AOPA President Michael Oros, CPO, LPO, FAAOP

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

64 | Then & Now AOPA and the evolution of the L codes

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

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

68 | Bridge to the Future Standardizing treatment protocols for cranial deformation

74| The Global Professional Meet the head of an O&P department at a hospital in Saudi Arabia

P.12 People & Places........................................16 Transitions in the profession

AOPA News.............................................. 82

COLUMNS Reimbursement Page........................ 20

Member Spotlight................................. 78

Adhering to deadlines for appeals, applications, and overpayments

The Clock Is Ticking

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

CREDITS

FitRight Precision Orthotic and Prosthetic Lab Mobius Bionics

AOPA meetings, announcements, member benefits, and more

Welcome New Members ................. 84 PAC Update ............................................. 84 Marketplace............................................. 86 Careers..........................................................91 Ad Index.......................................................91 Calendar......................................................92 Upcoming meetings and events

Ask AOPA.................................................. 96 P.78

Fingerprinting requirements, claim submission deadlines, and more

O&P ALMANAC | SEPTEMBER 2017

VIEWS FROM AOPA LEADERSHIP

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

Board of Directors OFFICERS

Marking the Moment

President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL

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

OU’VE HEARD FROM THE AOPA BOARD OF DIRECTORS these last few months about key areas of AOPA activities and developments in O&P that affect all of us. But this month, with the significance of the 100th anniversary of AOPA combined with the Second World Congress, I want to share with you my own thoughts on why this September 6-9 event in Las Vegas is so significant. One hundred years of service by any organization represents a milestone few achieve. There aren’t that many specialties in health care that can claim roots going back to the Civil War and beyond, where O&P can find many of its founding fathers. While AOPA itself is celebrating its 100-year milestone this year, there are dozens of loyal AOPA member companies whose roots go back even further. AOPA pays special tribute to our colleagues affiliated with those longstanding companies. That’s why AOPA members should recognize the Centennial Celebration as a truly once-in-a-lifetime opportunity to enjoy our legacy as a stepping stone to our future. There is no doubt in my mind that the next century will be even more demanding of our clinical skills and challenging to our business acumen. Taking part in the celebration in Las Vegas this month is part of a unique learning opportunity that will help prepare attendees for the changes to come in the future. Beyond the Centennial Celebration, where we will experience our own legacy and look through a window to the future, we have the dual opportunity to take part in the Second World Congress, which expands our view on the world of O&P care. The roster of global talent representing the most sophisticated learning opportunities ever assembled for an O&P event is just one more reason this year’s attendees will benefit from this O&P version of a “double header.” Research and treatment protocols that are creating better outcomes for patients are really what it is all about. And that is exactly what you will find at this Centennial Celebration and World Congress. Please join me and my colleagues on the AOPA Board of Directors as we share with AOPA members the thrill and the accomplishments that have advanced our patient care, as well as the reward we experience of almost always leaving our patients better than we found them.

Michael Oros, CPO, LPO, FAAOP, is president of AOPA.

SEPTEMBER 2017 | O&P ALMANAC

Vice President Chris Nolan, LPO Ottobock North America, Austin, TX Immediate Past President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Edmonds, WA Traci Dralle, CFm Fillauer Companies Inc., Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Townsend Design, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

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AOPA CONTACTS

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

Editorial Management Content Communicators LLC

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

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

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

Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org

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

Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org

Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com

AOPA Bookstore: 571/431-0865

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

SEPTEMBER 2017 | O&P ALMANAC

Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email landerson@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 12,500 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac17 for advertising options!

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NUMBERS

AOPA By the Numbers The association’s products and services have expanded as the association has grown

Over the past 100 years, AOPA has educated members, advocated on behalf of the profession, and created member benefits to aid the O&P community in providing optimal patient care.

ANNUAL MEETINGS

33 ~100

Number of attendees at the Artificial Limb Manufacturers Association (ALMA) Convention in Indianapolis in 1918.

MEMBERSHIP & DUES

$10

AOPA POLICY FORUM

1992

Annual AOPA dues in 1940.

Year the first Policy Forum was held in Washington, D.C.

$25/$50/$100

Dues in 1945, the first year of the tiered structure, based on gross sales.

>2,050

Number of member locations in 2017. Year that “Affiliate Members” were added to AOPA membership rolls.

1990

Number of attendees at the ALMA Convention in Chicago in 1937.

>395

NUMBER OF MEMBERS

1946 Budget: $17,500 Dues: Three Tiers Based on Gross Sales— $25/$50/$100

1,500

1,000

S. 1191 & H.R. 2599 Bill numbers for Medicare O&P Improvement Act of 2017, advocated for by 2017 Policy Forum attendees.

500

0 1917

1940

1946

1950 1955 1960

SEPTEMBER 2017 | O&P ALMANAC

1975

Year the Guide was first published, originally called the Pictorial Reference Manual of Orthotics and Prosthetics.

250 vs. 423

Number of pages in the Guide in 1986 versus 2016.

SEMINAL MOMENTS

2017 Budget: $5.8 million Dues: Patient-Care Facility—$1,995; Affiliate—$350; Supplier— Sliding scale based on gross sales volume

1940 Budget: $3,500 Dues: $10

1986

Number of congressional visits made by AOPA members during the 2017 Policy Forum.

MEMBERSHIP

2,000

Number of attendees at the 2016 AOPA National Assembly in Boston.

AOPA ILLUSTRATED GUIDE

AOPA Membership 1917-2017 2,500

>2,200

1980 1985 1990 1995 2000 2005 2010 2016

2017

1979

Year the pilot program for the L codes—developed by AOPA and Blue Cross Blue Shield— was rolled out.

1996

Year AOPA persuaded the Senate Judiciary Committee to shelve the Prosthetic Limb Access Act of 1996.

2015

Year AOPA drove initiatives that led to the DME MACs’ decision not to finalize a draft Local Coverage Determination and Policy Article governing Medicare coverage of lower-limb prostheses.

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Happenings RESEARCH ROUNDUP

Researchers Develop Assistive Stairs for the Mobility Impaired Demonstrating ascent on the energy-recycling stairs

movement alleviates work by the trailing ankle, which is what keeps you balanced and prevents you from falling too fast on normal stairs.” During testing, when trial participants ascended the stairs, the prototype was found to decrease leg exertion by 17 percent and knee exertion by 38 percent. During descent, leg exertion was decreased by 22 percent and ankle exertion by 26 percent, according to the researchers. The prototype has been tested by healthy young adults, and plans are underway for trials with mobility impaired participants. “Our promising results that show energy recycling during stair negotiation in young healthy participants motivates further refinement and optimization of the Energy-Recycling Assistive Stairs to aid older adults and individuals with a wide range of mobility impairments,” concluded the researchers. These results were published in a Public Library of Science PLOS ONE article in July.

PHOTO: Yun Seong Song et al (2017)

Researchers have developed a prototype of an EnergyRecycling Assistive Stair system designed to decrease leg, knee, and ankle exertion during ascent and descent. The stairs are intended as a low-cost solution to safer and easier stair navigation among individuals with mobility impairments. Karen Liu, a computer scientist at Georgia Tech in Atlanta, partnered with Lena Ting, PhD, a professor of biomedical engineering and rehabilitation medicine at Emory University, and Yun Seong Song, an assistant professor of mechanical engineering at the Missouri University of Science and Technology, in designing a prototype. Each step in the assistive stairs is supported by a system of springs. When test subjects descend the stairs, the springs compress and are held down by clamps. When they ascend, the springs release, offering an extra boost. The stairs are equipped with sensors that detect which step a user is on; the sensors are the only part of the system requiring electricity. “The spring in the stairs, instead of the ankle, acts as a cushion and brake,” said Song. “The gentle downward

Study Confirms Mirror Therapy May Alleviate Phantom Limb Pain

SEPTEMBER 2017 | O&P ALMANAC

Study participants each received 15 minutes of the assigned therapy daily, five days a week, for four weeks. During their treatments, members of the research team met with patients to oversee the therapy and complete pain surveys. The mirror-therapy group placed their intact hands before mirrors in the mid-sagittal line and performed a series of hand movements, moving their opposite residual limbs in a similar manner. Eight of the nine participants who took part in mirror therapy experienced a decrease in pain, while only one experienced an increase in pain. Five of the control group participants switched to mirror therapy after 11 treatment sessions and completed four weeks of mirror therapy; all had decreased pain severity and pain duration periods, according to the researchers. The results “confirm that mirror therapy is an effective therapy for phantom limb pain in unilateral, upper-extremity male amputees, reducing both severity and duration of daily episodes,” according to the researchers. The findings were published in the July issue of Frontiers in Neurology.

PHOTO:Getty Images/PeskyMonkey

Upper-extremity amputees with phantom limb pain experienced a significant decrease in pain scores by engaging in mirror therapy. Researchers at Walter Reed National Medical Center and Brooke Army Medical Center studied the efficacy of mirror therapy on 15 trial participants who were randomly assigned to either a mirror therapy group, where participants engaged in mirror therapy, or a control group, where mirrors were covered or participants relied on mental visualization therapy. Each participant had used medication for phantom limb pain without relief.

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HAPPENINGS

O&P INNOVATION

Research Company Develops Prosthetic Foot Emulator Emulator technology designed to aid researchers and clinicians in testing new prosthetic devices is being developed at Humotech, a company founded on research from Carnegie Mellon University (CMU). The emulator is a “robotic, wearable device that we program to mimic the behavior of conventional devices or to test novel device ideas,” says Josh Caputo, PhD, president and chief executive officer. The emulator is worn like a conventional device; for prosthetic foot testing, the emulator attaches to the user’s residual limb with a standard pylon. “What makes it very different from other devices is that the emulator is powered and controlled by an offboard motor,” Caputo explains. “For now, the emulator can only be used during walking or running on a treadmill or stairmill, but we are exploring other possibilities.” The offboard actuation Josh Caputo, PhD allows Caputo and his team to make the device that the person wears extremely lightweight, which is necessary for the emulator to accurately mimic passive, nonpowered devices. The technology originated at the Experimental Biomechatronics Lab at CMU, where Caputo earned his doctorate while working under the supervision of Lab Director Steve Collins, PhD. “We were interested in developing a prosthetic foot with actively powered push-off. We recognized that the development process for new O&P devices was rather inefficient; coming up with the idea for a new type of device can happen overnight, but then iteratively prototyping and testing with patients takes years of hard work,” says Caputo. The CMU team sought to create a versatile robotic platform where new ideas could be implemented and tested quickly with patients. “This way we could avoid spending tons of time

SEPTEMBER 2017 | O&P ALMANAC

PHOTOS: Josh Caputo, PhD

engineering and building feet and instead focus on what we think is a more fundamental challenge for the field: How should a prosthetic device behave in order to optimize outcomes for the patient?” Factors such as whether the device has a motor or is passive, is made of carbon fiber or fiberglass, etc., are secondary considerations. “Let’s first identify what is best for the patient, and then we can think about how to embody that functionality into a physical product they can take home with them,” explains Caputo. “Whether the goal of your work is to invent new technology to improve lives years in the future, or to figure out how to help the patient in your office achieve their goals, Humotech’s emulator technology is a way to quickly reach an evidence-based determination of what works best for the patient.” Caputo is currently working with David Morgenroth, MD, and his team at the Seattle VA Center for Limb Loss and MoBility on a Department of Defense-funded project studying test drive strategies for prosthetic foot prescription using the emulator. The technology is being leveraged in research applications, and clinical applications are forthcoming. “A solution like this is necessary if we are to improve outcomes and reduce costs in O&P,” says Caputo. “We have shown that prosthetic feet are really not one-size-fits-all; a device that works great for one patient may be very suboptimal for a similar patient. The best choice of a device can depend strongly on which outcomes you measure: Patient feedback? Metabolic energy consumption? Aesthetics of gait?” Using the emulator will enable new measurements and drive more informed decision making, says Caputo. Humotech is gathering data to show that the emulator experience is “realistic and predictive, results in better outcomes for the patient, and saves health-care costs,” says Caputo. “We believe if we can establish a new standard of care where patient outcomes data from emulator evaluations becomes integral to cost justification, that we can build trust and payors will be more interested in spending on care for amputees now to save later on reduced longer-term health-care costs.”

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HAPPENINGS

CODING CORNER

O&P INNOVATION

DME MACs Clarify Requirements for Use of A5513 The durable medical equipment Medicare administrative contractors have published a joint publication addressing the proper use of Health-Care Common Procedure Coding System (HCPCS) code A5513, which is used to describe Molded-to-PatientModel Diabetic Shoe Inserts. To meet the requirements of the HCPCS code descriptor, diabetic inserts billed using A5513 must be molded over an actual model of the patient’s foot, according to the joint publication. The use of generic, electronic, or “virtual” models, where custom fabrication occurs without creation of a physical model of the patient’s foot, does not meet the code descriptor, and diabetic inserts fabricated this way cannot be billed as A5513. Inserts fabricated using generic, electronic, or virtual models must be coded as A9270—Noncovered Service, according to the publication. AOPA is evaluating the impact of this clarification and will be discussing this issue with the DME MACs in the near future.

High-Tech Knees in the Works for Use in Developing Countries

SEPTEMBER 2017 | O&P ALMANAC

RAC Begins Audits for Custom-Fabricated AFOs and KAFOs Performant Recovery, the Recovery Audit Contractor (RAC) for national home health, hospice, and durable medical equipment, prosthetics, orthotics, and supplies, has initiated a postpayment medical review for custom-fabricated ankle-foot orthosis (AFO) and knee-anklefoot orthosis (KAFO) claims, as of July 7, 2017. Providers whose claims are selected for review will receive a letter from Performant Recovery requesting relevant documentation to support medical necessity. Providers who receive an additional documentation request (ADR) should respond; failure to do so will result in automatic claim denial and recovery of any payments. As with all RAC

reviews, specific rules are in place that limit the number of ADRs that O&P providers may receive to a maximum of 10 ADRs per taxpayer identification number every 45 days. The RAC audit for custom AFOs and KAFOs is the first O&P-specific approved issue since the award of the new RAC contract to Performant Recovery.

PHOTO: Getty Images/Sasesisuso, NorthernStock

AUDIT ANSWERS

PHOTO: http://d-rev.org/projects/mobility/gallery/

D-Rev, a development company based in San Francisco, was one of six organizations to be awarded grants in July by the United Kingdom Department for International Development, which identifies solutions to challenges facing people with disabilities in other countries. The company was awarded approximately $100,000 in aid money to develop a polycentric, four-bar knee designed for use on uneven ground. The prosthesis is to be geared toward amputees in Bangladesh, Burma, Kenya, Nepal, Rwanda, and South Africa. Rob Weiss, product manager at D-Rev, will lead the team during the research phase over the next 18 months. Their goal is to develop a safe, cost-effective prosthetic knee with hydraulics or microprocessors. The design will focus on improving walking speed, providing a natural gait, and offering protection against stumbling, according to the researchers. They are aiming to keep costs down to approximately $80 per unit, and reportedly hope to begin producing 10,000 knees each year by 2021.

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Jim Andreassen

Jim Andreassen has joined Nabtesco-Proteor USA as midwest sales and business development manager. He also will spearhead the company’s new Trial Fit Clinic initiative. Andreassen has 27 years of experience in the O&P field, including prior executive appointments at several patient-care facilities, and he is former president of OPGA in Waterloo, Iowa. Level Four Orthotics and Prosthetics Inc. announced the appointment of James Button as its new chief executive officer. Previously, Button served as chief executive officer of Allard USA, a company that in North America markets and sells orthotics manufactured in Europe and Asia.

James Button

John Craig, CPO, LPO, FAAOP, FISPO

John Craig, CPO, LPO, FAAOP, FISPO, of Brownwood, Texas, recently returned from Oaxaca, Mexico, where he was one of three medical rehabilitation professionals who were honored by Uniendo Fronteras for their pioneering efforts in continuing education conferences for medical rehabilitation team members in Latin America.

Kris Desjardins, CPO, FAAOP, has joined Ability Prosthetics & Orthotics’ Exton, Pennsylvania, patient-care center. She graduated from the Newington Certificate program affiliated with the University of Connecticut in 2006 Kris Desjardins, and completed her orthotic residency in CPO, FAAOP Chicago with Scheck & Siress. In 2012, she worked as an orthotist at Hanger Clinic and attended the Newington Certificate Program affiliated with the University of Hartford to complete her prosthetics residency. Traci Dralle, CFm, has accepted the position of vice president of Fillauer Companies Inc. Dralle, who also is a member of AOPA’s Board of Directors, has been with Fillauer since 2012 when she started as director of marketing, and most Traci Dralle, CFm recently served as director of marketing and sales. In her expanded role, Dralle will manage the coordination, implementation, and communication of the organization’s overall vision, mission, values, and strategic goals. She also will continue to oversee the marketing, sales, and product development teams. With this change, Amy Neeley has been promoted to marketing manager for Fillauer Companies Inc. Brandon Green, DO, BOCP, has assumed a full-time role as Myomo’s chief medical officer. He will conduct clinical presentations and training for physicians and other clinicians involved with fitting the company’s products on patients, and will engage with payors on reimbursement policies in conjunction with the company’s Scientific Advisory Board.

THE LIGHTER SIDE Amira Mouad, CPO

Amira Mouad, CPO, joined Ability Prosthetics & Orthotics’ Asheville, North Carolina, team. She received certifications in orthotics and prosthetics from Northwestern University in Chicago in 2012 and 2013, and gained additional certification as a cranial remolding specialist in 2015.

Gerald Stark, PhD, MSEM, CPO, LPO, FAAOP, has joined Coapt LLC as director of clinical innovation, and will be responsible for fostering an evolution of the relationship between Coapt and clinical professionals. He will enhance the Gerald Stark, PhD, support, efficacy, and education surrounding MSEM, CPO, LPO, Coapt’s pattern recognition technology. Formerly FAAOP with Ottobock Healthcare and The Fillauer Companies, Stark remains a faculty member at Northwestern University and the University of Tennessee at Chattanooga.

