September 2015 O&P Almanac by AOPA

SPECIAL SECTION: 2015 AOPA NATIONAL ASSEMBLY EXHIBITOR PREVIEW P.44 The Magazine for the Orthotics & Prosthetics Profession

S E P T E M B E R 2015

E! QU IZ M EARN

BUSINESS CE

CREDITS P.20

Understanding Common Modifiers and Their Usage P.18

Tips for Engaging and Treating Pro Athletes P.36

Consolidation and the Future of Independent O&P Facilities P.38

2015 National Assembly Product Guide WWW.AOPANET.ORG

P. 60

HighTOUCHfor

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AMBITIOUS ACTIVITY GOALS REQUIRE INCREASED COMMUNICATION, DEFINED BENCHMARKS, AND CUSTOMIZED COMPONENTRY P.30

This Just In: AOPA Responds to Draft LCD and Policy Article P.24

YOUR CONNECTION TO

EVERYTHING O&P

R EG American Orthotic & Prosthetic Association

IST

RAT

#AOPA2015

ION

The premier meeting for orthotic, prosthetic, and pedorthic professionals

IS N

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Register Today! The 98th Annual AOPA National Assembly in conjunction with the Texas Academy Chapter Meeting October 7-10, 2015 The Henry B. Gonzalez Convention Center On the Riverwalk in San Antonio, TX Experience an ideal combination of top-notch education, exhibits, and entertainment at the 98th AOPA National Assembly in San Antonio, Texas. We look forward to seeing you!

Earn over

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

O&P Almanac readers are invited to tour the AOPA National Assembly Exhibit Hall on Saturday, October 10, at the Henry B. Gonzalez Convention Center in San Antonio. You may choose to pre-register online at bit.ly/aopa2015 and use the promocode OPALMANAC (Be sure to select the registration category, Exhibit Hall Only, and then Saturday, Oct. 10) or you may choose to bring the adjacent coupon to the registration desk in San Antonio.

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contents

SE PTE M B E R 2015 | VOL. 64, NO. 9

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

Insights from AOPA President Charles Dankmeyer Jr., CPO

AOPA Contacts............................................6 PHOTO: Hanger Clinic

COVER STORY

FEATURES

30 | High-Touch for High-Impact O&P Treating high-activity patients requires a close partnership with the patient to understand his or her abilities and goals, a familiarity with the activity or sport the patient wishes to take part in, and careful design considerations to ensure a device that can withstand high impact and repetition. PLUS: An Orthotist Shares Tips for Treating Pro Athletes By Christine Umbrell

24 | This Just In: LCD Pushback

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 16

Transitions in the profession

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

Medicare Modifiers

Examining the two-digit modifier codes and their usage

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

CREDITS

P.24

AOPA and the O&P Alliance responded swiftly to the proposed Local Coverage Determination for Lower-Extremity Prosthetics Policy Article. AOPA’s 43-page response to the proposed LCD detailed the egregious and likely unlawful sections. Following on the heels of the August 26 patient demonstration at HHS organized by AOPA, CMS agreed to meet with O&P representatives.

38 | O&P Almanac Leadership Series

How to reach staff

Member Spotlight.................................66 n n

Shamrock Prosthetics LegWorks

AOPA News................................................70

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 74

P. 38

Careers......................................................... 76

Professional opportunities

Calendar...................................................... 78

A Place in the Consolidation Continuum?

Upcoming meetings and events

O&P business managers must take a closer look at costsaving measures, alliances with referral bases and payors, and increased integration with the greater medical community to ensure their viability as independent facilities, or consider teaming with other practices to realize economies of scale.

Ad Index....................................................... 79 Ask AOPA.................................................. 80

Expert answers to your questions about AOPA’s PAC and other key initiatives

SPECIAL SECTION: 2015 AOPA NATIONAL ASSEMBLY PREVIEW

44 | Sneak Peek Meet the title sponsors of this year’s event and learn what’s new on the trade show floor in San Antonio.

52 | Exhibitor

60 | Product

See the full list of companies that will be exhibiting at the AOPA National Assembly— including several first-timers.

Review a sampling of the innovative products that will be on display on the trade show floor.

Directory 2015

Guide 2015

O&P ALMANAC | SEPTEMBER 2015

PRESIDENT’S VIEW

Somebody Just Doesn’t Get It

the latest bombshell from regulators. The July 16, 2015, local coverage determination (LCD) published by the durable medical equipment Medicare administrative contractors (DME MACs) takes on an even greater significance than the “Dear Physician Letter” of just four years ago. Within 48 hours, AOPA developed and implemented an action plan that was approved by the board. It embraced using every possible tool at our disposal, ranging from pressing Congress, to a social media campaign, to public relations spots, to patient engagement—and everything in between. AOPA even made a formal Freedom of Information Act request for the DME MACs to provide evidence justifying the proposed revisions that impose 1970’s lower-extremity prosthetic technology on amputees in 2015. They did. It was scanty, embarrassingly so. More details of AOPA’s actions can be found on page 24 of this issue. Members of AOPA have received information enabling them to go to AOPAvotes.org to quickly generate a letter of comment to the DME MACs but with the added twist of a copy of their comments also being sent to their senators and representatives. Every AOPA member location received 10 postage-paid postcards with clear “Don’t harm my mobility” messages that patients could sign and send to AOPA. We then filed those postcard comments electronically with the DME MACs. AOPA developed media messages and accompanying artwork, brought in public relations and public affairs experts, purchased broadcast media time and newspaper space, made appointments with high-level officials in CMS, reached out to the Amputee Coalition, worked with our sister organizations in the O&P Alliance, and continued to press on the DME MACs directly. It was in every sense an all-out blitz. In the midst of all of this activity, an email arrived at AOPA in reference to the LCD announcement: “While Medicare is destroying our profession, AOPA is taking a smoke break. Please do something.... You should have senators and representatives that you count on to derail this legislation. We are facility certified, P and O certified, bonded, state licensed, insured, Medicare-standards-required office hours, and they still doesn’t trust us. DO YOUR JOB.” While AOPA benefits from and expects criticism, this email from a nonmember company got me pi**ed. Never mind that the writer was not a member and never contributed a dime to the AOPA PAC. When you’ve been on the board at AOPA and seen the hours colleagues spend away from their own business, volunteering to protect the businesses of their colleagues—well, you just wonder why people who criticize don’t put their money where their mouth is. Hell, my fellow board members and your AOPA staff are working their collective butts off to save the turkey who wrote that email! He hasn’t earned it, he doesn’t deserve it, and he’s probably responsible for submitting incomplete documentation that feeds audits. AOPA has done a significant amount of work to thwart and rescind the proposed LCD. Practices, manufacturers, suppliers, practitioners, patients, members of Congress, even the Department of Veterans Affairs—all have been reached out to and have responded favorably to our request to participate in the fight to correct the madness of this proposed policy. As I write this, we are still in the midst of the fight. By the time you actually read it, there will most likely have been some sort of resolution. I can assure you, my colleagues and friends in this proud profession, that we will have done everything in our power to prevent this LCD from moving forward. I grew up in the era of the Baltimore Colts and Johnny Unitas. Before every game, the defensive captain would give an impassioned speech. He would then turn to Unitas and ask, “Johnny, you got anything to say?” From the same spot at the exit to the field, Johnny would say the same line: “Talk’s cheap, let’s play.” Every time. It’s time for those on the sidelines to get in the game.

Charles H. Dankmeyer Jr., CPO AOPA President 4

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

HE LEADERSHIP AND STAFF at AOPA have been consumed by

SEPTEMBER 2015 | O&P ALMANAC

Board of Directors OFFICERS

President Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD President-Elect James Campbell, PhD, CO, FAAOP Becker Orthopedic Appliance Co., Troy, MI Vice President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Immediate Past President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis Inc., Rochester Hills, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Scott Schneider Ottobock, Austin, TX Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

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

REIMBURSEMENT SERVICES

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

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

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

MEMBERSHIP & MEETINGS Tina 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 Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

SEPTEMBER 2015 | O&P ALMANAC

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/293-1577, 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

Advertising Sales RH Media LLC 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 © 2015 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options!

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PROFESSIONAL LIABILITY

GENERAL LIABILITY

PROPERTY

AUTO

UMBRELLA

WORKERS COMP & MORE

NUMBERS

U.S. Health Spending on the Rise Percentage of GDP relegated to health care expected to increase by 2024.

While the past several years have

2014-2024 OUTLOOK

seen historically low growth rates of national health spending due to the

5.8 PERCENT

recession and its aftereffects, the trend is changing. CMS officials predict

Average annual rate of health spending growth.

health costs to rise through 2024,

$5.4 TRILLION

coverage expansions, faster economic growth, and the aging population.

Predicted health spend in 2024.

17.4 PERCENT Health share of U.S. gross domestic product (GDP) in 2013.

19.6 PERCENT

Projected share of GDP in 2024.

OUT-OF-POCKET EXPENSES TO DECLINE

MEDICARE SPENDING TO INCREASE

11.6 PERCENT

19.1 MILLION Projected increase in enrollment of elderly Americans between 2013 and 2024.

Out-of-pocket health spending in 2013.

20.1 PERCENT Share of national health spending paid for by Medicare in 2013.

22.5 PERCENT

10 PERCENT

Share of national health spending expected to be paid for by Medicare in 2024.

Projected out-of-pocket health spending in 2024.

U.S. Health Expenditures 2012

$2.8 Trillion

2015

$3.2 Trillion

2013

$2.9 Trillion

2018*

$3.8 Trillion

2014

$3.1 Trillion

2024*

$5.4 Trillion

*Projected

SEPTEMBER 2015 | O&P ALMANAC

“As the baby-boomer generation continues to age into eligibility for Medicare and as the Medicaid population ages, it is projected that nearly four out of every 10 health-care dollars will be spent on people enrolled in one or both of these two largely government-funded programs, in which per enrollee costs tend to be higher than average.” —“National Health Expenditure Projections, 2014-24: Spending Growth Faster Than Recent Trends,” Health Affairs, July 2015.

SOURCES: CMS Office of the Actuary; “National Health Expenditure Projections, 2014-24: Spending Growth Faster Than Recent Trends,” Health Affairs, July 2015.

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Happenings RESEARCH ROUNDUP

Researchers Test Low-Cost, High-Performance Knee

Custom Orthoses Found To Reduce PFPS Pain Researchers at the University of Calgary are studying how orthotic insoles can alter mechanical loading in the knee joint, resulting in significant pain reduction for individuals suffering from patellofemoral pain syndrome (PFPS), which is deep pain under the knee cap commonly known as “runner’s knee.” Lead researcher Ryan Lewinson convened a study group of 27 runners to try two different insoles: one that curves toward the inside, and another that curves toward the outside. Lewinson created 3-D models of participants’ runs to study the impact of each insole. “Our aim with this study was to determine if altered knee joint biomechanics would result in improved symptoms for runners who suffer from physician-diagnosed PFPS,” says Lewinson. “What 10

SEPTEMBER 2015 | O&P ALMANAC

we found was that regardless of which orthotic volunteers received, there was a relationship between change in biomechanics induced by the orthotic, and change in pain over the six-week period.” Participants who experienced large changes to knee loading tended to experience larger reductions in pain, while those participants who experienced small biomechanical changes tended to only experience small or no reductions in pain. Lewinson believes insoles can be fine-tuned to develop custom orthotics based on an individual’s characteristics. He plans to develop an effective way to determine which insole would work the best, as well as how frequently new insoles are needed and the long-term consequences of wearing insoles.

PHOTO: Courtesy of the MIT researchers; ILLUSTRATION: Courtesy of Amos Winter, Murthy Arlekatti et al.

A prototype of the prosthetic knee mechanism was tested at a Jaipur Foot organization in India.

The spring allows the knee to bend prior Massachusetts Institute of Technology to the foot pushing off the ground; the (MIT) researchers have designed a first damper also engages to prevent passive, low-tech prosthetic knee that the leg from swinging back. The second closely mimics higher-end prosthetic damper engages as the leg swings knees. Led by Amos Winter, assistant forward, which slows the movement professor and director of MIT’s Global before heel strike. Engineering and Research Lab, a research The prototype is undergoing testing team has built a prototype of a low-cost with volunteers in India, where there prosthetic knee that generates a torque profile similar to that of able-bodied knees. are more than 200,000 above-knee amputees. “This was a quick-and-dirty The team designed the prototype prototype, but so far, we’re seeing using simple mechanical elements, based on calculations of the ideal torque good indicators of natural gait,” says Winter. “I’m not ready to claim victory a prosthetic knee should produce to yet, but…this is a roadmap that is very induce able-bodied kinematics. different than what’s The researchers adjusted been done before, which the torque profile to apply will enable us to achieve to lighter leg segments very high performance at because prostheses are low cost.” generally one third to Details on the research one half as heavy as were recently published human limbs. The mechanism in operation: in IEEE’s Transactions The prototype features an early stance flexion (left) on Neural Systems and a spring and two dampers and the transition from Rehabilitation Engineering. that act as brake pads. stance to swing (right)

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HAPPENINGS

DIABETES DOWNLOAD

Ultrasound Treatment Accelerates Healing of Skin Ulcers Researchers at the University of Sheffield have begun using lowintensity ultrasound technology to reduce the healing time of diabetic wounds. The ultrasound technique consists of mechanically stimulating wound-healing fibroblasts to migrate into the wound—which researchers found to reduce healing time by 30 percent. The treatment also reduces the chance of wounds getting infected. “Using ultrasound wakes up the cells and stimulates a normal healing process,” says Mark Bass, MD, research team leader, from the university’s Centre for Membrane Interactions and Dynamics. “Because it is just speeding up the normal processes, the treatment doesn’t carry the risk of side effects that are often associated with drug treatments.” Bass says his research team will further explore ultrasound treatments over the coming months. He expects the technique to be in broad clinical use within the next three to four years. It has the potential to shorten hospital stays for diabetic patients, and possibly reduce the need for some amputations, according to Bass. The study was carried out in collaboration with the School of Biochemistry at the University of Bristol, the Wound Biology Group at the Cardiff Institute of Tissue Engineering and Repair, and Bioventus, an orthopedic company. Read more about the study in the Journal of Investigative Dermatology.

SEPTEMBER 2015 | O&P ALMANAC

CODING CORNER

ICD-10 Conversion Tool Now Available The Oct. 1, 2015, deadline is approaching fast! In just a few weeks, the nation will transition from Version 9 of the International Classification of Diseases (ICD-9) to ICD-10 coding for medical diagnoses and inpatient hospital procedures. AOPA has partnered with the Coding Institute to provide an ICD-10 conversion tool to all members. This free membership benefit allows you to quickly find a corresponding ICD-10 code simply by typing in any ICD-9 code. Access the conversion tool at bit.ly/icdbridge. To learn more about the changes and gain a general understanding of the impact the transition will have on O&P providers, read the Reimbursement Page article in the June 2015 issue of the O&P Almanac. This article, written by AOPA Director of Coding and Reimbursement Services, Education, and Programming Joe McTernan, is available from the O&P bookshelf: www.aopanet.org/publications/ digital-edition. Read the article directly at bit.ly/icdstory. ACOR-O+P-Almanac--05-05-15-XRD-PRINT.pdf 1 5/6/2015 1:40:04 PM

REIMBURSEMENT PAGE

By JOE MCTERNAN

PRESENTS:

ICD-10: What Does It Mean for O&P?

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CE Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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HERE HAS BEEN A tremendous amount of buzz surrounding the upcoming conversion from the use of ICD-9 diagnosis codes to the latest version, ICD-10. Orthotists and prosthetists are asking, “Do we have to memorize thousands of new diagnosis codes?” “How can we make sure we are reporting the ICD-10 codes correctly?” “Where can we look to find more information on the transition?” This month’s Reimbursement Page will take a look at the basics surrounding the ICD-10 conversion, currently scheduled for implementation on Oct. 1, 2015. This column will dispel some of the myths surrounding ICD-10 and provide a general understanding of the impact the transition will have on O&P providers.

P.20

How Is ICD-10 Diﬀerent?

ICD-10 is yet another acronym in the universe of acronyms in the medical community. It stands for International Classification of Diseases, 10th Edition, and is created and maintained by the World Health Organization. Although work on the ICD project was essentially completed in 1992, many countries, including the United States, have continued to use the previous version (ICD-9) as its primary resource for defining and classifying various diseases

and health-care-related conditions. ICD-10 greatly expands on the ICD-9 system by adding an alphabetical character at the beginning of the ICD-10 code, and additional digits to the five-place coding system used in the ICD-9 system. ICD-9 codes, which have been in use for more than 30 years, use a five-place numbering system with three digits before the decimal, followed by up to two digits after. The principle in place is that the three digits prior to the decimal provide basic information regarding the disease or condition, and the two digits after the decimal provide more specific information regarding the specific nature of the condition or disease. For example, the ICD-9 code for a fracture of the tibia is 823.00, but the ICD-9 code for a fracture of the tibial shaft is 823.30. The additional numbers after the decimal provide specific information regarding the section of the tibia where the fracture is located. Under ICD-10, physicians will be able to more accurately describe the nature of the fracture through the use of additional places after the decimal. ICD-10 codes will include information such as the degree of the fracture, whether it is displaced, etc.

