September 2014 Almanac

The Magazine for the Orthotics & Prosthetics Profession

SEPTEMBER 2014

Plan Now for Your 2015 Medicare Participation Status P.16

Growing STRONG Optimal pediatric care means staying one step ahead of your patients’ development

Business Insights on Big Issues P.32

NEW! Technicians Column Debuts P.38

This Just In: Positive News Regarding DMEPOS Audit Reform

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SE PTE M B E R 2014 | VOL. 63, No. 9

contents

Features

Departments | COLUMNS

COVER STORY

President’s View....................................... 4

Insights from AOPA President Anita Liberman-Lampear, MA

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

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

Transitions in the profession

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

22 | Growing Strong Becoming an advocate for your pediatric patients’ physical and emotional development improves care and fosters positive long-term relationships.

By Christine Umbrell

18 | This Just In

P. 32

Reforming the Audit Process Officially known as the Medicare DMEPOS Audit Improvement and Reform Act, HR 5083 aims to improve audit effectiveness and efficiency in paying for durable medical equipment, prosthetics, orthotics, and supplies under the Medicare program. Learn more.

By Adam Stone

Start planning now for your 2015 status

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

Credits

NEW!

Tech Tutor.......................... 38

Technicians 101

A look back at the history of the technician profession and take a sneak peek of where we are going

Member Spotlight.................................42 n

P.38

n

Endolite North America Lake Prosthetics and Research

AOPA News................................................46

32 | Big Sessions, Big Insights Panelists from several of the most anticipated sessions at this year’s AOPA National Assembly share takeaways on vital business topics and where to find more resources.

By Lia Dangelico

To Be A Participating Provider?

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 55

P. 42

About the cover: David Rotter, CPO, C.Ped, works closely with pediatric patients to gear care to their interests and needs. Here, a transhumeral prosthesis has been designed to allow a patient to ride her bike using both arms.

PHOTO: Courtesy of David Rotter, CPO, Scheck and Siress

Advertise with Us! For advertising information, contact Bob Heiman

Marketplace.............................................. 56

Careers........................................................ 60

Professional opportunities

Calendar...................................................... 62

Upcoming meetings and events

Ad Index....................................................... 63

Ask AOPA...................................................64 Expert answers to your questions about BAAs and the HIPAA Omnibus Rule

at 856/673-4000 or email bob.rhmedia@comcast.net.

O&P Almanac | SEPTEMBER 2014

3

PRESIDENT’s VIEW

100 Years and Beyond

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

W

hen most of you read this, we will have concluded our National Assembly in Las Vegas, having marked 97 years of service to the O&P community. And that means we’re only three years away from AOPA’s Centennial Celebration. Let’s make it a smashing success and unleash our most creative powers to ensure it’s a memorable—and groundbreaking—point of entry into our second century. All of you can use the occasion to think about any special observances within your own business that might complement and help elevate O&P into a more visible and relevant piece of the health-care pie.

What does it look like out there for you, your colleagues, and your patients in the next three years and beyond? A few things are assured: Purse strings on health care will continue to tighten, and an aging and diabetes-susceptible population will continue to expand the patient rolls. Our challenge will be to provide care and still pay the bills. Change will be another challenge and will drive a research agenda that will help to provide more cost-effective and outcomes-positive results. That’s what we’ll be focused on at AOPA as we prepare for that all-important 100th birthday celebration—ensuring we’re all present to participate in the revelry.

A key ingredient in our future will be mobilizing our patients to voice their concerns as more and more draconian cost-saving measures by all payers delay or limit care. A prime example of mobilizing patients was AOPA’s effort to facilitate patient response on the CMS prior authorization proposed rule. The proposed rule provided no guarantee of payment or relief from audits, all the while imposing another layer of bureaucracy, meaning delay, in trying to serve patient needs and get paid for it. Every AOPA member organization received an envelope with 10 postcards to be given amputee patients to sign and mail along with a message of concern about how possible treatment delays might affect them. AOPA conveyed 294 patient signed postcards to CMS by the July 28 deadline so there was a reliable patient voice as part of the rule’s consideration. A special thanks to all of you who seized this opportunity to educate your patients and CMS. Patient postcards combined with 450 AOPA member comments totaled 744 O&P comments to CMS. The same process was used on the OTS orthotic rule proposal with a similar hoped for result by the September 2 deadline.

We will be increasingly dependent on a patient voice to protect our ability to do what we’ve always done so well—helping our patients maintain or regain mobility and the quality of life they so richly deserve. If you haven’t been to the www.mobilitysaves.org website, please do it today. There are so many tools available there for you to help spread the good word about O&P, including ways to engage patients.

Thanks to so many of you who made the annual Wine Tasting and Auction a successful replenishing of our AOPA PAC coffers. Those resources are vital to protect you and your patients from the ongoing regulatory and legislative challenges.

Sincerely,

Anita Liberman-Lampear, MA AOPA President

Board of Directors Officers

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

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AOPA CONTACTS

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

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

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

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

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

EXECUTIVE OFFICES

O&p Almanac

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

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

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

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

MEMBERSHIP & Meetings Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, manager of membership services, policy, and strategic initiatives 571/431-0843, landerson@AOPAnet.org Betty Leppin, project manager, 571/431-0876, bleppin@AOPAnet.org AOPA Bookstore: 571/431-0865 Government affairs

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

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SEPTEMBER 2014 | O&P Almanac

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

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

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

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

Copyright © 2014 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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

Advertise with Us!

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

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NUMBERS

BLS Predicts Growth in O&P Profession Significant demand for orthotists and prosthetists on the horizon.

Statistics published in the Occupational Outlook Handbook, 2014-15 Edition, by the U.S. Department of Labor’s Bureau of Labor Statistics, offer a snapshot of the O&P profession, based on 2012 numbers. In addition to quantifying U.S. practitioners and current salaries, the BLS statistics indicate there will be a greater need for orthotists and prosthetists in the year 2022, given the aging population.

Annual PAY

SALARY BY COMPARISON

10-YEAR OUTLOOK

$62,670 Median salary for orthotists/prosthetists in 2012.

$17,190 Less Than PTs Orthotists/prosthetists’ salaries are more than $15,000 lower than the median salary for physical therapists, which was $79,860 in 2012.

Employment of orthotists and prosthetists is projected to grow 36 percent from 2012 to 2022.

3,000 More The number of U.S. orthotists/ prosthetists is expected to grow from 8,500 to 11,500.

O&P WORK ENVIRONMENT

Orthotists/Prosthetists By Industry Where Employed in 2012 Medical Equipment and Supplies and Manufacturing 30% Health and Personal Care Stores 22% Offices of Physicians 11% Federal Government 7% General Medical and Surgical Hospitals (State, Local, and Private) 6% Other 24% 8

SEPTEMBER 2014 | O&P Almanac

Median hourly wage for orthotists/prosthetists in 2012.

36%

$22,290 More Than Health Techs

Orthotists/prosthetists’ salaries are significantly higher than the median salary for health technologists/technicians, which was $40,380 in 2012.

$30.13

“The large, aging baby boom population will create a need for orthotists and prosthetists since both diabetes and cardiovascular disease, which are the two leading causes of limb loss, are more common among older people.”

—Occupational Outlook Handbook, 2014-15 Edition, U.S. Department of Labor’s Bureau of Labor Statistics

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Happenings TECH UPDATE

Mexican Researchers Begin Design of BCI Prosthetic Arm Mexican scientists at the Centre for Research and Advanced Studies (CINVESTAV) are developing an arm prosthesis that could be controlled by just imagining a motion, using a braincomputer interface. The prosthesis will be designed specifically for amputees who once had their entire arm—patients who have stored memories of moving their arm naturally.

The component will feature a mechanical and electronic system, the elements necessary to activate it, and a section to interpret the brain signals.

Researchers plan to create a direct communication pathway between the brain and the prosthesis to help or repair sensory and motor functions, and to create motion paths for the prosthesis. The goal is to design a device that weighs approximately the same as a biological human arm.

The electric signal will not come from the muscles that form the stump, but from the movement patterns of the brain, according to Roberto Muñoz Guerrero, researcher at the department of electrical engineering and project leader at CINVESTAV. “If this phase is successful, the patient would be able to move the prosthesis by imagining different movements,” he says.

The project is in early stages of development, and further research will be conducted to study patterns in EEGs and determine where memories can be electrically recorded. More information can be found in the August 6 edition of Investigación y Desarrollo.

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SEPTEMBER 2014 | O&P Almanac

DIABETES DOWNLOAD

How Income, Race Affect Amputation Rates Diabetics who live in low-income neighborhoods in California are up to 10 times more likely to undergo amputation than diabetics residing in more affluent areas of the state, according to researchers at the University of California—Los Angeles (UCLA).

Researchers used data from the UCLA Center for Health Policy Research’s California Health Interview Survey, which estimated the prevalence of diabetes among low-income populations by Zip code. These statistics were then blended with household-income figures from the U.S. Census Bureau and hospital discharge data from the Office of Statewide Health Planning and Development that tracked diabetesrelated amputations by Zip code.

Findings were illustrated in a detailed set of maps showing diabetic

amputation rates by neighborhood for patients 45 and older. Diabetic residents of low-income neighborhoods, such as San Fernando, were found to have a 10-fold higher risk of at least one amputation compared to patients in more affluent areas.

Researchers also studied amputation rates by race. African Americans accounted for nearly 13 percent of the patient population undergoing one or more diabetes-related amputation in 2009 in California, although less than 6 percent of diabetics in the state are African American.

Findings indicate many diabetesrelated amputations could be prevented with earlier diagnosis and proper treatment. For more information, see the August 2014 issue of Health Affairs.

Rate of Amputation by Patient Affluence in California

Amputations Among Diabetics from High-Income Areas

Amputations Among Diabetics from Low-Income Areas

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HappeningS

EDUCATION & ACCREDITATION

www.bocusa.org

SMEs Put BOC Pedorthist Exam to the Test

The Board of Certification/Accreditation (BOC) recently convened a group of subject matter experts in Kansas City, Missouri, to collaborate on the BOC Pedorthist Job Task Analysis.

Organized by BOC Chief Credentialing Officer Wendy Miller, BOCO, CDME, and testing professionals from BOC’s testing vendor, Applied Measurement Professionals Inc., the session brought together a panel of experts to study the job activities of the pedorthist profession. Participants included BOC-certified practitioners, educators, BOC-accredited facility representatives, and other medical professionals.

Job task analyses provide the basis for the valid development of certification examinations. Participants created a survey that was sent in July to thousands of pedorthists and other health-care professionals. After receiving the survey responses, BOC will update the content outline of the BOC pedorthist examination and make changes to the exam.

“It was a very productive meeting,” says Miller. “We sequenced the pedorthist task list from prescription to final fitting and evaluated each task to ensure our pedorthist certification candidates continue to be assessed on appropriate competencies.”

INTERNATIONAL MEETING

Invitation to Madrid, Spain for AOPA Members

BOC, ABC Exams Compared in Kentucky

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

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

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

The Commonwealth of Kentucky’s Board of Prosthetics, Orthotics, and Pedorthics recently commissioned an independent psychometric evaluation of the certification exams of both the Board of Certification/Accreditation (BOC) and the American Board for Certification (ABC). The only evaluation of its kind by an O&P licensure board, the evaluation focused on a side-by-side comparison of the exams’ abilities to measure skills, knowledge, and abilities. The study, which was led by Michael Cunningham, PhD, evaluated ABC’s and BOC’s prosthetist, orthotist, orthotic fitter, and pedorthist job task analyses and certification tests.