SEPTEMBER 2017 | O&P ALMANAC

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HAPPENINGS

PROFESSIONALS Nick Woeckel, MPO, has joined Ability Prosthetics & Orthotics’ Frederick, Maryland, patient-care center as a resident prosthetist and orthotist. He received his master’s degree from Northwestern University’s Prosthetic and Orthotic Center in Chicago in 2017.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The Orthotic and Prosthetic Group of America (OPGA) has released the Nick Woeckel, MPO names of the finalists for its inaugural O&P Woman of the Year award. The Board of Certification/Accreditation (BOC) has Out of 23 nominations, four have Rachel Friddleannounced the addition of three new employees: been selected to travel to Las Vegas Linda Collins Johnson • Judi L. Knott, MA, MBA, has been named for a special award presentation. chief marketing officer. Knott has more This year’s finalists are Linda than 26 years of marketing experience, Collins, senior director of market most recently serving as vice president of access, Össur’s reimbursement participant communications and education department; Rachel FriddleJudi L. Knott, for Empower Retirement. Knott will lead Johnson, president and chief MA, MBA the strategic planning and execution JoAnne Kanas Allison Kimura, executive officer of Friddle’s CO, LO of BOC’s marketing and corporate Orthopedic Appliances Inc.; communications and will oversee the JoAnne Kanas, corporate director of orthotics and prosorganization’s business development team. thetics for Shriners Hospital for Children in Tampa; and • Cecelia Huffman has been hired as Allison Kimura, CO, LO, MedEast Post-Op & Surgical Inc. marketing communications manager. “These women represent some of the O&P profession’s Cecelia Huffman Huffman has an extensive background in best and brightest,” said OPGA’s president, Todd Eagen. “Their nonprofit, health-care-related marketing roles and responsibilities vary, but at all of their cores is the and membership development. She will be responsible for unwavering mission to better their profession in the name of developing marketing and communications initiatives. the patients who require O&P care.” The O&P Woman of the • Tyrone Vines is BOC’s new business development specialist. Year award will be presented at the OPGA member/supplier He will educate O&P and durable medical equipment reception during the AOPA World Congress in Las Vegas. practices, clinics, and suppliers on BOC accreditation and focus on the customer service experience. IN MEMORIAM

John Sabolich, CPO John Sabolich, CPO, passed away on July 23, 2017. Sabolich followed in the footsteps of his father, Lester Sabolich, CPO, starting in John Sabolich, CPO the family prosthetics business at the age of 10. He was a true visionary in his field and helped modify the modern world of prosthetics and patient care. He founded one of the nation’s largest and most advanced prosthetic centers. Other accomplishments included patenting the Sabolich Socket; writing the book, You’re Not Alone; and founding the Limbs for Life Foundation. Sabolich’s boldness and dedication led to changing the world’s expectations of what an amputee could accomplish in life; the Sabolich name came to be synonymous with excellence in prosthetic care around the world. His methods are now standard university curriculum, and he is remembered by thousands of patients around the world as well as by the industry he helped revolutionize.

SEPTEMBER 2017 | O&P ALMANAC

Scheck & Siress was a sponsor of the Department of Defense Warrior Games, a competitive athletic event for injured service members and veterans, hosted in Chicago in July. The teams competed in a variety of events, including cycling, sitting volleyball, shooting, swimming, archery, track and field, and wheelchair basketball. More than 50 employee volunteers from Scheck & Siress took part in the 10-day event, supporting the athletes by assisting with adjustments and repairs to their prosthetic and orthotic devices and their wheelchairs. Tim Russo, CPO, led the volunteer effort on behalf of Scheck & Siress. “It was amazing to see the competitive warrior spirit on display throughout the games,” he said.

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REIMBURSEMENT PAGE

By DEVON BERNARD

E! QU IZ M

The Clock Is Ticking

EARN

Know the deadlines mandated by Medicare and its contractors

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 24 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

NE OF THE BIGGEST challenges

for O&P practitioners is trying to meet all of the deadlines and timeframes set by Medicare and its contractors—including the durable medical equipment Medicare administrative contractors (DME MACs), the Recovery Audit Contractor (RAC), and the National Supplier Clearinghouse (NSC). However, not complying with these time limits can be even more problematic. This month’s Reimbursement Page focuses on some of the more universal timeframes and deadlines, rather than those related to specific policies. Being aware of and complying with these deadlines and timeframes will help you stay Medicare-compliant, and may prevent trouble down the road.

NSC Deadlines

SEPTEMBER 2017 | O&P ALMANAC

CREDITS P.24

form, the NSC will review the form. If the form is not complete or is missing information, the NSC may request additional information to complete the revalidation/enrollment process. You must respond to all additional information requests within those 30 days because failure to submit a complete and valid revalidation application or respond in a timely manner to requests may result in the deactivation of your supplier number and your billing privileges, or delay your enrollment process.

Appeals Deadlines

The first level of appeals is redetermination, and the clock for the redetermination deadline begins when you receive an official notice of denial and/or recoupment request. The official notice of initial determination is presumed to be received five days after the date provided on the notice unless you can show a different date. A request for redetermination must be filed within 120 days after you receive the notice; if you miss the 120-day window, you may not proceed to the next level because your appeal will not be processed unless you can show “good cause.” The second level of appeal, reconsideration, has a slightly longer timeframe. You have 180 days from the receipt of a redetermination results notice to file a reconsideration request. The 180-day deadline is a hard deadline, and nothing can be filed late unless you can show good cause. The last three levels of appeals— the administrative law judge, the Departmental Appeals Board/Medicare Appeals Council review, and the federal court review—all have the same

PHOTO: Getty Images/FoxysGraphic

If you update or make any changes to your business that are inconsistent with the information reported on your most recent Medicare application—for example, adding or removing services, changing business hours, moving to a new location, changing ownership, etc.—you are required to notify the NSC within 30 days. This requirement is clearly spelled out in Supplier Standard 2. The ramifications of not updating such information in a timely manner will vary, but it may result in having your provider transaction access number (PTAN) revoked; in essence, you may lose your billing privileges, and this revocation could last up to three years. The NSC also allows a 30-day timeframe to respond to any requests for additional information. Once you have paid your application fee and submitted your enrollment/revalidation

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REIMBURSEMENT PAGE

deadline. All requests for each level must be filed within 60 days of the official receipt of outcomes or your official letter from the previous level. If at any point you cannot meet the 60-day deadline, your appeal requests will be dismissed, unless you can document and demonstrate good cause. The exception to this rule is when you are taking your appeal to the final level, the federal court review; if you cannot make the deadline, your appeal rights have ended. While requesting a reopening is not technically one of the official levels of appeal, it is worth mentioning the timeframe associated with such a request. A reopening allows you to reopen a Medicare claim and correct any minor clerical errors—for example, a wrong date of service, the wrong number of units, etc. You have one year from the date on your remittance advice to request a reopening. If the one-year deadline has passed, it is possible you could still file a reopening, as long as you can demonstrate a good cause for the need to reopen the claim past the one-year reopening period. When might constitute a good cause extension if you would like to reopen a claim past the Medicare set timeframe/deadline? A request for a good cause extension may not be used when your billing company, or any other entity hired by you to conduct business operations on your behalf, misses a deadline or misleads you about a timeframe. Other reasons

SEPTEMBER 2017 | O&P ALMANAC

There are several timeframes to keep in mind if you receive an overpayment/ recoupment demand letter.

that are not acceptable for good cause extensions include negligence by you or your employees; being a new company; and not understanding the rules. Circumstances where a good cause extension might be granted include situations where your facility was provided incorrect or incomplete information about the claim and/or appeal by official sources, such as CMS, the DME MAC, or the Social Security Administration. Also, unavoidable circumstances or situations that are beyond your control, such as major floods, fires, tornados, and other natural catastrophes, might be grounds for a good cause extension request.

There are several timeframes to keep in mind if you receive an overpayment/ recoupment demand letter. First is the timeframe to make sure you are not being charged any interest on the amount being recouped. If you repay Medicare within 30 days of receiving an overpayment demand/recoupment letter, you will not have to pay any interest to Medicare, as Medicare interest is calculated per 30-day periods. Also be aware of the 40-day deadline. If, 40 days after receiving a demand letter, you haven’t made any payments against the recoupment amount, Medicare will begin to offset your future claims until the recoupment amount and any accrued interest have been paid in full. Remember, however, that if you wish to be able to collect interest from Medicare, you must not voluntarily refund the money or voluntarily allow Medicare to offset your claims. To delay the recoupment process or the offsetting of future claims, you have 30 days from when you first receive an overpayment/recoupment demand letter to take action. You must file a redetermination request—the first level of appeal—within 30 days of receiving a demand/recoupment letter, rather than the traditional 120-day timeframe. If the request for a redetermination is filed after these 30 days, the recoupment process will resume as normal but will be halted once the request has been submitted and received. As you proceed to the reconsideration level of appeal, you may continue to have the recoupment process postponed. To do this, you must file the reconsideration request within 60 days of receiving the redetermination decision letter. This time period is far shorter than the previously discussed 180 days. If you file a reconsideration request after this 60-day deadline has passed, the recoupment process will begin again—but as soon as you file a request, the recoupment process will cease. Even though you may postpone the recoupment process, you may not postpone or extend the accrual of interest. Also, the ability to stop the

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Overpayment/Recoupments and Interest

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REIMBURSEMENT PAGE

recoupment process ends 30 days after you receive a reconsideration decision letter; this means that 30 days after the second level of appeals has concluded, Medicare will continue with the recoupment process even if you continue to proceed through the appeals process.

Self-Reporting

SEPTEMBER 2017 | O&P ALMANAC

Revocations

In general, prior to revocation of Medicare billing privileges, you will receive a certified letter outlining why your billing privileges are about to be revoked. The letter will state when the revocation will take effect—typically within 30 days of the postmarked date on the letter. The revocation is not a given; you do have the ability to appeal the revocation and possibly even stop it before it happens. To appeal a revocation, you must create and submit what is known as a Corrective Action Plan (CAP) within 30 days of the postmarked date on the letter of revocation. The CAP should be submitted if you can show that the NSC has made a factual mistake in its review and/or the noncompliance issue cited in the revocation letter has been addressed and corrected. You also must include assurances that you will comply in the future. If the CAP is not successful or you cannot create one in a timely manner, you may file reconsideration within 60 days of the postmarked date on the letter of revocation.

There are many deadlines associated with Medicare and its contractors. Be aware of all of them to ensure your claims and appeals are processed quickly. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. EDITOR’S NOTE: See AOPA Answers on page 96 for more information about timeframes and deadlines. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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PHOTO: Getty Images/Miha Pater

Health-care providers and suppliers have always been bound by rules to one extent or another. When it comes to overpayments—improperly paid claims or claims that should not have been paid—disregarding the rules could result in false claim liabilities, and even civil monetary penalties, if overpayments are not returned. These rules are most frequently cited when an outside entity, such as the RAC or DME MAC, identifies an overpayment and requests a refund. But what happens when you identify an overpayment on your own? Medicare published a final rule in early 2016 requiring providers and suppliers to report and return any and all overpayments that you may identify and uncover, no later than 60 days after the overpayment was identified. The final rule states that an overpayment is identified or uncovered when the person/facility has or should have, through due diligence, determined that the person/facility has received an overpayment and quantified the amount of the overpayment. So the day you find an overpayment is the day it is uncovered, and the 60-day clock begins. There is a limit, or lookback window, associated with mandatory self-reporting.

Under the final rule, overpayments must be reported and returned only if the overpayment is found or uncovered within six years of the date the overpayment was received. The process and forms (including the claims adjustment, claims offset, return overpayments, and self-reported refund form) used to report the overpayment and make the return are listed on the DME MAC websites.

The reconsideration request will likely result in an on-the-record hearing by a hearing officer not involved in the initial decision to deny or revoke billing privileges. Upon receipt of the reconsideration request, the NSC will forward all of the information to the hearing officer, who will then schedule, conduct, and render a decision. If your reconsideration is not successful, you will still have the option of an administrative law judge review, and then a Departmental Appeals Board review, just as you do with the claims appeal process. However, if you miss the 60-day window, you may not proceed to the next levels. To avoid missing deadlines, take these four steps: • Make sure that you and your staff are aware of all deadlines. • Because most deadlines and timeframes are initiated by the receipt of a notice, examine and read all of the mail you are receiving, and be sure all correspondences, letters, and notices are being sent to the proper locations. • Once you have read the notices, don’t forget about them. • Follow the golden rule: Document, especially if you need to demonstrate good cause.

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This Just In

Note-Worthy O&P Legislation House of Representatives approves legislation legitimizing orthotists’ and prosthetists’ notes

N JULY 25, the full House of

SEPTEMBER 2017 | O&P ALMANAC

1 SEC. 103. Orthotist’s and Prosthetist’s Clinical Notes as Part of the Patient’s Medical Record. Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) is amended by adding at the end the following new paragraph:

“(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS. For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals described in Section 1848(k)(3)(B).”

Advocating for the clinician’s notes to be recognized as part of the medical record has been a top priority for AOPA since the 2011 Sens. Charles Grassley “Dear Physicians” (R-Iowa) letter. This provision also has been included in the Medicare O&P Improvement Act, a bill that has been introduced every year since 2011 but never passed. Most recently, the Medicare O&P Improvement Act of 2017 was introduced in the 115th Congress earlier this summer as Senate Bill S. 1191 by Sens. Charles Grassley (R-Iowa) and Mark Warner (D-Virginia) and as House of Representatives Bill H.R. 2599 by Reps. Glenn Thompson (R-Pennsylvania) and Mike Thompson (D-California). Several members of Congress were instrumental in advancing the O&P notes provision in H.R. 3178, including Brady, Thompson, and Thompson; as well as Mike Bishop (R-Michigan), a member of the Ways & Means Committee; and Richard Neal (D-Massachusetts), the ranking minority member of the Ways & Means Committee. H.R. 3178 now moves on to the Senate, where S. 1191—the GrassleyWarner bill, supported by Sens. Bill Cassidy (R-Louisiana) and Tammy Duckworth (D-Illinois)—will hopefully move forward to favorable action.

PHOTO: Getty Images/BrianAJackson

Representatives acted by consent on suspension to adopt H.R. 3178, the Medicare Part B Improvement Act of 2017. The bill, sponsored by Kevin Brady (R-Texas), the House Ways & Means Committee chairman, would cut red tape and make some noncontroversial changes to the Medicare program by amending Title VIII of the Social Security Act “to improve the delivery of home infusion therapy and dialysis as well as the application of the Stark Rule under the Medicare Program,” according to the official record. Included in this bill was a single provision on orthotics and prosthetics—the long-awaited provision to recognize the orthotist’s/prosthetist’s notes as part of the medical record in Medicare Medical Necessity Determinations. Such recognition acknowledges that many amputee

and orthotic patients may not see the referring physician when they have issues or questions about their devices, and the bond between the patient and the O&P health professionals may be the major factor in regaining mobility and quality of life, according to AOPA. Follow-up care is one of the factors that distinguishes O&P care from wheelchairs and other durable medical equipment. This step would likely reduce unfavorable Recovery Audit Contractor audits and return the O&P provider notes to the status they previously enjoyed prior to the inception of the current CMS audit policy. Following is the specific text from H.R. 3178 as enacted by the House:

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COVER STORY

Uncommon Orthotists and prosthetists share their most interesting patient cases and innovative solutions By CHRISTINE UMBRELL

SEPTEMBER 2017 | O&P ALMANAC

PHOTO: Marlies Beerli Cabell, CPO, Ability P&O

Marlies Beerli Cabell, CPO, provided a 7-year-old patient with a prosthesis that enables her to hold an oar and kayak with her family.

COVER STORY

NEED TO KNOW • O&P clinicians who are challenged to come up with solutions to unique orthotic and prosthetic presentations may need to move out of their comfort zone and brainstorm with colleagues to best assist patients in achieving their goals. • Trial-and-error is a big part of problem solving. Patients should understand that the process may take some time and that the end result may be different than initially envisioned. • It’s important to consider the payor and try to craft a device that will result in optimal outcomes within the confines of the payors’ allowance. Some payors may be easier to work with than others. • While athletes may push clinicians to go beyond what is basic in their componentry, patients who are more limited in their abilities, or who have comorbidities, can be equally challenging in requesting solutions to help them achieve simpler goals. • Working with unique patients requires a great deal of creativity and attention to detail—in addition to ensuring that design solutions are anatomically appropriate.

F YOU HAD TO describe the job of the O&P professional with one simple phrase, “problem-solver” would likely be your first response. Orthotists and prosthetists know all too well that determining the best solution and ensuring that device fits appropriately is a complicated undertaking. No two patients are exactly alike. So it comes as no surprise that many practitioners have risen above and beyond expectations to design creative solutions for challenging patients. “Many clinicians are drawn into O&P specifically because they are problem-solvers and creative. With that being said, to come up with special solutions to unique problems, a clinician must be willing to move out of their comfort zone, and their employer must support this,” says Tim Russo, CPO, LPO, of Scheck & Siress. At Scheck & Siress, which has 15 locations, Russo says team members rely heavily on each other to tackle challenging cases, which is “an effective

way to give less experienced clinicians the confidence required to start with the unfamiliar.” Being able to find solutions for all types of patients also is key to establishing relationships with referral sources, says Russo. Many O&P professionals put forth a “can-do” attitude to help patients achieve their goals. No problem is too small, says Kim McQueen, CPO, LPO, who most recently worked at Hanger Clinic in Kirkland, Washington. “Our job is really to enhance their life. Whether it’s a simple problem-andanswer, such as mild drop foot and an ankle-foot orthosis (AFO), or a complex problem that doesn’t have a play-by-play answer we can pull from our textbooks, it’s our duty” to find a solution, she says. O&P Almanac recently spoke with Russo, McQueen, and several other creative clinicians to learn about some of their more outside-of-the-box cases and find out how they developed successful solutions. O&P ALMANAC | SEPTEMBER 2017

COVER STORY

Tim Russo, CPO, LPO, designed a partial hand prosthesis with a spring-loaded articulating digit for a patient who presented with just a fourth and fifth finger.