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JUNE 2015 | O&P ALMANAC

CERTIFICATION SPOTLIGHT

BOC’s Exams Undergo Expert Review The Board of Certification/ Accreditation (BOC) recently convened a group of subject matter experts to review and update the content for all of the organization’s exams. The experts worked in exam-specific groups to analyze and revise test questions. Exam content was validated by referencing current student textbooks. The group of subject matter experts comprised certificants from the two major national O&P credentialing organizations, educators, and other medical professionals. These individuals were trained in the exam development process in an exam question-writing workshop at the beginning of the meeting. This workshop included instruction on exam question structure, rules for composing multiple-choice answers, the need for a specific citation for a correct answer, and

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the importance of security. BOC Chief Credentialing Officer Wendy Miller, BOCO, LO, CDME, and Credentialing Manager Michelle Yoon organized the meeting, which took place in the Olathe, Kansas, headquarters of Applied Measurement Professionals (AMP). AMP has been BOC’s testing vendor and partner in test development and implementation for more than 20 years. “BOC complies with nationally recognized psychometric standards to assess the competency of our candidates,” says Miller. “The dynamic nature of the O&P and durable medical equipment fields necessitates periodic reviews of our examinations. The results of meetings like these are exams that are engineered to precisely gauge each candidate’s knowledge in his or her field.”

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HAPPENINGS

O&P ATHLETICS

National Amputee Basketball Team Competes in Los Angeles The AMP1 team of amputee stand-up basketball players gathered in Los Angeles August 7-9 to take part in the Nike 3ON3 Tournament. The street tournament attracts more than 5,000 players from more than 1,500 teams. AMP1 players, who wear high-tech

prosthetics from sponsor Freedom Innovations, competed against ablebodied, nonamputee teams during the tournament. AMP1 won three hotly contested games at the Los Angeles event, further building upon their against-the-odds reputation.

Military Athletes Prep for 2016 Invictus Games More than 400 competitors are expected to take part in the Invictus Games for Wounded Warriors, which are scheduled for May 8-12, 2016, at the ESPN Wide World of Sports Complex in Orlando. This event is an international adaptive sporting competition for injured active-duty and veteran service members. Trials will take place in early 2016. Athletes from 14 nations will compete in archery, track and field, cycling, indoor rowing, sitting volleyball, swimming, triathlon, wheelchair basketball, wheelchair rugby, and wheelchair tennis. The 2016 event is a follow-up to the inaugural Invictus Games that took place in 2014 at the Queen Elizabeth Olympic Park in London.

SEPTEMBER 2015 | O&P ALMANAC

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Thomas V. DiBello, CO, FAAOP, will be honored with the Lifetime Achievement Award at the 2015 AOPA National Assembly in San Antonio. This award is bestowed on individuals who have made exceptional Thomas V. DiBello, contributions to the orthotics and prosCO, FAAOP thetics profession. “Mr. DiBello is this year’s honoree because of his relentless passion for patient care, O&P education, and advancing the profession,” says AOPA President Charles Dankmeyer Jr., CPO. “Tom is a true visionary who has made a huge impact through his leadership at the Academy, AOPA, O&P educational programs, and his other volunteer work here and abroad.” DiBello is the Gulf Coast regional director at Hanger, honorary adjunct faculty at Texas Women’s University, and chairman of the Advisory Committee of the Baylor College of Medicine master’s program in orthotics and prosthetics. He is a past president of both AOPA and the Academy. DiBello will be presented with the Lifetime Achievement Award at the 2015 AOPA National Assembly General Session on Friday, October 9, at 7:30 a.m. Brian Greer, CP, BOCO, has joined Rehab Systems as a certified prosthetist/orthotist. Greer received his bachelor’s degree in health science from California State University— Dominguez Hills and completed his residency Brian Greer, CP, in Apple Valley, California. He spent the BOCO past 13 years working at various clinics in Maryland, Virginia, and Colorado. Greer will be leading the Twin Falls office of Rehab Systems, helping to implement new policies and procedures to further increase efficiency. Greer has worked in fabricating O&P devices and successfully fitting patients of all activity levels with high-quality, functional prostheses. Rehab Systems was founded in Twin Falls in 1994 by Dale Perkins, CPO. During the early years in Twin Falls, Perkins, also an amputee, began developing parts he felt were needed to provide better care for his patients. This eventually led him to co-found Coyote Design with his son in 1999. Rehab Systems later opened a second office in Boise, Idaho, at the same time Coyote Design moved to Boise. Coyote Design continues to develop high-function orthotic and prosthetic solutions. Through its partnership with Rehab Systems, Coyote is able to work closely with patients and practitioners, even in early stages of development. Recently both companies moved into a new larger facility in Boise that also contains newly centralized fabrication. Perkins is still involved in patient care, product development, and practitioner training, while his son Matt heads up both companies’ operations. 16

SEPTEMBER 2015 | O&P ALMANAC

Scott Ranson

Michael Wargo, CPO

Scott Ranson has joined Hanger as chief information officer (CIO). He previously served as CIO for Brookdale Senior Living. “Scott joins Hanger at a very critical time as we work toward implementing smarter systems, utilizing better data, and creating a scalable and supportable infrastructure,” says Hanger President and Chief Executive Officer Vinit Asar. Michael Wargo, CPO, has joined Lawall Orthotics and Prosthetics Inc. in Delaware. Wargo attended Penn State University, where he received his bachelor’s of science in mechanical engineering, and the University of Pittsburgh, where he received a master’s of science in prosthetics and orthotics.

IN MEMORIAM

Joseph “Joe” Arbogast Charles Joseph “Joe” Arbogast passed away unexpectedly at the age of 66 on August 10, after a heart attack. Arbogast had served as co-owner and executive vice president of WillowWood for the past 20 years as part of the third generation of the Arbogasts to lead the family business. As a young man, Arbogast served in the U.S. Army, then began working full-time at WillowWood in 1967. In the early 1980s, Joe, along with his two brothers, Eddy and Bob, agreed that the company was operating at capacity. Arbogast spearheaded the construction of WillowWood’s current facility. As he grew into leadership of the business, Arbogast was part of several key product releases and industry firsts. He is the holder of several U.S. patents, many in the field of prosthetics. While remaining active in business strategy and key decisions, during the 1990s Joe assumed a quieter leadership role within the company. From his relationship with his grandfather, William E. Arbogast, a bilateral amputee and founder of WillowWood, Joe gained an appreciation for the daily challenges faced by amputees. He held an unwavering dedication to help amputees regain functionality to live their lives comfortably and confidently in their prostheses.

PEOPLE & PLACES

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The Amputee Coalition has announced that Cindy Poorman, MSPT, and Joseph Webster, MD, have been awarded the Burgess Award. The award is given to outstanding clinicians, researchers, advocates, and professionals who serve the limb loss community. Poorman and Webster each received $1,000 checks, which they donated back to the Amputee Coalition. Nashville-based BCP Group recently announced it has partnered with Beacon Prosthetics and Orthotics, based in Raleigh, North Carolina. BCP Group has acquired ownership of Beacon and will provide services and resources to support Beacon’s continued growth, but the practice will retain its name. In addition, Eddie White, CP, Beacon’s founder, has become an equity partner in BCP Group and a senior clinical partner in BCP Group’s North Carolina market. White will serve as Beacon’s clinical director.

Ottobock has announced the creation of a business unit called Activity and Sports Medicine (ASM), which combines the products from the acquisitions of Ortho Rehab, Bio Cybernetics International, and Cybertech products, and additional orthotic solutions. The purchase of these companies “has spurred increased focus on spinal bracing in particular, allowing us to help meet the increased demand for nonsurgical interventions,” says Matt Waidelich, president and chief executive officer of Ottobock’s ASM business unit. “Our new name reflects the clinicians we work with, helping to improve outcomes for patients with acute and chronic conditions like osteoarthritis of the knee and spinal stenosis.”

Wright & Filippis Announces Acquisitions and the Opening of a New Office in Orangeburg, S.C. WRIGHT & FILIPPIS (“W&F”) is pleased to announce the acquisition of Williams Orthotics Services (“WOS”) in Flint Michigan. Steve Williams along with his wife Mary have been providing high quality Orthotic services in the Flint area for over 30 years. Steve will continue to see patients and attend clinics as part of the W&F team. A.J. Filippis, C.E.O. of W&F, said “Steve Williams a well-respected Orthotic clinician started his career at W&F over 40 years ago maintains a professional relationship with the physicians in Flint and the McLaren Healthcare System, one of the largest hospital systems in Flint, Michigan.” Wright & Filippis with help from Steve Williams also recently secured a new Prosthetic & Orthotic provider agreement with covering McLaren Healthcare system covering 11 hospitals. Steve Williams is currently working with Wright & Filippis and the WOS patients to assure continued high quality patient care.

As Wright & Filippis continues to focus on organic growth, we are experiencing a 6% growth rate in P&O from same store sales through June. Looking ahead, with the combination of our current growth and recent acquisitions we are forecasting double digit growth by the end of the year. Carolina Orthotics and Prosthetics (COP) an affiliate of Wright and Filippis, “has been actively growing and acquiring business in the state of South Carolina thanks to C. Ralph Hooper, JR., CPO and his expert staff”, said Steven M. Filippis, V.P. of Acquisitions and Mergers. “We are always looking for new partners and acquisitions, but our overriding goal is to find partners that share the same goal and expectation of growing the business while providing the highest quality of service to patients, just like partners Hooper and Williams have done.” In February, COP opened a new office in Orangeburg SC, which is in close proximity to the Orangeburg Regional Medical Center.

This new office is under the management and supervision of Wesley Haygood, CP, of Columbia, SC, and the day-to-day operations are handled by Jay Howland. “The addition of an office in Orangeburg has been geographically desirable in relation to our existing South Carolina offices. Hooper says. “We have had long standing relationships with the referral base in Orangeburg and until now, we were unable to service the community. Our new office will afford us the opportunity to do so”. Last year, COP also purchased Coastal Orthotics and Prosthetics in Murrells Inlet, SC., previously owned by Bill Van which he operated for over 25 years. Bill and the staff from COP will be working from one location to better serve the patients. Bill as part of his retirement plan continues to work part time with the COP staff. The Murrells Inlet office also serves the Myrtle Beach region and has been steadily increasing their referrals and business levels since the acquisition.

O&P ALMANAC | SEPTEMBER 2015

REIMBURSEMENT PAGE

by DEVON BERNARD

Medicare Modifiers Know which two-digit codes need to be included in your claims to ensure reimbursement

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

ITH THE FOCUS ON physician

documentation and proof of delivery forms, it can be easy to overlook the small things, such as modifiers. Modifiers are an essential part of the overall claim submission. While they may not seem as important as the codes themselves, they provide valuable information that assists in the proper and timely processing and payment of claims. This month’s Reimbursement Page examines the more common modifiers and their meanings and usage.

Directional Modifiers

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The most basic modifiers are the directional modifiers. These are used to provide information about where orthoses or prostheses will be placed and used in relation to the patient’s body—more specifically, their extremities, or where the item has been fit. Only three directional modifiers are used by O&P providers: LT, RT, and the combination of both, LTRT. The LT modifier is used to indicate that an item is being worn on the patient’s left side, and the RT modifier is used to indicate that an item is being worn

on the patient’s right side. The LTRT modifier is used when the patient will be wearing identical bilateral items. When you provide the same service bilaterally, you must indicate two units of service and not simply list the LTRT modifier.

Functional-Level Modifiers

Functional-level modifiers, or K-level modifiers, are used only for lowerlimb prosthetic claims, and only with Healthcare Common Procedure Coding System (HCPCS) codes that describe prosthetic knees, prosthetic hips, prosthetic ankles, and prosthetic feet. Functional level modifiers are the only O&P modifiers that are used to describe your patients—in particular, your patient’s ability or potential ability to ambulate using a prosthesis. K-level modifiers also are used to verify that the components (e.g., feet, knees, and ankles) that are being billed are covered for the specific patient to whom they are being provided. The chart at the bottom of the page shows a breakdown of all HCPCS codes that require a K-level modifier and their appropriate K-level.

L5611, L5616, L5710-L5718, L5810-L5812, L5816, L5818, L5970, L5974

L5972, L5978, L5982-L5986

L5610, L5613, L5614, L5722-L5780, L5814, L5822-L5840, L5848, L5856, L5857, L5858, L5859, L5961, L5973, L5976, L5979, L5980, L5981, L5987

L5930

REIMBURSEMENT PAGE

Remember that K-level modifiers describe the patient—not the componentry being provided—so the appropriate K-level must be represented on your claim. If your patient has the ability to ambulate at a K2 level, but you wish to provide that patient with K3-rated componentry, you would use the K2 modifier on the claim.

Policy- and Coverage-Driven Modifiers

Policy- and coverage-driven modifiers are typically required by policies to be included on your claims, and they will indicate if the items or services you are providing should be considered a Medicare benefit and paid or not, or if the items or services are not medically necessary. The KX Modifier. The KX modifier description reads: “The requirements specified in the medical policy have been met.” If a medical policy has set forth special documentation criteria for billing, you must meet all of the criteria in order to bill, and that is when you use KX. Four O&P medical policies currently require the use of a KX modifier: anklefoot orthosis (AFO)/knee-ankle-foot orthosis (KAFO); knee orthosis (KO); orthopedic shoes; and therapeutic shoes for persons with diabetes. When using the KX modifier, it’s important to know how the policies are written to determine whether the proper supporting documentation must be kept in the orthotist’s/prosthetist’s files. Under the “Documentation Requirements” heading of the local coverage determination (LCD) portion of the policy, there will typically be a phrase that explains when and how the KX modifier must be used. For example, in the KO policy under “Documentation Requirements,” there is this phrase: “Suppliers must add a KX modifier... if all of the coverage criteria…have been met and evidence of such is retained in the supplier’s files.” This means you must physically have the documentation supporting the use of the KX modifier in your files—and if you don’t have this documentation, you may not attach the KX modifier.

AW MODIFIER

MODIFIER

GA MODIFIER

MODIFIER

CG MODIFIER

However, if you review the same section of Therapeutic Shoes for Persons With Diabetes policy, you will not see such a statement. Instead, you will see the following: “Suppliers must add a KX modifier…only if criteria in the Nonmedical Necessity Coverage and Payment Rules section of the related policy article have been met. This documentation must be available upon request.” This verbiage indicates that it is not necessary to have all of the supporting documentation in your files; rather, you must be able to provide it upon request. Even though a policy may state that it is not necessary to have the supporting documentation in your files, it is still a good idea to obtain physical copies of any supporting documentation and place them in your files. Doing so will ensure that the documentation does exist, and it is easy to locate if it is requested. Note that when you include the KX modifier on your claim, you are attesting that everything required by policy is in place. Do not simply add the KX modifier to your claims because you know or believe it will get your claim paid. This practice can be viewed as abusive and could lead to fraudulent billing. Before using the KX modifier, review current medical policies to ensure that the specific policy criteria have been met and that the use of a KX modifier is required.

The GY Modifier. The GY modifier is the complete opposite of the KX modifier. While the KX modifier indicates that something is a Medicare benefit and should be covered, the GY modifier is used to indicate that the item or service you are providing is statutorily excluded from Medicare coverage, meaning there is no Medicare benefit for the service. A logical question is, “Why would anyone submit a claim for an item or service that he or she knows is not a Medicare benefit?” Upon enrollment in Medicare, you agree to submit claims on behalf of Medicare beneficiaries if the beneficiary requests that you do so. While it is not mandatory to submit a claim to Medicare for a statutorily noncovered service, if the beneficiary requests that you do so, you are required by your provider agreement to comply. The most common reason why a beneficiary will request that you submit a claim is if he or she has secondary insurance that requires a Medicare denial before the claim will be considered. In this scenario, the claim would be submitted with a GY modifier, Medicare would deny the claim as noncovered, and the secondary insurance would then consider the claim for payment. The GY modifier is most commonly associated with claims involving orthopedic shoes that are not attached to a brace, but it also is used with AFOs used solely for offloading and for diabetic shoes and inserts that exceed the number of allotted services in a year. These are examples of items that O&P ALMANAC | SEPTEMBER 2015

REIMBURSEMENT PAGE

are not a Medicare benefit but may be payable through a patient’s secondary insurer. Submitting a claim with a GY modifier will trigger a Medicare denial of the claim, releasing it for consideration by the secondary insurer. The CG Modifier. The CG modifier is used to indicate that specific spinal orthosis codes are being used to describe items that are flexible but not elastic in design. Medicare has stated that devices that are constructed solely of elastic materials do not meet the rigidity requirement in the definition of a brace and therefore are noncovered. Several codes that describe flexible spinal orthoses can be used to describe devices that are elastic in nature and devices that are flexible but not made of elastic materials. Because these nonelastic items remain eligible for coverage, providers have been advised to use the CG modifier to identify flexible spinal orthoses that are not made of elastic material. The lumbosacral orthosis/thoracolumbosacral orthosis (LSO/TLSO) policy says that only the following codes would require the use of the CG modifier: L0450, L0454, L0455, L0621, L0625, or L0628. Also, the Pricing, Data Analysis, and Coding (PDAC) contractor and the durable medical equipment Medicare administrative contractors (DME MACs) have stated that a claim for the L3923 also must include the CG modifier to be considered eligible for payment The AW Modifier. The AW modifier reads as follows: “Item furnished in conjunction with a surgical dressing.” While most surgical dressings are statutorily noncovered by Medicare, there is coverage for compression garments that are used in the treatment of open venous stasis ulcers, as stated in the Surgical Dressing Policy. The three codes that are covered in this scenario are A6531, A6532, and A6545. The AW modifier is used with these codes to indicate that they are being provided in conjunction with a surgical dressing, and are eligible for coverage. The GA Modifier. The GA modifier informs Medicare that you expect the code or codes in question to be denied 20

SEPTEMBER 2015 | O&P ALMANAC

as not medically necessary; that you have discussed this possibility with the patient; and that the patient has signed a properly issued advanced beneficiary notice (ABN). The ABN is used to notify the patient prior to provision of service that Medicare will most likely deny the claim as not medically necessary, and the patient agrees to assume financial liability for the codes in question should Medicare deny the claim. Without a GA modifier, Medicare assumes that financial liability remains with you, the provider, if the claim is denied. Remember the GA modifier may only be used when you believe a Medicare-covered item may be denied as not medically necessary and a properly issued ABN is on file. To learn more about ABNs and when the GA modifier is to be used, review the July 2015 Compliance Corner article, “Writing Valid ABNs,” on page 40 of the July 2015 O&P Almanac. The GZ Modifier. The GZ modifier also is used to indicate that you believe Medicare will deny a claim or an item as not medically necessary, just like the GA modifier. However, the GZ modifier should be used when you did not have the patient sign an ABN or if the patient refused to sign the ABN and you still wish to provide the item or service. The GZ modifier will automatically cause your claim or the item to be denied; you will have to appeal to demonstrate medical necessity, but you will not be able to collect from the patient if you are unsuccessful.