The Amputee Coalition posted the results of the report on its website July 2. The review found that candidates for certification and licensure in the disciplines of prosthetics and orthotics who passed all three BOC examinations are likely to possess the preparation and skills for professional practice in those disciplines, and that the BOC exams

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

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SEPTEMBER 2014 | O&P Almanac

www.bocusa.org

for orthotic fitter and pedorthics also meet current professional standards.

The Kentucky Board affirmed the conclusions of the report supporting ABC and BOC exams as equally valid. The board also voted to recommend adding BOC to Kentucky’s licensure regulations as a test provider for licensure candidates.

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People & Places Professionals TRANSITIONS

BUSINESSES TRANSITIONS

Allard USA has announced the release of its new ToeOFF 2.0 AFO.

Hanger Clinic patient Torri Biddle, born without part of her right arm, was featured on “Morning Express with Robin Meade” on CNN’s Headline News in July. Hanger Clinic teamed up with The Buried Life and a nonprofit organization called Invisible Children to provide Biddle with a prosthetic hand. Hanger Clinic’s Craig Jackman, CPO, provided the prosthetic clinical care.

Moise Brutus, a 24-year-old triple amputee and collegiate cyclist, was surprised with a pair of custom Flex-Run prosthetic feet while visiting Össur’s U.S. headquarters in Foothill Ranch, California, in August. Brutus has joined Marian University’s NAIA Division 1 cycling team and hopes to qualify for the U.S. Paralympic Cycling Team.

Connie Withers has been hired as the U.S. business development manager—orthotics for Ottobock’s orthopedic rehab team.

Connie Withers

Ability Prosthetics & Orthotics’ patient-care clinics have implemented DASH, an outcomes measurement protocol for upper-extremity prosthetics.

Body In Motion Sports & Orthopaedics Inc. has announced a formal strategic partnership with Aqualeg, a France-based manufacturer of high-tech waterproof prosthetic covers.

Leto Solutions Inc., a new company formed by Becky Ariana and several students at the University of Texas San Antonio, has launched an IndieGoGo campaign to accept contributions to develop its Aquilonix Prosthesis Cooling System, designed to improve the comfort of wearing prosthetic limbs. To contribute to the campaign, visit Indiegogo.com and search “Aquilonix.”

IN MEMORIAM

Dudley S. Childress, PhD Dudley S. Childress, PhD, passed away August 6 after a long illness. Childress was one of the developers of myoelectronic control in the United States. He fit the first selfcontained and self-suspended transradial myolectric prosthesis in 1968. His research also focused on the “roll-over shape” for prosthetic feet and the “squirt shape” for sockets.

Childress, who was 79, spent 47 years at Northwestern University. He held a joint faculty position in the medical and engineering schools at the college. Childress led the development of the first systems to control power wheelchairs activated by sip/puff movements. In 1998, Childress and his team developed a motionanalysis system dedicated to studying O&P ambulation and manipulation aids.

Childress served as director of the Prosthetics Research Lab and the Rehabilitation Engineering Research program at Northwestern, and was a senior rehabilitation research scientist at the VA Chicago Health-Care System.

Among his recognitions are the 2002 VA Rehabilitation and Research Development Services Paul B. Magnuson Award; the 2004 Mentor Award from the Rehabilitation Engineering Society of North America; the 2005 da Vinci Lifetime Achievement Award, the 2007 Amputee Coalition Ernest Burgess Lifetime Achievement Award; and the 2010 VA Rehabilitation Research and Development Service Lifetime Service Award. A memorial service for Childress is planned for September.

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SEPTEMBER 2014 | O&P Almanac

Correction: In the O&P Almanac August 2014 issue, please note the following images have additional photo credits on page 24 for NatGeo-4: Courtesy of BiOM/ Jimmy DeVarie and page 26 for the iWalk 3537: Courtesy of BiOM and BiOM 11: Nikki Hinkle/ Cambridge Health Institute. We regret the omission.

reimbursement Page

By Devon Bernard, AOPA government affairs department

Be A Participating Provider?

E! Q UI Z M Earn

Credits

Now is the time to assess your status with Medicare for 2015

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

After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

A

s the end of 2014 rapidly

approaches, so does Medicare’s open enrollment period and the opportunity to change your participation status. As a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier, you must decide annually whether to enter into a participation agreement with Medicare.

Participating or not with Medicare is a very important business decision, so you should carefully consider what is in the best interest of your business before you elect to maintain or change your current Medicare participation status for the upcoming year.

Medicare Participation Status Review

The term “participating provider” does not pertain to the fact of whether or not you wish to be part of the Medicare program; by obtaining a Medicare supplier number, you automatically become part of the Medicare program.

In fact, Medicare participation is an advanced agreement between a provider/supplier and Medicare, to automatically accept assignment for all Medicare claims.

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SEPTEMBER 2014 | O&P Almanac

When you elect to be a participating provider with Medicare, you are agreeing to accept assignment on all Medicare claims you submit; and by doing so, you agree to accept the Medicare allowable for any given item or service as payment in full. With assigned claims, Medicare will forward its payment, 80 percent of the approved allowed amount, directly to you, the provider. You may then collect the remaining 20 percent coinsurance directly from the patient. Providers who accept assignment on a claim may not collect more than the full Medicare allowable for any given Healthcare Common Procedure Coding System (HCPCS) code. A nonparticipating provider, on the other hand, is not automatically tied to accepting assignment.

In short, your decision to be a participating or a nonparticipating provider in the Medicare program hinges primarily on how you wish to handle the assignment of Medicare claims.

Accepting Assignment

If your facility chooses to automatically accept assignment on all claims, you should elect to be a participating provider. However, a facility can be a nonparticipating provider and still accept assignment. Nonparticipating providers have the flexibility and ability to make a claim-by-claim decision on whether to accept assignment.

The decision to accept or not accept assignment, however, must be made on a claim-by-claim basis; a facility cannot accept assignment on one claim line and then not accept assignment on another claim line.

In addition, a nonparticipating provider not accepting assignment

2

Business CE

P.17

on a claim has the ability to collect its usual and customary charge from the patient, and does not have to accept Medicare’s allowable as payment in full at the time of service. This flexibility, to choose or not choose assignment and collect the normal charge, is very useful for items that may have low Medicare allowables or allowables that are lower than a facility’s acquisition costs.

There are some risks associated with not accepting assignment for a claim, however. First, you must still submit the claim on the patient’s behalf and Medicare will make payment directly to the patient; the patient is not obligated to use the Medicare payment to pay you for the service/item provided. Also, the decision to not accept assignment does not relieve you from meeting Medicare policy criteria or eliminate your financial liability should the claim be denied as not medically necessary (NMN). If the claim is denied as NMN and you don’t have a signed Advanced Beneficiary Notice on file, you must refund any money you may have previously collected from the patient. The choice to not accept assignment only relates to the amount of money you may collect from the patient and where Medicare will send its check.

Pros and Cons

One of the main benefits of being a participating provider is receiving payment directly from Medicare. There are a few other advantages as well. First, your company’s name and contact information will be listed in the Medicare provider directory. This means that any Medicare beneficiary in your area is able to find you with ease. Second, any claims involving a Medigap supplement

?

REIMBURSEMENT PAGE

Status Selection for a New Facility

How do you elect your participation status when you open a new location, or become a Medicare supplier for the first time?

• If you open a new location under your existing tax identification (ID) number, that location will have the same participation status as all of your other locations. Participation status is tied to the tax ID and not the location.

• If you open a new location under a new tax ID number, that location will automatically be considered nonparticipating. If you wish to become a participating provider, you will have 90 days from when you receive your supplier number to fill out the CMS 460 form.

Once your status has been set, it cannot be changed until the next open enrollment period.

policy will be automatically crossed over by the durable medical equipment Medicare administrative contractors (DME MACs). Finally, the fact that all decisions involving whether to accept assignment or not have already been made in advance is considered a benefit by some, in terms of efficiency. You know the money will be sent to you, and you will not have to rely on the patient.

The obvious disadvantage to being a participating provider is that you don’t have the ability to accept or not accept assignment; you must accept assignment on all claims.

The biggest disadvantage of being a nonparticipating provider is having the Medicare payment sent directly to the patient. In addition, you will not be listed in the Medicare provider directory, and any Medigap claims will not be automatically processed.

However, being a nonparticipating provider offers the benefit of flexibility in choosing to accept or not accept assignment on a claim-by-claim basis.

One last thing to keep in mind when choosing your participation status for 2015 is that your status is tied to your tax identification (ID) number, and not to your physical location. So, if you have several locations operating under the same tax ID, you cannot have some locations be nonparticipating and other locations be participating; it is all or nothing.

How To Change Your Status

Starting around mid-November, the start of the open enrollment period, the National Supplier Clearinghouse (NSC) will send you a letter informing

you of your current participation status. The letter also will inform you that if you want to update or change your current participation status, you must do so before December 31 or the closing of the open enrollment period.

If your organization has a participation agreement in effect for 2014 and you wish to be nonparticipating for 2015, you must submit written notice to the NSC stating that you no longer wish to be a participating provider. The letter, which must be received—not simply postmarked—by Dec. 31, 2014, should be sent to: National Supplier Clearinghouse P.O. Box 100142 Columbia, SC 29202-3142 Be sure to factor in mailing time, and consider setting an artificial deadline of a week earlier to allow for prompt delivery. The letter must include the original signature of your office’s authorized representative—the person who is on file with the NSC as an authorized individual. If you are unsure who is on file as the authorized individual for your company, review your most recent Medicare enrollment application, the CMS 855S form, and review Section 15.

If your company currently is enrolled as a nonparticipating provider and you wish to change your status to participating, the process is more formal. Complete an official Medicare participation agreement for 2015, or the CMS 460 form. The one-page form is pretty straightforward and simple to fill out. As with most official Medicare DMEPOS forms, the

participation agreement must be signed by an authorized individual within your company. A copy of the CMS 460 should be sent with the letter you received from the NSC, but you also may access it from the Medicare website: https:// www.cms.gov/Medicare/CMS-Forms/ CMS-Forms/downloads/cms460.pdf. The completed form must be received by Dec. 31, 2014, or your participation status will remain nonparticipating for 2015.

If you do not wish to make any changes for 2015, simply do nothing and your status will remain the same.

Keep in Mind…

In addition to the basic information discussed above, you may need to consider some additional factors when deciding whether to become a participating provider. For example, you should review your existing and future contracts with outside private payers: Some of your contracts may require you to be a participating provider with Medicare, so if you choose to become a nonparticipating provider, the contract may be voided or will have to be renegotiated.

There is no wrong or right decision regarding Medicare participation status.

Study all of the options and possible ramifications, and make the choice that is best for you and your organization. Remember, you will not have a chance to change your status again until the next open enrollment period.

To learn more about Medicare participation and how it relates to and affects your business, attend the October AOPAversity webinar on Medicare Enrollment, Revalidation, and Participation.

Devon Bernard is AOPA’s assistant director of coding, reimbursement, programming, and education. Reach him at dbernard@aopanet.org.