Partial Hand Prostheses

Treating partial hand amputees can be one of the most challenging jobs for a prosthetist, according to Russo. “Upper-extremity solutions aren’t always easy to find,” he says. “With a partial hand [versus lower-limb or higher-level uppers], what you ultimately make may not look anatomical at all—the device may end up being materialized as a unique shape in an effort to fulfill a very specific function.” Russo works closely with patients to determine their goals and design a prosthesis accordingly. He usually

asks patients to fill out a Disabilities of the Arm, Shoulder, and Hand (DASH) survey at the start of the process. “It’s a quick way of ‘spending a day with a patient’ and defining what they really need and want,” he says. “The DASH has been a helpful tool in unique cases, in figuring out what’s needed,” says Russo, because the survey works as a “translator” between the patient and the clinician. Russo led with the DASH when working with a recent unilateral patient who presented with just a fourth and fifth finger, and no thumb. Her goal

SEPTEMBER 2017 | O&P ALMANAC

PHOTOS: Tim Russo, CPO, LPO, Scheck & Siress

Russo also designed bilateral wrist-driven partial hand prostheses with multiarticulating digits for a patient who had been injured at work.

was to be able to hold a drinking glass, so Russo sought to design a prosthesis that would enable holding a cylindrical object. Russo ultimately fit the patient with a prototypical version, which “worked great,” but when she attempted to oppose, it didn’t work. “So I added a spring-loaded articulating digit, which could be pushed out of the way when necessary,” he explains. With this addition, the patient has been pleased with her partial hand prosthesis. “She’s been using it a lot. I ran another DASH at follow-up, and her percentage of disability had improved” with the new device. Russo also worked with a unique bilateral partial hand patient who had been injured at work. “His passion is to work on cars, which required being able to use some very different tools,” he says. The patient’s insurance allowed for multiple devices, which was a consideration in coming up with the overall prosthetic treatment plan. His initial goal was to develop a broad-functioning, general-use prosthesis. With such a device, “you know there are instances where it will fall short,” he says. “You have to be careful with broad-functioning devices because you don’t want it to fail and lead the patient to decide that using a prosthesis is too difficult and burdensome. Because insurance would allow him to provide additional prostheses, Russo says he approached the design process a little differently. He created a wrist-driven partial hand prosthesis with multiarticulating digits. The prosthesis utilizes a cable system to couple wrist flexion to prosthetic digit flexion, in an anti-tenodesis manner. Now, starting with this broad-use device, “we can figure out what [the patient] wants to hold and will need in the future, and identify needs that might be addressed with an activityspecific device in the future. “I think he will be able to achieve his goal of working on cars, but it will look different than what he did in the past—and the final result will probably be an evolved prosthesis from what he has now,” says Russo.

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COVER STORY

Nancy Havlik, CPO, LPO, designed a lightweight prosthesis for competitive kayaker Nik Miller to use in his kayak, which provides stability and is easy to take off should the kayak turn over.

Prosthesis for a Competitive Kayaker

SEPTEMBER 2017 | O&P ALMANAC

PHOTOS: Hanger Clinic

Earlier this year, Nancy Havlik, CPO, LPO, achieved one of her proudest moments when she created a special prosthesis for Paralympic hopeful Nik Miller, an above-knee amputee. Havlik, an area clinic manager with Hanger Clinic in Gainesville, Georgia, had worked with Miller, a sprint kayaker, for several years and had become a fan, often watching him compete in local races. Unlike many other amputee kayakers, Miller always kayaked with a full prosthesis because he preferred the stability it provided even though the device added weight. But during one competition, Havlik was

inspired to create a special prosthesis that was lightweight and attached directly to the boat, lightening the load but maintaining stability. “Every nth of a second counts when you’re trying to get a medal,” Havlik says. “I was watching him compete for Worlds, and I started talking with one of his coaches about what could make him a little bit faster. That’s when my wheels started turning about engineering a new design specifically for use in his kayak, that would provide the stability he needed—not losing that lever arm that he had gained in the kayak and the comfort of him having that prosthesis, but maybe taking some of that

weight away so that he could gain that extra second.” Havlik worked closely with Miller to bring her idea to fruition. Over the course of several months, she had Miller bring his kayak into her facility to work on the design; on other occasions, she accompanied him to the lake to work on the trim lines. The final design is a socket made out of carbon composite, with a titanium pylon angled about 20 degrees, with tube clamps, and a carbon composite pylon. The “foot” is just the forefoot of a carbon graphite foot. Once Miller is in the boat, the prosthesis becomes part of the kayak, and its weight counts toward the weight of the boat. To ensure Miller’s safety, Havlik designed the prosthesis so that he is able to exit the kayak if he happens to roll or turn. “Because he is suspended with the prosthesis, he has to be able to get out of the leg if he flips, so getting the trim lines right was key,” she says. Miller has been using the prosthesis for a couple of months—during his three-a-day, six-times-a-week practices—and is happy with the results. He recently competed at the 2017 ICF Canoe Sprint World Championships in the Czech Republic August 23-27, and his ultimate goal is to compete in the Paralympic Games in Tokyo in 2020.

COVER STORY

TIPS FOR WORKING WITH

Unique Patients While it can be daunting to work with “unique” patients, orthotists and prosthetists who have been successful with this population offer the following advice: ■■ Ask other O&P professionals—inside or outside your own facility—for help. “The more minds you have in on the process,” the better, says Tim Russo, CPO, LPO, of Scheck & Siress. ■■ Take your time. “Avoid on-the-spot decisions, just to be the ‘solutions guy,’” says Russo. “Instead, take the time you need to really think through decisions and consult with others.” ■■ Involve patients in the process. “The patient has to be motivated,” says Marlies Beerli Cabell, CPO, of Ability Prosthetics & Orthotics. And with pediatric patients, it’s important to get buy-in not just from the parents, but from the patient as well. ■■ Don’t over-promise. Cabell stresses the necessity of a thorough assessment where everyone understands the role of the clinician. Then be very clear about the process. “Don’t promise things right away—it’s not magic,” she says. ■■ Develop solutions that are appropriate for the patient. It’s important to stay “within anatomical reason,” says Nancy Havlik, CPO, LPO, an area clinic manager with Hanger Clinic in Gainesville, Georgia. “If I have an out-of-the-box idea, I need to make sure it’s anatomically appropriate.” ■■ Pay attention to detail. “You need to be able to provide a prosthesis, and do it really well—with great attention to detail, so there’s no chance that it will be rejected by the patient for a silly reason, like a strap is rubbing,” says Russo.

SEPTEMBER 2017 | O&P ALMANAC

■■ If at first you don’t succeed, try, try again. “Don’t be afraid to try things and fail—that’s the way to get successes,” says Havlik. “But be upfront with patients who need specialized solutions that they should expect some trial-and-error.” ■■ Recognize that the initial “vision” and the final solution may differ. “Sometimes the idea for what will work, and the ultimate design, are miles apart,” says Russo. “So you sometimes have to let these things evolve. You can’t always see the end when you’re starting.” ■■ Be a cheerleader for your patients. Especially when working with children, remember they may have never engaged in a new activity and may feel like giving up soon after getting a new device. “They may need to learn and build muscles," says Cabell. ■■ Consider the payor. It can be challenging to create something that will result in optimal outcomes within the confines of the payors’ allowance, “but you need to be able to navigate payor sources and figure out the correct path to find the best outcome for the patient,” says Russo. “It’s a skill set to learn and develop.” ■■ Once the device is complete, consider your accomplishment. “Remember that what you do can be life changing,” says Kim McQueen, CPO, LPO. “People will appreciate you more than you know.”

“Athletes push a clinician to go beyond what is basic [in their componentry], because their needs are not basic,” says Havlik. “Nik actually pushes me more than I push him. It’s fun for me to think this way, and it makes the job more fun to think outside the box when working with patients who are OK with trial and error, in pursuit of innovation.”

Athletes push a clinician to go beyond what is basic [in their componentry], because their needs are not basic. —NANCY HAVLIK, CPO, LPO

Prosthesis for a Challenging Limb

Eric Shoemaker, MS, CPO, had to put his creative skills to the test when he encountered a new amputee with a lot of swelling and a very bulbous limb earlier this year. “Seven months out from amputation, there were still lots of blisters due to edema,” says Shoemaker, who is regional director for Ability Prosthetics & Orthotics. The patient was large distally, but small proximally. “The wounds were not able to heal,” he explains. “There was a cycle of edema and skin breakdown—we were all waiting for the edema to get under control. It’s kind of scary to try to weight-bear with the wounds so fresh. But at seven months out from amputation, it was time to find a way to get him up on his feet and wearing a prosthesis,” he says. Shoemaker worked with his colleagues to brainstorm a solution to

COVER STORY

allow the patient to partially weightbear, and to assist in clearing up the skin issues and edema. The end result was a system with a trap-door socket. “The back of the socket would actually swing open,” he explains. “It turned out very well.” Using the device, the patient was able to work with a physical therapist, starting out by using a prosthesis an hour or two a day, and progressing to the point where his wounds healed and he has increased his time on a prosthesis. “Had he not come here and tried our solution, he would probably still be without a leg today,” says Shoemaker.

Dystonia Device and Shower Sandals

One of McQueen’s most creative solutions occurred when treating a man in his 50s who is very active with two teenagers, but who has cervical dystonia, which causes him to extend and rotate his head to the right almost every two seconds. “As soon as he uses his right hand to place light pressure on the back of his head, the dystonia goes away,” explains McQueen.

“He presented in my office not only with the dystonia but with severe trap/shoulder pain from constantly trying to hold his head still with his right hand. We needed a solution.” The patient is a season ticket holder to the Seattle Sounders and hoped to watch a full game without using his right hand to hold his head. “I had my work cut out for me on this one,” McQueen says. “I knew we needed to mimic his right hand, but how?” The solution was to make a custom-fabricated posture device—a custom poly prop. “Plates on the chest and back fastened together with Velcro. Then I took some KAFO [knee-ankle-foot orthosis] uprights and attached them to the posterior plate. I formed a custom ‘occipital cup’ to encompass as much of the back of his head as I possibly could and attached the proximal edge of the KAFO upright to this.” McQueen says she had some trouble getting enough pressure to the occiput that would mimic the pressure exerted from his right hand. “We had to ensure that the anterior and posterior sternal and spinal plates were tight enough against his body to allow the KAFO upright to exert enough pressure to his occiput.” The process took nearly 20 visits. “We ended up getting a pretty

PHOTOS: Left: Eric Shoemaker, MS, CPO, Ability P&O; Right: Kim McQueen, CPO, LPO

BEFORE

AFTER

The limb on Shoemaker's patient before and after using the specially designed prosthesis Eric Shoemaker, MS, CPO, designed a prosthetic system with a trap-door socket for a patient with a bulbous limb and skin breakdown.

Kim McQueen, CPO, LPO, created a custom-fabricated posture device for a patient with cervical dystonia.

darn good device that allowed him to exercise daily and go to his beloved Sounders games. The patient had so much appreciation for all the time and effort that went into this,” she says. McQueen also was challenged on another occasion to think outside the box when designing a pair of shower sandals for a patient with Charcot who wanted to be able to take a shower. “We had struggled tirelessly with custom-molded shoes for this particular patient for years—inserts that looked like mountains and valleys. Using different materials to provide support and comfort was a challenge. We even ground out holes inside the shoes sometimes.” The patient was adamant that taking a shower versus a bath was very important to her, so McQueen and her co-workers sought a solution to allow her to stand up safely in the shower. “Her balance was my biggest issue, and her comfort was her biggest issue. She pushed me at times to try things that I knew in advance wouldn’t work,” says McQueen. “At one point we used halfinch-thick poron as the top layer upon her request and against my strongest advice. She took them home, and it was almost immediately apparent to her that it was like standing on two trampolines. She learned to trust my judgement a bit more after that incident.” O&P ALMANAC | SEPTEMBER 2017

COVER STORY

McQueen worked closely with a patient with Charcot to design sandals offering support and comfort to allow the patient to take a shower.

It took four or five tries, but McQueen finally created a suitable solution: the patient’s own Teva sandals, with a thick layer of black cloud and a thin layer of poron on top. “I tried stiffer materials for the base but she just couldn’t tolerate the hardness,” McQueen says.

Orthoses for Parkinson’s Patient and Pediatric Prosthesis

Marlies Beerli Cabell, CPO, designed bilateral custom-molded clamshell orthotics, with custom build-ups to the feet positions, for a patient with Parkinson's.

SEPTEMBER 2017 | O&P ALMANAC

occupational therapy would be needed to help build the muscles in the patient’s shoulder, which had not been previously used as they would need to be with the kayaking prosthesis. The check socket stage was critical in determining the angle of the forearm when most active, and finalizing the design. The result was a prosthesis that allows the patient to kayak, because an oar can rotate within the device without slipping out.

Just Doing Their Jobs

Patients who require unique solutions come in many shapes and sizes—from elite athletes to patients with comorbidities. The solutions shared by Russo, Havlik, Shoemaker, McQueen, and Cabell are just a small sample of the custom devices created everyday by clinicians who leverage all of the tools at their disposal to boost quality of life for their patients. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

PHOTOS: Top: Kim McQueen, CPO, LPO; Bottom: Marlies Beerli Cabell, CPO, Ability P&O

Sometimes it’s not the device that’s unique but the way that it’s used. Marlies Beerli Cabell, CPO, of Ability Prosthetics & Orthotics, came up with a creative solution for a Parkinson’s patient who was unable to stand due to her feet positioning. “She was in a powered chair and her pain was extreme. Her goal was to walk and stand to open the fridge and make a sandwich, to be independent.” Cabell’s solution was to fit the patient with custom-molded clamshell orthotics, with custom build-ups to the feet positions. “I did one leg at a time after the therapist completed serial casting. Then she stood with one AFO to have the second leg casted. Then she

was able to stand and walk with the bilateral set,” she explains. The patient has had the bilateral AFOs for more than a year and has progressed since initial fitting. “She is in physical therapy to build her strength. She is walking 150 feet. She is able to make a heel-to-toe rocking to gait. She can stand at the sink and do the dishes. She walks around her house every day with them on. She is even preparing her own food,” and achieving the goals she had when Cabell first started working with her. “Without the [devices], she would not be as active and independent as she is,” says Cabell. Cabell also treated a 7-year-old congenital arm amputee, who came in seeking a bike prosthesis but whose family mentioned they enjoy kayaking. Cabell suggested a prosthesis that would work while kayaking so the patient could be a more active participant in the trips. In this instance, as in many new device acquisitions, using the prosthesis required a little extra effort on the part of the patient. Cabell explained to the parents why

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Do the

Right Thing

How to develop and implement a code of ethics that addresses O&P’s unique challenges and serves the best interests of your patients

NEED TO KNOW ´´ Ethics programs geared specifically toward O&P facilities can provide a solid foundation for clinicians to work from in providing appropriate patient care. ´´ O&P-specific issues that may be addressed in a code of ethics include avoiding the promotion of specific products or services from manufacturers and referral sources, accommodating patients’ choices of devices, and providing treatment for patients with inadequate funds. ´´ Establishing an ethical code can yield positive results for a facility, including reducing waste, fraud, and abuse, and promoting a more structured and efficient workforce. Patients benefit by receiving optimal care and appropriate, functional devices.

SEPTEMBER 2017 | O&P ALMANAC

´´ All employees—including new hires—should understand and abide by a company code of ethics. Buy-in from the facility’s top leaders—and their demonstrated adherence to the policy—is essential. ´´ An ethics program should be supported by ongoing education and training to ensure moral conduct remains top of mind all year long. ´´ With Health-Care Compliance & Ethics Week approaching in November, now is a good time for O&P facilities to develop or re-examine their code of ethics. AOPA is offering compliance materials, webinars, posters, and other products and services to help celebrate the week.

OST O&P CLINICIANS WILL

agree that implementing a code of ethics is essential for a health-care facility. A code of ethics provides a tool for protecting the reputation of your facility while ensuring high-quality, appropriate, and unbiased care for your patients. What’s more, instituting a formalized ethics program can boost your business’s bottom line. Companies that make “an explicit commitment to doing business ethically” produce 20 percent higher profit than those without a similar stated commitment, according to a 2011 report by the Institute of Business Ethics. The report also found that companies with an established code of conduct “generated significantly more economic value… and showed a 50 percent increase in average return on capital employed.” In a time of reimbursement pressures and general uncertainty in the health-care space, it’s important to ensure O&P practices are financially stable. Ethics programs that address O&P’s unique challenges, including maintenance of confidential patient information, appropriate communications with physicians and prescribers, and correct utilization of codes during claims submittals, can help do just that. By implementing a well-developed ethics program that engages and educates employees while also holding them accountable, O&P facilities can improve their own reputation and success—and that of the industry as a whole.