Repair/Replacement Modifiers

Two modifiers may be used when you are repairing or replacing an item: the RA and RB modifiers. The RA modifier reads, “Replacement of a DME, orthotic or prosthetic item.” The RB modifier reads, “Replacement of part of a DME, orthotic or prosthetic item, furnished as part of a repair.” The RA and the RB modifiers do not translate easily or directly to the world of O&P and seem to be intended to describe DME-type claims. However, they must be used when you are providing a replacement

item or device to the patient or you are replacing just a component or a feature of an item or device. If you are replacing an entire device, including the base code and/or any addition codes, because the original item was lost, stolen, or damaged, then you would use the RA modifier. For example, when replacing a custom AFO with dorsiflexion assist joints on the patient’s left leg and the replacement is necessary because the patient lost his or her original device, your claim may look something like this: 1 x L1970 KXRALT 2 x L2210 KXRALT Let’s assume the entire AFO does not need to be replaced; instead, only the joints need to be replaced to conduct the repair and make the AFO functional. In this scenario, your claim may look something like this: 2 x L2210 KXRBLT Because you are not replacing the entire AFO, the RB modifier should be attached instead of the RA modifier.

Correct Coding

Reimbursement becomes much easier when claims are coded correctly. Be sure to use the correct two-digit modifier when required for all of the claims you submit to Medicare. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. 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 bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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SEPTEMBER 2015 | O&P ALMANAC

HE JURY IS OUT on how the dura-

ble medical equipment Medicare administrative contractors (DME MACs) will react to the outpouring of opposition to proposed revisions in the Local Coverage Determination (LCD) for Lower-Extremity Prosthetics Policy Article that was published July 16, 2015. AOPA developed an action plan within 48 hours to unleash an unprecedented and comprehensive challenge to these proposals that would take the standard of care for amputees back to the 1970s. AOPA was joined in its opposition by members of the O&P Alliance, the Amputee Coalition, and more than 108,000 individuals who signed the “We the People” White House position statement, which set a record for the number of signatures on a disability issue within a month of posting. Any petition with more than 100,000 signatures is promised a White House response. AOPA’s efforts through AOPAvotes.org generated more than 2,500 patient comment submissions to the DME MACs opposing the LCD, plus nearly 1,400 AOPA member comments. Significantly, even though Congress was on recess, a copy of every comment filed through AOPAvotes went to the senators and representatives of

each comment author. Additionally, AOPA mailed postage-free postcards to all AOPA member locations, which generated another 1,100-plus patient comments to the DME MACs. More than 400 O&P professionals, patients, and supporters convened August 26, when AOPA President Charles H. Dankmeyer Jr., CPO, and former board member and AOPA Past President Tom Watson, CPO, made oral presentations at the open forum convened by the DME MACs near CMS headquarters in Baltimore. The group then traveled by bus to the Department Health and Human Services headquarters, just three blocks from the Capitol building, for a patient demonstration against the proposal that received widespread media coverage. AOPA also organized a media campaign, featuring a powerful 30-second spot on This Week with George Stephanopoulos, and on CNN, Fox, MSNBC, and other outlets during the week of August 24. The ads are available to view on MobilitySaves.org. See the October issue of the O&P Almanac for a further wrap-up explaining how this issue was combated, and a report on the likely outcome. For an update of AOPA’s actions and results, visit bit.ly/amputeerally and bit.ly/lcdaction.

This Just In

Sen. Kerrey Weighs In Former Sen. Bob Kerrey

AOPA’s Objections

AOPA’s 43 pages of comments, which were filed by the August 31 deadline, zeroed in on each egregious section and pointed out the serious harm that would be caused to amputees. AOPA’s formal submission to the DME MACs called for an immediate rescission of the policy proposal to allow sufficient time for productive discussions between the DME MAC medical directors and affected stakeholders, such as Medicare beneficiaries, physician organizations, orthotic and prosthetic organizations, amputee advocacy groups, and other interested parties. Here are a few of the major points covered in AOPA’s comments. AOPA’s main concern was that the draft LCD and Policy Article would severely limit a Medicare beneficiary’s access to high-quality, medically necessary prosthetic care. The draft LCD 26

SEPTEMBER 2015 | O&P ALMANAC

indicates that before a patient may receive a definitive prosthesis, he or she must first be fit with an immediate prosthesis for use while the postamputation surgical incision is healing, followed by a preparatory prosthesis, consisting of only basic components, that will be used during a required rehabilitation program after the surgical incision is healed. According to the draft LCD and Policy Article, the provision of a definitive prosthesis will only be considered for coverage after these two previous steps have taken place. This is not the current standard of care—Medicare would be practicing medicine and writing a totally new, different, and deficient standard of care if the policy espoused in this proposal is finalized, one tantamount to a rationing program. The concept of requiring every amputee to be fit with either an immediate postsurgical

prosthesis and/or preparatory prosthesis, and only then, a definitive prosthesis, represents archaic and antiquated standards of care for amputees. While there may be some amputees who require this full progression of prosthetic care, the draft LCD and Policy Article should not require all amputees to be fit with an immediate postsurgical or preparatory prosthesis before they are eligible to be fit directly with a definitive prosthesis. Amputees are not “one size fits all”; they are individuals who benefit clinically from the provision of a definitive prosthesis as soon as their physician and prosthetist believe they are able to do so. Requiring the progression from an immediate prosthesis, to a preparatory prosthesis, and finally to a definitive prosthesis, will place arbitrary restrictions on the patient’s clinical progress that will result in unnecessary delays in care,

PHOTO:www.wikimedia.org/Stierch

NE OF SEVERAL PROMINENT individuals who share AOPA’s objections concerning the draft LCD and Policy Article is former Sen. Bob Kerrey, who became a below-knee amputee while serving as a U.S. Navy SEAL during the Vietnam War. Kerrey served as governor of Nebraska from 1983 to 1987 and as a U.S. senator from 1989 to 2001. Kerrey voiced his concerns about the LCD in an August 11 letter to the Department of Health and Human Services Secretary Sylvia Mathews Burwell. Kerrey offered a compelling argument, offering a list of specific concerns. For example, he notes that the draft LCD places the burden on prosthetists when it states the patient has to be “motivated to be ambulatory,” and will result in fewer amputees encouraged to push through the early pain and suffering. He also notes that restrictions in coverage of test sockets will lead to additional costs to the Medicare program, as poorly fitting prostheses will have to be adjusted or replaced. In addition, he criticizes the sections of the LCD stating that repairs and adjustments will not be covered in certain instances, and that socket and other component replacements will not be covered in certain circumstances. Kerrey lists several other areas of concern with the LCD, concluding with his recommendation to “rescind this draft LCD and begin a discussion with stakeholder groups to resolve any concerns that CMS may have with the prosthetic benefit.” To read the full letter, visit www.MobilitySaves.org.

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This Just In

additional costs to both the Medicare program and the patient, and the denial of patient access to the most clinically appropriate prosthetic devices for the specific patient’s individual needs. The draft LCD and Policy Article contains a particularly egregious and discriminatory provision that classifies Medicare beneficiaries who use a walker or crutches as K1 functionallevel ambulators and Medicare beneficiaries who use a cane as K2 functional-level ambulators regardless of their ability to use a prosthesis to qualify for higher functional status. It also precludes coverage of a prosthesis for those amputees who cannot achieve “the appearance of a natural gait” while wearing the prosthesis. These statements, offensive to amputee Medicare beneficiaries, do not define any objective criteria for a “natural gait.” An unconventional gait may, in fact, promote independence and future successful rehabilitative outcomes. The statements are not supported by any scientific study that justifies the elimination of prosthetic coverage for amputees who cannot achieve a natural gait while wearing

SEPTEMBER 2015 | O&P ALMANAC

The draft LCD and Policy Article contains a particularly egregious and discriminatory provision that classifies Medicare beneficiaries who use a walker or crutches as K1 functional-level ambulators and Medicare beneficiaries who use a cane as K2 functional-level ambulators regardless of their ability to use a prosthesis to qualify for higher functional status.

the prosthesis and the restriction or limitation of otherwise qualified individuals to lower functional status. By default, this limits Medicare beneficiaries who may require the temporary or full-time use of a walker, crutches, or a cane to ensure their safety and stability to only basic prostheses that are typically provided to household or limited community ambulators. The occasional use of a walker, cane, crutches or even a wheelchair is actually quite common for qualified community ambulators, whether because of a very active day that creates soreness, or routine bathroom access during the night. Occasional use of such assistive devices among those wearing a prosthesis should have no bearing on the functional assessment of the patient and assignment of their functional level. To exclude these patients from eligibility for a K3 prosthesis can only be considered as a discriminatory and a potentially illegal practice. The draft LCD and Policy Article contains provisions that require the patient to be cognitively capable, have

sufficient neuromuscular control, and have sufficient cardiopulmonary capacity to effectively use a prosthesis while ambulating in order to be eligible for a prosthesis, especially those rated for use by amputees who are evaluated as K3 or higher ambulators. While co-morbidities, often very minor or well-controlled, may be considered when determining the style and type of prosthesis that best meets the patient’s clinical and functional needs, they should not create barriers to coverage for patients with unrelated health conditions that may have no bearing on their ability to effectively use a prosthesis. Limiting access to proper prosthetic care for patients with additional health considerations is not in the best interest of providing overall quality health care or advancing independence by Medicare amputees. AOPA understands the importance of rehabilitation as an integral part of a Medicare beneficiary’s ability to use his or her prosthesis in a clinically appropriate and efficient manner. With that understanding in mind, the specific requirements in the draft LCD and Policy Article that the patient must successfully complete a comprehensive rehabilitation program prior to receiving a definitive prosthesis again appear to be arbitrary and not necessarily in the best interest of providing the prosthetic care that best meets the individual medical needs of the patient. For patients, especially those who reside in rural areas, who do not have readily available access to amputeespecific rehabilitation programs, these requirements may prevent them from being eligible to receive any prosthetic intervention. For these patients, the draft LCD and Policy Article leaves them no option other than the use of a wheelchair to perform their activities of daily living. Patients should not be denied the right to walk after an amputation simply because they do not live in an area of the country where rehabilitation programs that meet the arbitrary requirements of the draft LCD and Policy Article are available. AOPA believes that the restriction on the provision of a definitive

This Just In

prosthesis for 90 days following provision of a preparatory prosthesis may not be in the best interest of achieving the best outcome for the patient. The coverage of a definitive prosthesis should be available as soon as the patient is able to effectively ambulate using a definitive prosthesis, and patients should not be made to wait for 90 days in situations where their progress has exceeded the clinical benefit of a preparatory prosthesis. In addition, the draft LCD states that any adjustments, repairs, or component replacements for the first 90 days following delivery of the prosthesis are included as part of the delivery of the prosthesis. AOPA believes that adjustments, repairs, and component replacement necessitated by loss, theft, irreparable damage, or a change in the patientâ&#x20AC;&#x2122;s condition or functional abilities should continue to be eligible for separate reimbursement even when it is required within the first 90 days after delivery of the prosthesis.

Finally, the draft LCD and Policy Article indicates that Medicare coverage is limited to one socket code and descriptor per individual prosthesis. This limitation does not allow for the use of specific socket design features that may be necessary to meet the patientâ&#x20AC;&#x2122;s clinical needs. The Healthcare Common Procedure Coding System includes several codes that do not describe complete sockets, but describe specific socket design features (e.g., ischial containment, total contact, etc.). Failure to provide coverage for these medically necessary design features will force amputees to receive basic prosthetic sockets that do not provide the intimate fit and design necessary to maintain a proper interface between the prosthetic socket and residual limb and may result in injury to the patient.

O&P ALMANAC | SEPTEMBER 2015

COVER STORY

HighTOUCH

for High-Impact

O&P

Determining patientsâ&#x20AC;&#x2122; pre- and postamputation activity levels and goals is vital to creating an effective treatment plan By CHRISTINE UMBRELL

SEPTEMBER 2015 | O&P ALMANAC

COVER STORY

NEED TO

KNOW Practitioners must adapt treatment strategies for patients who want to participate in sports or other physical activities. These patients require increased communication to determine specific activity goals, clearly defined benchmarks, and customized componentry with adaptive equipment.

Identifying the optimal high-activity prosthesis may require trial-and-error and a great deal of patience. Some clinicians recommend participating in patients’ activities to better understand the movements involved and more easily determine componentry needs.

Achieving optimum fit for athletic patients entails designing a properly fitting socket, building a strong device that can withstand high-impact activities, and striving for “spot-on” alignment.

OR MOST O&P PATIENTS, a pros-

thetist’s primary goal is to restore function, so those patients can return to their activities of daily living. But some amputees enter an O&P facility with much more ambitious goals—such as participating in a sport or other physical activity. Establishing a patient treatment plan for achieving an activity goal requires a great deal of listening. Understanding what the patient was capable of preamputation, why the amputation occurred, and what the patient hopes to accomplish is key to determining how to proceed. Elliot Weintrob, CPO, emphasizes the importance of giving patients a chance to explain, in detail, their goals with their prosthesis. “You have to take some time and listen to what they’re currently doing, and what they’re trying to achieve,” says Weintrob, who is president of Orthotic Prosthetic Center in Fairfax, Virginia. An open and honest discussion is required to determine whether a patient’s goal is realistic.

Paralympian Jeremy Campbell

Once a patient’s goal is spelled out, practitioners can outline benchmarks to more clearly define the pathway to physical achievement. Practitioners work in tandem with physical therapists and recreational therapists to fit patients with appropriate componentry as their function improves and they progress toward their goal.

In the Trenches

Some clinicians believe it’s beneficial to participate in activities with their patients to get insight into their componentry needs. In fact, part of what originally drew Weintrob to work at his family’s O&P facility—which was founded by his mother 35 years ago— was the opportunity to incorporate sports into O&P treatment. O&P ALMANAC | SEPTEMBER 2015

PHOTOS: Hanger Clinic

Many athletic patients are more in tune with their bodies than average patients and become more educated about their devices. These patients may offer increased feedback to practitioners and require more specific adjustments.

COVER STORY

Skiers

TIPS

for Working With High-Activity Patients Richard Nguyen, CPO, and Alex Hetherington, CP, practitioners at the University of California—San Francisco’s Orthopedic Institute O&P Center, have a number of athletic patients and offer the following words of wisdom for working with this patient population: • Understand the mechanics of the sport/activity involved, and know the required range of motion and potential socket pressures. • Aim for more aggressive contours to gain skeletal control—sometimes at the sacrifice of comfort. • Try to provide optimal performance for the duration of activity—whether it’s 30 seconds for sprinting, four hours for cycling, etc. • Plan for longer or more frequent unscheduled appointments for finetuning of devices and replacement of broken components. • Expect increased patient input because athletes are generally more in tune with their bodies and devices, leading to more specific adjustments.

• Consider applying protective covers to reduce wear and breakage.

SEPTEMBER 2015 | O&P ALMANAC

“Prior to coming into the practice, I was involved in white-water kayaking and was part of the 1992 Olympic team,” says Weintrob. “I always wanted some element of sports in my professional life.” Because he is located in the Washington, D.C., area—a “well-employed and therefore well-insured patient base”—he has been able to market his facility to some very athletic O&P patients. His passion for sports gives him an edge in working with activity-minded patients. “Once I started practicing, I got into bike racing and triathlons, so I was able to better assess what my patients are looking for in a running foot, a skiing foot, or other specialized component,” he explains. “I also do a lot of cycling, so I understand how a bike is supposed to fit.” Weintrob’s facility is equipped to evaluate active patients. For example, for those patients who want to cycle, “we tell them to bring in their bikes, then we set them up on a stationary trainer and have them ride for 20 to 30 minutes,” he says. “We look at the foot, the socket, and the fit. If they’re not happy on a stationary bike, then they’re really not going to be happy riding outside.” Practitioners don’t have to be high-level competitors to try their patients’ activities. Chad Simpson, BOCP, LP, says he frequently accompanies patients when they run, cycle, kayak, and rock climb—often joining the activity. Simpson, who is clinic manager for Hanger’s Oklahoma City patient-care clinic, says these outings help him “better understand the nuances that go along with a

Kayaker Cameron Clapp

particular activity and help me see the potential positives and negatives of certain devices.”