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

Earn CE credits accepted by certifying boards: www.bocusa.org

O&P Almanac | SEPTEMBER 2014

17

This Just In

Reforming the Audit Process H.R. 5083 would alleviate documentation problems and separate O&P from DME in claims and audit data collection

By Adam Stone

W

e’ve all heard it said that

the making of laws, like the making of sausages, is not something one wishes to observe up close. But the law matters, and changes in the law can matter—especially to O&P providers struggling under the weight of Medicare rules that may seem both oppressive and arbitrary.

So when positive news breaks in Congress, it’s worth taking a close look.

There are no guarantees when it comes to national legislation, but every step forward can be significant, and it’s our obligation to stay on the cutting edge of any changes.

That’s why the O&P Almanac is excited to report on a new piece of legislation proposed in the House of Representatives. Introduced by Rep. Renee Ellmers (R-North Carolina), bill H.R. 5083 contains a number of provisions that could significantly change the landscape for O&P practitioners.

First the news, then a look at the sausage-making.

Details of H.R. 5083

Officially known as the Medicare DMEPOS Audit Improvement and Reform (AIR) Act, H.R. 5083 aims to improve audit effectiveness and efficiency in paying for durable medical equipment, prosthetics, orthotics, 18

SEPTEMBER 2014 | O&P Almanac

Officially known as the Medicare DMEPOS Audit Improvement and Reform (AIR) Act, H.R. 5083 aims to improve audit effectiveness and efficiency in paying for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) under the Medicare program. and supplies (DMEPOS) under the Medicare program.

To achieve this goal, the proposed law would deliver on O&P’s longstanding desire to have its documentation, the orthotist or prosthetist’s notes, recognized as a legitimate component of the patient’s official medical record.

This issue has profound practical significance. Typically, Medicare will ask for explicit documentation in the physician’s records as to whether orthotic treatment must be custom-fit or off-the-shelf. But such information often is not known until the provider directly assesses the patient. The only way to

break this cycle of illogic is to include the prosthetists’ and orthotists’ documentation/notes in the medical record.

In another arena, the proposed law would make positive changes in the way CMS aggregates claims and audit data. Traditionally, data from O&P has been lumped in with data from DME, giving an unrealistic picture of the true scale of inaccurate claims. In fact, fewer DME claims get appealed, and when appeals are made, O&P claims have a higher success rate than those of DME. It therefore requires some segregation to get an accurate view. “A little bit of pollution in the Caribbean Sea doesn’t make the water dirty. It looks pretty clean because there is a lot of water. But if you look at a smaller body of water, if you break it down to a smaller area, then you would see the pollution clearly,” says AOPA Executive Director Thomas F. Fise, JD. “This bill would require them to do that, to take a much more granular look at the data.”

In another clause, the bill would adjust the way CMS counts error rates.

Currently, if an O&P organization is called out by a recovery audit contractor (RAC) audit, and an internal appeal fails, that event will register as part of the overall denial rate. Under the

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This Just In

proposed law, the question of whether to register a claim as denied would remain open until all appeals options had been exhausted. Given the high rate of successful appeals, this would effect a significant change in the overall reported rate of O&P denials, and when the denial rate goes lower, good things happen like reductions in pre-payment audits.

Responding to Calls for Help

To understand the significance of H.R. 5083, we must take a close look at the legislative process that took us to this potential turning point. Things like H. R. 5083 don’t just happen. At last year’s AOPA World Congress there was an initial discussion by the O&P Alliance of crafting language for a bill that would help tackle the horrendous audit problem, distinguish O&P from DME and address other challenges to our business and our patients. Within six weeks AOPA’s lobbyists had drafted a proposed bill that was returned to the Alliance. After some refinements the Alliance embraced the bill early in 2014. It became a key component in AOPA’s Policy Forum and AOPA lobbyists, together with Peter Thomas, the Alliance Counsel, have pitched it to many offices on the Hill. When Rep. Ellmers wrote her bill she adopted some (but not all) of these provisions.

That’s the story of O&P working everyday for better outcomes.

So this is where AOPA’s leadership and membership involvement is important: if we keep having positive O&P provisions show up in different legislation, letters, calls, etc., hopefully we can make it something that will find a place in any eventual legislative or regulatory remedy on these issues.

In recent months, the issue of audits has been the subject of two hearings in the Health Subcommittee of the House Ways and Means Committee.

“This is the most likely committee to have the muscle to get anything done in Medicare because they are the ones who have the most direct oversight over Medicare, and they have said that they want to do something about these problems,” Fise says.

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SEPTEMBER 2014 | O&P Almanac

The House Committee on Oversight and Government Reform has held hearings, as has the House Energy and Commerce’s health committee, on which Ellmers serves. The Senate Committee on Aging also has taken up the topic, and initial work has been done in the Senate Finance Committee.

The volume of discussion on the Hill is indicative of, among other things, O&P’s success in generating attention to the imbalances with which it struggles. “It says there are a lot of constituents who are contacting their legislators to tell them just how terrible this situation is, not just for O&P but for hospitals and everyone else who is out there,” Fise says. “There has been a lot of agitation on the part of House members that something had to be done about these problems.”

While the need for reform may be obvious to many in the O&P world, it has taken considerable courage and creativity to turn that understanding into legislation. “The delicate part of this for legislators is that, on the one hand, they want to please their constituents, but they cannot afford, by any stretch of the imagination, to look as if they have one soft morsel in their body for anything that sounds like fraud. Everybody is against fraud, and everybody has to be against fraud,” Fise says.

Against this backdrop of political sensitivity, Ellmers has crafted a proposal that would seem to satisfy all requirements: getting needed relief, while standing tough on fraud. “She is walking a middle course: developing steps that can be understood as fraudfighting efforts, while also providing some measures that might make the RAC and the administrative law judge (ALJ) processes a bit fairer and saner for people,” Fise says.

One way to understand this balancing act is to look at how the law would calculate the likelihood of a provider being audited. Suppose a provider were to establish over time a relatively low error rate, something below 15 percent. That provider would see a reduced number of audits. This sends the message that the law will be tough on those with high error rates, where

fraud is more likely, while easing the burden on those with higher documented levels of performance.

While there is much positive news here, a few items from O&P’s wish list did not make it into the law as proposed. First, there is the longstanding position by O&P that unlicensed providers should not be compensated under Medicare. This was omitted, likely due to the possibility that such a clause might not have been perceived positively from within the DME community, where the question of licensure may be viewed differently.

Also lacking from the bill is an effort advocated by O&P to change the way money moves around in the wake of an audit. Today, a provider must pay according to an audit’s outcome as soon as the internal appeals process ends. That means the provider will be without those funds for as long as three to four years, as he or she waits for the ALJ hearing, despite the fact that such hearings overwhelmingly end in favor of the O&P provider.

A clause that would delay payment until after the ALJ step “would be a huge deal, it would save a lot of people from going out of business by eliminating the cash flow problems caused by the government while you are still in appeal,” Fise says.

That doesn’t mean the issue is dead.

As with all things legislative, tomorrow is another day. Of course, this also means H.R. 5083 is not yet a done deal.

Other bills will percolate up; more committees will meet. This bill likely won’t be the last word, but the content it provides could be invaluable in shaping final legislation.

“This will influence what the House Ways and Means Committee does. They will look and say: ‘What do we like or not like here? What should we add or subtract?’ Ultimately, it will contribute to what does or does not move,” Fise says. AOPA urges you to send a letter contacting your representative to support this bill at www.AOPAvotes.org.

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

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PHOTO: Courtesy of David Rotter, CPO, Scheck and Siress

David Rotter, CPO, C.Ped, pictured with one of his patients. Her transhumeral prosthesis is designed to allow the patient to ride her bike using both arms. When using the prosthesis, she is stable enough to ride standing off the seat.

COVER STORY

Optimal pediatric care means staying one step ahead of patients’ physical and emotional development, say experts

Need to Know: • Working with children means accommodating for rapid growth changes by initially fitting prostheses more loosely.

• Minimizing size and weight while maintaining high durability and adjustability is important in orthotic component selection.

• Dealing with parents of pediatric patients adds an extra layer of complexity to treatment. Establish trust with the child directly, so he or she will feel comfortable telling you when something is wrong.

• Gear treatment to the child’s interests: Explain how componentry will help children play their favorite sport, or invite young patients to help design their own devices.

• Treating teenagers, who place a higher value on body image, may mean following the patient’s lead for better device compliance.

W

hether your practice is popu-

lated by hundreds of children, or you see only a handful of pediatric patients a year, it’s important to recognize the inherent challenges in working with a young demographic.

Pediatric O&P patients have a reputation for making clinicians look good, simply because children generally are very adaptable. But it’s important to ensure a device you put on a child that fits well today will not cause long-term problems as the child grows.

With adult patients, practitioners must consider variances in fit related to weight fluctuation and changes in residual limb volume. “But kids also are growing vertically,” says David Rotter, CPO, C.Ped, clinical director of prosthetics at Scheck & Siress, and president of the Association of Children’s ProstheticOrthotic Clinics. “You have to plan in advance for them to grow up and out of their prostheses.”

Successful treatment of a young O&P patient means more than selecting componentry that will enable the child to participate in his or her favorite activities; it also means ensuring that device will assist in attaining the proper gait and contribute to the patient’s long-term health.

O&P Almanac | SEPTEMBER 2014

23

COVER STORY

Prosthetic Considerations

With pediatric patients, “you’re chasing a moving target so you have to be very creative, and you have to be adaptive in your treatment,” says Chrysta Irolla, MSPO, CPO, at the University of California, San Francisco.

Fitting children with prostheses means staying one step ahead of their development. “You have to accommodate for rapid changes in the body— not just girth, but length issues,” says Rotter. Instead of seeking the most intimate fit at the initial design stage, practitioners should fit pediatric patients more loosely, keeping strategies for growth in mind.

Chrysta Irolla, MSPO, CPO

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SEPTEMBER 2014 | O&P Almanac

the patient’s body weight is beyond the manufacturer’s recommendation or the patient’s foot is a full size larger than the prosthetic foot,” he says. This ensures the gait cycle is not compromised by having an overly small or large prosthetic foot system.

With trauma amputees, expect terminal bony overgrowth, says Irolla. She suggests designing the prosthesis “with gel pads and liners to accommodate.”

Growth considerations can be particularly challenging for unilateral lower-extremity patients. “Keeping up with the limb length of the sound side can be difficult,” notes Haun. For this reason, he suggests seeing pediatric patients every two to three months: “I advise parents to keep a growth chart weekly, and then to come back and see us if their child grows more than one quarter inch.”

Rare Conditions

While it’s good to know the general rules for pediatric clientele, it’s equally

imperative to know what to do when a child with an uncommon diagnosis arrives at your facility. Starting out by “reading” the residual limb and studying the clinical research can be key to an optimal outcome, says Haun.

Dennis Haun, CPO

For example, Haun has been treating a 12-year-old knee disarticulation patient for the past several years; her limb loss resulted from a Ewing sarcoma at age three—a particularly young age for such a cancer. Though her illness resulted in limb loss, she is a (Continued on page 27)

Photos: Courtesy of Dennis Haun, CPO; Chrysta Irolla, MSPO, CPO

The same is true when designing a socket for above-knee pediatric patients, says Dennis Haun, CPO, clinical director of Metro Prosthetics’ Baltimore location. He recommends an “onion peel” approach in socket design: He adds extra layers of liner material in his initial design, which can be taken out layer-by-layer as the limb grows.