Ethics in O&P

Before considering what an ethics program should look like in your practice, it’s important to understand what the term “ethics” means. According to scholars at Santa Clara University’s Markula Center for Applied Ethics, ethics is not dictated by a person’s feelings, values, religion, or even the law. Instead, “ethics refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues.” The Center also dictates that

ethics touch on “the continuous effort program, which places importance of studying our own moral beliefs and on ethics in the work environment, our moral conduct, and striving to provides individuals with systems ensure that we, and the institutions we and processes that foster appropriate help to shape, live up to standards that examination of patient care,” says Teri are reasonable and solidly based.” Kuffel, Esq., vice president of Arise O&P facility owners and managers Orthotics & Prosthetics in Minnesota, should adopt ethical which has a structured standards and procedures ethics program in place. in order to build structure “It is intuitive and and stability within their required of every person organizations. Thankfully, in our office.” a variety of resources exist Instituting and monifor O&P facility owners toring compliance with a and managers to reference company code of ethics as they plan and build their is easier said than done. own programs. Released O&P facilities that already Teri Kuffel, Esq. in January of 2009, have such a program in AOPA’s “Code of Interactions With place are familiar with the biggest Health-Care Professionals” (available challenges. One such challenge is at www.AOPAnet.org) provides clear dealing with pressure from outside guidance on training and company sources, including manufacturers and conduct, consulting, continuing educareferral sources who want clinicians to prescribe certain devices or the prodtion, gifts, and more. The American Board of Certification in Orthotics, ucts they may sell or endorse. In this Prosthetics, and Pedorthics; the Board vein, AOPA’s code makes recommendaof Certification/Accreditation; and tions for “Independence and Decision the Advanced Medical Technology Making,” including: “No grants, scholAssociation all have their own codes arships, subsidies, support, consulting and guides as well. contracts, or educational or practiceEstablishing an ethical code can related items should be provided or help avoid some common business offered to a health-care professional pitfalls, including quid-pro-quo in exchange for prescribing products arrangements—exchanges of goods or or for a commitment to continue services, where both sides get “someprescribing products.” This guidance can help clinicians steer clear of these thing for something”—bribery, false complicated situations. claims, stealing, and lying. “An ethical O&P ALMANAC | SEPTEMBER 2017

when [the nursing home] owes us money from some past thing we did?” Clinicians and other team members face these issues every day, and having an established standard in place simplifies decision making for everyone involved. “If everyone had a decent moral code, I just think that decisions would become easier,” she says. “The bottom line will take care of itself. I believe that with all my heart. Of course, you have to be smart financially, and know your numbers, but you also need to consistently do the right things.”

Building Blocks

When it comes to creating an ethics program for your facility, defining the legal components—what the law actually says businesses and individu“It doesn’t necessarily Patients, too, present als can and cannot do—may be the easy matter who the patient is their fair share of prespart. What may be more complicated or where the referral came is sitting down and investing the time sure and challenges, says from; we feel like it’s our to hammer out the key questions and Elizabeth Ginzel, MHA, responsibility as healthanswers that will define your culture, CPO, LPO, who oversees care providers to assist the says Perrone. For example, “What’s the operations for Baker individual with finding a hill you’re willing to die on? What is it Orthotics & Prosthetics funding source if they want that you’re going to stand for, and what in Texas. Baker, which to be a productive member is it that you’re not going to stand for?” is owned by BCP Group, Elizabeth Ginzel, of society,” says Ginzel. Once you’ve outlined your facility’s has had an official code MHA, CPO, LPO “But that’s a big caveat: The moral standard, you can create useful of ethics in place since individual has to be willing strategies and resources for recruiting 2001. Patients often to do what we ask of them—physical and training new hires and current come into the clinic with an idea therapy, follow-up appointments, etc.— staff. “The process of promoting an of what they want—for example, a so that they can return to functional ethical workplace begins with creating souped-up robotic limb they saw on independence.” a culture that starts from day one social media that they now want for Sometimes, funding concerns when someone is interviewed and themselves. The Baker team is willing arise in conjunction with other care hired,” says Ginzel. When interviewing to let patients try anything—as long providers. For example, say a patient applicants, she involves her team in as it’s safe—but, says Ginzel, “we, the is in need of a cervical panel-style interviews so clinicians, attempt to direct care based collar to stabilize his or everyone gets to ask quesupon experience and knowledge of components to attempt to say, ‘OK, this her spine, but the partictions and interact with the product would be great for person X, candidate. She also encourular nursing home that but for you, I really feel like there is provides his or her care ages applicants to spend as something more appropriate that will owes your facility $200. much time with the team help you accomplish your activities.’” Do you still provide the and in the space as possible. It is the clinician’s duty to marry the device? “Those are the By doing so, she may be patients’ goals and desires with what is sorts of questions staff able to observe or gather best for their ability and lifestyle. may start asking,” says information she wouldn’t Joyce Perrone Another aspect to consider is how to Joyce Perrone, director of normally get—increased navigate financial issues—for example, business development for interaction means greater if a patient does not have the funding De La Torre Orthotics & Prosthetics chances of someone noticing if there available for a device he or she needs. in Pennsylvania, and a consultant for is something “off” about a candidate. Baker has established a clear policy Promise Consulting. “Do we risk not “When you’re the ‘boss,’ [applicants] so employees aren’t left wondering getting paid and send someone out to behave differently with you versus what to do in such a circumstance. stabilize this person’s cervical spine someone else,” she says. 40

SEPTEMBER 2017 | O&P ALMANAC

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Celebrate

Health-Care Compliance & Ethics Week NOVEMBER 5-11, 2017 For the first time, AOPA is partnering with the Healthcare Compliance Association (HCCA) to celebrate Health-Care Compliance & Ethics Week, Nov. 5-11, 2017. HCCA is a member-based association for compliance professionals in the healthcare provider sector. While AOPA encourages members to make ethical choices all throughout the year, this week-long celebration is a way to show both your staff and patients that your organization cares about doing what it is right. Here are just a few ways to participate: • Be a part of the Celebrating Wall. For details and to submit your company to be part of this special opportunity, visit www.AOPAnet.org. • Purchase educational handbooks and other products for staff to enjoy. • Download the Health-Care Compliance & Ethics Week logo to add to your website. • Explore white papers, Compliance Corner articles, and other content with accompanying CE credit quizzes. • Purchase posters, tumblers, or pens to promote the activities among your staff; see the order form on page 94 or visit bit.ly/aopastore. • Gather your staff to participate in valuable webinars: • Gift Giving: Show Your Thanks & Remain Compliant: Nov. 8 at 1:00 p.m.; hosted by AOPA; $99 AOPA members/$199 nonmembers • “Three Amigos” of a Compliance Program—Compliance Officer, Legal, and Human Resources—Can Work Together To Support and Advance an Effective Compliance Program: Nov. 9 at 1:00 p.m.; hosted by HCCA; free for AOPA members/$50 nonmembers • Teaching Professionalism and Ethics During Residency: Friday, Nov. 10; free for AOPA members/$50 nonmembers. • Access these resources and more at www.AOPAnet.org.

SEPTEMBER 2017 | O&P ALMANAC

In addition to checking references and conducting background checks, Perrone ensures all new hires get the opportunity to meet with the owners to learn more about the organization and its mission. “It’s extremely important that the owners and top leaders are intimately involved in making sure that the company’s DNA is properly transferred” to new employees, she says. “And it should not be a one and done. Ongoing reinforcement is truly were the rubber meets the road.” She notes that imparting expectations of moral conduct is much more impactful when the message comes directly from the people that own the company. When employees start to slip and engage in noncompliant behavior, managers must be able to identify this behavior and address it immediately, says Perrone. “You have to … be pretty fearless on corrections when people go off of the path that your company has established based on its vision and values,” she says.

A Culture of Trust

Before an O&P company can expect its teams to respond appropriately and act on feedback, owners and managers have to create cultures that champion communication, trust, consistency, and leadership. At the same time, O&P facility owners and managers must not make excuses for unethical behavior in the workplace. “We don’t ask for buy-in from employees,” in regard to Arise O&P’s ethics program, says Kuffel. “We tell them it’s part of their job to maintain the highest level of professional ethics and care of their patients.” To promote transparency and honesty at Baker O&P, Ginzel encourages open communication and regular interaction among team members. She has a meeting or conference call with her staff twice a week—once with all staff in attendance, and another with just the clinicians. This allows her to establish a rapport with employees and ensures she is in the loop with any issues or challenges they face. “If someone makes a mistake, [you want them to know they can] go to a

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superior and say, ‘You know what, I messed up. Can you help me fix it?’” she says. “It’s not about pointing fingers or redirecting blame, but instead resolving the issue appropriately and educating to prevent future issues.” Feeling comfortable doing so could make the difference when an employee has an ethical dilemma. “The clear majority of organizations have policy-and-procedures manuals on the shelf regarding ethics, but sometimes lines do seem to get blurred, especially during a busy day. I think it’s important knowing to whom and what to ask before doing something that may be perceived as questionable.” Teams that work well together and trust each other are more likely to produce better results. Perrone meets with her staff regularly to go

over new devices and specific codes, and to discuss what is and is not acceptable in coding and billing. “It’s not always a one-size-fits-all kind of thing,” she says. “This information always needs to be put out there, discussed, reviewed, and understood clearly.” She also provides coding cheat sheets to help educate staff on how to code correctly. In addition, her facility’s billing team plays a key role in assessing how things are being coded and raising red flags as needed. “It has to be a team event, with all being held accountable for sharing and learning.” Many facilities and firms also employ compliance officers to oversee how well a business and its employees are adhering to policies and standards. “It is not a one-person job,” says Kuffel, who serves as compliance officer for her organization. “We rely on administrative staff to keep eyes and ears open on this issue, and request that all employees maintain the highest level of ethics while working.” Of course, an engaged team and an

open-door policy are great features in any culture, but if the staff doesn’t trust company leadership, they are going to be a lot less likely to walk through that open door. Good leaders “need to be totally approachable, totally open,” says Perrone. “You can’t be the kind of person who shuts down individuals from being able to come to you and tell you what’s going on.” Owners and managers also must strike a balance between enforcing strict standards and allowing O&P clinicians to enjoy the art of what they do, day in and day out. “You don’t want [oversight] to be so tight that people don’t have the ability to be open,” says Perrone. “Otherwise, that may become part of the new way that you do things… and becomes woven back into the genome of the company.” Staff should feel they have the freedom to perform the necessary job tasks. “Sometimes you do have to go back in and re-evaluate what you’re doing,” she says. “And just having that transparency, that is sometimes the hardest part.”

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Finally, an ethics program is not something you can just set and then forget about. “It is constant,” says Kuffel. “Employees are expected to adhere to it at all times.” Owners and managers need to provide ongoing education and training for staff so that it remains top of mind. Compliance also should be assessed and included as part of employees’ regular performance evaluations. While it is a multifaceted and labor-intensive process, having a detailed ethics program in place can yield many benefits—including reducing waste, fraud, and abuse and enjoying a more structured and efficient workforce. Patients benefit by receiving the best care and the most appropriate, functional devices and services so they can carry on with their lives. And employees can go to sleep every night with a clear conscience, knowing they don’t have to endure a workplace where cheating or dishonesty is part of the everyday experience. “There could be energy in that,” says Perrone. “There could be joy for employees in knowing, ‘Here are the lines that I get to color inside of, and here are the lines where I can color outside.’ It is very freeing in so many ways to have clarity.”

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Don’t Miss the Ethics Session at the World Congress!

Make plans now to attend the session “Compliance and Ethics in Orthotics and Prosthetics,” presented by Teri Kuffel, Esq., on Thursday, Sept. 7, at 10:30 a.m., in Las Vegas. During this one-hour session, Kuffel will explore the importance and development of ethics in O&P practice in particular and health care as a whole.

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Exhibition

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World Congress Sponsors............ 50

Meet the exhibitors that have signed on as title sponsors for the AOPA World Congress and Centennial Celebration Exhibit Hall Map........................... 56

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Exhibitor Directory...................... 56

Access a complete, alphabetical listing of the exhibitors and their booth numbers

SEPTEMBER 2017 | O&P ALMANAC

WORLD CONGRESS SPONSORS 2017

HE TRADE SHOW FLOOR at the

Mandalay Bay Resort in Las Vegas is “the place to be” for attendees of the AOPA World Congress and Centennial Celebration. The Exhibit Hall is home base for hundreds of exhibitors, special events, demonstrations, and show specials. Breaks and lunches are scheduled in this space throughout the conference. Mingle on the trade show floor throughout the four-day World Congress to meet and network with orthotic, prosthetic, and pedorthic professionals; business owners; physicians; researchers; investors; and other O&P stakeholders from across the globe. Central to this year’s Exhibit Hall is the keystone of AOPA’s commemorative activities—the Walk Through Time. This expansive display features items contributed by AOPA members and O&P stakeholders showcasing the evolution of orthotic and prosthetic products and facilities since the association’s founding 100 years ago. You’ll want to set aside plenty of time to immerse yourself in this display and visit artifacts from various eras throughout the history of the O&P profession. In addition, exhibitors and patient-care facilities will be displaying their own historical memorabilia to pay homage to the inventors and innovators of the past. Kick off your conference experience at the “Welcome to Las Vegas

Reception” in the Exhibit Hall from 5:30 to 7:30 p.m. on Wednesday, Sept. 6, where you will get your first introduction to the cutting-edge exhibits hosted by U.S. and international O&P companies. See the latest in O&P innovation and talk with representatives from exhibiting companies to find out how you can leverage the newest products to provide optimal patient care. Plus, exhibitors will compete to show you the best Vegas has to offer through costumes, props, and entertainment. Refreshments will be served. The trade show floor also is the meeting point for participants to mark AOPA’s 100th birthday during the Centennial Celebration, 5:30 to 6:30 p.m. on Thursday, Sept. 7. Grab a glass for the champagne toast scheduled for this celebratory event—the warm-up to the Party With a Purpose. On Friday, plan to make some more rounds on the trade show floor during the Happy Hour in the Exhibit Hall, sponsored by exhibitors. Attendees will enjoy refreshments while networking with colleagues and exhibitors. With so many special events planned for the Exhibit Hall at the World Congress, you will want to set aside several hours to browse the aisles and interact with like-minded O&P professionals from across the world. Keep these O&P Almanac pages handy to help guide your trip.

O&P ALMANAC | SEPTEMBER 2017

WORLD CONGRESS SPONSORS 2017

AOPA WORLD CONGRESS & 100TH ANNIVERSARY CELEBRATION

DIRECTORY

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20' Martin Bionics 20'

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346 344 10' 6'B ANQ 10

ALPS...............................................315 www.easyliner.com

indicates the exhibitor is a Supplier Plus Partner with AOPA.

ACOR Orthopaedic Inc. ................ 557 www.acor.com

• Adapttech..................................... 1154 www.adapttech.eu

10'

342

343

340

341

338

339

10'

6'B ANQ 10

Alternative Prosthetic Services Inc.......................................754 www.alternativeprosthetics.com

20'

10'

20'

440

441

ST&G USA Corp 30'

30'

335

233

435

434 20'

332

333

6'B ANQ 10

20' DAW Ind Inc 20'

6'B ANQ 10

227

6'B ANQ 10

20' Orthomerica 20'

Bion

327

425

6'B ANQ 10

American Academy of Orthotists & Prosthetists.................................. 342 www.oandp.org American Board for Certification in Orthotics, Prosthetics, & Pedorthics......................................... 338 www.abcop.org

20'

Friddles

6'B ANQ 10

20'

337

20' 20'

Exhibitors as of Aug. 14, 2017.

• AC Mould Engineering Limited... 760 www.acmould.com

6'B ANQ 10

• indicates new exhibitor for 2017. 5280 Prosthetics/ Adaptec............655 www.5280prosthetics.com

6'B ANQ 10

455

2018

Vancouver

Mandalay Bay Convention Center Shoreline Exhibit Hall Las Vegas, NV

Bold listings indicate the exhibitor is a member with the American Orthotic & Prosthetic Association (AOPA).