Beyond a Running Leg

It’s important for patients to be very specific about their goals because every sport is different—and that affects component selection. “Running” is too broad of a goal, says Simpson, because “sprinting versus long-distance running requires different feet. And a marathon runner versus a triathlete will need two totally different sets of equipment.” Regardless of the activity, practitioners need to ask how often the patient hopes to participate in the activity (monthly, weekly, or daily) as well as if there is a particular event that patient wants to take part in. Setting small goals can be a great way to help a patient achieve what may seem unattainable. “Sometimes a patient doesn’t know they’ll be able to achieve so much,” says Simpson. Fine-tuning a prosthesis for recreation requires a familiarity with both the patient and the activity. “Patients who wear an ischial socket who want to ride bikes will need to make an alteration to their socket to ensure comfort. That socket will need to be modified and then will only be used for cycling once it is modified and will not be able to be used for walking after those modifications,” says Simpson.

PHOTOS: Hanger Clinic

• When selecting devices, be aware that standard components serve as a good starting point, but be open to customizing them, or making a unique adapter. Besides running feet, many components aren’t available prefabricated.

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COVER STORY

Chris Kort, CPO, designed a prosthesis for national amputee champion golfer Kenny Bontz. Rock climber Seth Alexander

Simpson recalls a bilateral aboveknee amputee who wanted to climb mountains. Simpson fit the patient with special prostheses, and the patient was able to climb. Once that goal was accomplished, the patient decided he wanted to try ice climbing. So Simpson fit him with stubby feet that could be worn with crampons to dig into icy hills. Working incrementally allowed Simpson—and the patient—to progress according to his capabilities and prosthetic needs.

Perfect Fit

SEPTEMBER 2015 | O&P ALMANAC

Expectation Management

Some practitioners find that athletic patients work harder to understand their prostheses, and try to learn how adjustments will impact their movements. Working closely with such patients can help practitioners establish optimal fit and function. “Patients at the highest levels are so in tune with both their body and their prosthesis that they are tweaking their devices to achieve the maximum performance,” says Weintrob. Kort offers the example of a successful golfing patient for whom he designed a microprocessor knee and a high-tech shock/torsion-reducing pylon and foot. When the patient is out golfing, he “adjusts his own torsion,” says Kort. “He knows when he wants to hit the ball a certain way, he can adjust his prosthesis to get more torsion to help his swing.” But clinicians caution that no prosthesis is going to do the hard work required to become an athlete. “You have to look at the prosthesis as a tool that can be manipulated to assist you in your goals. You can’t shave time just by adjusting a device. You have to drive yourself forward with a training regimen and perseverance to achieve your goals,” says Simpson.

PHOTOS: Left–Hanger Clinic; Right–Prosthetics in Motion

Chris Kort, CPO, has treated hundreds of patients he categorizes as “high activity” at his mid-Manhattan facility, Prosthetics in Motion. He sees mainly trauma, congenital, and cancer amputees, with a younger-than-average patient base that is highly motivated to get back to work and re-engage in activities. Kort believes in a one-step-at-a-time approach with more active patients. “You have to start with their everyday prosthesis,” says Kort. “After they succeed with that, if there is an activity they want to try, then you can discuss the options,” he says.

For athletic patients, Kort’s first priority is designing a properly fitting socket. He fits all of his transfemoral patients using ischial containment sockets. The goal is to contain the ischial tuberoscity medially for maximal pelvic stability. For his transtibial patients, he has found vacuum systems to be extremely effective for running legs and other high-activity prostheses; he believes vacuum suspension provides helpful physiological benefits. Kort admits that, for the first couple of weeks trying vacuum suspension, many patients say their range of motion is limited—but “once they get used to it and the materials break in, range of motion is no longer an issue. They start to feel like it’s the closest thing to having a natural leg,” he says. Also important is the structural design of the socket and frame, which he tries to make “super-light and super-strong for high-impact activities. Structural integrity has to be maintained under high loads of force,” he says. Finally, he addresses alignment: It “has to be spot on, to get the maximum performance out of the components, and for the foot to achieve maximum energy return,” says Kort.

COVER STORY

“The high-end running feet are certainly helpful, but it comes down to the individuals themselves, and what they put into the activity,” says Weintrob. He offers the example of a new amputee who came in seeking to play basketball with a prosthesis. However, that individual had not played basketball for 15 years before his amputation. “There’s no magical foot that’s going to make him play basketball,” says Weintrob. “So I needed to help him manage his lifestyle. I helped him identify the stepping stones he would need to get where he wanted to be”—easier goals, such as becoming comfortable with his prosthesis, learning to jog or run, and handling a basketball.

“You have to look at what insurance will cover,” unless a patient is willing to pay out-of-pocket, says Weintrob.

‘Cool’ Factor

Many practitioners enjoy the challenge of helping active patients achieve their customized goals. Because a significant proportion of O&P patients tend to be geriatric, it can be a nice change to work with younger individuals who want to push the boundaries. Simpson recalls one instance when he altered prosthetic equipment to enable a patient to snowboard, which

led to a moment of empowerment. To prep the patient for a ski trip, Simpson designed customized feet and pylons. The patient returned from the trip “exhilarated from being able to move at such high speeds,” says Simpson. Kort recalls a male above-knee patient who wanted to take part in water and snow activities; he designed a special above-knee prosthesis that incorporates knee and foot componentry that replaces the function of the quadriceps. This patient has been highly successful in high-impact sports that involve a “crouched” position,

Componentry Challenges

PHOTO:Top-Prosthetics in Motion; Lower right-Hanger Clinic

Choosing the most appropriate components for active patients is important—and requires trial-and-error, as well as patience. “Every residual limb is unique,” says Simpson. “Often you think a component will work really well—but it ends up not being the optimum device.” Simpson uses videography to record patients using trial devices. “I’ll take videos, then bring them back to the office to help determine which device will provide the best option.” Weintrob says it’s important to look at the individual, plus the activity and the environment, to determine how functional and durable a device needs to be. A prosthesis for a surfer, for example, will need to allow for a great deal of ankle movement. In general, components for highly active patients need to be able to “withstand great stresses,” says Weintrob. It may even be helpful to consult with manufacturers: “They can help you take devices that are already out there and make them specific to the individuals.” Of course, reimbursement also is a consideration for patients who hope to have their devices covered by insurance.

Bilateral golfer

O&P ALMANAC | SEPTEMBER 2015

COVER STORY

Breaking Into the Pro Sports Market:

An Orthotist’s Success Story J

OHN HELD, CO, KNOWS many Minnesota sports stars on a first-name basis—but he won’t reveal most of those names. He has treated players from many of Minnesota’s professional teams (e.g., the Vikings, Wild, Timberwolves, and Lynx), as well as college-level athletes from the University of Minnesota, St. Cloud State, and St. Johns University. Held, who is president of Great Steps Orthotics and Prosthetics, knows how to keep a secret. For all orthotists, privacy rules prevent the sharing of patient information. But for those who work with high-profile athletes, there’s even more at stake. “You have to be able to keep your mouth shut—at least until a player retires. Pro sports teams are very vague on their injury reports, and you can’t be the leak. Then your credibility would be gone,” says Held. Held is well-known in the central Minnesota area for his ability to alleviate athletes’ injuries using a custom bracing approach with an emphasis on efficiency and durability. He most frequently fits foot orthoses, but he also provides custom ankle braces, special supports for acromioclavicular shoulder separations, and thumb splints for his most athletic patients. Held began working with local athletes about 15 years ago. He took the first step in onboarding professional sports players as patients by cold-calling the Vikings’ athletic trainer and telling him about a unique ankle brace he had helped develop that he believed would be useful to injured football players. Held was pleasantly surprised when the trainer expressed interest, and

SEPTEMBER 2015 | O&P ALMANAC

he began treating several of the team’s players as injuries occurred. Soon Held began treating athletes from other teams: “The Vikings’ orthopedic surgeon had connections with trainers on all of the local teams,” says Held, which led to a growing patient base. “These teams are all looking for an edge—anything that might help their team,” says Held. “So they really are open to talking to an orthotist about design solutions and improved bracing ideas.” Held has helped several professional athletes return to the playing field faster with braces than they would otherwise. For example, soon after he connected with the Vikings, Held fit wide receiver Cris Carter with an orthosis for a high ankle sprain—thus helping Carter continue his record of consecutive games played. “Fortunately, the sprain occurred right before a bye week, so he didn’t miss a game—he was able to play in the next game two weeks later with the brace I provided.” Around the same time, Held custom fit an ankle brace for quarterback Daunte Culpepper. “That was a challenge because he’s a big guy, and the brace had to withstand the stress. There’s a picture somewhere of Daunte wearing that brace with two big guys on top of him—and the brace held up.” Though Held no longer works with the Vikings due to a wholesale medical staff change, he continues to see dozens of athletes from other area teams on a regular basis. Most rewarding of all is when the players he treats in Minnesota are traded to other teams across the country—but continue to contact him when they need orthotic advice.

Held offers a number of tips to O&P practitioners who seek to add professional and college athletes to their patient rosters: • Connect with athletic trainers. “Know who to approach,” says Held. “With my sports clients, the most important relationship I have is with the trainers and the medical staff of the team.” Most communication goes through the trainers, including the medical files Held reviews before appointments. • Show athletes you value their time. Held usually sees patients at their athletic facilities and preps beforehand to ensure quick appointments. • Be prepared with quick solutions. “With pro athletes, there is no ‘next week’—it’s ‘tomorrow,’” says Held. “You have to be able to open your schedule up to see these patients quickly.” Great Steps O&P keeps fabrication in-house and can turn around orthoses in a day, or even a few hours, when necessary. • Think “durable” but not “restrictive.” Braces will undergo huge amounts of stress when worn by pro athletes. “Especially with football players, you have to be able to make something that will hold up in a game,” Held says. Be aware that athletes will agree to wear braces that allow them to play at

COVER STORY

• Try to get it right the first time. Though it’s important to work quickly, remember that the less modifying you have to do, the better. • Know your sports. Not only do you need to be a good orthotist— you also need to understand the nuances of each athlete’s position. “The mobility of a quarterback is much different than the mobility of a defensive back,” so bracing will be dictated by each individual’s needs on the field.

PHOTO: Prosthetics in Motion

or above their current level of play, but may refuse to wear restrictive devices. “They’ll do whatever it takes to recover—unless it’s going to slow them down.”

Chris Kort, CPO, designed a special prosthesis to allow his patient to wakeboard.

including snowboarding, snowmobiling, wakeboarding, and jet skiing. Weintrob speaks of a patient who has aspirations to compete in the triathlon event in the Paralympics, so he customized a special device for the bike portion. “We made his cycling leg aerodynamic—we made his leg a foil,” he says. He also recalls a patient who wanted to ride a motorcycle outside in winter, but his residual limb kept getting too cold. To solve the problem, Weintrob created a heated socket that plugged into his

motorcycle to heat his limb while riding. “That was a truly unique solution,” he says. Ultimately, many practitioners look forward to those days when they can help patients with unique requests. “That’s what’s really fun,” says Weintrob, “when you can take all of this technology and fine-tune it to help an individual.” Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.

• Prove your worth. Demonstrate that orthotic treatment can help return patients to work. “It’s our job to design orthoses that help athletes accomplish what they want to accomplish,” says Held.

PHOTOS: Elliot Weintrob/Orthotic Prosthetic Center

• Avoid dropped balls. Don’t overpromise, but do over-achieve, says Held. “Do what you say you’re going to do, and do it quickly.” • Don’t treat and tell. “You can say you work with a sports team, but you can’t talk about any particular player,” says Held. • Never ask for autographs. “We’re going in there as professionals, not as fans,” says Held. “Staff are very, very protective of these guys.”

Elliot Weintrob, CPO, fit a cycling patient with a transtibial aerodynamic cycling prosthesis.

O&P ALMANAC | SEPTEMBER 2015

LEADERSHIP SERIES

A Place in the

CONSOLIDATION Continuum?

Experts weigh in on the future of independent O&P facilities amid evolving economics

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of consolidation and vertical integration.

Meet Our Contributors

Pam Filippis Lupo, CO/LO, is a member of the board of directors at Wright & Filippis and at Carolina O&P. She also is a surveyor for the facility accreditation program of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, and an industry consultant.

SEPTEMBER 2015 | O&P ALMANAC

S O&P PROFESSIONALS GRAPPLE with reimbursement challenges and dwin-

dling profit margins, it’s impossible to ignore the industry consolidation trends taking place within the greater health-care arena. The number of “independent” health-care providers across medical specialties is falling. In fact, the number of U.S. physicians in independent practice has dropped significantly, from 57 percent in 2000 down to 37 percent in 2013, with a predicted decline to 33 percent by the end of 2016, according to data published by Accenture. The same report finds that those independent physicians who have sold their practices or sought employment directly with health systems have done so largely due to disruptive market conditions, such as reimbursement pressures. Some of the independent physicians who have kept their practices are coping by experimenting with other models to remain competitive—for example, 17 percent of U.S. independent physicians are participating in accountable care organizations (ACOs). Today’s O&P practitioners are facing similar reimbursement challenges and increasing costs. Several independent O&P facilities have recently consolidated with larger O&P practices, or have aligned themselves with suppliers or distributors on the O&P production pathway. What do these consolidation and vertical integration trends mean for today’s typical O&P provider and the outlook for the O&P profession? O&P Almanac recently spoke with three O&P experts, who shared their insights on the current business climate and the pros and cons of industry consolidation.

Mike Sotak is president and chief executive officer of PEL in Cleveland, Ohio. Sotak acquired PEL two years ago, after a diverse business career managing distribution and manufacturing businesses in pharmaceuticals, wound care, durable medical equipment, and related health fields.

Rick Riley is chief executive officer of Townsend Design in Bakersfield, California, a company with more than 150 employees. He worked in hospital administration before joining Townsend in 1995 as vice president of marketing, then took on duties as the company’s vice president of sales and marketing in 1997. He assumed the role of CEO in 2003.

LEADERSHIP SERIES

O&P ALMANAC: What is the

difference between consolidation and vertical integration? PAM FILIPPIS LUPO, CO/LO:

Consolidation is a merger or acquisition of smaller companies into a larger company. Vertical integration is when the supply chain or manufacturer owns the company to which it supplies products. MIKE SOTAK: Consolidation is gener-

ally driven by the need or objective to realize economies of scale; it’s fewer companies getting bigger to leverage costs and gain efficiencies. With vertical integration, the goal is usually different—diversification, to spread risk, or to gain control upstream or downstream across the continuum of care. Examples of vertical integration include aligning with referral sources and partnering with physical therapists or other service providers, such as ACOs. Many O&P facilities right now are vertically integrated with c-fabs, which are technically custom manufacturing operations. O&P ALMANAC: What types of

consolidation and/or vertical integration are occurring in O&P right now?

LUPO: There are a number of differ-

ent ways O&P facilities are consolidating and being integrated into larger companies. For example, O&P companies are buying other O&P companies. Several O&P companies have made acquisitions, including Hanger, Wright & Filippis, Level Four O&P, and New England Orthotics and Prosthetics. Some O&P companies are combining with physical therapy. Some hospitals are buying O&P and durable medical equipment (DME) facilities. Some physician groups are acquiring prosthetists. On the manufacturing side, some manufacturers are working together,

or are working together with O&P as a provider, potentially under competitive bidding. There are numerous configurations. SOTAK: We’re seeing some consolida-

tion on the patient-care side. Some larger regional players are looking to acquire other practices—facilities that are looking to get bigger for efficiencies of scale. For example, many organizations are feeling a need to hire compliance officers—but how can you afford to hire someone on staff as a compliance officer if you’re a two-person staff? So they’re looking to consolidate to justify hiring professionals necessary to consistently meet regulatory requirements. We’re also seeing consolidation at the manufacturer level, and I think we will see a lot more as manufacturers face new challenges in meeting expected financial performance. RICK RILEY: There is an emerging

model, especially in larger markets, where hospitals, physician clinics, and ancillary services—including

O&P—are vertically integrated to create increased synergy and efficiency. In some cases, a local O&P facility is purchased by a large medical provider, and in other cases the network is hiring in-house orthotists and prosthetists. Among suppliers and manufacturers, there is also increasing consolidation. The companies that have the financial capital to make acquisitions can amass a vast range of products. This creates a strategic advantage in terms of offering one-stop-shopping to group purchasing organizations and integrated provider networks. O&P ALMANAC: What types of opportunities do these mergers present for the O&P profession and its patients? LUPO: Mergers and acquisitions can

lead to decreased costs due to the consolidation of redundancies. They may also allow O&P companies to expand into different scopes of practice—for example, foot care or DME. O&P ALMANAC | SEPTEMBER 2015

LEADERSHIP SERIES

In addition, consolidation may allow O&P to better integrate into health-care delivery services. Two separate companies that merge into one may have more opportunities to partner with hospitals; they may have access to each other’s contracts and may have access to new payors. These mergers also provide opportunities for O&P facilities to work with companies that provide administrative support, such as human resources or payroll functions. SOTAK: Consolidation over the long term will result in stronger players. Those who are successful will have better and more sustainable businesses. For patients, consolidation will eventually bring more consistent patient care and also better outcomes for patients in general. Only the best practices delivering the appropriate care will ultimately succeed. RILEY: O&P professionals who choose to work within an integrated delivery system will likely get more cooperation from physicians in getting the documentation needed for insurance authorizations and Medicare billings because the network administrators expect the various providers to work together to reduce costs and optimize reimbursements. Patients in this type of network could have fewer choices for where they can go for O&P services and other ancillary services. But better collaboration between medical providers within a delivery network could potentially enhance the continuity of care for patients who require orthotics and prosthetics.