Another approach is to use a fiveply sock that can be taken down to one-ply, says Irolla. And distal end pads that are thicker at the beginning can be tapered down as growth occurs. Irolla also suggests using suspension styles that are more adaptable for growth: “a neoprene knee sleeve instead of purely anatomical suspension.”

In addition, it’s important to monitor the length of the sound foot to keep the prosthetic foot appropriately sized, says Haun. “I will typically over-size the length of the foot by one size to increase the life span of the foot, and I recommend changing the foot once

Dennis Haun, CPO, works with a 12-year-old knee disarticulation patient to adjust her prosthesis and optimize performance of her running device.

COVER STORY

Age-Appropriate O&P Care

E

very pediatric patient is

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SEPTEMBER 2014 | O&P Almanac

PHOTO: Courtesy of Natalie Webber

Dennis Haun, CPO, who has been treating this quadrilateral amputee for the unique, and different ages bring past eight years, emphasizes the importance of gearing treatment to the patient’s evolving considerations. For Daniel interests and activities.

Strzempka, CPO, LPO, working with pediatric patients is personal: “I lost my leg when I was four, and I try to remember the things I liked and the things that scared me when I visited my practitioner,” says Strzempka, who is the area practice manager for Hanger Clinic in Southwest Florida.

“You need to establish trust early on, so they’ll feel comfortable telling you when something is wrong,” he says. “Before you touch a child’s residual limb, you need to talk directly to that child, to get to know him or her and gear treatment to that child’s interests.” For example, explain how componentry will help them play their favorite sport or run again like their favorite character in a video game.

Inviting young pediatric patients to help design their own devices also can encourage acceptance, says Chrysta Irolla, MSPO, CPO, at the University of California, San Francisco. “You can ask patients to choose colors for a strap or plastic or choose a design,” says Irolla. This turns the experience into an event they’re particirefuse to wear a daily brace. “Remember, if they’re pating in—instead of something that’s happening to them. not going to wear it, it won’t help them,” she says.

Working with teenagers, on the other hand, poses its own set Dennis Haun, CPO, agrees that treating teenagers of challenges, as adolescents experience puberty and start to may mean following the patient’s lead. Haun, who is place an even higher value on body image. “The teenage years clinical director of Metro Prosthetics’ Baltimore locaare very difficult for everyone, and throwing limb deficiency tion, recalls a 16-year-old boy he has been treating for into the mix can make it especially tough,” says David Rotter, the past eight years. The boy, who was born without a CPO, clinical director of prosthetics for Scheck and Siress. spleen, became a quadrilateral amputee at 10 months Strzempka offers the example of a teenage girl with upperold after sepsis. “He started with voluntary closing extremity limb loss: “I have one patient, a 16-year-old girl who hands and bilateral above-knee prostheses. Now he lost her arm in a waverunner accident a few weeks ago. One has bilateral microprocessor knees, but uses everyday day, she’s on top of the world, and the next she’s down in the straight shafts with Flex-Runs for his legs, and chooses dumps,” says Strzempka. “I adapt by trying to be very direct and not to use upper-extremity prostheses,” says Haun. The honest with her, and sharing the experiences I went through.” patient is very active, hunting and go-carting with only his Teenagers with scoliosis can present with psychosocial prosthetic legs and remaining limbs on his upper body. challenges related to body image. If a teenage girl already Whatever a patient’s age, pediatric O&P specialists is struggling with her appearance and issues at school, then recommend introducing children to support groups and having to wear a brace can be traumatic. Irolla suggests camps, and connecting new patients with amputees using Providence nighttime TLSOs for patients who may of similar ages, to assist in their emotional recovery.

COVER STORY

(Continued from page 24) very active adolescent with no remaining health issues, so her prosthesis has been designed to keep up with her activity level. She has both an everyday leg and a running leg—but usually chooses to wear her running leg, and is constantly breaking her feet. “You often have to treat children as equivalent to extreme adult athletes,” Haun says. “They will use their prostheses to the maximum level possible.”

At the other end of the spectrum, meningitis patients must be treated with extra sensitivity.

Recently, there has been “an increase in the number of meningitis survivors,” due to improved medical care at hospitals treating meningitis patients, says Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics at Hanger Clinic.

Those survivors may face numerous complications, including brain damage, hearing loss, loss of kidney function, and necrosis leading to limb amputation. Treating meningitis patients requires a multidisciplinary approach, “with all hands on deck and checking egos at the door,” says Carroll. Prosthetists should work in conjunction with wound care specialists, plastic surgeons, infection control specialists, physical therapists, occupational therapists, and case managers for optimal results.

“It can be very difficult to fit these children with prostheses,” says Carroll, because the skin on their residual limbs usually is compromised—often tantamount to treating burn victims with skin-grafted limbs. “We have to be cautious in applying prosthetics, usually using gel materials, but in short intervals and building up over time, as with compression-type therapy,” he explains.

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As with prosthetic patients, orthotic patients present with growth issues that must be accounted for during brace fitting and selection. “It can sometimes be challenging to communicate with, and receive the cooperation (Continued on page 28)

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COVER STORY

ACPOC Puts Children’s Needs First

When selecting components, look to minimize size and weight, while maintaining high durability, LeCursi advises. “I once provided what I thought was an optimally durable and thin AFO to a young boy,” he recalls.

“When the family came back to clinic for follow-up with the AFO cracked, I was puzzled until I learned that he had been jumping off of the refrigerator with his brother while wearing it.

The Tamarack joints were still intact, however! Some kids are incredibly active in their orthoses and so the components have to keep up.”

The Association of Children’s Prosthetic-Orthotic Clinics (ACPOC) unites professionals who are involved in clinics providing O&P care for children with limb loss or orthopedic disabilities.

“ACPOC is an international multidisciplinary organization that approaches O&P pediatric care with a comprehensive resource of treatment options,” explains David Rotter, CPO, C.Ped, clinical director of prosthetics for Scheck & Siress and president of ACPOC. The organization promotes team collaboration among medical professionals, including physicians, orthotists, prosthetists, therapists, and nurses. Participating in ACPOC discussions and events “gives you a good perspective of how your element of care fits into the greater picture,” says Rotter.

The ACPOC Annual Meeting features high-level presentations that focus on both the surgical aspect and the rehabilitation aspect of pediatric O&P. The next meeting will take place May 13-16, 2015, in Clearwater Beach, Florida. Visit www.acpoc.org for details.

Nicholas LeCursi, CO

PHOTO: Courtesy of Hanger Clinic

(Continued from page 27) of, pediatric patients during the orthotic visit,” says Nicholas LeCursi, CO, director of research and product development for Becker Orthopedic.

“Often the presentation will change

Kevin Carroll, MS, CP, FAAOP

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SEPTEMBER 2014 | O&P Almanac

during the course of treatment. Even kids with nonprogressive pathologies will grow and change.”

LeCursi recommends “creativity” in finding ways to put patients at ease.

He also suggests encouraging patients to “perform specific tasks during delivery of care that make clinical indicators—both objective and subjective—more visible.”

Spending extra time up front can help ensure patients receive the most appropriate orthosis from the get-go.

“Your cast is king with pediatrics,” says Irolla. “Fitting issues can be avoided if you take a really good impression.”

Adjustability and reconfigurable componentry also are advantageous in pediatric orthoses, “because kids sometimes require the amount of support or the managed alignment to be adjusted to tune the orthosis to optimize their balance or function,” says LeCursi. “Adjustability also may be desirable in postsurgical care, where the function of the orthosis may change over a short time frame from rigid support to active maintenance of range of motion.”

For lower-limb bracing, optimizing posture, level of support, and range of motion while considering the longterm effects of orthotic support is paramount, says LeCursi. “The highly optimized tuning of lower-extremity orthoses to optimize function can be challenging and time-consuming.”

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Cerebral palsy (CP) patients require a slightly different approach: “Be mindful of the balance between motion restriction and patient functionality,”

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(Continued from page 30) says Irolla. Some CP patients use their spasticity to assist with ambulation.

“You need to account for that because sometimes a rigid solid ankle design is not the most functional,” she says.

“During assessment of CP patients, be mindful of the knee position and how the patient reacts to different amounts of control.”

The ‘Parent’ Factor

Because children are easily influenced by their parents, many practitioners find that dealing with them adds an extra layer of complexity to pediatric treatment. “Parents can be overly protective—or overly helpful,” says Daniel Strzempka, CPO, LPO, area practice manager for Hanger Clinic in Southwest Florida.

Working with parents is especially challenging for those practitioners seeing patients for the first time post-diagnosis. Parents are still dealing with multiple emotions and may

arrive at the facility with a predetermined idea of what treatment and outcome should be. “It takes time to demonstrate to parents the value of what we can do,” Haun says.

Daniel Strzempka, CPO, LPO

Occasionally, the treatment a parent requests is at odds with what a child wants—especially as children become adolescents. “Parents can have strong ideas about what device the child should have,” says Rotter. In such a situation, practitioners should educate all parties with objective information and feedback based on clinical experience. “Ultimately, it

needs to be a consensus,” he says.

Some practitioners recommend involving the whole family in appointments. “Everyone needs to understand the device and how it works, because if one parent doesn’t attend and doesn’t encourage use, it can lead to problems with acceptance,” says Irolla.

She requests that both of the patient’s parents, and his or her siblings, attend the delivery and fitting appointment.

Then it is more likely that everyone will be invested in the patient’s progress.

Ultimately, becoming an advocate for your patient will improve care— and foster positive long-term relationships. “Treat them like they’re your own child,” says Strzempka. “You may see that child for the rest of his—or your—life. So treat the lifestyle, not just the prosthetics.”

Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.

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Business Sessions,

Big

Insights

By Lia Dangelico

Need to Know A successful defense against health-care fraud starts with being proactive and establishing policies and procedures to protect your business in the event of an investigation.

By implementing a robust HR management program, employers can experience increased productivity, improved morale, low employee turnover, and more.

Despite big misconceptions, the ACA is a reform of health-care insurance rather than a reform of health care itself, and the law presents both challenges and opportunities for O&P.

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SEPTEMBER 2014 | O&P Almanac

Learn how fraud, human resources, and health-care reform are affecting health care and O&P— and what you can do about it

FEATURE: Business sessions, Big Insights

B

usiness leaders across the globe often look beyond their own board rooms for inspiration and to improve their bottom lines.

Especially in the most challenging environments, they understand that there’s strength in numbers. And this is just one of several reasons why O&P providers will gather in Las Vegas, September 4-7, for the 2014 AOPA National Assembly, to learn from one another, sharpen their skills, and get inspired and involved.

Alongside the clinical track, the business track will offer facility owners strategies and best practices for everything from preventing healthcare fraud to building a sound human resource program. Here, panelists from several of the most anticipated sessions at this year’s event share takeaways on vital business topics and where to find more resources.

Protecting Against Fraud

Many in O&P remain focused on the challenging audit environment that is restricting cash flow and jeopardizing stability and growth across the industry. But O&P practitioners and facility owners are facing other risks, one of which George Breen, JD, a 25-year litigator and chair of Epstein Becker Green Health Care and Life Sciences department, knows very well: health-care fraud. Breen, who specializes in the defense of health-care providers, manufacturers, and suppliers in False Claims Act cases and litigations, sees the far-reaching threats of these investigations and proceedings on the future of O&P. His session, “Health-Care Fraud Enforcement From the Trenches: How To Protect Yourself and Your Business,” will offer insight into this complicated process and share tips for preventing—or presenting a strong defense against—an investigation.