461

6'B ANQ 10

20'

6'B ANQ 10

F&B 6'B ANQ 10

6'B ANQ 10

ALPS

50'

6'B ANQ 10

315 10'

Advanced O&P Solutions LLC...... 837 www.aopsolutions.com

312

Allard USA Inc.............................937 www.allardusa.com American Central Fabrication......647 Email: americancenfab@aol.com

SEPTEMBER 2017 | O&P ALMANAC

313

410

412

413

EXHIBITOR HALL MAP 2017 FE

INTERNATIONAL PAVILION

ASIA

20'

567 665

562

563

560

662

561

663

660

762

661

6'B ANQ 10

EUROPE

764 763

760

862

761

863

860

962

861

SOUTH/CENTRAL AMERICA & MEXICO

960

961

6'B ANQ 10

O&P International Showcase

O&P Almanac

557

554

656

555

657

654

756

655

856

20'

755

754

854

855

957 954

1056

955

6'B ANQ 10

1057 1156

1054

1055 1154

1155 1254

1051 1150

1151 1250

6'B ANQ 10

6'B A NQ 10

W/D

6'B ANQ 10

1157 1256

6'B ANQ 10

F&B

6'B ANQ 10

W/D

6'B ANQ 10

10' FE

6'B ANQ 10

PRIVATE MEETING ROOMS

ADA

6'B ANQ 10

6'B A NQ 10

MR6 MR5 MR4 MR3 MR2 MR1

10'

549

20'

648

547

546

649

751

746

10'

644

545

645

20'

10'

20'

Ã&#x2013;ssur Americas 50'

538 20'

534

849

20' Spinal Tech Inc 20'

847

641

10'

736

635

734

OPGA

837

20' Allard USA Inc 20'

938

533

633

733

732

1045

1147

20'

1247 1346 W/D

1145 1244

1041

10'

20' Cascade Orthopedic Supply Inc 30'

Aspen Medical 30'

10'

1033

933

10'

1342

10'

1340

1239 1338

20'

Surestep 30'

20'

W/D

10'

1137

10'

934

FHC

Nabtesco & Proteor in USA

937

20'

W/D

20'

10'

940

839

738

637

Comfort Products 40'

1249 1348

20'

10'

943

20'

740

639

10'

1350

20'

10'

1048

20' Vorum 20'

20'

10'

946 W/D E

951 949

948

10'

742

20'

20' 20'

745

744

10'

542

10'

850 10'

748

647

20'

W/D

750

20'

10'

1336

1235 1334 W/D

1133 1232

10'

20'

20' PEL

OPTEC USA, INC 40'

ness 30'

50'

20' Knit-Rite 20'

20'

627

Freedom Innovations LLC

727

30'

10'

825

50'

523

1227

20'

10' 20'

Tech Fab Contest 1223

20'

Ottobock

50'

Endolite

30'

415

615

815

College Park Ind 40'

Fillauer 60'

30'

1015

W/D

50'

SPS

10'

1025 W/D

10'

20' Standard Cyborg 20'

20'

1129

10'

W/D

20' Becker Orthopedic Appliance Co 30'

1115

20' Townsend Design \ Thuasne USA 30'

1215

Freeman Service Desk

20' 20'

Walk Through Time Display

550

10' 20' OPIE Software 30'

1315

10' 813

913 20'

ENTRANCE

1012 1011 1013 1110 1111

1113 1210

Slot Machine

1312

1411

40'

FHC

Exhibitor Lounge

20' AOPA

10'

30'

100 O&P ALMANAC | SEPTEMBER 2017

EXHIBITOR DIRECTORY 2017

American Orthotic & Prosthetic Association...................100 www.aopanet.org

• Beijing Jingbo Prosthetics & Orthotics Technical Co., Ltd..............................665 www.jingbo-po.com

Cailor Fleming Insurance..............1232 www.cailorfleming.com

• Beijing P&O Technique Center....567 Bioness.............................................. 423 www.bioness.com American Prosthetic Components LLC..................................................... 534 www.apcomponents.com

BioSculptor Corp........................... 1055 www.biosculptor.com

Cascade Dafo Inc....................... 644 www.cascadedafo.com Cascade Orthopedic Supply Inc........................................ 1137 www.cascade-usa.com

Amfit Inc..........................................1041 www.amfit.com

Board of Certification/Accreditation International (BOC)..................... 1336 www.bocusa.org

Amputee Coalition.........................1338 www.amputee-coalition.org

www.bocusa.org

CBS Medical Billing & Consulting LLC................................850 www.cbsmedicalbilling.com

Anatomi Metrix Inc.........................938 www.manu3lab.com

Bort-Swiss Orthopedic Supply.....955 www.bort-swissortho.com

• Centro Protesi Inail........................ 761 www.inail.it/centroprotesi

Anatomical Concepts Inc............ 1247 www.PRAFO.com

Boston Orthotics & Prosthetics.... 339 www.bostonoandp.com

Charcot Marie Tooth Association.... 344 www.cmtausa.org

Anodyne........................................... 940 www.anodyneshoes.com

BREG Inc............................................842 www.breg.com

Click Medical...................................1147 www.clickmedical.co

AON Affinity..................................... 1110 www.affinityinsuranceservices.com/

Bremer Group Company, The...... 949 www.bremergroup.com

Clinical Education Concepts.............. 349 www.cecpo.com

Apis Footwear Co........................... 444 www.apisfootwear.com

Brightree LLC...................................734 www.brightree.com

Coapt LLC........................................ 449 www.coaptengineering.com

Aspen Medical Products.............. 1239 www.aspenmp.com

BSN Medical.....................................957 www.bsnmedical.com

College Park Industries.................1015 www.college-park.com

Becker Orthopedic Appliance Co.................................. 1025 www.beckerorthopedic.com

Bulldog Tools Inc............................. 332 www.bulldogtools.com

Comfort Products Inc.....................839 www.comfortoandp.com

• Confairmed-Gesellschaft für

Congressmanagement mbH............ 960 www.confairmed.de Coyote Design & Mfg. Inc.............. 732 www.coyotedesign.com Create O&P...................................... 1145 www.CreateOandP.com Curbell Plastics Inc............................554 www.curbellplastics.com/oandp

• Cypress Adaptive LLC................ 333 www.cypressadaptive.com • DARCO International................. 1254 www.darcointernational.com 58

SEPTEMBER 2017 | O&P ALMANAC

EXHIBITOR DIRECTORY 2017

DAW Industries Inc......................... 227 www.daw-usa.com DJO Global...................................... 440 www.djoglobal.com DME MAC Medicare Contractors........................................637 www.cgsmedicare.com Drew Shoe Corp...............................1334 www.drewshoe.com Endolite..............................................815 www.endolite.com

Engineered Silicone Products LLC...549 www.wearesp.com Epica Applied Technologies........ 1249 www.epicatech.com

• Expo Enterprises .. 657, 1111, and 1342

www.nano-ions.com

Fabtech Systems LLC...................... 855 www.fabtechsystems.com Fillauer..........................................1115 www.fillauer.com FLO-TECH® Orthotic & Prosthetic Systems Inc....................................... 413 www.1800flo-tech.com Freedom Innovations LLC.............. 825 www.freedom-innovations.com Friddle's Orthopedic Appliances Inc................................. 435 www.friddles.com

• Friends Surgicals............................ 561

www.friendsurgicals.org

• G&I Innovation............................. 1157 www.zerogravity.com • Globo-SA Inc................................. 341

www.globosainc.com

SEPTEMBER 2017 | O&P ALMANAC

Grace Prosthetic Fabrication Inc.....233 www.gpfinc.com

• Kiwi Orthotic Services...................562 www.kiwiorthoticservices.com

• Guangzhou Kang Mei Te Prostheses

• Kleiber Bionics LLC.....................455 www.kleiberbionics.org

Co. Ltd................................................762 www.kmtjz.com

• Hangzhou Kebo Orthopaedic

Rehabilitation Equipment Limited...............................................663 www.hzkebo.com.cn

KLM Laboratories........................... 412 www.klmlabs.com Knit-Rite Inc..................................... 727 www.knitrite.com

iFit Prosthetics LLC.........................736 www.ifitprosthetics.com

• Landis International................... 755 www.landisusa.com

Infinite Biomedical Technologies...856 www.i-biomed.com

LegWorks..........................................546 www.legworks.org

• Integrum Inc................................... 913 www.integrum.se

LIM Innovations..............................648 www.liminnovations.com

• Jiangsu Reak Healthy Articles

• LimbTex Ltd...................................763 www.limbtex.com

Co. Ltd................................................ 951 www.recohealth.com

• Kevin Orthopedic...........................313

www.kevinorthopedic.com

Kinetic Research Inc...................... 849 www.kineticresearch.com

• Kingsley Mfg. Co........................ 1057

www.kingsleymfg.com

KISS Technologies LLC...................542 www.kiss-suspension.com

Mac Dowell Silicones....................... 860 www.macdowell.it Makstride Prosthetics................... 946 www.makstrideprosthetics.com Martin Bionics Innovations........... 355 www.martinbionics.com

• Mary Free Bed Orthotics

& Prosthetics.................................... 633 www.maryfreebed.com

EXHIBITOR DIRECTORY 2017

MD Orthopaedics Inc....................1235 www.mdorthopaedics.com

O&P Almanac............................. 1256 www.aopanet.org

Med Spec (ASO EVO)......................847 www.medspec.com Medex International Inc...............1051 www.medexinternational.com

O&P EDGE......................................... 641 www.opedge.com

Medi USA..........................................545 www.mediusa.com

O&P News/SLACK Inc................... 1346 www.oandpnews.com

• Metiz Group...................................862 www.metiz-ltd.ru Mile High Orthotics Lab Inc...........312 www.mholabs.com

OHI, The Family of Brands Including: Apex, Arizona AFO, Langer, PedAlign, Safestep, and the Orthotic Group ................................813 www.ohi.net

Mobility Saves..................................100 www.mobilitysaves.org

OP Solutions Inc..............................550 www.opsolutions.us OPAF & The First Clinics.............. 1312 www.opfund.org

Mobius Bionics LLC.........................346 www.mobiusbionics.com

• Monetek LLC............................... 446 www.monetek.com Myomo..............................................1012 www.myomo.com Nabtesco & Proteor in USA......... 1045 www.proteor.com

OPIE Software................................. 1315 www.opiesoftware.com OPTEC USA Inc............................... 523 www.optecusa.com Orfit Industries America................639 www.orfit.com Original Bending Brace................. 1011 www.originalbendingbrace.com

• ORTEC...........................................662

Naked Prosthetics...........................447 www.npdevices.com

www.ortec.co.kr

National Commission on O&P Education................................340 www.ncope.org

www.orthobaltic.eu

New Options Sports...................... 1250 www.newoptionssports.com New Step Orthotic Lab Inc.............751 www.newsteporthotics.com

• Ningbo Yinzhou Yide Medical

• ORTHO BALTIC........................... 861

Orthomerica Products Inc............. 327 www.orthomerica.com Orthotic & Prosthetic Group of America (OPGA)............................. 733 www.opga.com

• Orthotics & Prosthetics

Devices Co. Ltd.................................1013

Association of India...........................563 www.opai.org.in

nora systems Inc..............................654 www.nora-shoe.com

Orthotics and Prosthetics One (O&P 1) ......................................741

• Nymbl Systems............................854 www.nymbl.systems

• Orthotics Prosthetics Canada

SEPTEMBER 2017 | O&P ALMANAC

(OPC)................................................. 461 www.opcanada.ca

• OrtoPed ULC............................... 560 www.ortoped.ca Osseointegration Group of Australia............................................635 www.osseointegrationaustralia.com.au OssKin Inc.........................................645 www.osskin.com Össur Americas Inc......................... 533 www.ossur.com

• Otto Trading Inc.............................347 www.unimedmassager.com Ottobock....................................... 615 www.ottobockus.com

• Ottobock Reimbursement

& Clinical Research........................ 410 www.ottobockus.com Paceline............................................ 649 www.paceline.com Pedorthic Foundation........................ 343 www.pedorthicfoundation.org PEL.....................................................627 www.pelservice.com

• Pereg Milano .........................................361 www.peregmilano.com

• Phoenix Molded Shoes

Inserts and Braces..............................1113 www.phoenixmolded.com Pine Tree Orthopedic Lab Inc........... 738 www.pinetreeorthopedic.com

• PLS - Pedorthic Lab

Specialties..........................................351 www.pedorthiclab.com Private Funding For Prosthetic Devices...............................................954 www.privatefundingforprosthetics.com Pro-Tech Orthopedics.................. 1244 www.protech-intl.com

EXHIBITOR DIRECTORY 2017

ProtoKinetics Gait Analysis Walkways........................................1048 www.protokinetics.com

Tamarack Habilitation Technologies Inc............................. 1133 www.tamarackhti.com

• Protosthetics................................ 555

www.protosthetics.com

TechMed 3D Inc...............................746 www.techmed3d.com

P.W. Minor LLC.................................740 www.pwminor.com

• Thermo-Ply Inc............................448 www.thermoplygel.com

Renia GmbH.....................................656 www.renia.com

thyssenKrupp Engineered Plastics.............................................. 337 www.onlineplastics.com

Restorative Care of America, Inc. (RCAI).............................................. 1054 www.rcai.com Rodin 4D...........................................750 www.rodin4d.com Royal Knit Inc...................................744 www.royalknit.com RS Print............................................. 538 www.rsprint.com RUSH Foot........................................934 www.rushfoot.com

Soletech Inc...................................... 335 www.soletech.com Spinal Technology Inc................ 745 www.spinaltech.com

• Tianjian Tairuibosi Medical

Appliance Co. Ltd..............................764 www.trbsorthosis.com Tillges Technologies/TCOP........... 933 www.tcopinc.com Top Shelf Orthopedics...................1151 www.pacmedical.com Townsend Design \ Thuasne USA................................................... 1215 www.townsenddesign.com

• Truffoire Las Vegas....................... 1155 www.truffoire.com • TS Medical.....................................547 Turbomed Orthotics....................... 441 www.turbomedorthotics.com

• Uniedo Fronteras/Uniting

Frontiers............................................. 961 www.uniendofronteras.org

• University of Hartford MSPO

Program ............................................. 345 www.hartford.edu/tmspo U.S. Member Society - ISPO.............756 www.usispo.org Vorum................................................943 www.vorum.com VQ Orthocare................................... 1411 www.vqorthocare.com WillowWood....................................1129 www.willowwoodco.com

• Win Walker Prosthetis & TRS Inc. (Therapeutic Recreation Systems Inc.)............. 1350 www.trsprosthetics.com

Orthotics Co. Ltd.............................. 660 www.win-walker.com

• Xiamen Kon Technology............... 661 www.fjyi.com

SPS................................................. 415 www.spsco.com ST&G USA Corp...............................434 www.stngco.com Standard Cyborg.............................1227 www.standardcyborg.com SteeperUSA......................................948 www.steeperusa.com SureStep.......................................... 1033 www.surestep.net

O&P ALMANAC | SEPTEMBER 2017

& NOW

THEN

AOPA and the Evolution of the L Codes AOPA leaders helped develop the L-code system and continue to educate clinicians about their proper use

Then & Now is a monthly department for 2017. As part of AOPA’s centennial celebration, O&P Almanac will feature a different AOPA product or service and discuss how it has evolved over the years. This month, we focus on AOPA’s involvement in the L-code system.

ERHAPS ONE OF AOPA’S most important contributions over the past century has been the association’s involvement in the development of the L codes and their integration into the health-care system. The participation of AOPA and its leaders was critical in designing a system that provides specific and universal coding for orthotic and prosthetic devices. What’s more, the association’s influence in encouraging the adoption of the system has been a key driver of their acceptance.

SEPTEMBER 2017 | O&P ALMANAC

THEN

AOPA representatives worked closely with Blue Cross Blue Shield (BCBS) of South Carolina in the 1970s to develop the first template for the L-code system. The system was developed to provide a consistent, logical, standardized method to describe the way O&P services were being provided. AOPA and BCBS created a pilot program, which BCBS-South Carolina applied in the late 1970s. The system was subsequently adopted as a requirement for all Medicare carriers to ensure the use of standardized coding and nomenclature. The success of the system is partially due to its design as an add-on system, which easily accommodates new components and allows for the retirement of obsolete codes. “The L-code structure is set up as a base code/addition code system. What that means is that most devices are billed using a single ‘base’ code and one or more ‘addition’ codes that describe unique features of the device,” explains Joseph McTernan, AOPA’s director of coding and reimbursement services, education, and programming. “This system allows providers to describe thousands of product variations using a relatively few number of L codes. Instead of having to have one L code for every version of an O&P

device—which would literally result in thousands of codes—the current code set contains several hundred codes that can be used in various combinations to describe most products on the market.” The Health Care Financing Administration (HCFA) adopted the South Carolina system and established the Healthcare Common Procedure Coding System (HCPCS) in 1978. The L codes are included in HCPCS Level II codes. Nationwide adoption was a slowbut-steady process, with some of the original codes changing in response to feedback from clinicians and payors. AOPA did its part to educate practitioners about the system and advocate for adoption by all facilities. “HCPCS was developed to standardize codes for medical and other health services nationwide,” reported the AOPA Medicare Manual, Fourth Edition, published in 1989. “It has taken more than a decade to get HCPCS from its original concept into a final set of codes that satisfies both HCFA and the health-care industry. AOPA has been working closely with HCFA on the orthotic and prosthetic portions of HCPCS for several years. After much hard work, and many trials and compromises, the orthotics and prosthetics portion of the larger coding system has been approved by HCFA and AOPA.”

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THEN & NOW

Pictorial Reference Manual, 1986

After the trial in South Carolina, AOPA “distributed the final version of the codes to all AOPA members and began offering workshops around the country to help members learn how to use the new codes,” according to the Manual. By 1989, all carriers in the United States used the HCPCS codes. The conversion to HCPCS was meant to standardize the industry. “Now that the conversion has taken place, it is very important for the orthotists and prosthetists in the area to understand the new coding system, what it can and can’t do, and to help the carriers continue to implement the codes so that they are as beneficial as possible to your industry,” the 1989 Manual stated. Over the years, as new devices hit the market and new coding regulations were implemented, coding and claims submission became more complicated. AOPA responded to members’ requests for assistance by developing products and services aimed at helping O&P professionals understand the L codes and learn to use them to attain appropriate reimbursement. To provide clear guidance in a documented format, the association published the AOPA Illustrated Guide— originally called the Pictorial Reference Manual of Orthotics and Prosthetics—in 66

SEPTEMBER 2017 | O&P ALMANAC

1986. The Guide was written to educate orthotists, prosthetists, and thirdparty payors, and to alleviate some of the confusion pertaining to the identification of specific devices, “even among insurance companies,” says Jon Leimkuehler, CPO, FAAOP, an AOPA past president. When the inaugural Pictorial Reference Manual was released, it featured 250 pages, plus appendices. AOPA sent out one copy to each member company, and offered additional copies for sale. AOPA also sent copies to insurance companies and to Medicare to ensure standardization for reimbursement purposes as well. Since its initial publication, AOPA has continued to publish the manual each year. After the first year, L codes were added to the descriptions. The publication eventually became known as the AOPA Illustrated Guide. In the early 1990s, the document served as the foundation for another seminal AOPA product, the AOPA Coding Pro—which was touted as the “electronic version of the Illustrated Guide,” according to Michael S. O’Donnell, CPO, who worked on the original Coding Pro. Ensuring members understood the L codes was again the focus when AOPA developed the Coding &

Billing seminar in the mid 1990s. The seminar was designed as a training course that could travel the country, providing much needed education and offering a forum to answer members’ questions regarding the coding issues of greatest concern. “AOPA was trying to figure out how to share coding and billing information on a national level,” says O’Donnell, who had presented some coding information at local seminars. The first seminar, held in Hartford, Connecticut, outperformed expectations, and drew hundreds of participants—demonstrating the need for ongoing Coding & Billing seminars to educate clinicians and ensure proper coding of O&P claims. AOPA began offering seminars a few times a year, at different locations across the country, to allow practitioners from all corners easy access to the information. At the early seminars, presenters “would show a device and explain how it was coded and why,” says McTernan. During the first few years, the seminars were given at a very basic level, with the goal of ensuring participants understood the fundamentals of coding. The seminar also included a session called “Special Topics,” which focused on issues that had been brought to the attention of AOPA’s Coding and Billing Committee. “We would go through questions that had come into the committee, that committee members had batted around and come up with an answer to, and share those with attendees,” says O’Donnell. Presenting the coding information in-person also offered AOPA and the Coding and Billing Committee a better understanding of what the members were experiencing, and “allowed us to tailor the seminars to more accurately meet their needs,” says Kathy Dodson, a former senior director of government affairs for AOPA. The presenters could spot problems being caused by Medicare and work with HCFA on fixing them. “It also allowed us to see variations between Medicare regions in how regulations were being interpreted and applied.”