O&P ALMANAC: What types of threats, or disadvantages, do these mergers present for practitioners and patients? LUPO: When participating in a con-

solidation, you may have to consider how it will impact job opportunities for clinicians. There may also be decreased points of access. 40

SEPTEMBER 2015 | O&P ALMANAC

SOTAK: Obviously, the smaller inde-

pendents will be more challenged to remain competitive. They must become excellent at patient-care operations or they may be forced to consolidate—to become a buyer or a seller. Many O&P facilities risk going the way of the neighborhood hardware store. The single independent familyowned hardware store used to be a mainstay, but now it has become rare. Consolidation, driven by economics, may threaten the independence of small practices if steps are not taken to meet the changing business requirements. RILEY: In any market where a moder-

ate or substantial percentage of O&P patient care is controlled by integrated networks, it could become increasingly difficult for standalone O&P facilities to remain relevant. What happens when doctors who historically have referred patients to a local O&P get acquired by a health system that has its own in-house O&P department? How many O&P facilities could lose 25 to 50 percent of their patient base and still stay in business? This potential disruption in traditional referrals can happen virtually overnight when a large physician group gets acquired. These networks also create potential threats for smaller manufacturers that don’t have the complete

range of products offered by larger manufacturers. These big suppliers also routinely employ specialized contracting personnel and in-house legal experts to negotiate agreements with GPOs (group purchasing organizations) and vertically integrated health-care networks. O&P ALMANAC: What should O&P business managers be doing right now to ensure the future survival of their businesses in this climate? LUPO: I would recommend that O&P

business managers look at supplier consolidation and optimize acquisition pricing. We really have to look at costsaving measures to ensure the viability of existing O&P facilities. With regard to pricing, be mindful that acquisition cost is not always the total value of a product. Factor in shipping, payment terms, educational programs for staff, and the other costs involved. Outsourcing continues to be a trend to reduce costs—for example, outsourcing of payroll and human resources. Also, take a closer look at reimbursement by payor for HCPCS code, and identify which products or components you can afford to provide—and modify your business accordingly.

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LEADERSHIP SERIES

SOTAK: I expect that we will experi-

SOTAK: Number one, O&P facilities really should be working on aligning with referral bases and payors, and strengthening those relationships. We also need to focus on operational efficiencies and best practices. That can be hard for O&P professionals who like to focus on patient care and sometimes acquisition costs, but operational excellence is a critical factor for success. Looking at how patients are being scheduled, who is taking care of documentation, and how human resources are utilized can pay big dividends. O&P can’t be an island in the medical arena. We need to focus on integrating with the medical community through data compatibility and providing outcomes evidence. O&P will be expected to demonstrate how we deliver clinical and economic outcomes. O&P will be working with hospital groups and ACOs to treat patients. If one check goes to the hospital, then the hospital gets to decide who is on their team and how much they get. In the past, the focus has been too narrow. As an O&P profession, we will benefit from greater awareness of what is going on across the continuum of care. O&P will become more integrated into medical care. It’s important for O&P to become widely recognized as part of the total care solution.

changes that could occur. They need to have relationships with hospital and physician clinic executives, and potentially make it known they are willing to consider becoming the O&P component for organizations that are creating integrated delivery networks. If an O&P provider is very dependent on one or two large doctor groups, there could be substantial vulnerability if these key referral sources become part of an integrated network that has its own O&P services. O&P owners and managers can try to maintain a diverse referral base, but, ultimately, some O&Ps will not survive if they aren’t part of a large integrated network that is managing all elements of care for patients who are enrolled in the major health plans that are contracted with the network. In the future, being part of a network could help an O&P provider maintain a reliable population of O&P patients, gain access to financial capital, and receive management and billing assistance from the network’s internal experts.

RILEY: The owners and managers of single-site or multisite O&P businesses need to understand the evolving dynamics in their local or regional market, and they need to try to anticipate

LUPO: I do believe there will continue

SEPTEMBER 2015 | O&P ALMANAC

O&P ALMANAC: What do you see happening in terms of consolidation and vertical integration in O&P 10 years from now?

to be consolidation. It’s a necessary response to the current reimbursement climate. As for more vertical integration—that remains to be seen.

ence significant consolidation at the manufacturer level. Economics will drive the rate of consolidation as barriers to entry tighten up and global markets continue to evolve. We also may see one or two global manufacturers enter into patient care—that’s already happening to some extent in Europe. Ultimately, O&P practices will likely get bigger or partner with other entities, and there will be fewer companies. Larger regional practices may remain independent, but they will have alliances with other stakeholders. We are highly fragmented compared to other health-care specialties, so consolidation may happen quickly if O&P practitioners are not properly recognized by CMS and other payors for the professional patient care they provide. Practitioners really need to take a hard look at their business model, and decide if they want to be a buyer or a seller. Professionally managed O&P patient-care organizations will thrive in any environment. A healthy business will be well positioned to deliver great patient care. RILEY: It is impossible to predict the future, but there is a high degree of certainty that cost containment will continue to be a defining factor for all facets of medical care, including O&P services. Medicare provides healthcare coverage to 56 million Americans who are 65 and older or disabled. Medicare is heading toward unsustainable levels as the baby boomer generation becomes eligible. Networks that are successful in controlling costs, while at the same time accumulating data that documents positive outcomes, will be able to attract more customers to their integrated delivery system. Consumers need affordable health care, and the government and private insurers will be drawn to the integrated systems that are able to reduce costs without compromising quality.

Meet several exhibitors that will display innovative products and services in San Antonio

SEPTEMBER 2015 | O&P ALMANAC

S THE AOPA NATIONAL Assembly approaches, some of the world’s leading O&P manufacturers are gearing up to show off their latest advances. New technologies, new ideas—the Assembly trade show floor promises to deliver an exciting mix of thought leadership from some of the industry’s biggest names. Several of the most prominent O&P players have demonstrated their commitment to AOPA, and the O&P industry in general, by signing on as title sponsors for this year’s seminal event. Here, these dedicated companies share their plans for the exhibit floor and offer glimpses into their company histories and philosophies.

O&P ALMANAC | SEPTEMBER 2015

SNEAK PEEK

Allard USA

A fully owned subsidiary of Sweden’s Camp Scandinavia AB, Allard USA considers itself a “partner” for O&P, offering educational programs, training, and marketing support to help O&P facilities increase their referrals. The corporation invests in continuous research and development for new products and is dedicated to supporting its caring management and employees. Sometimes the patients tell the story best. “I was hit by a car when I was 11 years old,” writes one Allard patient. Doctors said running would be out of the question. Since Allard came along, “I have run a marathon, four half marathons, and two Olympic distance triathlons, plus some sprint distance triathlons.”

ALPS

ALPS’s mission is succinct: “Making Lives Better.” That’s just what the company has strived to do since 1988, as a leading manufacturer of prosthetic and orthotic medical devices. The company has developed special expertise in the development of advanced gel-based products.

SEPTEMBER 2015 | O&P ALMANAC

ALPS originally focused on the development of innovative silicone products before expanding into the manufacturing of prosthetic devices in 1993. In recent years, its operations have expanded into six locations worldwide with four divisions: prosthetics, orthotics, silicone, and patient care. The company now holds more than 50 patents across several product categories, boasting a brand image that “makes employees, customers, and vendors proud to be associated with ALPS.”

American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc.

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc. (ABC), one of the industry’s credentialing boards, takes special pride in being part of this year’s AOPA gathering. “Our participation in the AOPA National Assembly allows us to engage with potential certification candidates, residents, and those already in the profession,” says Catherine A. Carter, ABC executive director. “This engagement keeps us connected to the profession and helps us understand the challenges and successes of our constituents.” ABC represents the interests of more than 14,000 certified individuals and over 6,000 accredited facilities. Its certification programs are accredited by the Institute for Credentialing

Excellence. ABC is recognized as a deemed authority for facility accreditation by CMS, the Department of Veterans Affairs, major health-care insurance providers, and health maintenance organizations throughout the United States.

Cailor Fleming Insurance

The professionals from Cailor Fleming Insurance will have a lot to share with O&P professionals at the upcoming Assembly. “The newest product in insurance is cyber liability, which is something every business is becoming more concerned about,” says principal Don Foley. “And with health in particular, there is privacy liability, which is becoming more and more important now that Medicare is enforcing the Health Insurance Portability and Accountability Act guidelines.” Founded in 1918, Cailor Fleming is an independent insurance agency offering advice on matters of loss prevention and loss control, along with insurance coverage. The company offers 24-hour emergency claim service, with claims often settled the same day they are made.

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Fillauer

Endolite North America

Endolite executives are firing on all six cylinders as they rev up for the coming Assembly. “As a leading manufacturer of prosthetic components, it is essential not only to showcase our new and existing products, but also to provide support and education opportunities to our profession,” says Christopher J. Nolan, vice president and general manager, Endolite North America. “The annual AOPA National Assembly meeting offers O&P professionals some of the finest education and one of the best networking opportunities, all in one location. The atmosphere at AOPA’s National Assembly is always positive and never fails to remind us why we are a part of this profession: to serve our patients,” he says. Endolite is a part of Blatchford Inc., which has been making artificial limbs and prosthetic components since 1890. The company plans a number of special events for the Assembly, including a showing of Linx, a fully integrated microprocessor-controlled lower-limb system. 48

SEPTEMBER 2015 | O&P ALMANAC

A leading name in O&P, Fillauer designs, manufactures, and customizes quality products to serve its local and international community. Its offerings are extensive, comprising some 3,200 orthotic and prosthetic products with a wide range of products, from pediatric to adult components. With more than a dozen styles available, Fillauer is best known for its prosthetic suspension lock systems. The company has a rich history. Founded as the Red Star Pharmacy in 1914 by George Fillauer Sr., the company moved into orthopedics in 1934 under the leadership of Carlton Fillauer. Today its many subsidiaries include Hosmer, Center for Orthotics Design, Motion Control, Centri, Fillauer North Carolina, Fillauer Composites, and Fillauer Orthotic and Prosthetics Patient Care. The company has grown to become a globally renowned leader in the development, manufacturing, distribution, and application of orthotic and prosthetic products.

Össur Americas

Össur Americas describes itself as “continuously pushing the boundaries to create some of the most effective, noninvasive mobility solutions on the market today.” Working by the motto

“Life Without Limitations,” its focus on prosthetic, osteoarthritis, and injury solutions has made it a leader in the field. The company has been an integral part of the O&P landscape, serving an extensive range of medical professionals, and working closely with leading research and educational bodies. It prides itself on “a powerful service ethic, listening and responding to the diverse needs of our customers across the continent.” Össur Americas has a truly global reach, with sales offices in Foothill Ranch, California; Vancouver, Canada; and Porto Alegre, Brazil, along with manufacturing and distribution facilities based in Michigan, New Jersey, and Tijuana, Mexico. Its parent company has its headquarters in Iceland and maintains a global presence, with operational centers in Europe, Asia, and beyond.

Ottobock

A leading light in the prosthetics field, Ottobock has been restoring and improving independence for people with mobility challenges for more than 90 years. This coming year promises to bring big things: Ottobock plans to launch more than 30 new products in 2016. The firm recently launched the C-Leg 4, and 2015 versions of the Genium and X3. The Kenevo is a new concept entirely, bringing K2 patients the stability benefits and intuitive function found exclusively in microprocessor-controlled knees.

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AOPA 2015 National Assemby Title Sponsors

“We look forward to the excitement of the largest O&P gathering in the United States,” says Matt Swiggum, Ottobock’s regional executive vice president of sales and marketing. “Ottobock has an especially powerful presence in 2015, with dozens of new products and services available to benefit our business partners.”

AOPA thanks the following companies for their generous support and sponsorship of the 2015 AOPA National Assembly. Diamond Sponsors

Gold Sponsors

www.bocusa.org

Spinal Technology Inc. Platinum Sponsors

Founded in 1991, Spinal Technology remains an O&P innovator. At this year’s Assembly, the company plans to announce its SpinaLoc X series of spinal orthoses. “This is a prefabricated brace sold only to O&P professionals and designed to be adjusted utilizing their expertise,” says Bob Burns, creative director, brand marketing.

Silver Sponsors

EXPERIENCE THE VALUE

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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Member Benefits

Membership has its benefits:

AOPA’s Mission Is To Serve YOU! The mission of the American Orthotic and Prosthetic Association is to work for favorable treatment of O&P businesses in laws, regulations and the media; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association. AOPA membership is one of the best investments you can make to assure the future of your O&P business. Just ask the world class providers whose membership makes AOPA possible and the world of O&P and better place for you and your patients.

SEPTEMBER 2015 | O&P ALMANAC

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join www.AOPAnet.org

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Founded in 1991 by Jim Tierney, the company aims to cultivate a partnership with the practitioner, putting in play the most advanced research and development available. The company has evolved over time—forming its lower-limb technology business in 2006, for example—and continues to innovate as new technologies emerge. Today the company focuses on highly effective spinal orthoses that contribute to positive outcomes and quality of life.

to San Antonio. “At the 2015 AOPA National Assembly, WillowWood will be featuring our new transfemoral vacuum solution, the WillowWood One System,” says Brian E. Stroup, marketing/education coordinator. “We value the opportunity the Assembly presents to show how we’ve utilized new technology to aid amputees and to educate clinicians through workshops, research presentations, and a symposium.”

These new technologies follow as a natural outgrowth of a company that has stayed as strong is its traditions. Today, the third and fourth generations of the founding family are active in daily operations. Despite changes that have swept through the business, “WillowWood stands by its promise to free the bodies and the spirits of amputees every day,” the company has said.

Affordable Orthotic Therapy www.bocusa.org

The Board of Certification/ Accreditation

Leaders at the Board of Certification/ Accreditation (BOC) say they are looking forward to the upcoming Assembly as a chance to express their ongoing support for their partners across the industry. “We always enjoy meeting and interacting with our credential holders and learning about new trends in the O&P world. The National Assembly offers us the perfect opportunity to accomplish all that, and more,” says Claudia Zacharias, MBA, CAE, president and chief executive officer of BOC. Founded in 1984, BOC is an independent, not-for-profit agency offering credentials for professionals and suppliers of comprehensive orthotic and prosthetic care and durable medical equipment services. Its certification programs and facility accreditation are an authoritative recognition of professional excellence.

WillowWood

The Ohio Willow Wood Company has served the O&P community for more than 100 years. With that substantial pedigree to back its efforts, the company plans to bring new technology

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O&P ALMANAC | SEPTEMBER 2015

EXHIBITOR

DIRECTORY 2015 On the following pages is an advance look at the companies that will be exhibiting at the 2015 AOPA National Assembly. You’ll find website information and booth numbers for each exhibitor—use this guide and floor plan to organize your visit to the Exhibit Hall. Better yet, check out their websites now and plan ahead! Poster Boards

Poster Boards

Bold listings indicate the exhibitor is a member with the American Orthotic & Prosthetic Association (AOPA). indicates the exhibitor is a Supplier Plus Partner with AOPA. • indicates new exhibitor for 2015. Exhibitors as of Sept. 1, 2015. Ability Dynamics LLC.................... 519 www.rushfoot.com Acor Orthopaedics Inc.................. 718 www.acor.com Advanced O&P Solutions LLC..... 513 www.aopsolutions.com Allard USA Inc.......................... 537 www.allardusa.com

BiOM

WEST REGISTRATION

Townsend Design

ALPS............................................ 501 www.easyliner.com

ENTRANCE Alternative Prosthetic Services Inc..................................... 725 www.alternativeprosthetics.com American Academy of Orthotists & Prosthetists............. 578 www.oandp.org 52

SEPTEMBER 2015 | O&P ALMANAC

514

516

415

417

Knit-Rite

Poster Boards

EXHIBITOR DIRECTORY 2015

Welcome to San Antonio

THE HENRY B. GONZALEZ CONVENTION CENTER

RECEPTION

EXHIBIT HALL A/B

le Texas Sty

(CONVENTION CENTER STREET LEVEL)

WEDNESDAY

OCTOBER 7-10, 2015

5:45 – 7:15 PM

OCTOBER 7, 2015

SAN ANTONIO, TEXAS, USA

New exhibitor for 2015 “Triton” Mechanical Bull

AOPA/ O&P PAC

Product Preview Theater

/Epica Intl.