Typically, a False Claims suit is filed on the part of the federal

government, in an effort to recoup what it believes to be fraudulent or insufficient payment on the part of the provider who is working within federal health-care programs. The results of such cases can lead not only to tremendous financial damages— enough to destroy even a very strong business—but also potential exclusion of that business from participation in federal health-care programs. “The Department of Health and Human Services Office of the Inspector General (OIG) has the ability to pursue an action against an individual or business to be excluded due to violations of this statute,” says Breen. For many, these instances become a case of personal survival more than anything else.

The results of [a False Claims suit] can lead not only to tremendous financial damages…but also potential exclusion of that business from participation in federal health-care programs.

During his session, Breen will offer attendees a greater understanding of how to prevent an investigation and what it takes to build a credible defense, including the following tips: • Establish a compliance program as a first line of defense. Facility owners must have policies and procedures in place to identify how employees should be practicing and the right way to do business.

In the event of an investigation, these resources can be pointed to as established efforts to prevent fraudulent activity.

• Routinely check OIG’s exclusion list. Facility management should avoid hiring or contracting with individuals who have been excluded from doing business with federal health-care programs, as doing so can make the company liable to a False Claims suit. A continually updated database of those who have been excluded (searchable by first or last name) is available at www.exclusions.oig.hhs.gov.

• Don’t think you are “too small” to count. “The reality is that regardless of the size of the company, the government is interested in what you’re doing and how it is that you’re doing it,” says Breen.

No segment is excluded from this.

Similarly, never underestimate whistle blowers—even the most tight-knit staffs have been subject to investigation due to allegations brought by “a member of the family.”

O&P Almanac | SEPTEMBER 2014

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FEATURE: Business sessions, Big Insights

national Plan to Attend AOPA’s

Learn more about these and other critical business topics by attending the following sessions at the 2014 AOPA National Assembly. Can’t make it to Vegas? No problem. AOPA and the O&P Almanac will live tweet sessions using the hashtag #AOPA14.

assembly ’14

Facing Facts on the ACA

“Health-Care Fraud Enforcement From the Trenches: How To Protect Yourself and Your Business” Mandalay Bay Ballroom L Saturday, September 6, 2014; 2:50 to 3:35 p.m.

“Human Resources: How To Develop a Human Resource Program for Your Company That Will Improve Employee Productivity and Loyalty, and Protect Your Company Against Costly Employee Litigation” Mandalay Bay Ballroom L Thursday, September 4, 2014; 1:00 to 3:00 p.m.

“The Affordable Care Act: An Overview” Mandalay Bay Ballroom L Sunday, September 7, 2014; 9:00 to 10:00 a.m.

“A Changing Health-Care World and Its Impact on Orthotics and Prosthetics” Mandalay Bay Ballroom L Sunday, September 7, 2014; 10:00 to 10:30 a.m.

Breen hopes attendees come away with the understanding that they need to be proactive to learn their risks areas are and assess potential exposures. “The time to respond is not when you have the subpoena,” he says.

“The only way you can defend yourself is to fight back.”

Building a Robust HR Program

Another way to prevent roadblocks and inefficiencies is to establish an effective human resource (HR) program within your facility. According to Pam Lupo, CO, director of orthotics at Wright & Filippis, employees are a business’s “human capital,” and she will demonstrate how to harness that capital during her session on September 4 at 1:00 p.m.

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SEPTEMBER 2014 | O&P Almanac

improved morale, low absenteeism, and low employee turnover. Lupo recommends implementing a program that provides every employee with an accurate job description; offers coaching and disciplinary opportunities; and guarantees a consistent employee review processes.

Attendees will come away with useful tips on where and how to begin, says Lupo. She also hopes they will understand that the process is not as daunting or time consuming as they might think.

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An industry veteran for more than 18 years, Lupo has encountered many misconceptions about HR managePam Lupo, CO ment and hopes to dispel several of them during her session. One of the biggest she hears is that small companies don’t need to develop a process to manage their employees because they aren’t a huge operation. Regardless of a company’s size, employees are “the single most important asset we have to develop growth and promote our vision for the organization,” says Lupo.

In her experience, an effective HR program can lead to increased performance, and productivity,

Despite facility owners’ best efforts inside their practices, the greater health-care world continues to spin outside their doors. Signed into law

by President Barack Obama in 2010, the Affordable Care Act (ACA) puts in place comprehensive health insurance reforms, including an end to rejecting patients based on pre-existing conditions, lifetime caps, and more. With the addition of 10.3 million Americans into the U.S. health-care system, it’s important for O&P practitioners and facility owners to understand this new legislation and how it will affect their business. That’s where James Walter, PhD, comes in. Walter, who taught bioethics for 41 years and currently works as a clinical bioethicist at Walter Reed National Military Medical Center, has researched the ACA extensively and lectured on it across the United States and in Europe. His session “The Affordable Care Act: An Overview,” will present the biggest ethical issues connected with recent health-care reform and debate and provide attendees with a better understanding of how the law will affect the industry.

Unfortunately, there are many misguided ideas among the general public about the ACA and its provisions, according to Walter. It’s important for everyone to understand that “the ACA is not a universal health-care plan,” he says. “Essentially, the act really is a reform of the insurance vehicle by which people get access to health care.

It is not principally about the reform of health care itself.”

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FEATURE: Business sessions, Big Insights

But, says Walter, this issue goes beyond politics. “There are ethical issues that are deeply embedded in this whole topic that we, as a country, have not settled,” he says. One example of this is establishing whether or not Americans have a fundamental right to health care and health-care insurance—the second part of that is, if people don’t have a fundamental health care, how do we determine who gets access? Additionally, with the ACA, many Americans now have access to health insurance through state or federal exchanges, but there are physicians who may refuse to participate with a specific carrier that offers coverage in the exchanges, so patients are no better off.

Many O&P patients, providers, and manufacturers mistakenly believe that, because the ACA was signed into law, insurance companies can no longer place arbitrary limits on coverage.

During the session, Walter will review four ethical issues—whether there is a fundamental right to health care or health insurance; who should have access and under what circumstances; what quality of care should achieved for the high sums spent; and the sustainability of expenditures and of the heath-care system—that must be addressed and why they are crucial to the advancement of health care in the U.S. In addition to information about key provisions of the ACA, Walter will provide key statistics and resources that highlight the positive and negative effects of the ACA on O&P. Some helpful tools he will share include a breakdown of accountable care organization reimbursement rates and limitations by state on CMS’s website at www.CMS.gov, as well as a litany 36

SEPTEMBER 2014 | O&P Almanac

of other resources at www.HHS. gov. Following his session, Walter will make his presentation available to the public on the AOPA website, www.aopanet.org.

Just as important as it is for O&P providers to grasp the impact of the ACA on their businesses, they also must understand how the law affects their patients. Dan Ignaszewski, director of government relations for the Amputee Coalition, will address the patient’s perspective in his session during the “A Changing Health-Care World and Its Impact on Orthotics and Prosthetics” program.

As the details of implementing ACA evolved, it had a substantial effect on essential health benefits. HHS was under pressures to reduce the cost of health plans, and so instead of establishing a set of national essential health benefits, as most had expected, HHS decided to allow the states to select its essential health benefits program by choosing one from as many as eight plans HHS identified for each state. Any plan selected must include some benefits in the 10 “essential health benefit” areas set out in the law, including “rehabilitative and habilitative services,” which includes orthotics and prosthetics. However, providers and patients are surprised to find that a meager benefit may still satisfy the

law, and because of the way HHS has implemented this, Medicaid plans may still exclude prosthetics and orthotics because these were deemed optional (rather than mandatory) benefits in the statute that established Medicare.

The session will attempt to shatter this incorrect notion and others, in addition to helping providers communicate what options patients do have despite the challenges and limitations. Detailed coverage information and other resources can be found on the Amputee Coalition website at www.amputeecoalition.org/advocacy-awareness/ health-care-reform/.

As health care continues to evolve and change, professionals and providers must develop an understanding of those changes and how they impact patients. “The ways in which patients are impacted oftentimes also impact providers, in terms of coverage rates and which patients have access,” he says. If patients can’t get access to care, providers are going to be hurting, too. But learning how to better serve patients isn’t enough; they also must understand how to advocate for their businesses and their patients’ best interests.

Lia Dangelico is a contributing writer to O&P Almanac. Reach her at ldangelico@contentcommunicators.com.

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AOPA Nation Assem al bly 2014

TECH TUTOR

By Brad Mattear, CPA, CFo

Technicians 101 The O&P Almanac debuts a column promoting the advancement of the technician profession

“Y

ou cannot do good until

devices that truly

you do well.” This quote, from the O&P industry’s legendary H.E. “Ted” Thranhardt, CPO(E), reminds us to question how well we are doing and how much good we have done. These are questions that the O&P technical field needs to examine.

Beginning this issue, the O&P Almanac will feature a quarterly Tech Tutor column geared toward technicians and anyone who has an interest or passion in the fabrication arts. The Tech Tutor space will explore current fabrication methods, future technology associated with fabrication, and technician-related hot topics.

This month, we will examine the history of the technician profession and take a sneak peek into where we are going—to explore “how well we did and how good we can be.”

complement every

Rewinding the Education Reel

With advances in material science and technology, today’s technician can create a vast array of

patient in the custom form intended.

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SEPTEMBER 2014 | O&P Almanac

Years ago, technical education was more difficult to acquire than it is today.

Historically, opportunities presented themselves in various forms, from traditional apprenticeships and military training to the evolution of formal matriculation at schools like 916 Northeast Metro Tech (Century College).

Glenn Hutnick, CPO, CTP, FAAOP, recalls: “In 1972, while I was in high school, my technical education was hands-on by the staff where I worked.”

Fast-forward to 2014: We have six technical schools, located throughout the United States, that have achieved accreditation by the National

Commission on Orthotic and Prosthetic Education. These institutions continuously elevate their curriculum to address today’s O&P fabrication environment and are currently producing tomorrow’s leaders in the technical arts.

“To be candid, with the exception of CAD/CAM, the labs and equipment haven’t changed all that much in the last 20 years. Technicians have been building and altering fabrication equipment and tools to their liking and means for as long as I can remember,” says Chad Eberhart, CPOA, CTPO, of Independent Tech Service LLC. As I travel the country, I witness many different approaches and methods of fabrication. Being able to see what technicians are doing from coast to coast and border to border has convinced me that the technical field is moving in a solid direction. With advances in material science and technology, today’s technician can create a vast array of devices that truly complement every patient in the custom form intended.

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Embracing Change

Evolution in Materials

One of the biggest challenges for technicians in years past was difficulties with materials and the material science aspect of the job. Eberhart recalls that when he was new to the profession, there were “different plastics, resins, lay-up material, soft goods, and thicknesses, etc. And to be honest, the fear of messing something up always weighed on my mind,” he says.

Today, metal and leather fabrication is slowly easing out of the orthotics field, giving way to more acceptable materials that allow patients easier donning and doffing, along with breathability and greater functionality. In the dual disciplines, terms like “computer-aided manufacturing,” “computer-aided design,” “3D printing,” and “rapid prototyping” are the buzz. These technologies are being generated for the next group of technicians to accept and improve upon.

Turnaround time is evolving as well.