“Before the seminars, everyone was trying to interpret the codes independently, or talking to people they knew to make challenging coding determinations,” says O’Donnell. “It was great when there was finally a voice, and a place to go to help everyone understand the coding.”

NOW

Nearly 40 years after AOPA first assisted with the development of the L codes, the association’s commitment to educating members about proper coding and billing techniques remains unwavering. Today, AOPA still offers the Illustrated Guide and the Coding Pro, and schedules several Coding & Billing seminars throughout the year. In addition, AOPA hosts monthly webinars, many of which address issues relating to the L codes. Each issue of O&P Almanac includes Reimbursement Page and Ask AOPA articles, often featuring billing and coding advice. Most importantly, staff members continue their relationship with CMS,

Illustrated Guide, 2017

formerly HCFA, and are always available to assist members with their coding questions. “I have served as one of AOPA’s L-code experts throughout my tenure at AOPA,” says McTernan, who currently oversees the seminars, webinars, and other coding activities. “I have a complete knowledge of how the L-code structure is set up as a base code/addition code system.”

Looking to the future, McTernan sees a need for the L-code system to evolve due to the technological changes in O&P componentry. “The L-code system is showing its age,” he says. “In many instances, technology has moved beyond the existing code set.” For example, many codes include the term “molded to patient model” in their descriptors, which requires that a custom-fabricated item is physically molded over a positive model of the patient’s body party. “With the advent of technology such as 3D printing and digital models, many devices no longer require a plaster or foam model of the specific body part in order to create a truly custom device. The outdated code language does not reflect these advances in technology.” If and when the appropriate changes are made, AOPA will keep the O&P community informed and will continue to educate practitioners about coding and billing issues to help ensure appropriate reimbursement for orthotists and prosthetists.

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O&P ALMANAC | SEPTEMBER 2017

BRIDGE TO THE FUTURE: THE INTERVIEWS

A Standardized Approach to Cranial Helmets Orthotists will have a greater repository of outcomes-based recommendations in determining treatment protocols for cranial deformation By CHRISTINE UMBRELL

Bridge to the Future: The Interviews is a monthly column for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will look to the next 100 years—by interviewing noted experts in the O&P field to learn their vision for the future of O&P. This month, we speak with Jim Brookshier, MSPO, CPO, LPO, about newly released data on the treatment outcomes of positional plagiocephaly.

Jim Brookshier, MSPO, CPO, LPO 68

SEPTEMBER 2017 | O&P ALMANAC

S THE U.S. HEALTH-CARE

landscape shifts to a value-based model, it is expected that more outcomes-based research and clinical practice guidelines (CPGs) will need to be developed. Guidelines promote quality and optimal patient care by reducing health-care variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective treatments. The movement to produce O&P-themed CPGs has already begun, and the recent publication of findings from a study on the management on positional plagiocephaly may further contribute to the refinement of optimal patient-care pathways for children with this condition. Orthotists—and other health-care practitioners who see patients with this condition—can reference the recently published article, “Factors Influencing Outcomes of the Treatment of Positional Plagiocephaly in Infants: A SevenYear Experience,” in treating patients and can share the article and its contents with other health-care team members as well as payors. The study findings, published in the Journal of Neurosurgery: Pediatrics, describe the results observed within a local care model and may serve as a foundation for other practitioners to consider in establishing similar care models or when conducting additional outcomesbased research.

Data-Driven Recommendations Jim Brookshier, MSPO, CPO, LPO, a clinician with Hanger Clinic and one of the authors of the “Factors” article, began working closely with Thomas G. Luerssen, MD, seven years ago at Texas Children’s Hospital in Houston. Since then, they and their team have treated thousands of patients with skull deformations caused by occipital plagiocephaly, occipital brachycephaly, or a combination of both. The “Factors” article, written in conjunction with several other team members, is the result of their study of treatments and outcomes of 991 patients. The article explains “how our clinic functions and how we have refined our protocols for optimal results as standard operating procedures, and provides a local care model that has worked well for us.” The article documents solid data explaining how and why cranial helmets have been found to be the proper treatment plan for most patients who present with skull deformation at 4 to 6 months of age. “Our research addresses the question, ‘At what point are we repositioning?’” explains Brookshier. “With torticollis, should we try repositioning, therapy, or helmets—or all three?” According to Brookshier and the “Factors” observations, earlier age at treatment and type of treatment impact the degree of measured deformational head shape corrections in

BRIDGE TO THE FUTURE: THE INTERVIEWS

positional plagiocephaly. Ultimately, “treatment with a custom cranial orthosis can result in more improvement in objective measurements of head shape,” he says. (See sidebar, “Recommended Treatment for Plagiocephaly,” for details on recommended treatment protocols.) The data-driven recommendations should prove useful in educating physicians and other health-care team members about why orthotic evaluation is necessary for this patient population. “Pediatricians are uninformed of the effectiveness of orthotic intervention and the need to treat for deformational plagiocephaly,” he says. Many pediatricians wait until babies have reached 10 months old or longer before pursuing treatment—“but it’s hard to achieve the same results as if they had come in for treatment at 4 months of age.”

Recommended Treatment for Plagiocephaly The following treatment protocol is recommended in “Factors Influencing Outcomes of the Treatment of Positional Plagiocephaly in Infants: A Seven-Year Experience”: • Patients presenting at the younger end of the age spectrum (1 to 4 months chronological age, adjusted for prematurity) with oblique diagonal difference (ODD) greater than 10 mm or cephalic ratio greater than 0.95 are recommended repositioning as first-line management and physical therapy if torticollis is present. Patients are re-examined and rescanned every four to six weeks. • If the head shape deformity does not improve or progresses with repositioning, with or without physical therapy, a cranial orthosis is recommended as the next step. If patients present at 4 to 6 months of age after prior attempts at repositioning and/or physical therapy have occurred without improvement in head shape deformity, and they have a measured deformity in the range described above, a cranial orthosis is recommended. A typical patient presenting in the 4- to 6-month age range without an initial course of conservative management would be referred for repositioning/physical therapy, with recommendation for cranial orthosis if there is not head shape improvement or if the deformity is worse at the 4- to 6-week follow-up.

• Cranial orthotic therapy ends at approximately 12 months of chronological age, adjusted for prematurity. Only one helmet is used, unless loss or damage occurs. Source: “Factors Influencing Outcomes of the Treatment of Positional Plagiocephaly in Infants: A Seven-Year Experience,” by Sandi Lam, MD, MBA; I-Wen Pan, PhD; Ben A. Strickland, MD; Caroline Hadley, MD; Bradley Daniels, BS; Jim Brookshier, MSPO, CPO, LPO; and Thomas G. Luerssen, MD, Journal of Neurosurgery: Pediatrics, January 2017.

SEPTEMBER 2017 | O&P ALMANAC

— Jim Brookshier, MSPO, CPO, LPO

PHOTO: Jim Brookshier, MSPO, CPO, LPO, Hanger Clinic

• If patients present in the older range (7 to 9 months), the time between conservative repositioning/physical therapy management and prescription of cranial orthosis therapy may be shortened as the velocity of head circumference growth slows. Depending on other factors, these patients are usually treated with a cranial orthosis within a shorter timeframe following presentation to clinic. Because there was found to be limited benefit to orthotic therapy in infants presenting after 10 months of age, patients at that age of presentation are generally not treated with an orthosis unless special circumstances are present.

“We use all three approaches—but the best and most effective has been found to be cranial orthoses.”

Texas Children’s Hospital uses a team approach to patient care, involving physicians, therapists, and orthotists, and leverages a combination of treatments—repositioning, physical therapy, and helmets—to treat patients on a case-by-case basis. “We use all three approaches—but the best and most effective has been found to be cranial orthoses,” he says. “These findings can be considered at other facilities across the nation as they determine best practices for treating positional plagiocephaly,”

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BRIDGE TO THE FUTURE: THE INTERVIEWS

Brookshier says. While every patient is different, Brookshier and his team have seen a significant patient population over a seven-year time span. “We have shown that, for us, this strategy works. We have tons of data—every step was documented.” The researchers included in their study only those patients for whom they had full data sets, excluding patients who did not complete follow-up visits. The local care model focuses on correcting overall growth patterns, rather than the amount of correction, according to Brookshier. “We have a specific way that we treat, an established treatment timeline, and a set of standards for helmets.”

“The treatment process is more seamless when the doctor, therapist, and orthotist all understand the expectations, techniques, and helmet treatment time.” — Jim Brookshier, MSPO, CPO, LPO

PHOTO: Getty Images/Jenjen42

Brookshier adds that cranial orthoses should be used primarily to change the growth pattern and reverse the deformational forces. The guidelines are designed to “achieve a good portion of correction. But we’re trying not to keep babies in helmets for too long.” His team looked to evaluate whether patients were rolling at night, rather than achieving maximum correction, and used this parameter as a measure of success. Rolling showed that the health-care team had disrupted patients’ growth pattern “and started a new growth pattern,” a pattern that would in turn prevent future deformation, according to Brookshier.

What the Findings Will Accomplish

With the data available from the study as a resource, Brookshier hopes that clinicians who treat patients with positional plagiocephaly “will consider the factors we have outlined while working with other health-care team members,” he says. “The treatment process is more seamless when the doctor, therapist, and orthotist all understand the expectations, techniques, and helmet treatment time.” The importance of communications among team members cannot be understated. “Some clinicians want to put everyone in a helmet. But the care team needs to collaborate and consider each other’s opinions,” he says. “We’ve done this work [with this patient population] for seven years. We know a helmet will work, but we also allow others to have their input.” Working collaboratively with a physician and therapist, and incorporating therapy and repositioning into the treatment protocol, will result in optimal outcomes. “If we can work together as a team, it helps us as an industry—and it helps patients.” As O&P professionals come to understand the value of outcomesbased research, which can ultimately be used to develop treatment protocols and CPGs, clinicians will start to

document their care models and associated outcomes. For cranial helmets specifically, “we are slowly educating therapists, pediatricians, and others on this approach. It’s not just a helmet approach, but a team approach. “Our treatment protocols offer a potential roadmap for orthotists,” Brookshier continues. “They educate orthotists on what physicians may be expecting to see. There’s so much variance in treatment in O&P in cranials. If an orthotist discharges a patient from a helmet, all of the medical professionals should be able to agree that it was the right time.” Brookshier adds that payors will expect to see more outcomes-based research to support the efficacy of cranial helmets—as well as other O&P interventions—going forward during the movement to value-based health care. “Insurance companies absolutely want to see clinicians more involved in that process. “I would hope this would contribute to a standardized treatment approach,” says Brookshier. “This is an algorithm that has worked for us and can be duplicated.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com. O&P ALMANAC | SEPTEMBER 2017

THE GLOBAL PROFESSIONAL

Burhan Dhar, CPO Riyadh, Saudi Arabia Head of O&P department at King Faisal Specialist Hospital shares his clinical experiences O&P ALMANAC: Describe a typical

work day for you.

BURHAN DHAR, CPO: A typical work

As the O&P profession prepares for the Second AOPA World Congress, to be held in conjunction with AOPA’s 100th anniversary celebration September 6-9, in Las Vegas, the O&P Almanac is featuring a question-and-answer section with international O&P experts. Each month, we spotlight an O&P professional from a different part of the world to find out how O&P is practiced across the globe.

Saudi Arabia

SEPTEMBER 2017 | O&P ALMANAC

At 9:00 a.m., clinics begin with scheduled patients for that day. As head of the orthotic and prosthetic department at King Faisal, my time is divided between clinical work (75 percent) and administrative work (25 percent). The department also is an internship site for fresh Saudi graduates in prosthetics and orthotics. It is my responsibility to mentor and monitor the progress of interns throughout the day. Afternoons are generally dedicated to annual reviews and evaluations of

O&P ALMANAC: Describe the location

where you provide services.

DHAR: King Faisal Specialist Hospital and Research Center is a tertiary care hospital with one of the world’s best oncology and transplant programs. It is located in the heart of the capital, Riyadh, in the kingdom of Saudi Arabia. Often referred to as “the jewel in the crown of Middle East health care,” King Faisal dominates the region with state-of-the-art and modern health care provided by employees from more than 100 nationalities. O&P ALMANAC: What types of

patients do you typically see, and what types of devices do you fit for these patients?

DHAR: The type of patients seen in the orthotic and prosthetic department include amputees and individuals with other musculoskeletal disorders. Many amputations result from sarcomas such

PHOTOS: Burhan Dhar, CPO

day starts at 7:30 a.m. at King Faisal Specialist Hospital & Research Center in Riyadh. My day begins with reviewing the clinics of practitioners and that of my own for that day. At 8:00 a.m., all practitioners and technicians gather to discuss the day ahead. Practitioners may discuss challenging cases scheduled for the day, and technicians may discuss depleting supplies and componentry or the upkeep of machinery to avoid bottlenecks in work flow.

department employees, which includes extending and terminating annual contracts based on performance. Some time also is dedicated to ordering the necessary supplies and speaking to representatives about the latest components available in the market. A weekly or monthly meeting of clinical services departments, which includes 20 other departments of allied health, also may be part of a typical work day.

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THE GLOBAL PROFESSIONAL

as osteosarcoma and vascular disease, and some are congenital amputees. Amputees are fitted with modern-day endoskeletal prostheses with a variety of modern socket technology. The orthotic and prosthetic department at King Faisal is the first and only facility that is a High-Fidelity (HiFi) certified socket technology center in Asia. Patients are typically fitted with the latest HiFi sockets or ischial containment sockets, for transfemoral amputees. There are many genetic diseases leading to musculoskeletal disorders. Although rare, there are still old polio cases in the country.

O&P ALMANAC: If the payor is other

than the patient, do nonpatient payors have an audit process? If there is an audit process, do you consider it to be fair? DHAR: The hospital has a department

dedicated to internal audit and transparency. Each year an inventory of items in stock is conducted by inspectors and compared with that of consumed items. The results of inventory are then compared to recorded patients seen and fitted in a typical fiscal year. Although the IT department is working on linking supplies to an Oracle system available for observation to anyone at any time, the current system also seems balanced and fair. O&P ALMANAC: Describe your edu-

cational background and any certifications you have. How do you keep your skills sharp? Patients are fitted with a variety of devices that range from simple foot orthoses to ankle-foot orthoses (dynamic as well as solid ankle), to a variety of knee-ankle-foot orthoses, etc. The department also has an active scoliosis management program that fits orthoses. This in addition to postoperative thoracolumbosacral orthoses, etc. The department also has a vibrant orthotic knee management program, including but not limited to osteoarthritis patients. Practitioners also participate in surgical teams for immediate postoperative orthotic management of soft tissue releases and amputations. O&P ALMANAC: How are the devices

you provide paid for?

DHAR: Devices are paid from the hospi-

SEPTEMBER 2017 | O&P ALMANAC

I keep my skills sharp by staying involved with clinical work, attending and participating in weekly interdepartmental grand rounds such as orthopedic grand rounds and vascular and neurosurgery grand rounds. I also am part of many committees, such as the Movement Disorder Committee and the Spina Bifida Clinic Committee. I attend and present my work at many forums all across the world, including ACPOC, AOPA, and the

O&P ALMANAC: What’s the biggest

challenge you face as a practitioner, and how do you deal with it?

DHAR: In Saudi Arabia, the spoken language and the language in schools and universities is Arabic. There is very little literature available about the role of orthotics in the treatment of neuromuscular skeletal disorders [in this language]. A lack of orthotic and prosthetic schools in the country contributes further in this regard. Hence, both patients and medical professionals lack proper knowledge about the appropriate role of orthotics and prosthetics in the treatment of disorders such as idiopathic scoliosis and arthritis management in knees. In terms of patients, it results in less compliance, unless they are given proper information. Educating others during presentations in weekly grand rounds and during regular follow-up patient visits with their medical consultants, and showing progress with the use of orthotics, has helped more doctors prescribe conservative treatments such as orthotics. Participating in conferences across the country and in interdepartmental exchanges and conducting clinics have resulted in the modernization of the orthotic and prosthetic field in the country. O&P ALMANAC: Describe any chari-

table work you or your organization does. DHAR: I have conducted free clinics in Indian Kashmir in the past, where there are many injury and amputation patients. I also try to offer help with prosthetic and orthotic advice to Yemen and Syrian war victims whenever possible.

PHOTOS: Burhan Dhar, CPO

tal budget for a typical year. The hospital is run by the government as a nonprofit and paid for by the government. King Faisal Specialist Hospital & Research Center has an annual budget allocated that is separate from the budget allocated under the ministry of health.

DHAR: I was awarded the “First Prize for New Investigator Research Paper Award” in 2016 and 2017 by the Association of Children’s ProstheticOrthotics Clinics (ACPOC).

International Society for Prosthetics and Orthotics, in addition to other national conferences.