363

Sensor Medica SAS

275

384

279

283

285

262

161

130

154

160

O&P Almanac

O&P ALMANAC | SEPTEMBER 2015

EXHIBITOR DIRECTORY 2015

American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC).......................... 565 www.abcop.org

American Central Fabrication.... 644 Email: americancenfab@aol.com American Orthotic & Prosthetic Association (AOPA)..................... 637 www.aopanet.org

ARTech Laboratory Inc................ 702 www.artechlab-prosthetics.com

Brightree LLC.................................. 415 www.brightree.com

Autodesk................................... 549 www.delcam-na.com

Bulldog Tools Inc........................... 834 www.bulldogtools.com

Aspen Medical Products.............. 636 www.aspenmp.com

Cailor Fleming Insurance............. 733 www.cailorfleming.com

Banyan Healthcare/Falk Prosthetics & Orthotics.................................... 660 www.banyanhealthcare.com Becker Orthopedic........................ 325 www.beckerorthopedic.com American Plastics, A Div. of Curbell Plastics................................ 456 www.americanoandp.com American Prosthetic Components LLC............................ 122 www.americanprostheticcomponents.com AMFIT INC................................ 233 www.amfit.com Amplitude Media Group................. 363 www.amplitude-media.com Amputee Coalition........................ 662 www.amputee-coalition.org Anatomical Concepts Inc............. 132 www.anatomicalconceptsinc.com

• Anodyne..................................... 739 www.anodyneshoes.com AON................................................. 382 www.insurance4op.com

biodesigns inc. ............................... 469 www.JoinHiFi.com BiOM......................................... 800 www.biom.com BioSculptor Corp............................ 618 www.biosculptor.com

• Blue Diamond Orthopedic...... 666 www.bluediamondortho.com Board of Certification/ Accreditation, Int’l (BOC)........... 378 www.bocusa.org

www.bocusa.org

Bort-Swiss Orthopedic Supply... 609 www.bort-swissortho.com

Apex Foot Health........................... 319 www.apexfoot.com

Boston Brace International Inc./ dba NOPCO..................................... 812 www.bostonbrace.com

Apis Footwear Co.......................... 465 www.apisfootwear.com

Breg.................................................... 417 www.breg.com

SEPTEMBER 2015 | O&P ALMANAC

Cascade Dafo Inc...................... 133 www.cascadedafo.com Cascade Orthopedic Supply Inc....................................... 255 www.cascade-usa.com CBS Medical Billing & Consulting LLC............................. 745 www.oandp-solutions.com CJ Socket Technologies................ 375 www.cjsocket.com

• Click Medical.............................. 716 www.clickmedical.co Clincial Education Concepts........... 822 www.cecpo.com College Park Industries Inc. ......... 431 www.college-park.com Comfort Products Inc. .................. 112 www.comfortoandp.com Coyote Design & Mfg Inc.............. 412 www.coyotedesign.com

• Create Prosthetics..................... 717 www.createprosthetics.com

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EXHIBITOR DIRECTORY 2015

DAW Industries Inc. ...................... 381 www.daw-usa.com

Fabtech Systems LLC.................... 908 www.fabtechsystems.com

KLM Labs Inc................................... 555 www.klmlabs.com

• Design Interactive.................... 820 www.designinteractive.net

Fillauer........................................ 102 www.fillauercompanies.com

Knit-Rite Inc. ................................. 425 www.knitrite.com

• LegWorks................................... 723 www.legworks.org

DIA-FOOT....................................... 516 www.dia-foot.com Dicarre LLC..................................... 824 www.dicarre.com DME MAC Medicare Contractors.... 477 www.NGSMedicare.com Dr. Comfort..................................... 365 www.DrComfort.com Drew Shoe Corp................................ 731 www.drewshoe.com

• e-life International Co. Ltd...... 130

www.e-lifebracing.com

Endolite...................................... 125 www.endolite.com

Footmaxx........................................... 621 www.footmaxx.com Freedom Innovations LLC............ 237 www.freedom-innovations.com Friddle’s Orthopedic Appliances Inc............................... 414 www.friddles.com Grace Prosthetic Fabrication Inc...... 142 www.gpfinc.com iWALK FREE..................................... 140 www.iwalk-free.com Janco.................................................. 134 www.janco-inc.com JMS Plastics Supply....................... 333 www.jmsplastics.com

• Epica International......................

www.EpicaInternational.com

455

ESP.................................................... 260 www.wearesp.com

• Ken Dall Enterprise Co. Ltd........ 619 Email: export.info@kendall.com.tw Kinetic Research Inc..................... 620 www.KineticResearch.com KISS Technologies LLC................. 357 www.kiss-suspension.com

Liberating Technologies Inc......... 515 www.liberatingtechnologies.com LIM Innovations............................. 713 www.liminnovations.com

• Makstride Prosthetics............. 463 www.makstrideprosthetics.com Martin Bionics Innovations.......... 481 martinbionics.com MD Orthopaedics Inc................... 603 www.mdorthopaedics.com Med Spec (ASO EVO)................... 828 www.medspec.com Medex International Inc.............. 709 medexinternational.com Medi USA........................................ 149 www.mediusa.com

• Midwest Orthotic Services LLC. 706 www.midwestorthotics.com

MIH International............................. 517 www.m-brace.com Mile High Orthotics Lab.................. 844 www.mholabs.com Mobility Saves................................ 637 www.mobilitysaves.org

Motion Control, Division of Fillauer.............................................. 102 www.fillauer.com

• Myomo........................................ 266 www.myomo.com Nabtesco Proteor - USA.............. 460 www.nabtesco-proteor-usa.com 56

SEPTEMBER 2015 | O&P ALMANAC

EXHIBITOR DIRECTORY 2015

Naked Prosthetics......................... 708 www.nakedprosthetics.com National Commission on O&P Education (NCOPE)............ 479 www.ncope.org

• National Orthotic and Prosthetic

Northwestern Uni. & Rehabilitation Institute of Chicago-Center for Bionic.......................................... 664 www.amputeeresearch.com O&P Almanac .................................. 154 www.AOPAnet.org

Appeal Advocates(NOPAA)........ 714 www.opappeals.com Nearly Me Technologies LLC...... 840 www.nearlyme.org New Options Sports...................... 256 www.newoptionssports.com New Step Orthotic Lab Inc.......... 560 www.newsteporthotics.com

• Nolaro24 LLC.............................. 562 www.thequadrastepsystem.com nora systems Inc. .......................... 444 www.nora-shoe.com North Sea Plastics LTD................... 809 www.northseaplastics.com

O&P EDGE/Western Media LLC.... 361 www.oandp.com/edge

Orthomerica Products Inc......................... 245 & 249 www.orthomerica.com ORTHOSERVICE AG................ 557 www.orthoservice.com OPAF & The First Clinics............. 279 www.opfund.org Orthotic & Prosthetic Equipment Corporation.................................... 580 www.optable.com

O&P News....................................... 607 www.healio.com

Orthotic & Prosthetic Group of America (OPGA)............................ 413 www.opga.com

OP Solutions Inc./OP Marketing... 720 www.opmarketing.com

Orthotics Prosthetics Canada..... 818 www.opcanada.ca

OPIE Software................................. 261 www.oandp.com

Össur Americas Inc....................... 401 www.ossur.com

OPTEC USA INC........................... 439 www.optecusa.com Orfit Industries America.............. 616 www.orfit.com

The Source for Orthotic & Prosthetic Coding

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HE O&P CODING EXPERTISE the profession has come to rely on is available online 24/7! LCodeSearch.com allows users to search for information that matches L Codes with products in the orthotic and prosthetic industry. Users rely on it to search for L Codes and manufacturers, and to select appropriate codes for specific products. This exclusive service is available only for AOPA members.

Log on to LCodeSearch.com and start today. Need to renew your membership?

Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

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Manufacturers: for 2015! AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571-431-0876.

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O&P ALMANAC | SEPTEMBER 2015

EXHIBITOR DIRECTORY 2015

Ottobock.......................................... 201 www.ottobockus.com

p.w. Minor......................................... 838 www.pwminor.com Paceline Inc..................................... 615 www.paceline.com

• Parker Hannifin Corporation..... 146

www.indego.com

PEL............................................... 531 www.pelsupply.com Pinnacle Prosthetic Labs......... 262 www.pinnlab.com PMT Corporation............................. 656 www.pmtcorp.com Polygel LLC........................................ 816 www.polygel.com

Rodin 4D.......................................... 612 www.rodin4d.com

ThyssenKrupp AIN Plastics......... 561 www.ainplastics.com

Royal Knit Inc.................................. 136 www.royalknit.com

Tillges Technologies LLC............. 369 www.pressureguardian.com

RS Print........................................ 161 www.resprint.com

Top Shelf Orthopedics................. 461 www.topshelforthopedics.com

• Sensor Medica SAS..................... 275 www.sensormedica.com

Touch Bionics.................................. 541 www.touchbionics.com

Silipos Inc........................................ 704 www.silipos.com

Townsend Design..................... 525 www.townsenddesign.com

Simona America Inc. ..................... 157 www.simona-america.com

TRS Inc. (Therapeutic Recreation Systems Inc.)................................... 712 www.trsprothetics.com

Soletech Inc. .................................. 468 www.soletech.com SOLS................................................. 814 www.sols.com Spinal Technology Inc.............. 137 www.spinaltech.com

Trulife............................................... 313 www.trulife.com Turbomed Orthotics................. 568 turbomedorthotics.com Ultraflex Systems.......................... 654 www.ultraflexsystems.com

POSI/Physio O&P.......................... 268 www.physiocorp.com

UNYQ............................................... 719 www.unyq.com

Pro-Tech Orthopedics................... 167 www.protech-intl.com

US Member Society - ISPO............ 380 www.usispo.org

ProtoKinetics Gait Analysis Walkways..........................................839 www.protokinetics.com Restorative Care of America........... 642 www.rcai.com Renia GmbH..................................... 345 www.renia.com Roboticom - Fabrica Machinale Srl.................................. 455 www.roboticom.it

SPS................................................ 113 www.spsco.com ST&G USA Corp.............................. 121 www.stngco.com Standard Cyborg........................ 830 www.standardcyborg.com SteeperUSA.................................... 625 www.steeperusa.com

SEPTEMBER 2015 | O&P ALMANAC

Welso Medical LLC.................... 474 www.welsomedical.com WillowWood.................................... 221 www.willowwoodco.com

Streifeneder USA........................... 143 www.streifeneder-usa.com SureStep.......................................... 349 www.surestep.net

XIAMEN Chengli Medical Equipment Co. LTD....................... 564 www.clylmedical.com

Tamarack Habilitation Technologies.................................. 432 www.tamarackhti.com

Xi’an Boao Prosthetic & Orthotic Company Ltd. .................................. 564 www.xaboao.com

Texas Chapter of the American Academy of Orthotists & Prosthetists................ 576 www.txaaop.org 58

Vorum.............................................. 449 www.vorum.com

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PRODUCT GUIDE 2015

On the following pages, you’ll see a sampling of the products that will be displayed at the 2015 AOPA National Assembly, Oct. 7-10, 2015. Visit www.AOPAnet.org to register.

XRD Is Now Available From Acor! BOOTH #718 XRD stands for Extreme Impact Protection. It is lightweight material that is engineered to absorb up to 90% of energy when impacted under high strain rates. This product is infused with an anti-microbial protectant which will help prevent the growth of bacteria that can cause stains and odors. Under the foot, the foam’s memory-like properties provide a contoured fit for each user. XRD raises the bar when it comes to comfort, control, and protection. Call today for your free sample! For more information contact Acor Orthopaedic, Inc. at 800/237-2267, ext. 1, or visit www.acor.com.

ALPS Thinner Seamless Suspension Sleeve BOOTH #501 Formulated with the ALPS GripGel, the new SFB seamless suspension sleeve provides superior comfort with a single-piece construction. The SFB sleeve features a new black-knitted fabric that allows the user excellent freedom of knee flexion. This new sleeve seals with the skin without restricting circulation, while the GripGel sticks to the patient’s skin without causing shear forces. With a thinner profile of 2 mm, the SFB is an ideal choice for those concerned about bulk. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Ave., North St. Petersburg, FL 33714.

SEPTEMBER 2015 | O&P ALMANAC

It’s Your Patient; Shouldn’t It Be Your Orthotic Design Too? BOOTH #233 Take complete control for the ultimate in patient satisfaction with Amfit Lab Services. • Carbon fiber (flex and firm) • Polypropylene (flex, semi-flex, rigid) • 5 EVA styles and densities • 1-4 day turn-around • Diabetic specific program: 3 pair for $60 includes shipping • Foam box processing • Contact Digitizer 3D Digital Casting system • Equipment rental and lease programs available 30 years specializing in custom foot orthotics and orthotic technology, we will help move your practice forward while saving time and money. Contact Amfit Inc. today at 800/356FOOT(3668), email sales@amfit.com, or visit www.amfit.com.

Introducing the New Peak Scoliosis Bracing System™ BOOTH #636 This revolutionary new bracing system from Aspen was specifically designed for Adult Scoliosis patients and has been shown to: • Significantly Reduce Pain • Improve the Quality of Life • Increase Mobility • Promote Better Posture • Increase Patient Compliance • Code L1005 Approved For more information, contact Aspen Medical Products, located at 6481 Oak Canyon, Irvine, CA 92618, by calling 800/295-2776 or visit www.aspenmp.com.

PRODUCT GUIDE 2015

Coyote Composite BOOTH #412 A great alternative to itchy, expensive carbon fiber braid! Coyote Composite, made from basalt filament is a safe, tough material for composite sockets and AFOs. Also easy to cut and finish compared to other materials. • Less Expensive • Less itch than carbon • Extremely Durable • Strong and Lightweight • Finishes Smooth and Easily • Uses Typical Prosthetic Resins • Not an Inhalant Risk • Inert, Non-Carcinogenic and Non-Toxic Our proprietary braid was designed to be used in equivalent amounts to carbon. Coyote Composite is more flexible than carbon (we consider this to be an advantage). For more information, contact Coyote Design at 208/429-0026 or visit coyotedesign.com.

Coyote Design: New Solid Brass Pins BOOTH #412 Coyote Design has introduced two new heavy duty solid brass pin options for its Air-Lock and Easy-Off Lock lines. Coyote found the new brass pins are more durable, have less deflection and have exceptional wear characteristics. These pins increase the Air-Lock weight capacity from 265lbs to 350lbs. Like most Coyote products, it is non-corrosive and water resistant, making it great for active people and heavier weight patients. The pin helps eliminate noise issues. CD103P8H (Eight click Brass Pin) CD103P11H (Eleven Click Brass Pin) CD103H (Air-Lock with Brass Pin). For more information, contact Coyote Design at 208/429-0026 or visit coyotedesign.com.

Coyote Design Easy Off BOOTH #412 • Airtight “suction” or vacuum suspension with the safety and security of a pin. • Easy donning and doffing with lever with lever release. • Self-lubricating materials reduce wear. • Water-resistant • Can be used with elevated vacuum. For more information, contact Coyote Design at 208/429-0026 or visit coyotedesign.com.

Coyote Design Quick Adhesive BOOTH #412 We use Coyote Quick Adhesive in fabrication of our prosthetic locks, socket adapters and valves. • Attaching Componentry • Repairing Sockets • Very quick to set with no sag • Ships non-hazardous • Safe to use and has no odor Coyote Quick Adhesive works in any situation when you need something glued quickly and easily. For more information, contact Coyote Design at 208/429-0026 or visit coyotedesign.com.

New Sure Stance Knee by DAW BOOTH #381 This ultralight, true-variable cadence, multiaxis knee is the world’s first four-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

O&P ALMANAC | SEPTEMBER 2015

PRODUCT GUIDE 2015

DawSkin New Mega Stretch BOOTH #381 DawSkin New MegaStretch is the most durable tear-free skin in the world. It is the ideal skin for your patient to shower on both legs (definitely the safer way). DawSkin MegaStretch provides the vertical ankle stretch required for multiaxis feet and energy restitution feet. “Heat-shrink” skins limit the ankle movement and will tear. DawSkin New EZ-Access dons on and off just like a sock yet provides all of the benefits of the DawSkin New MegaStretch. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

ePAD: The Electronic Precision Alignment Device BOOTH #381 The ePAD shows precisely where the point of origin of the ground-reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

Maximum Shock ValueWith the New Freedom Agilix™ BOOTH #237 The Freedom Agilix is a multiaxial, shock-absorbing, flexible foot system designed to manage loading impacts, reduce socket shear forces, and improve comfort while walking on nearly any terrain. The ultra-lightweight design offers low-impact K3 ambulators shockingly comfortable performance at a value like no other. Learn more about the Agilix at Freedom Innovations LLC by calling 888/818-6777 or visiting www.freedom-innovations.com. 62

SEPTEMBER 2015 | O&P ALMANAC

Fit, Finish, and Roll ... With the New Freedom DynAdapt™ BOOTH #237 The Freedom DynAdapt Foot is a slimprofile, carbon-fiber foot system with a slender, anatomic design for easy fit and finish. Its multiaxial function provides maximum comfort, and the uninterrupted strands of carbon fiber in the full-length heel provide patients with effortless rollover and a more natural gait. The new EnduraCore™ Technology composite laminate delivers up to three times the fatigue life of a standard laminate in a design that also returns more energy. The result is a highly durable product that preserves users’ energy so they can do more with confidence. Learn more about the Freedom DynAdapt Foot at Freedom Innovations LLC by calling 888/818-6777 or visiting www.freedom-innovations.com.

Dynamic Chopart Gait Stabilizer This unique ankle-foot orthosis (AFO) has been designed for Chopart amputees who wish to remain active. Often a traditional full-length AFO for this patient will be stiff, feeling unnatural. Using a hinged ankle and flexible foot plate with a segmented dynamic filler allows flexion before providing a “stop” that protects the residuum and prevents shoe vamp collapse. The PTB design and the anterior shell redistribute ground-reaction forces up the lower extremity. For more information, contact at 800/301-8275 or visit www.hersco.com.

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

PRODUCT GUIDE 2015

Orthomerica: Prosthetic Custom Fabrication BOOTH #245 & 249 Orthomerica Products, Inc. is pleased to introduce Prosthetic Custom Fabrication. First Stage and Second Stage Sockets. Check, BK, and AK Sockets are available with a 3 to 5 day turnaround time. All modifications and fabrications available. Most scans and casts accepted. For more information, visit www.orthomerica.com.