In prosthetics, it generally takes between one and three days cumulatively to fabricate a socket. With advances in technology, we can look forward to the day when fabrication will be completed in less than three hours—a significant advancement for the profession.

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SEPTEMBER 2014 | O&P Almanac

“Back in the day….” How many times have you heard this phrase applied to O&P? This statement comes out when we notice change. Hutnick recalls: “Our challenge was getting the owners to try new things. We lived in a world of SACH and single-axis feet. High-end users got Greissingers, if we were lucky.”

Changes in fabrication, such as using a preformed cone for an inner liner versus fabricating your own, or using new carbon fiber options in for lighter orthoses, are indicators of growth in our field.

The previous generation of technicians blazed the path for the current ones, and today’s technicians will create the pathway for the future. Technicians in the early years weren’t afforded the luxury of the fabrication technology we currently have; instead, they learned to create masterful pieces with what they had available, utilizing everything to the max with very little waste. As the materials were modified and became more of a commodity, the technician position began to morph away from a cobbler/hands-on artist to today’s trained fabricator and, in some cases, an assembler.

Today’s technicians are being viewed as potential care extenders in some businesses, with the potential to provide increased value to O&P facilities when properly trained. The American Board for Certification in Orthotics, Prosthetics, and Pedorthics’ (ABC’s) certified technician credentials (CTO, CTP, and CTPO) have aligned the technician with other certifications within the ranks of ABC. Hiring a certified technician or providing a current technician the pathway to get certified may be of value to you and your business.

Marketing your team as certified to referral sources and payers could offer even more value in years to come.

The one thing you can count on is that your technician (in-house or outsourced) is of vital importance to your business. Without a good technician, custom-fabricated devices would be hard-pressed to be created.

A Peek Into the Crystal Ball

The new generation of practitioners (MSPOs and PhDs) are gaining more clinical knowledge and leaning more heavily on the technical team.

Technicians must accept growing technologies and expand their capabilities beyond fabrication to comprehend how the technology is applied.

For example, understanding targeted muscle reinnervation (TMR) and how the sites in the socket relate can be one way for technicians to enhance their value. “The more complex clinical technique requires a more complex technical technique,” explains Patrick Prigge CP, FAAOP, of Advanced Arm Dynamics.

Prigge currently employs a technician at his location in Maple Grove, Minnesota, and says, “The two disciplines are codependent, and they cannot achieve the results if operated independently.”

In the world of upper-extremity prosthetics, many advances have come in the form of myoelectric devices and socket interfaces using multidurometer silicones. With these improvements comes the requirement of advanced clinical degrees. Prigge predicts: “The higher-degreed prosthetists of the future are going to need the technician to act like the prosthetist of the past.” This is a profound statement and coincides with the necessity of tomorrow’s technician to advance his or her knowledge base to the max.

As the technician profession continues to advance, the hope is that we can know we did good, and continually work toward the goal of doing well.

Brad Mattear, CPA, CFo, is central U.S. and national strategic account manager for Cascade Orthopedic Supply, Inc. Reach him at bmattear@cascade-usa.com.

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MEMBER SPOTLIGHT

Endolite North America

By Deborah Conn

Blurred Lines Manufacturer melds technology and biology in designing lower-limb prostheses

E

ndolite, well known for its lower-extremity pros-

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SEPTEMBER 2014 | O&P Almanac

COMPANY: Endolite North America, part of Chas A. Blatchford & Son Ltd. Location: Miamisburg, Ohio Owner: The Blatchford Family History: 124 years, 27 in the United States

issues, and developing clinical trials of new products.

In addition to developing the first prosthetic devices to use carbon fiber materials, Blatchford introduced the first articulating ankle; the first microprocessor knee, called the Intelligent Prosthesis, or IP knee, in the early 1990s; and the first commercially available hydraulic foot and ankle, the Echelon, in 2008.

Those developments are typical of the company’s commitment to research. “I think our research and development department does a phenomenal job understanding the biomechanical needs of amputees,” says Nolan. “We are always looking for products to make amputees walk more efficiently and comfortably. Our scientific team is top-notch.”

At the moment, that team is working on an integrated limb that will transmit data from the foot as it reacts to the ground to the knee and back again to the foot. “The result will be a completely linked limb system that will be safer and more efficient,” says Nolan.

“Ultimately, what we are trying to do with this is blur the lines between technology and biology.”

When introducing new products, Endolite works with O&P facilities to field-test them. “Much of the initial development happens

in the United Kingdom, so by the time we conduct our clinical trials, we’re probably at about 75 percent of where we need to be. We have relationships with several clinics that we know have the appropriate type of patient,” explains Nolan.

“When we have a new device, we let them test it and tell us what’s right and what can be improved.”

Endolite has experienced significant growth in the past seven years, leading to an expansion of its sales team and internal support. “We have established a whole new department aside from customer service to support customer activities like exchanges, returns, and warranties,” says Nolan.

The Endolite Institute offers certification programs in using and fitting Endolite products, holding them in both classroom and clinical settings. One class a month is held in the Miamisburg facility, and about 15 training sessions are offered each month in other locations throughout the country.

Nolan has been with Endolite for seven years, and he enjoys working for a family-run enterprise. “It’s refreshing to work for a company in the industry that is thinking about the amputee as the number-one concern,” he says.

“Being family-run, we can take the long view as to what will benefit the industry, rather than worrying about quarterly returns and share prices. I believe we symbolize what is great about this industry—a focus on the amputee.”

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

PHOTO: Endolite North America

theses and components, is part of Blatchford, a British artificial limb firm founded in 1890 and based in Basingstoke, England. The Endolite name was first applied to a product Blatchford developed in the United Kingdom in the 1980s that used carbon fiber composites originally developed for the aircraft industry. The resulting prosthetic systems were lighter and stronger than those available at the time and are ubiquitous in today’s advanced devices.

Blatchford, which includes patient-care as well as prosthetic manufacturing facilities in the United Kingdom, acquired its U.S. Endolite distributor. After relocating the business to the Dayton, Ohio, area, Blatchford acquired CaTech, a producer of hydraulic knee cylinders, and integrated all operations under one roof. Blatchford has similar facilities in Germany and France as well as ventures in India and Russia. The U.S. facility is unique in that it includes manufacturing in addition to sales and marketing activities, according to Endolite Vice President and General Manager Chris Nolan.

Today the firm makes prosthetic feet, knees, components, and activity monitoring devices, and is probably best known for its range of hydraulic ankle products, says Nolan.

The company has about 56 employees in Miamisburg and another 15 outside of Ohio, including four clinicians who are responsible for spearheading educational courses, troubleshooting fitting

Endolite North America

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MEMBER SPOTLIGHT

Lake Prosthetics and Research

By Deborah Conn

High Expectations for Upper-Limb Prostheses Texas facility specializes in fitting problematic residual limbs

C

hristopher Lake, CPO, FAAOP, has been drawn to

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SEPTEMBER 2014 | O&P Almanac

COMPANY: Lake Prosthetics and Research LLC Location: Euless, Texas Owner: Christopher Lake, CPO, FAAOP History: 3 years

breakdown, making it difficult to achieve a comfortable socket.

Lake and his technicians do not use computer-aided design or manufacturing, preferring to hand-fashion casts to fit patients. Nearly all fabrication takes place in-house.

“I do a lot of work in-house with custom silicones, both room temperature injectionmolded and high-temperature vulcanized milled materials,” he says. “Silicone is very temperamental so I have to find the right kinds of plaster and resins that work well with it.”

In addition to overseeing his facility, Lake is a clinical instructor at his alma mater, and he is a team member for several funded research studies. One, now in its second phase, seeks to develop body-powered fingers; in another, Lake is working with microprocessors and input devices.

Lake keeps two machinists on retainer and meets with them weekly—a testament to his interest in developing new orthotic

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

PHOTOS: Lake Prosthetics & Research

upper-extremity orthotics and prosthetics since the 1990s, when he attended the O&P program at the University of Texas Southwestern Medical Center, and throughout his residencies at Southern Illinois University and the University of Oklahoma.

“Upper-limb prosthetics has so much ground to cover as a functional replacement, so many things it needs to be able to do.

I’ve found it both challenging and a lot of fun,” he says.

After working for several years at Advanced Arm Dynamics’ Southwest Center as the clinical director, Lake decided to branch out on his own in a practice small enough that he could stay involved in all aspects of the business.

Lake started doing some O&P consulting work in May 2010, and in March 2011 he opened the doors to his patient-care facility, Lake Prosthetics & Research, in Euless, Texas, about halfway between Dallas and Fort Worth.

The facility comprises Lake, two technicians, and an office manager. An outside service performs billing functions. Most of his patients fall between 18 and 50 years of age, although he sees pediatric and elderly patients as well.

Lake specializes in fitting problematic residual limbs.

Because about 90 percent of upper-limb amputations are the result of trauma, the remaining limb can be significantly scarred and subject to

and prosthetic products. “If I can’t grab a part or order it, I get someone to make it for me,” he says.

The facility markets itself primarily through word of mouth and Lake’s relationships with doctors and other referral sources. The Dallas-Fort Worth area has plenty of competition, but “I established myself in my name,” says Lake.

Lake has a strong interest in the advancement of the O&P industry as a whole and is an active member of AOPA and the American Academy of Orthotists and Prosthetists (AAOP). He recently stepped down as chair of AAOP’s UpperLimb Prosthetics Society, but remains involved as a member of the Steering Committee.

Looking ahead, Lake hopes his clinical practice will continue to grow, but he plans to devote more time to product development and improving O&P industry protocols and procedures. For example, he is a strong proponent of trial and preparatory fittings, a process that allows a patient to try a variety of components during an evaluation period and choose what works best for that individual.

“We see a lot of patients [who have decided not to wear a prosthesis] after they have had bad experiences,” says Lake. “The more we can do to ensure the success of our patients, the more successful we all will be.”

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AOPA NEWS

THE AOPA BULLETIN

If It Works, Try It Again!

Patients encouraged to respond to CMS’s off-the-shelf proposal

“T

he right tools make

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

46

all the difference.” This saying is true whether you’re building a home or building an advocacy position. AOPA is learning that not only are the right tools critical, but using as many tools as necessary to ensure a well-built home—or, in this case, a well-built advocacy position— also is important.

Past efforts to involve patients in issues that can affect their care have produced negligible results. But the success of AOPA members in distributing postcards to amputee patients to comment on a harmful CMS proposal regarding prior authorization seemed to hit the right buttons. More than 294 patients voiced their reservations and concerns regarding the proposed rule prior to CMS’s July 28 comment deadline. Those consumer comments, added to the 448 sent by AOPA members, truly marked a new beginning in O&P advocacy efforts.

“If you don’t succeed, try, try again.” This saying is true as well—but AOPA also believes that if you do succeed, by all means try it again. And that’s what happened when CMS released another proposal July 2 on the heels of prior authorization, seeking to once again further expand the statutory definition of off-the-shelf (OTS) orthotics eligible for competitive bidding.

Congress was unambiguous when it mandated that orthoses

SEPTEMBER 2014 | O&P Almanac

eligible for competitive bidding were only those that could be used by the patient with “minimal self-adjustment.” CMS’s newest proposal went even further than the 2007 revisions that expanded CMS the definition, to include “minimal selfadjustment” by the beneficiary, caretaker for the beneficiary, or supplier of the device that can be performed, and does not require the services of a certified orthotist or an individual who has specialized training.