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O&P ALMANAC | SEPTEMBER 2017

MEMBER SPOTLIGHT

FitRight Precision Orthotic and Prosthetic Lab

Full-Service Ortho Illinois orthotists partner with orthopedic facility to offer a comprehensive patient-care experience

NE YEAR AGO, Andy Sestak,

SEPTEMBER 2017 | O&P ALMANAC

Clinicians at FitRight helped design their brand-new facility, which features separate spaces for grinding and plaster work.

FACILITY: FitRight Precision Orthotic and Prosthetic Lab LOCATION: Rockford, Illinois OWNER: OrthoIllinois HISTORY: One year

Andy Sestak, CO

Rick Allen, CO

Aaron Strom, CO

Sestak, Allen, and Strom were involved in planning the physical space in their brand-new facility, which features a main shop for vacuum forming and leatherwork, along with separate rooms for grinding and for plaster work, the latter with a gridded floor that allows plaster fragments and dust to drop through. The office includes a gait room with parallel bars and two separate standard fitting rooms, as well as a well-designed waiting area. “We also have access to a cast room at one of the clinics, where we have a little more room to spread out,” says Sestak. FitRight provides a full range of orthoses, including lowerand upper-extremity devices, spinal systems, and halos. The facility has a significant pediatric patient population, frequently fitting cranial helmets, Surestep orthopedic braces, and Cascade dynamic ankle-foot orthoses. Sestak, Allen, and Strom value the easy availability of physicians and additional services. “If I have a question, I just walk over to the other side of the building and connect with the doctor,” says

Sestak. “Everything is right here, and that means a better outcome for the patient. We can fit a fracture brace, take an X-ray, and adjust it on the spot. If a physician spots a bracing problem, patients don’t have to drive somewhere else to get it looked at.” The orthotists are often called in to consult during medical office visits so the doctor, orthotist, and patient can decide on an optimal device together. Another benefit is that patients are more likely to follow up on doctors’ orders when they can just walk across the building instead of making another appointment and driving to a different location. In addition to work originating with OrthoIllinois, FitRight also takes referrals from around 100 outside sources, including four area hospitals and Easter Seals. While OrthoIllinois handles much of the marketing for the facility, Sestak and his colleagues also make individual calls on outside physicians in town. “I’ve been here since 1993, and Andy since 1991, so we were already fairly well known,” says Allen. “But we’ve been calling on doctors to reintroduce ourselves and let them know where we are.” Looking ahead, in addition to adding prosthetic services, FitRight plans to focus on education and host several residents each year. OrthoIllinois’ business model concerning O&P may be rare— Rezin believes that when they built FitRight, only two other orthopedic practices in the country had a standalone O&P clinic—but it is likely to spread. “It’s getting tough to be a solo facility,” says Sestak. “We were working more than 60 hours a week before.” Allen agrees. “We’ve got a great facility, the patients get the best of everything, and we get to do the fun stuff!” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: FitRight Precision Orthotic and Prosthetic Lab

CO, Rick Allen, CO, and Aaron Strom, CO, officially became part of OrthoIllinois, a medical/surgical group of orthopedic physicians founded in 1967 as Rockford Orthopedic Associates. For Sestak and his colleagues, with 53 years of combined experience in orthotics, the move to OrthoIllinois was a unique opportunity to direct their focus on their patients. Sestak, Allen, and another orthotist previously owned a different facility. “We got sick of fighting with insurance companies, and OrthoIllinois had wanted to do something with us for years,” Sestak explains. Now, as clinicians at the company’s FitRight Precision Orthotic and Prosthetic Lab, Sestak and his colleagues leave insurance headaches, compliance issues, information technology, billing, and other business-related tasks to OrthoIllinois, allowing them to concentrate on patient care. The decision to incorporate an O&P facility into OrthoIllinois fell right in line with the company’s philosophy, says Chief Operating Officer David Rezin. “We try to offer convenience and the highest quality care to all patients, and that doesn’t mean just orthopedic and musculoskeletal medicine,” he explains. “We provide pain management, [magnetic resource imaging], rheumatology, physical therapy—and now patients can stay within our walls to get custom orthoses.” Rezin expects to hire a full-time prosthetist in the next fiscal year to add to the lab’s available services.

By DEBORAH CONN

Congratulations AOPA on 100 years of leading the profession. We are proud to have served together for generations.

MEMBER SPOTLIGHT

Mobius Bionics

By DEBORAH CONN

From Sci-Fi to Reality New Hampshire company brings the LUKE arm to market

EAN KAMEN CREATED Mobius Bionics to commer-

SEPTEMBER 2017 | O&P ALMANAC

COMPANY: Mobius Bionics OWNER: Dean Kamen LOCATION: Manchester, New Hampshire HISTORY: One year

Fred Downs explains how he uses his humeral configuration LUKE arm.

and condition of the residual limb, among other factors such as cognitive ability and balance. Evaluation and fitting by a skilled prosthetist with experience fitting the LUKE arm is critical, according to Burkholder. Mobius provides a fitting arm that is the same size and weight of the actual device to evaluate fit and see if a patient can manage it before making a significant financial investment. The LUKE arm has garnered significant fanfare throughout its development for its advanced features. Force sensors enable users to control the grip for such disparate objects as a grape and a power drill, and the wrist and fingers are automatically adjusted to perform six different user-chosen grips. Users have a number of options to control the device. “Standard control systems that work with current upper-limb prostheses will work with ours,” says Burkholder. In addition, Mobius offers wireless inertial measurement units, or IMUs, that are worn on the top of shoes. “It’s like a miniaturized Wii controller on your feet,” says Burkholder. “It responds to rocking the foot forward, backward, and from side to side. With both feet, that’s eight control signals, and the arm movement is proportional to the intensity of the signal.”

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

PHOTOS: Mobius Bionics

cialize the advanced prosthetic arm that DEKA Research and Development Corp. developed as part of the Defense Advanced Research Projects Agency’s Revolutionizing Prosthetics program. Dubbed the Life Under Kinetic Evolution (LUKE) arm, the device offers up to 10 powered degrees of freedom and a variety of control inputs, in configurations for transradial, transhumeral, and shoulder disarticulations. Following approval by the U.S. Food and Drug Administration (FDA) in 2014, two amputees, both veterans, received the first prescription devices this summer. Recipients Fred Downs, an aboveelbow amputee, retired national director of the U.S. Department of Veterans Affairs (VA) Prosthetic and Sensory Aids Service (PSAS) and now a prosthetics consultant for Paralyzed Veterans of America, and Artie McAuley, a U.S. Army veteran who received a shoulder configuration, had both participated in multiple clinical trials. “It’s been very exciting,” says Mobius General Manager Jay Burkholder. “With prescriptions coming through, we are now working with the government to create a standard process to provide the LUKE arm to veterans, and working through reimbursement justifications with private insurers.” Burkholder is quick to note that the LUKE arm is not for every upper-extremity amputee. “We have to take a number of biological considerations into account,” he explains. The fitting challenge depends on the length, strength,

Army veteran Artie McAuley demonstrates his new shoulder configuration LUKE arm.

Pattern recognition is another advanced control method. Coapt Engineering recently gained FDA clearance for a version of its COMPLETE CONTROL advanced myoelectric control system that interfaces with the LUKE arm. It uses the patient’s natural movement intentions to provide up to 16 inputs to control the arm. “It talks the native language of the LUKE arm, giving people a very intuitive way of controlling it,” says Burkholder. “All of these systems are configurable by the prosthetist and with a lot of input by the patient.” Despite the arm’s complexity, Burkholder says a new patient can have an operational limb within five minutes and be able to accomplish basic tasks in a few hours. Although not an amputee, Burkholder was able to approximate wearing the device with a version mounted to a frame that he can wear. “Our recommended protocol is to devote about a week to fitting the device, and then spend two weeks of on-and-off physical and occupational therapy mixed in with just living with the arm. In clinical trials, we’ve found that patients can do significantly more activities of daily living, with fewer difficulties than with their prior prosthesis, after 30 hours of training.” While the device is relatively expensive, Burkholder expects that increased production will create economies of scale. For now, careful growth is key. Mobius is highly selective in choosing and certifying prosthetists to fit the device—so far, practitioners have all been part of clinical trials—and want to ensure that every LUKE arm delivered is successful. “We are committed to getting this technology to everyone who needs it,” he says.

NEW! Co-OP

Co-OP

An AOPA Member Benefit As an online reimbursement, coding, and policy resource, this site includes a collection of detailed information with links to supporting documentation for the topics most important to AOPA Members. Like a Wikipedia of all things O&P, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of our membership body.

Resources include: • State-specific insurance policy updates, • L code search capability, • Data and evidence resources, and so much more!

Learn more and sign up at

www.AOPAnet.org/co-op. www.AOPAnet.org

AOPA NEWS

AOPAversity Webinars SEPTEMBER 13

OCTOBER 11

ABC Inspections & Accreditation Do you know everything you need to know about facility inspections and accreditation by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC)? Make sure your facility is meeting or exceeding expectations with regard to ABC accreditation by taking part in this webinar. Experts will discuss the following topics: • What can I expect during and after a site visit? • Which Quality Standards apply to O&P? • What can I do to prepare for accreditation? • Can you answer some accreditation myths and questions?

AFO/KAFO Policy Make sure you know all of the rules and requirements outlined in the Ankle-Foot Orthosis/Knee-Ankle-Foot Orthosis (AFO/KAFO) Policy. Hear from experts who will share their knowledge and answer the following questions: • What documentation must exist in order to use the KX modifier on a claim? • What are the coverage rules for AFOs with ambulatory versus nonambulatory patients? • How should repairs to AFOs and KAFOs be billed? • When is it acceptable to use a custom-fabricated AFO/KAFO? • What are the major components of a Medicare medical policy?

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2017webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Sign up for the half-year series and get three sessions FREE! This includes two bonus webinars added for Health-Care Compliance & Ethics Week Nov. 5-11. All webinars that you missed will be sent as a recording. Register at bit.ly/2017billing.

SEPTEMBER 2017 | O&P ALMANAC

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Join AOPA November 6-7 in Phoenix to advance your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics. AOPA experts provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group. Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2017billing.

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NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Arizona Desert Orthopaedic Center Inc. 13660 N. 94th Drive, Ste. C1 Peoria, AZ 85381 Member Type: Patient-Care Facility 623/974-6542 Thomas Hamm Limbionics of Raleigh Inc. 3824 Barrett Drive, Ste. 102 Raleigh, NC 27609 Member Type: Patient-Care Facility 919/441-0023 Marco Calcagno

Prosthetic & Orthotic Group—Mobile 2290 E. Prospect Road, Ste. 2 Fort Collins, CO 80525-9768 Member Type: Affiliate Parent Company: Prosthetic & Orthotic Group Inc., Signal Hill, CA 970/416-9357 Reliable Prosthetics & Orthotics 1505-C South Glenburnie Road New Bern, NC 28562 Member Type: Patient-Care Facility 252/638-8989 Todd Michael Ank, BOCPO 2017

O&P PAC

with a

HE O&P PAC UPDATE provides

information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: • • • • • • • • •

David A. Boone, PhD, MPH Rod Cheney, CPO Jeff Collins, CPA Jim Kaiser, CP Teri Kuffel, Esq. William Leimkuehler, CPO Jeffrey Lutz, CPO Chris Nolan Michael Oros, CPO, LPO, FAAOP • Brad Ruhl • Matt Swiggum • Jim Weber, MBA 84

SEPTEMBER 2017 | O&P ALMANAC

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level, which have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate, and other officials running for office, to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo. com/forms/op-pac-authorization. *Due to publishing deadlines this list was created on July 24, 2017, and includes only donations/contributions made or received between July 1, 2017, and July 24, 2017. Any donations/ contributions made or received on/or after July 24, 2017, will be published in the next issue of the O&P Almanac.

PURPOSE

7TH 6:30-9:30 PM 1923 Bourbon Bar

SEPTEMBER

Mandalay Place, Las Vegas

Support the PAC and the future of O&P at this special 100th Anniversary event. Enjoy prohibition inspired cocktails, dinner, live entertainment, a silent auction, a private cigar lounge, and much more. It is guaranteed to be the

cat’s pajamas!

Attend “Party With a Purpose” at the 2017 AOPA World Congress held Sept. 6-9 in Las Vegas. For more information and registration, visit AOPA Booth #100 or contact Devon Bernard at dbernard@AOPAnet.org. Register today, space is limited.

MARKETPLACE

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

Foam Box Lab Services for Diabetic, EVA, and Rigid Orthotics

2.0 Allard AFOs

Now all 2.0 Allard ankle-foot orthoses (AFOs) come with a Starter Interface Kit. Kit includes: One SoftKIT Pad and two Tibia Pads! For more information call customer service at 888/6786548. Make it a 2.0 Allard AFO today!

ALPS SP High Density Liner The SP High Density Liner features black fabric that allows for stability for active patients. The SP Liner has similar characteristics as silicone but provides the superior comfort of gel. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Custom Stealth Foot Orthotics Custom carbon-fiber foot orthotics—and boy, are they pretty. And strong. And lightweight. Trusted to protect the feet of our service members, this beauty goes more than skin deep. Fabrication available from foam boxes or Amfit digital files in two rigidities (firm or flex). Corrections and adjustments are molded into the carbon fiber to eliminate movement of pads and edges during wear. EVA heel counter maintains stability in the shoe or boot. Contact our customer service team to learn more today, orders@amfit.com or 800/356-FOOT(3668), x250.

SEPTEMBER 2017 | O&P ALMANAC

FootPrinter allows you to send your own boxes or use ours. Standard EVA orders manufactured in three to four business days; diabetic A5513, carbon fiber, and polypro in three to five days. PDAC-approved A5513 diabetic pricing includes shipping costs for bi-lam and tri-lam styles. EVA available in soft, medium, dual, firm, and cork blend. Carbon-fiber fabrication offered in flex or firm to best suit your patient. Milled polypropylene available in three widths and thicknesses for excellent fit and wear. Get started right away by emailing orders@amfit.com for an account form, or call 800/356-FOOT.

Anatomical Concepts Inc. PRAFO® RAPO™ Comparison • Totally adjustable and custom-fit ankle-foot orthoses that help manage numerous ankle/foot anomalies. • Custom-contoured aluminum heel connector bar helps control dorsi-plantar flexion by allowing infinite, measurable adjustments. Its ergonomically designed foot plate allows its liners to be replaced or cleaned easily without tools. • Universal right or left fit. What is the difference? The PRAFO® features a Kodel® vinyl reinforced liner, which has hook-and-loop Velcro straps and chafes. The RAPO™ has one dorsum hook-and-loop Velcro strap and chafe, and two hook self-stick 1.5-inch Velcro straps secured directly to the liner. For more information, contact 800/837-3888 or visit AnatomicalConceptsInc.com.

MARKETPLACE Advanced Myoelectric Control

Coyote Composite

The Complete Control system from Coapt is a powerful add-on enhancement to powered prosthetic arms. The controller provides more intuitive, natural control for prosthesis users and is specifically designed to work with commercially available prosthetic elbows, wrists, and terminal devices. Coapt’s advanced FDA-cleared pattern recognition technology works by using greater information from users' muscle signals and dramatically improves the function and adoption of the prosthesis. Other benefits include the elimination of mode switching, quick and easy recalibration, and better proportional control. For more information call 844/262-7800 or visit www.coaptengineering.com.

New Locking Shoulder Joint From College Park Formerly the LTI Locking Shoulder Joint, the new AXIS® has been re-engineered by College Park. With a patented friction hinge, the shoulder joint is operated with simple switches that simplify harnessing by eliminating the need for gross body movements. The AXIS is able to be integrated with all upper-limb control systems with a special channel to conceal and protect power cables. Unlike any product on the market, the AXIS provides better task control, a natural range of motion, and ease of use for the patient’s daily life. Learn more at www.college-park.com/ axis-shoulder-joint.

Coyote Design Adhesives We now have two glues COYOTE ADHESIVES to choose from. • Coyote Quick Adhesive— Quick Adhesive 30-second set time. • Coyote Smooth Smooth Adhesive Adhesive—New 60-second set time option. • Coyote’s glues are great for attaching componentry and multiple repairing uses. • They ship nonhazardous and are safe with no odor. Learn more at www.coyotedesign.com.

Coyote Composite Basalt COYOTE COMPOSITE Fiber is tough yet flexible. Ideal for ankle-foot tough stuff orthoses and prosthetics. • Costs less than carbon fiber www.coyotedesign.com • Less itch than carbon fiber COSTS LESS THAN CARBON FIBER • Tough, durable, and lightweight • Edges finish smooth. Learn more at www.coyotedesign.com.

CureVentions’ Pectus emBrace™ CureVentions’ Pectus emBrace™, invented by Joseph S. Pongratz, CPO, FAAOP, is designed exclusively for the treatment of pectus carinatum. The device works through implementing pressure gradients with Dynamic Force Plate technology to provide corrective compression over the pectus prominence. The Pectus emBrace™ was built with patient comfort in mind and promotes a new and more effective method of treating pectus carinatum. • 100 percent nonmetal components • Moisture-wicking KoolFlex™ fabric • Patent-pending Dynamic Force Plate • Latex-free and nonslip pads • Magnetic BOA™ closure for easy-on/easy-off • Allows 20+ hours of wearing time • Discreet low-profile design. For more information, call 480/897-2207, or visit www.cureventions.com/pectus-embrace.

Quick Set Time

NEW GLUE!!!