RHEO KNEE® 3 by Össur®: A Perfect Balance of Stability and Dynamics BOOTH #401 Featuring a new actuator and kinematic sensor, RHEO KNEE 3 offers increased resistance across a wider range of stance flexion. This improved support helps increase the confidence of all users, especially 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 via a more powerful actuator and a faster swing extension. For more information, contact your Össur rep or call 800/233-6263 today to get certified or demo RHEO KNEE 3.

EMS Socket Exclusively From Ottobock BOOTH #201 The EMS flexible inner socket provides up to 100% more surface area for better force distribution and 400% more coefficient of friction for better linkage to the socket. All of that translates into an advanced socket with superb connection for your patients who use Harmony vacuum suspension. In addition to the enhanced connection, EMS includes lower definitive socket trim lines for greater range of motion and reduced wear on sleeves. The EMS is available exclusively from Ottobock by calling your locals sales rep at 800/328-4058 or logging into www.professionals.ottobockus.com.

New AxonHook From Ottobock BOOTH #201 For maximum versatility, precision, and power, look for this latest addition to the AxonBus Family – the AxonHook. The AxonHook is the perfect complement to the Michelangelo Hand. It includes titanium with polyurethane coated fingers so the AxonHook can provide superb precision and power, making it the perfect companion to the Michelangelo Hand. For more information, contact your local sales reps at 800/328-4058 or logging onto www.professionals.ottobockus.com.

Ottobock: 300-lb Weight Limit on New Aluminum Components BOOTH #201 Our new line of aluminum pylons, adapters, and tube clamps are designed and tested to support up to a 300-lb weight limit while providing you with a costeffective, high-quality solution. The line includes double adapters at various lengths, a 30-mm pylon, a 30-mm tube clamp, and a pyramid adapter. For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.

PEL: Why Our Personalized Approach Yields Unsurpassed Outcomes BOOTH #531 Customer service representatives at PEL always strive to deliver the very best service in the O&P industry by anticipating each independent practitioner’s needs. They will follow through on your requests in a timely and responsive way to help you deliver better patient outcomes. For a superior service experience, call PEL at 800/321-1264. You will find it to be a powerful reason to rely on PEL for your O&P products and supplies. For more information, visit www.pelsupply.com.

O&P ALMANAC | SEPTEMBER 2015

PRODUCT GUIDE 2015

PressureGuardian Developed by Tillges Technologies LLC BOOTH #369 PressureGuardian® technology combines instantaneous pressure load measurement with a compatible data collecting and storing app. PressureGuardian comes with a four-sensor lead to monitor up-to-four sites on the body instantaneously. This tool helps clinicians manage their patients’ challenging diabetic wounds with astonishing results and is able to advance the healing process. PressureGuardian can also be used to measure pressure loads inside prosthetic sockets and orthotic devices to ensure they are being fit properly. New sensor calibration feature added in 2015! To learn more about PressureGuardian and our central fabrication products, visit us at BOOTH #369 at the AOPA assembly or visit www.pressureguardian.com.

Spinal Technology BOOTH #137 Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses. For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

SEPTEMBER 2015 | O&P ALMANAC

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

Turbomed: Walk, Run, Jog, Hike…Don’t Be Limited! BOOTH #568 Turbomed Orthotics introduces the revolutionary FS3000 foot drop AFO. This stunning, new AFO redefines comfort and freedom. The patented design, using an outsideof- the-shoe approach, gives new possibilities to patients with foot drop that they never thought possible. Features and benefits include: • 100% transferable • 100% outside of the shoe • As lightweight as a carbon fiber AFO • No contact with the foot or the ankle • Amazing energy return due to the patented design • Best warranty on the market. Try the FS3000 for two months, and if you are not satisfied for any reason, return it for a full refund. For more information contact Turbomed Orthotics at 418/563-8675 or visit www.turbomedorthotics.com.

PRODUCT GUIDE 2015

2015 AOPA Coding Products BOOTH #637 Get your facility up to speed, fast, on all of the O&P HCPCS code changes with an array of 2015 AOPA coding products. Ensure each member of your staff has a 2015 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

Have you Heard the News That Mobility Saves?

New research has proven that prosthetic and orthotic care saves money for payers and improves lives for patients. Read more at MobilitySaves.org.

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O&P ALMANAC | SEPTEMBER 2015

MEMBER SPOTLIGHT

Shamrock Prosthetics

By DEBORAH CONN

Reinvention

New facility aims to guide patients through the amputation journey

TEVE EHRETSMAN BECAME a below-knee amputee in April

SEPTEMBER 2015 | O&P ALMANAC

FACILITY: Shamrock Prosthetics LOCATION: Athens, Georgia OWNER: Steve Ehretsman HISTORY: 5 months

takes its name from the three leaves of a shamrock, says Ehretsman, which represent the three journeys of the amputee: hope, inspiration, and reinvention. Shamrock’s involvement with a patient begins when Ehretsman receives a text or phone call from a surgeon. Ehretsman meets with the patient during the pre-op appointment or at another time. “This is the hope phase,” he says. “I talk about the journey. I want to know where you were, where you are, where you want to go. Many patients are apprehensive; some don’t even want to use the word ‘amputation.’ My job is to give them hope that life will be okay, if not even better, after this, and I can use my own experience to show them.” Phase 2, inspiration, takes place as Ehretsman visits the new amputee once a week. The meetings generate a bond, he says, and as patients heal, they are able to take inspiration from Ehretsman’s own journey as an amputee. In addition, he shares photos of the patient’s residual limb with the surgeon, maintaining continuity of care and communication, which are “sometimes lacking in the health-care space,” he says.

PHOTOS:Shamrock Prosthetics

2002 after undergoing 13 surgeries to address a traumatic injury. That experience shifted his career focus from the corporate world to the health-care sector, and he eventually joined a prosthetic company in Atlanta as vice president of sales and marketing. Ehretsman also had an idea about how the prosthetics process should operate based on his own experience as a patient. “The O&P industry is very reactive,” he explains. “The normal course of action is that the surgeon amputates a limb, and the patient sees a prosthetist when it has healed. I wanted to make the process proactive, where I would see the patient before surgery and again every week after the operation as he or she heals.” He believes it is important to connect with the amputee early on, both physically and on mental and emotional levels. Ehretsman decided to open a prosthetic facility based on that idea, and he immediately called a former colleague, Tom Karr, to join him in the venture. Karr had spent more than 30 years in hospital management, 25 of them as chief operating officer (COO) of a major Atlanta health-care system, and seven years as manager of a prosthetics company. Karr had tried retirement twice and was happy to give it up again to help start a new business, once he heard Ehretsman’s vision. In April, Ehretsman, chief executive officer, and Karr, COO, opened Shamrock Prosthetics in Athens, Georgia. The company

Once the patient has healed sufficiently—usually at the four- to six-week point—he or she wears a shrinker sock for about a week, and then Shamrock’s Sharon Kelly, a certified prosthetist for 31 years, begins the clinical aspect of casting and fitting an appropriate device. That is the reinvention stage, says Ehretsman. Throughout the process, Ehretsman and Kelly make a point of listening as much as they talk. “We make sure it’s a two-way dialog,” he says. “As a patient, I’ve been to too many providers where the talk went only one way.” In addition to Karr and Ehretsman, Shamrock has four employees, including Kelly, a fabrication manager, and a front office administrator. Jarryd Wallace, who is a current Paralympian and unilateral amputee, is learning to work under Ehretsman in the first two phases of care. The facility occupies 3,400 square feet, with all fabrication completed on the premises. Shamrock’s patient volume has exceeded initial forecasts since it opened its doors in April, says Ehretsman. Marketing efforts so far have focused on word of mouth—a website is yet to come—but Ehretsman is not worrying about volume. “We are building valued relationships with surgeons. When you blend passion and authentic purpose in creating a patient-care facility, that becomes evident to referrers and amputees,” he says. “We build a lifetime bond with our patients. We are invested in their journey from the beginning—and for the rest of their lives.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

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MEMBER SPOTLIGHT

LegWorks

By DEBORAH CONN

Global Distribution For-profit prosthetic company develops devices for use in developing countries

EGWORKS, WHICH IS bringing

SEPTEMBER 2015 | O&P ALMANAC

LegWorks has tested its prosthetic knee among 50 patients in 10 countries.

LEGWORKS.ORG

COMPANY: LegWorks OWNERS: Privately held LOCATIONS: San Francisco and Toronto HISTORY: 2 years

Co-CEOs David Green and Emily Lutyens. LegWorks’s seed round includes a loan via Grand Challenges Canada of up to $1 million, matched by MaRS Innovation, Holland Bloorview Kids Rehabilitation Hospital, Ontario Centres of Excellence, and a group of private angel investors. The company has fewer than 10 employees. Burke, Lutyens, and Green are in San Francisco, while Andrysek remains in Toronto. The device is manufactured in Germany. LegWorks has conducted clinical testing and patient evaluations of the knee among 50 patients in 10 countries, some of whom have used the device for more than three years. The company plans to launch the product at AOPA’s National Assembly next month. The goal is to bring the AT-Knee to market globally, offering a premium version in the U.S. market and a more affordable, basic version for the developing world.

PHOTOS: LegWorks

to market the All-Terrain Knee (AT-Knee), doesn’t fit the usual definition of a prosthetic company. It is a “for-profit social enterprise,” says Brandon Burke, director of partnership development. “We use business approaches to address issues that are traditionally thought of as being more for charity. We developed our technology with the intention of providing affordable, but highly functional, prosthetic solutions for the developing world.” That technology originated at the Holland Bloorview Kids Rehabilitation Hospital in Toronto, where Jan Andrysek, a professor at the University of Toronto, sought to combine high-performance, durability, and affordability in a lower-limb prosthesis. The outcome was the AT-Knee. It incorporates Andrysek’s patented automated stance-phase lock (ASPL), which automatically locks the knee on extension and unlocks at toe-off, creating consistent stability for users. Clinical testing of the ASPL mechanism showed a significant decrease in reported falls compared to polycentric knees, notes Burke. “If amputees can’t rely on the stability of the prosthesis, they will never use the full functionality of the knee,” says Burke, an above-knee amputee since age 18. He has been wearing the AT-Knee for the past two years. “Compared to a friction-braking knee joint, we saw energy efficiency increase by 40 percent.” Andrysek founded LegWorks in 2014, along with Burke and

The premium version will include a stance-flexion adaptor, which will allow for shock absorption and flexion of the knee joint at heel strike, for a more natural movement. “The knee also has an optional manual lock feature, which patients can use as necessary during early rehabilitation, before transitioning to using the automatic stance-phase lock,” Burke says. A variable-friction controller in the knee allows amputees to walk smoothly and efficiently at different speeds, without the use of hydraulics or pneumatics. This combination of features allows patients to better progress through mobility class levels, he says. In addition, because the knee has a waterproof design, the device serves well as a secondary, recreational leg for use in activities such as going to the beach or fishing, for those who have more expensive (and not waterproof) microprocessor knees. After the October release of the knee, Burke says the company will sell directly to prosthetic clinics in the United States. Overseas, LegWorks plans to distribute the device via distributors and aid groups, including the International Red Cross, which has conducted a two-year clinical trial of the knee. LegWorks also has tested a pediatric version of the AT-Knee, which is about half the weight and size of the original. Burke expects it to be commercially available in 2016. “The World Health Organization estimates that as few as 5 to 15 percent of those in the developing world who need prostheses have access to them,” says Burke. “We are going to change that.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

DOWNLOAD the 2015 National Assembly App • Get up-to-date information regarding the National Assembly • Easily view the agenda and set up your own personal schedule • Interact with colleagues • Share photos and comments • Search for speakers and specific topics • Navigate the exhibit hall • Review speaker bios

Download the app by either scanning the QR code or by searching the keyword AOPA365 in the Apple or Google stores.

…and that’s not all: • Learn About AOPA • Review the O&P Almanac • See how membership with AOPA has its benefits • Get current with Hot Issues • See how Mobility Saves • Visit the AOPA Bookstore • Access the AOPA Membership Directory • Connect with AOPA through social media

REGISTER ONLINE: bit.ly/aopa2015 GENERAL INFORMATION: bit.ly/aopashow HOTEL RESERVATIONS: bit.ly/assemblyhotel QUESTIONS: Visit www.AOPAnet.org or contact AOPA at 571/431-0876 or info@AOPAnet.org.

AOPA NEWS

Join the Coding Experts in Las Vegas November 9-10

Prior Authorization: How Does It Work? Register for the September 9 Webinar

Are you curious about the status of prior authorization for orthotic and prosthetic services? Can you identify which O&P items could be subject to prior authorization? Find out the answer to these questions, and much more, by taking part in the September 9 webinar: “Prior Authorization: How Does It Work?” Topics for discussion will include the following: • History of the Medicare prior authorization process • Explanation of how the prior authorization process will work • Discussion of whether the prior authorization process will stop your audits • Pros and cons of the Medicare prior authorization process.

The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of both O&P practitioners and O&P billing staff. The seminar will feature hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Join your colleagues November 9-10 in Las Vegas.

Top 10 Reasons To Go to Vegas:

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions. Register online at bit.ly/aopawebinars.

1. Get your claims paid.

7. Overturn denials.

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

8. Submit your specific questions ahead of time.

SEPTEMBER 2015 | O&P ALMANAC

2. Increase your company’s bottom line. 3. Stay up to date on Medicare billing. 4. Code complex devices. 5. Earn 14 CE credits. 6. Learn about audit updates.

9. Advance your career. 10. Benefit from more than 70 years of combined experience from AOPA coding and billing experts. Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more at bit.ly/2015billing.

THE ALTERNATIVE!

TOUGH - SAFE - LIGHTWEIGHT - LESS ITCH - BET TER SATURATION

COYOTE COMPOSITE

A great alternative to itchy, expensive carbon fiber braid! Coyote Composite, made from basalt filament is a safe, tough material for composite sockets and AFOs. Also easy to cut and finish compared to other materials. LESS EXPENSIVE LESS ITCH THAN CARBON EXTREMELY DURABLE STRONG AND LIGHTWEIGHT FINISHES SMOOTH AND EASILY USES TYPICAL PROSTHETIC RESINS NOT AN INHALANT RISK INERT, NON-CARCINOGENIC AND NON-TOXIC

BRAID Our proprietary braid was designed to be used in equivalent amounts to carbon. Coyote Composite is more flexible than carbon (we consider this to be an advantage).

Phone (208) 429-0026 www.coyotedesign.com

AOPA NEWS

Have You Read the O&P Almanac’s Leadership Series?

8th Annual AOPA

WINE TASTING

& AUCTION

Attend the Wine Auction in San Antonio—

Support AOPA’s Government Relations Outreach

Thursday, October 8, 6:30-8:00 p.m. AOPA will be hosting the 8th Annual Wine Tasting & Auction during AOPA’s 2015 National Assembly in San Antonio, Texas. Plan to attend this can’t-miss event on Thursday, October 8, at 6:30 p.m. This popular event provides attendees with a unique opportunity to mingle, network, learn about, and taste a variety of wines. Most importantly, your attendance will help raise awareness of and funds for AOPA’s Government Relations outreach programs. Let’s keep the tradition of success alive and make the 8th Annual Wine Tasting & Auction the best ever. • Bid on a wide variety of items—previous events have featured wine, jewelry, cigars, vacations, and more. • Sample wines from an array of wineries and enjoy an open bar. • Enjoy camaraderie with a wide spectrum of O&P professionals. • Be entertained by a Special Guest Auctioneer. • Support an important cause! Register for the Wine Auction when you register for the Assembly. If you have already registered and wish to attend, contact rgleeson@AOPAnet.org to add your registration. 72

SEPTEMBER 2015 | O&P ALMANAC

Find out what senior-level O&P professionals have to say about the most critical issues facing the O&P profession. Several 2015 issues of the O&P Almanac have featured a new Leadership Series, showcasing Q&As with O&P experts on targeted topics of importance to the profession. Visit www.aopanet.org/publications/digital-edition to access past issues of the magazine and read what executives have shared, in their own words, on these important topics: TURF WARS Has “poaching” by noncertified O&P practitioners had an adverse effect on O&P businesses or patients in general? Rick Riley; Cindy Henderson, BOCO; Charles Kuffel, MSM, CPO, FAAOP; and Tom Padilla, CPO, give their opinions. March 2015 O&P Almanac, page 34 FINDING YOUR NICHE What are the advantages and challenges associated with running a “niche” O&P facility? Jonathan Naft, CPO; Megan McCarthy, CO; Dennis Clark, CPO; and Jon Bengtsson offer up their experiences. April 2015 O&P Almanac, page 36 HOSPITALS—WHAT’S THE HYPE? Find out why it’s important to build relationships with hospitals and institutional networks now. Andrew Meyers, CPO; Jim Kingsley; and Rebecca Hast detail their success strategies. June 2015 O&P Almanac, page 34 TECHNOLOGY SMARTS Why and how should you integrate new technologies into your practice? David Boone, PhD, MPH; Jan Saunders, CPO; and Stephen Blatchford share their insights. July 2015 O&P Almanac, page 36

National Partnership. Local Identities.

BCP Group is pleased to announce the newest partners in our expanding national network of high-quality O&P practices. Clinic Support Operations

BEACON

Prosthetics & Orthotics

6 1

# = Clinic Locations

New Member Clinics BEACON

Prosthetics & Orthotics

New Equity Partners Jason Musgrave Christian Bailey, CPO Eddie White, CP Bobby Latham, CP

Creative Technology OPS Creative Technology OPS Beacon P&O Bulow OPS

Denver, Colo. Denver, Colo. Raleigh, N.C. Columbia, S.C.