The newest CMS proposal states that “orthotic assistants and fitters are not considered to have specialized training for the purposes of providing custom fitting of orthoses and therefore any devices they fit or adjust will be considered off-the-shelf.”

In response, AOPA has sent postcards to members for distribution to their orthotic patients. These postcards explain CMS is attempting to limit the right for patients to “consult with, and receive fitting, adjustment, and training from your certified

orthotist.” These cards explain that CMS is attempting to reorganize much of what patients receive now as personalized care to off-the-shelf devices, which would eliminate the personal care and would likely be detrimental to the patient and any rehabilitation efforts that might be needed in conjunction with bracing needs. In fact, CMS is setting the stage for likely audits to challenge whether these patients have a legitimate need for personal orthotic care.

Although the extent of postcard participation comments submitted by patients before the Sept. 2, 2014, deadline is not known at press time, the comments AOPA members submitted through the AOPAvotes website was well into the hundreds. Of course, AOPA submitted comments prior to the deadline as well.

“Only time will tell” how CMS will react to the deluge of comments from O&P patients and professionals. The O&P Almanac will keep you posted.

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

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

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

Simple! Visit MobilitySaves.org.

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

Access the Full Study

Review the White Paper

Share this information with clinicians, practitioners, and insurance providers

Educate others with informative slide shows

Healthy Lives

Follow Mobility Saves on Facebook and Twitter

Watch the News Release

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

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

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

Mobility Saves Lives And Money!

Watch Queen’s story and more experiences.

Get Involved, Spread the Good Word

MobilitySaves.org

Mastering Medicare:

LIVEY

EVERTH MON

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

OCT

08 SEPT

Urban Legends in O&P: What to Believe*

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

10

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

SEPTEMBER AOPAversity Webinar Series

Medicare Enrollment, Revalidation, and Participation*

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

OCTOBER

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

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

2 NOV

12

nd

Wednesday of each month!

Gifts: Showing Appreciation without Violating the Law*

DEC

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

NOVEMBER

New Codes and Changes for 2015*

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

10

DECEMBER

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

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

EARN CREDITs

1.5 CE PER CONFERENCE

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

AOPA NEWS

Log On for Free at the AOPAversity Online Meeting Place

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

J

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

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

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

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

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

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SEPTEMBER 2014 | O&P Almanac

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

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

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

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

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

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

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

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

AOPA NEWS

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

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

Education Programs for 21st Century Entrepreneurs—

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

I

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

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

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

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

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

Review the videos as many times as you like.

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

2014 Coding Pro

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

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

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

2014 Quick Coder

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

2014 Coding Suite

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

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

51

AOPA NEWS

Earn CE Credits by Reading the O&P Almanac!

E! Q UI Z M Earn

2

Business CE

Credits P.17

Coding Questions Answered 24/7

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

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

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

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

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

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

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

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

Earn CE credits accepted by certifying boards:

52

www.bocusa.org

SEPTEMBER 2014 | O&P Almanac

AOPA’s Online Career Center gives you

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

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

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

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

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

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

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

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

Save the Date

OCTOBER 7-10, 2015 Mark your calendars for an ideal combination of top-notch education and entertainment at the 98th AOPA National Assembly in San Antonio, Texas. We look forward to seeing you in 2015!

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

WElCOME NEW MEMBERS

T

he officers and directors of the

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

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

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

iFIT Prosthetics LLC N27 W23655 Paul Road Pewaukee, WI 53072 414/333-1658 Category: Patient-Care Member Timothy Dillingham MD, MS

CBS Medical Billing & Consulting LLC 76 Lafayette Road Hampton Falls, NH 03844 603/601-2936 Category: Educational & Research Member Erin Cammarata Evergreen Prosthetics & Orthotics 11782 SW Barns Road Building C, Ste. 160E Portland, OR 97225 503/641-2020 Category: Patient-Care Member Alex St. Louis Health Care 21 846 W. Valley Blvd.

Alhambra, CA 91803 626/284-8188 Category: Patient-Care Member Paul Buck Yeo, COF

Is Your Facility Celebrating a Special Milestone This Year?

O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@contentcommunicators.com.

Limb Craft Inc. 810 E. Chapman Ave., Ste. C Fullerton, CA 92831 714/626-0417 Category: Patient-Care Member Nathan Lee, CPO OP Solutions Inc. 12206 Bruce B. Downs Blvd., Ste. 100 Tampa, FL 33612 866/990-0888 Category: Educational & Research Member Jason Kahle Rightway Medical Supply Inc. 3407 34th Street, Ste. A Lubbock, TX 79410 806/793-7444 Category: Patient-Care Member Dustin Milner

AOPA O&P PAC

T

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

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

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

The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • Michael Burton • J. Martin Carlson, CPO • Joe Martin, COO

• Robin Burton • Al Kritter, CPO, FAAOP • Frank Vero, CPO

*Due to publishing deadlines, this list was created on Aug. 8, 2014, and includes only donations and contributions made or received between July 15, 2014, and Aug. 8, 2014. Any donations or contributions made or received after Aug. 8, 2014, will be published in the next issue of the O&P Almanac.

O&P Almanac | SEPTEMBER 2014

55

Marketplace

Feature your product or service in Marketplace.

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

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

ARTech Laboratory Inc. The loss of a limb causes deep emotional trauma. Apart from the obvious difficulties with mobility and self-care, the disturbance in body image requires significant emotional readjustment. Our objective is to eliminate the stigma associated with the disfigurement. As opposed to the robotic or mannequin look of a traditional prosthesis, our restorations have a natural appearance since they are sculpted and painted to match the opposite limb. Without close examination, ARTech’s prostheses are virtually undetectable.

It is our privilege to work in an industry that gives self-sufficiency, mobility, and self confidence back to those with amputations and birth defects.

For more information, call 888/775-5501 or visit www.artechlab-prosthetics.com. ARTech Laboratory Inc. is located at 309 West Avenue F, Midlothian, TX.

RHEO KNEE® 3 by Össur®. A perfect balance of stability and dynamics.

Featuring a new actuator and kinematic sensor, RHEO KNEE 3 offers increased (and smoother) resistance across a wider range of stance flexion. This improved support from heel strike to toe off helps increase the confidence of all users whether walking on varied terrain, ramps, and stairs, or merely standing. However, it is especially reassuring to low K3 users.

At the same time, we didn’t sacrifice the dynamics that RHEO KNEE is known for and that high K3 users expect. In fact, we improved them! With a more powerful actuator and a faster, more consistent swing extension, RHEO KNEE 3 makes it even easier for high active users to walk their way.

Key Features: • NEW! Actuator and kinematic sensor enhance stance stability and dynamics.

• NEW! Redesigned extension assist for faster and more natural swing extension.

• NEW! 300-lb weight limit and up to 3 days of battery life.

• “Zero Lag” actuator provides an instant response.

• Effortless swing intiation enables a smoother gait.

Contact your Össur rep or call 800/233-6263 today to get certified or demo RHEO KNEE 3.

Next Generation Accent Foot from College Park The Accent® foot from College Park now comes in larger sizes and higher weight limits. The foot provides a service-free option for individuals who desire a cosmetically appealing foot with an easy-to-adjust heel height.

• • • • • • •

Features include: NEW: Sizes 27 and 28 cm NEW: Weight limits up to 250 lbs 2-in. (51-mm) user-adjustable heel height Dynamic pylon and integrated pyramid options Ankle fairing for superior finishing Sandal-toe foot shell, with narrow and wide width options Three firmness choices.

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

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

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

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

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

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

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

• Because of its superior saturation, Coyote Composite finishes as good or better than carbon laminations.

For more information, call 800/819-5980, AOPA 2014 National Assembly Booth 1031C, or visit www.coyotedesign.com.

56

SEPTEMBER 2014 | O&P Almanac

Marketplace 5XA Aluminum Hook from Fillauer • • • •

Lightweight aluminum body Canted “fingers” allow visual feedback Available in 1/2-20-in. or M12x1.5-mm thread Variety of anodized colors available: black, blue (pictured), gold, or red.

For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com

AllPro from Fillauer Have your patients walk and play like a Pro! Order the new Fillauer AllPro foot by contacting Fillauer at 800/251-6398 or 423/624-0946.

Fillauer is located at P.O. Box 5189, 2710 Amnicola Hwy., Chattanooga, TN 37406.

OTS Double Adjustable Ankle Joint • All stainless steel construction for stronger, longer lasting control • Lightweight—total weight only 1.5 oz. per hinge • Sold in pairs with an ultra small joint head to reduce overall bulk • Taller, reversible stainless steel upright helps to corrugate plastic strut, reducing the need for thicker plastics • AFOs can be fabricated with plastic as thin as 3/32 in.

• Adjustable stops allow movement from 0 to 30 degrees in both directions or anywhere in between • Contourable distal stirrup attachment increases strength connection to molded footplate and allows for thinner plastic in AFO fabrication.

For more information, call OTS Corp. at 800/221-4769 or 828/658-8330.

Trautman Expansion Arbors from Fillauer Fillauer’s NEW Trautman Expansion Arbors are designed to prevent the sanding cone from flying away.

When the expansion arbor spins, it expands and applies pressure to the inside of the sanding sleeve— holding the sleeve on the arbor.

Features and benefits: • Provides a smoother grinding surface for straighter lines and higher quality finish • Eliminates grinding chatter that hard grinding surfaces give • Available in three sizes and as a kit of three • Available in 1/2-13, 5/8-11 and M16 threads to fit most O&P machinery.

For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com

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

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

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

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

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

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

• Because of its superior saturation Coyote Composite finishes as good or better than carbon laminations.

For more information, call 800/819-5980, AOPA 2014 National Assembly Booth 1031C, or visit www.coyotedesign.com.

O&P Almanac | SEPTEMBER 2014

57

Marketplace Vista® 639 LSO 4 Panel

Coyote Design’s Proximal Lock from PEL

The new Vista® 639 LSO 4 Panel is Aspen’s most substantial LSO, offering multiple layers of support around the entire torso. With coverage from the symphysis pubis to the xiphoid process coupled with overlapping lateral and anterior panels, this clinically effective brace provides maximum motion restriction in all three planes of motion. Designed to be easily modified, the xiphoid extension can be adjusted to contour and conform to varying anatomies. This one-size adjustable brace offers both modularity and versatility and can be seamlessly stepped down to a Vista 637 LSO, to a Vista 631 LSO LoPro, and ultimately to a Vista 627 Lumbar to provide the needed support as the patient recovers. The Vista 639 LSO 4 Panel is code L0639 approved.

For more information, please call Aspen Customer Service at 800/295-2776, visit aspenmp.com., or AOPA 2014 National Assembly Booth 958.

PEL now offers the new Proximal Lock by Coyote Design. The Proximal Lock is a zero clearance, proximally mounted lock that works for suspension and rotational control. Using the distal adaptor of your choice, the new lock design allows for easy donning while the silicone liner attachment is more flexible and larger for increased pull.

Benefits and features include: • Zero clearance lock • Suspension and rotation control • Ideal for long limbs with minimal clearance • Silicone adhesive remains flexible after it sets • Flexible attachment rolls on easier • Water-resistant.

Contact PEL at 800/321-1264 or www.pelsupply.com.

O&P Student-ReSident AwArd wINNING

AOPA’s

national

POSteR AwARdS

assembly ’14 These awards have been made possible by a special endowment by Becker Orthopedic and WillowWood.