Longer Work Time

O&P ALMANAC | SEPTEMBER 2017

MARKETPLACE

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

New Prosthesis for Chopart and Lis Franc Patients Custom Composite Manufacturing’s new Partial Foot Prosthesis is designed specifically for Chopart and Lis Franc patients. The prosthesis restores normal foot biomechanics and properly transfers energy from a rigid lever arm to a progressive resistance carbon footplate. The Partial Foot Prosthesis is lightweight, durable, and custom made from a cast. It comes with a foam liner, Velcro® strap, and toe filler. It is the lightest, most functional design available today. Suggested L Codes: L5020, L5634, L5654, L5785, L5976 For more information, contact Custom Composite Manufacturing at 866/273-2230 or visit www.cc-mfg.com.

Fillauer The BT-4 Infrared Oven is capable of bubble forming and heating sheet plastic while taking up a minimal floor space. It is big enough to heat most knee-ankle-foot orthosis sheet plastics, and has enough drop for the largest check socket. The BT-4 has the same speed and reliability you’ve come to expect from PDQ Infrared Ovens. The eight 1,000-watt emitters—four on top and four on bottom—along with the dual electric fans, allow bubble forming plastics to be heated evenly and efficiently. The BT-4 is truly the best of both worlds with its small size and large capacity. For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com.

Custom Sockets When You Need Them Custom sockets and systems are made from your measurements and adhere to the patented design principles established in our standard sizes. Shown here from left to right, Flexion Contracture, Ischial Weight Bearing TransTibial, Symes, and Knee Disarticulation custom sockets. At FLO-TECH® custom sockets and systems are shipped on the same day as ordered, if order is received prior to Noon Eastern Standard Time. We also have components for all systems. More info at www.1800flo-tech.com.

SEPTEMBER 2017 | O&P ALMANAC

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

WalkOn® for Less This Summer WalkOn Reaction junior is the newest addition to the WalkOn line of custom ankle-foot orthosis products, featuring a durable design for less breakage and fewer clinic visits, fast and easy to fit due to trimmable sole, and extremely comfortable due to the open heel, light weight, and automatically designed anterior tibial shell. Take advantage of our WalkOn for less promotion from now through September 29 by talking with your local sales representative or logging onto professionals.ottobockus.com.

Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses. For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

MARKETPLACE TayCo External Ankle Brace This external, over-the-shoe, and custom ankle-foot orthosis (AFO) offers adult patients increased stability and performance while allowing the continued use of existing footwear and foot orthoses. It’s an easy-to-use alternative to walking boots or other internal AFOs. Developed by the University of Notre Dame athletic trainer Michael Bean, in collaboration with Surestep and a team of physicians, the TayCo External Ankle Brace is available in both athletic and medical versions. Custom fabricated strictly from measurements, this device will allow patients to return to the field, work, and their lives much faster. Suggested L1970 and L2820. For more information, contact Surestep at 877/462-0711 or visit taycobrace.com.

Texas Assistive Devices (TAD) Texas Assistive Devices (TAD) products are designed for upper-extremity amputees and persons with hand dysfunction or partial hand amputation. The TAD system is meant to temporarily replace the hook or prosthetic hand on either body-powered or electronic upper-extremity prostheses to allow the user to efficiently and safely perform a wide range of activities. The system can also work with a W-H-O brace to which a quick disconnect coupler is attached in the palm area of the brace. TAD’s quick insert-release terminal device can hold a wide selection of interchangeable tools and implements including dining or cooking utensils, personal grooming devices, and tools for gardening, carpentry, mechanic work, sports, hobbies, etc. TAD’s recommended L-code guide is available on request. Also, TAD offers a Demo Kit Loaner program to allow the practitioners and end users to evaluate the actual products in a clinical setting. Contact TAD for more info including catalogs and pricing. Call 800/532-6840 or email janet@n-abler.org. Visit www.n-abler.org.

design. dexterity. intelligent motion.

• Smarter: Uses simple gestures to change grips. • Faster: Boost digit speed by up to 30 percent. • Smaller: New form-fitting anatomical design reduces profile in every dimension. For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

The FS3000 Foot Drop AFO From TurboMed Orthotics This unique ankle-foot orthosis was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe. In the past 24 months, more than 7,500 units of the FS3000 have been sold worldwide. TurboMed innovative products are now available through distributor partnerships in more than 20 countries. Its unique design and material composition give another meaning to walking and running. For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the FS3000 in less than five minutes. Available in USA from Cascade Supply, SPS, and Lakes Medical Innovations. For more information, call 888/778-8726, or visit www.turbomedorthotics.com. SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

O&P ALMANAC | SEPTEMBER 2017

MARKETPLACE

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

VQ OrthoCare® Introduces Custom Knee Brace App VQ OrthoCare® introduces its newest custom brace measurement system: the eCast™ app, which uses image capture technology to provide precise anatomical details for a more accurate measurement and fit. The app guides the user to the proper height, distance, and tilt of the iPhone camera and auto-captures a picture when the image is correct. Orders are sent directly from an iPhone to manufacturing, reducing paperwork and eliminating the need for additional measurements. Faster ordering, faster delivery. Available at the Apple iTunes store. For more information, call VQ OrthoCare at 800/652-1135 or visit www.vqorthocare.com/ecast.

New WillowWood Custom Liner App Giving patients the unmatched comfort of Alpha DESIGN® Liners is now even easier with our new Alpha DESIGN app for iOS. Using a Structure Sensor™ and the Alpha DESIGN app, clinicians have a convenient solution for portable 3-D scanning. Once a patient is scanned, clinicians may add notes to shape files, take photos of limb shapes, complete order forms, and submit files directly to WillowWood for custom liner order placement. Download the Alpha DESIGN app for free from Apple’s App Store. Visit willowwoodco.com or call 800/848-4930 for more information.

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

SEPTEMBER 2017 | O&P ALMANAC

2017 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2017 AOPA coding products. Ensure each member of your staff has a 2017 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

Clinical Educator Rockaway, NJ

Allard USA, the world leader in Carbon Fiber AFOs, is seeking a clinical educator. • We are looking for a dynamic CPO/CO to provide technical support and educational programs to our customers and staff. • Candidates must be able to write and develop educational programs, review and edit technical literature and collateral support materials. • Ability to communicate to both small and large groups of medical professionals is required. • Allard USA will provide a competitive salary and an excellent benefits package to the right candidate. If you are ready to join a winning team, e-mail your resume or CV to Maria.Overton@AllardUSA.com, or mail to: Allard USA 300 Forge Way, Suite 3 Rockaway, NJ O7866 Attn: Human Resources Department

CAREERS Mid-Atlantic

Opportunities for O&P Professionals

Job location key:

Orthotist, Orthotist/Prosthetist Certified Fitter, ABC/BOC Orthotist

- Northeast - Mid-Atlantic

Ohio

- Southeast - North Central - Inter-Mountain - Pacific

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

COOPC, established in 1991, is a well-established multifacility company in central Ohio with two openings currently available: 1) licensed orthotist or licensed orthotist/prosthetist, and 2) certified fitter or ABC/BOC orthotist. COOPC offers a great benefits package and salary that's commensurate with skills and experience.

Contact: Sherri Smith Phone: 614/231-4256 Fax: 614/231-0127 Web: www.COOPC.org Email: 231HALO@coopc.org

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

ADVERTISERS INDEX Company

Allard USA ALPS South LLC American Board for Certification in Orthotics, Prosthetics, and Pedorthics Amfit Amputee Coalition Anatomical Concepts Becker Orthopedic Board of Certification/Accreditation The Bremer Group Cailor Fleming Insurance Cascade Dafo Inc. COAPT LLC College Park Industries ComfortFit Orthotic Labs Inc. Coyote Design Custom Composite Fillauer Companies Inc. Flo-Tech O&P Systems Inc. Hanger Clinic Hersco Kingsley Manufacturing Company LIM Innovations Orthomerica Products Inc. Ă&#x2013;ssur Ottobock Spinal Technology Inc. Surestep Texas Assisted Devices Touch Bionics TurboMed Orthotics VQ Orthocare WillowWood

Page Phone

Website

79 703/836-7114 41 800/356-3668 C3 800/267-5669 15 800/837-3888, 330/757-3569 49 800/521-2192 65 877/776-2200 31 800/428-2304 5 800/796-8495 33 800/848-7332 45 844/262-7800 21 800/728-7950 85 888/523-1600 51 800/819-5980 61 866/273-2230 27 800/251-6398 43 800/356-8324 77 512/777-3814 1 800/301-8275 71 800/854-3749 25 844-888-8LIM 7 800/446-6770 19 800/233-6263 53, C4 800/328-4058 37 800/253-7868 44 877/462-0711 69 800/532-6840 13 855/694-5462 11 888/778-8726 59 800/652-1135 17 800/848-4930

www.abcop.org www.amfit.com www.amputee-coalition.org www.anatomicalconceptsinc.com www.beckerorthopedic.com www.bocusa.org www.bremergroup.com www.cailorfleming.com www.cascadedafo.com www.coaptengineering.com www.college-park.com www.comfortfitlabs.com www.coyotedesign.com www.cc-mfg.com www.fillauer.com www.1800flo-tech.com www.hanger.com/careers www.hersco.com www.kingsleymfg.com www.liminnovations.com www.orthomerica.com www.ossur.com www.professionals.ottobockus.com www.spinaltech.com www.surestep.net www.n-abler.com www.touchbionics.com www.turbomedorthotics.com www.vqorthocare.com/ecast www.willowwoodco.com

23 9, 75

888/678-6548 800/574-5426

www.allardusa.com www.easyliner.com

O&P ALMANAC | SEPTEMBER 2017

CALENDAR

2017

October 1

September 6-9

AOPA World Congress and 100th Anniversary Celebration. Las Vegas. Mandalay Bay. For exhibitors and sponsorship opportunities, contact Kelly Oâ&#x20AC;&#x2122;Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

September 11-16

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

September 13

ABC Inspections and Accreditation. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Airport Plaza Hotel, New York. Contact Drew Shreter at 800/946-9170, ext.101, or email dshreter@pomac.com.

October 11

AFO/KAFO Policy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

October 26-27

International African-American Prosthetic Orthotic Coalition Annual Meeting. Atlanta Marriott Suites Midtown, 35 14th Street NE, Atlanta, GA 30309. For more info, visit www.iaapoc.org or contact Tony Thaxton Jr. at thaxton.jr@comcast.net or 404/875-0066.

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

Let us

your next event!

Free Online Training

Cascade Dafo Institute. Now offering a series of seven free ABC-approved online courses, designed for pediatric practitioners. Earn up to 10.25 CEUs. Visit cascadedafo.com or call 800/848-7332.

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

Calendar Rates

ABC: Application Deadline for ABC/OPERF Student Award for Academic Achievement. Ten exceptional students will be selected to win $1,000 to cover educational expenses. For more info or to apply, go to operf.org.

Apply Anytime!

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

October 1

November 1

September 16

www.bocusa.org

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

CREDITS

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

SEPTEMBER 2017 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

AOPA Celebrates

Health-Care Compliance & Ethics Week November 5-11, 2017

Why Should you Participate? • Demonstrate your company’s commitment to ethical business practices. • Create awareness of the Code of Conduct, relevant laws, and regulations. • Provide your staff with recognition for training completion, compliance, and ethics successes. • Reinforcement—of the culture of compliance for which your organization strives.

AOPA has developed tools and resources to assist you. Learn more about our products, special webinars, compliance tip of the day, how to win prizes and more at bit.ly/aopaethics.

www.AOPAnet.org

AOPA 2017 HEALTH-CARE COMPLIANCE & ETHICS WEEK

ORDER FORM Health-Care Compliance & Ethics Week products

Questions about your order? Contact Ryan Gleeson at 571/431-0836 or email rgleeson@AOPAnet.org. American Orthotic & Prosthetic Association 330 John Carlyle St., #200 Alexandria, VA 22314 Phone: 571-431-0876 • Fax: 571-431-0899 www.AOPAnet.org • info@AOPAnet.org

www.AOPAnetonline.org/store

Enter your user name and password for member discounts

Find products to use for fun giveaways to staff, and to help keep you compliant. Publication Title

Price

or fax this form to 571/431-0899.

Price

Member

Qty.

Nonmember

AOPA Compliance Guide CD This product will assist you in developing a compliance plan for your facility, as recommended by the Office of the Inspector General.

$159

$318

Health-Care Compliance & Ethics Week Tumblers 16 oz. Text reads: “Make Good Decisions” and includes the HCEW logo. Comes in a pack of 4.

$30

Health-Care Compliance & Ethics Week Bic Grip Roller Pen Text reads: “Make Good Decisions” and includes the HCEW logo. Comes in a pack of 4.

Health-Care Compliance & Ethics Week Poster 20x28 Poster. Text reads “In any moment of decision, the best thing you can do is the right thing” and has AOPA and HCEW logos.

Total SUBTOTAL $ ______________ (include $7.00 shipping for products)

TOTAL $ _________________

Payment Information ______________________________ CONTACT NAME

Health-Care Compliance & Ethics Week Bundle (4-pack) 4 tumblers, 4 pens, 1 poster

$35

Health-Care Compliance & Ethics Week Bundle (12-pack) 12 tumblers, 12 pens, 1 poster

$99

______________________________ COMPANY

______________________________ ADDRESS

Webinars

______________________________

Enter promo code “member” for the member rate.

All webinars begin at 1:00 PM EST and last 1 hour. Date

Webinar Title

______________________________

Price

Member

Price

Nonmember

November 8

Gift Giving: Show Your Thanks & Remain Compliant (Earn 1.5 CEs)

$99

$199

November 9

“Three Amigos” of a Compliance Program— Compliance Officer, Legal, and Human Resources—Can Work Together to Support and Advance an Effective Compliance Program

Free

$50

Teaching Professionalism and Ethics During Residency

Free

November 10

Total

CITY, STATE

______________________________ ZIP

______________________________ PHONE

______________________________ EMAIL

$50

______________________________ CREDIT CARD:

FREE White Papers and Samples

Access at bit.ly/aopaethics.

______________________________ NAME ON CARD

Take advantage of AOPA’s free resources to celebrate Health-Care Compliance & Ethics Week. AOPA will send you the following resources electronically. Free Resources

q f y

Price

White Paper: Why Do I Need a Compliance Plan?

Free

White Paper: Why Should I Celebrate?

Free

Sample Press Release Use this sample press release to announce that your company is celebrating Health-Care Compliance & Ethics Week.

Free

Sample emails to send your staff Tips on compliance, how to announce your daily activities

Free

Sample newsletter to send your staff Customize to announce your participation in CCEW and share information about your Compliance & Ethics plan

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November 5-11

Health-Care Compliance & Ethics Week 2017. AOPA will be celebrating Health-Care Compliance & Ethics Week and will be providing resources to help members celebrate.

November 6-7

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Phoenix. Sheraton Grand Phoenix, 340 N. 3rd Street, Phoenix. Book by October 13 for the $179 rate by calling 800/325-3535 or by calling the hotel directly at 602/262-2500. Register online at bit.ly/2017billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

November 9

“Three Amigos” of a Compliance Program— Compliance Officer, Legal, and Human Resources— Can Work Together To Support and Advance an Effective Compliance Program. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

November 6-11

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

November 8

November 10

Teaching Professionalism and Ethics During Residency. For more information, email Ryan Gleeson at rgleeson@ AOPAnet.org.

December 7-9

Shirley Ryan AbilityLab: Elaine Owen—Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. 25.5 ABC credits. For more information, contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/education.

December 13

New Codes and Other Updates for 2018. Webinar Conference Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Gift Giving: Show Your Thanks and Webinar Conference Remain Compliant. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Realize the facts. O&P care improves quality of life and is cost effective! Learn more at MobilitySaves.org. Reasons to visit MobilitySaves.org

O&P CARE IS A SAVER, NOT AN EXPENSE TO INSURERS!

Visit MobilitySaves.org. Follow us on social media!

Learn about the study proving orthotic and prosthetic care saves money

Find supporting data to get your device paid for

See how amputees rallied when their prosthetic care was threatened

“Search Mobility Saves” on Facebook, Twitter, and LinkedIn

O&P ALMANAC | SEPTEMBER 2017

ASK AOPA CALENDAR

Medicare Facts at Your Fingertips Clarification on fingerprinting, claims submittal deadlines, and more

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

Q/ What should I do if I think I may be required to be fingerprinted in order to obtain my Medicare supplier number?

Medicare, through its contractors, will send letters to high-risk-category providers/suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that are just entering the program or enrolling a new facility, if it determines there are individuals who need to be fingerprinted. The Medicare letter includes contact information for the Fingerprint-Based Background Check Contractor (FBBC). You must contact FBBC, which will provide you with a list of at least three potential locations, including law enforcement facilities, where you may go to have your fingerprints taken. You will have 30 days from the date of the notification letter to be fingerprinted, and will be responsible for all costs associated with the procedure.

SEPTEMBER 2017 | O&P ALMANAC

What is the timeframe for submitting a claim to Medicare?

In previous years, claims were required to be filed no later than the end of the calendar year following the end of the fiscal year (Oct. 1 for the government), which sometimes meant you could have up to more than 20 months to file a claim. However, the rules have changed. Now you have just one year from the documented date of service to file a claim. If you go past the one-year time limit, your claim will be denied—and denied without appeal rights.

What is the timeframe for billing under each Medicare supplier number or provider transaction access number (PTAN)?

At least one claim must be billed under each PTAN at least once within four consecutive quarters to keep the billing privileges active, and to prevent deactivation. If you do not file at least one claim under each of the PTANs you operate at least

once a year, the National Supplier Clearinghouse will deactivate your PTAN. To reactivate your PTAN, you will need to reapply and will be required to pay the application fee. How long do I have to respond to an audit request for additional documentation?

It depends on the type of audit, but typically you are required to respond to a request within 45 days. This timeframe is normally 45 days from the date listed on the request letter, and not the date you received the request.

Once a certifying physician signs the certifying statement, how long do I have to deliver diabetic shoes before I may be required to have a new form signed?

Shoes/inserts must be delivered within three months of the certifying physician signing the statement.

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

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

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