BCP Group is an O&P management company based in Nashville, Tenn., dedicated to enhancing the viability of the independent, clinician-driven O&P practice model. We make ownership investments in high-quality clinical practices and then provide behind-the-scenes business support and resources that enable our partners to focus on patient care and practice growth.

Visit bcpgroup.net for more information about BCP Group and partnership opportunities.

AOPA NEWS

Stay in the Know— Subscribe to AOPA’s Take! AOPA has designed AOPA’s Take, a new blog to keep you informed about important issues and up-to-date with real-time news that arise within the O&P world. This is a more immediate avenue to find the latest updates. AOPA’s Take is available at no charge to all members of the O&P community, and subscribing is simple. Go to www. aopastake.org and click on the subscribe button. Fill out a few fields, and you’re in! Welcome to AOPA’s Take….. Where you go when you need to know!

WELCOME NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publiwww.AOPAnet.org cation, 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.

Collier Orthotics & Prosthetics 3161 Putman Boulevard Pleasant Hill, CA 94523 925/943-1119 Category: Patient-Care Facility Richard Todd

Design Interactive 3504 Lake Lynda Drive, Ste. 400 Orlando, FL 32817 407/706-0977 Category: Research/ Institution Matt Johnston, MSc

Is Your Facility Celebrating a Special Milestone? 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.

SEPTEMBER 2015 | O&P ALMANAC

Freedom Orthotics & Prosthetics 840 FM 1960 W., Ste. 5 Houston, TX 77090 281/580-8228 Category: Patient-Care Facility Dale Sheen

RS Print 44650 Helm Court Plymouth, MI 48170 405/406-1441 Category: Supplier Level 1 Blake D. Norquist, CO, LO, OTR/L

M-Power Prosthetics and Orthotics 9900 N. Central Expressway, Ste. 205 Dallas, TX 75231 214/265-5060 Category: Patient-Care Facility Amy Mehary Orthotics & Prosthetics Associates Inc. 10506 W. Bluemound Road Milwaukee, WI 53226 414/257-2727 Category: Patient-Care Facility Jake Wood, CP, FAAOP Ortoprotesicos Especializados Ltda Carrera 3ra No. 1-116 Casa 19 Chia 19, Colombia 571/805-3601 Category: International

South County Artificial Limb Company Inc. 162 Main Street Wakefield, RI 02879 401/783-0063 Category: Patient-Care Facility Joshua R. James UNYQ 44 Tehama Street San Francisco, CA 94105 415/994-0515 Category: Patient-Care Facility Katherine Cook, CPO

Products & Services

For Orthotic, Prosthetic & Pedorthic Professionals

2015 OPERATING PERFORMANCE REPORT AOPA Helps Run

s s e n i s u B r u Yo 2015 OPERATING PERFORMANCE REPORT Are you curious about how your business compares to others? This updated survey will help you see the big picture. The Operating Performance Report provides a comprehensive financial profile of the O&P industry including balance sheet, income statement and payer information organized by total revenue size, community size and profitability. The data was submitted by more than 98 patient care companies representing 1,011 full time facilities and 62 part-time facilities. The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2014 operations. Electronic Version AOPA Member: $185.00 Non-Members: $325.00

HOW TO ORDER BY FAX: 571/431-0899

PUBLICATIONS. EDUCATION. SERVICES. Everything you need to manage a successful patient care facility.

ONLINE: www.AOPAnet.org BY MAIL: AOPA Bookstore, 330 John Carlyle Street, Suite 200, Alexandria, VA 22314 MORE INFORMATION: For AOPA products and educational opportunities, contact 571/431-0876 or e-mail info@AOPAnet.org.

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

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

Member Nonmember $80 $140

For more opportunities, visit: http://jobs.aopanet.org. Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Southeast Certified Prosthetist-Orthotist

Johnson City, Tennessee Well-established multioffice ABC-certified O&P company is looking for certified individual with excellent orthotic and prosthetic skills to provide comprehensive treatment of patients. Excel offers competitive salary and bonus opportunity with full benefits package. Salary to be determined on experience. Send résumé to:

Email: sethwalters@excel-prosthetics.com 76

Pacific

SEPTEMBER 2015 | O&P ALMANAC

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

Attention: Human Resources Inland Artificial Limb & Brace, Inc. Fax: 951/734-1538

Northeast Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Watertown, New York A well-established, multioffice practice has immediate openings for residents and ABC-certified CPOs/ CPs/ COs. Candidates must be motivated individuals who possess a strong clinical presence, technical experience, the ability to document all aspects of patient contact, and the desire to improve the quality of life for those who require our services. Northern Orthopedic Laboratory is based in Watertown, New York, located on the outskirts of scenic Lake Ontario and St. Lawrence River. We offer a competitive salary (commensurate with experience), medical, dental, vision, 401K, and profit sharing. Send résumé to:

Northern Orthopedic Laboratory Inc. 1012 Washington Street Watertown, NY 13601 Office: 315/782-9098 Email: nolcpo@aol.com www.northernorthopediclaboratory.com

INMOTION IS NOW AVAILABLE THROUGH THE IPHONE APP STORE AND GOOGLE PLAY! You will now be able to read inMotion, the Amputee Coalition’s latest blog, connect with other amputees on Facebook, check out our inspirational and educational videos on YouTube, and see what’s happening on Twitter anywhere and everywhere! Download our new app to your Apple or Android device now for Free!

Get it now!

amputee-coalition.org

CALENDAR

2015

October 1-3

September 9

Prior Authorization, How Does It Work? Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

September 10-11

Orthomerica Wound & Limb Salvage Seminar, Orlando. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Orlando. Tuition is $495; each attendee receives two free OWLS products (a $750 value). For more information, visit www. orthomerica.com/education or call Isora Purvis at 877/737-8444.

September 25-26

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Airport Plaza Hotel, New York. Contact Jon Shreter at 800/946-9170, ext. 108, or email jshreter@pomac.com.

October 1

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

2015 NC-SC Annual Meeting. The Ballantyne, Charlotte, NC. More information online at www. ncaaop.com/joinrenew-membership. For exhibitors and sponsorship opportunities, contact Jennifer Ingraham, jingraham@spsco.com or 800/767-7776, x1173, or contact Skyland Prosthetics at 828/684-1644.

October 7-10

98th AOPA National Assembly. The Henry B. Gonzalez Convention Center, San Antonio. More information at bit.ly/2015assembly. For exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/4310852, or koneill@AOPAnet.org. General inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

October 14

Understanding the LSO/TLSO Policy. Register online at bit.ly/ aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

November 1

ABC: Application Deadline for Certification Exams. Applications must be received by Nov. 1, 2015, for individuals seeking to take the January 2016 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. For more information call 703/836-7114, send email to certification@abcop.org, or visit www.abcop.org/certification.

Year-Round Testing

Online Training

BOC Examinations. BOC has year-round testing for all of its exams and no application deadlines. Candidates can apply and test when ready and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

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.

www.bocusa.org

Calendar Rates Let us share your upcoming event! Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www. AOPAnet.org for content deadlines.

SEPTEMBER 2015 | O&P ALMANAC

CE For information on continuing education credits, contact the sponsor. Questions? Email landerson@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 26-50 51+

$40

$50

1/4 page Ad

$482

$678

$50

$60

1/2 page Ad

$634

$830

$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 landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations.

CALENDAR November 4-6

NJAAOP. The New Jersey Chapter of AAOP presents the 21st Annual Continuing Education Seminar. Harrah’s Atlantic City, NJ. For more information contact Lisa Lindenberg at 973/6092263, or email director@njaaop.org, or visit www.njaaop.com.

November 6

COPA & UCSF: Orthotic and Prosthetic Innovation & Technology Symposium. Driving the Future of O&P—Connecting Innovators and Investors. Millberry Union Event & Meeting Center, University of California—San Francisco. Register at www.californiaoandp.com/Education. For more information, contact 415/206-8813, or email erin.simon@ucsf.edu.

November 9-10

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. The Flamingo, Las Vegas. Register online at bit.ly/2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

November 11

How To Make a Good Impression: Marketing Yourself to Your Referrals. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

December 3-5

R.I.C: Elaine Owen. Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago, IL. 22.0 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education.

December 9

Bringing in the New Year: New Codes and Changes for 2016. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

ADVERTISERS INDEX Company

Page Phone

Website

ACOR Orthopedics Inc.

800/237-2276

www.acor.com

ALPS South LLC

800/574-5426

www.easyliner.com

Orthotics, Prosthetics, & Pedorthics Inc.

703/836-7114

www.abcop.org

Amfit

49 800/356-3668

www.amfit.com

Amputee Coalition

888/267-5669

www.amputee-coalition.org

Arizona AFO Inc.

877/780-8382

www.arizonaafo.com

BCP Group

615/550-8774

www.bcpgroup.com

Becker Orthopedic

800/521-2192

www.beckerorthopedic.net

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

ComfortFit Labs Inc.

29, 51

888/523-1600

www.comfortfitlabs.com

Coyote Design

9, 71

800/819-5980

www.coyotedesign.com

DAW Industries

1, 55

800/252-2828

www.daw-usa.com

Dr. Comfort

877/713-5175

www.drcomfort.com

Freedom Innovations

888/818-6777

www.freedom-innovations.com

American Board for Certification in

Hersco

2 800/301-8275

www.hersco.com

Orthomerica

800/446-6770

www.orthomerica.com

Össur Americas Inc.

800/233-6263

www.ossur.com

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

PEL

5 800/321-1264

www.pelsupply.com

Spinal Technology Inc.

800/253-7868

www.spinaltech.com

Texas Assisted Devices

800/532-6840

www.n-abler.org

Tillges Technologies

855/484-5832

www.tillgestechnologies.com

stephaness2@hotmail.com

www.turbomedorthotics.com

Turbomed Orthotics

22-23

WillowWood

Insert 800/848-4930

Wright & Filippis Inc.

248/598-2114

www.willowwoodco.com www.firsttoserve.com O&P ALMANAC | SEPTEMBER 2015

ASK AOPA

Good Causes O&P PAC and Capitol Connection contributions fund key initiatives

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.

What is Capitol Connection, and how do I become a supporter?

Capitol Connection is a fund established by AOPA to supplement or aid its government relations program and to cover any costs or expenditures that may not be covered by the general government relations budget. Funds from Capitol Connection are used to create and distribute special educational materials or other projects that advance AOPA’s government relations agenda. On a more routine basis, the funds are used to create publications, including the traditional AOPA whitepapers, which support AOPA’s legislative and regulatory positions and help build a well-informed team of AOPA members. Most importantly, the funds are used to help cover costs related to hosting the annual AOPA Policy Forum. Also, in recent years the Capitol Connection fund has been used to help run and maintain the AOPAVotes website. It’s important to note that Capitol Connection is not federally registered as a lobbying branch of AOPA, and its

SEPTEMBER 2015 | O&P ALMANAC

funds cannot be contributed to the federal campaigns of key legislators who support the O&P community; the funds may be used only to create the educational materials AOPA provides to these key legislators. Because the fund is not federally registered, there are fewer restrictions on where the money comes from and who may contribute to Capitol Connection. Anyone may contribute to Capitol Connection, and the contribution may originate from a personal account or from a corporate/business account. Corporate contributions may be deductible for members as ordinary and necessary business expenses but may not be deductible as charitable contributions.

What is the O&P PAC, and how do I support it?

The O&P PAC is AOPA’s federally registered political action committee (PAC), AOPA’s lobbying branch, which represents the O&P profession on Capitol Hill to ensure the O&P voice is heard during pertinent discussions and debates on legislation that may have an effect on the future of orthotics and prosthetics. The O&P PAC is bipartisan and does not support one political party over the other. Instead, the O&P PAC focuses on seeking out legislators on key

committees who have demonstrated an interest and concern for the issues facing the O&P community. The O&P PAC then supports these legislators and their election efforts with donations to their campaign funds or helps sponsor fundraising events for these candidates. Because the O&P PAC is federally registered, it must comply with all of the regulations of the Federal Election Committee (FEC). The FEC has very specific rules on who may contribute to a trade association’s political action committee. All O&P PAC contributions must be voluntary and come from eligible employees of AOPA member companies, including O&P practitioners, executive and administrative personnel, board of directors, stockholders, and their family members. All contributions from these eligible individuals also must be made with personal funds. The O&P PAC may not accept contributions from corporate accounts. Monies collected by the O&P PAC cannot be used for government relations administrative functions (instead these functions are funded by Capitol Connection); O&P PAC funds may be used only for direct or indirect support of federal candidates. Lastly, in order to participate in and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo. com/forms/op-pac-authorization.

THE ONLY THING BETWEEN AMPUTEES AND A HIGHER AMPUTEES AND A AMPUTEES AND A HIGHER HIGHER QUALITYGLASS OF LIFE IS MEDICARE’S GLASS CEILING. CARE’S CEILING. CARE’S GLASS CEILING. MICROPROCESSOR KNEE POWER KNEE

BIONIC PROPULSIONDARPA ANKLE

BIONIC PROPULSION MYOELECTRIC ANKLE

POWER KNEE

As seen in The Washington Post and The Hill

MYOELECTRIC

HIGH ENERGY FOOT

Medicare’s glass ceiling moves today’s prosthetic s today’s prosthetic devices out of reach for most amputees. most amputees.

ney*

9,967

,513

Amputees Whohigher Receive Better quality Though new, Decades of technological advancements Prostheses Save Medicare Money* custom prostheses are mean that new levels of mobility, health and

Though new, higher quality custom prostheses are

widely available, Medicare independence are possible for amputees.

widely available, Medicare

K3 Prostheses (Higher Quality) $79,967 restrictions are a glass ceiling restrictions are a glass ceiling The only problem? Medicare. The federal that that keeps them out of reach government makes it highly unlikely that a keeps them out of reach of patient will qualify for these devices, andmost amputees. Even

K2 Prostheses (Lesser Quality) $81,513

of most amputees. Even

though it’s been shown these though it’s been shown these new regulations will make the situation worse, not better.

devices provide a better

FIRSTlife. 12 MONTHS, ALL HEALTH COSTS. quality of If Medicare is trying to save money, denying

LTH COSTS.

10.3%

amputees prosthetic devices isn’t the at require

devices provide a better quality of life.

10.3%

fewer skilled nursing fewer claims skilled nursing claims Who has fewer incidents that require

way the to do it. A new study shows patients es, it is

who receive timely prosthetic and orthotic iven the

for for people with high-quality expensive care? In most people cases, it is the with high-quality prostheses amputees who have been given the

prostheses

can actually save Medicare money activedevices and prosthetics that kept them active and It’s an outrage that MedicareIt’s would an outrage that deny Medicare would deny over patients who are not treated — more and its healthy. And now Medicare and its amputees the life-changing mobility amputees the life-changing that mobility that than restrict $231 million was saved for Medicare in further contractors are planning to further restrict comes with prosthetics. comes with prosthetics. 2014 alone. osthetic limbs. who can get these better prosthetic limbs.

Received Higher Quality Prosthetics

To learn more about the Medicare To learn more about study the Medicare study

Received Lower Quality Prosthetics

and what you can do to stop and what these you can do to stop these

Received

policies, visit mobilitysaves.org. policies, visit mobilitysaves.org. Quality Lower Quality Who Had Fewer Medical Incidents? Higher Prosthetics Prosthetics

Fewer E.R. Admissions? Fewer Skilled Nursing Needs? Fewer Doctor Visits? Fewer Hospice Admissions?

* Dobson | DaVanzo analysis of custom cohort Standard Analytic Files (2007‐2010) for Medicare beneficiaries who received O&P services are beneficiaries who received O&P services

from January 1, 2008 through June 30, 2009 (and matched comparisons), according to custom cohort database definition. tom cohort database definition.

C-Leg 4

Orion 2

Plié 3

Rheo 3

Clinically proven stumble recovery1 Reliable stance release on challenging surfaces Real time swing and stance control No charge reimbursement support PDAC verified2 User smartphone app IP rating3

Adjustable modes for special activities Default stance for increased safety No fixed service intervals Knee stability when walking backwards Stance control on stairs, ramps and across all terrain Dual standing functions Years on market4

Clinical publications4

1 C-Leg 4: International C-Leg Studies, published by Otto Bock HealthCare GmbH, 3rd Edition, 2014, 646B33=GB-05-1403; Rheo 3: In some situations, stumble recovery requires increased compensatory movements therefore it is not as effective as C-Leg. Bellman M, Schmalz T, Blumentritt S.,“Comparative biomechanical analysis of current microprocessor-controlled prosthetic knee joints.”, Arch Phys Med Rehabil 2010; 91:644-52. 2 L5828, L5845, L5848, L5856 and L5930 are verified. L5850, L5925 and L5999 are pending verification. 3 As stated in international standard IEC 60529, IP or Ingress Protection rating refers to the degree of protection provided against the intrusion of solid objects, dust, accidental contact and water in electrical enclosures. 4 Includes all product versions. Sources: www.endolite.com/products/orion2, www.freedom-innovations.com/plie3, www.ossur.com/prosthetic-solutions/products/knees-and-legs/bionic-knees/rheo-knee-3

Dare to compare

C-Leg® 4 microprocessor knee You and your patients will experience the difference, from personalized reimbursement support to walking backwards with confidence. To get the details, please contact your Sales Rep at 800 328 4058 in the US or 800 665 3327 in Canada. Or, visit Ottobockus.com and Ottobock.ca for easy online qualification.

ottobockus.com | ottobock.ca