Congratulations!

On behalf of AOPA, Becker Orthopedic, and WillowWood, congratulations to Georgia Institute of Technology as the affiliated school of both award winners. Be sure to join us on Saturday, September 6, at 7:15 AM as we honor Lauren Levey, Steven Siebert, and Georgia Institute of Technology.

2014 edwin and Kathryn Arbogast Award winner Lauren Levey, MSPO

Lateralization of Motor Control in the Lower extremity Georgia Institute of Technology

2014 Otto and Lucille Becker Award winner Steven Siebert A wireless instrumented AFO to Quantify Ankle Stiffness and Range of Motion Georgia Institute of Technology

For further information, contact Tina Moran at 571/431-0808 or tmoran@AOPAnet.org.

O&P Almanac | SEPTEMBER 2014

59

AOPA NEWS

CAREERS

Mid-Atlantic

North Central

CO/CP/CPO, Technician, Orthotic Fitter— Multiple Positions for Growing Offices!

CPO or Board-Eligible CPO

Washington, DC, Metro area Infinite Technologies Orthotics and Prosthetics is seeking a CO/CP/CPO, fitter, orthotic assistant, and technician to join our growing business needs. With three offices already in the DC metro area and two more opening this fall, we are looking to bring on more practitioners and technicians to service our growing population. Practitioners have the opportunity to treat both adult and pediatric patients in an office and hospital setting. The ideal candidate should possess good communication and organizational skills. We offer a very competitive salary based on experience plus a strong benefits package.

To learn more about Infinite Technologies, please visit our website www.infinitetech.org. To apply, please send your cover letter and resume to jobs@infinitetech.org with the position you are applying to in the subject line.

Email: jobs@infinitetech.org

Pacific CPO or CP–Facility Manager

Southern California Exceptional opportunity for a CPO/CP to manage our satellite office in California’s beautiful Santa Clarita Valley. Are you looking to grow your career and take on more responsibility? We are a well-established multifacility company with an immediate opening for an experienced practitioner (CPO or CP with orthotics experience) to run and grow our practice in Santa Clarita.

This ABC-certified practitioner must be self-motivated, and patient-oriented, and possess sound clinical, organizational, and interpersonal skills. Familiarity with OPIE software and chartless environment is a huge plus. A minimum of five years’ clinical experience is preferred.

We offer a highly competitive salary, incentive program, and outstanding benefits package. If you are ready to take the next step in your career and relocate to one of the safest and most desirable places to live in the nation, please send your resume with cover letter to:

Valley Institute of Prosthetics and Orthotics Joanna Chavez-Romero, Administrator Email: jchavez@vipoinc.com Fax: 661/322-0528 Website: www.vipoinc.com 60

SEPTEMBER 2014 | O&P Almanac

Grand Rapids, Michigan We are seeking a motivated CPO or board-eligible CPO for our Grand Rapids location. Position will be focused upon orthotics with some travel to satellite locations. Candidate should be articulate and possess organizational and interpersonal skills. Teter O & P is a privately owned company with 20 locations in Michigan. We offer a competitive salary, good benefits, IRA plan, and paid continuing education.

Please send resume to: Ladd Lorenz, CP 4024 Park East Ct., Ste. B Grand Rapids, MI 49546 Fax: 616/949-4051 Email: laddl@teterop.com

Northeast CO/CPO/ BEO/BOCO

Southern Maine Do you want to be more than a number?

We are a terrific, patient-orientated company looking for some awesome practitioners.

Is this you?

Our well-established O&P facility is seeking self-motivated, energetic practitioners. Our Southern Maine locations are in close proximity to the coast and mountain region. Our comprehensive compensation package includes bonuses commensurate with productivity. Learn more about joining our team of dedicated specialists by sending a resume to: O&P AD 0814 C/O: O&P Almanac 330 John Carlyle Street, Suite 200 Alexandria, VA 22314 Fax: 571/431-0899 Email: scuster@AOPAnet.org

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 http://bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

CAREERS

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

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

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

- Southeast - North Central - Inter-Mountain - Pacific

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

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

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

Job Board

Member $80

Nonmember $140

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

Discover new ways to connect with O&P professionals.

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

“The most gratifying piece of what I do

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

- Kevin Carroll, MS, CP, FAAOP

AVAILABLE POSITIONS CLINIC MANAGER Ardmore, OK

Corvallis, OR

Bartlesville, OK

Zanesville, OH

PROSTHETIST/ORTHOTIST

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

Albuquerque, NM

Poplar Bluff, MO

Burnsville, MN

Richmond, VA

Columbus, OH

San Antonio, TX

Dayton, OH

San Francisco, CA

Lansing, MI

Santa Rosa, CA

Join Hanger Clinic and make a difference today.

Macon, GA

Syracuse, NY

Oklahoma City, OK

Tulsa, OK

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

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

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

ORTHOTIST Jackson, MS

Orange, CA

Modesto, CA

Philadelphia, PA

Morgantown, WV

Cincinnati, OH

PROSTHETIST Livermore, CA

Riverside, CA

PEDORTHIST Dayton, OH

Newport Beach, CA

O&P AlmAnAc | SEPTEMBER 2014

61

CALENDAR

2014

October 1

September 4-7

97th AOPA National Assembly.

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

September 10

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

Webinar Conference

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

September 25-26

Northern Plains AAOP Annual Meeting. Jimmy’s Conference & Catering Center. Vadnais Heights, MN. For more information, visit www.oandp.org/membership/ chapters/northern_plains/ or contact info@oandp.org.

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

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

www.bocusa.org

Let us share your upcoming event!

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

AOPAnet.org for content deadlines.

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SEPTEMBER 2014 | O&P Almanac

October 1-2

North Carolina Orthotic and Prosthetic Trade Association (NCOPTA) 2014 Annual Meeting. The Ballantyne Hotel & Lodge. Charlotte, NC. For more information, visit www.ncopta.org/ or contact info@ncopta.org.

October 8

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

Webinar Conference

September 15-20

Calendar Rates

ABC: Practitioner Residency Completion Deadline for November and December/January 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.

October 8-10

New England Chapter of AAOP 2014 Annual Meeting.

Radisson Manchester. Manchester, New Hampshire. For more information, visit www.neaaop.org or email jckndk@comcast.net.

October 9-11

Tennesee Society of Orthotics & Prosthetics 2014 Annual Meeting. Chattanoogan Hotel. Chattanooga, TN. For more information, visit https://www.regonline.com/builder/site/Default. aspx?EventID=1596170 or contact TSOPStaff@gmail.com.

Online Training

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

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

Questions? Email scuster@AOPAnet.org.

Credits

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

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

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

CALENDAR Bio-Mechanical Composites, Inc.

October 10

November 12

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

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

Webinar Conference

November 15

Midwest Chapter AAOP—One-Day Fall Symposium.

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

October 11

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

October 16-18

December 4-6

R.I.C.: Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago, IL. Elaine Owen. 21.50 ABC Credit application. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education.

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

November 5-7

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

December 10

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

Webinar Conference

2015 OCTOBER 7-10

November 6-7

COPA 2014 Northern California Educational Event.

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

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

ADVERTISERS INDEX Company Ability Dynamics Allard USA ALPS South LLC American Board for Certification in Orthotics, Prosthetics & Pedorthics Inc. Amfit Inc. The Bremer Group Company Cailor Fleming Insurance Cascade Dafo College Park Industries Coyote Design DAW Industries Dr. Comfort Fillauer FLO-TECH O&P Systems Inc. Hersco Kingsley Manufacturing Orthomerica Össur Americas Inc. Ottobock PEL Spinal Technology SPS WillowWood

Page Phone 19 855/450-7300 29 888/678-6548 9, 45 800/574-5426 43 C2 35 13 15 21 39 1, 53 5 25, 41 27 2 58 37 11 C4 7 31 C3 Insert

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

703/836-7114 www.abcop.org 800/356-3668 www.amfit.com 800/428-2304 www.bremergroup.com 800/796-8495 www.cailorfleming.com 800/848-7332 www.cascadedafo.com 800/728-7950 www.college-park.com 800/819-5980 www.coyotedesign.com 800/252-2828 www.daw-usa.com 877/713-5175 www.drcomfort.com 800/251-6398 www.fillauer.com 800/356-8324 www.1800flo-tech.com 800/301-8275 www.hersco.com 800/854-3479 www.kingsleymfg.com 800/446-6770 www.orthomerica.com 800/233-6263 www.ossur.com 800/328-4058 www.professionals.ottobockus.com 800/321-1264 www.pelsupply.com 800/253-7868 www.spinaltech.com 800/767-7776 www.spsco.com 800/848-4930 www.willowwoodco.com O&P Almanac | SEPTEMBER 2014

63

ASK AOPA

Countdown to Grandfathering Expiration Date Answers to your questions regarding BAAs and the HIPAA Omnibus Rule

Early last year the HIPAA Omnibus Rule was released, requiring health-care providers to update their Notices of Privacy Practices and business associate agreements (BAAs) by Sept. 23, 2013.

However, the rule allowed for a one-year grandfathering period for amending/updating existing BAAs already on file. If a BAA was in effect prior to the release of the Omnibus Rule, health-care providers have until Sept. 23, 2014, to make any required revisions.

Q

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.

64

SEPTEMBER 2014 | O&P Almanac

Q/

Who or what is a business associate (BA)?

Traditionally, a BA is a person or entity that provides services on behalf of or to a covered entity (an O&P provider) and requires the use and disclosure of protected health information (PHI) to carry out those services.

With the new rules, a BA is any entity or person that creates, receives, maintains, or transmits PHI on behalf of a covered entity. This expanded definition also includes any subcontractors that a BA may use to carry out the duties assigned to it by a covered entity.

This slight change in the definition means that some of your prior informal arrangements may need formal BAAs because the entities may be considered BAs. Some examples of BAs include, but are not limited to, third-party billers, clearinghouses, accrediting/ credentialing organizations, consultants, and document destruction companies.

Some examples of companies/entities/ individuals that are not considered BAs include, but are not limited to, hospitals, referring physicians, Internet providers, and plan sponsors.

A/

How do I determine if the people, companies, and organizations I deal with are considered BAs?

Q/

Ask the following questions regarding any PHI being disclosed:

A/

• Is the PHI being disclosed to someone in the capacity of his or her job

description as a member of your workforce?

• Is the PHI being disclosed to a health-care provider (e.g., physician, hospital, skilled nursing facility) for treatment purposes?

• Is the PHI being disclosed to a health plan/insurer for payment purposes?

• Is the PHI being disclosed to another covered entity?

If the answer to any of the above questions is yes, then the entity, company, or individual is most likely not considered a BA, and a BAA would not be required. You will also want to ask these questions: • Does the entity create, receive, maintain, or transmit PHI for the purpose of any of the following activities: claims processing, administration, data analysis, utilization review, quality assurance, patient safety activities, billing, benefits management, practice management, etc.?

• Does the entity provide you with any of the following services (services requiring the disclosure of PHI): legal, accounting, consulting, data aggregation, management, administrative, accreditation, or financial?

• Will the entity be able to access PHI on a regular basis, and/or is there a possibility that the PHI in the entity’s control could be compromised?

If the answer to any of the above questions is yes, then the entity, company, or individual is most likely considered a BA, and a BAA would be required.

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